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  • Monitoring of asthma and COPD patients is usually based on symptom scores, use of rescue medication and measurement of lung function. However, both asthma and COPD are chronic inflammatory diseases of the airways and there is a need to assess and monitor inflammation using markers directly implicated in the inflammatory process. Several invasive (bronchoscopy, nasal and skin biopsies) and non-invasive (bronchial hyperresponsiveness, blood, urine, induced sputum, exhaled air) biomarkers have been examined as potential markers of airway inflammation for the diagnosis and follow-up of asthma and COPD patients. The advantages and disadvantages of each one of them are discussed in this review. Presently, available data support the use of bronchial hyperresponsiveness (BHR) and sputum induction as the best available biomarkers to guide treatment in the majority of asthmatic patients, whereas in COPD patients none of the available inflammatory markers has gained wide acceptance among investigators till now. Larger and longer-term population-based studies focused on the relationship between markers of inflammation and treatment regimens are needed to determine the optimum biomarker for any given treatment. Pneumon 2004, 17(3)
  • New treatment modalities have emerged since the introduction of inhaled drugs for the treatment of childhood asthma. Theophylline preparations are practically no longer used for asthma exacerbations, as inhaled β2-agonists and ipratropium bromide are sufficient for bronchospasm relief. Many long-term studies have established the effectiveness and safety of inhaled steroids, which henceforth replaced sodium chromoglycate, a widely used prophylactic drug. Leukotriene receptor antagonists and long acting β2-agonists are appropriate add-on treatment for those children not responding to steroid monotherapy. Patient compliance, as well as inhalation technique should always be checked before stepping up to more intensive treatment. Pneumon 2004, 17(3):251-257.
  • ABSTRACT. The difference between the alveolar and arterial oxygen pressure is known as alveolar – arterial difference (PA-aO2) or efficiency for gas exchange. Gas exchange within the lung is not perfect even at rest. During exercise, the gas exchange progressively worsens. The mechanisms that contribute to A-a DO2 are not well known. Ventilation-perfusion mismatch (VA/Q) is considered to be the main reason for A-aDO2 widening. VA/Q mismatch is due to the effect of gravity - structural differences in airways – blood vessels, bronchoconstriction, secretions from airways irritated by high flows or dry-cold air and mild interstitial edema. Diffusion limitation is a second contributing factor to A-aDO2 widening. It can be attributed to several reasons, such as: the surface area for diffusion, the distance required for diffusion from the alveolar membrane to the red blood cell, the transit time and the rate of equilibration of mixed venous blood with alveolar gas. Diffusion limitation may occur to well-trained athletes at high exercise intensity, while it is unlikely to occur in untrained subjects during low and moderate exercise. The last contributing factor to A-aDO2 widening is considered to be the mixing of shunted blood (intra-extrapulmonary shunt) with arterial blood. Even though there is not enough published data to support the previous statement, it seems that not only the A-aDO2 is negatively affected but simultaneously may play a positive role by protecting the alveolar – capillary membrane from liquid accumulation and disruption in athletes. Pneumon 2004, 17(3):265-271.
  • Fr. Vlastos
    Treatment of lung cancer is based on knowledge of the extent of the disease and the histologic tumor type (NSCLC and SCLC). Surgery for SCLC is considered in very selected patients with very limited disease who respond to chemotherapy, but is the best choice for patients with early stage NSCL and for those who do not have demonstrable metastases. Chemotherapy is the initial treatment of choice for SCLC with the maximal dose and combinations with several drugs. Also is recommended for metastatic lung cancer, certain NSCLC being treated with radiation therapy and in clinical trial investigation is used after surgery. Radiation alone or in combination with chemotherapy may be appropriate for inoperable tumor. It is also used as palliative therapy to relieve symptoms and is similar to surgery but not alternative to provide local control. After surgery, radiation is performed to decrease local recurrence and as preoperative therapy (neoadjuvant), alone or with experimental chemotherapy. New chemotherapy drugs, ongogenes, markers, monoclonal antibodies e.t.c. are under study. Pneumon 2004, 17(3):272-288.
  • Operability and resectability constitute a guide to the therapeutic options in lung cancer. Operability is determined by various preoperative test parameters, of which spirometry is of utmost importance. Resectability is dependent on tumor stage. The latter requires a host of investigative procedures, of which computed tomographic scanning is paramount. The multidisciplinary team approach is central in achieving an efficient therapeutic strategy as well as meeting patients’ preferences. Pneumon 2004, 17(3):289-296.
  • Patients with a chronic pulmonary disease often require long-term treatment with oral steroids. Prolonged use of glucocorticoids is associated with increased risk of bone loss and osteoporosis. The American College of Rheumatology (ACR) has published guidelines to prevent steroid-induced osteoporosis. The aim of this study was to investigate adherence to these guidelines in clinical practice. Medical records of 87 patients receiving oral steroids (prednisolone >10 mg/day) for at least 6 months were reviewed. Of these, 57 patients were treated by a rheumatology specialist, and 30 by a pulmonology specialist. Differences between the two groups were examined using Chi-square test. Altogether 33 patients (35%) received prophylactic treatment. Examination of between-groups variation revealed that 46% of patients treated by a rheumatologist received prophylaxis, while the respective percentage in those treated by a pulmonologist was only 23% (p<0.05). Our data suggest that only a relatively small proportion of patients receiving corticosteroid treatment are offered prophylaxis for steroid-induced osteoporosis, and this proportion is significantly lower in patients attended by pulmonary medicine specialists. Pneumon 2004, 17(3):297-303.
