Chest
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Lung transplant is now an established modality for a broad spectrum of end-stage pulmonary diseases. According to the International Society for Heart and Lung Transplantation Registry, more than 50,000 lung transplants have been performed worldwide, with nearly 11,000 recipients of lung transplants alive in the United States. ⋯ Immunosuppression, infections, and a variety of medications and environmental exposures can contribute to these complications. This review aims to provide representative pictures and describe the pathogenesis, epidemiologic characteristics, and clinical manifestations of dermatologic complications encountered among recipients of lung transplants.
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Observational Study
CT-Based Low-Attenuation Super Clusters in 3D and the Progression of Emphysema.
Distributions of low-attenuation areas in two-dimensional (2-D) CT lung slices are used to quantify parenchymal destruction in patients with COPD. However, these segmental approaches are limited and may not reflect the true three-dimensional (3-D) tissue processes that drive emphysematous changes in the lung. The goal of this study was to instead evaluate distributions of 3-D low-attenuation volumes, which we hypothesized would follow a power law distribution and provide a more complete assessment of the mechanisms underlying disease progression. ⋯ Low-attenuation super clusters are defining, quantitative features of parenchymal destruction that dominate disease progression, particularly in advanced COPD.
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Hepatopulmonary syndrome (HPS) is characterized by an arterial oxygenation defect, defined by an increased alveolar-arterial oxygen gradient, induced by pulmonary vascular dilatations in the context of liver disease. The pathogenesis of HPS is poorly understood. Morphologic changes associated with HPS are unknown. This study aimed at describing imaging and pathology changes associated with HPS. ⋯ HPS is associated with intrahepatic vascular changes and with features suggesting severe portal hypertension. These results raise the hypothesis that intrahepatic vascular changes precipitate the development of HPS, opening new therapeutic perspectives for HPS.
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Case Reports
Tamibarotene for the Treatment of Bronchiolitis Obliterans Associated With Chronic Graft-vs-Host Disease.
Bronchiolitis obliterans (BO) is a significant life-threatening complication that occurs after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and it is associated with increased morbidity and mortality. BO responds poorly to corticosteroids or immunosuppressants, and there are currently no established treatment approaches. ⋯ Tamibarotene led to a dramatic improvement in lung function as well as cutaneous manifestations of chronic graft-vs-host disease. A large prospective clinical trial is therefore warranted to confirm the efficacy of tamibarotene in BO.