Obliterative bronchiolitis (OB) is the main chronic complication after heart-lung (HLTx) and lung transplantation (LTx), limiting the long-term success of both transplant procedures.
Since 1981, 135 ...HLTxs and 61 isolated LTxs were performed in 184 patients at Stanford University.
The overall prevalence of OB in patients surviving longer than 3 months postoperatively was 64% after HLTx and 68% after LTx. The actuarial freedom from OB was 72%, 51%, 44%, and 29% at 1, 2, 3, and 5 years, respectively, after HLTx and LTx. An analysis of potential risk factors revealed that the frequency and severity of acute rejection episodes (
p < 0.001) and the appearance of lymphocytic bronchiolitis on biopsy (
p < 0.05) were significantly associated with the development of OB. With regard to diagnosis of OB, pulmonary function tests show early reductions of the forced expiratory flow between 25% and 75% of the forced vital capacity with subsequent decreases in the forced expiratory volume in 1 second. The sensitivity of transbronchial biopsies has increased to 71% since 1993. Current treatment consists of augmented immunosuppression. Concurrent acute rejection episodes or active OB on biopsy have been treated aggressively with high-dose steroid pulses. Analysis of data from 73 patients with OB after HLTx and LTx revealed actuarial 1-, 3-, 5-, and 10-year survival of 89%, 71%, 44%, and 17% versus 86%, 77%, 63% and 56% in patients without OB (
p < 0.05 by log-rank analysis). The main complication and cause of death in patients with OB was superimposed respiratory tract infection, which was treated aggressively.
Early diagnosis of OB using pulmonary function tests or transbronchial biopsy is possible and important, because immediate treatment initiation has led to acceptable survival rates, with nearly 50% of affected patients still alive 5 years after transplantation. Current experimental research on OB suggests that immune injury is the main pathogenetic event of airway obliteration in animal models; rapamycin and leflunomide are new immunosuppressive agents that may have the potential to prevent and treat airway obliteration.
Objectives: Partners or spouses of patients with cardiac arrhythmias were examined for mental and physical health. In addition, gender differences and other influential factors of well-being were ...analyzed. Methods: A total of 486 partners or spouses took part in a study which collected data on anxiety and depression (HADS-D) as well as quality of life (SF-12). The situation of the partners was correlated with social variables, psychological distress, and the physical and mental well-being of the patients. Results: Pathological anxiety was reported by 20 percent of the partners and 37 percent demonstrated notable values for depression. In comparison to healthy samples quality of life was diminished, especially in male subjects. There was a strong interconnection between the patient's psychological strain and that of his or her partner. Most important for the partner's physical quality of life was the patient's quality of life (18.4% explained variance). The partner's mental well-being was determined by his or her own psychological distress (31.1 % explained variance). Conclusion: Spouses and partners of patients with cardiac arrhythmias are highly impaired in their psychological well-being. This should be taken into account when dealing with medical care issues in such patients. It is therefore important to inform patients and their families in detail about the potential risks as well as the options for relatives' responses in arrhythmia-induced emergencies. Fragestellung: Das Befinden der Partner von Patienten mit Herzrhythmusstörungen wurde untersucht und Geschlechtsunterschiede sowie Einflussfaktoren auf das Befinden eruiert. Methode: 486 Partner wurden bezüglich ihrer Ängstlichkeit und Depressivität (HADS-D-D) sowie der körperlichen und psychischen Lebensqualität (SF-12) untersucht. Zusätzlich wurden Zusammenhänge mit sozialen Faktoren und dem körperlichen und psychischen Befinden der Patienten analysiert. Ergebnisse: 20 % der Partner zeigen pathologische Ängste, 37 % auffällige Depressivitätswerte. Die Lebensqualität ist im Vergleich zur Normalbevölkerung eingeschränkt, wobei Männer stärkere Einschränkungen aufweisen. Die psychische Belastung der Partner steht in enger Wechselwirkung mit der der Patienten. Am einflussreichsten hinsichtlich der körperlichen Lebensqualität der Partner erwies sich die Befindlichkeit der Patienten (18,4% Varianzaufklärung), bei der psychischen Lebensqualität war die eigene Befindlichkeit am bedeutsamsten (31,1 %). Diskussion: Partner von Patienten mit Herzrhythmusstörungen sind hinsichtlich ihrer Befindlichkeit deutlich belastet und müssen daher in der kardiologischen Versorgung stärker berücksichtigt werden. Wichtig ist hier die Aufklärung über potenzielle Risiken und die Unterstützungsmöglichkeiten bei Notfällen.
