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  • Ε. Igglezos
    cystic fibrosis
    Cystic fibrosis is an autosomal recessive disorder characterized by the production of thick, viscous secretions in the respiratory and gastrointestinal tract, increased salt secretion by sweat glands, pancreatic insufficiency due to pancreatic duct obstruction with abnormal mucus, infertility in males and, occasionally, hepatic failure.1
     
  • Cigarette smoke is by far the major extrinsic (non-genetic) cause of lung cancer. A small number of cases of this disease may be due to other environmental factors which act either independently or synergistically with tobacco smoke. The effect of environmental carcinogens is most obvious in occupational settings where the responsible substance may occur in relatively high concentrations. However, certain substances may cause carcinogenesis even after non-occupational exposure. The detailed study of environmental effects is fraught with methodological problems. However, it is clear that factors such as radon, arsenic, asbestos, urban pollution, and to a lesser degree socioeconomic conditions and nutrition, may be implicated in a small number of lung cancer cases. The avoidance of all these factors is not practical, and is not expected to have a significant impact on the incidence of lung cancer as long as the major carcinogen, tobacco, is not effectively controlled. Pneumon 2003, 16(1):29-37.
     
  • SUMMARY. The purpose of this study was to estimate the frequency of bronchial asthma in childhood in the town of Larissa and to assess the possible effects of social status, environmental factors, the child’s medical and family history on the course of the disease. A brief asthma questionnaire was distributed and completed by 754 families with at least one child attending a public day nursery in Larissa. Of these, 120 were found to have a child with symptoms consistent with asthma in the past year. Children were 4 8 years old and the questionnaire was completed by their parents. The International Study of Asthma and Allergy in Childhood (ISAAC)-Phase I questionnaire with additional items referring to the socio-economic status of the family, indoor environment factors and parental smoking habits was used. A child with asthma was identified in seventy families. Two years later the course of the disease was evaluated in 66 of those families, using a modified ISAAC questionnaire. The frequency of bronchial asthma in the study population was 9,3%, with the frequency of asthma attacks declining with age. The majority of the children had mild asthma. Allergic rhinitis was found in 31,4% and allergic dermatitis (eczema) in 14,2%. Parental smoking was not related to asthmatic attacks. Allergic rhinitis and conjunctivitis were strongly related to asthmatic attacks on reevaluation two years later. These results suggest an important role of atopic disease in the course of asthma and confirm the reports of declining attack frequency with advancing age. Pneumon 2003, 16(1):49-58.
     
  • A high prevalence of gastroesophageal reflux disease (GERD) symptoms in patients with bronchial asthma has been shown in several reports from North America and Europe. However, no data from Greece are available. The aim of this study is to assess the prevalence of GERD symptoms in Greek asthmatics. A total of 92 asthmatics (50 males and 42 females, aged 42.9±14.2 years) referred to our outpatient clinic, and 85 age- and sex-matched healthy control subjects were asked to complete a structured questionnaire on the presence of GERD symptoms. The prevalence of heartburn and regurgitation was higher in asthmatics (81.5% and 57.6%, respectively) than in controls (32.9% and 7.6%, respectively, p<0.01). None of the medications routinely used in the treatment of asthma was associated with increased prevalence of GERD symptoms. Our results suggest that Greek asthmatics referred to a tertiary care center have a significantly higher prevalence of GERD symptoms compared to controls. Additional studies in the general population of asthmatic patients are required to further clarify the relationship between asthma and GERD in Greece. Pneumon 2003, 16(1):59-66.
     
  • A case of miliary tuberculosis, tuberculous meningitis and severe hyponatremia, in a 19 year old man from Pakistan, is presented. The patient was admitted comatose to the ICU. A CT scan of the brain revealed a communicating hydrocephalus and external ventricular drainage was performed. Hydrocephalus is a common complication of tuberculous meningitis, and may be even fatal if left untreated. External ventricular drainage has both therapeutic and predicting value for the benefit of shunt surgery. Prompt ventriculoperitoneal shunting improves outcome, particularly in those patients who present with minimal neurological deficit. Neurological deterioration occurring in a patient under treatment for tuberculous meningitis may have various causes and always requires urgent radiological assessment. Pneumon 2003, 16(1):74-79.
     
  • The vast majority of parathyroid adenomas are excised through a cervical incision. The ectopic ones, which are usually are localized in the mediastinum, are excised through sternotomy or thoracotomy. In recent years, it has been possible to resect this kind of adenomas with the use of video assisted thoracoscopic surgery (VATS), this technique offering the advantage of lower morbidity. We describe a case of a patient with end stage renal failure and tertiary hyperparathyroidism with ectopic parathyroid adenoma localized on the aortic arch, between the origin of the left carotid artery and left subclavian artery. The adenoma was excised using VATS and the patient was discharged on the first postoperative day following excision. CT scans, parathormone and Ca blood levels returned to normal. Pneumon 2003, 16(1):80-85.
     
  • We present a case of pulmonary metastatic paraganglioma in association with in situ bronchogenic carcinoma. The primary tumor was located in the retroperitoneum and was surgically excised six years ago. The metastatic tumor was accidentally found on a chest x-ray and was initially considered as a primary bronchogenic carcinoma. The patient underwent lobectomy during which a metastatic paraganglioma was diagnosed. Paragangliomas are tumors of the neuroendocrine system, usually located in the abdomen. Pulmonary paragangliomas are rarely found. They are considered functioning when large amounts of catecholamines are excreted and they are surgically treated prognosis being satisfactory. Pneumon 2003, 16(1):86-90.
     
  • A 48-year-old man was admitted with hemoptysis, malaise, fatigue and anorexia in the last twenty days. A centrally located, 3 cm soft tissue mass in the right lower lobe of the lung was discovered on radiologic evaluation. His clinical and laboratory evaluation was unrevealing. Bronchoscopy, bronchial cultures and brushing were all negative. He underwent right thoracotomy with the radiologic suspicion of lung cancer. The frozen section was implying malignancy and the patient underwent a right lower lobectomy with mediastinal lymph node dissection. However, the routine histologic report showed bronchiolitis obliterans organizing pneumonia. Corticosteroids were not given and there is no clinical or roentgenographic evidence of recurrence of the disease twelve months postoperatively. This interesting case demonstrates that not only clinical or roentgenographic findings of bronchiolitis obliterans organizing pneumonia but frozen section too, can be confused with those of lung cancer.
     
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