Biomedical subjects
Publications and source records attributed to W B Emory.
A 47-year-old female patient with recurrent juvenile-onset laryngotracheal papillomatosis for 27 years had multiple bilateral pulmonary lesions, the largest of which was a well-differentiated squamous cell carcinoma. This case is unique because the malignant transformation occurred in a nonirradiated, nonsmoking patient.
Although we have not yet obtained the survival results that have been observed in heart and renal transplantation, the survival rate in lung transplantation is improving. Because the lung is the only organ that is continuously exposed to the environment after transplantation, infection continues to be the major cause of early and late morbidity and mortality. Bronchiolitis obliterans, the second most common cause of late morbidity and mortality, is a progressive and currently untreatable condition resulting in lung dysfunction. The cause of this condition after transplantation is likely multifactorial and related to processes that result in allograft lung injury, such as rejection, bacterial infection, and cytomegalovirus infection. Future improvement in intermediate and long-term survival after lung transplantation will largely depend on prevention and long-term control of infection and subclinical rejection.
Lung transplantation is a successful alternative treatment for a variety of end-stage lung diseases. The first 20 lung transplants performed in Louisiana between November 1990 and July 1994 are reported from Ochsner Foundation Hospital. Transplant procedures included 1 heart-lung, 11 bilateral sequential lung, and 8 single-lung transplants in 8 males and 11 females (1 retransplantation). The average age was 38 years (range 7-60), and the median waiting time was 34.5 days (range 1-329). Indications for transplant included emphysema, pulmonary fibrosis, pulmonary hypertension, cystic fibrosis, bronchiectasis, and bronchiolitis obliterans. Overall 1-year and 3-year survival were 65.0% and 58.5%, respectively. Infection was the major cause of morbidity and mortality. Rejection episodes were observed but treated successfully in all 20 patients. Lung transplantation has proved to be a successful treatment for a variety of severely limiting and terminal pulmonary conditions for patients in our state.
The number of lung and heart-lung transplantations is growing rapidly, and hundreds of combined heart-lung, single-lung, and double-lung transplantations have been performed to date, resulting in increased survival and improved quality of life for patients with end-stage pulmonary disorders. Improved surgical technique, immunosuppression, and optimal patient selection are largely responsible for this success. Although the indications for transplantation continue to expand, the number of potential recipients far exceeds the number of available donors, making the evaluation and selection process vital to the success of any transplantation program. A multidisciplinary approach is presented that can be expected to eliminate a large number of prospective candidates and thus enhance matching limited donor organs with transplantation candidates.
Cases of malignant fibrous histiocytoma arising from the aorta are rare and have a dismal outlook despite treatment. The longest reported survival period following resection is only 28 months. A patient with malignant fibrous histiocytoma of the descending thoracic aorta was successfully treated with resection and reconstruction with a prosthetic graft. The patient developed metastatic disease eight months postoperatively. With aggressive triple regimen chemotherapy, complete remission has been obtained. The patient is alive and free of disease six years postoperatively.
Pasteurella multocida appears to be an uncommon pathogen in human thoracic empyema. The morbidity and mortality associated with these infections has been significant, presumably secondary to the elderly populations they affect, many with chronic lung disease and impaired pulmonary defenses. We report a case of pasteurella empyema treated with open thoracostomy and rib resection and advocate use of such a procedure early in the treatment of patients with this infection.
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A retrospective study of 294 patients with biopsy- or autopsy-proven adenocarcinoma of the pancreas was done. The initial diagnosis of ten patients (3.4%) was primary lung cancer. All ten patients were cigarette smokers. Hilar adenopathy with mediastinal widening was the most common roentgenographic appearance. Tumors of the body and tail of the pancreas more often appeared to be primary lung tumors than did tumors of the head of the pancreas (about 10% vs. about 1%). Adverse consequences of this unrecognized phenomenon may include unnecessary lung surgery for some cancer patients and overreporting of deaths from lung cancer.
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