The gene product is dystrophin, which is a large cytoskeletal protein located at the cytoplasmic surface of the muscle plasma membrane (for a review of dystrophin, see Lapidos et al. The dystrophin gene is one of the largest genes known in humans and is composed of 79 exons. The model mdx mice series has been used to understand the pathomechanism and develop therapeutic strategies: for example, virus-mediated gene transfer, exon skipping, and gene boost of utrophin (for a review, see van Deutekom and van Ommen 2003). After the discovery of dystrophin, several transmembrane glycoproteins were identified (Campbell and Kahl 1989; Yoshida and Ozawa 1990). In dystrophin-deficient skeletal muscle, these components are concomitantly reduced from the muscle plasma membrane. The central rod domain of dystrophin consists of spectrin-like repeats and serves as the second site for actin binding (Rybakova et al. Importantly, the vascular dysfunction in these animals can be abolished by administration of verapamil (a calcium channel blocker with vasodilator properties), which presents a pharmacological intervention to prevent progression of cardiomyopathy (Cohn et al. Mutations in known or putative glycosyltransferase genes have been identified in patients with congenital muscular dystrophies. Genes responsible for dystroglycanopathies and their determined or putative function will be presented below. Fukuyama congenital muscular dystrophy is an autosomal recessive muscular dystrophy that is the most common congenital muscular dystrophy in Japan. A high population of patients carry this ancestral insertion, which may explain the high prevalence of this disease in Japan. Compound heterozygousity between retrotransposonal mutation and point-mutation results in a more severe phenotype than homozygous retrotransposonal mutation. The function of fukutin is unknown, but the protein has homologous to enzymes that modify glycolipids and glycoproteins (Aravind and Koonin 1999). On the other hand, targeted homozygous mutation of the fukutin gene in mice leads to embryonic lethality prior to development of skeletal muscle and mature neurons, and detailed analyses on the mutant embryos suggest that fukutin is necessary for the maintenance of the basement membrane function, which is required for early embryonic development (Kurahashi et al. According to its amino acid sequence and cellular localization study (Esapa et al. The mutation is an intragenic deletion, which causes a frame shift resulting in pre- mature termination. The Large gene encodes a protein with a transmembrane domain followed by a coiled-coil domain and two DxD-containing putative catalytic domains (Peyrard et al. Extracellular matrix proteins and receptors Skeletal muscle fibers are surrounded by an extracellular matrix called the basement membrane. The basal lamina is a felt-like layer that is directly linked to the plasma membrane. The basement membrane is believed to be involved in lateral force transmission of contractile force generated by the myofibrils and provides the tensile strength of the muscle structure. Accordingly, genetic evidence has revealed that congenital muscular dystrophies can arise from the loss of components in the extracellular matrix proteins and their membrane receptors. Laminin-2 (merosin, laminina2b1c1) is a major component of the skeletal muscle basal lamina. Laminin-2 presents the forms of a cross-shaped heterotrimer through the association of an a2-, a b1-, and a c1-chain, each of which is encoded by separate genes. Laminin-2 forms polymers through the short arm regions, and this laminin network adheres to the plasma membrane through the laminin globular domain in the a2-chain (Colognato and Yurchenco 2000). The dy2J mouse presents an in-frame deletion in the short arm region of the a2-chain, demonstrating that an incomplete lamininpolymer formation can lead to muscular dystrophy (Colognato and Yurchenco 1999). Thus, the laminin polymer scaffold appears to be necessary for the organization of the basement membrane and the interaction between the matrix and cell membranes, both of which are essential for maintenance of the skeletal muscle functions. Genetic interventions designed to inhibit the mitochondrial apoptotic pathway demonstrate an improvement of the disease pathology and lifespan of laminin-2-deficient mice (Girgenrath et al.
