Oestrogen deficiency results in microarchitectural alterations of trabecular bone in both the mandible and the tibia within 16 weeks. The size of marrow spaces and the shape of trabeculae in the mandible correlate with osteoporotic changes in the long bone.

A 49-year-old woman underwent bilateral lung transplantation for advanced idiopathic pulmonary fibrosis. During the postoperative period she received immunosuppressive medications as well as corticosteroids. Aspergillus fumigatus grew from a sputum sample, and she was treated with nebulized amphotericin. She was discharged on tacrolimus and prednisone. After initially doing well, she required re-hospitalization for treatment of cytomegalovirus and Pseudomonas aeruginosa pneumonia. She was treated with ganciclovir and cefepime and, after a 2-week hospitalization, was discharged. Seven months after transplantation she developed progressive sinusitis, treated with antibiotics and sinus debridement surgery. Aspergillus organisms were recovered and, at the periphery of the tangled masses of Aspergillus hyphae, numerous amebic cysts were also identified, which were morphologically consistent with Acanthamoeba spp. Subsequent electron microscopy and immunofluorescent staining confirmed this impression. She was initially treated with intravenous amphotericin, later changed to voriconazole and caspofungin. Debridement of the sinuses 3 weeks later revealed fungal hyphae but no amebae. Infections with Acanthamoeba have rarely been reported in lung transplantation but have been recognized in bone-marrow and renal transplant patients, and have been lethal in many cases, particularly in patients with immunosuppression due to human immunodeficiency virus infection. More recently, aggressive antimicrobial therapy has resulted in successful outcomes, as discussed herein.

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included. Missing data were addressed using multiple imputation. The exposure was donor to recipient race match. The outcome was time to death following transplantation. Patients were censored at the last date they were known to be alive. The propensity to receive a race-matched organ, based on available covariates, was calculated using logistic regression. A Cox regression model was used to compare the hazard of death for patients who did and did not receive a racematched organ, adjusted for their propensity to receive a race-matched organ. Results: There were 13464 lung transplants for which the donor and recipient races were known that occurred between May 4, 2005 and May 3, 2014. 59% (8005) were men and the median age was 58 years. The indication for transplant was obstructive disease in 30% (4088), pulmonary vascular disease in 4% (485), cystic fibrosis or immunodeficiency in 13% (1786), and restrictive disease in 53% (7101). 57% (7642) received lungs from race-matched donors and 43% (5822) received lungs from race-mismatched donors. The median survival time was 5.7 years. Recipient race was identified as an effect measure modifier. The propensity-adjusted hazard of death for Caucasian patients who received race-matched lungs compared to those who did not was 0.88 (95% CL 0.82, 0.95; p= 0.0003). There was no difference in the propensity-adjusted hazard of death for African American or non-Caucasian, non-African American recipients who received race-matched lungs compared to those who did not. Conclusion: Race mismatch between donor and recipient is common in lung transplantation. In Caucasian patients, use of a race-matched lung was associated with a reduced hazard of death. African American and non-Caucasian, non-African American patients who received a race-matched lung did not have the same reduction in the hazard of death.