Background: COVID-19 can cause severe respiratory failure and acute respiratory distress syndrome (ARDS). Lung transplantation is a potentially lifesaving treatment for patients with COVID-19–associated ARDS, but uncertainty still surrounds patient selection and timing of referral. Study objective: To identify factors associated with recovery (weaning from ECMO and intensive care unit discharge) versus death of patients with covid-19-associated ARDS on Extracorporeal Membrane Oxygenation (ECMO) listed for lung transplantation. Methods: Retrospective review of all consecutive cases referred to our center and listed for lung transplantation between January and December 2021. Factors associated with recovery versus death while on the waitlist were assessed. Results: Sixteen patients were included in the study: 2 underwent a lung transplant, 8 recovered, and 6 died. The median time on the transplant wait list was 20 days. Patients who recovered were significantly younger (47 vs. 58) with a trajectory towards decreased time on ECMO (71.5 vs. 83.5) and a longer time interval between hospital admission and initiation of mechanical ventilation (7 vs. 2.5 days), ECMO (9 vs. 4 days) or listing for transplant (75 vs. 56.5 days). Conclusions: Although the question regarding which of the patients on ECMO due to COVID-19 ARDS needs lung transplant remains unanswered, it appears that younger patients are more likely to recover without transplant even after a prolonged period on ECMO.

In this unique environment of both recipients and donors'; young donors transplanted into young recipients had the best survival at 1-year post-transplant. Once, using older donors the survival at 1-year post-transplant was reduced regardless if transplanted into young or old recipients. Future analysis, should address the concept claiming that using old lungs is better than no lungs in a large scale multi center studies.

Single lung transplant recipients may develop complications in their native lung that have a significant impact on outcomes. Among the most serious complications requiring native lung pneumonectomy are infection and malignancy. There is a little data on safety of pneumonectomy after lung transplantation even the native lung usually has a minimal contribution to the overall lung function. The purpose of this study was to assess our institutional experience of native lung pneumonectomy in single-lung transplant recipients and determine its safety, short and long term complications and a impact on survival and lung function. A retrospective review of all single-lung transplant recipients at our institution from May 1, 1997 to September 1, 2014 who underwent native lung pneumonectomy. During the study period 350 patients underwent single lung transplantation. Nine of these patients developed significant native lung complication requiring pneumonectomy (table 1). Seven patients underwent Right and two patients Left Pneumonectomy for Lung Cancer (7/9) and Infection (2/9). Four patients died in the perioperative period (7 days) from severe cardiovascular complications (3) and sepsis (1). Five patients survived post-operative period to hospital discharge without postoperative complications. Four of these five developed significant deterioration in lung function without evidence of infection, airway complication or acute rejection on trans-bronchial lung biopsy. In our experience native lung pneumonectomy is associated with high morbidity and mortality and may reveal to significant negative impact on lung function. Additional studies are needed to better understand the underlying mechanism of lung function deterioration.

The prognosis of patients with non-small cell lung cancer (NSCLC) is important, as patients with resectable disease and poor prognostic variables might benefit from neoadjuvant therapy. The goal of this study is to evaluate SUVmax, SUVmax ratio, CT volume (CTvol), metabolic tumour volume (MTV) and total lesion glycolisis (TLG) as survival prognostic markers. In addition, we defined two variables; MTV x SUVmax (MTVmax) and CTvol x SUVmax (CTvolmax) and assessed whether they can be used as prognostic markers.

