Faculty Bibliography

OBJECTIVES: Posttransplant lymphoproliferative disorders (PTLD) can be a significant cause of morbidity in lung transplant (LT) recipients. Risk factors include Epstein-Barr virus (EBV) infection, particularly primary infection, and immunosuppression. This article updates the incidence and presentation of PTLD at our lung transplant program. METHODS: We retrospectively reviewed the immunosuppression, EBV serology, and cases of PTLD among 129 lung transplant recipients at risk who survived > 1 month. RESULTS: There were two cases of PTLD among 129 LT patients, 2/129 (1.6%). One of these patients was among the 6 EBV seroconverters, 1/6 (16.7%), and had a typical presentation of PTLD in the allograft resulting in dissemination and death. The second case of PTLD developed in an EBV seropositive recipient who presented 33 months following LT with isolated colonic involvement. He subsequently died from chronic rejection. CONCLUSIONS: The incidence of PTLD in a LT program with a large EBV seropositive population is low, 1.6%. The presentation of PTLD in LT recipients is variable and may present typically with allograft involvement in the first year following transplantation, or late with isolated, extrapulmonic involvement.

OBJECTIVES: Evaluate whether weight-loss diets are more effective than regular diets or other antihypertensive therapies in controlling blood pressure and preventing morbidity and mortality in hypertensive adults. SEARCH STRATEGY: MEDLINE and The Cochrane Library were searched through November 1997. Trials known to experts in the field were included through June 1998. SELECTION CRITERIA: For inclusion in the review, trials were required to meet each of the following criteria: 1) randomized controlled trials with one group assigned to a weight-loss diet and the other group assigned to either normal diet or antihypertensive therapy; 2) ambulatory adults with a mean blood pressure of at least 140 mm Hg systolic and/or 90 mm Hg diastolic; 3) active intervention consisting of a calorie-restricted diet intended to produce weight loss (excluded studies simultaneously implementing multiple lifestyle interventions where the effects of weight loss could not be disaggregated); and 4) outcome measures included weight loss and blood pressure. DATA COLLECTION AND ANALYSIS: Studies were dual abstracted by two independent reviewers using a standardized form designed specifically for this review. The primary mode of analysis was qualitative; graphs of effect sizes for individual studies were also used. MAIN RESULTS: Eighteen trials were found. Only one small study of inadequate power reported morbidity and mortality outcomes. None addressed quality of life or general well being issues. In general, participants assigned to weight-reduction groups lost weight compared to control groups. Six trials involving 361 participants assessed a weight-reducing diet versus a normal diet. The data suggested weight loss in the range of 4% to 8% of body weight was associated with a decrease in blood pressure in the range of 3 mm Hg systolic and diastolic. Three trials involving 363 participants assessed a weight-reducing diet versus treatment with antihypertensive medications. These suggested that a stepped-care approach with antihypertensive medications produced greater decreases in blood pressure (in the range of 6/5 mm Hg systolic/diastolic) than did a weight-loss diet. Trials that allowed adjustment of participants' antihypertensive regimens suggested that patients required less intensive antihypertensive drug therapy if they followed a weight-reducing diet. Data was insufficient to determine the relative efficacy of weight-reduction versus changes in sodium or potassium intake or exercise. REVIEWER'S CONCLUSIONS: Weight-reducing diets in overweight hypertensive persons can affect modest weight loss in the range of 3-9% of body weight and are probably associated with modest blood pressure decreases of roughly 3 mm Hg systolic and diastolic. Weight-reducing diets may decrease dosage requirements of persons taking antihypertensive medications.

Bronchiolitis obliterans (BO) is a fibrotic lung disease involving the small conducting airways. BO may be classified by etiology and underlying disease or, more commonly, by histopathological pattern. The two major histopathological categories are (1) BO organizing pneumonia (BOOP) and proliferative bronchiolitis and (2) constrictive bronchiolitis. The former is often idiopathic in nature and may also be associated with connective tissue diseases and inhalation injury. Characteristic findings on chest imaging include alveolar infiltrates and ground glass opacities and pulmonary function tests (PFTs) usually reveal restrictive dysfunction. Constrictive bronchiolitis is associated with organ transplantation, infections, connective tissue diseases, inhalation injury, and drugs and may also have an idiopathic origin. The radiographic characteristic is a mosaic pattern on high-resolution computed tomography (HRCT) and PFTs most often reveal obstructive dysfunction. This article will attempt to review constrictive BO, including histopathology, clinical presentation, radiographic appearance, and physiological findings, for both idiopathic diseases, as well as specific clinical-associated entities.