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  • toxicity, Oxygen, lung
    The supplemental oxygen administration is a common therapeutic intervention in the management of patients with arterial hypoxemia, in order to improve tissue hypoxia and maintain aerobic metabolism. Unfortunately the therapeutic use of high concentration of FiO2 for a prolonged period of time causes anatomic and functional damage to the lungs similar to that described in Acute Respiratory Distress Syndrome (ARDS). The aim of the study is to review the data from recent about oxygen toxicity mechanisms - which is a biochemical paradox since oxygen is simultaneously essential for aerobic metabolism - and to understand of the cellular and molecular mechanisms that finally cause the cellular damage and death. This is a field for future research about the oxygen caused damage and the final goal is the investigation of new therapeutic approaches to confront and minimize the hyperoxia induced problems. Pneumon 2004, 17(1):18-28.
     
  • K. Psathakis
    During the first half of the 20th century, thoracoscopy was applied in the management of pulmonary tuberculosis. After the discovery of the anti-tuberculous drugs, it was developed to a diagnostic tool for thoracic disorders. Thoracoscopy, as it is applied nowadays by pneumonologists, differs from thoracoscopic surgery (evolution and application of the technique in thoracic surgery) and concurrently has the advantage of being less invasive and cheaper, since it is performed under local anesthesia, in an endoscopy suite, using undisposable instruments. Due to its high diagnostic accuracy, it is the procedure of choice for undiagnosed pleural effusions, which is the main indication of this technique. It also gives the option of talc poudrage that is the procedure of choice for pleurodesis in malignant pleural effusions. Thoracoscopy encounters similar applications in the management of pneumothorax. It is a safe, effective and easy to learn method. As the interest for the technique and the number of the trained pneumonologists are continuously increasing, thoracoscopy is expected, within the next years, to find the position it merits in the diagnostic and therapeutic armamentarium of pneumonologists. Pneumon 2003, 17(1):29-38.
     
  • Airway inflammation plays an important role in diseases such as asthma, bronchiectasis, cystic fibrosis and chronic obstructive pulmonary disease. The use of non-invasive techniques for the evaluation of these inflammatory diseases has been the object of increasing interest in the past few years. The ollection of expired breath condensate (EBC) is achieved by freezing the exhaled air with the use of special condensing devices and provides useful information about areas of the respiratory tract accessible exclusively with invasive techniques. In the exhaled breath condensate there have been measured molecules, such as hydrogen peroxide, 8-isoprostane, end products of NO metabolism (nitrites/nitrates, nitrotyrosine), leukotrienes and, recently, pH. These measurements have given useful information regarding the inflammatory pathophysiology of airway diseases. Despite the methodological problems of this procedure, its non-invasive nature gives the opportunity for repeated measurements on the same person and provides valuable information for the assessment of airway inflammation. Pneumon 2004, 17(1):39-44.
     
  • Pulmonary embolism is a frequent and often undiagnosed cause of increased mortality. Only in the United States of America pulmonary embolism is considered as the main cause of more than 150.000 deaths every year. The clinical diagnosis of pulmonary embolism is unreliable because the patients’ symptoms and signs are usually nonspecific. The use of computed tomography for the diagnosis of pulmonary embolism was first described in 1980 but a definite diagnosis was usually limited to large central artery branches. Spiral computed tomography and the new protocols have established a very important diagnostic technique for suspected pulmonary embolism. The aim of this paper is to show the direct and indirect spiral computed tomography findings of pulmonary embolism, computed tomography protocols that we use in our hospital, and to present clinical and CT findings of 12 cases with suspected pulmonary embolism. Pneumon 2004, 17(1):45-54.
     
