DAS181 treatment of severe parainfluenza type 3 pneumonia in a lung transplant recipient.

Parainfluenza virus (PIV) may cause life-threatening pneumonia in lung transplant patients and there are no proven effective therapies. We report the use of inhaled DAS181, a novel sialidase fusion protein, to treat severe PIV type 3 pneumonia in a lung transplant patient. Treatment was well tolerated and associated with improvement in oxygenation and symptoms, along with rapid clearance of PIV. DAS181 should be systematically evaluated for treatment of PIV infection in transplant recipients.

Pheochromocytoma crisis, cardiomyopathy, and hemodynamic collapse.

Pheochromocytoma is a notorious clinical entity. Although suspicion is aroused by severe hypertension in young patients, this sign is often absent. We present a case in which early absence of hypertension and nonspecific signs and symptoms led to failure of prompt diagnosis. The delay proved fatal when the patient developed fulminant pheochromocytoma crisis. This case illustrates a variety of clinical features seen from the vantage of the evolution of the disease as it went unrecognized. The patient's course underscores the importance of familiarity with the gamut of manifestations for timely diagnosis, and the priority of the latter given the looming risk of overwhelming complications.

Surgical approaches to advanced emphysema.

The care of patients with advanced emphysema requires an understanding of both medical and surgical therapy for this disease. Current surgical approaches to advanced emphysema include bullectomy, lung volume reduction surgery, and lung transplantation. Each procedure is applicable to a specific subset of patients. This article reviews the evaluation and selection of patients for each procedure, as well as operative and postoperative management, mechanisms by which surgery improves function, and overall outcomes after each procedure.

Lung transplantation. A disease-specific approach.

Lung transplantation has emerged as a viable option for the treatment of end-stage disease attributable to a wide spectrum of primary disorders. Although many aspects of patient management are indifferent to the underlying indication, important differences related to timing of transplantation, selection of candidates, choice of procedure, and post-transplant complications exist among the various primary disease groups. Optimal utilization of transplantation for these challenging patient populations with advanced lung disease mandates a thorough appreciation of those differences.

Bilateral sequential lung transplantation for pulmonary alveolar microlithiasis.

Pulmonary alveolar microlithiasis (PAM) is characterized by deposition of calcium phosphate within the alveolar airspaces. There is currently no effective medical therapy and affected individuals may progress to end-stage lung disease requiring transplantation. Two patients with PAM underwent bilateral sequential lung transplantation. This study reviews the clinical manifestations of PAM and discusses the particular difficulties that may be encountered in the use of lung transplantation as treatment for this uncommon disease. Also addressed is the question of recurrence in the allograft.

Potassium supplementation in ritodrine-induced hypokalemia.

Acute hypokalemia occurs during infusion of beta 2 agonists for tocolysis. This study examines the efficacy of supplemental potassium in treating this hypokalemia. Four groups of dogs were anesthetized and given lactated Ringer's solution (group I), potassium chloride (group II), ritodrine hydrochloride (group III), and ritodrine plus potassium (group IV). Arterial blood gases, pH, and serum and urinary electrolytes were measured. Results were analyzed by an analysis of variance. Serum potassium fell in groups I and III, rose in group II, and remained stable in group IV. Urinary potassium levels in groups that received ritodrine (III and IV) were not different from control levels. Potassium given with ritodrine will prevent hypokalemia. However, the risks of hyperkalemia exist if vigorous replacement is undertaken. There were no dysrhythmias and no adverse effects in any of the hypokalemic animals. Therefore, the routine administration of potassium is not advocated even in obstetric patients who undergo general anesthesia.

Serum potassium levels during and after terbutaline.

The intravenous infusion of terbutaline is associated with decreased levels of serum potassium. The duration of this hypokalemia has not been reported. Therefore, serum potassium levels were measured in dogs before during and for 3 hours after a 2-hour intravenous infusion of 0.5 micrograms/kg/min of terbutaline. Serum potassium levels decreased significantly during the infusion and returned to near preinfusion levels within 3 hours after the infusion was stopped. The mechanism for the decrease in the serum potassium is most likely a shift of the potassium ion from the extracellular space to the intracellular space.