Complete Care for a Patient with Asthma or COPD – from Education and Treatment Plan to Pulmonary Rehabilitation

Astma i kronična opstruktivna plućna bolest (KOPB) su kronične upalne bolesti dišnog sustava, kojima je zajednička bronhoopstrukcija, ali se u mnogo pojedinosti razlikuju, tako da suvremeni pristup tim bolestima uključuje više različitih endotipova i fenotipova bolesti. Edukacija ima važnu ulogu u skrbi o tim bolesnicima jer pruža bolesniku saznanja o njegovoj bolesti, koja mu pomažu da zna kako postupiti u pogoršanjima, kao i u mirnim fazama bolesti. Plan liječenja za bolesnike s astmom i KOPB-om se razlikuje po stupnjevima bolesti. Liječenje je medikamentozno i nemedikamentozno (respiratorna rehabilitacija, promjene u prehrani, liječenje kisikom). U terminalnoj fazi KOPB-a primjenjuje se trajno liječenje kisikom u kućnim uvjetima, što bolesnicima značajno olakšava tegobe. U respiratornoj rehabilitaciji, koja se provodi multidisciplinarno, najvažnije je prilagođenim tjelesnim vježbanjem olakšati simptome, poboljšati plućnu funkciju, zaustaviti pogoršanje plućne funkcije i progresiju bolesti. Vježbe disanja su osnovne u plućnoj rehabilitaciji bolesnika s astmom, a važno je da se provode redovito i pravilno. U KOPB-u uz vježbe disanja provodi se posturalna drenaža i poticanje iskašljavanja, kako bi se sekret iz donjih dijelova pluća mobilizirao prema gornjim dijelovima pluća. Svaki bolesnik koji boluje od astme ili KOPB-a zahtijeva potpunu skrb, od postavljanja dijagnoze do terminalne faze bolesti. Ona u početku obuhvaća edukaciju, a zatim praćenje bolesnika u provođenju plana liječenja, koje čini medikamentozno liječenje, ali i, ne manje važna, respiratorna rehabilitacija. Posljednjih godina respiratorna rehabilitacija je u velikom zamahu zbog povoljnih rezultata koji se postižu njezinim stručno vođenim metodama.Asthma and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the respiratory system, both characterized by airway obstruction, but which differ in many aspects, so the modern approach to these diseases includes several different endotypes and phenotypes of the disease. Education plays an important role in the care of these patients because it provides the patient with knowledge about the disease, which helps him to act properly in exacerbations as well as in the silent stages of the disease. The treatment plan for patients with asthma and COPD varies by disease stage. Treatment includes drug and non-drug treatments (respiratory rehabilitation, dietary changes, oxygen therapy). In the terminal phase of COPD, permanent oxygen treatment is administered at home, which significantly facilitates patient’s difficulties. In respiratory rehabilitation, which is conducted multidisciplinary, the most important thing is to relieve symptoms, improve lung function, and prevent the deterioration of lung function and disease progression through adapted physical exercise. Breathing exercises are essential in the pulmonary rehabilitation of patients with asthma, and it is important that they are performed regularly and properly. In COPD, postural drainage and expectoration are performed in addition to breathing exercises, in order to mobilize secretions from the lower parts of the lungs towards the upper parts of the lungs. Every patient suffering from asthma or COPD requires complete care, from diagnosis to the terminal stage of the disease. It initially includes education, and then monitoring the patient in the implementation of the treatment plan, which consists of drug treatment, but also, not less important, respiratory rehabilitation. In recent years, respiratory rehabilitation has been in full swing due to the favorable results achieved by its expertly guided methods

