Prospective study of functional status and quality of life before and after lung transplantation.

STUDY OBJECTIVES: To determine the impact of lung transplantation on patients' function and quality of life (QOL), 10 lung transplant patients were followed from before transplantation to 3 months after transplantation. The following variables were examined: (1) perceived functional status; (2) respiratory function; (3) moods; (4) satisfaction with overall QOL and health; and (5) thoughts about the decision to undergo lung transplantation. DESIGN: A longitudinal, small-group, repeated-measures design. SETTING: A large Midwest university medical center. MEASUREMENTS AND RESULTS: Several instruments were used to measure perceived health, QOL, functional status, and respiratory function. The perceived improvement in physical function after transplantation was accompanied by increased satisfaction with physical strength, current health, and QOL. In addition, dramatic improvements in pulmonary function were seen after transplantation (FVC, FEV(1), and forced expiratory flow at 25 to 75% of FVC); however, only the FEV(1) values significantly improved between 1 and 3 months after transplantation. For example, the FEV(1) (mean +/- SD) increased from 22 +/- 11% of predicted before transplantation to 46 +/- 12% and 55 +/- 14% of predicted at 1 month and 3 months after transplantation, respectively. Although the total number of psychological symptoms did not decrease significantly over time, the intensity and distress associated with the symptoms did. Psychological function scores did not change significantly. Ninety percent of the subjects reported being very satisfied with their transplant decision. CONCLUSIONS: Lung transplantation significantly improved the subjects' overall function and their satisfaction with their QOL and health status. However, since this report only addressed data for the first 3 months after transplantation, additional longitudinal research is needed to further elucidate the experiences and outcomes associated with lung transplantation.

Disk drusen and angioid streaks in pseudoxanthoma elasticum.

Visual field loss secondary to optic disk drusen became evident before the development of angioid streaks in a patient with pseudoxanthoma elasticum. The incidence of optic disk drusen in cases of pseudoxanthoma elasticum is 20 to 50 times greater than that in the healthy population. We postulate that the abnormal aggregation of macromolecules with a high affinity for calcium (resulting in abnormalities in elastin in cases of pseudoxanthoma elasticum) also develops at the cribriform plate, disrupting axonal flow and leading to disk drusen formation. Pseudoxanthoma elasticum is associated with marked cardiovascular and gastrointestinal morbidity. Moreover, macular hemorrhage and precipitation of angioid streaks have frequently been noted after trauma. Prompt diagnosis of pseudoxanthoma elasticum will allow necessary prophylaxis and must be considered in patients with optic disk drusen.

A low molecular weight immunosuppressive factor produced by Onchocerca gibsoni.

An immunosuppressive factor(s) which is heat stable, and dialysable, with a molecular weight less than 10,000 molecular weight, and is not species specific, has been shown to be produced during the in vitro culture of Onchocerca gibsoni microfilariae. The factor(s) is capable of abolishing lymphocyte mitogenesis induced by Con A in bovine lymphocytes and PHA in human lymphocytes. The factor(s) may play a role in establishing the microfilariae in the tissues of the host by depressing cell mediated immune reactions during invasion.