Partners or spouses of patients with cardiac arrhythmias were examined for mental and physical health. In addition, gender differences and other influential factors of well-being were analyzed.
A ...total of 486 partners or spouses took part in a study which collected data on anxiety and depression (HADS-D) as well as quality of life (SF-12). The situation of the partners was correlated with social variables, psychological distress, and the physical and mental well-being of the patients.
Pathological anxiety was reported by 20 percent of the partners and 37 percent demonstrated notable values for depression. In comparison to healthy samples quality of life was diminished, especially in male subjects. There was a strong inter-connection between the patient's psychological strain and that of his or her partner. Most important for the partner's physical quality of life was the patient's quality of life (18.4% explained variance). The partner's mental well-being was determined by his or her own psychological distress (31.1% explained variance).
Spouses and partners of patients with cardiac arrhythmias are highly impaired in their psychological well-being. This should be taken into account when dealing with medical care issues in such patients. It is therefore important to inform patients and their families in detail about the potential risks as well as the options for relatives' responses in arrhythmia-induced emergencies.
The purpose of this study was to investigate whether obliterative bronchiolitis might occur after xenogenic pulmonary transplantation. A model for obliterative airway disease (OAD) after tracheal ...allograft transplantation in the rat undergoes tracheal obliteration with histologic features characteristic of obliterative bronchiolitis in human lung transplant recipients. Using this model, the pathogenesis of OAD and its prevention with immunosuppressive drugs was studied in rat recipients of hamster tracheal grafts.
Tracheae from 30 hamsters (xenografts) or 23 Brown-Norway rats (allografts) were implanted and wrapped in the greater omentum of untreated Lewis rats. The grafts were removed on day 1, 3, 7, 14, 21, or 28 after transplantation and stained with hematoxylin and eosin and Masson's trichrome and by immunohistochemistry and immunofluorescence (IFL) techniques. In addition, 25 recipients were treated with cyclosporine (CsA, 10 mg/kg p.o.), leflunomide (LFM, 20 mg/kg p.o.), or rapamycin (RPM, 6 mg/kg i.p.) for 14 or 21 days (5 animals per treatment group). Visual and morphometric analyses were used to evaluate the extent of airway obliteration, luminal coverage by respiratory or flattened cuboidal epithelium, and extent and density of peritracheal cellular inflammation.
In all xenografts, a neutrophilic infiltration of the mucosa and submucosa was observed from day 1 until day 14 and was associated with complete loss of tracheal epithelium by day 14. A marked peritracheal mononuclear cellular infiltrate mixed with plasma cells and eosinophils was seen on days 7 and 14. Both the extent of peritracheal inflammation and the density of the mononuclear cell infiltrate were significantly increased in xenograft tracheae when compared with the allografts. Tracheal obliteration began on day 14 and reached a maximum of 43% on day 21 with evidence of intraluminal fibrosis. In contrast to IFL of allografts, IFL of xenografts demonstrated marked deposition of rat immunoglobulin in the peritracheal tissue on days 7 and 14. The effects of treatment with immunosuppressive drugs on tracheal graft narrowing and protection of respiratory epithelium were as follows: After 14 days of treatment, the percentage of tracheal graft narrowing was 12%, 23%, and 19% in the no treatment, CsA, and LFM groups, respectively; the percentage of respiratory epithelium at 14 days was 0%, 21%, and 95%. After 21 days of treatment, the percentage of tracheal graft narrowing was 43%, 49%, 12%, and 5% for the no treatment, CsA, LFM, and RPM groups, respectively; the percentage of respiratory epithelium at 21 days was 0%, 39%, 86%, and 0%. Using computerized morphometry, the extent and densities of the peritracheal cellular infiltrates were significantly reduced in LFM- and CsA-treated groups when compared with untreated xenograft controls. LFM and RPM, but not CsA, significantly reduced the degree of luminal obliteration compared with no treatment (P<0.05). LFM and, to a lesser extent, CsA were able to prevent the loss of normal respiratory epithelium. Analysis by IFL revealed a marked decrease in rat immunoglobulin deposition in xenografts from LFM- and RPM-treated groups compared with xenografts from CsA-treated or untreated rats.