Levodopa should be started immediately to prevent the development of disabling rigidity. A 63-year-old man seeks medical attention because of progressive weakness of the left foot and lower leg over the last 6 months. The progression has been gradual, and he only noticed it initially because of cramping and tripping while playing squash. On physical examination, vital signs are normal and the only abnormalities are on neurologic examination. His left leg strength is notably diminished in the hip flexors, hip adductors, quadriceps, and calf muscles. There are no sensory abnormalities in light touch, pinprick, temperature, or proprioception. Cervical spondylosis Foramen magnum tumor Lead poisoning Multifocal motor neuropathy with conduction block Vitamin C deficiency an urgent care setting. Physical examination reveals a right arm that is more moist and hairy than the left arm. However, the right arm is clearly more edematous than the left, and the skin appears shiny and cool. A 42-year-old woman seeks medical attention for a 5- to 6-week history of marked fatigue that is affecting her work. She reports that she has felt some general fatigue but her symptoms are most notable when she starts moving around during the day. She reports no loss of consciousness, but does say that she feels lightheaded and has blurred vision after arising. She has no notable past medical history and takes no medications other than a calcium/vitamin supplement. On physical examination, her supine heart rate is 90 beats/min with blood pressure of 110/70 mmHg. Upon standing her heart rate increases to 130 beats/min and is regular, and her blood pressure standing is 115/75 mmHg. A 72-year-old woman presents with recurrent episodes of incapacitating facial pain lasting from second to minutes and then dissipating. The episodes occur usually twice per day, usually without warning, but are also occasionally provoked by brushing of her teeth. A 72-year-old female presents with brief, intermittent excruciating episodes of lancinating pain in the lips, gums, and cheek. He gives a history of having slipped on the ice and severely contusing his right shoulder approximately 6 months ago. Soon thereafter, he developed sharp, knifelike pain in the right arm and forearm that lasted for a few months. A 33-year-old woman presents with rapidly worsening pain at the top of the back over the last 3 days. A 17-year-old adolescent is seen in the clinic several weeks after he suffered a concussion during a highschool football game. At the time of the event, paramedics reported that he experienced no loss of consciousness but was confused for a period of about 10 minutes. He describes a generalized headache that is present all the time since his trauma, and he occasionally feels dizzy. His mother is concerned that he is having a hard time concentrating in school and seems depressed to her lately; she describes him as being very energetic prior to his concussion. She has noted progressive weakness in the lower extremities with loss of sensation "below the belly button" and incontinence. Physical examination is notable for a sensory level at the level of the umbilicus. There is no history of head trauma, prior neurologic or psychiatric disease, or family history of dementia.
Variations in the composition of breast milk among individual mothers can be quite dramatic. Some women will have relatively modest fat content in their milk, resulting in a caloric content as low as 9 to 10 calories per ounce. In contrast, other mothers produce rich, creamy breast milk, with a high fat content and a caloric density that may reach 30 calories per ounce. The concept of bioavailability, or the capacity to extract nutrients from food sources, is an important one. Because the composition of breast milk and that of formula differ, it is essential that the food substances, minerals, and vitamins in formula are accessible so that they can be utilized by the neonate. Term infants fed only breast milk beyond 6 months will rarely show evidence of iron deficiency anemia, even though the iron content of breast milk is lower than that of iron-fortified formula (0. Similarly, protein in breast milk is more bioavailable than protein in formula, and the concentration of protein in formula is correspondingly higher than the amount of protein in breast milk (formula contains approximately 2 to 2. Similar differences between formula and breast milk exist for other vitamins and minerals, as well, to overcome the reduced bioavailability in formula. Breast milk is composed of approximately 60% whey (lactalbumin) protein and 40% casein. When a mother first gets her milk supply, her breasts will feel significantly engorged, usually beginning on the second day after delivery. Placing the infant to the breast will allow the expression of the let-down reflex at this time. This response results in the formation of milk droplets on the nipple opposite from the the breast at which the baby is nursing. Although most term neonates take to nursing right away, some are a bit slower to master the technique. In addition, the nipple needs to be toughened gradually so that the mother does not experience any discomfort while nursing. Therefore the duration of nursing should be limited to 5 minutes at one breast before the infant nurses from the other breast. Many babies will initially need some encouragement to keep nursing because they fall asleep early in the feeding. A little bit of stimulation, such as gently rubbing the shoulders or face, or repositioning the infant will usually be adequate to prompt the baby to resume nursing. Ideally, in the first few days a newborn should have between 8 and 12 feedings per day. Once the milk supply is well established, the infant usually will gain interest in feeding. As that occurs, the time spent on each breast can be progressively increased, although a maximum of approximately 10 minutes is generally a good idea during the first 2 weeks of nursing. After that time, mother and infant usually develop a comfortable pattern that no longer calls for watching the clock. A 3-week-old baby who is nursing falls asleep after approximately 10 minutes at the breast. Once a mother has established a solid breast milk supply, an infant will meet the bulk of its nutritional and fluid needs (>90%) within 10 minutes of nursing. It is important, however, that a mother empty her breasts regularly on both sides to reduce the risk of cracking of the nipples and mastitis. If the infant nurses on one side and then falls asleep, the mother should try to awaken the baby and place the baby on the other breast for some time, although the added nutrition will be modest. What should a mother do if she cannot get the baby to nurse as long as she wishes? In general, neonates regulate their intake needs quite well, and if the baby cannot be aroused with gentle stimulation, he or she is probably satiated. For comfort, however, the mother might elect to use a breast pump to express some milk from the side that has not been nursed. That milk can be saved and refrigerated in a clean bottle, allowing the father to get up in the middle of the night and share in the feeding responsibilities. There is little question that breast milk suffices for the overwhelming majority of infants.
