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  • Cheyne-Stokes respiration is reported in 30-40%% of patients with severe heart failure. Its presence complicates clinical presentations with day-time somnolence, insomnia and additional complaints of profound fatigue and dyspnea; moreover, it has an adverse effect on the course of heart failure due to the activation of the sympathetic nervous system and the increase in the afterload of the left ventricle of the heart. The trigger for Cheyne-Stokes breathing is the stimulation of vagal receptors by lung conges¬tion leading to hyperventilation and a fall in PaCO2 below the threshold for the maintenance of the respiratory drive. Variations in PaCO2 levels as a result of activation of central and, mainly, peripheral chemoreceptors, entail significant instability in the respiratory and, consequently, cardiovascular func¬tion. Cheyne-Stokes respiration is easy to identify, provided that clinical suspicion is high. A variety of pharmacological agents (theophylline, benzodiazepines) have been used for its treatment with poor results; on the other hand, oxygen therapy which reduces to some extent episodes of apnea/hyperventi¬lation, and non-invasive mechanical ventilation (CPAP, Bilevel ASV) had the most encouraging out¬comes. Pneumon 2005,18(2):135-143.
  • Pulmonary arterial hypertension (PAH) is defined as a group of diseases characterized by identical pathological changes of the pulmonary microcirculation. The disease is associated with poor progno¬sis and before the introduction of intravenous prostacyclin, median life expectancy from the time of diagnosis was 2.8years. Continuous intravenous administration of epoprostenol improved survival of patients with PAH and currently is considered as the most effective therapy. Nevertheless, this therapy presents significant difficulties in the modality of administration and also systemic side-effects. Owing to the problems with epoprostenol, new prostacyclin analogues administered subcutaneously (trepros-tinil), orally (beraprost) and by inhalation (iloprost), have been sought for the treatment of PAH. Other emerging therapies for treatment of PAH include endothelin-1 receptor antagonists, phosphod¬iesterase inhibitors and L-arginine. The impact of new therapies on survival of patients with PAH and also the combination of diverse drugs need further investigation. Pneumon 2005,18(2):144-155.
  • Lung volume reduction surgery is a proposed treatment for emphysema. Several groups have reported on the long-term benefits of LVRS in respect of sustained improvements in lung function tests, quality of life, exercise capacity and dyspnoea. Despite the above reports the duration of improvement varies within groups and the survival is not significantly different compared with medical treatment. The most representative study of LVRS is NETT, a randomized trial, which compared LVRS to continued medical treatment. The main conclusions from the NETT were the identification of a specific group with predominantly upper lobe emphysema and low baseline exercise capacity which benefits in the field of mortality compared to the other groups as well as to continued medical treatment. Patients with homogenous emphysema, low diffusion capacity and low FEV1 are at high risk of death following 30-90 days after LVRS. The main difficulties in evaluation of LVRS lie on the absence of identification of medical treatment and specifically the fact that, this procedure is not compared yet with the current treatment of COPD, which seems to be completely different from the one currently applied. Although there are some encouraging reports, LVRS is still an experimental palliative surgical procedure and several large randomized multicenter studies are needed to investigate the effectiveness and cost of LVRS in comparison to vigorous conventional therapy. Pneumon 2005, 18(2):156-162.
  • G. Hamalakis
    Τhoracic Surgery Department, Athens Chest Hospital (Sotiria), Athens According to the law of Boyle-Mariotte the gas volume of the human body cavities increases when the barometric pressure decreases. The same happens with the oxygen concentration as we mount from the sea level. Both factors affect mainly the patients with respiratory insufficiency. Nowadays, it is obvious that the number of medical air transportations is increasing due to the special geography of Greece, namely the existence of the islands. It is imperative to study all the guidelines for the safety of air transportations taking into consideration the cabinet pressure decreases of many airplanes. The principles and the kinds of medical air transportations are described. The indications of the medical air transportations are set and medical instructions are mentioned, while, relevant conclusions are drawn. Pneumon 2005, 18(2):163-173.
  • Heparin- induced thrombocytopenia (HIT type II) is a severe complication of heparin therapy, and it must be distinguished from other causes of thrombocytopenia. Unlike other drug- induced thrombocytopenias, HIT does not usually cause bleeding, but instead causes thrombosis. It is associated with high rates of morbidity (thrombosis and amputation) and mortality. HIT is mediated by antibodies against the heparin/platelet factor 4 complex. Patients receiving any form of heparin who develop a decreasing platelet count, unexplained thrombosis or resistance to heparin anticoagulation should be tested for these antibodies. If antibodies are detected, all forms of heparin therapy must be immediately discontinued and initiation of alternative anticoagulation is strongly recommended, i.e. the direct thrombin inhibitors (DTIs). As early diagnosis of heparin-induced thrombocytopenia seems to improve outcome, it is advisable that all patients on heparin should have frequent monitoring of platelet counts. Early administration of coumadin for the treatment of venous thromboembolic disease efficiently prevents the occurrence of heparin- induced thrombocytopenia type II. Pneumon 2005, 18(2):184-189.
