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  • Pulmonary toxicity resulting from treatment with antineoplastic drugs is common because of the wide use of such drugs in the treatment of malignant and other diseases. It is estimated that approximately 10% of patients receiving cytotoxic drugs will develop pulmonary toxicity. The risk of toxicity increases in the presence of other factors. The diagnostic approach includes the history and clinical examination, chest radiography, high resolution computed tomography, lung function studies, bronchoscopy with transbronchial biopsy and bronchoalveolar lavage and finally open lung biopsy. It is important to exclude other conditions such as progression of the primary disease, lower respiratory tract infections, and radiation-induced lung injury. The management of antineoplastic drug related pulmonary toxicity is based on clinical suspicion, discontinuation of the drug and administration of corticosteroids. Mortality varies among different drugs, and even with early treatment there may be residual lung da¬mage. Pneumon 2004, 17(2):120-137.
     
  • The sleep laboratory consists of the patient testing area, the attending personel and the recording apparatus. Among the various types of sleep studies, standard polysomnography, which records parameters of sleep and respiration, is considered as the gold standard. Manual scoring is necessary, additional to the automated scoring in order to avoid serious mistakes. Before the use of CPAP at home, a sleep study titration of the optimum pressure and control of possible side effects should be performed. In Greece, polysomnography obligatorily includes parameters of sleep and respiration. The sleep laboratories must reside in hospitals and the physician running a sleep lab must have a proved training and experience in this field. Pneumon 2004, 17(2):138-144.
     
  • Bakakos P., Cheilas G. The importance of T cells in regulating antibody production is well established and we understand a great deal about the mechanism that allergen-specific T cells interact with allergen specific B cells. T cells have very precise antigen recognition requirements. It is well known that T cells play a major role in the regulation of inflammation in bronchial asthma, possibly through the production of cytokines. It has been demonstrated in animal models, but also in humans that T cell subsets, defined by a different β-chain, show functional differences. In the human context, analysis of TCR family usage at sites of inflammation such as the airways, can yield insight into the forces that drive the formation of TCR repertoire and the pathogenesis of inflammation. These studies provide further encouragement to those who believe in the importance of T cells in the pathogenesis of asthma and create new perspectives in the understanding of the mechanisms that underlie inflammation. Pneumon 2004, 17(2):145-149.
     
  • The objective of the present study was to investigate the diagnostic validity of a new diagrammatic approach to the diagnosis of acid-base balance disorders as proposed by A. Grogono. In order to examine the diagnostic validity of the proposed diagram, 3,122 arterial blood gas samples were drawn from 114 ICU patients and were interpreted using the Grogono diagram and the following approaches as comparators: 1. Τhe Siggaard-Andersen (S-A) chart, 2. The “Oxygen Status Algorithm” (OSA) software and 3. Τwo physicians with more than 10 years of experience in ICU, considered experts in acid-base balance disorders. Our results showed that: 1. Τhe Grogono diagram presents the higher diagnostic agreement with the other methods ranging from 59.7% to 72.5%; 2. The diagnostic agreement between the Grogono diagram and the OSA software (70.5%) is significantly higher (p<0.001) in comparison to that between the Grogono diagram and the S-A chart (59.7%); 3. Τhe ratios of diagnostic agreement between the Grogono diagram and each one of the two experts (72.5% and 62.1%, respectively) are significantly higher (p<0.001) than those calculated for the “S-A chart” (48.3% and 56.4%, respectively); 4. Τhe two expert physicians disagreed with each other in the diagnosis of 1/3 of the cases of arterial blood gases disturbances. Moreover, they presented significant diagnostic variation in the comparisons with the other methods. In conclusion, the Grogono diagram, although superior to the S-A chart, cannot be safely used for the diagnosis of acid-base balance disorders in everyday clinical practice, because it has been shown to provide inaccurate diagnoses in at least 25% of the cases. Pneumon 2004, 17(2):150-158.
     
