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  • Severe community acquired pneumonia (CAP) is defined as CAP that has to be treated in an Intensive Care Unit (ICU). Treatment in the ICU may be needed because of: a) acute respiratory failure, b) hemodynamic instability, c) monitoring and treatment of dysfunction of other organs or systems. Thus severe CAP is CAP that results in severe sepsis or multiple organ failure. Severe CAP is a syndrome with high mortality (20-50%), that demands early recognition and immediate and aggressive treatment. At the same time an effort should be made to isolate responsible pathogens, utilizing in selected cases, invasive diagnostic techniques. Objective criteria can help to recognize these high risk patients. Empirical treatment should provide adequate coverage for S. pneumoniae, Gram (-) bacilli and Legionella pneumophila. Pneumon 2003, 16(2):126-141.
     
  • Asthma represents a chronic inflammatory process of the airways followed by healing whose end result may be an altered structure referred to as remodeling of the airways. Remodeling in asthma is characterized by the following structural changes: Hypertrophy/hyperplasia of airway smooth muscle, increase in mucus glands, thickening of the reticular basement membrane, vascular dilation/angiogenesis and ECM deposition. Mechanisms of airway remodeling involve growth factor expression, protease/antiprotease balance, chronic antigen challenge, Th2 cytokines, myofibroblast hyperplasia, leukotrienes, IL-6 group cytokines, tryptases and possible genetic susceptibility. Despite the evidence that supports a close relationship between remodeling and clinical severity, the presence of airway remodeling is considered as an independent factor in the whole pathophysiological process of the disease. Low postbronchodilator FEV1/VC ratio in early life confirms the start of airway remodeling in childhood. The efficacy of anti-inflammatory treatment on the natural course of remodeling is still debated. Inhaled corticosteroids seemed to be the ideal treatment although they suppress part of the whole remodeling process without reversing it. Recent in vivo evidence supports the beneficial effect of long acting β2 agonists. We still need further research in order to better understand the relationship between remodeling, the natural history of the disease and the early relevant markers that might predict its appearance and its progress. Pneumon 2003, 16(2):142-152.
     
  • Study objectives: To determine if interleukin-6 (IL-6), which contributes to the regulation of inflammation is related to oxygen kinetics during maximal CPET and early recovery in patients with sarcoidosis. Participants: Twenty-six patients with sarcoidosis (11 male/15 female, aged 42±11) and 11 healthy volunteers (3 male/8 female, aged 29±5) underwent maximal CPET on a treadmill. Breath by breath analysis was used for measuring oxygen consumption (VO2), anaerobic threshold (AT) and first degree slope at the early phase of recovery. Serum levels of IL-6 were measured before, at peak of exercise, and 15 minutes after exercise with a high sensitivity ELISA method. Results: Patients with sarcoidosis had significantly higher IL-6 serum levels, lower values for VO2 at peak of exercise (VO2 peak % pred 80±17 vs 90±19, p < 0,05), and slower recovery (1±0.289 lt/min/min vs 1.24 ± 0.166, p = 0,003) when compared to healthy subjects. A negative correlation was found between IL-6 serum levels and VO2 peak (lt/min) (r= - 0,483, p = 0,013) and anaerobic threshold (ml/kg/min) (r= -0,507, p= 0,008). There was also found that the mean value of IL-6 serum levels in patients with VO2/t slope < 0.8lt/min/min were significantly higher compared to patients with VO2/t slope ³0.8 lt/min/min (p < 0,05). Conclusion: These data may indicate an important role of the inflammatory process in the pathophysiological mechanisms of exercise limitation in patients with sarcoidosis. Pneumon 2003, 16(2):153-162.
     
