Ενδοσκοπικά ευρήματα αναλόγως τον ιστολογικό τύπο του καρκίνου του πνεύμονα και διαγνωστική προσέγγιση

Εισαγωγή Ο καρκίνος του πνεύμονα αποτελεί δυστυχώς την κακοήθεια με την μεγαλύτερη θνησιμότητα παγκοσμίως, όντας ο μοναδικός του οποίου τα ποσοστά επίπτωσης και θανάτων αυξάνουν συνεχώς παρά την βελτιούμενη και πιο επιθετική θεραπεία. Σκοπός Σκοπός της μελέτης είναι να παραθέσει τα κυριότερα βρογχοσκοπικά ευρήματα σε ασθενείς με καρκίνο του πνεύμονα και να τα συσχετίσει με τα ιστοπαθολογικά δεδομένα και τις ευαισθησίες των διαθέσιμων τεχνικών. Μέθοδος Σε αυτή την αναδρομική μελέτη αναλύθηκαν τα δεδομένα διαδοχικών ασθενών οι οποίοι υπεβλήθησαν σε βρογχοσκοπικό έλεγχο στην Α Πνευμονολογική κλινική του Γ.Ν Σισμανόγλειο από το 2014 ως και το 2017. Οι ασθενείς ταξινομήθηκαν με βάση τα ιστοπαθολογικά ευρήματα σε α) ασθενείς με πλακώδες καρκίνωμα, β) ασθενείς με αδενοκαρκίνωμα πνεύμονα, γ)ασθενείς με μικροκυτταρικό καρκίνωμα πνεύμονα και δ) ασθενείς με γιγαντοκυτταρικό καρκίνωμα πνεύμονα. Τα ιστοπαθολογικά αποτελέσματα σχετίζονται με τα κυριότερα ενδοσκοπικά ευρήματα και αναλύονται οι διαγνωστικές προσεγγίσεις αυτών των βλαβών με την καλύτερη ευαισθησία. Αποτελέσματα Τα διαθέσιμα δεδομένα αφορούσαν 96 ασθενείς των οποίων μελετήθηκαν οι φάκελοι. Τα κυριότερα ενδοσκοπικά ευρήματα είναι η ενδοβρογχική μάζα για το πλακώδες καρκίνωμα πνεύμονα, η πίεση εκ των έξω για το αδενοκαρκίνωμα πνεύμονα και η βλεννογόνια διήθηση για το μικροκυτταρικό καρκίνωμα. Στους ασθενείς με ενδοσκοπικά ορατό όγκο, καλύτερη ευαισθησία εμφανίζει η ενδοβρογχική βιοψία(ποσοστό ευαισθησίας περίπου 80%) ενώ για τις περιφερικές βλάβες φαίνεται να εμφανίζουν καλύτερα αποτελέσματα η βιοψία βρόγχου(65% ευαισθησία) και τα βρογχικά ξέσματα(50%). Για τους μη ορατούς όγκους φαίνεται να υπερτερεί η λήψη βρογχικών εκκρίσεων σε ποσοστό κοντά στο 60%. Συμπεράσματα Σημαντικό ρόλο στην διαγνωστική προσέγγιση του καρκίνου του πνεύμονα έχουν η ύπαρξη ορατής ή μη ορατής βλάβης, τα χαρακτηριστικά αυτής καθώς και η εντόπισή της. Κατανοώντας και αξιολογώντας σωστά αυτά τα ευρήματα, είναι εφικτή η χρησιμοποίηση της τεχνικής με την υψηλότερη ευαισθησία ή συνδυασμός αυτών των τεχνικών ώστε να τεθεί άμεσα και αποτελεσματικά η διάγνωση.Introduction Lung cancer is unfortunately the most mortality in the world, being the only one whose incidence and fatality rates continually increase despite improved and more aggressive treatment. Purpose The purpose of the study is to list the main bronchoscopic findings in patients with lung cancer and to associate them with histopathological data and the sensitivities of bronchoscopic techniques. Method In this retrospective study were analyzed the data of successive patients who tabled in bronchoscopy control in the Α Pulmonary Clinic of G. N. Sismanoglio from 2014 to 2017. Patients were classified based on histopathological findings in a) patients with squamous lung carcinoma, b) lung adenocarcinoma c) small cell lung carcinoma and patients with d) large cell carcinoma. The histopathological results related to the main endoscopic findings and we analyze the diagnostic approaches of these lesions with the best sensitivity. Results Results were available for 96 patients whose dossiers were studied. The main endoscopic findings are the endobronchial mass for squamous lung cancer, the external compression for adenocarcinoma and the mucosal infiltration for small cell carcinoma. In patients with endoscopic visible tumor, a better sensitivity is shown in the endobronchial biopsy (80%) while the peripheral lesions appear to show better results for bronchial biopsy (65%) and bronchial brushings (50%). For the non-visible tumors, it appears that bronchial washings have the best sensitivity (60%). Conclusions An important role in the diagnostic approach of lung cancer is the existence of visible or non-visible damage, its characteristics and its localization. Understanding and evaluating these findings correctly, it is possible to use the technique with the highest sensitivity, or even better combination of these techniques, to put the diagnosis directly and effectively

