Search

Summary: Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. Funding: Medical Research Council of South Africa.

Summary: Background: We aimed to summarise the extent and nature of published research about eye health and eye health services in Pacific Island Countries and Territories since 1980. Methods: We searched Medline, EMBASE, Global Health and Cochrane Library to identify publications about eye health and eye health services in 22 Pacific Island Countries and Territories from 1 January 1980 to 26 January 2024. Study selection and data extraction were conducted by two reviewers independently. Findings: Of the 1610 publications identified, 180 were included. This research was most commonly conducted in Papua New Guinea (n = 52) or Fiji (n = 33) and focused on diabetic retinopathy (n = 29) or trachoma (n = 18), with few focused on cataract or refractive error. While eye health services research was common in the past, recent research focused on trachoma. The included research was largely undertaken and funded by people and organisations from Australia, Aotearoa New Zealand and the USA, though authors with Pacific affiliations is increasing. Interpretation: Few countries have up-to-date estimates of the prevalence of vision impairment or service coverage to enable evidence-informed planning. Increased effort is required to strengthen research capability to ensure research priorities in eye health are set by Pacific Peoples. Funding: The Fred Hollows Foundation New Zealand.

Summary: Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.

RESUMO: No presente estudo, os autores avaliaram a eficácia da terapêutica inalatória com iloprost (análogo estável da prostaciclina) efectuada durante o período de um ano em doentes com Hipertensão Pulmonar (HTP) severa, monitorizando, para tal, o grau de tolerância ao esforço físico e diversos parâmetros hemodinâmicos.Foram estudados 24 doentes com o diagnóstico de Hipertensão Pulmonar Primária refractária à terapêutica médica convencional, incluindo os blo- queadores dos canais de cálcio, que apresentavam uma grave limitação da sua capacidade de exercício físico â classes funcionais III/IV da New York Heart Association (NYHA). O grau de tolerância ao esforço foi determinado pela prova de marcha de 6 minutos e as variáveis hemodinâmicas por cateterismo cardíaco direito. Doentes com HTP secundária, bem como indivíduos com Insuficiência Cardíaca Direita grave sob terapêutica com catecolaminas foram excluídos.Após a diluição de 50 μg de iloprost em 5 ml de solução salina isotónica, este foi administrado utilizando um nebulizador ultrassónico, durante cerca de 10 a 15 minutos, do que resultou uma dose cumulativa de iloprost entre 14 a 17 μg. Imediatamente após a inalação e a cada 15 minutos no espaço de uma hora, foram avaliadas as variáveis hemodinâmicas, no sentido de determinar o efeito máximo atingido num curto intervalo de tempo após a inalação e registar temporalmente a resposta hemodinâmica. Todos os doentes iniciaram o tra-tamento com 100 μg/dia de iloprost distribuídos por 6 a 8 nebulizações com o intervalo de 2 a 3 horas (interrupção nocturna) de acordo com a informação obtida pelo cateterismo cardíaco direito efectuado anteriormente. Se a resistência vascular pulmonar diminuía mais de 20% em relação ao valor basal, mas retomava ao mesmo num período inferior a 60 minutos, o indivíduo era submetido a 8 inalações/dia. A dose foi aumentada até 150 μg em 6 doentes cujo grau de tolerância ao esforço não sofreu qualquer alteração após 3 meses de terapêutica.Os doentes foram reavaliados mensalmente em ambulatório tendo sido readmitidos aos 3 e 12 meses para determinação da capacidade de tolerância ao exercício e repetição do cateterismo cardía- co. A prova de marcha foi efectuada mais de 1 hora após a última inalação e o cateterismo antes da 1ª inalação diária, isto é, 10 a 12 horas após a última administração do iloprost.A idade média dos doentes era de 38±12 anos, sendo 15 do sexo feminino e estando20na classe III da NYHA e4na classe IV.A distância percorrida na prova de marcha aumentou cerca de 75±67 m, após 3 meses de tra-tamento, não ocorrendo alterações do valor atingido até ao fim do estudo em análise.Tendo em consideração os parâmetros hemodinâmicos basais (pressão arterial pulmonar, pressão auricular direita, resistência vascular pulmonar, volume de ejecção, débito cardíaco e saturação do O2 no sangue venoso misto) registou-se, também, uma melhoria significativa dos mesmos, após um ano de terapêutica com iloprost em aerossol. Observou-se diminuição