Patients with atherosclerotic peripheral arterial disease have a high risk of lung cancer: Systematic review and meta-analysis of literature.

PURPOSE: Lung cancer and atherosclerosis share common risk factors. Literature data suggest that the prevalence of lung malignancy in patients with peripheral arterial disease (PAD) is higher than in the general population. Our goal was to determine, through a systematic literature review, the prevalence of lung cancer in patients with PAD. METHODS: We consulted available publications in the Cochrane library, MEDLINE, PUBMED, EMBASE, and ClinicalTrials.gov. We included all articles, written in English or French, published between 1990 and 2020 reporting the prevalence of lung cancer in patients with PAD (atherosclerotic aortic aneurysm or peripheral occlusive diseases). Patients with coronary artery disease, cardiac valvulopathy or carotid stenosis were not included. We did not include case reports. We performed a critical analysis of each article. Data were collected from two independent readers. A fixed effect model meta-analysis allowed to estimate a summary prevalence rate. RESULTS: We identified 303 articles, and selected 19 articles according to selection criteria. A total of 16849 patients were included (mean age 68.3 years, 75.1% of males). Aortic aneurysms were found in 29% of patients and atherosclerotic occlusive disease in 66% of patients. Lung cancer was identified in 538 patients, representing a prevalence of 3%. DISCUSSION: Lung cancer is found in 3% of patients with atherosclerotic PAD. This prevalence is higher than that found in lung cancer screening programs performed in the general population of smokers and former smokers. These patients should be screened for lung cancer. Their selection may dramatically increase the benefit of lung cancer screening.

The psychological challenge of paediatric organ transplantation: gift and incorporation.

The specific feature of organ transplantation is the confrontation of the patient with a body part not being his own and coming from somebody else. Thus the psychological challenge of transplantation will be the gift and incorporation of the graft. The given organ confronts the patients with mental manifestations related to emotions of grieving and guilt, most constantly directed to the donor himself. It can also cause a fantastical imagination related to the idea of having to some extent inherited the character of the donor. This very special gift relationship has to be questioned, as it can be interpreted in terms of a tyranny of the dept. A dept the recipient will never be able to reimburse. In this context the contribution of sociological knowledge is determining. It makes it possible to reconsider the problem, and to discover that a gift relationship offers transplant patients much vaster possibilities than a materialistic conception of the gift, based on the dept, would do.

Long-term psychosocial adjustment following pediatric liver transplantation.

This study assessed long-term psychosocial adjustment to pediatric liver transplantation in 146 patients aged 4-25 yr, who had received a transplant 2-12 yr previously. Evaluations of psychosocial adjustment and related variables were based on the Harter Self-Perception Profiles for children, Child Behavior Checklist (CBCL), and children's academic level. Up to the age of 8 yr, transplant children as a group did not perceive themselves as less competent than healthy peers. Gender effects were characterized by older girls perceiving significantly less scholastic cognitive competence than their healthy peers. Adolescent and young adult boys had significantly lower global self-worth and lower perceived athletic competence than their healthy peers. In comparison to normative data of healthy children, CBCL parent-reported scores revealed significant deficits in competences for all age groups. Only for the older boys, however, did these deficits reported by the parents reach a pathological level. The majority of transplant children also had significantly higher problem scores, but they remained within the normal range, except for the older boys whose internalizing problems reached a borderline level. Our results suggest that liver transplantation does not substantially affect schooling. Regardless of statistically significant differences in psychosocial adjustment, the majority of the transplant children functioned at a normal level. For adolescent and young adult boys, however, the presence of problems and the lack of competences observed by parents and by the youngsters themselves reached borderline to pathological levels. Our findings stress the importance of psychological post-transplant follow-up with increased attention of caregivers to child and parental concerns about their long-term psychosocial adjustment process.

Psychological and social adjustment after pediatric liver transplantation as a function of age at surgery and of time elapsed since transplantation.

The study assessed psychological and social adjustment to pediatric liver transplantation in 101 patients aged 4-16 years who had undergone transplantation 2-10 years earlier. Each parent completed the Child Behavior Check List (CBCL) independently and answered a transplantation questionnaire assessing psychosocial issues. Most children scored within the normal range for both parts of the CBCL (i.e. Behavioral Problems and Social Competences). The impact of age at transplantation and of time elapsed since transplantation were examined. Earlier transplantation was associated with subsequent higher scores for Aggressive Behavior and Sex Problems, with lower scores for Activities and Competences, and with more parental anxiety concerning their child's health. The longer the time elapsed since transplantation, the more mothers rated high levels on the Somatic complaints, Anxiety/depression, Competence, and Social activity CBCL scales for their child. Parents reported talking more about the transplantation with their children with increasing time following transplantation. This suggests that transplantation remains an important event even after long periods of time from the transplant event. Finally, despite the difficulties encountered, more than 80% of the parents considered the transplantation had been beneficial to their child.