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Because the clinical features of diabetic neuropathy are similar to those of other neuropathies, the diagnosis of diabetic neuropathy should be made only after other possible etiologies are excluded. All individuals with diabetes should then be screened annually for both forms of neuropathy. Polyneuropathy/Mononeuropathy the most common form of diabetic neuropathy is distal symmetric polyneuropathy. It most frequently presents with distal sensory loss, but up to 50% of patients do not have symptoms of neuropathy. Symptoms may include a sensation of numbness, tingling, sharpness, or burning that begins in the feet and spreads proximally. Neuropathic pain develops in some of these individuals, occasionally preceded by improvement in their glycemic control. Pain typically involves the lower extremities, is usually present at rest, and worsens at night. Both an acute (lasting <12 months) and a chronic form of painful diabetic neuropathy have been described. As diabetic neuropathy progresses, the pain subsides and eventually disappears, but a sensory deficit in the lower extremities persists. Physical examination reveals sensory loss, loss of ankle reflexes, and abnormal position sense. Diabetic polyradiculopathy is a syndrome characterized by severe disabling pain in the distribution of one or more nerve roots. Involvement of the lumbar plexus or femoral nerve may cause severe pain in the thigh or hip and may be associated with muscle weakness in the hip flexors or extensors (diabetic amyotrophy). Involvement of the third cranial nerve is most common and is heralded by diplopia. Physical examination reveals ptosis and ophthalmoplegia with normal pupillary constriction to light. Peripheral mononeuropathies or simultaneous involvement of more than one nerve (mononeuropathy multiplex) may also occur. Autonomic neuropathies affecting the cardiovascular system cause a resting tachycardia and orthostatic hypotension. Hyperhidrosis of the upper extremities and anhidrosis of the lower extremities result from sympathetic nervous system dysfunction. Anhidrosis of the feet can promote dry skin with cracking, which increases the risk of foot ulcers. Autonomic neuropathy may reduce counterregulatory hormone release, leading to an inability to sense hypoglycemia appropriately (hypoglycemia unawareness; Chap. Improved glycemic control should be aggressively pursued and will improve nerve conduction velocity, but symptoms of diabetic neuropathy may not necessarily improve. Efforts to improve glycemic control may be confounded by autonomic neuropathy and hypoglycemia unawareness. Risk factors for neuropathy such as hypertension and hypertriglyceridemia should be treated. Avoidance of neurotoxins (alcohol) and smoking, supplementation with vitamins for possible deficiencies (B12, folate), and symptomatic treatment are the mainstays of therapy. Loss of sensation in the foot places the patient at risk for ulceration and its sequelae; consequently, prevention of such problems is of paramount importance. Patients with symptoms or signs of neuropathy (see "Physical Examination" later in the chapter) should check their feet daily and take precautions (footwear) aimed at preventing calluses or ulcerations. Chronic, painful diabetic neuropathy is difficult to treat but may respond to antidepressants (tricyclic antidepressants such as amitriptyline, desipramine, nortriptyline, or imipramine or selective serotonin norepinephrine reuptake inhibitors such as duloxetine) or anticonvulsants (gabapentin, pregabalin, carbamazepine, lamotrigine). However, pending further study, most recommend beginning with other agents such as a tricyclic antidepressant and switching if there is no response or if side effects develop. Therapy of orthostatic hypotension secondary to autonomic neuropathy is also challenging.