(1) OAD occurs not only after tracheal allotransplantation but also after xenotransplantation. (2) Subepithelial infiltration of neutrophils and the appearance of plasma cells and eosinophils in the peritracheal infiltrates distinguished the histology of rejected xenografts from allografts. (3) Antibody deposition was detected by IFL only in xenografts. (4) Treatment with LFM or RPM significantly decreased the severity of luminal obliteration. Importantly, LFM also prevented the loss of respiratory epithelium.
Objectives: In a changing climate, flood disaster may not only threaten the health of the population, but may also interfere with the function of its health providers. Few data are available about ...hospital evacuation in these situations. Therefore, this study evaluated the effects of the emergency evacuation of the Dresden Heart Centre in August, 2002, due to the flood disaster along the Elbe, on its 168 critically ill patients, i.e. the patients' perceptions and their psychological stress. Materials and methods: A retrospective survey was started 1 month after the evacuation (T1) and a prospective follow-up study was carried out 6 months later (T2). The questionnaire consisted of a list of items related to the evacuation as well as standardized psychosocial tools - Hospital Anxiety and Depression Scale (HADS), Posttraumatic Symptom Scale (PTSS-10) and Impact of Event Scale (IES-R). A module of the Structured Clinical Interview (SCID) was applied to validate post-traumatic stress disorder (PTSD). In all, 147 patients were eligible for the study (conscious, non-ventilated, adequate mental status). Results: A total of 111 patients (75.5%) returned the questionnaire at T1. Of those, 72 patients completed the study after 7 months (T2); 64 patients underwent the SCID. Patients were mainly satisfied and felt safe during the evacuation. However, only 47% of them agreed with the amount of information passed on to their relatives. Anxiety and depression showed no significant alteration. PTSD and avoidance behaviour showed a higher prevalence compared with the general population (8.7% vs 6.5%, p<0.05). No correlation with cardiac diagnoses was observed. Conclusion: Emergency hospital evacuation of patients with cardiac diseases during a natural disaster such as a flood can be done safely without risking a PTSD in most of the patients independent of the underlying cardiac diagnosis. The data indicate that lack of broad information, both to the patients and their relatives in this setting, may be a relevant cause and promoter of anxiety and PTSD. Therefore special focus should be given to personalized care to prevent such apprehensive reactions. Sufficient information on the medical and current status of affected patients should be provided to both patients and their relatives in similar situations.
The aim of this cross-sectional study was to explore the psychological and physical well-being of patients with chest pain depending on availability cardiological disease (coronary heart disease, ...different cardiological disease, no cardiological disease, unclear diagnose).
In a total of 383 cardiological outpatients, anxiety and depression (HADS) as well as physical complaints (B-L) were assessed.
For half of the outpatients, no cardiological diagnose was found that explained the symptoms of chest pain. In comparison to the general population, outpatients with various cardiological symptoms exhibited a lower psychological and physical well-being independent of availability cardiological disease. 50.9% of the outpatients showed elevated anxiety scores, 35.2% showed elevated depression scores and 71.7% felt impaired by physical complaints. In comparison to males, females were more anxious and exhibited a lower physical well-being. In general, physical impairment increased with age, while anxiety decreased.
The present study discovered a very high psychological comorbidity in cardiological outpatients with chest pain that underlines the necessity of an integrated psychosomatic care regardless of clinical finding. In order to understand the symptom of chest pain it is not indicated to differentiate between cardiologically vs. psychologically ill patients.
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