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  • SUMMARY. The respiratory system consists essentially of two parts, a gas-exchanging organ, the lung, and a pump to pump gas in and out the gas exchanging part, consisting of the respiratory muscles and the chest wall. The lung and its diseases have traditionally been the focal point of interest, whereas pump disorders have received comparatively little attention. Research on respiratory muscles has accelerated during the last two decades. Respiratory muscles are all skeletal muscles having similar fibre composition to the limb muscles. Fibre composition of respiratory muscles is an important factor for their endurance and contractile properties. There are two fibre types, the fast (FT) and slow (ST) twitch fibres. Of the FT fibres two subgroups named FOG and FG have been identified. Human intercostals muscles appear to have mostly ST fibres. The diaphragm has a high percentage of fatigue-resistant fibres. The main respiratory muscles are the diaphragm, intercostal muscles and muscles of the abdominal wall. The accessory muscles of respiration include the sternomastoid and other muscles of the neck, back and shoulder girdle. The intercostals muscles are subdivided into two groups: the external and internal intercostals. The contraction of the diaphragm which is the most important respiratory muscle, decreases the intrathoracic pressure and increases the abdominal pressure in normal man by lowering the diaphragmatic dome. Intercostal muscles move the rib cage and can be inspiratory or expiratory. The scaleni is now believed to be true muscles of inspiration and not "accessory". The most important accessory muscles of inspiration are probably the sternocleidomastoid muscles. The respiratory muscles are the motive power for breathing and are subject to weakness from a variety of processes that affect the motor nerves, neuromuscular junction and muscle cell. Chronic neuromuscular disorders result in altered lung volumes. The effectiveness of cough is reduced in expiratory muscle weakness. Patients with respiratory muscle weakness breath faster and with a smaller tidal volume compared to healthy subjects. The main change in blood gases in patients with respiratory muscle weakness is usually a fall in PaO2. Hypercapnia may be a late event. Muscle fatigue, which is a reversible event, can be defined as the inability to sustain the required or expected force with continued contractions. The respiratory muscles, particularly those of inspiration, can fatigue and precipitate or intensify ventilatory failure. Pneumon 2001, 14 (2): 91-108
     
  • Adhesion molecules can be subdivided into five different classes: Integrins, cadherins, selectins, the immunoglobulin gene superfamily and CD44. These molecules are thought to play a crucial role in carcinogenesis and in the development of metastatic disease. Their role in lung cancer is not yet completely clarified, recent studies suggesting though that some of these adhesion molecules may be potential markers of the development and progress of lung cancer disease. We just focus on research of these molecules, which are some integrins, E-cadherin, ICAM-1, VCAM, NCAM, CEA, some selectins and CD44. Recent data and future perspectives of adhesion molecules are presented. Pneumon 2001, 14(2): 109-117
     
  • The role of fine-gauge (21,22-gauge) transbronchial needle aspiration (TBNA) in obtaining cytology specimen through flexible bronchoscope (FB) is well established. Indications extend from staging of bronchogenic carcinoma to diagnosis of bronchogenic cyst. However, the procedure is associated with certain limitations. These limitations do not exist with histological examination of the tissue obtained from the mediastinum or hilar areas using histology needle 19G through FB (TBNB). The first studies using this technique report good results, without complications in the majority of patients. Although current technology manufactured the system of needles to penetrate the tracheobronchial wall easily, problems sometimes occur. Therefore a combination of simple techniques, which are described below, is often necessary for a successful procedure. The overall diagnostic yield of TBNB by histology needle ranged from 52% to 72% in several studies. Furthermore, when histology was combined with cytology (flush specimen), the sensitivity increased to 86%. Even though the experience with TBNB is limited, we believe that it carries a great potential for acceptance as a routine staging procedure for bronchogenic carcinoma. It may become a procedure of choice for condition such as type I and II sarcoidosis, lymphoma, and other conditions presenting with mediastinal involvement, thereby limiting the need for mediastinoscopy. Pneumon 2001, 14(2): 118-125
     
  • Non-invasive mechanical ventilation (NIMV) has been recently applied to patients with acute respiratory failure (ARF) complicating chronic pulmonary disease or other medical disorders mainly in ICUs. This study aims at evaluating the efficacy of NIMV in patients with ARF in a Pulmonary Department of a general hospital. Twenty-one patients with hypercapnic respiratory failure (Group A, 16 pts) or hypoxaemic respiratory failure (Group B, 5 pts) were treated with NIMV via a nasal or facial mask connected to a BiPAP ventilatory device, in order to avoid intubation and improve gas exchange. In 21 patients of group A, PaO2 improved (from 45,1±8 to 62,8 ±10,5 mmHg, p<0,001), PaCO2 decreased (from 83,5±15,4 to 65,7±11,4 mmHg, p <0,001) and pH improved (from 7,25±0,04 to 7,37±0,06, p<0,001). Four patients failed to improve and were transferred to the ICU in order to receive invasive mechanical ventilation. PaO2 improved in all patients of group B (from 35,6±6,5 to 63,6±7,3 mmHg under NIMV). None of them needed invasive mechanical ventilation. The mean duration of NIMV was 48,9±35,7h in group A versus 90,8±46,7h in group B. The mean length of hospitalization was 11,3±9,1 and 14,8±8,2 days respectively. NIMV could be introduced in every day clinical practice in the treatment of ARF in a Pulmonary Department. Especially in cases of acute exacerbations of chronic respiratory insufficiency as in COPD, it can reduce the need of intubation and subsequent invasive mechanical ventilation. Pneumon 2001, 14 (2): 126-132
     
