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  • Objective: To investigate which cells are the main source of hydrogen peroxide (H2O2) production in stable asthma and the possible relationship between H2O2 levels on the one hand, and airway inflammation and disease severity on the other. Material and methods: Fifty stable asthmatics with disease severity ranging from mild to moderate were studied. H2O2 was measured in expired breath condensate and its relationship with variables indicating asthma severity [e.g. FEV1% pred, peak expiratory flow rate (PEFR) variability, symptoms score and airway responsiveness to histamine] or airway inflammation [differential cell counts in induced sputum, levels of eosinophil cationic protein (ECP) in sputum supernatant] was assessed. Results: Our results showed that mean (95% CI) concentrations of H2O2 were significantly elevated in patients with asthma compared to the values obtained from control subjects (.67, .56 .77 vs .2, .16 .24 mM, respectively, P<.0001). The difference was primarily due to the significantly increased H2O2 levels observed in moderate asthma patients as compared to those observed in patients with mild persistent or mild intermittent asthma (.95, .76 1.12 μM vs .59, .47 .7, vs .27, .23 .32 μM, respectively, P<.0001). H2O2 levels were positively related to sputum eosinophilia, as well as to ECP concentrations. A positive relationship was also found between H2O2 levels and neutrophil counts in patients with moderate asthma. H2O2 levels were also associated with symptoms score and PEFR variability. There was an inverse relationship between H2O2 levels and FEV1% pred. Further analysis showed that the relationship between H2O2 levels and the examined variables was significant only in moderate asthma patients not receiving inhaled steroids. Conclusions: Eosinophils are the main H2O2 producing cells in asthma of varying severity, whereas neutrophils might also contribute to the much higher H2O2 levels observed in the more severe cases. The predictive value of H2O2 levels as regards disease severity and inflammatory activity is limited and depends on the use of inhaled steroids and the severity of the disease itself. Pneumon 2002, 15(3):263-274.
     
  • Objective: Bronchial carcinoids are classified as pulmonary neuroendocrine neoplasms; the latter encompass a wide variety of tumors from typical carcinoid to small cell carcinoma. A retrospective analysis of 38 consecutive patients (22 male, 16 female, age range: 28 78 years) who had undergone resection surgery for bronchial carcinoid tumors in the period from 1988 to 1997, was performed. Material-methods: Tumor resection surgery procedures included lobectomy (25 patients), bronchoplasty (4 patients), pneumonectomy (3 patients) and wedge resection (6 patients). The histologic appearance of original tissue sections was re-assessed applying the up-dated classification criteria for neuroendocrine neoplasms proposed by Travis. Results: No peri-operative mortality was reported. Original histologic examination identified 28 typical and 10 atypical carcinoid tumors. Four cases of atypical carcinoid tumors were reclassified as large cell neuroendocrine carcinoma (LCNEC) and 2 cases of typical carcinoid tumors as atypical. Survival was significantly higher in patients with typical carcinoids compared to either LCNEC (P=.0008, Fischer’s exact) or atypical carcinoids (P=.027, Fischer’s exact). Only 4 patients (3 with atypical carcinoid, 1 with LCNEC) received adjuvant chemotherapy. Conclusion: The observed diversity in the behavior of pulmonary neuroendocrine neoplasms indicates the necessity of identifying the most virulent tumors and applying multi-modality regimens to such cases. Pneumon 2002, 15(3):286-290.
     
  • Oxidant/antioxidant imbalance has been reported in various respiratory diseases including pneumonia. The purposes of this study were the measurement of total antioxidant status in the serum of patients with community acquired pneumonia (CAP) and the investigation of the probable relationship between TAS and the severity of the disease. Thirty patients (22 males, 8 females, mean age 48±21 years) were studied. Clinical, laboratory and radiographic data obtained on admission as well as on the 7th day of the hospital stay were recorded. At the same time points, serum TAS was also determined using a colorimetric method at 600 nm. TAS values on admission (TAS1) were significantly lower compared to TAS values obtained on the 7th day of the hospital stay (TAS2) (0.84±0.13 mmol/L vs 1.00±0.17 mmol/L, respectively, P=.0001). There was a positive association between TAS1/TAS2 ratio and the change in the severity score (r=.50, P=.007). TAS1/TAS2 ratio was inversely related to PaO2 on admission (r=.47, P=.008). Furthermore, the change in TAS was positively related to white blood cell count on admission (r=.399, P=.029) and significantly greater in patients at risk for CAP (P=.01) as well as in patients with Gram(-) pneumonia (P=.032). Another interesting finding is that TAS1/TAS2 ratio was significantly higher in patients with bilateral pneumonia (P=.023). In conclusion, low TAS values in patients with CAP suggest the presence of oxidative stress. The decrease in TAS values may be useful in estimating the severity of CAP and in determining the appropriateness of antioxidant administration in selected cases. Pneumon 2002, 15(3):295-304.
     
  • A 27 year old woman who had been complaining of symptoms mimicking bronchial asthma since her childhood, is presented. A cystic mass of the mediastinum was recently diagnosed. The symptoms were resolved completely after radical surgical excision of the mass, which was found to be a bronchogenic cyst. The literature is briefly reviewed. Pneumon 2002, 15(3):314-318.
     
  • A case of a 71 years old, male patient, who was admitted to the hospital for lymphocytosis in the peripheral blood is presented. The diagnosis of B-cell chronic lymphocytic leukemia was established, based on the morphology and immunophenotypic analysis of lymphocytes of the peripheral blood. During diagnostic work-up the coexistence of a tumor in the right cardiophrenic angle was discovered at chest CT scan. Right thoracotomy and resection of the tumor was performed and biopsy revealed a mixed histology thymoma (AB according to the WHO classification). The association of thymoma with B-cell chronic lymphocytic leukemia is α very rare finding. Pneumon 2002, 15(3):319-322.
     
  • We present a case of a thirty years old intravenous drug user (IVDU), who was admitted to the hospital due to temperature of 38°C, cough, blood in sputum and a chest pain. Clinical examination revealed a small degree of spleenomegaly and absence of cardiac murmurs. He was started treatment with Vancomycin 1gr x 2, Ampicillin 2 gr x 6 and Amikacin 500 gr x 2 daily. Laboratory testing was normal, except blood cultures which revealed a group A streptococcus. Echocardiography is missing because the patient left the hospital without permission the next day following his admission. GAS bacteremia is responsible for only 1,07% of all bacteremias. There is a significant increase of its incidence, in the third decade of life, concerning young IVDU patients, free of underlying diseases, as a consequence of IV drug use, under non aseptic conditions. Its clinical characteristics are similar to those of the patient presented. In fact, it is a benign disease of low mortality, a long period of evolution before diagnosis, often associated with septic pulmonary embolism, developing due to septic thrombophlebitis. Characteristically, there is an absence of cardiac murmurs and endocardial lesions in echocardiogram, while underlying endocarditis is only present in 6,5% of cases. In the case presented, the possibility of an underlying endocarditis has not been determined, because of lack of echocardiogram. Anyhow, the isolation of GAS, as a cause of bacteremia is definitely of particular interest. Pneumon 2002, 15(3):323-326.
     
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