Heart-lung transplantation for cystic fibrosis. 2: Outcome

Article Abstract:

Cystic fibrosis can result in respiratory failure, or irreversible impairment of lung function. Advanced lung disease in adults with cystic fibrosis can be treated by transplantation of the lungs and heart. Children with cystic fibrosis account for the majority of children referred for heart-lung transplantation. The outcomes of 11 children aged five to 15 years with cystic fibrosis who underwent heart-lung transplantation were assessed. The immune system was suppressed by medication to prevent rejection of the transplanted tissue. Immunosuppressive agents included cyclosporin, azathioprine, corticosteroids, and antithymocyte globulin. Six of the children survived between 1.5 and 23 months following transplantation and had improved quality of life. Lung function, as indicated by a measure known as mean forced expiratory volume at one second, improved from 25 percent of normal before the transplant to 73.5 percent of normal at six months after the transplant. Death occurred during the operation in one case, and deaths due to inflammation of the airways occurred at two, eight, and nine months after transplant in three cases. Death also arose as a result of inflammation of the mediastinum, the tissue between the lungs, at four months in one case. Ten of 15 patients who were accepted for transplantation but did not receive a transplant died. Complications included graft rejection in 10 cases, blockage of the intestines by feces in three cases, inflammation of the pancreas in one case, diabetes in four cases, and high blood pressure in one case. Rejection of the lung tissue occurred an average of 5.7 times for each patient in the first six months following transplantation. Lung infection developed infrequently, and most often involved the bacteria Pseudomonas aeruginosa. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Heart-lung transplantation for cystic fibrosis. 1: Assessment

Article Abstract:

Cystic fibrosis is a genetic disorders characterized by abnormal function of the pancreas, sweat glands, and respiratory tract. In 1988, the condition caused 41 deaths, mainly due to respiratory failure, among children aged one to 14 years in the United Kingdom. Respiratory failure can be treated by transplantation of the heart and lungs. Early studies suggest that the heart-lung transplantation can be successfully performed in children, and can be beneficial. Most children referred for heart-lung transplantation are suffering from cystic fibrosis. There is limited knowledge about the short-term survival following heart-lung transplantation. An assessment of 45 patients aged five to 15 years with cystic fibrosis, who had been referred for heart-lung transplantation, was conducted. The two main criteria for consideration for heart-lung transplantation included a life expectancy of less than two years and extremely poor quality of life in the absence of a transplant. Patients placed on a waiting list differed from those placed on a provisional list in terms of heart rate, ideal weight, severity of impairment of lung function, blood oxygen levels, ability to walk for a 12-minute period, and scores on tests specifically designed to evaluate children with cystic fibrosis. Psychological problems affected 55 percent of individuals and 50 percent of families. Twenty-six patients were accepted onto the waiting list, including 11 who received transplants after an average of 3.3 months of waiting. Ten patients died within 3.7 months of acceptance onto the waiting list, whereas five are still waiting to receive a transplant. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Long term follow up after inhalation of foreign bodies

Article Abstract:

The inhalation of foreign substances reaches a height in infancy and early childhood, a time when the lungs are especially sensitive to damage. Most studies have concentrated on the immediate complications of inhaling foreign objects; little is known about the long-term consequences. In a children's hospital and a tertiary referral center, 21 children were examined to determine the long-term results of treatment for foreign body inhalation. The results of chest X-rays and other tests that measure lung performance were analyzed. The incidence of a child inhaling a foreign body in the district hospital population was one in 14,000. Three of the 12 children reviewed there had abnormal chest X-rays and four had abnormalities of tests that indicate how well the lungs are receiving oxygen (V/Q lung scans). Eight of the 21 children reviewed at the referral center had abnormal chest X-rays and 14 had abnormal V/Q lung scans. Factors that were important in determining the child's prognosis were: the site in the lung where the foreign body impaction occurred, the child's chest x-ray, and the duration of time before removal of the foreign object. Children who were at greatest risk of developing long-term complications were those who had inhaled the foreign object into their left lung and whose chest x-rays indicated a partial collapse of the lung. Children with these conditions should be closely monitored for evidence of long-term lung damage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Complications and side effects, Demographic aspects, Lung, Foreign bodies (Medical care), Foreign bodies

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