Successful renal transplantation following lung transplantation: a survey of the first Hungarian case

The authors review the case of their young patient, who underwent a lung transplantation in Vienna because of an end stage idiopathic pulmonary fibrosis. During the prolonged postoperative phase renal failure full of complications developed, which necessitated haemodialysis. As the pulmonological rehabilitation was complete, but the regular dialyses considerably raised the risk of opportunistic infections, and also significantly reduced the quality of life of the patient, renal transplantation was performed in Debrecen four years after the lung transplantation. This is the first lung transplanted patient in Hungary who also underwent renal transplantation. Now, more than two years after the renal transplantation the patient lives a compensated, rehabilitated life, the respiratory function values have improved and the renal function values are also acceptable. The number of transplanted patients has significantly increased in recent years worldwide, and also in Hungary. However, due to immunosuppressive medications, calcineurin inhibitors mainly, numerous complications must be reckoned with. An outstanding one among them is the secondary renal failure which may occur both in acute and chronic form and may even necessitate renal transplantation. Renal transplantation is an excellent treatment option for end stage renal failure patients, who had received another organ transplant earlier. Kidney transplantation improves quality of life and increases expected survival, too.     

老年人肺癌的病因及治疗研究

目的探讨老年人肺癌的病因及治疗措施。方法回顾性分析我院2007年1月至2010年7月收治的老年肺癌患者51例的临床资料。结果 51例患者手术过程平稳,无手术死亡。术后发生并发症16例（31.37%）,死亡3例（5.88%）。结论年龄并非老年肺癌患者手术的忌证,治疗必须以根治为主要目标。     

Hemithoracic intensity-modulated radiotherapy using helical tomotherapy for patients after extrapleural pneumonectomy for malignant pleural mesothelioma

Postoperative hemithoracic irradiation is regarded as an important part of the curative treatment for resectable malignant pleural mesothelioma (MPM). Because the clinical target volume in postoperative MPM is irregular and surrounded by dose-limiting critical structures, intensity-modulated radiation therapy (IMRT) is thought to be suitable. However, postoperative hemithoracic IMRT remains experimental due to a high incidence of fatal pneumonitis. Therefore, a Phase I dose escalation study for hemithoracic IMRT using helical tomotherapy was planned, and the results of the first three patients are herein reported because this technique may provide benefits to such patients. For 3 patients with postoperative MPM, who were treated by extrapleural pneumonectomy (EPP), a radiation dose of 45.0 Gy in 25 fractions was given to cover 95% of the PTV. The lung V5s of the three patients were 14.3%, 10.0%, and 31.3%, respectively. The V5s of the present plans was smaller than that of the recent IMRT planning studies. The lung V20s of these patients were 2.4%, 2.2%, and 4.3%, respectively. Their MLDs were 4.3 Gy, 3.4 Gy, and 5.8 Gy, respectively. The follow-up periods of the patients were 26, 14 and 9 months from initiation of IMRT, respectively. All patients were alive, although local and contralateral recurrences had developed in 1 patient. Only 1 patient had Grade 2 acute esophagitis and nausea. There was no treatment-related pneumonitis. Hemithoracic IMRT using helical tomotherapy may play a crucial role in adjuvant treatment for MPM after EPP.     

Avoiding Opioids and Their Harmful Side Effects in the Postoperative Patient: Exogenous Opioids,Endogenous Endorphins,Wellness, Mood,and Their Relation to Postoperative Pain

Prescribed opioids are routinely used for many postoperative patients. However, these medications have daunting adverse effects on the body''s innate pain management system - the action of the beta-endorphins. The prescribed opioids not only severely impair the function of the mu-opioid receptors, but also inhibit the release of beta-endorphin. This is unfortunate, because beta-endorphin appears to be a much more potent agonist of the mu-opioid receptor than opioids. In addition, beta-endorphin indirectly elevates dopamine, a neurotransmitter related to feelings of euphoria. Therefore, by prescribing opioids, practitioners may inadvertently prolong and increase the overall intensity of the postoperative patients'' pain as well as herald anhedonia. This article highlights the relationships between prescribed (exogenous) opioids, beta-endorphins, mu-opioid receptors, wellness, mood, and postoperative pain. The role of patient education, opioid alternatives, and additional recommendations regarding pain control in the postoperative patient are also discussed.     

