Impact of donor chest radiography on clinical outcome after lung transplantation.

BACKGROUND: Organ donation guidelines recommend a "clear" conventional bedside chest radiograph before lung transplantation despite only moderate accuracy for cardiopulmonary abnormalities. PURPOSE: To evaluate the influence of donor image interpretation on lung transplantation outcome in recipients by following early and late complications, one-year survival, and to correlate imaging findings and blood gas analysis with lung transplantation outcome in recipients. MATERIAL AND METHODS: In 35 lung donors from a single institution clinical reports and study reviews of imaging findings of the mandatory bedside chest radiographs and blood gas analyses were compared with clinical outcome in 38 recipients. Hospitalization time, peri- and postoperative complications, early complications (primary graft dysfunction, infection), 30-day and one-year survival, and forced expiratory volume in 1 s percentage of predicted normal value (FEV1%) at one-year follow-up were analyzed. RESULTS: Findings in clinical reports and study reviews differed substantially, e.g. regarding reported decompensation, edema, infection, and atelectasis. No correlation was shown between imaging findings in clinical report or study review and blood gas analyses in the lung donors compared to postoperative outcome in recipients. CONCLUSION: The interpretation of the mandatory chest radiograph in its present form does not influence one-year outcome in lung transplantation. Larger imaging studies or a change in clinical routine including computed tomography may provide evidence for future guidelines.

Imaging of the Lungs in Organ Donors and its Clinical Relevance: A Retrospective Analysis.

PURPOSE: The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them. MATERIALS AND METHODS: Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and cardiovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation. RESULTS: Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differences were found in 71 (52%) examinations (P<0.0001). In 31 of 42 (74%) complete or incomplete CT examinations, 50 of 74 findings with relevance for lung donation were not primarily reported (P<0.0001). CONCLUSIONS: The majority of donor patients undergo only chest radiography. A targeted imaging review of abnormalities affecting the decision to use donor lungs may be useful in the preoperative stage. With a targeted list, substantial changes were made from initial clinical interpretations. CT can provide valuable information on donor lung pathology, even if the lungs are only partially imaged.

Early prognostic factors in distal radius fractures in a younger than osteoporotic age group: a multivariate analysis of trauma radiographs.

BACKGROUND: Treatment of distal radius fractures in patients of a younger than osteoporotic age is complex, because they often are the result of a high-energy trauma and have intra-articular fractures and associated injuries. As yet no fracture classification exists that predicts outcome. Our aim was to find the earliest possible prognostic factor by testing which radiological parameter on the trauma radiograph would have the greatest impact on clinical outcome in a younger than osteoporotic age group. METHODS: We assessed 66 patients (34 F) with unilateral fractures of the distal radius from a non-Osteoporotic age group. The median age was 42 years, (10th -90th percentile 20-54). Pre-reduction antero-posterior and lateral wrist radiographs were obtained and fracture pattern, radiocarpal joint surface tilt, radial length, radial inclination and ulnar variance were measured. Clinical outcome was assessed with the subjective part as well as the complete modified Gartland and Werley score. Multivariate analysis of those parameters was performed to assess which radiological parameter would best predict outcome. RESULTS: It was found that post-traumatic ulna + (>2 mm) was the single factor that significantly correlated with a bad outcome. An intra-articular fracture pattern may also be a strong marker; however this was not statistically significant (RR 95% conf interval 0.94 - 20.59). CONCLUSIONS: The present study showed that post-traumatic ulna + is the most important factor in predicting bad outcome in non-osteoporotic patients, but that especially intra-articular fractures and to a lesser extent dorsal tilt may be of importance too.

Successful treatment of a child with t(15;19)-positive tumor.

A subset of poorly differentiated carcinomas is characterized by the translocation t(15;19)(q13;p13), resulting in a BRD4/NUT fusion gene. Typically, this tumor affects children or young adults, with a predilection for midline head and neck or thoracic structures. The clinical course is invariably fatal, in spite of intensive chemotherapy and radiotherapy. We here present the successful treatment of a 10-year-old boy who presented with a BRD4/NUT-positive undifferentiated tumor in the iliac bone. The patient was selected for combined modality therapy, and has remained in complete continuous remission for close to 13 years. The findings show that t(15;19)-BRD4/NUT-positive tumors may arise in locations more typical for other pediatric tumors, such as Ewing sarcoma, and that they not always display epithelial differentiation. More importantly, our results also demonstrate that at least some patients with t(15;19)-positive tumors may be successfully treated.