  • The objective of this study was to evaluate compliance with the use of the CPAP machine in a sample of Greek patients with SAHS, as well as to investigate which factors influence compliance in these patients. We studied 138 consecutive patients (114 men, 24 women, mean age±SD: 52±10 years) who were scheduled for a follow up visit in the last 3 months of the year 1999. The single one eligibility criterion was the presence of an integral time clock in the CPAP machine. The patients had the machine in their possession for 20 to 2,315 days (mean value: 379 days). The total time of CPAP use was 57 to 14,388 hours (mean value: 1733 hours), while daily CPAP use varied from 0.429 to 10.08 hours (mean: 5.54 h/day). Analysis of study data showed that 77.5% of the patients used the CPAP machine for more than 4 hours daily; adjusted compliance was 77%. Apnea/hypopnea index (AHI) was the only parameter that correlated with daily use (p<0.01) and adjusted compliance (p<0.03). An inverse significant correlation between adjusted compliance and duration of CPAP treatment was found. Women used the CPAP machine for a shorter daily time, showed lower adjusted compliance [64±27 vs. 80±28 (p<0.02)] and reported more problems with their partners (p=0.0014) compared to men. Conclusively, the studied sample of Greek SAHS patients shows a generally satisfactory compliance with CPAP therapy, which is similar to that reported in the literature. However, women adduce a variety of reasons to justify their low CPAP use, even though they have accepted this treatment. Pneumon 2004, 17(2):167-176.
     
  • Taxanes are increasingly used in the management of small cell lung cancer (SCLC), but optimal dose and combination with other antineoplastic agents remains to be determined. We used two different dosage regimens of paclitaxel (P) in combination with carboplatin (C) in 148 chemotherapy-naive SCLC patients (age up to 75 years, WHO performance status 0-1) divided in two groups. All patients received C (AUC=6) with P at a dose of either 175 mg/m2 (Group A, 76 pts [68 men]) or 190 mg/m2 (Group B, 78 pts [73 men]), all given on day 1. The regimen was repeated every 28 days for up to 8 cycles. All responders received radiotherapy at the primary tumor site (48 Gy given over 4 weeks) between cycles 6 and 8. Complete responders were given additional prophylactic cranial irradiation. The overall response (OR) rate was 63.1% in Group A (LD: 81.1%, ED: 60%), and 66.6% in Group B (LD: 77.5%, ED: 58.3%) [not significant difference]. Median survival was 270 days in Group A (95% CI: 222-318) and 300 days in Group B (95% CI: 247-352) [p=0.05]. The median time to progression was 200 days in both groups. Toxicity: grade 3/4 neutropenia: 6.5% in Group A, 14.1% in Group B; grade 3/4 anaemia: 5.2% and 10.2%; grade 3 thrombocytopenia: 5.2% and 1.2%; and grade 1/2 neurotoxicity: 27% and 16.6%, respectively. Compared to conventional regimens in the management of SCLC, the combination of P with C is equally effective and well tolerated. There is no significant difference in response or survival rates with the higher dose of P, as indicated in the present study. Pneumon 2004, 17(2):186-194.
     
  • We present a case of a 16-year old female patient with tranfusion-related ARDS, which necessitated the use of non-invasive mechanical ventilation for 72 hours. We discuss the pathogenesis of this syndrome as well as its epidemiology, clinical findings, diagnosis and treatment. Pneumon 2004, 17(2):203-206.
     
  • A case of a 58 years old male, ex-smoker since 10 years (30 pack/years), who was admitted to our hospital due to bilateral pulmonary nodules is presented. Abdominal CT was normal and bronchoscopy showed endobronchial alterations of mild inflammation. A nodule was removed by open lung biopsy. Histological diagnosis excluded cancer and confirmed Cryptogenic Organizing Pneumonia - Bronchiolitis Obliterans with Organizing Pneumonia (COP – BOOP). This di¬sorder is characterized by granulomatous tissue that obstructs small bronchioles and organizes pneumonia. Open lung biopsy or VATS is required to establish the diagnosis with certainty. In BOOP, bilateral pulmonary nodules as the only manifestation in chest radiograph are rare. Pneumon 2004, 17(2):207-212.
     
  • Reexpansion pulmonary edema is a rare complication of thoracentesis for pleural effusion or pneumothorax. The underlying mechanism of this condition is unclear, but several mechanisms have been proposed. Significant morbidity can result and death is reported in up to 20% of cases. We present a case of ipsilateral reexpansion pulmonary edema following chest tube insertion for pneumothorax successfully treated with continuous positive airway pressure. Pneumon 2004, 17(2):213-216.
     
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