News on lung volume reduction surgery

Lung volume reduction surgery (LVRS) is an established therapeutic option for patients with advanced pulmonary emphysema after all conservative measures, including comprehensive pulmonary rehabilitation, have been exhausted. LVRS improves pulmonary function, shortness of breath, exercise capacity and hence quality of life in some 80% of cases for up to four years. Even patients with homogeneous types of pulmonary emphysema improve if those with extremely low FEV1 and/or very low diffusion capacity are excluded. At experienced centres perioperative mortality is less than 2% in appropriately selected patients, and current results suggest that the five-year survival in COPD patients may even be improved by this palliative surgical intervention. In patients under 60 LVRS may serve as a bridging procedure to lung transplantation. Bronchoscopic creation of extraanatomic bronchopulmonary passages--endoscopic LVRS--is a novel approach now under investigation.     

Successful lung volume reduction surgery in a child with severe airflow obstruction and hyperinflation due to constrictive bronchiolitis

Lung volume reduction surgery (LVRS) may improve pulmonary function in patients with severe emphysema. However, its effects in other types of obstructive lung disease are unknown. To delay the need for lung transplantation, we performed LVRS in a 14-year-old boy with disabling airflow obstruction/hyperinflation secondary to postinfectious bronchiolitis nonresponsive to medical therapy. Within days after LVRS, a major improvement of symptoms and lung function occurred and persisted for > 1 year. Our observation suggests that LVRS may be a novel treatment option in selected patients with extreme hyperinflation even if the underlying disease is not emphysema.     

Cell surface expression of c-kit receptors by childhood acute myeloid leukemia blasts is not of prognostic value: a report from the Childrens Cancer Group

The prognostic significance of c-kit receptor expression on leukemic blast cells was determined in 122 children with acute myeloid leukemia (AML) entered onto Childrens Cancer Group protocol 213. Clinical and laboratory characteristics as well as outcome were analyzed according to the percentage of blast cells expressing c-kit receptors and the relative number of c-kit receptors per cell as determined by indirect immunofluorescence. c-kit receptor expression was strongly associated with the expression of the CD34 antigen. However, contrary to findings in adult patients with AML, c-kit receptor expression by childhood AML blast cells was not predictive of a poor response to therapy.     

Pneumocystis carinii Pneumonia and mucosal candidiasis in a previously healthy homosexual man

Summary A fatal case ofPneumocystis carinii pneumonia in a previously healthy homosexual man with no evidence of malignancy is reported. Despite appropriate treatment with high doses of i. v. trimethoprim-sulfamethoxazole, the patient died.

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Pneumocystis carinii-Pneumonie und Schleimhautcandidose bei einem Homosexuellen ohne Vorerkrankung

Zusammenfassung Wir berichten über einePneumocystis carinii-Pneumonie mit letalem Ausgang bei einem vorher gesunden Homosexuellen, bei dem kein Anhalt für eine maligne Erkrankung bestand. Der Patient verstarb trotz adäquater Behandlung mit hohen intravenösen Dosen von Trimethoprim-Sulfamethoxazol.

     

Population-based study of severe hypoglycemia requiring emergency medical service assistance reveals unique findings

Objective

The objective is to report a contemporary population-based estimate of hypoglycemia requiring emergency medical services (EMS), its burden on medical resources, and its associated mortality in patients with or without diabetes mellitus (DM, non-DM), which will enable development of prospective strategies that will capture hypoglycemia promptly and provide an integrated approach for prevention of such episodes.

Methods

We retrieved all ambulance calls activated for hypoglycemia in Olmsted County, Minnesota, between January 1, 2003 and December 31, 2009.

Results

A total of 1473 calls were made by 914 people (DM 8%, non-DM 16%, unknown DM status 3%). Mean age was 60 ± 16 years with 49% being female. A higher percentage of calls were made by DM patients (87%) with proportionally fewer calls coming from non-DM patients (11%) (chi-square test, p < .001), and the remaining 2% calls by people with unknown DM status. Emergency room transportation and hospitalization were significantly higher in non-DM patients compared to DM patients (p < .001) and type 2 diabetes mellitus compared to type 1 diabetes mellitus (p < .001). Sulphonylureas alone or in combination with insulin varied during the study period (p = .01). The change in incidence of EMS for hypoglycemia was tracked during this period. However, causality has not been established.Death occurred in 240 people, 1.2 (interquartile range 0.2–2.7) years after their first event. After adjusting for age, mortality was higher in non-DM patients compared with DM patients (p < .001) but was not different between the two types of DM.