Serum levels of calcium, phosphorus, magnesium, selenium, and zinc should be monitored and appropriate supplementation instituted after documenting deficiency. Impairment in the absorption of fats and fat-soluble vitamins secondary to cholestasis, resulting in steatorrhea and deficiencies in vitamins A, D, E and K is reviewed. Comprehensive review of the causes of neonatal cholestasis, as well as diagnosis and management of cholestatic complications. Mattei P, von Allmen D, Piccoli D, Rand E: Relief of intrac pruritis in Alagille syndrome by partial external biliary diversion. Comprehensive review of the pathophysiology of liver dysfunction and injury seen with the use of total parenteral nutrition. Goksu N, Ozsoylu S: Hepatic and serum levels of zinc, copper, and magnesium in childhood cirrhosis. Review of current therapy options for patients with cholestatic pruritus, including pruritus resistant to fi rst-line therapy. At 12 months, there was a significant decline in alanine aminotransferase, -glutamyl transpeptidase and plasma levels of copper and manganese. Causes of pruritus associated with liver disease, including those associated with cholestasis are reviewed. The Penetrance of Copy Number Variations for Schizophrenia and Developmental Delay Supplemental Information Table S1. The raw intensity data was processed using the Illumina Genome Studio software (v2011. The proportion of excluded samples in the control datasets should not be taken as evidence about different quality of the datasets, as some of these had already been filtered for quality before being downloaded from dbGaP. These rounds of standardization help reduce noise created by natural fluctuations in probe intensity. The selection coefficients (s) are presented in the last two columns, as the ratio of de novo/(de novo+inherited) numbers. No selection coefficients are presented for cases with <5 observations, as they would be very unreliable. Comparison of penetrance estimates from this study with those from the main previous publications. Malhotra D, McCarthy S, Michaelson Jacob J, Vacic V, Burdick Katherine E, Yoon S, et al. Girirajan S, Dennis Megan Y, Baker C, Malig M, Coe Bradley P, Campbell Catarina D, et al. Guilmatre A, Dubourg C, Mosca A-L, Legallic S, Goldenberg A, Drouin-Garraud V, et al. The Autism Genome Project Consortium (2007): Mapping autism risk loci using genetic linkage and chromosomal rearrangements. Van der Aa N, Rooms L, Vandeweyer G, van den Ende J, Reyniers E, Fichera M, et al. Chronic: Exposure to high concentrations may cause central nervous system depression. Immediately flush skin with plenty of water for at least 15 minutes while removing contaminated clothing and shoes. Section 8 - Exposure Controls, Personal Protection Engineering Controls: Use explosion-proof ventilation equipment. Facilities storing or utilizing this material should be equipped with an eyewash facility and a safety shower. Section 9 - Physical and Chemical Properties Physical State: Liquid Appearance: clear colorless to light yellow Odor: none reported pH: Not available. Hazardous Decomposition Products: Carbon monoxide, carbon monoxide, carbon dioxide. Neurotoxicity: No information found Other Studies: Section 12 - Ecological Information Ecotoxicity: No data available.
On the other hand, the open design principle can conflict with the desire to keep a design and its implementation proprietary for commercial or national security reasons. For example, software companies often do not want a competitor to review their software in fear that the competitor can easily learn or copy ideas. Many companies attempt to resolve this conflict by arranging reviews, but restricting who can participate in the reviews. This approach has the danger that not the right people are performing the reviews. Closely related to the question whether designs should be public or not is the question whether vulnerabilities should be made public or not? Again, the debate about the right answer to this question has been raging for ages, and is perhaps best illustrated by the following quote from a 1853 book* about old-fashioned door locks: A commercial, and in some respects a social doubt has been started within the last year or two, whether or not it is right to discuss so openly the security or insecurity of locks. Many well-meaning persons suppose that the discussion respecting the means for baffling the supposed safety of locks offers a premium for dishonesty, by showing others how to be dishonest. Rogues are very keen in their profession, and know already much more than we can teach them respecting their several kinds of roguery. Rogues knew a good deal about lock-picking long before locksmiths discussed it among themselves, as they have lately done. If a lock, let it have been made in whatever country, or by whatever maker, is not so inviolable as it has hitherto been deemed to be, surely it is to the interest of honest persons to know this fact, because the dishonest are tolerably certain to apply the knowledge practically; and the spread of the knowledge is necessary to give fair play to those who might suffer by ignorance. It cannot be too earnestly urged that an acquaintance with real facts will, in the end, be better for all parties. Computer security experts generally believe that one should publish vulnerabilities for the reasons stated by Hobbs and that users should know if the system they are using has a problem so they can decide whether or not they care. For example, a bank has little incentive to advertise successful compromises because it may scare away customers. In California companies must inform their customers if an adversary might have succeeded in stealing customer priviate information. If the secret is com prised, it must be replaced; if the secret is minimal, then replacing the secret is easier. This principle forces every access to be explicitly authenticated and authorized, including ones for initialization, recovery, shutdown, and maintenance. It implies that a foolproof method of verifying