CHRONIC OBSTRUCTIVE PULMONARY DISEASE GROUP B AND C: ARE THEY REALLY THE OPPOSITE OF EACH OTHER REGARDING EXERCISE CAPACITY AND MUSCLE STRENGTH?

WOS: 000446023500003Purpose: 'Combined COPD Assessment' in the classification of chronic obstructive pulmonary disease (COPD) was proposed as a new method by The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD). The aim of this study was to evaluate exercise capacity, and muscle strength (respiratory and peripheral muscle strength) between two groups (Group B and C) of the new GOLD combined COPD assessment in this study. Methods: Patients were categorized into group B (n=18) and C (n=18) according to the GOLD combined COPD assessment. Patients' exercise capacity (the six-minute walk test [6MWT]) and the six-minute pegboard and ring test (6PBRT]), respiratory muscle strength (maximal inspiratory pressure [MIP] and maximal expiratory pressure [MEP]), and peripheral muscle strength (hand-grip and knee extensor strength) were assessed. Results: The MEP value was significantly higher in group B than in group C (p=0.024). Other values (6MWT distance, 6PBRT score, MIP values, and peripheral muscle strength) were not significantly different between the two groups (p>0.05). Conclusion: This study shows that comprehensive assessment is very important to evaluate patients with COPD. The GOLD spirometry measures are not solely enough, symptoms and exacerbation history must be evaluated

Investigation of inherited thrombophilias in patients with pulmonary embolism

Inherited thrombophilias are thought to play an important role in the cause of pulmonary embolism and its recurrence. Ninety of 281 patients objectively diagnosed as pulmonary embolism between 2006 and 2009 were included in the study. The screening for thrombophilia included mutations of factor V Leiden (FVL), prothrombin (PTM) G20210A, methylene tetrahydrofolate reductase C677T-A1298C, the serum levels of antithrombin III, protein C, protein S, factor VIII and activated protein C resistance. Forty-two male (46.7%) and 48 female (53.3%) patients had a mean age of 62.6 +/- 13.4 years. Patients with common thrombophilias comprised 30% of all cases (FVL: 19.1%, PTM G20210A: 3.4%, antithrombin III deficiency: 1.1%, protein C deficiency: 5.7%, protein S deficiency: 13.6%). A significant association between recurrence of pulmonary embolism (10 patients, 12.2%) and protein S deficiency was established (P=0.040). Serum level of protein C was also significantly lower in the subgroup of recurrent pulmonary embolism (P=0.049). FVL and PTM mutations were high in cancer patients; the presence of inherited thrombophilia was low with risk factors of surgery and immobilization. Genetic risk factors were high in patients with pulmonary embolism. Protein C and S deficiencies may play a role in pulmonary embolism recurrence. DVT or family history of pulmonary embolism was not found to be related to inherited thrombophilias. Surgery and immobilization were thought not to have priorities for detection of genetic risk factors. The high percentages of FVL and PTM mutations in cancer patients should be considered. Blood Coagul Fibrinolysis 24: 140-149 (C) 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

DRAMATIC TUMOUR RESPONSE TO PEMETREXED THERAPY IN MALIGN MESOTHELIOMA IN AN OLD PATIENT

Malignant mesothelioma is a highly aggressive kind of tumour with a poor prognosis and a limited response to chemotherapy. Pemetrexed disodium, a multi-targeted antimetabolite inhibiting folate pathway, has demonstrated promising clinical activity in a wide variety of solid tumours including mesothelioma. An 81-year-old female patient was admitted to our hospital because of cough and dyspnea. Unilateral right-sided massive pleural effusion and multiple pleural nodules were determined by thorax CT. Mesothelioma was diagnosed by an open lung biopsy. As chemotherapy could be toxic for an elderly patient, radiotherapy was administered. After an asymptomatic follow-up period of 18 months, a new TCT revealed multiple pleural nodules, massive pleural effusion, mediastinal lymph nodes with pathological sizes and a subcutaneous mass, which was interpreted as progression of the primary tumour. We decided to administer chemotherapy containing pemetrexed and cisplatin at tolerable doses. After the chemotherapy, the patient was evaluated with TCT, which revealed that, subcutaneous mass had disappeared and mediastinal lymph nodes and pleural nodules had dramatically regressed. As is known, studies on chemotherapy for treatment of malign mesothelioma are not very promising. This case, with a dramatic tumour response is presented to show that pemetrexed can be an effective and favorable chemotherapeutic agent for mesothelioma treatment, even in elderly patients