Outcomes of endoscopic sinus surgery in adult lung transplant patients with cystic fibrosis

The aim of this study was to evaluate prevalence of chronic rhinosinusitis (CRS) and nasal polyps in adult patients with cystic fibrosis (CF) in Russian Federation. Additionally, we investigated the clinical course of CRS and developed the optimal therapeutic strategy.Methods. Three hundred and forty eight CF patients were involved in the study. Physical examination, computed tomography (CT) of paranasal sinuses and audiometry, if needed, were used. CRS and bilateral nasal polyps were diagnosed in 28 patients. Nasal endoscopy, SNOT-20 questionnaire, rhinomanometry, micro - biological examination of sputum and mucus from paranasal sinuses (obtained during puncture or surgery), spirometry, and measurement of serum markers of inflammation were used. Endoscopic sinus surgery was used in 14 patients (the group 1) and others were treated non-surgically (the group 2). Both group were treated during 6 months using intranasal mometasone, mucolytics and antibiotics via PARI SINUSTM nebulizer.Results. An improvement in symptoms, CT signs, rhinomanometry parameters and endoscopic signs was seen in both groups after treatment and was more prominent in the surgical treatment group compared to the non-surgical treatment group. Bacterial load reduction in nasal sinuses, decrease in the rate of pulmonary disease exacerbations, and an improvement in oxygen blood saturation were found in the surgical treatment group only. Treatment of CRS did not affect lung function, sputum microbiology and serum inflammatory markers.Conclusion. Endoscopic sinus surgery followed by intranasal mucolytics and antibacterials is an effective and well-tolerated treatment in adult CF patients with CRS.

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Impact Of Pretransplant Ventilatory Support On Posttransplant Outcomes In Lung-Transplant Patients With Cystic Fibrosis In The Post-LAS Era

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a4323 ◽

2010 ◽

Author(s):

Erin M. Lowery ◽

Sean M. Forsythe ◽

Robert B. Love ◽

Charles G. Alex

Keyword(s):

Cystic Fibrosis ◽

Lung Transplant ◽

Ventilatory Support ◽

Transplant Patients

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Office-Based Sinus Surgery for Cystic Fibrosis Chronic Rhinosinusitis

ORL ◽

10.1159/000512495 ◽

2020 ◽

pp. 1-4

Author(s):

Daniel B. Spielman ◽

David A. Gudis

Keyword(s):

Cystic Fibrosis ◽

Mechanical Ventilation ◽

Chronic Rhinosinusitis ◽

Local Anesthesia ◽

Endoscopic Sinus Surgery ◽

Care Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Sinus Surgery ◽

Office Setting

Objective: Chronic rhinosinusitis (CRS) is nearly ubiquitous in the cystic fibrosis (CF) population, and many patients require multiple endoscopic sinus surgeries throughout their lifetime. Recent studies have demonstrated the profound pulmonary and systemic health benefits of comprehensive CRS treatment. Both endotracheal intubation with mechanical ventilation and inpatient hospital care represent significant risks for CF patients. The goal of this study is to evaluate the safety and feasibility of performing revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia to decrease the need for mechanical ventilation and inpatient hospitalization. Methods: This is a prospective cohort study conducted at a tertiary care academic medical center with a CF Foundation-accredited care center. Patients with CF and refractory CRS despite prior surgery and medical therapy were eligible for inclusion. Comprehensive revision ESS was performed in the office using only local anesthesia. Results: Five patients were enrolled and underwent revision endoscopic sinus surgery without complication. The average preoperative Sinonasal-Outcome Test-22 score was 52.0 ± 12.1 and the average preoperative Lund-Mackay score was 15.2 ± 3.8. No patients requested aborting the procedure early due to pain, discomfort, or any other reason. No subjects required prolonged observation or postoperative hospital admission. Conclusion: This prospective pilot study is the first to demonstrate the safety and feasibility of performing comprehensive revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia.

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690 Most Effective Antimicrobial Combinations Against Burkholderia cepacia Complex, Stenotrophonomas maltophilia and Pseudomonas aeruginosa Isolated from Cystic Fibrosis Lung Transplant Patients

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2012.01.705 ◽

2012 ◽

Vol 31 (4) ◽

pp. S237

Author(s):

S.N. Peart ◽

A. Nicholson ◽

F.K. Gould ◽

J.D. Perry ◽

E. Marrs ◽

...

