ABSTRACT
INTRODUCTION: The number of lung transplantations performed is increasing worldwide. With an improved experience and outcomes, the age of the recipient on its own has ceased to be an absolute contra-indication. We report our first experience with lung transplantation in patients aged 65 years or older. METHODS: From January 2014 to March 2019, the files of patients aged 65 years or older undergoing lung transplantation were retrospectively reviewed. RESULTS: During the study period, 241 patients underwent lung transplantation in Bichat hospital (Paris, France), including 25 recipients aged 65 years or older. Underlying diagnoses were interstitial (72%) and obstructive (28%) disease. The rate of single lung transplantation was 80%. Sixteen patients required ECMO assistance during the procedure. Early complications were mostly grade III primary graft dysfunction (12%) and cellular rejection (20%). Overall one-year survival rate was 76%. CONCLUSION: After a careful selection of the recipients, the early results of our retrospective single center series are encouraging. We continue to consider lung transplantation in rigorously selected recipients of aged 65 years and more.
Subject(s)
Lung Diseases, Interstitial/epidemiology , Lung Diseases, Interstitial/therapy , Lung Diseases, Obstructive/epidemiology , Lung Diseases, Obstructive/therapy , Lung Transplantation , Age Factors , Age of Onset , Aged , Aged, 80 and over , Female , France/epidemiology , Graft Survival , Humans , Lung Diseases, Interstitial/mortality , Lung Diseases, Obstructive/mortality , Lung Transplantation/adverse effects , Lung Transplantation/methods , Lung Transplantation/mortality , Lung Transplantation/statistics & numerical data , Male , Paris/epidemiology , Postoperative Period , Primary Graft Dysfunction/epidemiology , Retrospective Studies , Survival Rate , Time Factors , Treatment OutcomeABSTRACT
INTRODUCTION: Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. Manifestations of TE include pneumothorax and haemothorax. Treatment is based on surgical and hormonal therapy that aims at eradicating existing endometrial thoracic plaques and to prevent reseeding from pelvic endometriosis. CASE REPORT: We report the case of a 36 year-old young woman presenting thoracic endometriosis revealed by a recurring spontaneous, large and isolated right haemothorax. Diagnosis, pathogeny and treatment are discussed. CONCLUSION: Thoracic endometriosis needs to be considered as a cause of haemothorax in women of childbearing age.
Subject(s)
Endometriosis/diagnosis , Hemothorax/diagnosis , Thoracic Diseases/diagnosis , Adult , Endometriosis/complications , Endometriosis/surgery , Female , Hemothorax/etiology , Hemothorax/surgery , Humans , Pleural Diseases/complications , Pleural Diseases/diagnosis , Pleural Diseases/surgery , Pneumothorax/diagnosis , Pneumothorax/etiology , Pneumothorax/surgery , Recurrence , Thoracic Diseases/complications , Thoracic Diseases/surgerySubject(s)
Ischemia/mortality , Ischemia/surgery , Limb Salvage/mortality , Lower Extremity/surgery , Vascular Grafting , Female , Humans , MaleABSTRACT
Advanced care decision in emergency medicine is difficult for the elderly. How to be fair, avoiding an unreasonable obstinacy? Based on the case of very old person, we show how an optimal management can be decided in accordance with the spirit of the law.