Stereotactic radiation therapy (SBRT) has become the standard therapy for non-operative treatment of early stage lung cancer. In centrally located tumors the appropriate dose and fractionation is not known. RTOG 0813 has studied this question in a dose escalation study. We sought to report our institutional experience at the highest dose level of 12 Gy × 5. We retrospectively reviewed the full records of patients treated with SBRT for central lung tumors (<2 cm of the carina) with IRB approval. Patients included both primary NSCLC as well patients with recurrence following surgery and/or conventional radiation therapy. All patients, underwent 4D-CT simulation and treatment planning was done with IMRT or VMAT techniques. Dose fractionation was 12 Gy × 5 prescribed to the 95% of the PTV. RTOG normal tissue constraints were used, with the exception of that no constraints were placed on the trachea or major airways. All patients were followed with PET/CT at 2 months and CT or PET at 3-4 month intervals thereafter. 71 patients, between 5/09 to 4/13, were treated. Median age was 71, 88% had biopsy proven disease. 33 patients had undergone previous thoracic radiation therapy and 15 had prior thoracic resection. . The median lesion diameter was 2.8 cm (Max 8 cm) and the median GTV volume was 13.59 cc (Max 372 cc). With a median follow-up time of 21 months the local control rate is 97%. At two months 46% had a metabolic CR, 37% had metabolic PR and 19% had stable disease on PET. 7% of patients developed radiation pneumonits, (no grade 4 or 5 events). One patient who had previous surgery and radiation therapy developed esophageal bleeding after SBRT 4 months after treatment that was fatal. Overall survival is 24 months (95% CI 18.8: 27.3). SBRT is safe and effective at the 12 Gy × 5 dose level for central lung lesions. Local control and response are highly encouraging.

The shortage of organs for lung transplantation has led to the growing use of "marginal" donors. Although patients on hemodialysis are still excluded as lung transplant donors because of the possible effects of renal failure on the lungs, recent data suggest that they may be suitable in selected cases. This article describes the successful transplantation of two lungs from a single donor who had been receiving long-term hemodialysis treatment. In the absence of other causes of pulmonary diseases, such as smoking or lung infection, lungs from dialysis-dependent patients may be acceptable for lung transplantation.

Background: Itraconazole is often given for fungal prophylaxis to lung transplant recipients after transplantation. The aim of this study was to determine the extent of interaction between tacrolimus and itraconazole in lung transplant recipients and the efficacy of itraconazole prophylaxis.Methods: The study group included 40 lung transplant recipients followed for at least 12 months. All received prophylactic itraconazole, 200 mg twice a day, for the first 6 months after transplantation. Tacrolimus levels and dosage requirements were compared (luring and after itraconazole therapy. Rejection rate, fungal infection rate, and renal function were assessed. The mean cost per daily treatment of the itraconazole/tacrolimus combination and tacrolimus alone was calculated.Results: The mean tacrolimus dose during itraconazole treatment was 3.26 +/- 2.1 mg/day compared with 5.74 +/- 2.9 mg/day after itraconazole was stopped (p < 0.0001) for a mean total daily dose elevation of tacrolimus of 76%. When the cost of itraconazole was taken into account, the average total daily cost of the combined treatment was US$5.86 less than the treatment with tacrolimus alone. No differences in the rejection or fungal infection rate, or in renal toxicity, were observed between the periods with and without itraconazole treatment, although less positive fungal isolates were identified during itraconazole therapy.Conclusion: Prophylaxis therapy with itraconazole is highly effective. Itraconazole reduces the dose of tacrolimus and therefore lowers the cost of therapy without causing an increase in rejection rate and with renal function preservation.

Tracheobronchial injuries are rare among all age groups and are extremely rare among the pediatric age group. Yet, the incidence has seemed to increase. Most of these patients die before reaching the hospital from severe associated injuries. Isolated bronchial injury is even more rare than tracheal injury, and it is the focus of the present study. A retrospective national survey was conducted among all tertiary referral and trauma centers in Israel regarding the period between the years 1983 and 1998. Only six cases (3 males and 3 females) of isolated bronchial rupture were found the throughout the country. Ages of the patients ranged from 2 to 14 years; all were involved in motor vehicle accidents, four of them as pedestrians. Ruptures occurred in the bronchus intermedicus (2 cases), left and right main bronchus (2 cases each). All but one patient went through primary repair. We give a full description of the procedure and discuss the literature regarding incidence, diagnosis, treatment, and outcome.

Short-term improvement in lung function was observed in 5 of 6 lung transplant recipients with bronchiolitis obliterans syndrome (BOS) who were treated with oral azithromycin. We assessed the long-term effect (mean duration 10 months) of treatment with oral azthromycin in 11 lung transplant recipients with BOS. Mean forced expiratory volume in 1 second (FEV1) was 40 +/- 9% at initiation of azithromycin treatment, 39 +/- 10% after I month, 39 +/- 12% after 4 months, 38 +/- 10% after 7 months and 38 +/- 10% after 10 months, respectively (statistically non-significant for all data). We conclude that long-term administration with oral azithromycin does not reverse BOS in lung transplant recipients, but may slow progression of the disease.

