Lung transplantation in patients with cystic fibrosis and Mycobacterium abscessus infection

AbstractMycobacterium abscessus lung disease is difficult to treat and has been considered a strong relative contraindication to lung transplantation. We performed double lung transplantation in three cystic fibrosis patients with ongoing, and a fourth with recent treatment for Mycobacterium abscessus lung infection. Despite prolonged antibiotic courses and adjustment of immunosuppressive therapy the first three patients developed skin infection and abscesses. At follow-up after 1, 3, 5 and 7years respectively no patient had evidence of M abscessus infection and all had stable lung function. Lung transplantation in patients with M abscessus lung infection is feasible but may involve severe complications

Non-infectious sternal dehiscence after coronary artery bypass surgery

Funding Information: This study was funded by the University of Iceland Research Fund, Landspitali University Hospital Research Fund, and the Memorial Fund of Helga Jonsdottir & Sigurlidi Kristjansson. Publisher Copyright: © 2022, The Author(s). © 2022. The Author(s).Introduction: Non-infectious sternal dehiscence (NISD) is a known complication following coronary artery bypass grafting (CABG), with previous studies estimating an incidence of 0.4–1% of surgeries. We aimed to study the incidence of NISD together with short- and long-term outcomes in a whole-nation cohort of patients. Materials and methods: A retrospective study on consecutive CABG patients diagnosed with NISD at Landspitali from 2001 to 2020. Patients diagnosed with infectious mediastinitis (n = 20) were excluded. NISD patients were compared to patients with an intact sternum regarding patient demographics, cardiovascular risk factors, intra- and postoperative data, and estimated overall survival. The median follow-up was 9.5 years. Results: Twenty out of 2280 eligible patients (0.88%) developed NISD, and the incidence did not change over the study period (p = 0.98). The median time of diagnosis was 12 days postoperatively (range, 4–240). All patients were re-operated using a Robicsek-rewiring technique, with two cases requiring a titanium plate for fixation. Patients with NISD were older, had a higher BMI and EuroSCORE II, lower LVEF, and more often had a history of COPD, MI, and diabetes compared to those without NISD. Length of stay was extended by 15 days for NISD patients, but short and long-term survival was not statistically different between the groups. Conclusions: The incidence of NISD was low and in line with previous studies. Although the length of hospital stay was extended, both short- and long-term survival of NISD patients was not significantly different from patients with an intact sternum.Peer reviewe

Cardiovascular risk factors and peripheral vascular function in lung transplant recipients

Objective: Cardiovascular disease is a major contributor to morbidity and mortality after organ transplantation. Development of cardiovascular risk factors, like hypertension, is common after transplantation. The mechanism of post transplant hypertension is incompletely understood but vasoconstriction and endothelial dysfunction have been suggested to participate.Aims: To describe the prevalence of new-onset cardiovascular risk factors after lung transplantation, identify independent predictors and to investigate possible vascular mechanisms responsible for the development of hypertension after lung transplantation.Materials and methods: I: Lung transplant recipients (Ltx) without pre-transplant cardiovascular risk factors were included in a retrospective descriptive study. Cumulative prevalence of new-onset hypertension, hypercholesterolemia and diabetes were calculated, and independent preoperative predictors were identified. II-IV: Forearm vascular resistance (FVR) and effects on forearm blood flow of endothelial-dependent and independent vasodilators, inhibition of endothelial nitric oxide synthesis and endothelinA-receptor blockade were investigated in Ltx early (II-III) and late after transplantation (IV), and in healthy subjects by means of venous occlusion plethysmography. Plasma levels of endothelin-1 (ET-1) were determined and arterial compliance was measured by echo-tracking. Results: I: Three years after transplantation 90% of Ltx had developed at least one cardiovascular risk factor, and 40% two or more. Independent pre-transplant predictor for hypertension was; diastolic blood pressure, for hypercholesterolemia; serum-cholesterol level and for diabetes; cystic fibrosis and blood glucose level. II: Basal FVR, endothelial-independent vasodilatation and nitric oxide synthesis-inhibition induced vasoconstriction did not differ significantly between Ltx and controls. Ltx had an increased arterial stiffness. III: Ltx had an impaired vasodilatation to endothelinA-receptor blockade and increased plasma levels of ET-1. IV: Basal FVR was lower in Ltx late after transplantation while endothelial-dependent and -independent vasodilatation did not differ between the groups. There was a significant correlation between endothelin-1 levels and FVR in healthy subjects, but not in Ltx. Conclusions: Development of new-onset cardiovascular risk factors is common after lung transplantation and occurs early. No evidence of general vasoconstriction and endothelial dysfunction was detected after lung transplantation and accordingly, the results question this concept as being responsible for post-transplant hypertension. In contrast, alterations in endothelin-1 handling and endothelinA-receptor function were demonstrated in Ltx, which may have importance for the development of post-transplant hypertension

