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Cyclical recruitment of atelectasis with each breath is thought to contribute to ventilator-associated lung injury. Extrinsic positive end-expiratory pressure (PEEPe) can maintain alveolar recruitment at end exhalation, but PEEPe depresses cardiac output and increases overdistension. Short exhalation times can also maintain end-expiratory recruitment, but if the mechanism of this recruitment is generation of intrinsic PEEP (PEEPi), there would be little advantage compared with PEEPe. In seven New Zealand White rabbits, we compared recruitment from increased respiratory rate (RR) to recruitment from increased PEEPe after saline lavage. Rabbits were ventilated in pressure control mode with a fraction of inspired O2 (FɪO2) of 1.0, inspiratory-to-expiratory ratio of 2:1, and plateau pressure of 28 cmH2O, and either 1) high RR (24) and low PEEPe (3.5) or 2) low RR (7) and high PEEPe (14). We assessed cyclical lung recruitment with a fast arterial Po2 probe, and we assessed average recruitment with blood gas data. We measured PEEPi, cardiac output, and mixed venous saturation at each ventilator setting. Recruitment achieved by increased RR and short exhalation time was nearly equivalent to recruitment achieved by increased PEEPe. The short exhalation time at increased RR, however, did not generate PEEPi. Cardiac output was increased on average 13% in the high RR group compared with the high PEEPe group (P < 0.001), and mixed venous saturation was consistently greater in the high RR group (P < 0.001). Prevention of end-expiratory derecruitment without increased end-expiratory pressure suggests that another mechanism, distinct from intrinsic PEEP, plays a role in the dynamic behavior of atelectasis. [ABSTRACT FROM AUTHOR]

Arya B, Hussian S, Hariharan S.Rhodococcus equipneumonia in a renal transplant patient: a case report and review of literature.Clin Transplant 2004 DOI: 10.1111/j.1399-0012.2004.00276.x© Blackwell Munksgaard, 2004Immunocompromised patients are susceptible to many pathogens, including those that are predominantly problems in veterinary medicine. We report a case of a 42-yr-old white male who presented 19 months post-cadaveric renal transplant (for IgA nephropathy) with a 5 d history of nausea, vomiting, abdominal cramping and diarrhea. Admission chest X-ray revealed a suspicious mass lesion in the left lower lobe.Computed tomography (CT) guided biopsy of the lesion showed a large zone of CD68 +ve histiocytes in a non-caseating granuloma. Gram stain revealed multiple gram-positive rods within the histiocytes, which were eventually identified asR. equi. After 4 months of therapy with fluoroquinolones (Avelox) and Azithromycin a repeat CT showed complete resolution of the lesion. We reviewed the literature with special focus on the clinical features, challenges in diagnosis, and treatment of this rare infection (especially in the transplant patients who are also on immunosuppressive therapy). [ABSTRACT FROM AUTHOR]

Porretti L, Coluccio E, Prati D, Colombo MB, Lopa R, Tombolini P, Ambrosone A, Crespiatico L, Scalamogna M, Rebulla P. Flow-cytometric approach to the prompt laboratory diagnosis of TRALI: a case report. Eur J Haematol 2004: 73: 295–299. © Blackwell Munksgaard 2004. Objectives: Transfusion-related acute lung injury (TRALI) is a rare but serious complication which can occur after transfusion of blood components. In this report we describe our flow-cytometry approach to the laboratory diagnosis of a case of TRALI in a recipient of fresh frozen plasma containing human leukocyte antigen (HLA) class II antibodies. Methods: The post-transfusion reaction work-up included the direct and indirect Granulocyte Immunofluorescence Test (GIFT) on the recipient's neutrophils collected before and after the reaction and on the serum from the recipient and from all implicated donors; flow-cytometry bead-based screening and identification assay for HLA class I and II antibodies in donor sera and flow cytometry cross-matching on T and B patient's lymphocytes. Finally, we investigated the reactivity of one donor serum, containing HLA class II antibodies, with the patient's neutrophils activated in vitro to induce expression of HLA class II. Results: We found an increased level of IgG bound on patient's granulocytes collected after TRALI, in the absence of detectable granulocyte and HLA class I antibodies in the five implicated donors. One of them showed HLA-DR 1 and -DR 51 antibodies, which determined a positive cross-match with patient's B lymphocytes and in vitro activated granulocytes. Both HLA class II antigens were present in the recipient and absent in the donor. Conclusions: In some pathological conditions, HLA class II antibodies can react with activated granulocytes expressing HLA-DR antigens, and activate TRALI reaction. HLA class II antibodies screening and flow cytometry cross-matching techniques should be added to the current diagnostic algorithm of TRALI. [ABSTRACT FROM AUTHOR]