The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 months, range 6 – 18 months) and value of transaxillary single-port thoracic sympathectomy using a thoracoscope with an operating channel for the treatment of hyperhidrosis. Between December 1992 and October 2002, 176 consecutive patients (94 men, 82 women, mean age 21 years) with hyperhidrosis underwent thoracoscopic sympathectomy via a 12-mm single-port approach. Data on postoperative morbidity and outcome were analyzed to validate the technique. Mean operative time per side was 9 min; there was no conversion to an open procedure. Ninety-five percent of the patients were discharged the next day. Thirty-day mortality was zero. Complications included unilateral transient Horner’s syndrome ðn ¼ 1Þ; residual pneumothorax requiring chest drainage from the port entry ðn ¼ 4Þ; and segmental atelectasis of the lung ðn ¼ 4Þ which was treated conservatively. Complete relief of symptoms was observed in all patients at the 6-month follow-up; 45% experienced compensatory hyperhidrosis. Single-port thoracoscopic sympathectomy produces excellent medical and cosmetic results in patients with hyperhidrosis, and is associated with a short hospital stay and a low risk of complications. Overall satisfaction is high. A few patients may experience compensatory symptoms. q 2004 Elsevier B.V. All rights reserved.

Thymic cysts are rare lesions of the anterior mediastinum or neck. The majority are asymptomatic, and the remainder are associated mainly with symptoms of dysphagia or dyspnea. Diagnosis is difficult before surgery. Cervical thymic cysts are relatively rare; age at presentation ranges from the neonatal period to adulthood, and the most frequent presenting sign is a lateral neck mass. Mediastinal thymic cysts are more common and account for 1% of all mediastinal masses. They tend to occur in the older age group and are usually detected incidentally on chest X-ray film or computed tomography scans. Dysphagia and dyspnea are the main symptoms. We describe two brothers, aged 5 and 8 years, with mediastinal thymic cysts that presented as low cervical masses and review the embryology, diagnosis and management of thymic cysts.

PURPOSE: Long-term survival after lung transplantation is limited by the development of bronchiolitis obliterans syndrome (BOS). Recently, a pilot study reported an improvement in lung function in 5 of 6 lung transplant recipients with BOS treated with oral azithromycin. However, there are no available data on the long-term effect of macrolides in BOS.

Recipients of organ transplants are at increased risk for infection owing to their immunosuppressed state and the possibility of contamination of the donor organ. We report a case of multidrug resistant tuberculosis (MDR) transmission via a donor lung. After medical treatment with four drugs had failed, the patient underwent right upper lobectomy. There were no signs of disease on follow up more than 2 years later. To our knowledge, this is the first report of MDR tuberculosis in a lung transplant recipient. The need for a non-conservative approach, including pulmonary resection, to eradicate the infection is emphasised.

OSTTRANSPLANT diabetes mellitus (PTDM) has gained widespread attention due to the micro- and macrovascular complications that increase the morbidity and mortality rates of patients receiving solid organs. A higher incidence of PTDM has been associated with immunosuppressive therapy. This study compares glucose metabolism in heart transplant recipients receiving either FK506 or cyclosporine. METHODS Two groups of heart transplant recipients, differing in their immunosuppressive regimen—FK506 or cyclosporin—were followed for periods up to 6 years. Blood levels of glucose and of the respective immunosuppressive agent were measured regularly, and, if needed, anti-hyperglycemic treatment prescribed. The concomitant therapy with low-dose steroids and azathioprine was the same for both cohorts. T-test were performed to compare with the mean values of the two groups. RESULTS

Inflammatory myofibroblastic tumor is a rare solid tumor that most often affects children and young adults. Although benign, the tumor may be very aggressive locally. We describe a 9-year-old boy with primary inflammatory myofibroblastic tumor of the left upper lobe involving the left atrium.