Proceedings of the American Thoracic Society
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Immunosuppression remains the mainstay of therapy for successful outcomes after lung transplantation. The need for optimal immunosuppression became evident to maintain long-term graft survival and to navigate the delicate balance between infection and rejection. ⋯ This review will discuss both the current immunosuppressive medications that are used as well as different therapeutic combinations that are currently employed. In addition, we will discuss the current literature regarding the efficacy of these agents in lung transplantation.
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Review
Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis.
Overall survival rates of lung transplantation have improved since the first human lung transplantation was performed. A decline in the incidence of airway complications (AC) had been a key feature to achieve the current outcomes. Several proposed risk factors to the development of airway complications have been identified, ranging from the surgical technique to the immunosuppressive regimen. ⋯ Also, medical management, like antibiotic prophylaxis and therapy for endobronchial infections, or noninvasive positive-pressure ventilation in case of bronchomalacia, are used to treat an AC. In some cases, different surgical approaches are occasionally required. In this article we review the risk factors, the clinical presentation, the diagnostic methods, as well as the management options of the most common AC after lung transplantation.
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Our purpose was to review the reported behavior and malignant risk of small noncalcified pulmonary nodules detected by computed tomography (CT). A review of published clinical guidelines and studies using CT scan for lung cancer screening was performed. Small pulmonary nodules are found in 5 to 60% of patients in published CT screening studies. ⋯ The risk of malignancy for a single nodule appears to be low, but is increased by serial growth, diameter greater than or equal to 10 mm, and semisolid appearance. The role of PET in evaluating these nodules needs further exploration. Serial follow-up for 24 months in a high-risk cohort appears reasonable based on present data, but further longitudinal information is required.
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Since the introduction of multi-detector row computed tomography (MDCT), most attention has been directed toward the use of this technique to improve the characterization of anatomic changes at the level of the airways and lung parenchyma in patients with chronic obstructive pulmonary disease. The introduction of fast rotation speed and dedicated cardiac reconstruction algorithms exploiting the multislice acquisition scheme of the data has opened new possibilities for thoracic imaging, starting with the possibility to integrate cardiac functional information into a diagnostic CT scan of the chest. ⋯ More recently, the introduction of dual-source CT and its subsequent ability to apply dual energy to chest imaging has added another area of clinical interest at the level of the pulmonary capillary level. The purpose of this article is to review the potential applications of these technological developments in the population of patients with chronic obstructive pulmonary disease to provide a noninvasive depiction of the cardiovascular abnormalities known to occur in this subset of patients.
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This article provides a brief overview of the important issues influencing the effective use of quantitative X-ray computed tomography (QCT) in the assessment of the lung parenchyma in patients or research subjects with chronic obstructive pulmonary disease (COPD). This effort builds on an earlier workshop that was done in 2001. ⋯ Data storage, data transfer and data archival issues are reviewed. Current image processing techniques to derive meaningful quantitative measures of emphysema are also discussed.