das seguintes variáveis: pressão arterial pulmonar 7±8,7 mmHg (-12%); pressão auricular direita 3±4 mmHg, resistência vascular pulmonar 339±260 dym.sec. cm-5 (â3%). O volume de ejecção aumentou 9±16 ml (+20%), o débito cardíaco 0,6±1,3 l/min. (+16%) e a saturação de O2 no sangue venoso misto 5±8% (+8%). Após comparação da diminuição imediata da resistência vascular pulmonar desencadeada pela inalação de iloprost no início do estudo com o valor obtido antes da inalação do mesmo, após 12 meses de terapêutica, verificou-se que os doentes que apresentavam uma resposta inicial mais pro-nunciada tinham, também, uma maior probabilida-de de manterem a redução da resistência vascular pulmonar a longo prazo.O aumento deste último parâmetro foi, no entanto, detectado em 4 doentes, dos quais 2 conti-nuaram com o mesmo fármaco por via endovenosa, tendo sido submetidos, posteriormente, a transplante pulmonar. Apenas 1 doente não revelou quaisquer alterações hemodinâmicas com a tera-pêutica em discussão.O tratamento com iloprost em aerossol foi bem tolerado. O aparecimento da tosse durante a inalação foi comum nos primeiros dias, mas desapareceu espontaneamente até à 4a semana. Apenas 5 doentes revelaram flushing, cefaleias ou artralgias no final da nebulização, mas estes efeitos secundários foram ligeiros, não tendo sido necessário tratamento sintomático ou a interrupção da terapêutica. Não se verificaram, também, episódios de hipotensão ortostática. Contudo, a maioria dos doentes referiu alguma flutuação na sua tolerância ao esforço, a qual era, usualmente, maior logo após a inalação, deteriorandose progressivamente até à próxima administração. COMENTÃRIO: A Hipertensão Pulmonar Primária é uma patologia rara, progressiva que se caracteriza por uma pressão arterial pulmonar média, determinada por cateterismo cardíaco direito, superior a 25 mmHg em repouso, ou a 30 mmHg sob exercício, não atribuível a valvulopatia, doença coronária, cardio-patia congénita, patologia pulmonar crónica, conectivopatia ou doença tromboembólica crónica, entre outras causas.Embora não exista um tratamento curativo, têm sido desenvolvidos esforços significativos, na última década, para identificar qual a medida tera-pêutica mais eficaz a implementar nas situações de Hipertensão Pulmonar Primária com consequente melhoria do prognóstico da mesma.O transplante pulmonar constituiu, até alguns anos atrás, a única opção terapêutica nos indivíduos refractários ao tratamento médico convencional, com particular relevância para os bloqueadores dos canais de cálcio em altas doses, cujo uso pro-longado se traduz numa melhoria significativa da sobrevida destes doentes, facto este amplamente demonstrado em diversos estudos científicos.Em 1995 foi aprovada a utilização da prostaciclina â epoprostenol â por via endovenosa em doentes com HTP nas classes funcionais III e IV da NYHA no sentido de melhorar as alterações hemodinâmicas e a qualidade de vida destes indivíduos. O epoprostenol apenas pode ser administrado em perfusão contínua devido à sua semivida curta (3-5 min.), necessitando, para isso, de uma seringa perfusora portátil ligada a uma linha subcu-tânea até à veia subclávia (catéter de Hickman). As infecções, trombose ou anomalias de funcionamen-to da bomba infusora com subdosagem ou sobre-dosagem, constituem os efeitos secundários mais graves deste tipo de terapêutica, tendo os doentes que estar treinados na preparação da medicação e resolução dos problemas técnicos. à um fármaco instável à temperatura ambiente e fotossensível.Posteriormente, surgiram os análogos da prostaciclina de que é exemplo o iloprost, também utilízado por via endovenosa. Embora os resultados clínicos e hemodinâmicos sejam sobreponíveis aos obtidos com o epoprostenol, o iloprost tem como vantagens uma maior semivida (20-30 min.), ser estável em solução salina e à temperatura ambiente e não ser fotossensível.Ambos podem ser utilizados por via inalatória, o que constitui uma alternativa atraente, pois permite uma vasodilatação apenas de zonas pulmona-res bem ventiladas. No entanto, o iloprost apresenta uma maior facilidade de preparação e de arma-zenamento, o que o torna mais adequado para a terapêutica crónica.Outra vantagem da utilização do iloprost inalado sobre a administração endovenosa resulta de não requerer a inserção permanente de um catéter venoso central.Tal como Hoeper demonstrou no presente trabalho, também Olschewski confirmou que a terapêutica prolongada com iloprost em aerossol conduz a uma vasodilatação pulmonar selectiva, um aumento do débito cardíaco e