Correlation Between Serum Levels of 25-Hydroxyvitamin D and Severity of Community-Acquired Pneumonia in Hospitalized Patients Assessed by Pneumonia Severity Index: An Observational Descriptive Study

Introduction Pneumonia severity index (PSI) is a prognostic index used for estimating the possibility of death due to community-acquired pneumonia. Vitamin D is a fat-soluble vitamin, essential for calcium and phosphate homeostasis. Vitamin D also has antimicrobial properties and according to recent studies, its deficiency may be correlated to an increased frequency of respiratory infections. The serum concentration of 25-hydroxyvitamin D (25(OH)D) is the best vitamin D status index reflecting vitamin D produced in the skin and offered from food and dietary supplements. Methods The study involved patients, who fulfilled the criteria of community-acquired pneumonia. The exclusion criteria were: patients <18 years old, severely immunocompromised patients, patients with tuberculosis, patients with malabsorption disorders, nursing home residents, patients with a history of malignancy, chronic renal or liver disease, patients with congestive health failure or cerebrovascular disease, and patients receiving vitamin D as a supplement. The following parameters, recorded on admission, were evaluated: age, sex, co-morbidity, residence in a nursing home, duration of symptoms, clinical symptoms, confusion, blood gas analysis, chest radiograph (pleural effusion), and laboratory parameters. The patients were classified in risk classes according to the PSI. Blood samples were collected within the first 48 hours of hospitalization. The serum levels of 25-hydroxyvitamin D were determined by electrochemiluminescence binding assay in Roche Cobas 601 immunoassay analyzer and mean serum levels of 25-hydroxyvitamin D in each risk class were calculated. For statistical analysis, the statistical program SPSS for Windows version 17.0 (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL) was used. Results A total of 46 patients, 28 males and 18 females, with a mean age of 71.5 +/- 17.57 years, hospitalized with community-acquired pneumonia, were included. Sixteen patients (35%) had a severe deficiency, with 25(OH)D levels <10 ng/ml, 17 patients (37%) had moderate deficiency with 25(OH)D levels between 10-20 ng/ml, and 13 patients (28%) had insufficiency with 25(OH)D levels between 20-29 ng/ml. According to the PSI, four (8.7%) patients with a mean age of 53.75 +/- 15.43 years were classified as risk class I, 10 (21.7%) patients with a mean age of 54.7 +/- 14.82 years as class II, 10 (21.7%) patients with a mean age of 68.41 +/- 3.96 years as class III, 17 (37%) patients with a mean age of 84.82 +/- 9.73 years as class IV, and five (10.9%) patients with a mean age of 80.2 +/- 9.41 years as class V. The mean levels of 25(OH)D were 19.11 +/- 11.24 ng/ml in class I, 16.81 +/- 8.94 ng/ml in class II, 16.65 +/- 9.18 ng/ml in class III, 14.76 +/- 10.22 ng/ml in class IV, and 7.49 +/- 4.41 ng/ml in class V. There was a positive correlation between low levels of 25(OH)D and the pneumonia severity and statistically significant difference between the mean levels of 25(OH)D in class V (7.49 +/- 4.41 ng/ml) compared to overall mean levels in classes I, II, III and IV (16.15 +/- 9.49 ng/ml), with p<0.05. Conclusions According to our results, there was a positive association between low levels of 25-hydroxyvitamin D and community-acquired pneumonia severity assessed by PSI. The determination of 25-hydroxyvitamin-D status, mostly in patients >60 years old, may prevent severe community-acquired pneumonia

