Yield of surveillance bronchoscopy for acute rejection and lymphocytic bronchitis/bronchiolitis after lung transplantation

BACKGROUND: Better understanding of the timing and pattern of surveillance bronchoscopy findings after lung transplantation could influence the timing and frequency of surveillance bronchoscopy. We present our surveillance bronchoscopy experience and test the hypothesis that patients not encountering early acute rejection or lymphocytic bronchitis/bronchiolitis are less likely to have subsequent occult occurrences in the 1st year after lung transplantation. METHODS: We conducted a retrospective study of 204 patients who underword transplantation between 1996 and 2000. Based on contemporary biopsy-specimen grading in the first 100 days, we formed 2 groups: No Early Rejection and Early Rejection. We compared subsequent yields of surveillance bronchoscopy and the incidence of acute rejection or of lymphocytic bronchitis/bronchiolitis. RESULTS: We reviewed 645 biopsies taken from 204 recipients during the first 100 days to classify patients into a No Early Rejection Group (n=67) or an Early Rejection Group (n=137). Yield of surveillance bronchoscopy for acute rejection or lymphocytic bronchitis/bronchiolitis was 31% with the greatest yield during the first 30 days (45%), and then decreasing to 26% (p <0.001). After Day 100, 71% of occult acute rejection episodes involved minimal (A1) lesions. Yield of surveillance bronchoscopy after Day 100 was 20% in the No Early Rejection Group and was 27% in the Early Rejection Group (p=0.22). Incidence of acute rejection or lymphocytic bronchitis/bronchiolitis after Day 100 was 41% in the No Early Rejection Group and was 50% in the Early Rejection Group (p=0.17). CONCLUSION: Surveillance bronchoscopy detects occult acute rejection or lymphocytic bronchitis/bronchiolitis in approximately one-third of biopsy specimens during the 1st year, with the majority of late abnormalities being minimal (A1) rejection. The absence of acute rejection or lymphocytic bronchitis/bronchiolitis during the first 100 days does not predict freedom from such events in the remainder of the 1st year.     

Organ dysfunction following stem cell transplantation: relationship to plasma cytokine concentrations.

Patients receiving high-dose preparation for stem cell transplantation are at risk for organ dysfunction (OD). Signs of early OD include hypoxia, mental status changes, and liver dysfunction. These early signs have not been correlated with potential cytokine mediators. We compared plasma concentrations of IL-6, TNF-alpha, and IL-10 in OD patients and controls. Cytokines were measured before preparation, 5 days before OD, day of OD, and 5 days after OD. TNF-alpha and IL-10 were not measurable prior to preparation. IL-10 was more likely to be measurable in OD patients than in controls 5 days prior to onset of OD (P = 0.039), on the day of OD (P = 0.023), and 5 days later (P < 0.0001). TNF-alpha was more likely to be measurable only on the day of OD (P = 0.0035). IL-6 was significantly elevated in OD patients at all time points. Patients who had measurable IL-6 on admission were 5.1 times more likely to develop OD (95% CI = 1.4-17.9; P = 0.011). Five days prior to OD for each 100 pg/ml increase in IL-6, patients were 2.75 times more likely to develop OD (95% CI = 1.3-5.8; P = 0.0087). The early elevation of IL-6 in patients who develop OD may help identify a high risk group where preventive therapies can be evaluated.     

Primary leiomyosarcoma of adrenal gland. Case report with immunohistochemical and ultrastructural study

A primary leiomyosarcoma of the right adrenal gland is reported in a 49-year-old male who presented with progressive flank pain. This is the second case in the English language literature and the first to have documentation of malignant behavior. The tumor measured 11 cm in diameter and showed marked necrosis with prominent mitotic activity (average 15 per 10 high-power fields). Smooth muscle differentiation was apparent ultrastructurally and confirmed by positive immunostaining for muscle-specific and alpha-smooth muscle actin. Bony metastases developed; following palliative treatment with radiation and chemotherapy, the patient is alive with tumor 9 months later. Origin from smooth muscle associated with the central adrenal vein or its tributaries is proposed.     

Home Care of the Ventilator-Dependent Child

Advances in medical technology have resulted in the survival of an increasing number of infants and young children who require longterm mechanical ventilation For some of these infants home care may be a viable and cost effective option to prolonged hospitalization With the cooperative effort of the family and a multidisciplinary health team, a comprehensive home care program can be developed and the quality of life improved for the child dependent on a ventilator.     

Effect of a new conditioning agent on dentin

The effect of varying the duration of application of the conditioner for light-cured Zionomer was studied. The conditioner is a solution of oxalic acid and aluminum nitrate in a weak mineral acid and has a pH of 2.06. Recently extracted non-carious human premolars were sectioned horizontally 300 microns below the amelodentinal junction and then lightly ground with a high-speed diamond bur under copious water-spray to produce a smear layer. Each was then sectioned vertically into three and all the specimens were either treated with the Zionomer Conditioner for 5, 10, 20 or 30 seconds, or with distilled water as a control. All the specimens were examined in a scanning electron microscope at x1000 and photomicrographs taken which were then assessed, independently, by the authors. The results revealed that application of Zionomer Conditioner for as little as 5 seconds was sufficient to remove most of the smear layer. There was complete removal of the surface smear layer in specimens treated for 10 seconds or more. Either a 20 second or a 30 second application removed the smear layer completely and could also widen the exposed tubule orifices.     

The relationship of minority students' MCAT scores and grade point averages to their acceptance into medical school

The authors identified relationships between quantitative academic variables--specifically, grade-point averages (GPAs) and Medical College Admission Test (MCAT) scores--and the admission decisions of 58 students from minority groups underrepresented in medicine. These students had participated in a summer enrichment program at the University of Virginia School of Medicine and had applied to medical school. A total of 49 of the students were offered admission, and ultimately enrolled in 17 different medical schools. Results of a stepwise multiple regression analysis indicated that scores on the Skills Analysis: Quantitative Subtest of the MCAT explained the greatest percentage of the variance related to medical school admission (26%); scores on the Skills Analysis: Reading Subtest contributed an additional 7% to the explained variance, and scores on the Physics Knowledge Subtest, another 5%. The overall GPAs did not contribute significantly to the explanation of the variance in admission decisions. These results differ from published findings based on data from minorities' admissions to individual institutions. Caution must therefore be exercised when using GPAs and MCATs as medical school admission predictors for students from minority groups.