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  • Asthma is a common disease that is encountered all across the spectrum from primary to tertiary care. In most cases the diagnosis of asthma is made easily, based on the response to standard doses of inhaled therapy.
     
  • In Europe, critical care medicine has evolved into a new medical specialty over the past few years.
     
  • SUMMARY. This is a review of the use of lung ultrasound (US) in routine clinical practice. Over the past few years, the use of lung US in critically ill patients has gained in popularity, and has been associated with very good outcomes. Lung US is the fastest, noninvasive, sophisticated diagnostic tool used in the Intensive Care Unit (ICU) and in other in-patient settings, free of complications and with minimal cost. It is common knowledge that the US beam cannot normally pass through air-filled structures, making the evaluation of lung parenchyma under the ribs impossible. This does not prevent the diagnosis of several abnormal conditions, including pneumothorax, consolidation, atelectasis, pleural effusion, and others. The aim of this review is to summarize the applications of sonographic imaging of the lungs and the findings associated with major respiratory disorders. Pneumon 2007; 20(2):134-141.
     
  • SUMMARY. Interleukin-6 (IL-6) is a pleiotropic cytokine, which, apart from its role in inflammation and the immune response, influences a variety of systems, including the respiratory system. IL-6 is recognized by two membrane receptors, IL-6Rα receptor and glycoprotein 130 (gp130). Binding of IL-6 to its receptors forms an active membrane protein complex and leads through gp130 to the activation of the Janus Kinase/Signal Transducer and Activation of Transcription (JAK/STAT) cascade and the Mitogen-Activated Protein Kinase (MAPK) cascade. IL-6 signalling is terminated by tyrosine phosphatases, Suppressor of Cytokine Signalling (SOCS) proteins and Protein Inhibitor of Activated STAT (PIAS) proteins. The balance between signalling pathways and suppressors of signalling mediates the final action of IL-6 in cells. Pneumon 2007; 20(1):154-167.
     
  • SUMΜARY. Aim: To investigate the local and systemic antioxidant status and inflammation, and the correlation between them in patients with lung cancer. Subjects and methods: Forty two male patients (mean age 65 ± 8 yrs) with primary lung cancer were studied. Sixteen male subjects matched for age (mean age 62 ± 5 yrs) and smoking history, without any final evidence of malignancy served as controls. Total antioxidant status (TAS), glutathione (GSH), interleukin-1a (IL-1a), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) were measured in bronchoalveolar lavage fluid (BALF) and serum samples. Results: The levels of TAS and GSH in BALF were statistically significantly increased in patients with lung cancer compared to controls (0.27 ± 0.24 mmol/L vs. 0.12 ± 0.02, p=0.02 and 7.56 ± 4.29 μmol/L vs. 4.62 ± 2.23, p=0.01 respectively). A statistically significant increase of TNF-α in BALF (15.90 ± 25.22 vs 4.94 ± 10.97 pg/ml, p=0.02) and of IL1a in serum (10.20 ± 2.59 vs 7.18 ± 6.33 pg/ml, p=0.02) was also observed in lung cancer patients. Statistically significant correlation in normal subjects was observed only between TAS and IL-1a in BALF (r=0.7, p=0.002). Statistically significant correlation in cancer patients was observed in BALF between TAS and a) IL-1a (r=0.84, p<0.001), b) IL-6 (r=0.52, p=0.001), and c) TNF-α (r=0.67, p<0.001). Conclusions: Alteration in antioxidant and inflammatory status was found in lung cancer patients both in serum and in BALF compared with normal subjects matched for smoking history. Positive correlation was observed between antioxidants and cytokines locally but not systematically. Pneumon 2007; 20(2):174-180.
     
  • SUMMARY. Background. Monitoring of respiratory mechanics during mechanical ventilation usually focuses on elastance (Ers) and resistance (Rrs). Evaluation of the impedance (Zrs), reactance (Xrs) and phase angle (θrs) seem sophisticated in clinical intensive care unit (ICU) practice. This study examines the diagnostic utility of a detailed mechanical profile composed with the aid of Fourier Analysis (FA). Patients and methods. Thirty mechanically ventilated patients (CMV mode) were classified into 3 groups: a) without respiratory disease (WRD) (n=10), b) with chronic obstructive pulmonary disease (COPD) exacerbation (n=9) and c) with acute respiratory distress syndrome (ARDS) (n=11). FA produced values of Zrs and θrs, from which Rrs, Xrs and Ers were derived. Results. Ers was significantly higher and Xrs significantly lower in ARDS. Rrs and Zrs were significantly lower in WRD while θrs was significantly higher (less negative) in COPD. The detailed mechanical profile is characteristic for each group. Conclusions. The primarily calculated parameters, Zrs and θrs, examined concomitantly may strongly indicate the predominant mechanical disorder and help in the differential diagnosis between the three entities, WRD, COPD and ARDS. Pneumon 2007; 20(2):187 193.
     
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