降低肺癌患者术后静脉血栓栓塞症发生率

降低肺癌患者术后静脉血栓栓塞症发生率,是提高肺癌患者生存质量的重要举措。从临床实际出发,运用品管圈方法,探讨肺癌患者术后静脉血栓栓塞症发生现状,针对VTE评估表未细化等真因拟定对策并予以实施,包括建立围术期VTE风险评估工具、制定围术期“三级三段”干预方案。通过开展活动,使肺癌患者术后静脉血栓栓塞症发生率由10.13%下降至3.16%,达成了活动目标。     

Clinical characteristics of pulmonary hamartoma resected surgically as undiagnosed pulmonary nodule

Pulmonary hamartoma is the most common tumor in benign lung neoplasm. We reviewed the clinical characteristics of 9 patients who had undergone surgical resection for pulmonary hamartoma between 2000 and 2009. There were 1 male and 8 female patients. The age of the patients ranged from 42 to 77 years old (mean 59). Calcification was not observed by computed tomography scan except in 1 patient. Although transbronchial lung biopsy (TBLB) was performed in 5 patients, no definitive diagnosis was obtained. Six patients underwent 18F-fluorodeoxyglucose (FDG)-positron emission tomography, and none of them showed any accumulation of FDG except for 1 patient. Concerning the operative procedures, a sleeve lobectomy was performed in 1 patient, a segmentectomy in 1, a lobectomy in 2, a partial resection of the lung in 3, and a nucleation in 2 patients. The postoperative courses were uneventful, and no findings of recurrence were observed in any of the patients after surgery. As a preoperative diagnosis of pulmonary hamartoma is often difficult in TBLB, it is necessary to perform surgical resection in the differential diagnosis of lung cancer or metastatic lung tumor, unless there are typical findings of pulmonary hamartoma in clinical imaging.     

Estimating a treatment effect in survival studies in which patients switch treatment

For disease indications such as Acquired Immune Deficiency Syndrome (AIDS) and various cancers, randomization to a pure control treatment may be scientifically desirable but not ethically acceptable. Clinicians may insist that the experimental treatment be made available, at least as a rescue medication, for all patients in the control arm. A method for estimating a treatment effect in survival data from randomized clinical trials of this type is developed under an accelerated failure time model. This approach retains all patients in the groups to which they were randomized and is not based on an ad hoc subgroup analysis. By conditioning on having observed patient switch times, this method avoids the need to model patient switching patterns in the analysis. This new approach is evaluated using simulation studies, and is illustrated through analysing data from a Medical Research Council lung cancer trial.     

Testing of the new artificial lung ventilation apparatus Avenir-221P

Results of testing of new apparatus for mechanical lung ventilation (MLV) Avenir-221 P under conditions of postsurgical resuscitation are discussed. Particular emphasis is placed on specific features of the use of the MLV apparatus Avenir-221 P in military hospitals.     

The first heart-lung transplantation in a Hungarian patient with cystic fibrosis

INTRODUCTION: Progressive lung disease and respiratory insufficiency is the leading cause of early death for patients with cystic fibrosis. METHOD: Successful heart-lung transplantation was performed in the 24 years old man with cystic fibrosis for end stage lung diseases and for concomitant dilatative cardiomyopathy. RESULTS: Six months following the operation the patient returned to full-time his job, and leads an active life like other fellow-men of his age. CONCLUSIONS: The attention is called with this case report to a rarely necessary intervention available for Hungarian patients as well. The criteria of the lung transplantation in cystic fibrosis, the preoperative screening and the tasks of the postoperative care are summarised.     

肺区域性阻抗通气图在尘肺临床诊断中的应用价值

目的 探讨不同类型尘肺患者的肺区域性通气分布的特征及其对临床的应用价值。方法 对132例不同类型尘肺患者进行了肺区域性阻抗通气图检测和常规肺功能试验，将结果与100例健康人测定值比较。结果 铸工尘肺、矽肺和石棉肺3种尘肺的肺区域性通气分布皆为两上肺区通气增加和两下肺区通气减少；而左、右两侧肺通气分布则以右侧肺通气增加为主，占53．03％（70／132），与健康正常人肺阻抗通气图比较，差异有显著性（P＜0．01）。三种尘肺之间比较，差异未见显著性（P＞0．05），尘肺通气功能“正常”者与不同类型通气障碍者之间差异亦无显著性（P＞0．05）。2例矽肺中，1例X线胸片显示其左侧上叶肺萎缩；另1例并发左侧中央型肺癌。肺区域性阻抗通气图显示符合X线影像。结论 肺区域性阻抗通气图是非常规肺功能所能检测到的，可作为常规肺功能补充参数。对尘肺并发其他肺部区域性病变，临床似有可能用肺阻抗通气图替代核素显像通气法。     