Mucoepidermoid carcinoma of the lung - case report and literature review

Mukoepidermoidni karcinom (MEC) rijetki je primarni maligni tumor traheobronhalnoga stabla i obuhvaća 0,1 – 0,2% primarnih karcinoma pluća. Tumor sačinjavaju epitelne stanice, stanice koju izlučuju sluz, te stanice intermedijarnog tipa koje se jednake stanicama koje se javljaju u žlijezdama slinovnicama. Prognoza bolesti ovisi o histološkom stupnju malignosti i može biti loša, naročito u starijih bolesnika. Prikazali smo bolesnicu u dobi od 27 godina, koja je bila subfebrilna četiri mjeseca prije javljanja liječniku. Standardna sumacijska snimka torakalnih organa pokazuje homogeno zasjenjenje promjera 50 mm u gornjem lijevom plućnom polju. Višeslojna kompjutorizirana tomografija (MSCT) prsnoga koša pokazuje lobuliranu formaciju veličine 50 x 27 mm s uključenim hipodenznim zonama, koja se utiskuje u lijevi glavni bronh i opstruira ga. Nisu ustanovljene metastaze medijastinalnih limfnih čvorova, niti drugih organa. Bronhoskopijom se nađe tumor koji opstruira ulaz u lijevi B1 + B2 bronh. Patohistološki i imunohistokemijski nalaz biopsije tumora pokazuje MEC niskoga stupnja malignosti. U bolesnice je učinjena gornja lobektomija lijevoga plućnog krila i medijastinalna limfadenektomija. Makroskopski je u reseciranom lobusu, u lumenu lijevoga glavnog bronha viđen dobro ograničeni, žućkasti tumor, promjera 35 mm. Histološki nalaz tumora jednak je nalazu ranije učinjene biopsije tumora. Tumor se većim dijelom nalazio u lumenu bronha, kroz koji je prodro u okolno plućno tkivo, ali nije zahvatio pleuru. U reseciranim limfnim čvorovima nije bilo stanica tumora. Nikakvo adjuvantno liječenje nije provedeno. 15 mjeseci nakon operacije tumora pluća naša je bolesnica rodila treće zdravo dijete. Nakon 37 mjeseci praćenja od operacije, nema znakova recidiva tumora pluća.Mucoepidermoid carcinoma (MEC) is a rare primary malignancy of the tracheobronchial tree and comprising 0.1 – 0.2% of primary lung cancers. The tumour is composed of epithelial cells, mucus secreting cells and cells of an intermediate type identical to those occurring in the salivary glands. The prognosis depends on the histological grade. We report the case of a 27-year-old woman who was four months sub febrile before referring to a physician. Chest radiography revealed a mass shadow measuring 50 mm in diameter in the left upper lung field. Chest CT showed a lobulated mass shadow measuring 50 x 27 mm in which there were hypo dense zones. The tumour was pressed into the left main bronchus, and was obstructing it. No mediastinal lymph node metastasis or other organ metastases were observed. Bronchoscopy revealed a tumour obstructing the entry of left B1+2 bronchus. Pathohistological and immunohistochemical findings of tumour forceps biopsy lead to diagnosis of low-grade MEC. The patient underwent left upper lobe resection and mediastinal lymphadenectomy. Macroscopic findings showed a yellowish well-confined tumour node 35 mm in diameter in the lumen of the main bronchus. The tumour tissue was mainly located in the lumen of the bronchus, and penetrated the wall of the bronchus and entered in the underlying lung tissue. The tumour did not affect the pleura. There were no tumour cells in the resected lymph nodes. No adjuvant treatment was administered. Fifteen months after surgery she gave birth to a third healthy son. The patient remains in remission after 37 months of follow-up from tumour resection

Multiple Recurrence of Hydatid Disease Lasted 19 Years

Hydatid disease (echinococcosis) is a potentially fatal parasitosis caused by tapeworm larvae of the genus Echinococcus which affects primarily the liver and the lungs. However, despite effective medical and surgical treatment, risk of recurrence remains the main problem in the treatment of the disease. We describe here a rare case of multiple recurrence of hydatid disease that lasted more than 19 years. The patient presented with multiple cysts of the liver and dissemination to the lung. The way of dissemination remained unclear and speculative. Despite surgical and intensive medical treatment the disease progressed and the patient died in septic shock

Pericardial effusion as the first manifestation of occupational tuberculosis in a health care worker

