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  • SUMMARY The patients with chronic obstructive pulmonary disease (COPD) exhibit several abnormalities in the echocardiogram, which are the result of the increased pressure in the right ventricle and the pulmonary artery. The prognostic value of the pressure level in the pulmonary artery and the systolic and diastolic flattening of the interventricular septum as assessed with the echocardiogram has not been established in the literature yet. The aim of this study is to estimate the systolic pressure of the pulmonary artery in patients with COPD, who present with or without flattening of the interventricular septum. Pneumon 1999, 12 (1): 20-25
     
  • SUMMARY This study was designed to determine the efficacy of iodized talc pleurodesis in patients with malignant pleural effusions. From September 1992 until July 1997 seventy-two patients underwent this mode of treatment (four of them bilaterally). All patients had complete lung reexpansion after tube thoracostomy with a fluid drainage count of less than 250 ml in 24 hours. A slurry containing iodized talc was administered in the pleural cavity through the chest tube. Chest tubes were removed the next day. The patients' age ranged from 26 to 88 years (average 50 years). Thirty-five patients had breast cancer, 26 lung cancer, 6 intestinal cancer, 3 kidney cancer, 2 carcinoma of the uterus, 2 sarcoma, 2 ovary cancer and 1 cancer of the oesopagus. Serial chest radiographs showed complete response in all patients. The follow up period ranged from 1 to 24 months (average 4,5 months) with 4 recurrences of pleural effusion. There were no complications. These observations indicate that intrapleural administration of slurry iodized talc is a safe, adequate and effective treatment for the control of neoplastic pleural effusions. Pneumon 1999, 12 (1): 26-31
     
  • SUMMARY Lignocaine is commonly used for local anesthesia during fibreoptic bronchoscopy (FOB). Its toxicity is related to plasma concentrations. Aim of our study was to record the plasma concentrations of lignocaine before, during and after FOB and to evaluate whether the dose for nasal and endobronchial anesthesia has any correlation with the peak serum concentrations of the drug. Twelve patients (mean age 57±3 yr SEM) undergoing FOB were studied. Mean time of FOB was 27 ± 2min. None of our patients had a history of cardiac disease, was on any regular medication neither suffered from hepatic or renal failure. Lignocaine was administered as 2% solution using a larynx-syringe (mean dose 100 mg), 2% gel (mean dose 182.5±15mg) and finally 2% solution through the bronchoscope (mean dose 339±12 mg). Total dose was within 500-720mg (622±20mg). Venous blood samples were drawn before the beginning of local anesthesia and then at time 5, 10, 20, 60, 90 and 120 min after that. ECG, blood pressure and oxygen saturation were simultaneously recorded. Our results showed that peak plasma concentrations of lignocaine in 8 patients were reached within 20 min (2.15±0.4 μg/ml), in 3 patients within 30 min (1.9±0.3 μg/ml) and in one patient within 60 min from the beginning of local anesthesia (1.81 μg/ml). None of our patients exceeded the critical level of toxicity (5 μg/ml). Two hours after the beginning of local anesthesia lignocaine's concentrations were still measured (1.48±0.15 μg/ml). There was a significant positive correlation between total dose of lignocaine and peak serum concentration (r=0.63, p, 0.05). Similar correlation was found between endobronchial dose of lignocaine and peak serum concentration (r=0.64 p=0.02). No correlation was found between dose for nasal anesthesia and peak serum concentration of the drug. No adverse reactions were observed. In conclusion, local administration of lignocaine during FOB usually exceeds the proposed highest dose (400mg), but even in this occasion, drug administration is usually safe with no toxic levels observed. Peak plasma concentrations were found within 20-30 min from the beginning of local anesthesia. Dose for nasal anesthesia expresses a significant percentage of the total dose but with no correlation with peak serum concentration. Pneumon 1999, 12 (1): 32-38
     
  • SUMMARY Two cases, one of 64 year old man and another of 65 old woman with severe hypophosphatemia, with phosphate serum level below 1 mgr/dl are presented.They were admitted to the Intensive Care Unit with severe respiratory failure requiring mechanical ventilation. They had a very difficult weaning, even when the reason of respiratory failure was promptly reversed. The correction of severe hypophosphatemia by intravenous administration of phosphate salts, resulted in a dramatic improvement of the contractile properties of the respiratory muscles followed by a successfull weaning from mechanical ventilation. Pneumon 1999, 12 (1): 39-45
     
  • SUMMARY Purpose: After observation that asthma is more frequent in psoriatic patients than in general people the aim of this study was the determination of any correlation between asthma and psoriasis and the investigation of the association between psoriasis severity and extent of respiratory function disorder. Material and methods: The study included 57 patients with psoriasis. After their separation in two groups, according to clinical history of asthma or not, spirometry was performed in all patients and FEV1, FVC, FEV1/FVC and MMEF were recorded. Then patients underwent dermatologic consultation in order to confirm the severity of psoriasis by three parametres namely, erythema > 1, injuries infiltration, clinical stability or activation of illness. Results: Twelve out of 57 patients have had clinical history of asthma. The mean FEV1 value (as a percentage of predicted) was 81.08% in asthmatic patients and 98% in the other group. Normal ratio FEV1/FVC was found in 60% (18/30) of the patients with erythema > 1 and in 88% (22/25) with erythema  1. Normal FEV1/FVC ratio was also found in 68,75% (33/48) of the patients with infiltration in psoriatic injuries and in 100% (7/7) of those who had not. In addition, normal FEV1/FVC ratio was observed in 59,9% (13/28) of the patients with active psoriasis and in 81,8% (27/33) of those with stable disease. MMEF (maximum midexpiratory flow rate) was normal in 36,3% (8/22) of the patients with active psoriasis and in 60,6% (20/33) of those who were clinically stabilized. Conclusions: Our data reveal an evident correlation between psoriasis severity and extent of respiratory function disorder. Psoriasis and asthma might correlate through a common pathogenetic pathway that needs to be studied. Pneumon 1999, 12 (1): 46-51
     
  • SUMMARY A 44-years old male patient from Egypt, current smoker, with past medical history of active tuberculosis, was admitted complaining of fatigue, malaise and back pain (in vertebral column). The above symptoms started two years ago, when the patient was admitted and treated with anti-tuberculosis treatment, consisting of INH and RIF. The final diagnosis was active pulmonary tuberculosis, associated with spondylitis of the lower thoracic and upper lumbar vertebral column, a conclusion that was supported by clinical and laboratory work-up. A part of the diagnosis was a "cold" abscess extending from L1 to L4 vertebral body. Although the vertebral column tuberculosis is supposed to be the commonest extrapulmonary manifestation of the disease, nowadays, after monitoring correctly its treatment and following the bacilli sensitivity results, it has become rare, though strongly influencing patient's recovery and rehabilitation. Regarding the above case, the tuberculosis mycobacterium was resistant to INH and RIF. Pneumon 1999, 12 (1): 52-56
     
  • SUMMARY We present the case of 54 years old woman with recurrent pneumonia, herpes labialis and moderate pancytopenia. The final diagnosis was Systemic Lupus Erythematosus. Pneumon 1999, 12 (1): 57-61
     
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