uma melhoria da oxigenação venosa e arterial em doentes que apre-sentam deterioração progressiva, apesar da tera-pêutica convencional optimizada.No entanto, há algumas questões que ficam por esclarecer no trabalho de Hoeper e colaboradores. Será que, alterando o intervalo entre as inalações e/ou as doses de iloprost, se obteriam maiores benefícios? De salientar que nos estudos efectuados com epoprostenol endovenoso, as doses utilizadas foram aumentadas progressivamente, enquanto que Hoeper manteve constante a dose de iloprost inalado⦠Torna-se, assim, fundamental comparar os resultados a longo prazo entre a terapêutica endovenosa com epoprostenol e a administração por via inalatória de iloprost, pois esta última é substancialmente menos onerosa.O presente estudo permite-nos comprovar, pois, que o tratamento a longo prazo com iloprost em aerossol é eficaz na Hipertensão Pulmonar Primária em fase avançada, aumentando, desta forma, as opções terapêuticas disponíveis, mas, também, as incertezas em relação a qual a medida de 1ª linha a implementar nos indivíduos com esta patologia. Palavras-chave: Hipertensão Pulmonar Primária, análogos de prostaciclina, iloprost, via inalatória

Objective: To analyze patient and caregiver narratives addressing experiences related to substance use and substance use disorder (SUD)., Methods: Thirty audio-narratives from the MyPaTH Story Booth archive addressed substance use between 5/20/2016 and 2/24/21. Two coders established an average Cohen's kappa statistics of 0.81 over 16 stories. The primary coder coded and summarized additional narratives and conducted content and thematic analyses. The final analytic sample addressed perspectives of individuals with SUD, caregivers for individuals with SUD and individuals who have used opioids to manage pain., Results: Storytellers' average age was 51, 55 % were female and 85 % were white. Participants with SUD and caregivers described frustration with the current treatment system, reported limited treatment of SUD in medical settings, and noted relying on community-based groups for ongoing care. Individuals with chronic pain felt stigmatized and resented perceived restrictions on pain treatment due to the opioid epidemic., Conclusions: Unstructured narratives provide insights into the lived experiences of people impacted by SUD. Participants reported struggling with the effects of SUD and failing to find adequate treatment from the medical system. Stories highlight SUD-related stigma., Practice Implications: Understanding patient and caregiver perspectives related to SUD can be a critical step towards developing effective interventions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: Evidence shows many misconceptions exist around permanent contraception, and there are numerous barriers to accessing the procedure. This qualitative study explored physician perspectives regarding patients' informational and decision-support needs, the complexities and challenges of counseling and access, and how these factors may differ for people living on lower incomes., Study Design: We conducted 15 semistructured, telephone interviews with obstetrician-gynecologists in three geographic regions of the United States to explore their perspectives on providing permanent contraception counseling and care. We analyzed the interviews using content analysis., Results: Physicians discussed a tension between respecting individual reproductive autonomy and concern for future regret; they wanted to support patients' desire for permanent contraception but were frequently concerned patients did not have the information they needed or the foresight to make high-quality decisions. Physicians also identified barriers to counseling including lack of time, lack of continuity over the course of prenatal care, and baseline misinformation among patients. Physicians identified additional barriers in providing a postpartum procedure even after thedecision was made including lack of personnel and operating room availability. Finally, physicians felt that people living on lower incomes faced more challenges in access primarily due to the sterilization consent regulations required by Medicaid., Conclusions: Physicians report numerous challenges surrounding permanent contraception provision and access. Strategies are needed to support physicians and patients to enhance high-quality, patient-centered sterilization decision making and ensure that patients are able to access a permanent contraceptive procedure when desired., Implications: This qualitative study demonstrates