Where did the lungs go? Vanishing Lung Syndrome in an HIV positive patient

Vanishing-lung syndrome is a rare condition characterized by lung emphysema with giant bullae. Giant bullae occupy more than 30% of hemithora and are often misdiagnosed as pneumothorax. We present the case of a 34-year-old HIV positive man, who had worsening respiratory symptoms for six months before seeking clinical care

Endobronhalnim ultrazvukom vođena aspiracija tankom iglom (EBUS-TBNA): Phyllodes tumor s me- tastazom u medijastinumu, vrlo rijedak tip metastatske neoplazme dojke

Phyllodes tumor of the breast, diagnosed predominantly in middle-aged women, is a rare fi- broepithelial neoplasm that makes up less than 1% of all breast neoplasms. Most phyllodes tumors have a benign nature with rare local recurrences, but some cytological subtypes are known for their malignant behavior. In this case report, we presented a patient with an extremely rare malignant sarcomatous differentiation of phyllodes tumor with metastasis to mediastinal lymph nodes, diagnosed by using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Phyllodes (filoidni) tumor dojke, dijagnosticiran pretežno u žena srednje dobi, rijetka je fibroepitelna neo- plazma koja čini manje od 1% svih neoplazmi dojke. Većina filoidnih tumora dojke ima benignu prirodu s rijetkim lokalnim recidivima, ali određeni citološki podtipovi poznati su po svom malignom ponašanju. U ovom prikazu slučaja prikazali smo bolesnicu s iznimno rijetkom malignom sarkomatoznom diferencijacijom tumora filoidesa s metastazama u medijastinalne limfne čvorove, dijagnosticiranom uz pomoć transbronhalne aspiracije iglom vođene endobronhalnim ultrazvukom (engl. Endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA)

Lyophilized bacterial extract OM 85-BV in the treatment of patients with chronic obstructive lung disease

Težina i učestalost akutnih egzacerbacija važna su odrednica kronične opstruktivne plućne bolesti (KOPB), a uspjeh liječenja ove bolesti u znatnoj mjeri ovisi upravo o brzini i kakvoći njihova zbrinjavanja. U liječenju težih egzacerbacija, koje su u pravilu bakterijske, koriste se različite terapijske mjere pri čemu racionalan odabir antibiotika često ima centralno mjesto. Učestala primjena antibiotika u ovih bolesnika može uzrokovati rezistenciju bakterija na jedan ili više antibiotika te uz neadekvatan imunološki odgovor pogodovati reinfekciji. Radi toga, osobito u bolesnika s čestim egzacerbacijama, valja razmotriti mogućnost primjene imunostimulansa poput pročišćenog bakterijskog lizata OM 85-BV. U kontekstu rezultata dosadašnjih kliničkih ispitivanja i činjenice da je svaka terapijska mjera koja smanjuje broj, trajanje i težinu egzacerbacija KOPB-a dobrodošla, može se zaključiti da je OM 85-BV potencijalna terapijska opcija koja može pomoći bolesnicima s KOPB-om, osobito onima s čestim bakterijskim egzacerbacijama.The number and severity of its acute exacerbations determine in great extent the course of chronic obstructive pulmonary disease (COPD). Furthermore, the general efficacy of treatment of COPD depends significantly on the readiness and quality of cure of exacerbations. Although in the treatment of severe, most often bacterial exacerbations, different therapeutic measures are used, the rational choice of an antimicrobial has the pivotal role. The frequent use of antibiotics in patients with COPD can generate bacterial resistance to one or more antibiotics as well as an inappropriate immune response preparing the ground for re-infection. Therefore, the use of immunostimulants, such as purified bacterial extract OM 85-BV, should be considered, especially in frequent exacerbations. Based on results of performed clinical trials and the fact that each therapeutic measure, which diminishes the number, severity, and duration of COPD exacerbations, is welcome, we can consider OM 85-BV a potentially useful therapeutic modality for COPD patients, especially those with frequent bacterial exacerbations

