[Safety Analysis of Perioperative Period in Non-Small Cell Lung Cancer Patients with Comorbid Pneumoconiosis].

Objective: To explore the surgical safety of patients with comorbid non-small cell lung cancer (NSCLC) and pneumoconiosis. Methods: In this study, the clinical data of 165 NSCLC patients treated at West China Fourth Hospital, Sichuan University from August 2019 to May 2021 were collected. Among them, 21 patients with comorbid pneumoconiosis were included in the pneumoconiosis group, and the remaining 144 patients were included in the general group. Radical resection for lung cancer was performed in both groups. The perioperative clinical data, including preoperative, intraoperative and postoperative indicators, of the two groups were compared and analyzed. Results: There was no perioperative death in either group. The proportions of male patients and patients with smoking history in the pneumoconiosis group were significantly higher than those in the general group ( P<0.05). The body mass index (BMI), pulmonary ventilation function and diffusion function in the pneumoconiosis group were significantly lower than those in the general group ( P<0.05). There was no significant difference in the median operative time and the median volume of intraoperative blood loss between the pneumoconiosis group and the general group. In the pneumoconiosis group, the proportion of advanced tumors (stage Ⅱ/Ⅲ), incidence of postoperative complications, median duration of postoperative intubation, and postoperative length of hospital stay were higher/longer than those of the normal group ( P<0.05). Compared with the general group, the incidences of lymph node calcification, dense pleural adhesion and surgical method alteration (switching from thoracoscopic surgery to open surgery or video-assisted thoracoscopy) were also significantly higher in the pneumoconiosis group ( P<0.05). Univariate analysis showed that age, smoking history, pneumoconiosis, pulmonary ventilation dysfunction, lymph node calcification, dense pleural adhesion and the volume of intraoperative blood loss were the risk factors for postoperative complications. Further multivariate regression analysis demonstrated that smoking history ( OR=1.37, P<0.05), lymph node calcification ( OR=2.36, P<0.05) and pulmonary ventilation dysfunction ( OR=5.21, P<0.05) were independent risk factors for postoperative complications. Conclusion: NSCLC patients with comorbid pneumoconiosis face relatively greater risks during the perioperative period when they undergo radical resection for lung cancer. Therefore, the close attention of surgeons and the nursing staff should be raised accordingly.

Giant Cell Interstitial Pneumonia In Native, Transplanted And Re-Transplanted Lungs 8 Years Apart Without Known Hard Metal Exposure.

Pneumoconioses are a group of non-neoplastic pulmonary disorders caused by inhaled inorganic particles. Well-described pneumoconioses include asbestosis, silicosis, coal worker's pneumoconiosis, chronic beryllium disease, and hard metal lung disease. Giant cell interstitial pneumonia (GIP) is a distinctive and rare pneumoconiosis most frequently found in workers exposed to hard metals, primarily cobalt and tungsten carbide. The pathologic picture is considered virtually pathognomonic for hard metal lung disease, although this dogma has been questioned by a few reports of giant cell interstitial pneumonia in patients without apparent hard metal exposure. Giant cell interstitial pneumonia is even rarer in lung transplant recipients. Here, we present a patient without known hard metal exposure who was found to have persistent giant cell interstitial pneumonia in native, transplanted and re-transplanted lungs 8 years apart.

Indium kinetics in an indium exposed worker before and after bilateral lung transplantation.

BACKGROUND: A male worker with indium-tin oxide (ITO)-induced pneumoconiosis underwent bilateral lung transplantation (LT). METHODS: Post-LT histopathological investigations of the isolated lungs and hilar lymph nodes were performed and indium concentration in serum (In-S) and serum Krebs von den Lungen-6 (KL-6) were tracked for 122 weeks. RESULTS: He has attained the ultimate treatment goal of > 2-year survival. The main histopathological characteristics were pan-lobular emphysematous change, interstitial fibrosis, and lymphocytic infiltration in the peribronchiolar/perivascular portions, and numerous cholesterol clefts and giant cells containing brown particles. These findings support the conclusion that the lung injury was caused by the inhalation of ITO. Metal element mapping and indium in the isolated lungs revealed that inhaled ITO particles in humans migrate to the lymph nodes. In-S remained at remarkably high levels (≥30 ng/mL) and showed wide fluctuation with bimodality until 46 weeks after LT, but KL-6 remained in the normal range for almost the entire period. The indium concentration in the donor's resection lung at 10 weeks after LT was 143.5 ng/g wet-weight, which was only one one-thousandth of the recipient's lung (161 µg/g wet-weight). After 48 weeks of LT, the recipient's In-S had gradually decreased; the biological half-life was 1.2 years. These results clearly suggest that indium remaining in the recipient's tissues did not adversely influence the transplant donor's lungs. CONCLUSIONS: The transplanted donor's lungs were not influenced by indium in the recipient's organs. Bilateral LT is thus an effective treatment option in severe indium lung disease cases.

