"White-Out" After Lung Transplantation: A Multicenter Cohort Description of Late Acute Graft Failure.

Graft failure represents a leading cause of mortality after organ transplantation. Acute late-onset graft failure has not been widely reported. The authors describe the demographics, CT imaging-pathology findings, and treatment of patients presenting with the latter. A retrospective review was performed of lung transplant recipients at two large-volume centers. Acute late-onset graft failure was defined as sudden onset of bilateral infiltrates with an oxygenation index <200 without identifiable cause or concurrent extrapulmonary organ failure. Laboratory, bronchoalveolar lavage (BAL), radiology, and histology results were assessed. Between 2005 and 2016, 21 patients were identified. Median survival was 19 (IQR 13-36) days post onset. Twelve patients (57%) required intensive care support at onset, 12 (57%) required mechanical ventilation, and 6 (29%) were placed on extracorporeal life support. Blood and BAL analysis revealed elevated neutrophilia, with CT demonstrating diffuse ground-glass opacities. Transbronchial biopsy samples revealed acute fibrinoid organizing pneumonia (AFOP), organizing pneumonia, and diffuse alveolar damage (DAD). Assessment of explanted lungs confirmed AFOP and DAD but also identified obliterative bronchiolitis. Patients surviving to discharge without redo transplantation (n = 2) subsequently developed restrictive allograft syndrome. This study describes acute late-onset graft failure in lung allograft recipients, without known cause, which is associated with a dismal prognosis.

Intraosseous Hemangioma of the Left Parietal Bone.

BACKGROUND: A 26-year-old male presented with pain in his left tibia. Ultrasonography revealed no abnormalities. Tc-99m-bonescan was requested to rule out stress fracture. The scan confirmed the presence of a left tibial stress fracture, as well as an enhancing lesion in the left parietal bone. The patient had no neurological symptoms.

Phosphatidylinositol and not phosphatidylglycerol is the important minor phospholipid in rhesus-monkey surfactant.

Pulmonary surfactant was isolated from lung tissue and alveolar washes of lungs of adult rhesus monkeys (Macaca mulatta). The phospholipid composition was determined and compared to the composition of human surfactant fractions. Contrary to human surfactant, phosphatidylinositol is the major acidic phospholipid, whereas phosphatidylglycerol is only a minor component in rhesus-monkey surfactant. These differences are not caused by a difference in plasma myo-inositol concentrations between the two species.

Determination of lamellar body phospholipids in amniotic fluid: a method to predict when the fetal lung becomes mature.

Lamellar body material was isolated by highspeed centrifugation from the amniotic fluids of 10 mildly diseased patients followed longitudinally and of 60 other women. Three stages of development were defined: (1) immature stage: the phospholipid concentration is less than 20 mumol/l and phosphatidylcholine (PC) is approximately 50%; (2) transitional stage: the phospholipid concentration is between 18 and 40 mumol/l, of which PC is approximately 75% and phosphatidylinositol (PI) 10%. Phosphatidylglycerol (PG) is absent or present at very low concentrations; (3) mature stage: the phospholipid concentration is above 40 mumol/l; its PC percentage is 75% or more. PG is present and the percentage of PI decreases. An increase in phospholipid concentration of 3.27 +/- (SD) 0.75 mumol/l/day was found during the transitional stage. The rate of increase enables us therefore to approximate the number of days that it will take before the fetal lung is mature.