Evaluation of Immature Platelet Fraction in Lower Respiratory Tract Infections: A Retrospective Study

Introduction Immature platelet fraction (IPF) is a parameter of an automated hematologic analyzer and is related to platelet size and cytoplasmic RNA content. It reflects thrombopoiesis and is often used as the marker of platelet activity. IPF has been evaluated mostly in hematologic disorders and has also been evaluated in patients with gestational hypertension, sepsis, autoimmune diseases and in hospitalised patients with neutrophilia. Platelets, asides from the maintenance of hemostasis, release inflammatory mediators that can modify leukocyte and endothelial responses to various inflammatory stimuli. Lower respiratory tract infections are the leading cause of death from infections worldwide. The role of platelets in lower respiratory tract infections has been reported in many studies. IPF, which is related to platelet activation, has not been evaluated in patients with lower respiratory tract infections. Methods The study involved patients who fulfilled the criteria of community-acquired pneumonia (CAP) and aspiration pneumonia (AP). In addition, age and sex-matched healthy controls were involved. Whole blood samples were collected from healthy controls and from the patients on admission. The mean IPF% and C-reactive protein (CRP) levels were measured in patients with CAP, in patients with AP and in healthy controls. The mean IPF% values in patients with infection were compared to mean IPF% values in healthy controls. The mean IPF% values were compared to mean CRP levels in patients with infection. Additionally, the mean IPF% values in patients that died in the first 14 days were compared to the mean IPF% values in patients that were alive. The statistical analysis of data was performed with the Statistical Package for the Social Sciences (SPSS) for Windows, Version 13.0 (SPSS Inc, Chicago, IL). Results The study population consisted of 45 patients (27 patients with CAP and 18 patients with AP), 27 males and 18 females, with a mean age of 72.11 +/- 16.4 years and 39 healthy controls, 22 males and 17 females with a mean age of 64.2 +/- 14.8 years. The mean CRP levels in patients with infection were 155.2 +/- 119.1 mg/dl. The mean IPF% value of patients with infection was 2.76 +/- 2.27 and the mean IPF% value of controls was 1.72 +/- 0.77 (p < 0.006). The IPF% value in patients with CAP was 2.55 +/- 2.02 and in patients with AP 3.07 +/- 2.64 (p = 0.595). The mean IPF% value in patients with infection had no linear correlation with CRP value in these patients (r = 0.076, p = 0.62). The mean IPF% value in all patients that died in the first 14 days was 3.75 +/- 2.44 and the mean IPF% value in all patients alive was 2.35 +/- 2.11 (p = 0.06). The mean IPF% value in patients with CAP who died in the first 14 days of hospitalisation was 5.54 +/- 3.17 and in patients with CAP who were alive was 1.87 +/- 0.72 (p = 0.06). The mean IPF% value in patients with AP who died was 2.63 +/- 0.85 and in patients with AP who were alive was 3.41 +/- 3.51 (p = 0.554). Conclusions Mean IPF% value is greater in patients with lower respiratory tract infections, including CAP and AP, compared to healthy controls. There is no linear correlation between IPF values and CRP values in patients with lower respiratory tract infections. In addition, there is a difference in mean IPF% value between patients who died in the first 14 days of hospitalisation compared to those who were alive, but not statistically significant