Transplantation for work-related lung disease in the USA.

OBJECTIVES: Work-related lung diseases (WRLDs) are entirely preventable. To assess the impact of WRLDs on the US transplant system, we identified adult lung transplant recipients with a WRLD diagnosis specified at the time of transplant to describe demographic, payer and clinical characteristics of these patients and to assess post-transplant survival. METHODS: Using US registry data from 1991 to 2018, we identified lung transplant recipients with WRLDs including coal workers' pneumoconiosis, silicosis, asbestosis, metal pneumoconiosis and berylliosis. RESULTS: The frequency of WRLD-associated transplants has increased over time. Among 230 lung transplants for WRLD, a majority were performed since 2009; 79 were for coal workers' pneumoconiosis and 78 were for silicosis. Patients with coal workers' pneumoconiosis were predominantly from West Virginia (n=31), Kentucky (n=23) or Virginia (n=10). States with the highest number of patients with silicosis transplant were Pennsylvania (n=12) and West Virginia (n=8). Patients with metal pneumoconiosis and asbestosis had the lowest and highest mean age at transplant (48.8 and 62.1 years). Median post-transplant survival was 8.2 years for patients with asbestosis, 6.6 years for coal workers' pneumoconiosis and 7.8 years for silicosis. Risk of death among patients with silicosis, coal workers' pneumoconiosis and asbestosis did not differ when compared with patients with idiopathic pulmonary fibrosis. CONCLUSIONS: Lung transplants for WRLDs are increasingly common, indicating a need for primary prevention and surveillance in high-risk occupations. Collection of patient occupational history by the registry could enhance case identification and inform prevention strategies.

Lung transplantation is increasingly common among patients with coal workers' pneumoconiosis.

BACKGROUND: The prevalence of coal workers' pneumoconiosis (CWP) in U.S. coal miners has increased, and severe presentations are increasingly common. METHODS: We describe trends in lung transplantation during 1996-2014 for recipients with a primary diagnosis of CWP or pneumoconiosis unspecified, and we summarize recipient characteristics and estimate survival. RESULTS: A total of 47 transplants were included; nearly three-quarters were performed during 2008-2014. All recipients were male, 96% were white, and the mean age was 56 years. Mean FEV1 % was 35%; mean FVC% was 53%. Mean time on a waitlist was 155 days, and 60% of transplants were bilateral. Median survival was 3.7 years. CONCLUSIONS: These transplants reflect the use of a scarce resource for an entirely preventable disease, and highlight the need for enhanced efforts to reduce coal mine dust exposures.

The tracheobronchial foreign body in welder without the history of allotriophagy and foreign body aspiration.

The typical chest computed tomography (CT) finding of the arc welders is ill-defined micronodules diffusely distributed in the lung. We report a rare case of tracheobronchial foreign body in welder without the history of allotriophagy and foreign body aspiration. We used the CT and mineralogical analysis in diagnosis and the flexible fiberoptic bronchoscope in therapy. The CT showed bronchiectasis with pulmonary infiltration of the right lower lobe and high-density shadow in the basal bronchus of the right lower lobe. The foreign bodies were removed by a fibreoptic bronchoscope. Semiquantitative chemical analyses showed that the constituent of foreign body was similar to the dregs which were collected in the same garage. This is an unusual case of the welding-related respiratory diseases, which is different from Welder's siderosis and broncholith.

Lung transplantation in a Japanese patient with schizophrenia from brain-dead donor.

We herein report a case of lung transplantation in a patient with schizophrenia. The findings show that patients with schizophrenia can be considered for lung transplant after careful evaluation of psychiatric status and indications.

[Comparing the therapeutic effect of lung transplantation with the therapeutic effect of whole lung lavage for the patients with end-stage pneumoconiosis].

OBJECTIVE: To explore the therapeutic effects of lung transplantation (LTx) and whole lung lavage (WLL) for patients with end-stage pneumoconiosis. METHODS: From June 2002 to February 2011, 5 cases with end-stage pneumoconiosis were treated with LTx and 12 cases with end-stage pneumoconiosis were treated with WLL. The clinical symptoms, pulmonary functions, pulmonary artery pressures, blood gas analysis, imagings of chest and survival status were retrospectively analyzed. RESULTS: In LTx group, the clinical symptoms (cough, sense of suppression in the chest), pulmonary functions and blood gas indicators were improved, pulmonary artery pressures decreased to normal levels, the imaging of chest showed that the implanted lung inflated well and was with clear lung markings. But the contralateral lungs without treatment appeared the progression of disease in the imaging of chest. In WLL group, the clinical symptoms in a half year after treatment were improved but the symptomatic relief rate declined with time, the pulmonary functions in half year after treatment were improved but decreased after 2 years, the pulmonary artery hypertension enhanced generally, as compared with that prior to WLL. The disease progression in the chest imaging examination was not found in a half year after WLL, but appeared in 1 ∼ 2 years after WLL. During following-up. the mean survival times in LTx and WLL groups were 40.5 and 21.4 months, respectively. In LTx group, one patient died of multiple organ dysfunctions (MODS) caused by primary graft dysfunction (PGD), one case died of severe infection in seven months after LTx. Up to now, other 3 cases have survived for 65, 41 and 29 months, respectively. In WLL group, 3 cases died of pulmonary infection, 2 cases died of respiratory failure, one case died of heart failure and one case died of encephalon vascular accident, the mean survival time of these 7 patients was (19.0 ± 8.7) months. So far other 5 cases have survived for 7, 9, 13, 18 and 26 months, respectively. CONCLUSION: LTx has greater risk of death during preoperative period, but patients after LTx may have long survival times with good quality of life. The clinical symptoms and pulmonary functions of patients can be improved temporarily after WLL, but the survival time of WLL is inferior to that of LTx.