药物导入肿瘤治疗仪的研制

目的：研制一种药物导入肿瘤治疗仪，探讨一种治疗部分肿瘤疾病（肝癌、肺癌、肠道癌、胰腺癌等）的新方法。方法：根据药物导入理论，结合医学、电子学和计算机原理和技术，采用微处理器完成数据处理和治疗控制。结果：开发的药物导入肿瘤治疗仪具有实用价值。结论：该治疗仪采用单片机控制，使中药的有效成分通过电致孔和毛孔导入人体内部，到达病灶部位发挥作用。     

Attitudes towards the integration of smoking cessation into lung cancer screening in the United Kingdom: A qualitative study of individuals eligible to attend

IntroductionThere is limited research exploring how smoking cessation treatment should be implemented into lung cancer screening in the United Kingdom. This study aimed to understand attitudes and preferences regarding the integration of smoking cessation support within lung cancer screening from the perspective of those eligible.MethodsThirty‐one lung cancer screening eligible individuals aged 55–80 years with current or former smoking histories were recruited using community outreach and social media. Two focus groups (three participants each) and 25 individual telephone interviews were conducted. Data were analysed using the framework approach to thematic analysis.ResultsThree themes were generated: (1) bringing lung cancer closer to home, where screening was viewed as providing an opportunity to motivate smoking cessation, depending on perceived personal risk and screening result; (2) a sensitive approach to cessation with the uptake of cessation support considered to be largely dependent on screening practitioners'' communication style and expectations of stigma and (3) creating an equitable service that focuses on ease of access as a key determinant of uptake, where integrating cessation within the screening appointment may sustain increased quit motivation and prevent loss to follow‐up.ConclusionsThe integration of smoking cessation into lung cancer screening was viewed positively by those eligible to attend. Screening appointments providing personalized lung health information may increase cessation motivation. Services should proactively support participants with possible fatalistic views regarding risk and decreased cessation motivation upon receiving a good screening result. To increase engagement in cessation, services need to be person‐centred.Patient or Public ContributionThis study has included patient and public involvement throughout, including input regarding study design, research materials, recruitment strategies and research summaries.     

Experience with Light Scattering Particle Counters

A cigarette-smoke dosage apparatus for controlled smoke dosages is constructed particularly for rodents. This apparatus can be adapted to their oral cavity, in which a minimizing of the distance between the cigarette and the oral cavity is obtained. The construction and characteristics of the apparatus is presented. The apparatus can be used in studies concerning the effect on lung clearance of cigarette smoke with or without simultaneous exposure to different air pollutants.     

Role of hepatic resection in the treatment of hepatolithiasis.

BACKGROUND: The aim of the present study was to evaluate the safety and the efficacy of hepatic resection in the treatment of hepatolithiasis with intrahepatic biliary strictures. METHODS: Experimental design: retrospective study. Setting: University hospital, Italy. Patients: 6 consecutive patients with single lobe hepatolithiasis operated on during the 4-year period 1994-98 inclusive. Interventions: major hepatic resections (3 left hepatectomies, 2 left lobectomies, 1 right hepatectomy). Main outcome measures: type and duration of the surgical procedure, intra/postoperative blood losses, intra/postoperative course and complications, pathology, and hepatolithiasis recurrence. RESULTS: Mean operative time was 3.34+/-0.02 hrs (range 3.0-4.3 hrs). Mean blood loss was 233+/-150 ml (range 100-500 ml). No patient required intra/postoperative blood transfusions. No intraoperative complication was recorded. Mean postoperative hospitalization was 17+/-7 days (range 6-28 days). Postoperative course was uneventful in 4 (66%) cases. No postoperative mortality was recorded. One pancreatitis and 1 biliary fistula occurred, for an overall postoperative morbidity of 33%. Pathology showed cholangiocarcinoma in 2 cases (33%). During the follow-up period (range 3-48 months, mean 19.1+/-16.4 months), 1 patient had recurrent cholangitis due to right lobe lithiasis and 1 patient died for cholangiocarcinoma. CONCLUSIONS: Hepatic resection is the treatment of choice in patients with single lobe hepatolithiasis and unreversible biliary strictures or possible presence of cholangiocarcinoma. An early indication for surgery may reduce the mortality/morbidity rates of hepatic resection for hepatolithiasis.     

