Fabíola Adélia Perin

Acute humoral rejection in a lung recipient: reversion with bortezomib.

on treatment, the poorly functioning area signifying the abscess cavity showed a reduction in size with alteration of shape and a decline in R2* value within, whereas T1-weighted and T2-weighted images showed only minimal changes (Fig. 1). Functional changes preceded morphologic changes as the abscess became gradually enclosed by normal functioning renal tissue. Prednisolone perhaps reduced the surrounding fibrosis as described by Haramaki et al. (4) No hypermetabolizing tissue was seen around the abscess as might be expected in a pyogenic abscess with surrounding inflammation. Using its ability to estimate tissue oxygen bioavailability, BOLD MRI can distinguish between acute rejection and acute tubular necrosis in a setting of early renal allograft dysfunction (5, 6). Although this technique cannot quantify absolute tissue oxygen levels because of the nonlinear relationship between R2* values and the partial pressure of oxygen, it could be used in various clinical situations to monitor renal oxygenation. This is the first report of the use of BOLD MRI to demonstrate the functional changes associated with a healing tuberculous abscess in a renal allograft. More studies may be required to obtain any further conclusion. This ability to combine functional with morphologic imaging heralds a new horizon and could emerge as a useful tool for vascular and functional assessment of the kidneys.

Surgical maneuvers for the management of bronchial complications in lung transplantation

BACKGROUND Many advances have substantially improved the clinical results of lung transplantation. However, the incidence of bronchial complications is still high, with significant impact on survival and limited interventional strategies for complex cases. Our aim is to evaluate the surgical management of bronchial complications following lung transplantation. METHODS From May 1989 to June 2007, 251 patients were submitted to lung transplantation at our institution. In five cases, the bronchial complications observed were dealt with open surgical procedures. RESULTS Complications surgically dealt were one broncho-arterial fistula and four stenosis. One left upper sleeve lobectomy, one right upper sleeve lobectomy and three segmental bronchial resections with anastomosis were performed. In all five cases the surgical procedure was successful and optimal bronchial healing was observed. Three patients died due to causes unrelated to the bronchial anastomosis 5, 21 and 32 months after the bronchoplastic procedure. Two patients are still alive and functionally well at 52 and 70 months post-bronchoplasty. CONCLUSIONS Surgical management of bronchial complications after lung transplantation may be the last resort in complex, recalcitrant cases, nevertheless it is a feasible procedure and can provide good results not only on short- but also long-term follow-up.

Round pneumonia: a rare condition mimicking bronchogenic carcinoma. Case report and review of the literature

CONTEXT Round pneumonia is a condition usually described in children, with few reports addressing adult patients. It is an oval-shaped consolidation that, due to its radiological appearance, simulates bronchogenic carcinoma. Its evolution tends to be benign, although diagnostic dilemmas have sometimes required exploratory thoracotomy. Deaths caused by this condition have even been reported. To the best of our knowledge, there have been 31 previous cases of round pneumonia in adults reported in the English and Portuguese-language literature, of which only one was completely asymptomatic. CASE REPORT The case of a 54-year-old female patient presenting a lung mass found on routine imaging evaluation is reported. Respiratory symptoms and signs were absent, but the patient had a significant history of smoking. Her physical examination gave normal results. On chest radiographs, a mass located in the middle third of the right lung was observed. Three weeks after the initial evaluation, the patient was admitted for a complete evaluation and for staging of a pulmonary malignancy, but repeated chest radiographs showed complete resolution.

Transplante pulmonar sem circulação extracorpórea em uma paciente com síndrome de Kartagener

A discinesia ciliar primaria e uma condicao rara que evolui com a formacao de bronquiectasias, e invariavelmente o tratamento cirurgico esta indicado; alguns desses pacientes evoluem para doenca pulmonar avancada, refrataria ao tratamento clinico e as resseccoes cirurgicas, tornando-se, portanto, candidatos ao transplante pulmonar. Quando associada a dextrocardia, bronquiectasias e sinusopatia cronica, a discinesia ciliar primaria e chamada de sindrome de Kartagener e e considerada como uma contraindicacao de transplante pulmonar por muitos centros.

Oxigenação por membrana extracorpórea em paciente acordado como ponte para o transplante pulmonar

O transplante pulmonar (TxP) é uma terapêutica estabelecida para o tratamento das doenças pulmonares avançadas. Embora o número de transplantes esteja aumentando em todo mundo,(1) durante a espera por um transplante pode haver agravamento da doença de base, especialmente nos pacientes com diagnóstico de doenças intersticiais, que eventualmente evoluem para insuficiência ventilatória com necessidade de suporte ventilatório. O suporte por ventilação mecânica invasiva (VMI) é a forma mais comum de manter esses pacientes vivos até o transplante, mas tem como inconveniente o risco aumentado de infecções e a falência muscular relacionada à sua imobilização e ao uso de drogas para a sedação. Nesse sentido, a utilização de algum suporte que mantenha o paciente fora da VMI aumenta as chances de sucesso do transplante futuro.

What is expected in lung function after lung transplantation due to end-stage pulmonary silicosis?

In this study, we aimed to determine the impact of lung transplantation (LTx) on pulmonary function tests (PFTs) and survival among patients with end‐stage silicosis. We included patients with end‐stage silicosis on the wait list for LTx, between January 1989 and July 2015 (N = 26). Sixteen of these patients received LTx; 10 were eligible, but did not undergo LTx (non‐LTx) during the study period. Retrospective information on PFTs (spirometry [volumes and flows], 6‐minute walking test [6MWT], and DLCO) was retrieved from patients’ medical charts, including baseline information for all patients and follow‐up information for the LTx. At baseline, most patients presented with spirometric and 6MWT values that were suggestive of severe disease (FEV1/FVC 76.5 ± 29.7; 6MWT 267.4 ± 104.5 m). Significant increases in these values were observed at follow‐up in the LTx (P = .036 and .151, respectively). The overall median survival of patients in the LTx and non‐LTx was 3.35 years (95% CI: 0.16‐14.38) and 0.78 years (95% confidence interval [CI]: 0.12‐3.65) (P = 0.002), respectively. For patients with end‐stage silicosis, LTx offers significant benefits regarding pulmonary function and survival when compared to non‐LTx, and is a reliable tool to help this critical population of patients, whose only treatment option is LTx.

Ground-glass nodules and CT-guided placement of platinum coils

Various centers perform the excision of these small growing nodules using video-assisted thoracoscopic surgery (VATS) in order to minimize postoperative morbidity, as well as to remove as small a volume of lung tissue as possible. Small nodules are often visible with the thoracoscope if they lie within 5 mm of the visceral pleural surface; however, if they are located deeper in the lung, palpation is required in order to locate them for excision. A previous study found that, in a series of 92 consecutive patients undergoing VATS, 50 (54%) required conversion to thoracotomy.