Superior mesenteric artery syndrome after lung transplantation: a rare early gastrointestinal complication of lung transplantation

Gastrointestinal complications sometimes occur after lung transplantation and remain a cause of postoperative morbidity. Superior mesenteric artery syndrome is caused by the compression of the duodenum by the superior mesenteric artery, but few reports have described superior mesenteric artery syndrome after lung transplantation. We herein report two cases of superior mesenteric artery syndrome as an early complication after lung transplantation. Both patients were emaciated and had lost weight before transplantation. They also lost an additional 2–4 kg early after transplantation. They were medically treated with enteral nutrition and recovered without recurrence of the syndrome. Since critically ill patients with pulmonary disease usually lose weight both before and early after lung transplantation, superior mesenteric artery syndrome is important to consider in the differential diagnosis of gastrointestinal complications after transplantation.     

Postoperative outcomes of lung transplant recipients with preformed donor-specific antibodies

OBJECTIVESFew studies have evaluated the outcomes of lung transplantation (LTx) in recipients with preformed donor-specific antibodies (DSAs). This study investigated the postoperative changes in preformed DSAs based on prospectively collected data of DSAs, and the influences of preformed DSAs on postoperative outcomes among LTx recipients. Open in a separate windowMETHODSBetween July 2010 and December 2019, 216 recipients underwent LTx (81 living-donor lobar lung transplants and 135 deceased-donor lung transplants). We reviewed 8 cases with preformed DSAs to determine postoperative changes in DSAs and compared postoperative outcomes between recipients with and without DSAs.RESULTSThe preoperative mean fluorescence intensity of preformed DSAs ranged from 1141 to 14 695. Two recipients experienced antibody-mediated rejection within 2 weeks after LTx. DSAs disappeared in 7 recipients; however, 1 recipient experienced the relapse of DSAs and died from chronic lung allograft syndrome (CLAD), whereas 1 recipient had persisting DSAs within the study period and died from CLAD. Neither overall survival (OS) nor CLAD-free survival was significantly different between recipients with and without DSAs (P = 0.26 and P = 0.17, respectively). However, both OS and CLAD-free survival were significantly lower in recipients with DSAs against HLA class II than in those without these antibodies {5-year OS: 25.0% [95% confidence interval (CI): 0.9–66.5%] vs 72.1% (95% CI: 63.8–78.9%), P = 0.030 and 5-year CLAD-free survival: 26.7% (95% CI: 1.0–68.6%) vs 73.7% (95% CI: 66.5–79.5%), P = 0.002}.CONCLUSIONSPrognosis in recipients experiencing the relapse of preformed DSAs and those with persisting DSAs may be poor. The recipients with anti-HLA class II preformed DSAs had a significantly worse prognosis.     

Diameter of the dilated main pulmonary artery in patients with pulmonary hypertension decreases after lung transplantation

Surgery Today - The pulmonary artery (PA) in patients with pulmonary hypertension (PH) becomes dilated. We analyzed the postoperative changes of the main PA after lung transplantation (LuTx). The...     

Carotid arterial circumferential strain by two-dimensional speckle tracking: a novel parameter of arterial elasticity

Recently, the development of two-dimensional speckle-tracking (2DST) technology has allowed the direct measurement of the elastic parameters of the carotid arterial wall. The aims of this study were to determine the feasibility of measuring peak circumferential strain (CS) of the carotid arterial wall using 2DST and to compare this value with conventional arterial stiffness parameters in subjects with and without hypertension. The study included 90 healthy subjects and 40 age-and sex-matched patients with hypertension. The short-axis view of the right common carotid artery was recorded. The CS in the posterior region of the carotid artery was calculated by 2DST using special software and corrected by the following equation: ?(circ)=ln (systolic blood pressure/diastolic blood pressure)/CS. We simultaneously measured the stiffness index β (β) at the same location and the brachial-ankle pulse wave velocity (baPWV). Sixty randomly selected healthy subjects were used to assess the inter/intra-observer variability of ?(circ) and β. In healthy subjects, ?(circ) was significantly correlated with β, age and baPWV. These correlations were slightly better than the corresponding correlations of β with age and baPWV. The hypertensive patients had a significantly larger ?(circ) than the healthy subjects (0.112±0.074 vs. 0.066±0.029/%, P<0.001). The inter/intra-observer variability for ?(circ) was significantly lower than that for β. Our data suggest that the measurement of carotid ?(circ) using 2DST is feasible and has better reproducibility than conventional carotid arterial stiffness.     

Imaging of methamphetamine incorporated into hair by MALDI-TOF mass spectrometry

Matrix-assisted laser desorption ionization (MALDI)–time-of-flight (TOF) mass spectrometry (MS) was used for visual demonstration of methamphetamine (MA) incorporation into human hair. Longitudinal sections of human scalp hair shafts from chronic MA users were directly subjected to imaging MS. Numerous MA-positive spots with various intensities were observed in the specimens, which probably reflect habitual MA abuse and the different MA blood levels upon each administration. This imaging MS method for drugs in hair seems to give much more accurate chronological information on drug use, and clearer discrimination between deliberate drug use and passive exposure, using only a single hair shaft. This is the first report of imaging MS applied to forensic toxicology. This method is expected open a new field in analyses of drugs in hair.     

P-glycoprotein mediates brain-to-blood efflux transport of buprenorphine across the blood-brain barrier

The involvement of P-glycoprotein (P-gp) in buprenorphine (BNP) transport at the blood-brain barrier (BBB) in rats was investigated in vivo by means of both the brain uptake index technique and the brain efflux index technique. P-gp inhibitors, such as cyclosporin A, quinidine and verapamil, enhanced the apparent brain uptake of [3H]BNP by 1.5-fold. The increment of the BNP uptake by the brain suggests the involvement of a P-gp efflux mechanism of BNP transport at the BBB. [3H]BNP was eliminated with an apparent elimination half-life of 27.5 min after microinjection into the parietal cortex area 2 regions of the rat brain. The apparent efflux clearance of [3H]BNP across the BBB was 0.154 ml/min/g brain, which was calculated from the elimination rate constant (2.52 x 10- 2 min- 1) and the distribution volume in the brain (6.11 ml/g brain). The efflux transport of [3H]BNP was inhibited by range from 32 to 64% in the presence of P-gp inhibitors. The present results suggest that BNP is transported from the brain across the BBB via a P-gp-mediated efflux transport system, at least in part.