Kalambokis G, Stefanou D, Arkoumani E, Tsianos E. Bronchiolitis obliterans organizing pneumonia following chlorambucil treatment for chronic lymphocytic leukemia. Eur J Haematol 2004: 73: 139–142. © Blackwell Munksgaard 2004. A 70-yr-old man developed cough, chest pain, hemoptysis and a pulmonary infiltrate shortly after initiation of treatment with chlorambucil for chronic lymphocytic leukemia. Chlorambucil was discontinued and an open lung procedure was performed with complete excision of the pulmonary lesion. The biopsy specimens showed histological alteration consistent with the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). There was no evidence of other known causes usually associated with BOOP. The patient recovered completely after surgery. This report suggests that BOOP must be considered in the differential diagnosis of respiratory symptoms and pulmonary infiltrates in patients treated with chlorambucil. [ABSTRACT FROM AUTHOR]

Buxhofer-Ausch V, Ruckser R, Kier P, Habertheuer KH, Zelenka P, Tatzreiter G, Ausch C, Schmid I, Hruby W, Reiner-Concin A, Sebesta C, Ogris E, Hinterberger-Fischer M, Hinterberger W. A rare case of interstitial pneumonitis after tandem high-dose melphalan conditioning and autologous stem cell transplantation in multiple myeloma. Eur J Haematol 2004: 73: 143–146. © Blackwell Munksgaard 2004. A 57-yr-old woman with multiple myeloma received an autologous tandem transplant at a 4-month interval. She was conditioned twice with 225 mg/m2 melphalan. After the second transplant, interstitial pneumonitis (IP) ensued. The clinical course was life threatening and mechanical ventilation was required for 32 d. All attempts to identify an infectious agent failed. A presumptive diagnosis of idiopathic IP, possibly related to melphalan toxicity, was made. High-dose methylprednisolone administration led to rapid and durable improvement. Melphalan was employed for conditioning in the tandem setting with an interval of only 3–4 months between two courses or a dose elevation to 225 instead of 200 mg/m2, may have induced IP which responded favorably to methylprednisolone. [ABSTRACT FROM AUTHOR]

Kalambokis G, Stefanou D, Arkoumani E, Kitsanou M, Bourantas K, Tsianos EV. Fulminant bronchiolitis obliterans organizing pneumonia following 2 d of treatment with hydroxyurea, interferon-α and oral cytarabine ocfosfate for chronic myelogenous leukemia Eur J Haematol 2004: 73: 67–70. © Blackwell Munksgaard 2004. A 65-yr-old man developed increasing dyspnea and fulminant respiratory failure 48 h after introduction of hydroxyurea, oral cytarabine ocfosfate (YNK01) and interferon- α for treatment of Philadelphia chromosome-positive chronic myelogenous leukemia. The chest radiograph showed bilateral patchy infiltrates while computed tomography revealed multiple bullas, ground glass opacities, and patchy consolidations with possible cavitation. Bronchoscopic examination was normal and microbiological tests performed on all biologic fluids were negative. The patient did not respond to multiple antibiotic treatment and corticosteroid administration and died of progressive respiratory failure 5 d after chemotherapy introduction. The postmortem lung examination was consistent with the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). [ABSTRACT FROM AUTHOR]

