Donor to recipient age matching in lung transplantation: A European experience.

BACKGROUND: The age profile of organ donors and patients on lung transplantation (LT) waiting lists have changed over time. In Europe, the donor population has aged much more rapidly than the recipient population, making allocation decisions on lungs from older donors common. In this study we assessed the impact of donor and recipient age discrepancy on LT outcomes in the UK and France. METHODS: A retrospective analysis of all adult single or bilateral LT in France and the UK between 2010 and 2021. Recipients were stratified into 3 age author groups: young (≤30 years), middle-aged (30-60) and older (≥60). Their donors were also stratified into 2 groups <60, ≥60. Primary graft dysfunction (PGD) rates and recipient survival was compared between matched and mismatched donor and recipient age groups. Propensity matching was employed to minimize covariate imbalances and to improve the internal validity of our results. RESULTS: Our study cohort was 4,696 lung transplant recipients (LTRs). In young and older LTRs, there was no significant difference in 1 and 5-year post-transplant survival dependent on the age category of the donor. Young LTRs who received older donor grafts had a higher risk of severe grade 3 PGD. CONCLUSION: Our findings show that clinically usable organs from older donors can be utilized safely in LT, even for younger recipients. Further research is needed to assess if the higher rate of PGD3 associated with use of older donors has an effect on long-term outcomes.

Survival of HIV-infected patients admitted to the intensive care unit in the era of highly active antiretroviral therapy.

We retrospectively studied outcomes for HIV-infected patients admitted to the intensive care unit (ICU) between January 1999 and June 2009. Patient demographics, receipt of highly active antiretroviral therapy (HAART), reason for ICU admission and survival to ICU and hospital discharge were recorded. Comparison was made against outcomes for general medical patients contemporaneously admitted to the same ICU. One hundred and ninety-two HIV-infected patients had 222 ICU admissions; 116 patients required mechanical ventilation (MV) and 43 required renal replacement therapy. ICU admission was due to an HIV-associated diagnosis in 113 patients; 37 had Pneumocystis pneumonia. Survival to ICU discharge and hospital discharge for HIV-infected patients was 78% and 70%, respectively, and was 75% and 68% among 2065 general medical patients with 2274 ICU admissions; P = 0.452 and P = 0.458, respectively. HIV infection was newly diagnosed in 42 patients; their ICU and hospital survival was 69% and 57%, respectively. From multivariable analysis, factors associated with ICU survival were patient's age (odds ratio [OR] = 0.74 [95% confidence interval (CI) = 0.53-1.02] per 10-year increase), albumin (OR = 1.05 [1.00-1.09] per 1 g/dL increase), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 0.55 [0.35-0.87] per 10 unit increase), receipt of HAART (OR = 2.44 [1.01-4.94]) and need for MV (OR = 0.14 [0.06-0.36]). In the era of HAART, HIV-infected patients should be offered ICU admission if it is likely to be of benefit.

Meningioma metastatic to the lung.

Meningiomas constitute 15% to 18% of all primary intracranial and intraspinal tumors. Distant extracranial metastases are reported to occur in fewer than 1 in 1000 cases. Of 1992 primary intracranial meningiomas seen at Mayo Clinic Rochester from 1972 through 1994, we identified 3 (0.15%) with documented extracranial metastasis. A review of the literature suggests that previous craniotomy, venous sinus invasion, local recurrences, histological malignancy, and papillary morphology may be risk factors for systemic spread, as demonstrated in our cases. Although rare, metastatic meningioma should be considered in the differential diagnosis of abnormal findings on chest radiography in patients with known or suspected intracranial meningioma.

Successful treatment of obstructive sleep apnea with use of nasal continuous positive airway pressure in three patients with mucosal hemangiomas of the oral cavity.

Cysts and benign tumors are uncommon causes of obstructive sleep apnea (OSA), and surgical removal is usually favored. In patients in whom an operation poses a high risk, however, nasal continuous positive airway pressure (CPAP) may prove beneficial. We describe three patients with hemangiomas of the oral cavity in whom polysomnography revealed moderate to severe OSA. In all three patients, nasal CPAP effectively decreased sleep-related disordered breathing events and dramatically improved their sleep. To our knowledge, this is the first report of OSA associated with hemangiomas involving the upper airway. Our experience suggests that nasal CPAP therapy is effective and well tolerated in such patients.

Rapidly growing mycobacterial lung infection in association with esophageal disorders.

Esophageal or other swallowing disorders complicated by lipoid pneumonia are reported to be associated with pulmonary infections caused by rapidly growing mycobacteria. Herein we describe a 63-year-old woman with achalasia of the esophagus complicated by lung infection with Mycobacterium chelonae and a 47-year-old man in whom long-term ingestion of mineral oil was complicated by lipoid pneumonia and M. fortuitum lung infection. A MEDLINE search of English language publications from 1966 to 1997 revealed 18 cases of lung infections caused by rapidly growing mycobacteria in patients with esophageal disorders. Of these 18 patients and our 2 patients, 11 were men and 9 were women (mean age, 50 years). Achalasia was present in 11 patients, and 6 had lipoid pneumonia without evidence of esophageal disorders. Three patients had lipoid pneumonia caused by lipoid ingestion in the setting of achalasia or another swallowing disorder. In 14 patients, lung infection was caused by M. fortuitum; in 5, M. chelonae; and in 1, a non-M. fortuitum rapidly growing mycobacterial infection. The most common clinical feature was fever, and the most common roentgenologic abnormality was the presence of unilateral or bilateral and patchy or dense infiltrates. The sputum was the most common source of isolation of rapidly growing mycobacteria. Achalasia and lipoid pneumonia are important risk factors for the development of lung infections caused by rapidly growing mycobacteria. Treatment of the esophageal disease might prevent occurrence of and facilitate recovery from these infections.

