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  • SUMMARY. Alcohol abuse is a comorbid variable that independently increases by about 3-4 times the incidence and severity of acute respiratory distress syndrome (ARDS) in patients at risk. Chronic overconsumption of alcohol causes oxidative stress in the lungs through its metabolism, and diminishes the synthesis and utilization of glutathione (GSH), which is a major antioxidant, resulting in impairment of the antioxidant ability of cells. The decreased concentration of GSH in the lungs leads to a variety of lung changes, including decrease in alveolar liquid clearance and increased protein leak across the alveolar epithelium, overexpression of transforming growth factor-β1, depression of the synthesis and secretion of surfactant phospholipids by type II alveolar epithelial cells, increased apoptosis of alveolar macrophages and loss of their phagocytic ability, and dramatic alterations in connective tissue remodelling. GSH replacement by the administration of GSH precursors such as N-acetylocysteine and procysteine has been demonstrated to minimize alcohol induced injuries More detailed studies are needed to define the mechanisms by which alcohol abuse renders the lungs susceptible to acute lung injury, in order for more specific therapeutic strategies to be developed. Pneumon 2008; 21(4):–
     
  • SUMMARY. Polysomnography is a medical diagnostic test which offers a large amount of information by recording the activity of various organ systems for a period of several hours with the aim of diagnosing pathological conditions associated with sleep. It is used for the diagnosis of apnoea-hypopnoea and upper airway resistance syndromes, and a variety of other sleep conditions related to daytime sleepiness that cannot be classified as breathing disorders, such as restless leg syndrome, disorders during REM sleep and other parasomnias. The first manual- report in Polysomnography published in 1968 by Rechtschaffen and Kales (R & K) contained scoring rules for the assessment of all parameters of sleep, and became a guide for thousands of polysomnographic tests. During the 40 years which have passed since the publication of the first manual, there has been vigorous development in the methodology of recording the parameters of polysomnography and the scoring rules. As a result of these developments, the American Academy of Sleep Medicine (AASM) published a new manual in 2007: The AASM Manual for the Scoring of Sleep and Associated Events – Rules, Terminology and Technical Specifications, which revises some of the rules and adds others concerning disorders and syndromes that have been described since the first edition of the manual. Πνεύμων 2008, 21(4):-.
     
  • SUMMARY. Background: APACHE-II is one of the severity-of-illness scoring systems. It describes in an arithmetical manner the severity of injury by calculating 12 variables, the Acute Physiology Score (APS), age and the chronic health status. Objectives: The aim of this study was to find a regression equation to predict the APS from a limited number of variables in patients with traumatic brain injury (TBI). Population and Method: The characteristics were studied of 74 subjects admitted to the Intensive Care Unit (ICU) of the University General Hospital of Alexandroupolis, Greece, during the decade 1994-2003 with the diagnosis of “TBI”. The subjects had a mean age of 45.19±2.55 years, 65 were male (87.8%) and 9 female (12.2%) and their mean Glasgow Coma Scale (GCS) score was 6.39±0.55. Statistical analysis was made using stepwise regression, with APS as the dependent variable and the 12 physiological variables and age being the independent variables. The following selection criteria were also taken into consideration: Akaike, Amemiya, Mallows’ and Schwarz. Results: The data analysis provided the following equation: APS = 148.843 – (1.074*GCS) – (16.878*pH) – (0.190*HCT) + (4.082*CR), where HCT is the haematocrit and CR is serum creatinine. The statistics of the equation were: F=116.304 (p=0.000), adjusted coefficient of determination (R’2)=0.863 and standard error of the estimate=2.624. The corresponding values for Akaike, Amemiya, Mallows’ and Schwarz selection criteria were: 147.575, 0.148, 3.053 and 159.095. Conclusions: These results suggest that it is possible to estimate the APS value based on four variables only, thus saving time in APACHE-II calculation. In this series, 86.3% of the APS change was due to the four aforementioned variables, while the remaining 13.7% was due to other factors which are not entered in the equation. Pneumon 2008; 21(4):–
     
  • SUMMARY. Background The occurrence of obstructive sleep apnoea in children with achondroplasia has already been described. Objectives To investigate the association between achondroplasia and obstructive sleep apnoea syndrome (OSAS) in adult patients. Subjects and methods Three women aged 43-59 years with achondroplasia were studied. They all complained of snoring, daytime somnolence and chronic fatigue. Their past history included tonsillectomy and adenoidectomy. Polysomnography, spirometry, blood gases and blood biochemistry analysis were performed. Results All three women had OSAS, with RDI 42.8/h, 23.3/h, 40.1/h respectively. Spirometry and arterial blood gases were within normal limits, but blood biochemistry showed hyperlipidaemia in all the women. Cephalometry showed middle face hypoplasia. Neck CT-MRI demonstrated constriction of the foramen magnum amd stenosis of the oropharynx and hypopharynx. Conclusions OSAS should always be suspected in adult patients with achondroplasia, as well as in patients with skeletal deformities of the face and upper airway soft tissue abnormalities. Pneumon 2008; 21(4):–
     
  • SUMMARY. The need for new, more effective antituberculous drugs is pressing. The treatment of active disease needs to be shortened and simplified, the treatment given for latent tuberculosis (TB) also needs to be shortened and, most importantly, improved therapy for multi-drug resistant TB (MDR-TB) is needed. The fluoroquinolones are the first novel drugs since the rifamycins found to exert significant activity against M. tuberculosis. They are currently being used for the prophylactic treatment of individuals who have been exposed to MDR-TB, for the treatment of MDR-TB, for empirical treatment of TB in areas with high rates of MDR-TB and for patients who present severe adverse reactions to the conventional antituberculous regime. Conversely, their use is not recommended as a first-line drug for the routine treatment of TB. Fluoroquinolones are relatively safe antimicrobial compounds that bind to bacterial topoisomerases, resulting in cell death. They show strong bactericidal activity both in vitro and in vivo, and some, such as moxifloxacin, also exert sterilizing activity. Resistance to fluoroquinolones, associated with their previous use, is a significant issue. The emergence of resistance is far more likely when ciprofloxacin is included in the regime. In the case of community-acquired pneumonia the decision to administer a fluoroquinolone should be made with caution and the possibility of pulmonary TB should be considered. The appropriate use of fluoroquinolones both in the treatment of TB and for community-acquired pneumonia is of critical importance, since the emergence of resistance is becoming a significant problem. Pneumon 2008; 21(4):–
     
  • SUMMARY. This is a case report of a young woman, a nun, who presented with fever, arthralgia, intense non-specific symptoms and erythema nodosum. Despite the non-typical radiological features, the careful review of her medical and personal history was decisive for the diagnosis and treatment. The patient suffered from Coccidioidomycosis, which is a rare infection in Greece. The appropriate treatment led to immediate clinical and laboratory improvement. The three-year follow-up did not show no any residual lesions or disorders. Pneumon 2008; 21(4):–
     
  • SUMMARY. The case is presented of a young woman suffering from necrotizing pneumonia caused by community acquired methicillin resistant Staphylococcus aureus (CA-MRSA), carrying the Staphylococcal Chromosome Cassette mecIV (SCCmecIV) and Panton-Valentine-Leukocidin (PVL) gene (ST80 clone). She developed acute respiratory distress syndrome (ARDS) and remained under mechanical ventilatory support for 49 days. Finally, she improved and was discharged from the ICU on the 55th day and from the hospital on the 84th day. Pneumon 2008; 21(4):–
     
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