the authenticity of the origin and data of every request must be devised. This principle applies to a service mediating requests, as well as to a kernel mediating supervisor calls and a virtual memory manager mediating a read request for a byte in memory. This principle also implies that proposals for caching results of an authority check should be examined skeptically; if a change in authority occurs, cached results must be updated. The human engineering principle of least astonishment applies especially to mediation. The mechanism for authorization should be transparent enough to a user that the user has a good intuitive understanding of how the security goals map to the provided security mechanism. It is essential that the human interface be designed for ease of use, so that users routinely and automatically apply the security mechanisms correctly. For example, a system should provide intuitive, default settings for security mechanisms so that only the appropriate operations are authorized. Another widely applicable principle, adopt sweeping simplifications, also applies to security. The fewer mechanisms that must be right to ensure protection, the more likely the design will be correct: Economy of mechanism the less there is, the more likely you will get it right. Designing a secure system is difficult because every access path must be considered to ensure complete mediation, including ones that are not exercised during normal opera tion. As a result, techniques such as line-by-line inspection of software and physical examination of hardware implementing security mechanisms may be necessary.
The initial antibiotic of choice for acute sinusitis is amoxicillin 500 mg orally three times daily or 875 mg twice daily. If a patient has had exposure to antibiotics within the past 30 days or treatment failure, a respiratory fluoroquinolone can be give. In these cases, one can consider referral to otolaryngology for sinus aspiration and culture. In addition, treatment with antibiotics within 48 hours of onset of symptoms decreases symptom duration and, importantly, decreases transmission of streptococcal pharyngitis. In adults, the recommended diagnostic procedure by the Centers for Disease Control and Prevention and the Infectious Disease Society of America is a rapid antigen detection test for group A streptococci only. In children, however, the recommendation is to perform a throat culture for confirmation if the rapid screen result is negative to limit spread of disease and minimize potential complications. Throat culture generally is regarded as the most appropriate diagnostic method but cannot discriminate between colonization and infection. Because most cases of pharyngitis at all ages are viral in origin, empiric antibiotic therapy is not recommended. However, dyspnea is a complex symptom and is defined as the subjective experience of breathing discomfort that includes components of physical as well as psychosocial factors. A significant body of research has been developed regarding the language by which a patient describes dyspnea with certain factors being more common in specific diseases. Individuals with cardiac causes of dyspnea also describe chest tightness and air hunger but do not have the same sensation of being unable to draw a deep breath or have increased work of breathing. Nocturnal dyspnea is seen in congestive heart failure or asthma, and orthopnea is reported in heart failure, diaphragmatic weakness, and asthma that is triggered by esophageal reflux. When discussing exertional dyspnea, it is important to assess if the dyspnea is chronic and progressive or episodic. Platypnea is a rare presentation of dyspnea in which a patient is dyspneic in the upright position and feels improved with lying flat. Lung examination may demonstrate decreased diaphragmatic excursion, crackles, or wheezes that allow one to determine the cause of dyspnea. Acute cough (<3 weeks) is most commonly due to a respiratory tract infection, aspiration event, or inhalation of noxious chemicals or smoke. In virtually all instances, evaluation of chronic cough merits a chest radiograph. The list of diseases that can cause persistent coughing without other symptoms and without detectable abnormality on physical examination is long. An abnormal chest film leads to evaluation of the radiographic abnormality to explain the symptom of cough. Measurement of serum IgE may be a component of the comprehensive evaluation of patients with refractory asthma or suspected allergic bronchopulmonary aspergillosis. It is not helpful in the initial evaluation of cough in a patient without allergic history. However, clinical experience does not support this contention, and strict adherence to this concept discourages the search for alternative explanations by both clinicians and researchers. Serious pulmonary diseases, including inflammatory lung diseases, chronic infections, and neoplasms, may remain occult on plain chest imaging and require additional testing for detection. In most instances, a safe alternative is available; angiotensinreceptor blockers do not cause cough. Post-nasal drainage of any etiology can cause cough as a response to stimulation of sensory receptors of the cough-reflex pathway in the hypopharynx or aspiration of draining secretions into the trachea. It is thought that reflux of gastric contents into the lower esophagus may trigger cough via reflex pathways initiated in the esophageal mucosa. Reflux to the level of the pharynx with consequent aspiration of gastric contents causes a chemical bronchitis and possible pneumonitis that can elicit cough for days after the aspiration event. Assigning the cause of cough to gastroesophageal reflux must be weighed against the observation that many people with chronic reflux (such as frequently occurs during pregnancy) do not experience chronic cough. Cough due to asthma in the absence of wheezing, shortness of breath, and chest tightness is referred to as "cough-variant asthma", and is more common in children than adults.