Churg-Straussov sindrom sa zahvaćenim mioperikardom

Churg-Strauss syndrome (CSS) is a small-vessel necrotizing vasculitis typically characterized by asthma, lung infiltrates, extravascular necrotizing granulomas and hypereosinophilia. Cardiac disease is a major contributor to disease-related death in CSS. We describe a 38-year- old man with late-onset asthma, allergic rhinosinusitis, and high extravascular and peripheral blood eosinophilia, who presented with migratory pulmonary infiltrates and acute myopericarditis. Antineutrophilic cytoplasmic antibodies (ANCA) were negative. Early therapy with medium-dose methylprednisolone led to resolution of the pericardial effusion and significant clinical improvement. In the present case report, the importance of early recognition of CSS in patients with asthma and peripheral eosinophilia is discussed. Cardiac magnetic resonance imaging, besides electro- and echocardiography, may be helpful in early detection of cardiac involvement in CSS, enabling appropriate treatment aimed to prevent further disease progression and potentially fatal consequences.Churg-Straussov sindrom (CSS) je nekrotizirajući vaskulitis malih krvnih žila koji je znakovito obilježen astmom, plućnim infiltracijama, ekstravaskularnim nekrotizirajućim granulomima i hipereozinofilijom. Srčana bolest je najvažniji uzrok smrti kod CSS. Opisuje se 38-godišnji muškarac s astmom kasnog nastupa, alergijskim rinosinusitisom i visokom ekstravaskularnom i perifernom eozinofilijom, koji se prezentira s migrirajućim plućnim infiltratima i akutnim mioperikarditisom. Antineutrofilna citoplazmatska antitijela (ANCA) bila su negativna. Rana terapija srednjom dozom metilprednizolona riješila je perikardijalni izljev i dovela do značajnog kliničkog poboljšanja. U ovom prikazu slučaja raspravlja se o važnosti ranog prepoznavanja CSS kod bolesnika s astmom i perifernom eozinofilijom. Uz elektro- i ehokardiografiju, magnetska rezonancija srca može pomoći u ranom otkrivanju zahvaćenosti srca kod CSS, te tako omogućiti primjereno liječenje kako bi se spriječilo napredovanje bolesti i moguće pogubne posljedice

Endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUSTBNA): Solitary fibrous tumor of the mediastinum

A solitary fibrous tumor is a rare type of mesenchymal neoplasm with a described incidence of 1 new case in a million people a year. It is slowgrowing tumor that can arise almost anywhere in the body, usually with benign characteristics with little or no symptoms, until it grows big enough to cause symptoms of compression. In this case report we presented a patient with a rare case of a mediastinal solitary fibrous tumor

THE TREATMENT OF ASTHMA EXACERBATIONS IN ADULTS

Egzacerbaciju astme najčešće karakterizira brzo i progresivno pogoršanje simptoma ove bolesti: zaduhe, kašlja, piskanja i osjećaja pritiska u prsima. Intenzitet egzacerbacije može varirati od sasvim blagog, kratkotrajnog pogoršanja popraćenog podražajnim kašljem i blagom zaduhom pa sve do vrlo teškog, za život opasnog stanja. Klinička obilježja napadaja astme su ubrzano disanje, kašalj, produžen i otežan ekspirij. Opstruktivne smetnje disanja mogu se objektivizirati i pratiti mjerenjem plućne funkcije (PEF ili FEV1). Iznimno je važno što ranije prepoznati simptome egzacerbacije, procijeniti stupanj njezine težine te promptno započeti liječenje. Temelj terapije egzacerbacije astme čini ponavljana primjena inhalacijskih bronhodilatatora brzog djelovanja, rano uvođenje sustavnih glukokortikoida te adekvatna oksigenoterapija. Cilj je liječenja ublažiti stupanj bronhoopstrukcije i korigirati hipoksemiju što je prije moguće. Blaže egzacerbacije mogu se liječiti u izvanbolničkim uvjetima, dok teške treba liječiti u bolnici.Asthma exacerbation is characterized by a rapid and progressive worsening of symptoms, mainly dyspnea, cough, wheezing and chest tightness. The intensity of an exacerbation may vary form a mild, transient worsening marked by a cough and moderate shortness of breath to a very severe and life-threatening condition. The clinical features of asthma include increased rate of breathing, cough, and prolonged and difficult expiration. The expiratory flow limitation could be quantified, objectified, and monitored by the lung function measurements (PEF or FEV1). It is of crucial importance to recognize properly the early signs of an exacerbation, judge its severity, and promptly start the treatments. The strategy of the treatment of an asthma exacerbation includes the repeated administration of rapid-acting inhaled bronchodilators, the early introduction of systemic glucocorticoids and oxygen supplementation. The treatment is aimed to resolve the airflow limitation and ameliorate the hypoxemia, as quickly as possible. Mild exacerbations could be treated in general practice while the severe ones should be treated in emergence units