The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14,118 patients

Abstract Background To determine the discriminative accuracy and calibration of EuroSCORE II in relation to age, sex, and surgical risk in a large nationwide coronary artery bypass grafting (CABG) cohort. Methods All 14,118 patients undergoing isolated CABG in Sweden during 2012–2017 were included. Individual patient data were taken from the SWEDEHEART registry. Patients were divided by age ( 8%). Discriminative accuracy was determined by the area under the receiver operating characteristic curve (AUC) and calibration by the observed/estimated (O/E) mortality ratio at 30 days. Results AUC and O/E ratio were 0.82 (95% CI 0.79–0.85) and 0.58 (0.50–0.66) overall, 0.82 (0.79–0.86) and 0.57 (0.48–0.66) in men, and 0.79 (0.73–0.85) and 0.60 (0.47–0.75) in women. Regarding age, discriminative accuracy was highest in patients aged 60–69 years (AUC: 0.86 [0.80–0.93]) but was satisfactory in all groups (AUC: 0.74–0.80). O/E ratio varied from 0.26 for patients > 60 years to 0.90 for patients > 80 years. Regarding surgical risk, AUC and O/E ratio were 0.63 (0.44–0.83) and 0.18 (0.09–0.30) in low-risk patients, 0.60 (0.55–0.66) and 0.57 (0.46–0.68) in intermediate-risk patients, and 0.78 (0.73–0.83) and 0.78 (0.64–0.92) in high-risk patients. Conclusions EuroSCORE II had good discriminative accuracy independently of sex and age, but markedly overestimated mortality risk, especially in younger patients. Accuracy and calibration were better in high-risk patients than in low-risk and intermediate-risk patients

Forty year old female with cough and chest pain

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Forty year old female with cough and chest pain

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Short- and long-term outcomes following surgery for primary spontaneous pneumothorax in Iceland

