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  • SUMMARY. The development of Intensive Care Units (ICUs) has been associated with the emergence of new iatrogenic diseases, which reflect a continuous “cross-talk” between various different noxious stimuli, the preserved through the evolution of homeostatic pathophysiological mechanisms and the treatment effects upon organ systems. One such disease or syndrome is the acute respiratory distress syndrome (ARDS). The majority of currently used definitions for ARDS, including that proposed by the American-European Consensus Conference (AECC), apply common diagnostic criteria for different pathological processes, resulting in misclassification of heterogeneous groups of patients within the same syndrome. This brief overview emphasizes the significant questions that were raised by investigators regarding the description of ARDS in the early years. Despite the progress that has been made, many methodological issues remain unresolved. The incorporation of new knowledge into appropriate definitions is a challenge, since the better understanding of the pathophysiology, and the design of clinical trials with positive results both depend on an appropriate description of ARDS. In this article, an attempt is made to emphasize the challenges of adopting a reliable and valid definition for ARDS, as indirectly proposed in the most recent relevant literature. Pneumon 2009, 22(3):223-229.
     
  • SUMMARY. The aim of this study was to examine whether BIS values during sleep correspond to the different sleep stages, in order to assess BIS as an alternative means of sleep staging. Patients-Methods: The study was conducted on 23 patients who were examined concurrently with polysomnography (PSG) for diagnosing sleep-disordered breathing and with BIS. Exclusion criteria were sleep duration <4 hours, sleep efficiency <80% on PSG and signal quality index (SQI) <50% on BIS. Comparisons in recordings were performed. Results: The patients provided 806 different sleep periods. The mean BIS value was 93.6±4.8 in the wakeful state, and in sleep, according to each stage: 84±11.5 in stage 1, 75.4±13.2 in stage 2, 53.4±15.8 in slow wave sleep (SWS), and 81.5±13.3 during REM sleep. A significant difference was observed between BIS values in the wakeful state and stage 1 (p<0.005) and between stages 1 and 2 and SWS (p<0.001), but not between stage 1 and REM (p=0.102). Conclusion: BIS values decrease with sleep and remain low, with the exception of REM sleep, the BIS values in which overlap with those in stage 1, reducing the sensitivity of BIS in sleep staging. Pneumon 2009, 22(3):235-239.
     
  • SUMMARY. Introduction: Idiopathic pulmonary fibrosis (IPF) is characterized by progressive deterioration of lung function, leading ultimately to death. No pharmacological treatment has been found to stabilize the evolution of the disease, but interferon-g and azathioprine have been used as therapeutic options. Aim: To compare the effectiveness of treatment with interferon-g plus low dose prednisone or azathioprine plus low dose prednisone in patients with IPF. Materials and methods: Patients newly diagnosed with IPF were recruited, 22 in total, of whom 10 received azathioprine plus prednisone and 12 patients received interferon-g plus prednisone for six months. Clinical evaluation, lung function tests, HRCT, bronchoscopy and bronchoalveolar lavage (BAL) were performed at baseline and after six months of treatment. Results: All patients were alive after six months of treatment. No statistically significant difference between the two groups was detected regarding clinical deterioration, inflammatory biomarkers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and BAL cell sub-populations. There was a trend, not statistically significant, towards a greater reduction in forced vital capacity and diffusing capacity for carbon monoxide in the interferon-g group. Conclusion: Interferon-g does not offer any therapeutic advantage over azathioprine as regards the clinical course, lung function tests and BAL cell counts of patients with IPF. Pneumon 2009, 22(3):247-253.
     
  • SUMMARY. Pulmonary actinomycosis is a rare, chronic granulomatous disease, which is difficult to diagnose because it is commonly confused with other granulomatous infections or lung cancer. The case is reported of a 48 year-old man, a smoker, who presented with a 30 day history of productive cough with blood tinged sputum and a peripheral lung mass on the chest X-ray. He underwent full clinical and laboratory evaluation including bronchoscopy, which was unrevealing. Because of the haemoptysis the patient refused a computerized tomography (CT) guided fine needle aspiration biopsy, and proceeded directly to surgery. Following a right posterolateral thoracotomy and lysis of adhesions, a wedge resection of the right lower lobe mass in the lung was performed and sent for frozen section which was negative for malignancy. His postoperative course was unremarkable. The final pathology report established the diagnosis of pulmonary actinomycosis. Pulmonary actinomycosis should be included in the differential diagnosis of a lung mass in a patient presenting with haemoptysis, because an early and accurate diagnosis will preclude unwarranted surgery. Pneumon 2009, 22(3):258-261.
     
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