  • Selecting the appropriate reference values for maximal oxygen uptake (VO2peak) is of pivotal importance in the differential diagnosis of abnormal findings in cardiopulmonary exercise testing. The currently used reference values proposed by Jones et al, Hansen et al, and Fairbarn et al, which are based on cycle ergometry, present significant interstudy differences and cannot be applied to sedentary subjects, whereas reference values for several other variables have not been assessed at all, making it difficult to deduce valid conclusions. We studied 68 normal male adults, aged 18–48 years, who reported absence of systematic exercise. A progressive incremental exercise of 20 Watts/min up to exhaustion was performed, using a cycle ergometer and a mixing chamber system (EOS Sprint, Jaeger). Maximal oxygen uptake, heart rate, performed work, tidal volume, ventilation, oxygen pulse, lactate threshold and respiratory reserve were measured at peak exercise. The height of the subjects ranged from 166 to 194 cm and the weight from 57 to 95 kg. Smokers and subjects with exertional dyspnea or cough were included in the study, provided that resting spirometry was normal. In overweight subjects, Bruce’s correction for weight was used. Predicted values for VO2 proposed by Fairbarn, Jones and Hansen were found to be systematically higher by 45%, 25% and 6%, respectively. VO2peak varied according to age and height, while maximal heart rate was predicted by age alone. Normal values for respiratory reserve set at >11 Lit/min showed specificity of 99% and for VT/FVC ratio at >30% had a specificity rate of 96%. Lactate threshold appeared at 80% of VO2peak, with a lower limit of 56% (SD 9%). In conclusion, predicted values proposed by Hansen et al are comparatively more representative of the Greek sedentary general population, but still not ideal. The results of the present study are proposed as useful reference values in the evaluation of cardiopulmonary exercise testing in the average Greek population. Pneumon 2004, 17(1):55-63.
     
  • To study retrospectively the clinical manifestations and course of near-drowning in sea water. Adult patients who presented to a district hospital with near-drowning, from 11/6/1994 to 1/9/2001. In all 35 patients (24 female, 11 male), aged 18-88 were studied. Of the patients, 28 were elderly (³65 years). Immediately after rescuing at the seaside, 10 of the patients had a GCS <9 and 6 had a GCS of 9-14. At presentation, 7 patients had a GCS <15 and two of them were still comatose and had to be intubated for airway protection. Α third patient had to be intubated within the first 24 hours, because of ARDS. In all, 4 patients had to be transferred to an ICU - 2 of them because of coma and 2 because of acute respiratory failure. Of the comatose patients, one died because of ventilator-associated pneumonia. No other fatalities were observed. All patients, with two exceptions, had a PaO2/FiO2 <300 at presentation. Criteria of ARDS were fulfilled in 14 and criteria of ALI (acute lung injury) in 12 cases. Superimposed pneumonia was observed in 4 patients (one intubated). Improvement of arterial blood gases was rapid in most cases and 24 hours after presentation, only 6 patients still had ARDS. A worsening of gas exchange after the first day was observed in 2 cases. Duration of hospitalization varied from 2 tο 11 days (5,23±0,47 days, mean±SEM). Duration of hospital stay was significantly longer in patients who presented with GCS <15 (7,57±0,78 vs 4±0,79 days, p=0,023). In the absence of serious neurologic impairement, near drowning victims, even when they are elderly, can be expected to have a good outcome, despite the frequent presence of severe acute respiratory failure. Pneumon 2004, 17(1):72-79.
     
  • We present the case of a 42-year-old Caucasian female with recurrent respiratory infections since early adulthood. Her previous medical history included a left posterior mediastinal tumor presenting in her childhood and a year ago, a radical right mastectomy. Although a chest CT-scan and a fiberobronchoscopy were performed, exploratory thoracotomy revealed the coexistence of an extralobar bronchogenic cyst and a bronchial abnormality, namely trifurcation of the left main bronchus. Pneumon 2004, 17(1):87-93.
     
  • A 45 year old woman was admitted to the emergency department of our hospital with an one and a half month history of gradually developing dyspnea. The chest x-ray showed pleural effusion which involved the middle and lower right pulmonary field. The patient underwent thoracoscopy (VATS) and a well differentiated papillary mesothelioma was diagnosed. Right pneumonectomy was performed and the conclusive histological diagnosis was extrasceletal Ewing sarcoma. The above case is presented because this Ewing sarcoma was primary located at the lungs given that the bone scanning was negative for neoplastic foci. Pneumon 2004, 17(1):94-100.
     
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