A comparison of the results of checked versus unchecked individual patient data meta-analyses

OBJECTIVES: Systematic reviews and meta-analyses of individual patient data involve the central collection, validation, and reanalysis of raw data from randomized controlled trials. Checking individual patient data before its inclusion in a meta-analysis involves a number of different procedures that can be both time- and resource-intensive. We therefore aimed to assess the utility of data checking by investigating whether checks made any appreciable difference to the results of an individual patient data meta-analysis. METHODS: Data that were included in a meta-analysis of postoperative radiotherapy in non-small-cell lung cancer were used in a comparison of checked and unchecked data to investigate whether checking impacted the final results of the meta-analysis. Data "as received" were compared with fully checked and with followed-up data. RESULTS: Checking influenced the results, in this case mainly due to the exclusion of a single trial that failed to meet checking procedures. Checking data from most trials had only a small effect and did not materially alter the overall results of the meta-analysis. CONCLUSIONS: Although data checking and cleaning is time-consuming, and for the majority of trials may make little difference to the analysis, such procedures provide a useful safeguard against rare occurrences of data with major problems. Checking may also lend additional confidence in the data set, which may be particularly important when using unpublished data that has not been subject to standard peer review.     

MRSA医院获得性肺部感染流行趋势

目的研究MRSA院内获得性肺部感染流行趋势和防治对策。方法对重症监护病房患者MRSA肺部感染及传播因素进行监测。结果金黄色葡萄球菌中MRSA占的比例逐年升高，尤其重症监护病房肺部感染的患者痰中MRSA检出率为75％；医护人员工作中手、呼吸机管道MRSA阳性率为40％～50％，水龙头、拖布MRSA阳性率为50％～100％；通过环境消毒，物表未检出MRSA。结论MRSA是医院获得性感染重要致病菌，在重症监护病房引起肺部感染流行，医务人员的手是感染的重要媒介。     

The Role of the Enteral Route and the Composition of Feeds in the Nutritional Support of Malnourished Surgical Patients

In surgical patients, malnutrition is an important risk factor for post-operative complications. In undernourished patients undergoing major gastrointestinal procedures, preoperative enteral nutrition (EN) should be preferred whenever feasible. It may be given either orally or by feeding tubes, depending on patient compliance. Early oral intake after surgery should be encouraged, but if an insufficient postoperative oral intake is anticipated, tube feeding should be initiated as soon as possible. The use of immunomodulating formulas offers significant advantages when compared to standard feeds and the positive results on postoperative complications seem independent from the baseline nutritional status. In malnourished patients, the optimal timing and dose of immunonutrition is unclear, but consistent data suggest that they should be treated peri-operatively for at least two weeks.     

Pulmonary Fibrosis in a Worker Using an Aluminium Powder

A young woman was employed for five years as a “flash filler” in a fireworks factory, using a mixture containing aluminium powder. The powder reached a considerable concentration in the atmosphere of the small room in which the patient worked, after she had swept the room. This was done several times a day.

The patient had developed marked dyspnoea on mild exertion at the end of the five-year period. She was found to have limitation of chest movement with marked tracheal deviation. The radiograph showed the hila to be displaced upwards, a fine granular shadowing throughout the lung fields, and a small pulmonary cyst at the right lung apex. Lung function studies showed a marked reduction in lung volumes and a severely impaired diffusing capacity, while the mechanical function was only slightly below normal. Over the right upper lung lobe a small pneumothorax developed, which gradually resolved.

The similarity of this case to other reported cases in workers with particulate aluminium is noted, as is the view that rheumatoid disease may have had some action in the development of the lung lesion. An alternative diagnosis is considered. Finally, the possibility that personal idiosyncrasy may be responsible for the development of such lung lesions in aluminium workers is mentioned.

     

肺癌病人外周血NK细胞与TNF检测及其临床意义

为探讨肺癌患者体内肿瘤坏死因子（TNF）与自然杀伤（NK）细胞活性水平及影响二者活性的临床因素。采用外周血诱生TNF测定法检测TNF活性;应用荧光检测法分析细胞毒性效应DNA以观察NK细胞活性。结果发现肺癌患者NK细胞活性显著低于正常人和非癌胸病病人,并随病期进展、肿瘤增大及淋巴结转移而加重,不受病理学类型影响。TNF活性水平显著高于非癌胸病人与正常人,而与病期、肿瘤大小、淋巴结转移与否及病理学类型无关。结果认为肺癌病人体内细胞免疫功能处于严重失衡状态,表现为NK细胞活性下降,全血诱生TNF活性呈高水平状态,检测二者活性可为肺癌病人的综合治疗提供理论依据。