A 38-year-old cadaveric kidney transplant recipient presented with fever, pneumonia, and mesenteric lymphadenopathy 9 months after transplant. Blood culture, bone marrow culture, and fine-needle aspiration cytology of mesenteric lymph nodes confirmed the diagnosis of disseminated Penicillium marneffei infection. He recovered after receiving parenteral amphotericin B followed by oral itraconazole therapy. P. marneffei infection is a dimorphic fungal opportunistic infection endemic in Southeast Asia, southern China, Taiwan, and Hong Kong. It has been well reported in human immunodeficiency virus (HIV)-positive patients in the endemic areas, and also in other immunocompromised patients. This diagnosis must be considered for all febrile transplant recipients who have the relevant clinical features and travel history to Southeast Asia. Prompt treatment with anti-fungal therapy improves the survival and outcome of these patients. [ABSTRACT FROM AUTHOR]

We report the case of a 24-year-old woman with cystic fibrosis in whom spondylodiscitis developed after bilateral sequential transplantation. The diagnostic work-up included magnetic resonance imaging, computed tomography-guided disk biopsy, histological examination, and cultures of disk specimens. The infective organism was D group Streptococcus and the patient was successfully treated with intravenous piperacillin followed by oral ampicillin. To our knowledge, this is the first reported case of spondylodiscitis after lung transplantation. [ABSTRACT FROM AUTHOR]

Reviews the incidence and characteristics of pulmonary infections caused by `Mycobacterium avium' complex over a 10-year period among patients without predisposing conditions. Study details; Results; Conclusions.

This article presents information regarding the book "Doctor Dock: Teaching and Learning Medicine at the Turn of the Century," by H.W. Davenport. Davenport's book reproduces selected passages from a unique source. At the turn of the century George Dock was Professor of Theory and Practice of Medicine at the University of Michigan. He held a teaching clinic for medical students twice a week, and for nine years he had a secretary make a shorthand record of the interactions between Dock, his students, and the patients. The typed transcripts of these notes amount to some 6000 pages, held by the university of Michigan. Davenport has published a selection of extracts from that voluminous cache of transcripts. Davenport's own choice and arrangement of the extracts does not reflect any particular perspective on the history of medical knowledge, practice or education. The extracts are collected under medically defined categories, cardiovascular problems, kidney trouble, tuberculosis, typhoid fever etc., etc. He imposes little by way of explicit interpretative framework. The extracts are preceded by a chapter introducing Dock, who was a physician of broad education, and a friend of the more famous Osler.

Reviews the book "Organizing the Breathless: Cotton Dust, Southern Politics, and the Brown Lung Association," by Robert Botsch.

The article reviews the book "Pulmonary Pathophysiology: The Essentials," 7th edition, by John B. West.

Starkman H, Das S. Cystic fibrosis presenting as new onset diabetes mellitus in adolescent twins. We describe identical adolescent twin girls who presented with symptoms consistent with type 1 diabetes. Medical work up for evaluation of gastrointestinal symptoms led to a diagnosis of cystic fibrosis (CF) in both. These cases suggest that diabetes can be a presenting symptom of CF in the absence of pulmonary symptomatology. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy is a rare form of heart failure that occurs during pregnancy or in the postpartum period with an etiology yet to be clarified. Approximately 20 percent of women with the disorder either die or survive only because they receive cardiac transplants. Postpartum, heart failure due to systolic dysfunction of the left ventricle might be caused by a combination of three main factors, a change in blood circulation after surgery, during the early postpartum period, endothelial dysfunction induced by preeclampsia and cardiac damage due to beta-stimulant drugs.

Reviews the book "Coping With Chronic Obstructive Pulmonary Disease," by Elaine Fantle Shimberg.

Reviews the book "Occupational Lung Diseases," 2nd ed., by W. K. P. Morgan and A. Seaton.