Tuberkuloza (TBC) zarazna je bolest, stoga je prijeko potrebno zaštititi ne samo bolesnike nego i osoblje koje dolazi u kontakt s njima, u prvom redu medicinske sestre i liječnike. Nakon kontakta s bolesnicima oboljelima od TBC-a (u kulturama pozitivne) 43-godišnji imunokompetentni medicinski tehničar, zaposlen u psihijatrijskoj bolnici, obolio je od profesionalnog diseminiranog TBC-a. Prva manifestacija bolesti bio je eksudativni perikarditis s dokazanim Mycobacterium tuberculosis (MT), dva mjeseca nakon perikardiocenteze i evakuacije 1200 mL perikardijalnog izljeva. Histološki nalaz limfnih čvorova na više lokalizacija pokazivao je granulomatoznu upalu s nekrozom. Liječenje antituberkuloticima bilo je praćeno komplikacijama. Došlo je do prolaznog, kratkotrajnog, medikamentozno toksičnog hepatitisa, dugotrajnog febriliteta, nespecifičnog ljevostranog pleuralnog izljeva i mononeuritisa desnog peronealnog živca. Liječenje je trajalo 14 mjeseci. Kao trajna posljedica razvio se fibrotoraks, koji je doveo do restriktivnih smetnji ventilacije i smanjene difuzije alveolarno-kapilarne membrane. Ovaj slučaj upozorava na potrebu poboljšanja zaštite zdravstvenih radnika koji su u kontaktu s oboljelima od tuberkuloze, kao i korisnost tuberkulinskog kožnog testa i QuantiFERON-TB testa, koji mogu rano otkriti latentni TBC.Tuberculosis (TB) is an infectious disease and, apart from protecting patients, attention must be given to protecting the persons who come in contact with them, especially nurses and medical practitioners. A 43-year-old immunocompetent male nurse developed occupationally disseminated TB after contact with patients affected by active TB (culture positive) while working in a psychiatric hospital. The first manifestation of the disease was exudative pericarditis with Mycobacterium tuberculosis (MT) confirmed two months after pericardiocentesis and evacuation of 1200 mL of pericardial effusion. Many lymph nodes showed histologic findings of granulomatous inflammation with necrosis. Treatment with antituberculosis drugs caused complications, including transient short-term medication-induced toxic hepatitis, prolonged fever, left pleural nonspecific effusion, and mononeuritis of the right peroneus nerve. The treatment lasted 14 months and led to permanent consequences, including fibrothorax with restrictive ventilation disorders and reduced diffusion of the alveolar-capillary membrane. This case highlights the need to improve the protection of health care workers who are in contact with TB patients, as well as the usefulness of the tuberculin skin test and QuantiFERON-TB test, which can be used to identify early latent TB

Diagnostic value of tumour markers in pleural effusions

Introduction: We investigated whether tumour markers carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cancer antigen 125 (CA125), and cytokeratin 19 fragment (CYFRA 21-1) in pleural effusions and serum can be used to distinguish pleural effusion aetiology. Materials and methods: During the first thoracentesis, we measured pleural fluid and serum tumour marker concentrations and calculated the pleural fluid/serum ratio for patients diagnosed with pleural effusion, using electrochemiluminescence immunoassays. Receiver operating characteristic (ROC) analysis was carried out and the Hanley and McNeil method was used to test the significance of the difference between the areas under ROC curves (AUCs). In order to detect which tumour marker best discriminates between malignant and non-malignant pleural effusions and to establish the predictive value of those markers, discriminant function analysis (DFA) and logistic regression analysis were utilized. Results: Serum tumour markers CYFRA 21-1 and NSE as well as pleural NSE were good predictors of pleural effusion malignancy and their combined model was found statistically significant (Chi-square = 28.415, P < 0.001). Respective ROC analysis showed significant discrimination value of the combination of these three markers (AUC = 0.79). Conclusions: Serum markers showed superiority to pleural fluid markers in determining pleural fluid aetiology. Serum CYFRA 21-1 and NSE concentrations as well as pleural fluid NSE values had the highest clinical value in differentiating between malignant and non-malignant pleural effusions. The combination of these three markers produced a significant model to resolve pleural effusion aetiology

Medijastinalni glatkomišićni tumor nepoznatog malignog potencijala: prikaz slučaja i pregled literature - ispravak

U članku „Medijastinalni glatkomišićni tumor nepoznatog malignog potencijala: prikaz slučaja i pregled literature”, čiji su autori Veljko Flego, Darian Volarić, Koviljka Matušan Ilijaš, Ljiljana Bulat-Kardum, tiskanom u časopisu Medicina Fluminensis 2019;55:89-94, objavljena je pogrešna slika 4. U nastavku objavljujemo ispravnu sliku 4

Medijastinalni glatkomišićni tumor nepoznatog malignog potencijala: prikaz slučaja i pregled literature - ispravak

U članku „Medijastinalni glatkomišićni tumor nepoznatog malignog potencijala: prikaz slučaja i pregled literature”, čiji su autori Veljko Flego, Darian Volarić, Koviljka Matušan Ilijaš, Ljiljana Bulat-Kardum, tiskanom u časopisu Medicina Fluminensis 2019;55:89-94, objavljena je pogrešna slika 4. U nastavku objavljujemo ispravnu sliku 4

Mediastinal smooth muscle tumor of uncertain malignant potential: case report and literature review

