Bronchus-associated lymphoid tissue lymphoma arising in a patient with bronchiectasis and chronic Mycobacterium avium infection.

We describe a 67-year-old woman with bronchiectasis and Mycobacterium avium complex infection who underwent wedge resection of her pulmonary infiltrates because they were progressing despite antibiotic therapy. In addition to the expected granulomatous changes, she was found to have a B-cell lymphoma of bronchus associated lymphoid tissue (BALT). Despite normal bone marrow morphology, marrow involvement was demonstrated by flow cytometry. Her lymphoma remains suppressed with antimycobacterial therapy 6 months after resection of bulk disease.

Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery.

STUDY OBJECTIVE: Thoracotomy, sternotomy, and upper abdominal laparotomy are associated with high rate of postoperative cardiopulmonary complications (POCs). We hypothesized that symptom-limited stair climbing predicts POCs after high-risk surgery. DESIGN: A prospective evaluation of 83 patients undergoing thoracotomy, sternotomy, and upper abdominal laparotomy surgery. METHODS: The 52 men and 31 women completed symptom-limited stair climbing. A separate investigator, blinded to the number of flights of stairs climbed, assessed 30-day actual outcomes for POCs, including pneumonia, atelectasis, mechanical ventilation for > 48 h, reintubation, myocardial infarction, congestive heart failure, arrhythmia, pulmonary embolus, and death within 30 days of surgery. The operations performed included 31 lobectomies, 6 wedge resections, 3 pneumonectomies, 3 substernal thymectomies, 1 substernal thyroidectomy, 23 colectomies, 3 laparotomies, 7 abdominal aortic aneurysm repairs, 5 esophagogastrectomies, and 1 nephrectomy. RESULTS: POCs occurred in 21 of 83 patients (25%) overall, in 9 of 44 patients undergoing thoracotomy/sternotomy (20%), and in 12 of 39 patients undergoing upper abdominal laparotomy (31%). Of those unable to climb one flight of stairs, 89% developed a POC. No patient able to climb the maximum of seven flights of stairs had a POC. The inability to climb two flights of stairs was associated with a positive predictive value of 82% for the development of a POC. The number of days in the hospital postoperatively decreased with a patient's increased ability to climb stairs. CONCLUSIONS: Symptom-limited stair climbing offers a simple, inexpensive means to predict POCs after high-risk surgery.

Postoperative pulmonary complications.

Patients undergoing elective surgery first need to be screened for operative risks by reviewing factors that relate to the patient and factors that relate to the procedure they are undergoing. The identification of high-risk patients undergoing high-risk procedures may be aided by reviewing the following factors: the presence of symptomatic lung disease, smoking, obesity, abnormal blood gas values, spirometry, and presence of sleep apnea. The more risk factors a patient has, the more likely the patient will develop postoperative complications. Further risk stratification may be accomplished by means of exercise testing, either through formal cardiopulmonary exercise testing or through symptom-limited stair climbing. When high-risk patients are identified, preoperative therapy aimed at reducing overall postoperative morbidity and mortality may help decrease the risk to a minimum.