the various challenges faced by physicians to support permanent contraception decision making. These challenges may limit patients' access to the care they desire. This study supports the need to transform care delivery models and improve the federal sterilization policy to ensure equitable patient-centered access to desired permanent contraception., Disclaimer: Although the term permanent contraception has increasingly replaced the word sterilization in clinical settings, we use sterilization in some places throughout this paper as that was the standard terminology at the time the interviews were conducted and the language the interviewed physicians used., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Robust data on the outcome of MET-aberrant NSCLC with nontargeted therapies are limited, especially in consideration of the heterogeneity of MET-amplified tumors (METamp)., Methods: A total of 337 tumor specimens of patients with MET-altered Union for International Cancer Control stage IIIB/IV NSCLC were analyzed using next-generation sequencing, fluorescence in situ hybridization, and immunohistochemistry. The evaluation focused on the type of MET aberration, co-occurring mutations, programmed death-ligand 1 expression, and overall survival (OS)., Results: METamp tumors (n = 278) had a high frequency of co-occurring mutations (>80% for all amplification levels), whereas 57.6% of the 59 patients with MET gene and exon 14 (METex14) tumors had no additional mutations. In the METamp tumors, with increasing gene copy number (GCN), the frequency of inactivating TP53 mutations increased (GCN < 4: 58.2%; GCN ≥ 10: 76.5%), whereas the frequency of KRAS mutations decreased (GCN < 4: 43.2%; GCN ≥ 10: 11.8%). A total of 10.1% of all the METamp tumors with a GCN ≥ 10 had a significant worse OS (4.0 mo; 95% CI: 1.9-6.0) compared with the tumors with GCN < 10 (12.0 mo; 95% confidence interval [CI]: 9.4-14.6). In the METamp NSCLC, OS with immune checkpoint inhibitor (ICI) therapy was significantly better compared with chemotherapy with 19.0 months (95% CI: 15.8-22.2) versus 8.0 months (95% CI: 5.8-10.2, p < 0.0001). No significant difference in median OS was found between ICI therapy and chemotherapy in the patients with METex14 (p = 0.147)., Conclusions: METex14, METamp GCN ≥ 10, and METamp GCN < 10 represent the subgroups of MET-dysregulated NSCLC with distinct molecular and clinical features. The patients with METex14 do not seem to benefit from immunotherapy in contrast to the patients with METamp, which is of particular relevance for the prognostically poor METamp GCN ≥ 10 subgroup., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: While some attention has been paid to men's contraceptive use and attitudes in international contexts, relatively little is known about the attitudes towards contraception and pregnancy of low-income, urban men in the U.S., Study Design: We conducted semi-structured interviews with 58 low-income men in Pittsburgh, PA, to explore their perspectives on contraception, pregnancy, fatherhood, and relationships. We analyzed the interviews using a combination of content analysis, the constant comparison method, and thematic analysis., Results: Men who we interviewed frequently described feeling that they lacked agency regarding when pregnancies occurred and whether or not they became fathers. Several factors contributed to their sense of low agency, including the belief that women should control contraception and reproduction, a reluctance to have conversations about contraception in some contexts, a lack of acceptable male-controlled contraceptive methods, experiences with pregnancy-promoting behaviors by women, and fatalistic attitudes towards pregnancy occurrence., Conclusions: Many men in our study described perceptions of limited reproductive agency. In describing their lack of agency, men reinforced contemporary gender norms in which the "work" of pregnancy prevention is a woman's responsibility. Responses to men's perceived limited reproductive agency should work towards deconstructing gendered norms in the work of pregnancy prevention and promote shared and mutual gender responsibility over reproduction while also supporting women's reproductive autonomy., Implications: This study identifies several factors that contribute to low-income men's sense of low reproductive agency and highlights the complexity of acknowledging men's feelings and perceptions about reproductive control in the broader context of gender and power., (Copyright © 2018. Published by Elsevier Inc.)