  • The aim of this study was to investigate treatment regimens of bronchial asthma, bronchiolitis and laryngotracheobronchitis at a pediatric emergency room. This is a retrospective study of children with bronchial asthma, bronchiolitis or laryngotracheobronchitis who presented to the pediatric emergency room of a tertiary care teaching hospital over a 12month period (year 2001). The demographic characteristics, diagnosis and treatment were recorded. During the study period, 881 children with the above mentioned respiratory disorders were examined. It was found that bronchodilators were administered to 89% of them, corticosteroids (inhaled or systemic) to 71%; a combination of bronchodilators and corticosteroids was used in 70% of the patients. The most commonly used bronchodilators were nebulized epinephrine in patients with laryngotracheobronchitis (90%) and salbutamol alone or in combination with ipratropium bromide in those with asthma or bronchiolitis (86% and 70%, respectively). Forty seven per cent of the children received 3 or more medications. We conclude that treatment of asthma and laryngotracheobronchitis with bronchodilators is in accordance with the guidelines of the Hellenic Thoracic Society; inappropriate use of inhaled steroids is though observed. Bronchiolitis is not consistently treated according to current guidelines. Pneumon 2004, 17(3):311-318.
  • A patient with non small-cell bronchogenic carcinoma, who underwent percutaneous transthoracic fine-needle aspiration cytology under the guidance of computed tomography, is presented. The patient developed implantation of the tumor in the muscles of the chest wall one year after the fine-needle aspiration cytology. It is emphasized that this diagnostic method should be applied only on patients for whom it is expected that the therapeutic decision will change on the basis of the cytological diagnosis. Pneumon 2004, 17(3):327-331.
  • Legionella pneumophila is considered as a relatively common cause of pneumonia characterized by high mortality rate. Microbiological diagnosis of Legionnaires’disease includes a wide variety of methods such as culture, direct fluorescent antibody staining (DFA), serum antibody (IFA) testing and Legionella urinary antigen testing. The reported sensitivities of these methods vary widely. Detection of Legionella urinary antigen by the immunochromatographic assay ICT Binax Now Legionella Urinary Antigen is considered a successful alternative to culture. There are no reports on the applicability of this test to specimens other than urine, in recent literature with an exception of a BAL positive ICT Binax Legionella antigen result. We present a case of an 18 year old girl with severe community-acquired pneumonia in whom diagnosis was mainly based on the detection of Legionella antigen in pleural fluid by the method of ICT Binax. Detection of Legionella antigen in pleural fluid by this particular method is the first described in literature, while a single case of detection of Legionella antigen in pleural fluid has been described in 1991 using RIA method. Pneumon 2004, 17(3):332-335.
  • The experience obtained from the successful management of two recent cases of early, post-pulmonary resection, high volume lymph leakage, by the combined administration of total parenteral nutrition (TPN) and octreotide is presented. Significant lymph losses (>600 ml/24 hrs) through the chest tubes were observed the 3rd postoperative day in two male patients (74 and 50 years old), who underwent right middle and upper lobectomy and left upper lobectomy respectively for primary lung cancer. Complete cessation of oral feeding and the administration of TPN and octreotide resulted in conservative resolution of the leak within 9 and 7 days respectively. Chest tubes were removed on the 14th and the 10th postoperative day respectively, while both patients received a fat free oral diet for one month, to avoid reccurrence of the lymph leak. Post-pulmonary parenchyma resection lymph leakage can be conservatively managed by cessation of oral feeding and the combined administration of TPN and octreotide, if full expansion of the remaining lung in the operated hemithorax by efficient chest tube drainage is achieved. Pneumon 2004, 17(3):336-340.
  • We report a case of recurrent pulmonary infections in a 14 years old patient with an abnormal chest x-ray. The patient was admitted to our department with a high fever, for which she was treated in another hospital. The chest x-ray was abnormal, with a shadow of the left upper lobe and emphysematous hyperinflation of the left lower lobe. After a conservative treatment with the administration of wide spectrum antibiotics and physiotherapy, the patient became free of fever, while the chest x-ray showed the remaining mass of the left upper lobe, with the organs of the mediastinum in normal position and without the existence of emphysema of the lower lobe. Chest CT Scan, revealed the existence of a huge mass of the left upper lobe, with a tumor mass into the left main bronchus. Also there were enlarged mediastinal lymph nodes and a suspicion of mediastinal infiltration caused by the tumor mass. Bronchoscopy showed an endobronchial mass that caused a 90% obstruction of the left main bronchus lumen. The patient underwent a left anterior mediastinotomy (Chamberlain procedure), which demonstrated the absence of mediastinal infiltration. A left posterolateral thoracotomy followed, and a sleeve left upper lobectomy was performed. The postoperative course was uneventful. Histology examination confirmed the diagnosis of pulmonary blastoma. This rare tumor is called adenocarcinoma of embryonic type, it represents less than 1% of all lung tumors and is characterized by poor prognosis. Pneumon 2004, 17(3):341-344.
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