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

Cardiovascular Risk Assessment in a Cohort of Newly Diagnosed Patients with Obstructive Sleep Apnea Syndrome

Objectives. Obstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular morbidity and mortality. The aim of this study was to assess whether the 10-year risk for cardiovascular disease in newly diagnosed patients with OSAS is increased. Materials and Methods. Recently diagnosed, with polysomnography, consecutive OSAS patients were included. The Systematic Coronary Risk Evaluation (SCORE) and the Framingham Risk Score (FRS) were used to estimate the 10-year risk for cardiovascular disease. Results. Totally, 393 individuals (73.3% males), scheduled to undergo a polysomnographic study with symptoms indicative of OSAS, were enrolled. According to apnea-hypopnea index (AHI), subjects were divided in four groups: mild OSAS (AHI 5–14.9/h) was diagnosed in 91 patients (23.2%), moderate OSAS (AHI 15–29.9/h) in 58 patients (14.8%), severe OSAS (AHI > 30/h) in 167 patients (42.5%), while 77 individuals (19.6%) had an AHI < 5/h and served as controls. Increased severity of OSAS was associated with increased SCORE p<0.001 and FRS values p<0.001. More specifically, a significant correlation was observed both between AHI and SCORE r=0.251, p<0.001 and AHI and FRS values r=0.291, p<0.001. Furthermore, a negative correlation was observed between FRS values and sleep efficiency r=−0.224, p=0.006. Conclusions. The 10-year risk for cardiovascular morbidity and mortality seems to increase with severity of OSAS. Physicians should bear this finding in mind, in order to seek for and consecutively eliminate risk factors for cardiovascular disease and to prevent future cardiovascular events in OSAS patients

Ανίχνευση Κ-ras μεταλλάξεων και αστάθεια του μικροδορυφορικού DNA στο Βρογχογενή καρκίνο

Microsatellite instability (MI), loss of heterozygocity(LOH) and K-ras mutatios are defected in lung cancer specimens. However, their importance tumorigenesis remains unknown. The aim of this study was to idehtify the presence of MI, LOH and K-ras mutations in non-small-cell lung carcinoma (NSCLC). Methods: We performed biopsies from the tumor and form the opposite site normal bronchial mucosa in 20 patients with NSCLC. All paired speciments were studied using PCR technique for MI and LOH on chromosomes 17p, 17q, 9p, 9q, with ten polymorphic markets. Tumor DNA was also studied for K-ras mutations. Results: From 20 paired speciments, genetic alterations were found in 16 tumors (80%). Eleven tumors (55%) exhibited MI while 10 tumors(50%) exhibited LOH. The most frequent incidence of LOH was found for the 17q21, whereas of MI was 17p. K-ras mutatons in codon 12 were 8/20 (40%), 6 of them displayed MI concurrently (odd ratio=4.2). Conclusion: MI, LOH and K-ras mutations are depicted in DNA from biopsies of NSCLC. MI appears to be a novel molecular in NSCLC and may affect mutations in K-ras oncogene.Η κατανόηση του μηχανισμού καρκινογένεσης του καρκίνου του πνεύμονα αποτελεί προτεραιότητα στην έρευνα, καθότι η θνησιμότητα του νεοπλάσματος αυτού δεν έχει μεταβληθεί τα τελαυταία 20 χρόνια. Σκοπός της μελέτης ήταν η ανίχνευση μικροδορυφορικής αστάθειας (ΜΑ) και απώλειες ετεροζυγωτίας (ΑΕ) σε βιοψίες καρκινικού βρογχικού επιληθίου σε σχέση με το αντίστοιχο υγιές καθώς και η σχέση τους με πιθανή ύπαρξη μεταλλάξεων του K-ras. Μέθοδος:Πραγματοποιήσαμε με εύκαμπτο βροφχοσκόπιο, βιοψίες του προς μελέτη όγκου και της αντίστοιχης υγιούς περιοχής του απέναντι βρογχικού δέντρου (βιοψίες καθρέπτη) σε 20 ασθενείς με μη- μικροκυτταρικό καρκίνο πμαύμονα(ΜΜΚΠ). Τα 20 ζεύγη, εξετάσθηκαν αρχικά ιστολογικά όπου διαπιστώθηκε αφενός η ύπαρξη καρκίνου, αφετέρου η ύπαρξη φυσιολογικού βλεννογόννου. Κατόπιν εξήχθη το DNA και μελετήθηκε η ύπαρξη ΜΑ και ΑΕ με 10 πολυμορφικούς δείκτες σρα χρωμοσώματα 9 και 17, καθως και η ύπαρξη μεταλλάξεων του K-ras. Τα ευρήματα συνδιάσθηκαν με κλινικά εργαστηριακά χαρακτηριστικά. Αποτελέσματα: 16 /20 ζεύγη παρουσίασαν ΜΑ και AΕ (80%). Εντεκα όγκοι παρουσίαζαν ΜΑ (55%) ενώ 10 παρουσίαζαν ΑΕ(50%). Η συχνότερη ΑΕ βρέθηκε στο δείκτη ΗΒΧ(4/20, 20%), δείχνοντας ότι το hbx γονίδιο αποτελεί ογκοκατασταλτικό γονίδιο. K-ras μεταλλάξεις παρατηρήθηκαν σε συχνότητα 8/20 (40%) στο κωδικόνιο 12. Εξι από αυτές σχετίζονταν με ΜΑ (odd ratio=4.2). Δεν βρέθηκε συχέτιση της συχνότητας της ΜΑ, της ΑΕ η /και της παρουσίας μετάλλαξης του K-ras με τον ιστολογικό τύπο ή το στάδιο της νόσου. Η ύπαρξη αυτών των γενετικών ανωμαλιών δεν σχετίζεται με την επιβίωση

A rare case of "switch on and off" multi-system Langerhans cell histiocytosis in an adult patient

Abstract Introduction We report the case of a 24-year-old Greek woman with histologically proven osseous and pulmonary Langerhans cell histiocytosis whose lesions had progressively regressed with a "switch on and off" mode. This is the first report in the literature of this mode of presentation of Langerhans cell histiocytosis. Case presentation The patient had first presented at the age of 20 years with a solitary lesion of the humerus which spontaneously regressed. At that time, no therapy or smoking cessation was indicated. Four years later she presented with bilateral pneumothorax and pulmonary lesions of Langerhans cell histiocytosis. She had pleurodesis for this disease-related complication, and no further systemic treatment was applied, except with regard to smoking cessation. During the follow-up period, her pulmonary lesions regressed without recurrence six years after the initial lung involvement. Conclusion This uncommon case of remission of multi-system Langerhans cell histiocytosis indicates the unpredictable evolution of the disease, raising the question of conservative management in such a patient.</p

Inflammation of the Pleural Cavity: A Review on Pathogenesis, Diagnosis and Implications in Tumor Pathophysiology

Pleural effusions are a common respiratory condition with many etiologies. Nonmalignant etiologies explain most pleural effusions and despite being nonmalignant, they can be associated with poor survival; thus, it is important to understand their pathophysiology. Furthermore, diagnosing a benign pleural pathology always harbors the uncertainty of a false-negative diagnosis for physicians and pathologists, especially for the group of non-specific pleuritis. This review aims to present the role of the inflammation in the development of benign pleural effusions, with a special interest in their pathophysiology and their association with malignancy