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Background: Ventilation‐perfusion (VQ) scintigraphy and lung function testing are often used to assess allograft function after single lung transplantation (SLTX). However, it is unknown whether allograft defects on VQ scintigraphy presage all‐cause mortality after SLTX. Objective: To investigate whether allograft defects on VQ scintigraphy portend poorer lung function and increased mortality after SLTX. Methods: We retrospectively identified 45 consecutive patients in which a VQ scintigraphy was performed as part of the routine workup 12 weeks after SLTX. VQ scintigraphies were scored for matched and mismatched perfusion defects in the allograft. Lung function testing was performed according to established guidelines six months after SLTX. Time to all‐cause mortality was the endpoint. Results: 19 (42%) patients had matched VQ defects. After a median follow‐up of 4.1 (IQR 1.5–7.9) years since SLTX, 35 (78%) had died. Those with matched defects in the allograft had lower diffusing capacity (mean 42 [SD 14] versus mean 54 [SD 18] % of predicted, p <.05) and increased mortality (univariable HR 2.06, 95% CI: 1.05–4.06, p =.04). However, in multivariate analysis, only lower post‐transplantation diffusing capacity remained associated with mortality (HR 1.08, 95% CI: 1.02–1.30 per % lower diffusing capacity of predicted, p =.003). Conclusion: In SLTX patients, a lower diffusing capacity appeared to explain the increased mortality among those with matched VQ defects in the allograft. [ABSTRACT FROM AUTHOR]

Purpose Right ventricular dysfunction ( RVD) is an important prognostic factor of 30-day mortality in patients with acute pulmonary embolism ( PE). The aim of our study was to evaluate whether non-electrocardiogram ( ECG)-gated cardiovascular parameters attained during computed tomography pulmonary angiography ( CTPA) could predict RVD in patients suspected of PE using ECG-gated cardiac CT angiography as reference. Methods Consecutive patients suspected of PE were referred to a ventilation/perfusion single-photon emission tomography (V/Q- SPECT) as first-line imaging procedure. Patients had a V/Q- SPECT/ CT, a CTPA and an ECG-gated cardiac CT angiography performed the same day. Results A total of 71 patients were available for analysis. Seventeen patients (24%) had RVD. The non- ECG-gated dimensions of left and right ventricle and the major vessels were correlated with ECG-gated cardiac dimensions. The size of the pulmonary trunk could identify patients with RVD: AUC (0·67, 95% confidence intervals ( CIs) 0·52-0·82) as seen in the ROC curve ( P<0·05). With a cut-off value of the pulmonary trunk of 29 mm, the sensitivity and specificity were 70·6% and 55·5%, respectively. The positive predictive and negative predictive values for detection of RVD were 59·1% and 85·7%, respectively. Conclusion In the present study, we demonstrated correlation between ECG-gated cardiac dimensions and non- ECG-gated cardiovascular parameters, however with only moderate diagnostic accuracies. We demonstrated that the dimension of the pulmonary trunk might be of value in detection of patients with RVD. We suggest further studies on the potential value of non- ECG-gated cardiac dimensions in patients suspected of PE. [ABSTRACT FROM AUTHOR]

Introduction The aim is to describe the importance of leakage monitoring in hyperthermic isolated limb perfusion ( ILP). It is generally recommended that leakage should not exceed 10% because of risk of systemic toxicity. Material and methods Data retrieved by retrospective analysis of 131 perfusions performed in 115 consecutive patients (77 women and 38 men; median age 66 years) with recurrent and/or clinically apparent, cutaneous or subcutaneous melanoma metastases in an extremity. Radionuclide monitoring was performed with continuous, precordial count rate determinations of an intravascular 99mTc-labelled tracer infused into the isolated limb circulation. Results One hundred and sixteen of 131 procedures were completed. In 13%, a leakage of ≥10% was detected; in 6% ( n = 8), the cytotoxic drug was never infused because of constant leakage; in 7% ( n = 9), leakage ≥10% was measured during the perfusion resulting in two perfusions being terminated before 30 min, 5 perfusions were considered completed though with early termination (after 30 min, before 60 min), and 2 fully completed. No patients had systemic toxicity requiring treatment, whereas considerable or serious local toxicity were observed in 14%. Three of the patients with leakage ≥10% were successfully treated in a repeated procedure. Conclusion Leakage monitoring using a threshold of 10% during ILP saves the patients from systemic toxicity, however, at the expense of early termination or cancellation of ILP treatment in a few patients and repeated ILP procedures in some. [ABSTRACT FROM AUTHOR]

Mucociliary clearance has long been known to be a significant innate defence mechanism against inhaled microbes and irritants. Important knowledge has been gathered regarding the anatomy and physiology of this system, and in recent years, extensive studies of the pathophysiology related to lung diseases characterized by defective mucus clearance have resulted in a variety of therapies, which might be able to enhance clearance from the lungs. In addition, ways to study in vivo mucociliary clearance in humans have been developed. This can be used as a means to assess the effect of different pharmacological interventions on clearance rate, to study the importance of defective mucus clearance in different lung diseases or as a diagnostic tool in the work-up of patients with recurrent airway diseases. The aim of this review is to provide an overview of the anatomy, physiology, pathophysiology, and clinical aspects of mucociliary clearance and to present a clinically applicable test that can be used for in vivo assessment of mucociliary clearance in patients. In addition, the reader will be presented with a protocol for this test, which has been validated and used as a diagnostic routine tool in the work-up of patients suspected for primary ciliary dyskinesia at Rigshospitalet, Denmark for over a decade. [ABSTRACT FROM AUTHOR]

