Bilateral empyema treated by sequential pleuroscopy

Bilateral empyema associated to infectious pericarditis is an extremely rare, yet life-threatening condition. Pleuroscopy-medical thoracoscopy has proved its efficacy in series of patients with empyema. Yet, all reported cases treated by this technique, concerned patients with pleural infection located to a single hemithorax. We present the case of a 71-year-old man with bilateral empyema treated successfully by sequential pleuroscopy, associated to infectious pericarditis

Effect and Safety of Mycophenolate Mofetil or Sodium in Systemic Sclerosis-Associated Interstitial Lung Disease: A Meta-Analysis

Background. Interstitial lung disease (ILD) is the most common complication of systemic sclerosis (SSc) with treatment ineffective. Objective: The aim of this meta-analysis was to provide an estimate of the safety and efficacy profile of Mycophenolate Mofetil (MMF) or sodium (MMS) in SSc-ILD patients. Materials and Methods. All studies were reviewed systematically. The main end-points were safety and efficacy profile as estimated by forced vital capacity (FVC)% and diffusion capacity of the lung for carbon monoxide (DLCO)% of the predicted normal value (%pred.) before and after treatment in patients with SSc-ILD. Quality assessment and data extraction were performed independently by two reviewers. Results. Seventeen studies were reviewed systematically. Six studies, one prospective, were eligible for analysis encompassing 69 patients, including 10 subjects from our, yet unpublished, retrospective study. There was no statistically significant difference in both efficacy outcomes of interest, including FVC% pred. (weighted mean difference 1.48, 95% confidence interval (CI): −2.77 to 5.72, P = 0.49) and DLCO % pred. (weighted mean difference −0.83, 95% CI: −4.75 to 3.09, P = 0.93). No cases of clinically significant side effects were documented. Conclusions. Meta-analysis data suggest that MMF is a safe therapeutic modality which was associated with functional stabilization in patients with SSc-ILD

Local anesthesia thoracoscopy with versus without midazolam: a randomized controlled trial