Increased plasma level of lipoprotein(a) and homocysteine is a marker of increased cardiovascular risk

Introduction. Recent molecular research regards Lp(a) as the “third cholesterol” which should be treated in the same way like the total and LDL-cholesterol in reduction of total cardiovascular risk. Although early data on the relationship between elevated blood homocysteine concentrations and CAD and stroke have been somewhat inconsistent, hyperhomocystinemia has been suggested as an indicator of an increased risk of cardiovascular disease. In light of this, our study objective was to provide answers to the following questions: 1. Is serum Lp(a) concentration a risk factor for coronary artery disease in Croatian population; 2. What are the frequencies of various apo(a) isoforms in elevated serum Lp(a) concentrations; 3. Is there a relation between elevated serum homocysteine and Lp(a) concentration; 4. Investigate the relation of Lp(a) to other lipid disorders and other cardiovascular risk factors. Methods. This study was performed in Dubrava University Hospital in Zagreb, Croatia. 87 patients participated with no known preliminary coronary or peripheral vascular disease. The patient groups were stratified according to increased and normal Lp(a) levels measured from serum. Extensive medical history was obtained, blood biochemistry was evaluated and all patients underwent exercise stress testing. Results. In the group with increased concentration of Lp(a) in serum (> 0.30 g/L) there were 53 patients (average age 55 years, 32 males and 21 females), and normal concentration of Lp(a) in serum (< 0.30 g/L) was found in 34 patients (average age 52 years, 20 males and 14 females). The patients with increased Lp(a) levels were significantly older than the patients with normal Lp(a) levels (p = 0.020). The average concentration of Lp(a) in patients with negative exercise stress testing results was 0.38g/L, and in those with positive exercise stress testing results it was 0.51 g/L, with this difference among groups being significant (p = 0.049). The correlation of homocysteine and Lp(a) levels was statistically significant (r = 0.57, p < 0.01). Frequencies of phenotype Lp(a) were determined with the predominance of S4 phenotype (in 34 patients, 39.10%). Conclusions. Lp(a) concentration is a statistically significant risk factor for coronary artery disease. Homocysteine and Lp(a) seem to interact to increase the risk of CAD. No significant association was observed between Lp(a) levels and conventional risk factors for CAD

Maligna bolest, ili je nešto drugo?

Sarcoidosis is a disease characterized by formation of granulomas in various tissues and organs. Changes most frequently occur in the lungs and lymph nodes.Sarkoidoza je bolest karakterizirana rastom granuloma u raznim tkivima i organima. Ove promjene se najčešće pojavljuju u plućima i limfnim čvorovima

The Role of Anticholinergics in Asthma Treatment

Iako su antikolinergici prihvaćeni kao prva linija bronhodilatacijskog liječenja KOPB-a, mnogi ih liječnici tradicionalno propisuju i u astmatičara. Učinkovitost ipratropija u akutnoj i stabilnoj astmi etablirana je još prije dvadesetak godina, a nekoliko recentnih ispitivanja ističe terapijski potencijal tiotropija u liječenju ove bolesti. Antikolinergici su tradicionalno klasificirani kao brohodilatatori. Na temelju istraživanja “neživčanoga” kolinergičkog sustava dišnih putova očito je da barem neki od njih (tiotropij) uz poznati mehanički, bronhorelaksacijski učinak manifestiraju i nemehaničke, protuupalne i protuproliferativne, učinke. Ovi rezultati promiču tiotropij od pukog bronhodilatatora u preparat s potencijalnim protuupalnim djelovanjem koji bi mogao modificirati tijek astme i/ili KOPB-a. Za potvrdu ovog koncepta potrebni su dodatni klinički pokusi planirani na način da se izravno dokažu navedene postavke.Although anticholinergics have been accepted as first-line bronchodilators in COPD, many physicians also prescribe them to asthmatics. The efficacy of ipratropium in acute and stable asthma was established about twenty years ago, and some recent studies emphasize the therapeutic potential of tiotropium in asthma treatment. Traditionally, anticholinergics have been classified as bronchodilators. On the basis of the research of non-neuronal cholinergic respiratory system, it is obvious that at least some of them (tiotropium) exhibit non-mechanical, anti-inflammatory, and antiproliferative effects in addition to their known mechanical and bronchorelaxing effects. These results promote tiotropium from its position of a mere bronchodilator to that of a potential anti-inflammatory agent that could modify asthma and/or COPD course. Additional clinical trials should be conducted to confirm these hypotheses