A 47-Year-Old Woman With Hemoptysis and a Lung Cyst.

CASE PRESENTATION: A 47-year-old woman was admitted to the hospital for an episode of hemoptysis. She coughed out small amount of clotted blood the morning of admission. She had no other symptoms on further review. Her medical history was unremarkable with the exception of an upper respiratory tract infection 9 months previously. She did not have any significant medical history or recent sick contacts. She was a lifelong nonsmoker and the mother of three teenaged children. She had irregular menses for the past 2 years, and her last menstrual period was 3 months ago. She reliably reported not engaging in any sexual contact for the past 2 years.

Extension of donor lung preservation with hypothermic storage after normothermic ex vivo lung perfusion.

BACKGROUND: Ex vivo lung perfusion (EVLP) allows normothermic evaluation and treatment of donor lungs not currently acceptable for transplant and improves organ use. Donor lungs undergo a period of cold preservation before (cold ischemic time [CIT]-1) and after (CIT-2) EVLP. We investigated the effect of an extended CIT-2 on lung function after transplantation. METHODS: Explanted pig lungs, preserved in low-potassium dextran flush (Perfadex) at 4°C for 10 hours, were subjected to 6 hours of EVLP. They were subsequently allocated to 2 groups: short CIT-2 (CIT-2 = 2 hours; n = 5), and long CIT-2 (CIT-2 = 10 hours; n = 5). In a control group (n = 6), explanted lungs were placed in cold static preservation for 24 hours without EVLP. After the total preservation period, the left lung was transplanted in all groups. RESULTS: After 4 hours of reperfusion, oxygenation function, acute lung injury score, inflammatory markers, and cell death pathway markers were similar between short and long CIT-2 groups. Both EVLP groups fared significantly better than the control group in oxygenation function (p < 0.05). CONCLUSIONS: The intervention of EVLP improved lung function after transplantation, and this was not affected by a prolonged cold static preservation time after EVLP. These results provide the basis for a practical prolonged lung preservation strategy using a combination of cold and warm preservation techniques, which may improve lung transplantation logistics and outcomes.

Chemotherapy response in East Asian non-small cell lung cancer patients harboring wild-type or activating mutation of epidermal growth factor receptors.

INTRODUCTION: Previous exploratory analysis of epidermal growth factor receptor (EGFR) mutational status in tumor samples from randomized clinical studies suggested that patients with activating mutation of the EGFR had better survival than those harboring wild-type EGFR. METHODS: We analyzed the EGFR sequence of tumor samples from advanced stage non-small cell lung cancer patients previously participated in treatment clinical trials. Responses to chemotherapy and survival of EGFR mutation-positive or -negative patients were compared. RESULTS: Tumor samples from 122 patients were available for analysis. EGFR mutation was present in 58 patients (47.5%). In 105 stage IIIB/IV patients, there was a nonstatistically significant trend toward a higher chemotherapy response rate of patients with mutated EGFR than those with wild-type EGFR (44.6% versus 30.6%, p = 0.162). Female, never-smoking, and adenocarcinoma patients lived longer than male (p = 0.0139), smoking (p = 0.0045), or nonadenocarcinoma (p = 0.0151) patients. There was no difference in the survival of patients with mutated or wild-type EGFR (p = 0.2159). There was no difference in progression-free survival of first-line chemotherapy between patients with wild-type or mutation in EGFR (6.6 months versus 6.1 months). CONCLUSION: There is a nonstatistically significant trend toward a higher chemotherapy response rate in patients with mutated EGFR than those with wild-type EGFR. EGFR gene mutation is not a predictive biomarker for progression-free and overall survival to cytotoxic chemotherapy in East Asians with advanced non-small cell lung cancer.