Cilj: glatkomišićni tumori su lejomiomi i lejomiosarkomi. Postoji rijetka skupina, u kojoj se biološki potencijal tumora ne može utvrditi; to su glatkomišićni tumori nepoznatog malignog potencijala. Cilj je prikazati pacijenta s takvim tumorom, koji je nastao iz glatkog mišićnog tkiva medijastinuma. Prikaz slučaja: 48-godišnji muškarac, subfebrilan, bolovi u grudnom košu sa širenjem u leđa. Kompjutorizirana tomografija toraksa pokazala je oštro ograničenu cističnu tvorbu stražnjeg medijastinuma. Ezofagogastroduodenoskopija je otkrila u srednjoj trećini jednjaka pritisak izvana, a rendgen pasaža jednjaka jednjak lučno potisnut izvana prema desno i ventralno. Bronhoskopijom je utvrđeno da je membranozni dio lijevog glavnog bronha blago ekstramuralno komprimiran. Učinjen je kirurški zahvat, torakotomija lijevo i potpuno odstranjenje tumora medijastinuma. Patohistološki nalaz pokazao je područje nekroze, tumorsko tkivo građeno od vretenastih stanica, koje pokazuju blagu polimorfiju. Imunohistokemijska analiza tumora bila je pozitivna na glatkomišićni aktin (SMA) i dezmin, a negativna na S100 i CD34, što potvrđuje podrijetlo tumora iz glatkomišićnih stanica. Dodatna imunohistokemijska analiza utvrdila je da proliferacijski biljeg Ki-67 iznosi 5,9 %, a p16 je pozitivan u više od 50 % tumorskih stanica. Zaključni patološki nalaz je glatkomišićni tumor nepoznatog malignog potencijala. Pacijent je praćen 48 mjeseci nakon operacije, bez recidiva tumora ili znakova metastaza. Zaključak: Patohistološka dijagnoza može biti otežana, općenito, ali posebno u rijetkim novotvorevinama. Prikazani slučaj pokazuje da ponekad nije moguće utvrditi radi li se o benignom ili malignom glatkomišićnom tumoru. Tada se postavlja dijagnoza glatkomišićnog tumora nepoznatog malignog potencijala, ovdje smještenog u medijastinumu. Nakon kirurškog odstranjenja neoplazme potrebno je redovito pratiti pacijenta, kako bi se utvrdio recidiv bolesti i provelo dodatno liječenje.Aim: Smooth muscle tumors are divided into leiomyomas and leiomyosarcomas. The aim is to present a patient with a rare tumor called smooth muscle tumor of uncertain malignant potential. Case report: The reported patient was a 48-year-old male, subfebrile, with chest pain. Chest computed tomography showed a sharply limited cystic formation of the posterior mediastinum. Esophagogastroduodenoscopy revealed outside compression in the middle third of the esophagus, and X-ray of the esophageal passage showed that the esophagus was pressed from the outside to the right and ventral. Bronchoscopy determined that the membranous part of the left main bronchus was slightly extramurally compressed. A left thoracotomy and an extirpation of the mediastinal tumor were performed. In pathohistology area of necrosis and tumor tissue composed of spindle cells were identified, which showed mild polymorphia. Immunohistochemical findings included positive smooth muscle actin (SMA) and desmin markers, negative S100 and CD34 markers, Ki-67 was 5.9%, and p16 was positive in more than 50% of tumor cells. The patient was followed up for 48 months, with no signs of tumor recurrence. Conclusion: Pathohistological diagnosis can be difficult, particularly in cases of rare neoplasms. The reported case shows that sometimes it is not possible to determine if smooth muscle tumor is benign or malignant. Therefore, the diagnosis of smooth muscle tumor of uncertain malignant potential is established, in our case the tumor was located in the mediastinum. After surgical removal of the neoplasm, the patient should be followed up regularly in order to detect disease recurrence and to give additional treatment

Medijastinalni glatkomišićni tumor nepoznatog malignog potencijala: prikaz slučaja i pregled literature - ispravak

U članku „Medijastinalni glatkomišićni tumor nepoznatog malignog potencijala: prikaz slučaja i pregled literature”, čiji su autori Veljko Flego, Darian Volarić, Koviljka Matušan Ilijaš, Ljiljana Bulat-Kardum, tiskanom u časopisu Medicina Fluminensis 2019;55:89-94, objavljena je pogrešna slika 4. U nastavku objavljujemo ispravnu sliku 4

Central Type of Chondrosarcoma with a Fulminant Course – A Case Report

Primary chondrosarcoma is a rare malignant tumor. The five types of chondrosarcomas are: central, peripheral, mesenchymal, differentiated and clear cell. The classic chondrosarcomas are central (arising within a bone) or peripheral (arising from the surface of a bone). We describe a patient with central chondrosarcoma of the humerus who underwent surgery and only two weeks later presented with multiple metastases of the lung and small pulmonary tumor embolisms mimicking bilateral pneumonic infiltrates. Therefore, such a fulminant course of central chondrosarcoma, which is not described so far, must be taken into consideration during the treatment of patients with primary chondrosarcoma