Pulmonary transplant complications: a radiologic review

Lung transplantation has become the definitive treatment for end stage respiratory disease. Numbers and survival rates have increased over the past decade, with transplant recipients living longer and with greater comorbidities, resulting in greater complexity of care. Common and uncommon complications that occur in the immediate, early, intermediate, and late periods can have significant impact on the course of the transplant. Fortunately, advancements in surgery, medical care, and imaging as well as other diagnostics work to prevent, identify, and manage complications that would otherwise have a negative impact on survivability. This review will focus on contextualizing complications both categorically and chronologically, with highlights of specific imaging and clinical features in order to inform both radiologists and clinicians involved in post-transplant care.

Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing

BACKGROUND

Sleep-disordered breathing in general and obstructive sleep apnea in particular are commonly encountered conditions in allergy practice. Physiologically, nasal (or nasopharyngeal) obstruction from rhinitis, nasal polyposis, or adenotonsillar hypertrophy are credible contributors to snoring and nocturnal respiratory obstructive events. Nevertheless, existing practice parameters largely relegate the role of the allergist to adjunctive treatment in cases of continuous positive airway pressure intolerance.

OBJECTIVES

To survey active American Academy of Allergy, Asthma & Immunology members regarding their perceptions and practices concerning sleep-disordered breathing in adult and pediatric patients with rhinitis, and to review the medical literature concerning this connection to identify therapeutic implications and research gaps.

METHODS

Members of the Work Group on Rhinitis and Sleep-disordered Breathing composed and distributed a Web-based clinically oriented survey to active American Academy of Allergy, Asthma & Immunology members in mid-2015. The group, in addition, conducted an English-language literature review using PubMed and other sources.

RESULTS

Survey results were returned by 339 of 4881 active members (7%). More than two-third of respondents routinely asked about sleep problems, believed that sleep-disordered breathing was a problem for at least a "substantial minority" (10%-30%) of their adult patients, and believed that medical therapy for upper airway inflammatory conditions could potentially help ameliorate sleep-related complaints. Literature review supported the connection between high-grade nasal congestion/adenotonsillar hypertrophy and obstructive sleep apnea, and at least in the case of pediatric patients, supported the use of anti-inflammatory medication in the initial management of obstructive sleep apnea of mild-to-moderate severity.

CONCLUSIONS

Clinical allergy practice and the medical literature support a proactive role for allergists in the diagnosis and management of sleep-disordered breathing.

Acute endogenous endophthalmitis due to Bartonella henselae

A 45-year-old man presented with progressively worsening vitreitis of 1 week's duration. Treatment for cat-scratch disease 3 years prior to presentation and persistent vitreitis led to vitrectomy, and analysis of the vitrectomy specimen revealed inflammatory cells and necrotic debris; polymerase-chain-reaction analysis of the vitreous fluid sample, done by use of a novel heminested protocol, demonstrated the presence of Bartonella henselae DNA. Treatment with doxycycline led to improvement in the intraocular inflammation but resulted in a poor visual outcome.

Assessing the influence of maternal depression on the validity of the Child Behavior Checklist

The relative effects of maternal depression, child gender, and child psychiatric status on mothers' ratings of their children were assessed in a study of the validity of the Child Behavior Checklist (CBCL). Both maternal depression and gender were found to be significantly associated with mothers' ratings of their children on the CBCL. Nevertheless, mothers' ratings continued to differentiate groups of children with and without psychiatric problems even after the variance accounted for by maternal depression and child gender was removed. These findings support the criterion validity of the CBCL, and point also to the importance of assessing parents as part of the clinical evaluation of children.

Procedure for assessment of neurodevelopmental delay in young children: preliminary report

This report describes the development of a new procedure for assessing neurodevelopmental delay in young children. The Primitive Reflex and Postural Adjustment Assessment procedure is designed to measure degrees of occurrence of remnants of primitive reflexes and immature postural adjustment. Preliminary findings show that the Primitive Reflex and Postural Adjustment Assessment procedure can successfully identify degrees of neurodevelopmental delay in young children, and that the procedure differentiates normal children from mentally retarded and emotionally disturbed children. Additional work is needed to assess the validity and reliability of this procedure.

Child global rating scales: selecting a measure of client functioning in a large mental health system

The Global Assessment Scale for Children (GAS-Children) and the Children's Impairment Scale (CIS) were examined for inter-rater reliability, discrimination of outpatients from inpatients, and clinician acceptance. Forty-four clinicians used the two scales to rate 146 recently admitted children and adolescents in eight mental health programs. An additional study assessed the inter-rater reliability of the two scales compared with the Connors Parent-Teacher Questionnaire and the correlation of the GAS-Children with both the Connors Parents Questionnaire and Achenbach's Child Behavior Checklist. The GAS-Children showed better interrater agreement than any of the four subscales of the CIS, although the sum of the CIS subscales also showed adequate inter-rater reliability. Among adolescents, the GAS-Children correlated highly with the adult GAS, but the scales showed different mean values. Clinicians slightly preferred the GAS-Children over the CIS. To assess comparability of scale usage across sites, clinicians rated six case vignettes. Inpatient clinicians rated the vignettes as more dysfunctional than did their outpatient counterparts. Bias-adjusted scores still discriminated outpatient from inpatient children. Nevertheless, these rater biases should make evaluators cautious about comparing functioning scores across programs, even when the rating scale is ostensibly the same.