Fatal case of swine influenza virus in an immunocompetent host.

Swine influenza virus (SIV), a common zoonotic infection, affects swine, particularly during late autumn and winter. Transmission of SIV from pigs to humans has been reported occasionally; most cases are mild infections and rarely lead to death. Herein we describe an immunocompetent woman in whom the adult respiratory distress syndrome developed; she died of a fulminant course of swine influenza. The documented pathogen was the H1N1 strain of SIV. To our knowledge, only four other deaths in immunocompetent adults have been previously reported in the literature. Our patient had a hemophagocytic syndrome, which may have contributed to her death.

Respiratory syncytial virus pneumonitis-induced diffuse alveolar damage in an autologous bone marrow transplant recipient.

A 24-year-old woman with recurrent Hodgkin's lymphoma, stage IIB nodular sclerosing type, underwent an autologous bone marrow transplantation. Forty-five days after transplantation, an upper respiratory tract infection developed that progressed to respiratory distress necessitating mechanical ventilation. An open-lung biopsy demonstrated diffuse alveolar damage. After an extensive search for the cause of the respiratory compromise, we detected respiratory syncytial virus in a bronchoalveolar lavage specimen. The patient was immediately treated with aerosolized ribavirin and intravenous immunoglobulin; her symptoms resolved, and she was extubated 4 days after initiation of therapy.

Cardiac arrhythmias during normal sleep and in obstructive sleep apnea syndrome.

Normal sleep is associated with a slowing in heart rate due to a relative shift from sympathetic to parasympathetic neural dominance. Bradyarrhythmias consisting of sinus bradycardia, sinus arrest and second degree (Mobitz type 1) heart block are not uncommon in young adults. With aging, bradyarrhythmias decrease in frequency while atrial arrhythmias and ventricular ectopy increases. Patients with obstructive sleep apnea (OSA) have been demonstrated to have bradyarrhythmias and increased ventricular ectopy in association with apneas when oxyhemoglobin desaturations become severe. Although retrospective studies have suggested that cardiovascular mortality may be increased in patients with OSA, this remains to be proven in prospective clinical studies. Sudden death during sleep secondary to apnea related brady or ventricular tachyarrhythmias may occur. However, this is likely to be a very rare event that remains to be documented in the literature.

Demographic perspectives on China and India.

This paper compares levels and trends of population growth rates, age and sex composition, mortality, and fertility including family planning practices in the world's two most populous countries, China and India. Both countries are undergoing demographic transition but China is nearer than India to achieving a stationary population. Fertility in China has declined below replacement level while in India it is nearly one and a half children per woman above replacement level. Both countries have achieved large reductions in mortality but life expectancy at birth in China is currently about 10 years longer than in India. Both countries have young populations but China will precede India in the aging of population structure during the 21st century.

PIP: The most populous countries in the world, China and India, with almost 50% of world population, have annual population growth rates of 1.1% and 2.1% respectively. Population is added every year at 16 million for India and 13 million for China. Both countries have an imbalance in the sex ratio favoring sons, which has increased in recent times. India's sex ratio was higher than China's. Teenage fertility and fertility for those in their early 20s declined in both countries due to increases in the age at marriage. Both countries' emphasis on sterilization has resulted in lower fertility for those older than their the late 20s. In China, the IUD was also promoted for child spacing after one child and for stopping childbearing. Contraceptive usage was 71% in China and 45% in India. Provincial rates of fertility varied. Since the war, each country pursued different political and economic models of development. Populations in China were relatively homogeneous, while India's population was quite varied. Both countries had advanced agricultural systems and long histories of record keeping. Both countries were largely self-sufficient. Mortality declined sharply during 1951-61 and 1961-71. Declines in the birth rate appeared during 1971-91. During 1982-90, low fertility and mortality prevailed. Fertility decline in India has been slower due to socioeconomic conditions, weak political commitment, and a program emphasis on sterilization. China has experienced a modest decline in the population under 15 years old. Between the decades of the 1950s and the 1960s, life expectancy in India increased by 9 years. China's life expectancy during 1986-88 was 67 years, while India's was only 57 years. Infant and child mortality improvements contributed to both countries' increases.

Torsades de pointes ventricular tachycardia associated with overdose of astemizole.

An overdose of astemizole predisposes the myocardium to ventricular dysrhythmias, including torsades de pointes. Herein we describe a case of astemizole-induced torsades de pointes ventricular tachycardia and also review previous case reports in the literature. All the patients were young, and dysrhythmias developed only in those with corrected QT intervals greater than 500 ms. Although several mechanisms have been postulated, no clear explanation has been provided for why astemizole promotes myocardial dysrhythmias. Treatment of astemizole-induced torsades de pointes includes discontinuing use of astemizole, intravenous administration of magnesium sulfate and isoproterenol, temporary cardiac pacing, and, when necessary, direct current cardioversion. A cardiac cause of syncope or convulsions must not be overlooked, especially in patients taking H1 antagonists because they often have these symptoms before hospitalization or detection of torsades de pointes (or both).