  • To follow-up the development of pleural plaques in the rural population of Almopia (a province in Northern Greece) where exposure to asbestos as an environmental pollutant had occurred in the past. In the two years’ period from 1988 through 1990, 1,086 people aged over 5 years, 818 of whom were over 40 years old, were examined with chest radiographs. These people were inhabitants of 7 villages in the province of Almopia with a total population of 3,931 people. Until 1935, the inhabitants of this area had been using rocks containing a high concentration of asbestos fibers as whitewash. Pleural plaques were found in 198 persons over 40 years; malignant lung neoplasm in 9; and malignant mesothelioma in 5 persons. Respiratory function was tested as well in 23 individuals. In 2003 (15 years later), follow-up examinations were performed, including: i) 126 survivors out of the 198 subjects initially presenting pleural plaques, underwent a chest x-ray examination; new radiological findings were compared to the previous ones (1988) using digitalization of radiological films and measurement of the area of shading; ii) respiratory function was re-evaluated in 18 out of the 23 individuals who had been evaluated 15 years ago. In addition, the cause of death of 72 persons who had passed away in the meantime was examined. A) Expansion of radiologically evident lesions was observed, despite the fact that exposure to asbestos had ceased long before. Not only was the area of previous plaques increased, but new plaques had appeared as well (total increase 1,091.1 cm2). B) Total lung capacity declined from 95.6±14.8 to 76.5±9.3 percent of the expected value. C) It was found that, of the 72 deaths in total, 11 people had died of malignant lung neoplasm and 4 of mesothelioma. The radiological appearance of pleural plaques in people with environmental exposure to asbestos in the past gets worse over time; respiratory function is proportionately affected as well. With reference to the total Greek population, prevalence of mesothelioma in the certain area was found to be higher than expected. Pneumon 2005, 18(2): 197-203.
  • In the 1980s, our investigation on “endemic calcifications” and increased incidence of mesothelioma in Metsovo revealed at least seven areas in Greece that showed a similar epidemiologic pattern of exposure and disease incidence. One of these areas was Megarchi in Trikala. In the twenty years that followed, despite the high incidence of calcifications in this area, there has been no case of mesothelioma. This paradox has stimulated the present study. Our findings showed that asbestos (tremolite) contained in the ground used in Megarchi has the form of crystals, which, in contrast to the thin/long fibers of asbestos found in Metsovo, has experimentally been shown to be unable to induce neoplasia. The study was expanded obtaining bronchoalveolar lavage fluid from all healthy inhabitants with calcifications. Amorphous, non-organic material inside and outside alveolar macrophages was found in all cases; the number of asbestos bodies ranged from low (8-30/100,000 cells) to null. Mineralogical studies of lavage fluid showed tremolite crystals. The present study shows that: i) there is a true high incidence of pleural calcifications, but no mesothelioma case has been reported in the area of Megarchi; ii) as in Metsovo, tremolite is implicated in the development of pleural calcifications; however, tremolite found in this area has completely different aerodynamic properties that have been shown to be associated with different biological effects. Hence, this type of tremolite has a fibrosing effect (pleural plaques), but lacks carcinogenicity (no mesothelioma case); iii) areas in Greece where “endemic calcifications” have previously been reported should be reassessed with a view to identify the causative agent and subsequently to rid the population of the threat of a “mesothelioma epidemic”, which may in fact never come up, provided that findings are similar to that in Megarchi. Pneumon 2005, 18(2):214-222.
  • Department of Internal Medicine, “Sotiria” General Hospital of Athens Measurement of ascitic fluid adenosine deaminase (ADA) and serum cancer antigen 125 (CA 125) may represent an effective tool in the prompt diagnosis of tuberculous peritonitis. We report the case of an immunocompetent male adult where diagnosis was made on the basis of increased values of ascitic ADA and serum CA 125. Immediate initiation of antituberculous treatment resulted in quick resolution of ascites. Diagnosis was confirmed six weeks later with positive cultures of bronchoalveolar lavage for Mycobacterium tuberculosis. ADA and CA 125 should be considered as rapid, noninvasive diagnostic tests for tuberculous peritonitis. Pneumon 2005, 18(2):223-227.
  • A post-traumatic pulmonary pseudocyst is a rare complication of blunt chest injury, in which an increase in intrapulmonary pressure causes shearing of the lung parenchyma without rupture of the pleura. We describe a young man who presented with a history of haemoptysis and a cavitary lesion on his chest film two weeks after a blunt chest injury due to a fall. Computed tomography showed appearances consistent with a post-traumatic pseudocyst, and bronchoscopy disclosed evidence of inflammation, with growth of abnormal flora in the bronchial washings. Administration of oral antibiotics based on sensitivity testing led to rapid and complete clinical and radiological resolution. Pneumon 2005, 18(2):228-232.
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