Reviews the book "The Chronic Bronchitis and Emphysema Handbook," by Francois Hass and Sheila Sperber Haas.

A course of seven video lectures on pulmonary pathophysiology has been placed on the internet. This is a companion to the course on respiratory physiology available at http://meded.ucsd.edu/ifp/jwest/. That course dealt with normal respiratory physiology, and the new lectures are about the function of the diseased lung. The topics covered include pulmonary function tests, chronic obstructive pulmonary disease, asthma and localized airway obstruction, restrictive lung diseases, pulmonary vascular diseases, environmental or industrial lung diseases (with a short section on neoplastic and infectious diseases), and respiratory failure. Although it could be argued that PhD physiologists do not have a responsibility for teaching pathophysiology, collaborative teaching has become increasingly common in medical schools where, for example, a pulmonary block includes both normal respiratory physiology and some pulmonary pathophysiology. It is hoped that these lectures will be useful to physiologists in that setting. [ABSTRACT FROM AUTHOR]

The article reviews the book "Thoracic Imaging," by Michael Galanski, part of the book series "Direct Diagnosis in Radiology."

The article reviews the book "Molecular Basis of Pulmonary Disease: Insights From Rare Lung Disorders," edited by Francis X. McCormack, Ralph J. Panos, and Bruce C. Trapnell, part of the book series "Respiratory Medicine."

The article reviews the book " Pulmonary Arterial Hypertension and Interstitial Lung Diseases: A Clinical Guide," edited by Robert P. Baughman, Roberto G. Carbone, and Giovanni Bottino.

This article reviews the DVD release "Anatomy of a Puff," produced by Human Relations Media.

The article reviews the book "The Pulmonary Epithelium in Health and Disease," edited by David Proud.

The article reviews the book "Color Atlas and Text of Pulmonary Pathology," 2nd edition, edited by Philip T. Cagle.

The article reviews the book "The Comfort of Home for Chronic Lung Disease: A Guide for Caregivers, " by Maria M. Meyer and Paula Derr, with Mary E. Gilmartin.

The article reviews the book "Fishman's Pulmonary Diseases and Disorders," 4th edition, edited by Alfred P. Fisherman, Jack A. Elias, Jay A. Fishman, Michael A. Grippi, Robert M. Senior, Allan I. Pack

The article reviews the book "Diffuse Parenchymal Lung Disease," volume 36, edited by U. Costabel, R.M. du Bois, and J.J. Egan.

The article reviews the books "Diffuse Lung Disease: A Practical Approach," edited by Robert P. Baughman, Roland M. du Bois, Joseph P. Lynch and Athol U. Wells and "Pulmonary Circulation: Diseases and Their Treatment," edited by Andrew J. Peacock and Lewis J. Rublin.

The article reviews the book "The Burden of Lung Disease," second edition.

Reviews the book "Color Atlas and Text of Pulmonary Pathology," edited by P. T. Cagle.

Reviews the book "Baum's Textbook of Pulmonary Diseases," edited by James D. Crapo, Jeffrey Glassroth, Joel B. Karlinsky and Talmadge E. King Junior.

Reviews the book "Principles of Pulmonary Medicine," 4th ed., by Steven E. Weinberger.

Reviews the book "Life and Breath," by Neil Schachter.

Reviews the book "Chronic Obstructive Pulmonary Disease," 2nd edition (2003), edited by P. Calverley, W. MacNee, N. Pride and S. Rennard.

Reviews the book 'The Lung: Molecular Basis of Disease,' by Jerome S. Brody.

Reviews the periodical `Clinical Pulmonary Medicine,' edited by Michael S. Niederman.

Reviews the book "Immunologically-mediated Pulmonary Disease," edited by J. P. Lynch and R. A. De Remee.

Reviews the book 'Occupational Lung Disease,' edited by Wm. Keith C. Morgan and Anthony Seaton.