Transabdominal robot-assisted diaphragmatic plication: a 3.5-year experience.

Objectives: Diaphragmatic paralysis, a known cause of dyspnoea, can drastically reduce breathing efficiency, diminishing quality of life. We report our 3.5-year experience with 22 consecutive patients who underwent transabdominal, robot-assisted diaphragmatic plication for diaphragmatic paralysis.

Vena cava filter fracture with migration to the pulmonary artery.

Inferior vena cava filter (IVCF) placement has been recommended by clinicians for patients with venous thromboembolism who are at high risk for pulmonary embolism. There are a number of complications with IVCF insertion, removal, and migration that have been reported in the literature. Although those resulting from structural failure are rare, they can also be among the most critical.

Lung herniation after supraclavicular thoracic outlet decompression.

Lung herniation after first rib resection for thoracic outlet syndrome (TOS) has not been reported to our knowledge. We present a unique case of cervical lung herniation causing displacement of the brachial plexus and chronic pain in a patient who had previously undergone supraclavicular thoracic outlet decompression with first rib resection. This was successfully treated with thoracoscopic reduction and resection of the herniated lung and pleural flap closure of the defect.

Impact of video-assisted thoracoscopic surgery on benign resections for solitary pulmonary nodules.

Background: Differentiating benign from malignant pulmonary lesions is an important part of surgical decision making. We reviewed our experience of resecting suspicious pulmonary nodules to test the hypothesis that the increased use of video-assisted thoracic surgery (VATS) has increased the resection rate of benign lesions.

Methods: A retrospective analysis was carried out on 3,217 patients who underwent resection for focal pulmonary lesions between 1995 and 2009.

Respiratory virus-induced dysregulation of T-regulatory cells leads to chronic rejection.

Background: Lower respiratory viral infections predispose to bronchiolitis obliterans syndrome (BOS). In addition, there is emerging evidence to support the role of autoimmunity in the pathogenesis of BOS. Because CD4(+)CD25(+)Foxp3(+) regulatory T-cells (Treg) control autoimmunity, we tested the hypothesis that respiratory virus-induced Treg dysfunction leads to BOS.

Pneumothorax, bullous disease, and emphysema.

This article addresses several distinct but related pulmonary conditions that are commonly referred to general thoracic surgeons for decision making and management. The management of various types of pneumothorax is reviewed, with particular attention to the selection of the appropriate level of surgical intervention. The related entities of bullous lung disease and diffuse emphysema are discussed, with a focus on the identification of appropriate circumstances for surgical intervention.

Recurrent subcutaneous air of the face and neck.

Subcutaneous air of the face and neck can be seen after trauma to the lungs, airway, and esophagus. We present a case of a 29-year-old with recurrent subcutaneous air of the face and neck with minimal pneumomediastinum. In this report, we discuss the workup of this patient and review the literature regarding self-inflicted causes.

Immunological link between primary graft dysfunction and chronic lung allograft rejection.

Background: Primary graft dysfunction (PGD) in the immediate post-lung transplant period strongly increases the risk of chronic rejection (broncholitis obliterans syndrome). Here, we hypothesized that PGD-induced inflammation augments alloimmunity, thereby predisposing to broncholitis obliterans syndrome.

Methods: Primary graft dysfunction and broncholitis obliterans syndrome were diagnosed according to the established International Society for Heart and Lung Transplantation criteria.

Role of airway epithelial injury in murine orthotopic tracheal allograft rejection.

Background: Murine tracheal transplantation is a model used to study bronchiolitis obliterans syndrome, a major cause of morbidity and mortality after lung transplantation. Unlike murine heterotopic tracheal transplants, orthotopic transplantation does not cause luminal obliteration despite major histocompatibility antigen mismatch. Repopulation of the tracheal allografts with recipient-derived epithelium confers protection against luminal obliteration.

Respiratory viral infection in obliterative airway disease after orthotopic tracheal transplantation.

Background: The long-term survival after human lung transplantation is limited by bronchiolitis obliterans syndrome (BOS). Clinically, community-acquired respiratory viral infections have been correlated with an increased incidence of BOS. The goal of this study was to investigate the role of respiratory viral infections in chronic lung allograft rejection using the murine orthotopic tracheal transplantation model.

IL-12 p80 is an innate epithelial cell effector that mediates chronic allograft dysfunction.

Rationale: Bronchiolitis obliterans syndrome is the leading cause of chronic lung allograft dysfunction. We have demonstrated that respiratory viral infection is a bronchiolitis obliterans syndrome risk factor and virus-dependent injury induces expression of innate airway epithelial genes belonging to the interleukin (IL)-12 family. Thus, we hypothesized that epithelial cell IL-12 family members could mediate lung allograft dysfunction.

Animal models for bronchiolitis obliterans syndrome following human lung transplantation.

Lung transplantation is the only viable treatment option that can improve survival and enhance the quality of life of patients with end-stage lung diseases such as emphysema, cystic fibrosis, idiopathic pulmonary fibrosis, and primary pulmonary hypertension. However, the long-term survival of lung allografts is still limited by the development of bronchiolitis obliterans syndrome (BOS), an irreversible condition unresponsive to therapy. BOS is the most significant cause of long-term morbidity and mortality after lung transplantation.

Molecular mechanisms of chronic rejection following transplantation.

Although significant advances have been made in the field of organ transplantation, chronic rejection remains a major limiting factor for prolonged graft survival. The long-term survival and function of transplanted lungs are limited by the development of bronchiolitis obliterans syndrome (BOS). The 10-yr lung graft survival rate is only 18.

Immune mechanisms in the pathogenesis of bronchiolitis obliterans syndrome after lung transplantation.

Lung transplantation is recognized as the only viable treatment option in a variety of end-stage pulmonary diseases. However, the long-term survival after lung transplantation is limited by the development of obliterative bronchiolitis, and its clinical correlate bronchiolitis obliterans syndrome (BOS), which is considered to represent chronic lung allograft rejection. Histopathologically, BOS is an inflammatory process that leads to fibrous scarring of the terminal and respiratory bronchioles and subsequent total occlusion of the airways.

Cut it out: Managing hepatic abscesses in patients with chronic granulomatous disease.

Background: Hepatic abscesses develop in patients with chronic granulomatous disease (CGD) because the liver is a site of constant bacterial challenge. The authors investigated the roles of drainage and hepatic resection in the management of liver abscesses in CGD patients.

Methods: Medical records of CGD patients with hepatic abscesses from 1990 to 2001 were reviewed.