Lung transplantation for patients older than 65 years: is it a feasible option?

BACKGROUND: Advanced age has been a relative contraindication to lung transplantation. However, the exact age limit for this procedure has not yet been established. The aim of this work is to present our experience with this particular group. METHODS: This retrospective review included medical charts of patients who underwent lung transplantation at our institution from January 2004 to February 2009: namely, 112 cadaveric lung transplants with 12 patients (10.7%) >65 years old. RESULTS: There were 9 male patients and the overall mean age was 68 years (range 66-72). The indications were pulmonary fibrosis in 8 and emphysema in 4 cases. Four patients had mild coronary artery disease and 4 systemic hypertension. All of the procedures were unilateral and only 2 required extracorporeal circulation. Only 5 patients received blood product transfusions intraoperatively; the mean ischemic time was 222 minutes. Four patients developed primary graft dysfunction, the mean requirement for mechanical ventilation was 30 hours, and the mean intensive care unit stay, 11 days. Postoperative complications were respiratory infections (n = 8), catheter-related infection (n = 1), atrial fibrillation (n = 2). The mean hospital stay was 28 days and the 1-year survival was 75%. CONCLUSION: Lung transplantation is a feasible option for well-selected patients with end-stage pulmonary disease who are >65 years old. Our study reinforces the modern trend for unilateral procedures in this situation.

Lung transplantation for lymphangioleiomyomatosis: single-center Brazilian experience with no chylothorax.

BACKGROUND: Lymphangioleiomyomatosis (LAM), a rare cystic disease characterized by proliferation of smooth muscle cells in the lung interstitium, almost exclusively affects females in their reproductive years. Lung transplantation has been established as effective therapy for end-stage pulmonary LAM. METHODS: This retrospective study includes lung transplantation patients with LAM at a single institution between 1989 and 2009. RESULTS: During the study period we performed 300 lung transplantations, and in 10 cases the recipients had LAM. All patients were females with a mean age of 43.8 years. The mean time from the diagnosis to lung transplantation was 5 years. Seven patients had experienced previous pneumothoraces, five of whom were treated with pleurodesis. In all patients we performed a single-lung transplantation (left-sided = 9 and right-sided = 1). In three cases, the pleurodesis was on the same side as the transplantation, with great intraoperative bleeding in one subject (left pleurectomy). There was one early death due to infective endocarditis at posttransplant day 19. The median length of mechanical ventilation was 13 hours, while the mean hospital stay was 16.75 days. There was no case of chylothorax. Late complications included one case of native lung pneumothorax, one diaphragmatic hernia, one posttransplant lymphoproliferative disease, one respiratory sepsis, and one mycobacterial infection. The 1- and 3-year survival rates were 90% and 80%, respectively. CONCLUSION: Lung transplantation is a feasible therapeutic option for patients with LAM, despite previous ipsilateral pleurodesis. The left-sided predilection for our procedures may have been responsible for the absence of chylothorax in this series.

Multiple synchronous bronchial carcinoid tumors: report of a case.

Peripheral bronchial carcinoids are uncommon. Their presentation as synchronous tumors is rare and limited to anecdotal cases.We report the case of a 62-year-old female with the radiological finding of multiple bilateral nodular lesions. Bilateral sequential thoracotomies were performed and all three nodules were treated by sublobar resections. Pathological examination revealed all specimens to be carcinoid tumors and subsequent investigation confirmed the lung as the primary site. A review of previous cases of multiple carcinoids is presented and the particularities of their management are discussed.

Intraoperative detection of sentinel lymph nodes using Patent Blue V in non-small cell lung cancer.

AIM: The aim of this article was to determine sentinel lymph node (SLN) identification rate (IR) using Patent Blue V in patients with non-small cell lung cancer (NSCLC) and to evaluate the accuracy of SLN for the presence of mediastinal metastasis. METHODS: Between 2004 and 2006 the data from 32 patients with clinical stage IA to IIB, who underwent lung resection for NSCLC, were prospectively analyzed. Patent blue V dye was injected in the peritumoral tissue, and the first lymph node to stain was identified as a sentinel node. RESULTS: SLN was identified in fifteen patients (IR=46.9%). SLN with metastatic involvement was observed in four patients. Accuracy, sensitivity and specificity of the sentinel lymph node in predicting the status of other mediastinal lymph node stations were respectively 86.7%, 100%, and 84.6%. In 63.1% patients, the SLNs corresponded to the lymph node stations 10 and 11. In seven patients (36.9%), the SLNs were located in the N2 stations. CONCLUSION: Although the use of Patent Blue V for SLN identification is feasible, this technique presents relatively low identification rate. The major difficulty on the detection of SLNs was the black coloration of the lymph node, which interfered with the visualization of the dye.

