Intermediate-term results after en bloc double-lung transplantation with bronchial arterial revascularization

AbstractObjective: Between May 1990 and January 1994, 18 patients underwent en bloc double-lung transplantation with tracheal anastomosis and bronchial arterial revascularization. Because at that time it was already suggested that chronic ischemia could be a contributing factor in occurrence of obliterative bronchiolitis, the purpose of this study was to evaluate, with a follow-up ranging from 22 to 69 months, the midterm effects of bronchial arterial revascularization on development of obliterative bronchiolitis. Results: Results were assessed according to tracheal healing, functional results, rejection, infection, and incidence of obliterative bronchiolitis. There were no intraoperative deaths or reexplorations for bleeding related to bronchial arterial revascularization, but there were three hospital deaths and five late deaths, two of them related to obliterative bronchiolitis. According to the criteria previously defined, tracheal healing was assessed as grade I, IIa, or IIb in 17 patients and grade IIIa in only one patient. Early angiography (postoperative days 20 to 40) demonstrated a patent graft in 11 of the 14 patients in whom follow-up information was obtained. Ten patients are currently alive with a 43-month mean follow-up. Among the 15 patients surviving more than 1 year, functional results have been excellent except in five in whom obliterative bronchiolitis has developed and who had an early or late graft thrombosis. Furthermore, those patients had a significantly higher incidence of late acute rejection (p < 0.02), cytomegalovirus disease (p < 0.006), and bronchitis episodes (p < 0.0008) than patients free from obliterative bronchiolitis. Conclusion: We conclude that besides its immediate beneficial effect on tracheal healing, long-lasting revascularization was, at least in this small series, associated with an absence of obliterative bronchiolitis, thus suggesting but not yet proving the possible role of chronic ischemia in this multifactorial disease. (J THORAC CARDIOVASC SURG 1996;112:1292-300

Outcomes after Bronchoscopic Procedures for Primary Tracheobronchial Amyloidosis: Retrospective Study of 6 Cases

Respiratory amyloidosis is a rare disease which refers to localized aberrant extracellular protein deposits within the airways. Tracheobronchial amyloidosis (TBA) refers to the deposition of localized amyloid deposits within the upper airways. Treatments have historically focused on bronchoscopic techniques including debridement, laser ablation, balloon dilation, and stent placement. We present the outcomes after rigid bronchoscopy to remove the amyloid protein causing the airway obstruction in 6 cases of tracheobronchial amyloidosis. This is the first report of primary diffuse tracheobronchial amyloidosis in our department; clinical features, in addition to therapy in the treatment of TBA, are reviewed. This paper shows that, in patients with TBA causing airway obstruction, excellent results can be obtained with rigid bronchoscopy and stenting of the obstructing lesion

Le pleurotalcage pour les épanchements pleuraux récidivants (indications et résultats)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Efficacité à long terme de la haute sympathectomie thoracique haute par vidéo-thoracoscopie dans l'hyperhidrose essentielle des membres supérieurs

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Effets secondaires de la Nivaquine* (à propos d'un cas survenu au décours d'un séjour au Sénégal)

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Quand le pneumologue doit-il envisager la greffe pulmonaire pour un de ses patients ? Critères d’inscription en liste d’attente : mucoviscidose, HTAP et maladies systémiques (sarcoïdose, histiocytose langerhansienne, lymphangioleïomyomatose et connectivites)

National audienceIntroduction Placing a patient on the national lung transplant waiting list remains a difficult matter, and is more a question of timing than selection of the candidate according to disease-specific criteria. Back-ground The listing criteria for cystic fibrosis are FEV1 less than 30% of the predicted value, hypoxaemia with a PaO2 less than 55 mm Hg and hypercapnia with a PaCO2 over 50 mm Hg. The rate of decline of FEV1, increasing antibiotic requirements and life threatening complications can all accelerate the listing procedure. For primary pulmonary hypertension the criteria are persistent dyspnoea, NYHA grade III or IVA, despite epoprostenol treatment and a 6 minute walk test of less than 250 metres. Sarcoidosis, lymphangioleiomyomatosis, histiocytosis X and connective tissue diseases are rare indications for which the listing criteria are similar to those for the more usual respiratory diseases. View points Further therapeutic advances, increased numbers of available organs and changes in the allocation rules will necessitate periodical updates of these selection and listing criteria. Conclusion The optimal time for placing lung transplantation patients who have been referred early in the course of their disease on the waiting list will be determined by clinical experience and individual patient follow-up.Introduction L’inscription d’un patient sur la liste nationale d’attente de transplantation pulmonaire reste une question délicate non tant par les critères de sélection des candidats que par le choix du moment. État des connaissances Les critères d’inscription pour la mucoviscidose sont définis par un VEMS inférieur à 30 % de la valeur théorique, une hypoxémie inférieure à 55 mmHg et une hypercapnie supérieure à 50 mmHg. La vitesse du déclin du VEMS, l’antibiodépendance et une complication mettant en jeu le pronostic vital accélèrent l’inscription. Les contre-indications restent relatives. Ceux de l’hypertension artérielle pulmonaire sont une dyspnée stade III ou IV NHYA persistante après traitement par époprosténol et un périmètre de marche inférieur à 250 mètres. La sarcoïdose, la lymphangioleïomyomatose, l’histiocytose et les connectivites sont des indications rares dont les critères d’inscription rejoignent ceux des autres pathologies respiratoires plus classiques. Perspectives Les innovations thérapeutiques, l’augmentation des greffons disponibles et les changements des règles d’allocations des greffons devront faire réévaluer les critères de sélection des patients et d’inscription sur la liste d’attente. Conclusion L’expérience clinique et le suivi de chaque patient restent des éléments primordiaux pour juger du moment opportun d’inscription sur liste de transplantation de patients adressés suffisamment tôt aux centres spécialisés

Sedation for critically ill patients with COVID-19: which specificities? One size does not fit all

International audienc

Strategies to reduce external ventricular drain–related infections: a multicenter retrospective study

International audienc

Strategies to reduce external ventricular drain–related infections: a multicenter retrospective study

International audienc

Lung transplantation for pulmonary Langerhans' cell histiocytosis : A multicenter analysis

International audienceBackground. Lung transplantation (LT) may represent a therapeutic option in case of advanced pulmonary Langerhans' cell histiocytosis (PLCH). Little is known however about the characteristics of the patients considered for LT or its results. Methods. We conducted a retrospective multicenter study by questionnaire on 39 patients who underwent LT for end-stage PLCH at seven centers in France. Results. Of the 39 patients, 15 received single lung transplantation, 15 double lung transplantation and 9 heart-lung transplantation. At evaluation, extrapulmonary involvement was present in 31% of the patients, pulmonary hypertension (PAPm > 25 mm Hg) was observed in 92% of cases and was moderate-to-severe (PAPm >= 35 mm Hg) in 72.5%. The survival was 76.9% at 1 year, 63.6% at 2 years, 57.2% at 5 years, and 53.7% at 10 years. Recurrence of the disease occurred in eight cases (20.5%) with no impact on the survival rate. The sole risk factor for recurrence of the disease was the presence of preoperative extrapulmonary involvement. Conclusion. Severe pulmonary hypertension is a common feature in patients with end-stage PLCH. Given the good postransplant survival rate and despite a recurrence rate of the disease of approximately 20% after LT, we conclude that LT is a therapeutic option in this setting