Acute Interstitial Pneumonia (Hamman–Rich Syndrome) in Lung Transplantation: A Case Series

BackgroundAcute interstitial pneumonia (AIP), also known as Hamman–Rich syndrome, is a rare and rapidly progressive idiopathic interstitial lung disease with a high mortality rate. Treatment is limited to supportive care and empirical high-dose steroids; however, outcomes are generally poor. There are few reports of lung transplantation (LTx) in patients with AIP.MethodsWe retrospectively identified patients with AIP among those who underwent LTx at our center between January 2008 and December 2020.ResultsDuring the study period, 4 patients with AIP underwent bilateral LTx: 3 men and 1 woman, between 30 and 57 years of age. The lung allocation score ranged between 71 and 89. Of the 4 patients, 2 needed extracorporeal membrane oxygenation and mechanical ventilation (MV) and 1 needed MV preoperatively. Time of onset to transplant ranged from 1 to 3 months. None of the patients had primary graft dysfunction after LTx; 2 had acute cellular rejection and 1 had chronic lung allograft dysfunction. The 4 patients are alive with survival ranging between 1 and 12 years after LTx.ConclusionAIP should be considered in patients with acute respiratory failure without a clear etiology. Our study showed that LTx led to good outcomes and should be considered as a treatment option in appropriate candidates.     

Case Report: Bilateral Lung Transplantation for Rapidly Progressive Undifferentiated Interstitial Lung Disease—A Cautionary Tale

Interstitial lung disease is fast becoming one of the most common indications for lung transplantation (LTx); however, LTx for Goodpasture's syndrome with pulmonary involvement has not been previously described in the literature. In this report, we outline the case of a young male with undifferentiated rapidly progressive interstitial lung disease who ultimately received a bilateral sequential LTx after deterioration requiring extracorporeal membrane oxygenation. The original disease soon recurred in the graft, and unfortunately, the patient did not survive. The diagnosis of Goodpasture's syndrome was made postmortem and was not clearly evident on examination of the native explanted tissue, nor was there an elevated titer of antiglomerular basement membrane antibodies during his initial work-up. We hypothesize that the donor and recipient's HLA profile made him more susceptible to aggressive disease. In hindsight, active Goodpasture's disease would have been a contraindication to proceed to transplantation. This case is a cautionary reminder of the high stakes of performing LTx without a certain diagnosis.     

Granulomatous Interstitial Nephritis in a Patient with Crohn’s Disease

A case of granulomatous interstitial nephritis (GIN) associated with Crohn’s disease (CD) was reported. GIN is a rare pathological finding in renal biopsy specimens. In a patient affected by CD, granulomas may be found in various tissues and organs such as lymph nodes, mesentery, liver, and lungs and occasionally in bones, joints, and skeletal muscle. Few cases of granuloma have been reported in the kidney, and it is not always possible to relate the presence of granuloma to CD, to other interstitial granulomatosis diseases, or to a drug-induced reaction. The issue has a remarkable clinical effect; indeed, the answer requires a completely different therapeutic approach. The diagnosis analysis on the basis of clinical–pathological evidences and on reports from literature is discussed.     

Aesthetic Improvements in Poland��s Syndrome Treatment with Omentum Flap

Background  

There are many techniques that can be used to reconstruct anomalous breast volume in Poland’s syndrome, but repair of the stigmatizing deformities such as the transverse skin fold in the anterior axillary pillar, infraclavicular depression, and anomalous breast contours continues to be a challenge. This study aimed to demonstrate the superior results of laparoscopically harvested omentum flap to achieve these aesthetic improvements.     

Alveolar and Bronchial Nitric Oxide in Chronic Obstructive Pulmonary Disease and Asthma–COPD Overlap

Introduction

Exhaled nitric oxide (F_ENO) measurements differentiate COPD phenotypes from asthma–COPD overlap (ACO). To date, no study has been conducted to determine whether alveolar and bronchial components differ in this group of patients.

Is Interstitial Pneumonia in Patients with Collagen Diseases a Contraindication to Lung Cancer Surgery?

Purpose

Lung cancer surgery can be dangerous in patients with interstitial pneumonia (IP) as acute exacerbation of the IP may prove fatal. It remains unclear if patients with collagen diseases (CD), who often suffer from IP, are also at increased risk during lung cancer surgery.

Methods

We retrospectively examined 17 (3.1%) patients with CD among 545 patients who underwent surgery for lung cancer at our institution.

Results

Nine patients with rheumatoid arthritis, five with systemic sclerosis, two with Sjögren's disease, and one with systemic lupus erythematosus were enrolled in this study. Eleven patients (65%) were taking corticosteroids at the time of surgery. Fourteen patients underwent lobectomy and lymph node dissection, and three patients with pStage IA lung cancer underwent pulmonary wedge resection. Pathologically, 11 (65%) patients had IP with various inflammatory cellular infiltrations, and three (18%) had honeycombing of the lung. Postoperatively, none of the patients suffered acute exacerbation of their IP.

Conclusions

Despite the high incidence of IP in patients with lung cancer and CD, our results suggest that CD is not a contraindication to the surgical resection of lung cancer.

