Cardiac tamponade secondary to pneumopericardium after lung transplantation: a case report

Pneumopericardium is a rare cause of cardiac tamponade. It is an exceptional complication of lung transplantation. We have presented a case of a patient with cystic fibrosis who experienced cardiac tamponade secondary to a tension pneumopericardium during the postoperative course after lung transplantation. Dehiscence of the bronchial suture line was confirmed by fiberoptic bronchoscopy.

Cholesterol and serum albumin as risk factors for death in patients undergoing general surgery

Background

Serum levels of total cholesterol, its fractions (high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol) and albumin are related to a poor outcome during hospital stay. It has been not assessed whether they are related to death in the long term after general surgery.

Methods

This prospective cohort study included 2848 general surgical patients with a median follow-up of 6 years after discharge from hospital. Sampling for biochemical measurements was done at the time of admission. The outcome investigated was all-cause mortality and multivariable Cox regression was used for statistical analysis.

Results

Three hundred and seventy-eight patients (13·3 per cent) died during follow-up. Serum albumin (adjusted hazard ratio (HR) 2·2 (95 per cent confidence interval (c.i.) 1·5 to 3·4) for lowest versus highest quintile), total cholesterol (HR 1·6 (95 per cent c.i. 1·1 to 2·3) for lowest versus highest quintile) and HDL-C (HR 1·6 (95 per cent c.i. 1·1 to 2·4) for lowest versus highest quintile) showed a significant inverse relationship with all-cause mortality in both crude and multivariable analyses. Serum albumin and HDL-C were associated with death for up to 2 years after surgery, whereas total cholesterol had the strongest association more than 2 years after discharge.

Conclusion

Low levels of serum albumin, total cholesterol and HDL-C are associated with death after discharge from hospital in patients having general surgery.

Sleep disorders are underdiagnosed in patients on maintenance hemodialysis

BACKGROUND

Sleep apnea-hypopnea syndrome (SAHS) is a cardiovascular risk factor. The aim of this study was to evaluate sleep disorders using polysomnography on a non-selected population of patients on maintenance hemodialysis.

METHODS

Overnight polysomnography was performed on 32 hemodialysis patients (24 men/8 women, 54 +/- 16 years), and on 19 healthy subjects of similar age, sex and body mass index who were used as controls.

RESULTS

In hemodialysis patients, the most frequent sleep disorder was SAHS in 44% (14/32), followed by insomnia in 41% (13/32). Compared to healthy controls, patients on hemodialysis showed less slow-wave sleep and rapid eye movement sleep (23 vs. 36%, p = 0.001), less sleep efficiency (71 vs. 87%, p = 0.0079) and a higher periodic limb movement index (39.7 vs. 9.1; p = 0.003). An increase in apnea-hypopnea index (18.9 vs. 4.3; p = 0.007) and dips in the SaO(2) (> or =4%) per hour of sleep (22.6 vs. 6.4; p = 0.021) were also significantly greater in hemodialysis patients than controls. 72% of the cases of SAHS were diagnosed solely by means of polysomnography.

CONCLUSIONS

The patients on hemodialysis showed poor sleep quality with a significant increase in the apnea-hypopnea index and in the number of dips in SaO(2). SAHS was underdiagnosed in a large percentage of the hemodialysis patients.

Respiratory Disorders and Quality of Sleep in Patients on the Waiting List for Lung Transplantation

BACKGROUND

The purpose of this study was to assess the quality of sleep and extent of respiratory disorders in patients awaiting lung transplantation as compared with a control group.

METHODS

From September 2003 to November 2003, 17 clinically stable patients on the waiting list for lung transplantation and 14 healthy controls (with similar age, gender, and body mass index) were studied. Diagnostic polysomnography (PSG) was carried out for all subjects.

RESULTS

Seventeen patients were included, 15 men and 2 women, aged 51 +/- 14 years. The indication for lung transplantation was emphysema in 7 cases, pulmonary fibrosis in 6, and "other" in 4. Patients awaiting lung transplantation had the following respiratory values: mean FEV1, 1105 mL (34% of predicted); PaO2, 54 mm Hg; and PaCO2, 44 mm Hg. Significant differences were found among the waiting-list patients in terms of predominance of light sleep, wakeful periods, and phase changes per sleep-hour, as compared with the control group. The recording of the respiratory events showed an apnea-hypopnea index of 6.13, sleeping time with SaO2 <90% of 1.80%, and a mean number of significant desaturations (<4%) of 6.38. There were no statistically significant differences with respect to the control group.

CONCLUSIONS

Poor quality of sleep was observed in patients awaiting lung transplantation as compared with a healthy control group. There was no evidence of more respiratory events or significant desaturations in these patients, probably due to the provision of supplementary oxygen therapy during the PSG.