Background: Medical thoracoscopy is the gold standard for the diagnosis of pleural diseases. To date, no consensus exists regarding the choice of sedative and analgesic agents in patients undergoing local anesthetic thoracoscopy (LAT) and questions are raised as to whether sedatives may add to respiratory side effects. Objectives: To test the hypothesis that administration of midazolam associated with lidocaine versus lidocaine alone in patients with LAT add to respiratory side effects. Methods: We randomly assigned 80 patients to a 1:1 study to two groups: local anesthesia by lidocaine (n=40) vs lidocaine and midazolam (n=40) with the primary end point being the mean lowest oxygen saturation. Secondary end points were cardiovascular parameters, complications, days of drainage, hospital stay, and patients’ quality of life (QoL) as assessed by a visual analogue scale (VAS). Results: The mean age of all patients was 66.6±13.1. The study comprised 50 males (62.5%). No difference was observed in the demographics between the two groups. No significant difference was observed between the two groups in oxygen saturation (primary endpoint). A significant difference was observed in favor of the midazolam group regarding the quality of life assessed by VAS. Conclusion: Midazolam does not add to respiratory side effects when it is used with lidocaine for LAT, while patients’ QoL improved in this group. Therefore, in our department, we changed our strategy in favor of the association of lidocaine and midazolam.Εισαγωγή: Η θωρακοσκόπηση με τοπική αναισθησία (ΘΤΑ) αποτελεί την εξέταση επιλογής για τη διερεύνηση των παθήσεων του υπεζοκώτα. Μέχρι σήμερα δεν υπάρχει συμφωνία όσον αφορά την χρήση αναισθητικών και αναλγητικών σκευασμάτων σε ασθενείς που υποβάλλονται σε ΘΤΑ, με κύριο ερώτημα την εμφάνιση επιπλοκών από το αναπνευστικό. Σκοπός: Να διαπιστωθεί αν η χρήση μιδαζολάμης σε συνδυασμό με λιδοκαΐνη έναντι μόνο λιδοκαΐνης στη ΘΤΑ προκαλεί περισσότερες αναπνευστικές επιπλοκές. Μέθοδοι: Στη μελέτη συμμετείχαν 80 ασθενείς οι οποίοι χωρίστηκαν τυχαιοποιημένα (1:1) σε δύο ομάδες. Στην πρώτη ομάδα χρησιμοποιήθηκε μόνο λιδοκαΐνη (40 ασθενείς) και στην δεύτερη λιδοκαΐνη και μιδαζολάμη (40 ασθενείς) για τη διενέργεια της θωρακοσκόπησης. Πρωτεύον καταληκτικό σημείο ήταν η χαμηλότερη τιμή του κορεσμού του οξυγόνου στο αίμα και η υποξυγοναιμία κατά τη διάρκεια της εξέτασης. Δευτερεύοντα καταληκτικά σημεία ήταν οι καρδιοαγγειακές παράμετροι, οι επιπλοκές (απειλητική για τη ζωή αιμορραγία, διασωλήνωση του ασθενούς, μηχανικός αερισμός ή μεταφορά του ασθενούς σε ΜΕΘ, θάνατος), η διάρκεια της παροχέτευσης και της νοσηλείας. Επίσης αξιολογήθηκε η ποιότητα ζωής (QoL) και η ανοχή της εξέτασης από την πλευρά του ασθενούς χρησιμοποιώντας οπτική αναλογική κλίμακα (Visual Analogue Scale - VAS). Αποτελέσματα: Η μέση ηλικία των ασθενών ήταν 66.6 ± 13.1. Συμμετείχαν 50 άνδρες (62,5 %). Δεν παρατηρήθηκε διαφορά όσον αφορά τα δημογραφικά στοιχεία των ασθενών των δύο ομάδων. Δεν παρατηρήθηκε στατιστικά σημαντική διαφορά όσον αφορά τον κορεσμό του οξυγόνου αίματος και την υποξυγοναιμία (πρωτεύον καταληκτικό σημείο) μεταξύ των δύο ομάδων. Στατιστικά σημαντική διαφορά παρατηρήθηκε υπέρ της μιδαζολάμης όσον αφορά την ποιότητα ζωής και την εμπειρία του ασθενούς όπως αυτή αξιολογήθηκε με την VAS. Συμπέρασμα: Σε ασθενείς που υποβάλλονται σε ΘΤΑ, η μιδαζολάμη σε συνδυασμό με τη λιδοκαΐνη δεν διαφέρει από την λιδοκαΐνη στις αναπνευστικές επιπλοκές, ενώ βελτιώνει την ανοχή του ασθενή στην εξέταση όπως προκύπτει από την ποιότητα ζωής. Σαν αποτέλεσμα στην κλινική μας πλέον χρησιμοποιείται ο συνδυασμός των δύο φαρμάκων κατά τη διενέργεια ΘΤΑ

Ruptured echinococcus cyst

IMAGES IN PNEUMONOLOG

Expression of Hypoxia-Inducible Factor (HIF)-1a-Vascular Endothelial Growth Factor (VEGF)-Inhibitory Growth Factor (ING)-4- axis in sarcoidosis patients

Abstract Background Sarcoidosis is a granulomatous disorder of unknown etiology. The term of immunoangiostasis has been addressed by various studies as potentially involved in the disease pathogenesis. The aim of the study was to investigate the expression of the master regulator of angiogenesis hypoxia inducible factor (HIF)-1a – vascular endothelial growth factor (VEGF)- inhibitor of growth factor 4-(ING4) - axis within sarcoid granuloma. Methods A total of 37 patients with sarcoidosis stages II-III were recruited in our study. Tissue microarray technology coupled with immunohistochemistry analysis were applied to video-assisted thoracoscopic surgery (VATS) lung biopsy samples collected from 37 sarcoidosis patients and 24 controls underwent surgery for benign lesions of the lung. Computerized image analysis was used to quantify immunohistochemistry results. qRT-PCR was used to assess HIF-1a and ING4 expression in 10 sarcoidosis mediastinal lymph node and 10 control lung samples. Results HIF-1a and VEGF-ING4 expression, both in protein and mRNA level, was found to be downregulated and upregulated, respectively, in sarcoidosis samples compared to controls. Immunohistochemistry coupled with computerized image analysis revealed minimal expression of HIF-1a within sarcoid granulomas whereas an abundant staining of ING4 and VEGF in epithelioid cells was also visualized. Conclusions Our data suggest an impairment of the HIF-1a – VEGF axis, potentialy arising by ING4 overexpression and ultimately resulting in angiostasis and monocyte recruitment within granulomas. The concept of immunoangiostasis as a possible protection mechanism against antigens of infectious origin needs further research to be verified.</p