Keyword(s):

Cystic Fibrosis ◽

Pseudomonas Aeruginosa ◽

Burkholderia Cepacia ◽

Lung Transplant ◽

Cystic Fibrosis Lung ◽

Burkholderia Cepacia Complex ◽

Transplant Patients ◽

Antimicrobial Combinations

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Sinonasal Posttransplant Lymphoproliferative Disorder in Pediatric Lung Transplant Patients

Otolaryngology ◽

10.1016/j.otohns.2005.03.064 ◽

2005 ◽

Vol 133 (1) ◽

pp. 38-41 ◽

Cited By ~ 28

Author(s):

Brian W. Herrmann ◽

Stuart C. Sweet ◽

David W. Molter

Keyword(s):

Cystic Fibrosis ◽

Head And Neck ◽

Lymphoproliferative Disorder ◽

Lung Transplant ◽

Nasal Polyposis ◽

Case Series ◽

Posttransplant Lymphoproliferative Disorder ◽

Transplant Patients ◽

Occult Disease ◽

Lung Transplants

OBJECTIVE: To evaluate sinonasal manifestations of posttransplant lymphoproliferative disorder (PTLD) in the pediatric lung transplant population. STUDY DESIGN AND METHODS: Case series of children less than 18 years presenting with PTLD after pulmonary transplantation at St Louis Children's Hospital between Jan 1, 1990 and Dec 31, 2003. RESULTS: Two hundred eighty-two lung transplants were performed in 246 children. Thirty-two cases of histopathologically confirmed PTLD were identified with 8 (25%) presenting in the head and neck. Sinonasal PTLD was the most common site of head and neck involvement (63%), with 40% of patients presenting with occult disease. All patients with sinonasal PTLD had longstanding nasal polyposis related to cystic fibrosis ( P = 0.07). CONCLUSIONS: This is, to our knowledge, the first report identifying an increased frequency of sinonasal PTLD after pediatric pulmonary transplantation, particularly in children with cystic fibrosis and associated nasal polyposis. Because sinonasal PTLD may be asymptomatic, this region should receive close scrutiny on surveillance evaluations.

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Pharmacological considerations for azole antifungal drug management in cystic fibrosis lung transplant patients

Medical Mycology ◽

10.3109/13693786.2010.505203 ◽

2010 ◽

Vol 48 (O1) ◽

pp. S52-S59 ◽

Cited By ~ 21

Author(s):

Eliane M. Billaud ◽

Romain Guillemain ◽

Maud Berge ◽

Catherine Amrein ◽

Sandrine Lefeuvre ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Transplant ◽

Antifungal Drug ◽

Cystic Fibrosis Lung ◽

Drug Management ◽

Transplant Patients

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First Wave of COVID-19 in French Patients with Cystic Fibrosis

Journal of Clinical Medicine ◽

10.3390/jcm9113624 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3624 ◽

Cited By ~ 1

Author(s):

Harriet Corvol ◽

Sandra de Miranda ◽

Lydie Lemonnier ◽

Astrid Kemgang ◽

Martine Reynaud Gaubert ◽

...

Keyword(s):

Cystic Fibrosis ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Lung Transplant ◽

Distress Syndrome ◽

Rt Pcr ◽

Respiratory Complications ◽

Short Term ◽

Transplant Patients

Viral infections are known to lead to serious respiratory complications in cystic fibrosis (CF) patients. Hypothesizing that CF patients were a population at high risk for severe respiratory complications from SARS-CoV-2 infection, we conducted a national study to describe the clinical expression of COVID-19 in French CF patients. This prospective observational study involves all 47 French CF centers caring for approximately 7500 CF patients. Between March 1st and June 30th 2020, 31 patients were diagnosed with COVID-19: 19 had positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs; 1 had negative RT-PCR but typical COVID-19 signs on a CT scan; and 11 had positive SARS-CoV-2 serology. Fifteen were males, median (range) age was 31 (9–60) years, and 12 patients were living with a lung transplant. The majority of the patients had CF-related diabetes (n = 19, 61.3%), and a mild lung disease (n = 19, 65%, with percent-predicted forced expiratory volume in 1 s (ppFEV1) > 70). Three (10%) patients remained asymptomatic. For the 28 (90%) patients who displayed symptoms, most common symptoms at admission were fever (n = 22, 78.6%), fatigue (n = 14, 50%), and increased cough (n = 14, 50%). Nineteen were hospitalized (including 11 out of the 12 post-lung transplant patients), seven required oxygen therapy, and four (3 post-lung transplant patients) were admitted to an Intensive Care Unit (ICU). Ten developed complications (including acute respiratory distress syndrome in two post-lung transplant patients), but all recovered and were discharged home without noticeable short-term sequelae. Overall, French CF patients were rarely diagnosed with COVID-19. Further research should establish whether they were not infected or remained asymptomatic upon infection. In diagnosed cases, the short-term evolution was favorable with rare acute respiratory distress syndrome and no death. Post-lung transplant patients had more severe outcomes and should be monitored more closely.

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