Lung cancer after heart transplantation: a 17-year experience

Background

The effects of heart transplantation on lung cancer incidence in heart transplant recipients are unclear.

Methods

In an observational study, we retrospectively reviewed the charts of all patients undergoing heart transplantation at our institution from July 1982 to July 1999. Data on lung cancer incidence, risk factors, treatment, and outcome were collected.

Results

Five hundred seventy-two patients (mean age, 50 ± 11 years; range, 18 to 73) were considered at risk for lung cancer. Of these, 324 (57%) had a more than 20 pack-year history of smoking before transplantation. Lung cancer developed in 2 patients 1 year or less after transplantation and in 8 patients more than 1 year after transplantation (incidence, 2.2 per 1,000 patients per year of follow-up). Non-small cell lung cancer was diagnosed in all cases. Median survival was 10.8 months (range, 2 to 37.5). Routine annual chest radiographs after transplantation enabled early diagnosis in 5 cases (stages Ia and IIa), which correlated with better mean survival (28.1 months [range, 19 to 37.5] versus 5.1 months [range, 2 to 10.8]; p = 0.0002).

Conclusions

The incidence of lung cancer in our population of heart transplant recipients appears to be no higher than in nontransplant populations with similar risk factors (ie, smoking and age). Routine radiographic imaging of transplant recipients may allow earlier detection of lung cancer and thus offer a survival benefit.     

Ventricular Pseudoaneurysm after Transaortic Septal Myotomy for Hypertrophic Subaortic Stenosis

Clinical and morphological features are described in a man in whom a pseudoaneurysm arising from the ventricular septum developed after transaortic septotomy for hypertrophic subaortic stenosis. Pseudoaneurysm of the left ventricle or ventricular septum has not been described previously in a patient with hypertrophic cardiomyopathy in whom only the transaortic approach was utilized for septotomy or septectomy or both. In addition, no previous studies have reported pseudoaneurysm arising from the ventricular septum.     

Fluid and fibrosis in the human middle ear

Temporal bones from 12 cases of adult otitis media with effusion were studied for the process of fibrosis. There were three types of fibrotic courses, including total replacement of fluid and complete obliteration of middle ear spaces. Thus, the author concluded that effusion, tissue proliferation, fibrosis, and adhesions of the tympanic membrane are sequential findings of otitis media with effusion.     

Glucocorticoid receptors in human tumors

Glucocorticoid receptors were examined in a range of solid human tumors. In addition to breast carcinomas, subsets of other tumor types (notably renal cell carcinomas) contain concentrations of these receptors characteristic of glucocorticoid-responsive tissues. The physico-chemical properties of the single glucocorticoid receptor present in the human tumors resembled those of the glucocorticoid receptor in rat tumors and the pre-dominant form found in normal target tissues of the rat.     

Effect of triethyllead on protein synthesis in rat forebrain

Triethyllead (PbEt₃) inhibited both oxygen utilization and l-[U-¹⁴C]-leucine incorporation into acid-insoluble protein in a cell suspension prepared from 20-day-old rat forebrain. At the same concentrations of PbEt₃, protein synthesis was inhibited more than respiration. The cell-free protein synthesis studied in the cytopalsmic fraction was not affected by the neurotoxin. Thus, PbEt₃ does not directly interfere with the protein synthesizing systems and the observed inhibition is secondary to the suppression of the tissue oxidative metabolism.