Osteoporosis in Lung Transplantation Candidates: Association With 6-minute Walking Test and Body Mass Index.

BACKGROUND: Osteoporosis is a well-recognized complication in lung transplantation because of steroid use and immobilization. The aim of the study was to assess the prevalence of osteoporosis and risk factors associated with osteoporosis in lung transplantation candidates. METHODS: The bone mineral density of 174 patients with various end-stage lung diseases was assessed at the pretransplantation period. Osteoporosis risk factors were analyzed with the consideration to principal diagnosis, demographic, and clinical parameters of lung disease, lung function tests and mobility test (6-minute walking test). A multivariate analysis was conducted to determine various demographic and clinical risk factors associated with bone mass loss in the pretransplant period. RESULTS: The prevalence of osteoporosis and osteopenia was 46% and 35%, respectively, in the study population. Osteoporotic patients have lower body mass index and lower 6-minute walking distance than patients without osteoporosis. In addition, they have higher pulmonary artery pressure and history of noninvasive mechanical ventilation than in patients without osteoporosis. There was a significant negative correlation between the 6-minute walking test, body mass index, and the presence of osteoporosis in the study population. Multivariate logistic regression analysis confirmed that 6-minute walking test (odds ratio, 0.996) and body mass index (odds ratio, 0.847) were significantly and negatively correlated with the presence of osteoporosis. CONCLUSIONS: A significant proportion of patients with end-stage lung diseases have osteopenia or osteoporosis pretransplantation. This is the first study to demonstrate that 6-minute walking distance and bone mineral density independently predict osteoporosis in lung transplant candidates.

Treatment of multiloculated empyema thoracis using minimally invasive methods.

INTRODUCTION: The purpose of this study was to investigate the results of minimally invasive treatment modalities in early stage multiloculated empyema thoracis. METHODS: The minimally invasive treatment modalities of 114 patients with Class 5 thoracic empyema were retrospectively reviewed. The patients' demographics, symptoms, diagnostic studies, treatment options and complications were evaluated. RESULTS: A total of 47 patients underwent tube thoracostomy, 23 patients underwent fibrinolytic therapy with streptokinase and 44 patients underwent video-assisted thoracoscopic surgery (VATS) deloculation and debridement. No statistical differences were found in the patients' age, gender, Gram stain and antibiotherapy before intervention among the groups. Illness days before intervention was significantly longer in the tube thoracostomy group than in the others. The VATS group had a shorter drainage time and hospital stay than the others. The VATS and fibrinolytic therapy groups had lower complication rates and less open decortication requirements than the tube thoracostomy group. Success rates were 66, 95 and 100 percent in the tube thoracostomy, fibrinolytic therapy and VATS groups, respectively. In total, there were 35 patients with complications. The most frequent complication was air space. Two inhospital mortalities occurred. CONCLUSION: In patients with early stage multiloculated empyema, VATS deloculation and debridement is superior to tube thoracostomy alone and fibrinolitic therapy in reducing drainage time and hospital stay. It has a relatively high success rate without significant morbidity. Therefore, VATS decortication may be recommended as a first-line therapy in early stage multiloculated empyema thoracis.

Reinforcement bronchial stump increases early mechanical integrity: an ex-vivo experimental study.

OBJECTIVE: The purpose of this study was to investigate the effects of different bronchial suture techniques, with and without tissue reinforcement, on the resistance to pressure of the bronchial stump. MATERIALS AND METHODS: Fifty-four tracheo-bronchial trees obtained from the local slaughterhouse were prepared for manual closure. After right pneumonectomy, specimens were divided into three groups (n = 18). Interrupted suture pattern (group 1), continuous horizontal mattress + over-over continuous pattern (group 2) and continuous over-over + coverage with a diaphragmatic part with interrupted U sutures pattern (group 3) were used for bronchial closure. Multifilament absorbable 4-0 sutures were used in all specimens. Air leakage pressures were measured with a sphygmomanometer. RESULTS: Groups 1 and 2 had nearly equal mean air leakage pressures (98 +/- 37 and 95 +/- 51 mmHg, respectively, p = 0.985). Group 3 showed significantly higher mean leakage pressure (153 +/- 66 mmHg, p = 0.002) compared to the other groups. CONCLUSION: Reinforcement of the bronchial stump with viable tissue contributes to the bronchial stump integrity by increasing the air leakage resistance.

Single-stage VATS and thoracotomy in multiple organ hydatidosis.

We report a case of hydatidosis of the bilateral lung and of the left lobe of the liver which we treated by cystotomy and capitonnage via right video-assisted thoracoscopy, left posterolateral thoracotomy, and diaphragm incision in a single-stage operation. The patient developed a right pleural infection in the ninth postoperative month and underwent exploratory thoracotomy and recapitonnage. Thoracoscopic cyst extirpation can be safely performed alone or in combination with thoracotomy to reduce the operative inconvenience for patients.

Recurrent Cerebral Fat Embolism Due to Pleural Irrigation: Fat Density Lesions on CT. A Case Report.

Fat embolism syndrome is a rare, but life-threatening problem and is usually associated with severe trauma. Neurological symptoms are variable, and the clinical diagnosis is difficult. We describe a patient with fat density lesions on cranial CT sections and discuss the etiopathogenesis of cerebral fat embolism (CFE) in this patient who does not have a history of long bone fracture, but metastatic lung disease and empyema. This is probably the first case report of CFE secondary to pleural irrigation of empyema with demonstrative CT findings.

Mechanism of release of gastric luminal somatostatin-like immunoreactivity in response to pentagastrin and sham feeding in man.

We studied in five healthy volunteers whether the cholinergic pathway regulated the secretion of gastric intraluminal somatostatin-like immunoreactivity (SLI) in response to stimuli of pentagastrin infusion (0.9 micrograms/kg/h, intravenously) and sham feeding. We measured gastric secretory volume, hydrogen ion output, and SLI at base line, during pentagastrin infusion, after sham feeding, and after applications of atropine (0.0, 0.7, 7.0 micrograms/kg, intramuscularly) given before pentagastrin and sham feeding. The stimuli were given randomly, at separate times on different days. After each stimulus, eight 15-min gastric juice collections were made; samples were adjusted to pH 7, pepstatin-A and aprotinin were added, and samples were extracted with acetone to determine SLI by radioimmunoassay. Pentagastrin and sham feeding significantly increased gastric luminal SLI secretion, which appeared to correlate with the increases in volume and acid output. Atropine at 7 micrograms/kg significantly suppressed gastric volume, acid, and SLI outputs stimulated by sham feeding; however, responses to pentagastrin stimulation remained unchanged. To conclude, the cholinergic mechanism regulates gastric intraluminal SLI response to sham feeding but not to pentagastrin infusion.