The Annals of thoracic surgery
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Review
Diffuse pulmonary infiltrates after bone marrow transplantation: the role of open lung biopsy.
Diffuse pulmonary infiltrates is the major complication and cause of mortality after bone marrow transplantation. We analyzed the etiologies and prognostic factors in bone marrow recipients with diffuse pulmonary infiltrates and assessed the role of open lung biopsy in managing this complication. ⋯ Among bone marrow recipients, we found diffuse pulmonary infiltrates in 20% and a mortality rate of 50%. Idiopathic interstitial pneumonitis and cytomegalovirus pneumonitis were the most common causes and should be suspected in patients with diffuse interstitial infiltrates. In endemic areas, miliary tuberculosis should be suspected in bone marrow recipients with diffuse reticulonodular lesions. Respiratory failure and acute graft-versus-host disease were poor prognostic factors. By establishing a correct diagnosis, open lung biopsy led to treatment changes in about two-thirds of these patients.
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There is a dire need, especially in emergent societies, for a mitral substitute that does not require anticoagulation, and is not affected by early degeneration. ⋯ We believe the pulmonary autograft is a good mitral substitute at the disposal of cardiac surgeons, especially when patients are young and when life anticoagulation is contraindicated or impractical.