Publisher Copyright: © 2022 Laeknafelag Islands. All rights reserved.INNGANGUR Frumkomið sjálfsprottið loftbrjóst er algengur sjúkdómur þar sem skurðaðgerð er beitt við viðvarandi loftleka eða endurteknu loftbrjósti. Tilgangur rannsóknarinnar var að kanna árangur þessara skurðaðgerða á Íslandi á 28 ára tímabili. EFNIVIÐUR OG AÐFERÐIR Afturskyggn rannsókn á 386 sjúklingum (miðgildi aldurs 24 ár, 78% karlar) sem gengust undir 430 aðgerðir á Landspítala 1991-2018. Sjúklingaþýðinu var skipt í fjögur 7 ára tímabil og þau borin saman. Árlegt nýgengi aðgerða var reiknað og upplýsingum safnað úr sjúkraskrám um fyrra heilsufar, ábendingu, tegund aðgerðar, fylgikvilla og legutíma eftir aðgerð. Aðgerðir vegna endurtekins loftbrjósts voru skráðar og forspárþættir þeirra metnir með aðhvarfsgreiningu. NIÐURSTÖÐUR Árlegur aðgerðafjöldi á tímabilinu var 14,5 (miðgildi, bil 9-27) og lækkaði nýgengi aðgerða um 2,9% á ári (p=0,004). Tæpur helmingur (49%) sjúklinga reyktu fram að aðgerð og 77% aðgerðanna voru gerðar með brjóstholssjá. Helstu fylgikvillar eftir aðgerð voru viðvarandi loftleki (17%), lungnabólga (2%) og fleiðruholssýking (0,5%) en enginn lést innan 30 daga frá aðgerð. Tuttugu og sjö sjúklingar (6%) þurftu enduraðgerð vegna endurtekins loftbrjósts, að meðaltali 16 mánuðum frá upphaflegu aðgerðinni, þar af 24 (7%) eftir brjóstholssjáraðgerð. Aðhvarfsgreining sýndi að yngri sjúklingar voru líklegri til að gangast undir aðgerð vegna endurtekins loftbrjósts. ÁLYKTANIR Skurðaðgerð vegna frumkomins sjálfsprottins loftbrjósts er örugg meðferð og alvarlegir skammtímafylgikvillar sjaldgæfir. Líkt og erlendis greinast um 6% sjúklinga með endurtekið loftbrjóst sem krefst endurtekinnar skurðaðgerðar. Nýgengi aðgerða af óþekktum orsökum hefur lækkað en benda má á að tíðni reykinga hérlendis hefur lækkað verulega á rannsóknartímabilinu.BACKGROUND: Primary spontaneous pneumothorax (PSP) is a common disease where surgery is indicated for persistant air leak or recurrent pneumothorax. We studied the outcomes of PSP-surgery over a 28 year period in a whole nation. MATERIALS AND METHODS: A retrospective study on 386 patients (median age 24 years, 78% males) that underwent 430 PSP surgeries at Landspitali University Hospital 1991-2018. Annual incidence of the procedure was calculated and previous medical history, indication and type of surgery, complications and length of hospital stay were registered. Patients in four 7 year periods were compared, recurrent pneumothoraces requiring reoperation (median follow-up 16 years) registered and predictors of reoperation identified with logistic regression. RESULTS: Annually 14.5 PSP surgeries (median, range 9-27) were performed; the incidence decreasing by 2.9% per year on average. Every other patient smoked and 77% of surgeries were performed with video assisted thoracocopic surgery (VATS). The most common early complications (p<30 days from surgery) were persistent airleak (17%), pneumonia (2%) and empyema (0,5%). No patient died within 30 days from surgery. Reoperation for recurrent pneumothorax was performed on 27 patients; 24 following VATS (7%), median time from the primary surgery being 16 months. Logistic regression showed that younger patients were more likely to require reoperation for recurrent pneumothorax. CONCLUSIONS: Surgical treament for PSP is safe and major early complications rare. The rate of recurrent pneumothorax requiring surgery was 6%, which is similar to other studies. For unknown reasons the incidence of PSP surgery declined, but future research has to answer if it is linked to decreased smoking in the Icelandic population.Peer reviewe

Impaired differentiation of chronic obstructive pulmonary disease bronchial epithelial cells grown on bronchial scaffolds

Chronic obstructive pulmonary disease (COPD) is characterized by airway inflammation, small airway remodeling, and emphysema. Airway remodeling in patients with COPD involves both the airway epithelium and the subepithelial extracellular matrix (ECM). However, it is currently unknown how epithelial remodeling in COPD airways depends on the relative influence from inherent defects in the epithelial cells and alterations in the ECM. To address this, we analyzed global gene expression in COPD human bronchial epithelial cells (HBEC) and normal HBEC after repopulation on decellularized bronchial scaffolds derived from patients with COPD or donors without COPD. COPD HBEC grown on bronchial scaffolds showed an impaired ability to initiate ciliated-cell differentiation, which was evident on all scaffolds regardless of their origin. In addition, although normal HBEC were less affected by the disease state of the bronchial scaffolds, COPD HBEC showed a gene expression pattern indicating increased proliferation and a retained basal-cell phenotype when grown on COPD bronchial scaffolds compared with normal bronchial scaffolds. By using mass spectrometry, we identified 13 matrisome proteins as being differentially abundant between COPD bronchial scaffolds and normal bronchial scaffolds. These observations are consistent with COPD pathology and suggest that both epithelial cells and the ECM contribute to epithelial-cell remodeling in COPD airways