Objective To investigate the development of lung function in HIV-infected patients. Methods In a prospective cohort study, 88 HIV-infected patients had a lung function test performed and 63 patients (72%) had their LFT repeated with a median follow-up period of 4·4 years. Forty-eight per cent were smokers, and at the re-examination, 97% were on combination antiretroviral therapy. Results Carbon monoxide diffusion capacity was reduced and decreased over time in both smokers and non-smokers. Alveolar volume decreased and forced vital capacity increased similarly in both smokers and non-smokers. No changes were observed in forced expiratory volume or peak flow, but smokers had reduced values compared with those of the non-smokers at both examinations. FEV1/ FVC was reduced especially in smokers and declined in both smokers and non-smokers. Conclusions Carbon monoxide diffusion capacity is reduced in HIV-infected patients and seems to decline over time. Additionally, signs of obstructive lung disease are present in HIV-infected patients and seem to increase over time, although only modestly. [ABSTRACT FROM AUTHOR]

Summary Background: Recent research supports the efficacy of various plasma biomarkers in diagnosing pulmonary embolism (PE) including E-selectin, MMP-9, MPO, sVCAM-1, sICAM-1, adiponectin, hs-CRP and tPAI-1. Objective: We hypothesized that these biomarkers, which are affected in both venous and arterial thromboembolic diseases, have a limited potential of diagnosing PE in patients with concomitant coronary atherosclerosis, as assessed from a low-dose CT scan of the thorax, compared to patients without atherosclerosis. Methods: Consecutive patients suspected of PE were referred. All patients had a ventilation/perfusion single photon emission tomography (V/Q-SPECT), low-dose pulmonary CT, pulmonary multidetector computer tomography angiography, blood samples and ECG-gated cardiac CT performed the same day. Results: A total of 69 patients were included, of which 28 (41%) had PE. In patients without coronary calcium, MMP-9 and tPAI-1 were significantly elevated ( P<0·042 and P<0·049) in patients diagnosed with PE. From the receiver operating curves, we chose a cut-off value for MMP-9 at 164·4 ng l−1, which yielded sensitivity, specificity, positive and negative predictive values of 63%, 78%, 71% and 70%, respectively. With a chosen cut-off value for tPAI-1 at 56·3 ng l−1, the sensitivity, specificity, positive and negative predictive values were 88%, 89%, 88% and 89%, respectively. In patients with coronary calcium, none of the biomarkers could discriminate between PE and no PE. Conclusion: Plasma levels of tPAI-1 and MMP-9 are potentially useful in patients suspected of PE, however, not in the presence of the coronary atherosclerosis. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE). Methods: Patients suspected of PE had a ventilation/perfusion-single-photon emission-tomography (V/Q-SPECT), pulmonary multidetector computer tomography (MDCT) angiography, blood samples and ECG-gated cardiac CT performed the same day. Results: Pro-ANP, BNP and D-dimer are associated with significantly elevated levels in PE patients with RVD. ROC curves demonstrated that D-dimer, pro-ANP and BNP were accurate for detection of RVD. Conclusion: Because measurements of cardiac biomarkers are inexpensive and easily obtained they may prove useful in the clinical diagnosis of RVD. However because of the small sample size, the results need to be confirmed in larger studies. [ABSTRACT FROM AUTHOR]

In 29 chronic obstructive pulmonary disease (COPD) patients and nine lung healthy volunteers, above the age of 50 years, ventilation defects were examined by81mKr planar scintigraphy and81mKr single photon emission computed tomography (SPECT) to investigate if SPECT adds information regarding size and extent of visually scored ventilation defects, and to correlate the extent of defects obtained from the two imaging settings with standard pulmonary function tests performed in these patients/volunteers. For testing the reproducibility of the visual defect score of81mKr scintigraphy additionally 13 patients suspected for pulmonary embolism or lung cancer were included. Each series of planar or SPECT studies were read for the extent (% abnormal lung) and severity (0–3) of ventilation abnormalities. Seventeen scans were read twice for reproducibility studies. The extent of ventilation defect assessed by81mKr SPECT was higher than by81mKr planar (slope of regression line 0·60,P<0·0001), likewise severity score (rank signed test:P<0·0001). Correlation between ventilation inhomogeneity and pulmonary function test (residual volume and TL,CO) in the COPD group revealed only significance for the SPECT acquisition. We found good reproducibility of visual assessment of ventilation defect extent (correlation: 0·97,P<0·0001) and severity (Kappa 0·62). In conclusion, visual scoring of extent and severity of ventilation defects was reproducible. Ventilation defects were better demonstrated with SPECT than planar imaging. The correlation to pulmonary function was better with SPECT than planar imaging. [ABSTRACT FROM AUTHOR]