  • Sleep studies and distribution of sleep during the day arouse high scientific interest. The aim of the study was to record the sleep habits of medical students of the University of Crete before and during the examination period. A questionnaire consisting of 14 questions and a 24 - hour daily diagram was daily filled by 493 medical students before and during the examination period. The students attended from the first to the fifth year of the medical studies, and 202 were male and 291 female. Four parameters were statistically significant (p <0.05). The mean duration of night sleep was reduced from 7.21±1.02 h before the examination to 6.14±0.63 during the examination period (p <0.001). The bed time was delayed from 1.29±01.21 a.m. before the examination to 02.28±00.58 a.m. (p <0.02). The hours of daily study were increased from 3.45±1.63 hours before the examinations to 5.98±2.02 hours during the examinations (p <0.001). Feeling sleepy during the day was increased from 36% of the days before the exams to 44% of the days during them (p <0.003). During the examination period mean duration of the students sleep was reduced, while bed time was delayed and students report tiredness at awakening in almost half of the days of this period. In conclusion examinations seem to effect the sleep habits of the students. Pneumon 2001, 14 (2): 133-138
     
  • Dyspnoea and exercise intolerance are common clinical manifestations in patients with sarcoidosis. The aim of this study was to explore the ventilatory response to exercise and oxygen kinetics during maximal exercise in patients with sarcoidosis as compared to healthy subjects. Thirty nine consecutive patients with sarcoidosis and 11 healthy volunteers underwent maximal cardiopulmonary exercise test (CPET) on a treadmill. Maximal oxygen consumption (VO2 peak) and the first degree slope for oxygen consumption during early recovery (VO2/t-slope) were measured. Tidal flow-volume loop during exercise was utilized to identify expiratory flow limitation (EFL). At peak exercise, EFL was observed in 53% of patients with sarcoidosis and in none of the healthy subjects (p<0.001). The presence of EFL in patients with sarcoidosis was independent of the stage of the disease and the treatment with corticosteroids. VO2 peak, breathing reserve and VO2/t-slope were lower in patients with sarcoidosis (23.0±6.0 ml/kg/min vs 34.5±7.6 ml/kg/min p<0.001, 28±17 vs 36±12 p<0.05 and 0.9±0.4 vs 1.1±0.6 p<0.05 respectively). In conclusion our data constitute a useful approach to the understanding of the pathophysiological mechanisms which might be involved in exercise intolerance in patients with sarcoidosis. Pneumon 2001, 14 (2): 140-147
     
  • We present a case of a female patient who had undergone a complete hysterectomy for endometrial cancer. Three years after the operation she presented with a chronic paroxysmal cough and diagnostic investigation revealed a single metastatic lesion of the spleen. A splenectomy was performed and surprisingly the cough was completely abolished. Pathophysiology of the cough reflex is reviewed and medical literature search on relevant cases with splenic metastasis is presented. Pneumon 2001, 14(2): 147-150
     
  • A case of a 25 year old female with a smoking habit of 2 packs per day since the age of 15 years, who was admitted to our hospital complaining for dyspnoea on exertion since 4 months is presented. On the basis of history and the findings of the HRCT we performed fiberoptic bronchoscopy where the BAL and transbronchial biopsy set the diagnosis of alveolar proteinosis. It is a rare disease that is characterized by a deposit of a formless, insoluble protein molecule, in alveoli and bronchioles. Fiberoptic bronchoscopy with BAL and transbronchial biopsy remain the basic diagnostic methods. The differential diagnosis includes eosinophil granuloma, sarcoidosis, congenital absence of a1-antitrypsin, extrinsic alveolitis and vasculitis. Pneumon 2001, 14(2):151-155.
     
  • A case of pulmonary hyalinizing granuloma is presented. The patient was a 61-year-old Caucasian male who was found to have multiple bilateral pulmonary nodules at a routine chest x-ray. The patient was asymptomatic and the nodules were considered as metastatic disease of an abdominal lesion. Complete imaging and extensive laboratory tests excluded the presence of any malignancy. No definite diagnosis was established either by brushing cytology or percutaneous fine needle biopsy. A nodule of the right lung was removed by open lung biopsy. Histological diagnosis was pulmonary hyalinizing granuloma, consisting of hyalinized collagen fibers and bundles infiltrated with chronic inflammatory cells. The patient remains asymptomatic, with no specific therapy and the imaging findings are the same till today, 30 months after the diagnosis. Pneumon 2001, 14 (2): 156-160
     
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