  • The outcome of Legionnaires’disease relies mainly on the time laboratory diagnosis is confirmed, allowing initiation of appropriate therapy. We performed and evaluated the current tests for the diagnosis of Legionella infection, in 88 patients presenting with severe community-acquired pneumonia, who had been hospitalized in “Sotiria” Hospital, Athens. We performed detection of the Legionella antigen in sputum by DFA, serology by ELISA and IFA detection of soluble Legionella urinary antigen by ELISA (Biotest EIA) as well as by the new rapid immunochromatographic assay (ICT-Binax OW). Detection of Legionella antigen by DFA gave the poorest positive results (4,3%), while serology and detection of urinary antigen gave almost the same results (6,8%). The main difference was that the detection of urinary antigen was must faster, regardless the methods used, concluding that it has been an important tool for the diagnosis of Legionnaires’disease and should never be neglected. Interestingly, the ICT-Binax NOW seems more practical, because while not lacking sensitivity compared to Biotest EIA, it is much more rapid and simple, while no special equipment or stuff skillfulness. Pneumon 2003, 16(2):173-180.
     
  • Lung cancer is the most common cause of cancer death in developed countries. More than two thirds of the patients present at the time of diagnosis with advanced stage disease IIIb or IV which is practically considered to be incurable. The 5-year survival rate after diagnosis is less than 15%. The high mortality rate argue for new approaches for controlling this disease such as chemoprevention and early detection. Chemoprevention, which has been defined as the use of agents that inhibit or reverse carcinogenesis, represents the therapeutic interventions at early stage of carcinogenesis, before the onset of invasive cancer. Towards this purpose, retinoids have been studied in the past and are being considered as potential chemopreventive agents. At present, research focuses on molecular targeted therapies such as EGFR receptor inhibitors and COX inhibitors. Several studies have shown that early detection of lung cancer improves the outcome of lung cancer. The identification of intermediate biomarkers of carcinogenesis, the use of laser-induced fluorescence endoscopy (LIFE), sputum cytology and low dose spiral computed tomography have increased diagnostic sensitivity. Optimal targeted population is of major importance for applying clinical investigations and screening-tests for lung cancer. Pneumon 2003, 16(2):189-198.
     
  • Lemierre’s syndrome is characterized by acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein, which is usually complicated with septic metastatic lesions in many organs, but mainly in the lung. Nowadays, the syndrome is a rare complication of the oropharyngeal infections, with generally good prognosis, because of the wide use of antibiotics. The major etiologic factor which is isolated in most cases, is Fusobacterium necrophorum, but rarely the syndrome is caused by other organisms, as Streptococcus species, Peptostreptococcus, Bacteroides, or multiple infecting organisms. We present a case of a 20 years old man, with Lemierre’s syndrome caused by an unusual pathogen, namely Pasteurella multocida. Pneumon 2003, 16(2):209-214.
     
  • A 41 year-old man was admitted to our Hospital because of pleuritic chest pain and mild fever (37,4°C). He had no medical history. He had been treated with roxythromycin for the preceding ten days. Routine physical examination revealed dullness and decreased breath sounds over the basal part of the right hemithorax. His labaratory data revealed leukocytosis with hypereosinophilia. At initial thoracentesis, an exudative effusion containing 54% eosinophils was documented with simultaneous peripheral eosinophilia of 35%. Values for the remainder of his labaratory studies were within normal range. There were no nuclear antibodies and no rheumatic factor; screening for parasites, bacteria, mycobacteria and malignant cells was negative. Tuberculin skin reaction was positive (19mm). Chest radiography showed moderate accumulation of fluid in the right pleural space. Computed tomographic films of the thorax showed pleural effusion in both lungs with no hilar or mediastinal lymph node enlargement. The patient underwent video-assisted-thoracic surgery (VATS) procedure to establish a diagnosis. Histologically there were lesions that formed granulomas. Antituberculous therapy was adninistered and six months later a new X-ray was normal. Conclusion: Pleural fluid eosinophilia does not exclude the diagnosis of tuberculous pleuritis. Pneumon 2003, 16(2):215-220.
     
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