Hospitalizations for bacterial septicemia after renal transplantation in the united states.

BACKGROUND: It is common belief in the transplant community that rates of septicemia in transplant recipients have declined, but this has not been studied in a national population. METHODS: Therefore, 33,479 renal transplant recipients in the United States Renal Data System from July 1, 1994 to June 30, 1997 were analyzed in a retrospective registry study of the incidence, associated factors, and mortality of hospitalizations with a primary discharge diagnosis of septicemia (ICD9 Code 038.x). RESULTS: Renal transplant recipients had an adjusted incidence ratio of hospitalizations for septicemia of 41.52 (95% CI 35.45-48.96) compared to the general population. Hospitalizations for septicemia were most commonly associated with urinary tract infection as a secondary diagnosis (30.6%). In multivariate analysis, diabetes and urologic disease, female gender, delayed graft function, rejection, and pre-transplant dialysis, but not induction antibody therapy, were associated with hospitalizations for septicemia. Recipients hospitalized for septicemia had a mean patient survival of 9.03 years (95% CI 7.42-10.63) compared to 15.73 years (95% CI 14.77-16.69) for all other recipients. CONCLUSIONS: Even in the modern era, renal transplant recipients remain at high risk for hospitalizations for septicemia, which are associated with substantially decreased patient survival. Newly identified risks in this population were female recipients and pre-transplant dialysis.

The upper airway resistance syndrome masquerading as nocturnal asthma and successfully treated with an oral appliance.

Over the past 10 years, our ability to recognize, treat, and identify the morbidity associated with the upper airway resistance syndrome (UARS) has improved vastly. The diagnosis of this syndrome is dependent on a high degree of clinical suspicion, and in the presence of an already known pulmonary disease such as asthma, the identification of UARS may be elusive. Treatment of this condition has received more recent attention in the literature, with oral appliance therapy as a viable treatment option in place of the usual positive-pressure ventilation devices.

Severe intrapulmonary shunting associated with metastatic carcinoid.

A 37-year-old woman with a 10-year history of metastatic carcinoid presented to her oncologist with increased dyspnea. Further evaluation revealed hypoxemia and intrapulmonary vasodilatation. We describe a case of hepatopulmonary-like physiology associated with metastatic carcinoid in a patient with intact liver function. To our knowledge, this is the first documented case of intrapulmonary shunting and hepatopulmonary-like physiology associated with metastatic carcinoid.

alpha 1-antitrypsin deficiency and idiopathic pulmonary fibrosis in a family.

Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease of unknown etiology with an estimated prevalence of 3 to 5 per 100,000. We describe a patient with a family history of both IPF and alpha 1-antitrypsin (AAT) deficiency. The patient had a 6-month history of worsening dyspnea when first seen, and he later died of multisystem organ failure and recalcitrant hypoxemia. He had IPF and AAT deficiency, with the phenotype PiSZ. His father and younger brother died of respiratory failure due to IPF. Other family members are heterozygous for AAT deficiency. A variety of inflammatory diseases have been associated with AAT deficiency, and an association between heterozygous AAT deficiency and IPF has been reported in the literature. Most current theories on the pathogenesis of IPF suggest an aberrant inflammatory response to some stimulus. This family cluster and another reported in the literature suggest that AAT deficiency may be a factor predisposing to inflammatory lung disease manifested by interstitial fibrosis.