Conclusions

The population burden of EMS requiring hypoglycemia is high in both DM and non-DM patients, and imposes significant burden on medical resources. It is associated with long-term mortality.     

Randomised controlled trial for emphysema with a selective agonist of the γ-type retinoic acid receptor

Palovarotene is an oral γ-selective retinoid agonist. In animal emphysema models, palovarotene reduced inflammation, promoted structural repair and functional improvement. REPAIR (Retinoid treatment of Emphysema in Patients on the α(1)-antitrypsin International Registry), was an investigator-initiated, double-blind, placebo-controlled randomised study to assess the safety and efficacy of 5 mg·day(-1) palovarotene given for 1 year to 262 patients with severe α(1)-antitrypsin deficiency and emphysema confirmed by computed tomography. Change in volume-adjusted 15th percentile point lung density from baseline in 1 year was the primary end-point; functional end-points were also regularly assessed. We randomly assigned 133 and 129 patients to placebo or palovarotene, respectively. Both groups were well matched for all baseline characteristics, including respiratory medications. 88% and 85% of patients completed 1 year of treatment with placebo and palovarotene, respectively. Palovarotene was generally well tolerated. In the study completers population, the placebo-corrected difference of lung density was -0.45 HU at week 28 (p=0.64) and -0.25 HU at week 52 (p=0.94). A nonsignificant treatment difference in most functional parameters of the lung in favour of the drug was observed over time suggesting potential pharmacological effects of palovarotene. Palovarotene 5 mg·day(-1) over 1 yr failed to show a significant benefit on lung density in moderate-to-severe emphysema secondary to severe α(1)-antitrypsin deficiency.     

Detection of antibodies to human immunodeficiency virus type 2 (HIV-2) in blood donor sera using United States assay methods for anti-HIV type 1

Twelve serum samples from French blood donors that were uniformly reactive in tests for antibody to human immunodeficiency virus type 2 (anti-HIV-2) also were reactive in 92 to 100 percent of tests with three anti-HIV type 1 (anti-HIV-1) enzyme-linked immunoassays currently in widespread use for donor screening in the United States. Supplemental tests for anti-HIV-1 on these anti-HIV-2-reactive samples differed in their responses. All samples reacted in a licensed anti-HIV-1 Western blot, but there was an atypical band near the p41 position, which could be a clue to the fact that this result was a cross-reaction with anti-HIV-2. A recombinant immunoblot gave an indeterminate result for anti-HIV-1 in all 12 samples. A local immunofluorescence assay for anti-HIV-1 reacted with 92 percent of the samples, but a commercial one detected only 58 percent.     

Sexual transmission of hepatitis B virus,hepatitis C virus,and human immunodeficiency virus type 1 infections among male transvestite comercial sex workers in Montevideo,Uruguay

Prostitution may constitute a risk behavior for infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). We conducted a seroepidemiologic study among 200 male transvestite commercial sex workers (CSWs) in Montevideo, Uruguay in 1999. Evidence of exposure to HBV, HCV, and HIV was found in 101 (50.5%), 13 (6.5%), and 43 (21.5%) individuals, respectively. Positivity for HIV was correlated with both HBV (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.01-4.67) and HCV (OR = 3.47, 95% CI = 0.90-12.79) infection. Predictors of infection were older age (> or = 26 years; P < 0.01) for all 3 viruses and time in CSW (> or = 5 years; P < 0.05) for HBV and HIV. Prior history of use of drugs (OR = 3.54, 95% CI = 1.09-11.52) and sexual contact with foreigners (OR = 9.2, 95% CI = 1.16-73.12) were found to be associated only with HCV infection. Sexual transmission of these viruses constitutes a significant problem among male transvestite CSWs.