Relationship between hospital infection and long-term mortality in general surgery: a prospective follow-up study

A prospective study of 1431 patients admitted to a general surgery department were followed up for a median of 6.2 years after discharge (7679 person-years of follow-up). We collected information on underlying conditions, including severity of illness, and healthcare-related variables. Relative rates of death and their 95% confidence interval (CI) were estimated using person-years as the denominator. Multiple-risk factors adjusted for relative rates (RR) were obtained using Poisson regression analysis. There were 172 deaths during the follow-up period after hospital discharge (2/100 person-years). Follow-up was complete in 91% of the cohort. There were no important differences in demographic characteristics or risk factors between patients followed up and those lost to follow-up. The death rate in patients with any hospital-acquired infection was 5.3/100 person-years, and the relative rate was 3.07 (95% CI: 2.20-4.24). After adjusting for the main predictors of mortality, we found an effect modification by the presence of chronic disease (P = 0.01 for the product-term between hospital infection and the diagnosis of chronic diseases). Among patients without any underlying chronic disease, hospital-acquired infection was related to a significantly higher long-term mortality (RR = 2.47, 95% CI: 1.24-4.91). In these patients, surgical wound infection yielded a RR of mortality of 3.44 (95% CI: 1.63-7.27). Among patients with underlying chronic disease no association between hospital infection and long-term mortality was found. No evidence of an important modification of the relative rate along the follow-up period was observed. In conclusion surgical patients without chronic disease developing hospital-acquired infection have an increased risk of long-term mortality.

Acute intestinal anisakiasis in Spain: a fourth-stage Anisakis simplex larva

A case of acute intestinal anisakiasis has been reported; a nematode larva being found in the submucosa of the ileum of a woman in Jaén (Spain). The source of infection was the ingestion of raw Engraulis encrasicholus. On the basis of its morphology, the worm has been identified as a fourth-stage larva of Anisakis simplex. In Spain, this is the ninth report of human anisakiasis and also probably the first case of anisakiasis caused by a fourth-stage larva of A. simplex.

Bronchial mucoepidermoid carcinoma after allogeneic bone marrow transplantation

A 16 year old man underwent an allogeneic bone marrow transplantation (BMT) from an HLA identical sibling donor for acute lymphoblastic leukaemia in 1984. He developed chronic graft versus host disease involving the skin and kidneys. At day 400 after BMT his condition was complicated by obstructive airways disease, which was partially responsive to azathioprine and steroids. Five years after withdrawal of immunosuppressive treatment he developed dyspnoea and decreased pulmonary function test results, and steroid treatment was resumed. Fibrobronchoscopy revealed the presence of a mucoepidermoid carcinoma in the left main bronchus. After surgical laser resection, there was gradual clinical and functional improvement. There was no evidence of recurrence one year after surgery.

[Usefulness of determining 2 cell membrane enzymes in bronchial aspirate and lung tissue in patients with cancer of the lung]

The cell membrane enzymes, Alkaline Phosphatase and Gamma Glutamyl Transferase, have been studied in lung aspirates from healthy subjects and lung cancer patients. These enzymes were studied, in the latter, both in healthy and in neoplastic tissue. The enzymatic activity both in the lung aspirate and in the neoplastic tissue was significantly lower in poorly differentiated cancers when compared to well or moderately differentiated tumors. Similarly, analysis revealed that there was a statistically significant decrease in the activity of both enzymes in lung aspirates from patients with bronchogenic tumors when compared to healthy controls. The results obtained in this present work, together with the easiness of obtaining a lung aspirate suggest that these enzymes should be determined in order to obtain further information about the histological origin of lung cancer. These enzymatic changes could be explained with the "fatalism" theory for neoplastic tissue as we explain in this work.

Primary bronchopulmonary malignant melanoma. Case report

A case of pulmonary melanoma is presented. Because of the tumor's evolution and clinical features and, in particular, its pathoanatomic characteristics, we believe that it complied with sufficient criteria for classification as primary bronchopulmonary malignant melanoma. The literature is briefly reviewed.

Alkaline phosphatase, gamma-glutamyl transferase, lactate dehydrogenase and creatine kinase in bronchial aspirate from neoplastic and normal pulmonary tissue

The activities of 4 enzymes, i.e. alkaline phosphatase, gamma-glutamyl transferase, lactate dehydrogenase and creatine kinase were studied in bronchial aspirates and serums from two groups of subjects, the first one was composed of 14 subjects without active bronchopulmonary pathology and the other of 20 patients with lung cancer. The results showed a statistically significant decrease of the activities of alkaline phosphatase and beta-glutamyl transferase in bronchial aspirate from patients with bronchogenic malignant tumors in relation to normal subjects. This finding could be explained by the 'fetalism' principle, which states that the quantitative pattern of enzymes of immature human tissues resembles those of neoplastic tissues.