Clinical course of postinfectious bronchiolitis obliterans.

We performed a prospective observational study to define the clinical course and the prognostic factors of 31 patients with postinfectious bronchiolitis obliterans. All patients presented with an episode of acute bronchiolitis in the first 2 years of life, and respiratory symptoms and signs persisted since then. Other diseases which may cause chronic airflow obstruction were excluded. The patients were followed after their inclusion in the study and the clinical findings were recorded in a standardized questionnaire and form. Repeated chest radiographs and lung perfusion scans were obtained in all 31 patients and semiannual spirometry was performed in 8 older patients. Eight patients had lung biopsies. The clinical course varied in the 31 patients during a mean of 3.5 years of follow-up. The outcome of the patients included clinical remission (22.6%), persistence of respiratory symptoms and signs (67.7%), and death (9.7%). An older age at onset of illness and presence of atopy as suggested by an elevated serum IgE appeared to predispose to a poor prognosis.

Fungal infection in single and bilateral lung transplantation: report of 17 cases in 42 consecutive recipients

We reviewed the frequency and type of fungal infections in patients undergoing lung transplantation at Pavilhäo Pereira Filho Hospital between may 1989 and january 1995. Among the 42 lung transplant recipients studies, 17 ( 40 por cento ) had histologic diagnosis of fungal infection: aspergillosis 8 casos, candidosis 6 cases, and aspergillosis combined with candidosis 3 cases. Among all fungal infections, 47 por cento ( 8 of 17 cases ) occurred in the first month after transplantation, and 82 por cento occurred within the first six months after the transplant. The diagnosis was done during life in candidosis in 77 por cento of patients by transbronchial biopsy. However, aspergillosis was revealed in autopsy material in 82 por cento of cases. Most of the patients with candidosis had a local infection in the transplanted lung. On the contrary, in aspergillosis patients 88 por cento had the mycosis in the native lung

Actinomycotic intracavitary lung colonization.

We describe four cases of actinomycotic intracavitary lung colonization and review the literature on the subject. Aspergillus fumigatus, A. niger, A. flavus, Pseudallescheria boydii are responsible for the majority of fungi intracavitary lung colonization (fungus ball). The similarities in clinical symptom (haemoptysis) and radiologic feature (pulmonary air meniscus) of fungus ball and actinomycotic intracavitary colonization prompted the investigation into a range of microorganisms, including Nocardia spp. and Actinomyces spp. We report four cases of such actinomycotic syndrome, three of them in diabetic patients, and review briefly the literature.

Adiaspiromycosis treated successfully with ketoconazole.

We describe a case of adiaspiromycosis in a 37-year-old male Caucasian. This is the first reported case with diffuse involvement of both lungs in a severely ill patient treated successfully with antifungal chemotherapy.

Syngamosis: two new Brazilian cases and evidence of a possible pulmonary cycle.

Cases of syngamosis due to Mammomanogamus laryngeus are reported, with a discussion of diagnostic aspects. A pulmonary cycle for M. laryngeus is proposed, suggested by the appearance of a transient area of homogeneous consolidation of the lung, detected by X-ray.

Acute pulmonary histoplasmosis and first isolation of histoplasma capsulatum from soil of Rio Grande do Sul, Brazil

Apresenta-se um caso de histoplasmose pulmonar aguda, onde a história clínica orientada levou à identificaçäo da fonte natural do Histoplasma capsulatum. O fungo foi obtido em cultivo a partir de fragmentos de baço e fígado de ratos inoculados intraperitonealmente com solo da zona rural de General Câmara, pela primeria vez no Rio Grande do Sul

Multiple paracoccidioidomas simulating Wegener's granulomatosis.

Five cases of paracoccidioidomas are reviewed. One case with multiple coin-lesions simulating Wegener's granulomatosis is described.

Bronchopulmonary lavage in alveolar microlithiasis.

We describe the first known use of volume-controlled bronchopulmonary lavage in a case of alveolar microlithiasis. Although the procedure has often been discussed in the literature as theoretically useful in the therapy for this disease, in our case it showed no efficacy in clearing the alveolar spherules.