Fatal Mycobacterium tuberculosis infection in a lung transplant recipient.

Lung transplant recipients are at increased risk for Mycobacterium tuberculosis infection secondary to the intense immunosuppressive regimen after transplantation. We report a case of fatal M tuberculosis infection that presented as a pericardial abscess in a lung transplant recipient and review the literature.

Malignancy in kaolin pneumoconiosis found with F-18 FDG positron emission tomography.

Kaolin pneumoconiosis may produce radiologic findings similar to those of malignancy. Current management includes serial radiologic examination and lung sampling of suspicious parenchymal opacities and nodules to exclude associated malignancy. This may result in unnecessary pulmonary resections in patients with already compromised lung function. In a patient with known kaolin pneumoconiosis and multiple nodules, we used positron emission tomography to identify suspicious areas for malignancy that were confirmed by open lung biopsy, leading to successful lung cancer treatment.

Successful use of iv diltiazem to control perioperative refractory complex atrial tachyarrhythmias in a patient with pneumoconiosis.

PURPOSE: To present a patient with pneumoconiosis who developed a complex, life-threatening atrial tachyarrhythmia during anesthesia. Intravenous diltiazem was effective in controlling the ventricular rate and hemodynamics after failure of other antiarrhythmic drugs and direct current cardioversion. CLINICAL FEATURES: A 79-yr-old man with pneumoconiosis complicated by cor pulmonale suffered from gout-related cellulitis of the left lower limb. Debridement of the left gangrenous big toe was carried out under general anesthesia. During anesthesia, a wide-QRS tachycardia occurred suddenly and a complex atrial tachyarrhythmia was later diagnosed. Hemodynamics deteriorated despite aggressive treatment with lidocaine, verapamil, direct current cardioversion, magnesium, digoxin and amiodarone. Correction of the underlying respiratory acidosis was not sufficient to control the rapid ventricular response. Eventually, iv diltiazem adequately controlled the rapid ventricular rate and quickly improved the deteriorating hemodynamics. CONCLUSION: Life-threatening complex atrial tachyarrhythmias may occur in patients with chronic lung diseases perioperatively. Intravenous diltiazem was effective in the management of complex atrial tachyarrhythmia in a patient with underlying cor pulmonale.

Pulmonary anthracosis in children.

We report two cases of children with malignancies and subpleural nodules found on computed tomography (CT) scan. In both cases the diagnosis was anthracosis. This pathologic condition has never been reported in children. Causes of anthracosis include a smoking environment, living in urban areas and air pollution.

Temporary extracorporeal support of the right ventricle.

Six patients having severe right ventricular failure after cardiac surgical procedures were treated temporarily with an extracorporeal pump to bypass the right ventricle. The initial operative procedures included coronary artery bypass procedures with and without concomitant valvular and aortic replacement. A Biomedicus centrifugal pump was used as the right ventricular assist device in most cases. The assist period ranged from 3 to 96 hours, and an intra-aortic balloon pump was used in five of the six patients. All patients initially responded to the right ventricular assist device, four were successfully weaned, and one patient is a long-term survivor. The use of a right ventricular assist device is not difficult or complicated and can be lifesaving for those patients having potentially reversible profound right ventricular failure.

Kaolin pneumoconiosis. A case report.

A 35-year-old man who had been occupationally exposed to aerosolized kaolin for 17 years in a Georgia processing plant had diffuse reticulonodular pulmonary infiltrates and an upper lobe mass. Exploratory thoracotomy, performed to evaluate the nature of the mass, revealed an 8 X 12 X 10-cm conglomerate pneumoconiotic lesion containing large amounts of kaolinite. Coincident deposition of silica in the tissue was not demonstrable by either analytic scanning electron microscopy or x-ray diffraction. The case illustrates the effect of chronic kaolin exposure on the human lung and emphasizes the need for periodic evaluation of exposed workers.