     

The Surgical Treatment of Graves�� Disease in Children and Adolescents

Background  

Surgery as definitive treatment of pediatric Graves’ disease is recommended for children and adolescents experiencing adverse effects of thionamides or disease relapse after at least 2 years of medical treatment. In addition, it is indicated in patients with a large goiter or with suspicious nodules. Total or near-total thyroidectomy should be performed, since subtotal thyroidectomy is associated with a high risk of relapse in this group. Patients should be referred to surgeons experienced in thyroid surgery because studies show that children and adolescents have a higher complication rate than adults.     

Anterior Spinal Cord Syndrome in a Patient with Behçet's Disease

Although neurological involvement in Beh?et's disease is not so uncommon, isolated spinal cord disease is quite rare and reported to be observed in about 2% of all cases with neurological involvement. Here we report a Beh?et's patient with spinal cord disease presented with anterior spinal cord syndrome. This rare syndrome is caused by hypoperfusion of the anterior spinal artery and to our knowledge has not been previously reported in patients with Beh?et's disease. This report defines the characteristic clinical features of this entity and emphasizes the importance of early immunosuppressive treatment and initiation of rehabilitation.     

Guillain-Barr�� Syndrome and Postbariatric Surgery Polyneuropathies

Background:

Postbariatric surgery poly-neuropathies (BSP) are infrequent events. However, with the number of gastric bypasses performed each year increasing, the incidence of BSP is expected to increase as well. The long-term sequelae of BSP worsen with delays in diagnoses. Therefore, early evaluation, recognition, and treatment are important in minimizing morbidity and mortality.

Methods:

We present the case report of a patient who developed a poly-neuropathy after a laparoscopic Roux-en-Y gastric bypass.

Results:

The patient''s symptoms were ultimately determined to result from Guillain-Barré syndrome. Symptoms resolved with proper treatment.

Conclusion:

Characteristic differences exist between the various surgery poly-neuropathies. With proper evaluation, this determination will aid in prompt and appropriate treatment and will prevent morbidity and mortality.     

Diffuse Interstitial Lung Disease as a First Manifestation of Waldenström's Macroglobulinemia: Case Report and Review of the Literature

Waldenström's macroglobulinemia (WM) is a lymphoid malignancy characterized by infiltration, mainly of the bone marrow and lymph nodes, by small mature lymphocytes showing plasmacytoid differentiation, associated with an IgM monoclonal band, and in general, a low degree of aggressiveness. We present the first case reported in the Spanish literature of interstitial lung disease presenting as MW and we review the literature.     

Tocilizumab Treatment for Nephrotic Syndrome Due to Amyloidosis in Behcet’s Disease

Renal involvement is an unusual but significant Behcet´s disease (BD) complication and AA amyloidosis appears to be the most common etiology. IL-6 is a pro-inflammatory cytokine with an important role in AA amyloidosis development. Tocilizumab (TCZ) is a humanized anti-IL-6 receptor antibody that has emerged as an effective and specific treatment in AA amyloidosis secondary to chronic inflammatory disorders. We report on a patient diagnosed with BD who developed nephrotic syndrome caused by renal AA amyloidosis with an excellent response to TCZ therapy.     

Prognostic Value of Modified Lateral Pillar Classification in Legg-Calv��-Perthes Disease

Background

To evaluate the usefulness of the modified lateral pillar classification as a prognostic factor in Legg-Calvé-Perthes disease (LCPD).

Methods

Thirty nine patients diagnosed with lateral pillar C in LCPD from May, 1977, to October, 2001 were reviewed, and their skeletal maturity was followed. The mean follow up duration was 12 years and 7 months (4 years, 6 months to 24 years, 9 months). Lateral pillar C classification was divided into C1 (50-75% collapse of the lateral pillar) and C2 (> 75%). All radiological and clinical prognostic factors were evaluated. The final results were evaluated according to the Stulberg classification.

Results

Twenty one and 18 of the affected hips were in groups C1 and C2, respectively. According to the Stulberg classification, the final results of group C1 were better than those of C2 (p = 0.002). Patients with more head-at-risk signs had significantly poorer outcomes.

Conclusions

The modified lateral pillar classification has significant value for predicting the prognosis of LCPD.     

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??The usage of Overlap method in Billroth I reconstruction of totally laparoscopic distal gastrectomy??A report of 1 case MIAO Ru-lin , LI Zi-yu , SHAN Fei, et al. Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing100142, China
Corresponding author: LI Zi-yu, E-mail: ligregory@outlook.com
Abstract Objective To introduce the usage of Overlap method in Billroth I reconstruction of totally laparoscopic distal gastrectomy. Methods This study retrospectively analyzed 1 case of overlap Billroth ?? reconstruction for totally laparoscopic distal gastrectomy in Peking University Cancer Hospital and described the technique details of the method. Results In overlap Billroth ?? reconstruction, the duodenum bulb is transected in the caudal-to-cranial direction and then the cranial part of the transection line is opened. After transection of the stomach, the point of greater curvature 60mm from the transection line is opened. Then a 60mm linear stapler is used for the side-to-side anastomosis of gastric greater curvature and upper-lateral wall of duodenum. Finally, the conjuncture incision is closed with another linear stapler. Conclusion The overlap Billroth ?? reconstruction method for totally laparoscopic distal gastrectomy is simple to operate and the digestive tract is not twisted which may contribute to faster recovery of bowel function.