Spatial heterogeneity is an inherent property of any living environment and is expected to favour biodiversity due to a broader niche space. Furthermore, edges between different habitats can provide additional possibilities for species coexistence. Using computer simulations, this study examines metacommunities consisting of several trophic levels in heterogeneous environments in order to explore the above hypotheses on a community level. We model heterogeneous landscapes by using two different sized resource pools and evaluate the combined effect of dispersal and heterogeneity on local and regional species diversity. This diversity is obtained by running population dynamics and evaluating the robustness (i.e., the fraction of surviving species). The main results for regional robustness are in agreement with the habitat heterogeneity hypothesis, as the largest robustness is found in heterogeneous systems with intermediate dispersal rates. This robustness is larger than in homogeneous systems with the same total amount of resources. We study the edge effect by arranging the two types of resources in two homogeneous blocks. Different edge responses in diversity are observed, depending on dispersal strength. Local robustness is highest for edge habitats that contain the smaller amount of resource in combination with intermediate dispersal. The results show that dispersal is relevant to correctly identify edge responses on community level., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Simple Western is a new technology that allows for the separation, blotting, and detection of proteins similar to a traditional Western except in a capillary format. Traditionally, identity assays for biological products are performed using either an enzyme-linked immunosorbent assay (ELISA) or a manual dot blot Western. Both techniques are usually very tedious, labor-intensive, and complicated for multivalent vaccines, and they can be difficult to transfer to other laboratories. An advantage this capillary Western technique has over the traditional manual dot blot Western method is the speed and the automation of electrophoresis separation, blotting, and detection steps performed in 96 capillaries. This article describes details of the development of an automated identity assay for a 15-valent pneumococcal conjugate vaccine, PCV15-CRM197, using capillary Western technology., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Within pharmaceutical industry charge heterogeneity testing of biopharmaceuticals has to be reproducible and fast. It should pass method validation according to ICH Q2. Classical approaches for the analysis of the charge heterogeneity of biopharmaceuticals are ion exchange chromatography (IEC) and isoelectric focusing (IEF). As an alternative approach, also capillary zone electrophoresis (CZE) was expected to allow reliable charge heterogeneity profiling by separation according to the analyte's net charge and hydrodynamic radius. Aim of this study was to assess if CZE possesses all of the required features. Therefore, beside lab internal validation of this method also an international cross company study was organized. It was shown that CZE is applicable across a broad pI range between 7.4 and 9.5. The coefficient of correlation was above 0.99 which demonstrated linearity. Precision by repeatability was around 1% (maximum relative standard deviation per level) and accuracy by recovery was around 100% (mean recovery per level). Accuracy was further verified by direct comparison of IEC, IEF and CZE, which in this case showed comparable %CPA results for all three methods. However, best resolution for the investigated MAb was obtained with CZE. In dependence on sample concentration the detection limit was between 1 and 3%. Within the intercompany study for CZE the same stressed and non-stressed samples were analyzed in each of the 11 participating labs. The finally obtained dataset contained more than 1000 separations which provided an extended dataset for further statistical evaluation. Among the different labs no significant differences between the peak profiles were observed. Mean driver for dropouts in quantitative evaluation was linked to the performance of some participating labs while the impact of the method performance was negligible. In comparison to a 50cm capillary there was a slightly better separation of impurities and drug substance related compounds with a 30cm capillary which demonstrates that an increased stability indicating potential can be combined with the increased separation velocity and high throughput capability of a shorter capillary. Separation can be performed in as little as approx. 3min allowing high throughput applications. The intercompany study delivered precise results without explicit training of the participating labs in the method prior to the study (standard deviations in the range of 1%). It was demonstrated that CZE is an alternative platform technology for the charge heterogeneity testing of antibodies in the pharmaceutical industry., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Regular preoperative application of corticosteroids has been considered as a contraindication to lung transplantation for fear of an increased risk of postoperative morbidity and mortality. Recently, however, we have accepted patients for transplantation in whom treatment with steroid medication could not be terminated preoperatively. Up to February 1991, 27 unilateral and bilateral transplantations in 26 patients were analyzed. Corticosteroid therapy was discontinued at least three months prior to transplantation in 13 patients (group 1), whereas in 14 cases, the patients continued their daily corticosteroid therapy to the time of transplantation (prednisolone, 0.1 to 0.3 mg/kg/day; group 2). There were no significant differences between the groups with respect to sex, age, diagnosis, or type of transplantation. One limited bronchial dehiscence occurred; the incidence of postoperative bronchial stenosis was identical in both cohorts; one patient died in each group. In conclusion, no increased morbidity or mortality could be found following lung transplantation with regular preoperative administration of prednisolone up to 0.3 mg/kg/day. Thus, patients who cannot be weaned from their steroid medication but who otherwise are acceptable candidates should not be excluded from lung transplantation.

Pulmonary rejection and infection are the most important complications after lung transplantation. To evaluate the diagnostic value of pulmonary function testing for early detection and discrimination of these complications, seven heart-lung recipients were examined. The diagnosis of each complication was confirmed by clinical and laboratory findings including transbronchial biopsies and bronchoalveolar lavage. Eight episodes of rejection, ten episodes of viral infection and six episodes of bacterial pneumonia were analyzed. Pulmonary rejection was associated with a significant fall in the FEV1/IVC% and the FEF50%. In viral infection, the most impressive finding was a reduction in the DCO, whereas no obstructive or restrictive airway dynamics were observed. During bacterial pneumonia, pulmonary function measurement revealed a decrease in IVC without signs of obstructive airway dynamics. Adequate treatment resulted in reconstitution of pretreatment values. Assessment of lung function provides valuable information for the diagnosis of pulmonary complications following HLTx.