Lung immunogenicity, rejection, and obliterative bronchiolitis

Evidence suggests that obliterative bronchiolitis (OB) following human heart-lung transplantation is a form of allograft rejection related to augmented expression of class II major histocompatibility complex antigens (MHCII) on airway epithelium and mediated by activated T cells. Other forms of OB, including those related to viral infection and autoimmune disease, may reflect a similar mechanism.     

Recommendations of the National Heart,Lung, and Blood Institute Heart and Lung Xenotransplantation Working Group

The National Heart, Lung, and Blood Institute (NHLBI) recently convened the Heart and Lung Xenotransplantation Working Group to identify hurdles to the clinical application of xenotransplantation, defined as the use of animal organs or tissue for transplantation, and to recommend possible solutions to these problems. The group consisted of experts in xenotransplantation from academia, industry, and federal agencies, and the discussions focused on those areas within the mission of the NHLBI. The areas covered included immunologic and physiological barriers to xenotransplantation, the limitations of the current animal models, the need for collaboration among groups, the high costs of studies using nonhuman primates and genetic engineering of pigs, and the unique problems of lung xenotransplantation. This report is a summary of those discussions.     

Extracorporeal Assist — Liver,Spleen, and Lung

Laboratory and clinical studies have been described demonstrating the metabolic efficiency of animal livers perfused with human blood. Such a preparation has been used to support patients in liver failure. Pig and calf spleens washed free of blood will also function when perfused with human blood. Preliminary attempts have been made utilizing the cellular and circulating antibodies from such a preparation for immunotherapy on five patients with metastatic malignant melanoma.

Laboratory studies are reported evaluating the use of pig and calf lungs as a biologic oxygenator for human blood.     

Lung cancer: epidemiology, etiology, and prevention

Lung cancer is the leading cause of cancer death in the United States and around the world. A vast majority of lung cancer deaths are attributable to cigarette smoking, and curbing the rates of cigarette smoking is imperative. Understanding the epidemiology and causal factors of lung cancer can provide additional foundation for disease prevention. This article focuses on modifiable risk factors, including tobacco smoking, occupational carcinogens, diet, and ionizing radiation. It also discusses briefly the molecular and genetic aspects of lung carcinogenesis.     

Lung cancer--a philosophical, ethical, and personal perspective.

Lung cancer is a formidable worldwide health problem causing more deaths than breast, prostate, and colorectal cancer combined. Eighty percent are non-small cell type (NSCLC) and less than one in five patients can have a curative resection. Decisionmaking in treating cancer, and lung cancer specifically, requires an understanding of the basic ethical principles as well as a prioritization of values beyond medical knowledge alone. Choosing a treatment plan can be difficult because of the multiple confronting dilemmas occurring simultaneously. Economic analysis also is required of every major treatment strategy proposed. Active patient involvement is helpful in making these important and difficult choices at the same time clinicians must be mindful of their roles as healers, educators, and innovators of knowledge in a disease that has a five year mortality rate of nearly 90%. Finally, because end of life care issues are so common with this illness, clinicians must be aware of their importance in making dying easier for so many individuals.     

Lung volumes: measurement, clinical use, and coding

Measurement of lung volumes is an integral part of complete pulmonary function testing. Some lung volumes can be measured during spirometry; however, measurement of the residual volume (RV), functional residual capacity (FRC), and total lung capacity (TLC) requires special techniques. FRC is typically measured by one of three methods. Body plethysmography uses Boyle's Law to determine lung volumes, whereas inert gas dilution and nitrogen washout use dilution properties of gases. After determination of FRC, expiratory reserve volume and inspiratory vital capacity are measured, which allows the calculation of the RV and TLC. Lung volumes are commonly used for the diagnosis of restriction. In obstructive lung disease, they are used to assess for hyperinflation. Changes in lung volumes can also be seen in a number of other clinical conditions. Reimbursement for measurement of lung volumes requires knowledge of current procedural terminology (CPT) codes, relevant indications, and an appropriate level of physician supervision. Because of recent efforts to eliminate payment inefficiencies, the 10 previous CPT codes for lung volumes, airway resistance, and diffusing capacity have been bundled into four new CPT codes.From the Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.Correspondence to: Judd D. Flesch, MD, Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, 8 Maloney Bldg, 3400 Spruce St, Philadelphia, PA 19104; e-mail: judd.flesch@uphs.upenn.eduFinancial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.