The treatment of chylothorax is placement of a chest tube with administration of octreotide, a somatostatin analogue. While it is not entirely clear why this is effective, the hypothesis is that octreotide decreases splanchnic blood flow and thereby decreases triglyceride production and thoracic duct flow. Patients are often also asked to stop all oral intake to further decrease chyle production. Prolonged chest tube drainage is contraindicated, however, as the high protein content in the drained fluid can lead to malnutrition and increased infection risk. Most individuals who present with a primary spontaneous pneumothorax are young, and primary spontaneous pneumothorax occurs almost exclusively in cigarette smokers, with cigarette smoking being the primary risk factor. Primary spontaneous pneumothorax is also more common in men and has been associated with a tall, thin body habitus. About half of individuals will experience more than one primary spontaneous pneumothorax. Oxygen is given simultaneously to speed resorption of the residual air in the pleural space. Pneumothoraces that fail to resolve or are recurrent often require thoracoscopy with stapling of blebs and pleural abrasion, a treatment that is effective in almost 100% of cases. Pleural effusions occur in heart failure when there are increased hydrostatic forces increasing the pulmonary interstitial fluid and the lymphatic drainage is inadequate to remove the fluid. Parapneumonic effusions are the most common cause of exudative pleural effusions and are second only to heart failure as a cause of pleural effusions. Breast and lung cancers and lymphoma cause 75% of all malignant pleural effusions. Many patients with hypoventilation are relatively asymptomatic or only endorse symptoms after pointed questions about sleep quality, morning headache, or orthopnea due to diaphragmatic weakness if present. The patient described here has asymptomatic hypoxemia and a normal chest radiograph aside from low lung volumes. Ventilation-perfusion mismatch and shunt are unlikely to be present without infiltrates, thus atelectasis, mucous plug, and pneumonia are not the correct answers. Hypercapnia causes cerebral vasodilation, which manifests as headache upon wakening. The headache typically resolves soon after awakening as cerebral vascular tone returns to normal with increased ventilation. Patients with frequent nocturnal arousals from sleep and patients with nocturnal hypoventilation commonly complain of daytime somnolence and may also exhibit confusion and fatigue. With central hypoventilation disorders, patients may also have impaired cranial nerve reflexes or muscular function, causing aspiration. Five-year survival is similar for all indications for lung transplantation at approximately 50%. For most indications, double-lung transplantation is the preferred procedure, and it is mandatory for patients with suppurative lung disease like cystic fibrosis. In general, in patients with idiopathic pulmonary arterial hypertension, double-lung transplantation is preferred because of concern of overcirculation in the low-resistance vascular bed of the transplanted lung when a native lung is present with markedly elevated pulmonary vascular resistance. It is very rare for the primary disease to recur after transplantation, and this has not been described in idiopathic pulmonary arterial hypertension. The right ventricle is highly plastic and will generally recover function after elevated pulmonary vascular resistance is removed by lung transplantation. Although osteoporosis, post-transplant lymphoproliferative disorders, and chronic kidney disease are important complications of steroids, calcineurin inhibitors, and other agents used for immunosuppression, the major complications post-transplant are in the lung. Airway complications such as anastomotic dehiscence or stenosis have similar occurrence rates, but can usually be managed bronchoscopically with good survival. Rejection of transplanted organ is very common and is the main limitation to better medium- and long-term outcomes. Rejection occurs as acute cellular rejection often presenting with cough, low-grade fever, dyspnea, infiltrates on radiographs, and declining lung function.
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