Rev Pneumol Clin
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Lung transplantation has become an established treatment for end-stage pulmonary failure refractory to medical management. However, the scarcity of lung grafts and the growing number of candidates has led to an increase in deaths among patients on waiting lists. Despite improvements in donor management, organ preservation, and the use of marginal and cardiac death donors, only about 20% of candidate lungs are currently being transplanted. ⋯ Given the longer storage times provided by this technique, transplantation can be programmed, with better surgical efficiency. A new mobile organ-care machine is currently under evaluation. In near future, a pilot laboratory will be created and dedicated to ex vivo reconditionning of all lung grafts before transplantation and grafts will be sent to lung transplant centers after immunologic cross-matching.
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Lung transplant (LT) is a valid treatment for patients with end-stage lung disease such as cystic fibrosis, emphysema, pulmonary fibrosis and pulmonary arterial hypertension (85% of indications) and for selected candidates. The "good recipient" was introduced early to a specialised center, has had complete pre-LT assessment and complete information. ⋯ Death without LT prognosis criteria are still studied, and even if they do not fully define the risk of death of an individualised patient, they are taken into account by the recommendations of the societies; since 2006, LT indications are based on severity criteria of the selected patient, defined for each recipient diagnosis. LT aims to improve survival and quality of life of the patient, and this is especially true when the patient is referred, prepared and monitored early enough by the transplant team; the aim is to limit the risk of death before LT (before listing and on waiting list) and early post-LT morbimortality.
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We report the case of a 57-year-old patient admitted for dyspnea and dry cough. Thoracic radiograph showed a right pneumothorax and right paracardiac opacity. Thoracic drainage was carried out allowing the return of the lung at the wall. ⋯ Death occurred one month after diagnosis confirmation. Pneumothorax is a usual mode of revealing sarcoma's pulmonary metastases; however, it is exceptionally associated with primitive pulmonary sarcomas. Our case is the second published case, to our knowledge, of primitive pulmonary leiomyosarcoma presenting with pneumothorax.
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Gas exchange abnormalities occur firstly during sleep in restrictive and obstructive chronic respiratory failure. Nocturnal hypoxemia is often a revealing feature of a sleep-related hypoventilation/hypoxemia syndrome in patients who will have later a diurnal hypoxemia. On the other hand, sleep may induce breathing abnormalities in individuals without lung diseases, like in obstructive sleep apnea syndrome (OSAS). ⋯ These features are believed to be related to both sleep fragmentation and nocturnal hypoxia/hypercapnia. Sleep-related hypoventilation/hypoxemia and pharyngeal obstructive events may occur together in patients with respiratory insufficiency, especially in obese and/or chronic obstructive pulmonary disease (COPD) subjects. A correct qualitative and quantitative assessment of sleep-disordered breathing may only be performed by recording specific physiological signals during sleep.