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  • Pulmonary Medicine, Intensive Care Unit, Pulmonary Medicine Department, Regional General Hospital of Athens “Evangelismos”
     
  • Gr. Stratakos
    ABSTRACT. Postintubation tracheal stenosis is an iatrogenic complication that occurs in critically ill patients receiving mechanical ventilation. It is by far the commonest benign cause of tracheal stenosis with an estimated incidence of 1% among intubated patients. Following simple and concrete preventive measures should avert this severe and potentially fatal complication. High clinical suspicion is vital to promptly diagnosing this condition once it appears. Treatment of post intubation tracheal stenosis may be difficult due to usually poor patient health status at the time of diagnosis. Circumferential sleeve resection of trachea with end-to-end anastomosis remains the treatment of choice, although it is only applied in strictly selected patients by highly experienced surgeons and is related to serious complications and significant relapse rates. Bronchoscopic, non-surgical techniques applied by pneumonologists, including bronchoscopic or balloon dilatation, laser resection and stenting have been proposed as alternatives to open surgery and feature several advantages. Indeed, short, web like stenoses may be definitively cured by laser resection and gentle dilatation, while stents are helpful for splinting lengthy stenoses. In inoperable cases, silicone stents represent the only therapeutic alternative; they are also valuable as initial conservative treatment in view of prospective surgical correction, allowing time for preparing the patient. A multidisciplinary approach engaging pneumonologists, as well as thoracic and ORL surgeons is crucial for the best management of patients with postintubation tracheal stenosis. Pneumon 2003, 16(3):262-270.
     
  • Chronic or recurrent cough is extremely common in young children and the management of cough during childhood constitutes a diagnostic and therapeutic challenge for the general practitioner and the pulmonary specialist. The differential diagnosis encompasses a wide range of pathology, however in most instances clinical and laboratory investigations do not identify a specific cause. Usually the pressing question to the clinician is whether this common symptom is an expression of asthma (cough variant asthma). Recent epidemiological, clinical and laboratory evidence suggests that cough without wheeze most likely is not asthma. Cough and bronchoconstriction are probably mediated via two separate pathways that may be activated simultaneously or separately and can be selectively inhibited. There is little room for non-etiologic pharmacological treatment of cough. The present review discusses the definition, epidemiology, diagnostic approach and treatment of chronic and recurrent cough in children. The complex relationship of cough, bronchial hyperreactivity, atopy and asthma are also reviewed and the need for thoughtful dispensing of anti-asthma medication in cough that is not accompanied by other characteristics of asthma is highlighted. Pneumon 2003, 16(3):271-284.
     
  • In the past there was significant scepticism for the role of chemotherapy in patients with inoperable non-small cell lung cancer (NSCLC). Nevertheless, randomised trials of the 80’s and the meta-analysis that followed demonstrated that the use of cisplatin improves overall survival and the quality of life of these patients. Later, the introduction of newer cytotoxic agents, such as gemcitabine, paclitaxel, docetaxel and vinorelbine established the role of chemotherapy as main treatment of inoperable NSCLC patients. We thoroughly reviewed the efficacy and toxicity of the most commonly used chemotherapy agents and we present data οf ongoing studies. Pneumon 2003, 16(3):285-288.
     
  • Tuberculosis still remains the most common cause of death from infectious diseases in the general population, whereas proofs of the disease have been found in mummies aged 5.000 years old. These data confirm that the mycobacterium of tuberculosis is characterized by high tolerance and potential alternation of its ability to infect and its defense mechanisms that have allowed it to survive through centuries. The knowledge of the molecular mechanisms of apoptosis, which is the basic defense mechanism of macrophages and the clarification of the role of cytokines and virulent components of mycobacterium in combination with the understanding of the potential role of other agents such as nitric oxide and calcium could possibly provide us with new therapeutic alternatives beyond the known antibiotic treatments in the future. Pneumon 2003, 16(3):289-305.
     
  • ABSTRACT. Smoking is considered responsible for the death of millions of people every year around the world. The aim of this survey was to evaluate the smoking habits of medical students at the University of Athens, since they are expected to have leading role in antismoking campaign due to their doctor status in future. A 32-item anonymous questionnaire was distributed to a random sample of 418 students, 231 males and 187 females, at Athens Medical School, irrespective of the semester they attended. Statistical analysis was performed using the SPSS program. Sixty-eight percent of the students were found to have tried smoking; of them, 40% are regular smokers, 47% occasional and 13% ex-smokers. Thirty five per cent of smokers started smoking at some age between 15-18 years and 27% are light smokers (1-10 cigarettes daily). Males reported that the main reason for starting smoking was pleasure (32%), whereas females said it was anxiety (28%) or curiosity (28%). Smoking habit is related to alcohol consumption (p=0.0001). Lastly, 8% of the students are unaware of the adverse effects smoking has on health. In conclusion, more efforts to educate students about the harmful consequences of smoking are needed, so as to reduce the percentage of smokers among medical students. Pneumon 2003, 16(3):314-321.
     
  • ABSTRACT. Typical pulmonary carcinoid tumors are well-differentiated neuroendocrine tumors. The objective of the present study is to review cases of typical pulmonary carcinoid tumors diagnosed in the Bronchoscopy Department of the General Regional Hospital “G. Papanikolaou” over the period from 1990 through 2001. Reviewing the medical records of this period, 25 patients [16 male, 9 female, aged (mean±SD) 56,96±15 years] with typical pulmonary carcinoid tumors were identified, which account for 0.32% of all lung tumors diagnosed during the same period. All cases of pulmonary carcinoid tumor were diagnosed by endobronchial biopsy, whereas additional cytology studies on specimens obtained by brushing, lavage, or transbronchial needle aspiration (TBNA) were performed in the majority of the patients. Locations of typical carcinoid tumors, presenting symptoms, as well as sensitivities of the available diagnostic methods are also presented. In conclusion, bronchoscopy is very effective in the diagnosis of typical carcinoid tumors due to their frequent occurrence in major airways. Endobronchial biopsy and, to a lesser extent, TBNA are considered bronchoscopical diagnostic methods of choice, whereas the risk of bronchoscopy associated bleeding is insignificant. Pneumon 2003, 16(3):327-331.
     
  • ABSTRACT. The majority of patients with lung cancer (LC) are elderly patients, since 60% of the newly diagnosed patients with LC are >65 years old and 30% are >70 years old. It is common for elderly patients to suffer from a variety of chronic diseases and hence receive multiple drug treatments, which combined with their particular psychosocial and financial situation makes the process of diagnosis, staging and treatment of the disease difficult; therefore, it is necessary to employ an individualized approach. We thoroughly reviewed the differences between elderly and younger patients with lung cancer and pinpoint the need for an individualized approach to the management of elderly patients with lung cancer. Pneumon 2003, 16(3):337-341.
     
  • We present a case of a 72 years old woman, non-smoker, who has been referred to our hospital due to dyspnoea on exertion and interstitial bilateral infiltrates on chest x-ray. Based on her medical history no typical symptoms of systemic disorder were reported apart from generalized aching. Clinical examination revealed symmetric joint swelling of knees and morning stiffness of hand joints for at least one hour. Moreover the rheumatoid factor was highly positive, whereas the x-ray of the hands indicated unequivocal bony decalcifications localized to the joints. The high resolution CT-scan of the chest revealed interstitial bilateral filtrates and three small (3-5 mm) nodules (rheumatoid nodules). Clinical and laboratory findings were consistent with rheumatoid arthritis which causes pulmonary fibrosis. It is a systemic disease which mainly affects the joints and other organs including the respiratory system. Pneumon 2003, 16(3):342-347.
     
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