The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem... more The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem, autoimmune diseases characterized by necrotizing small and medium vessel vasculitis and the association with ANCA. The diagnosis and management of these patients may be challenging due to the variability of clinical features, the possibility of life-threatening events (acute renal failure or pulmonary hemorrhage) and the relative rarity of these syndromes. ANCA-associated vasculitis include granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. The treatment requires significant immunosuppression and there are frequent treatment related side effects. Although the standard protocol with cytotoxic agents and glucocorticoids has dramatically improved patient outcome, its toxic profile remains a major problem. Recent progress in evidence base and consensus in understanding the pathogenic mechanism and the quantification of disease acti...
Number: 5146 Publication Number: P3353 Abstract Group: 1.1. Clinical Problems Title: To treat or ... more Number: 5146 Publication Number: P3353 Abstract Group: 1.1. Clinical Problems Title: To treat or not to treat with corticosteroids radiation induced pneumonitis
ABSTRACTPulmonary rehabilitation is a comprehensive therapeutic intervention with proven efficacy... more ABSTRACTPulmonary rehabilitation is a comprehensive therapeutic intervention with proven efficacy in relieving symptoms and increasing exercise tolerance in patients with chronic respiratory diseases.One of the main components of a pulmonary rehabilitation program is lower limbs exercise training. There are several ways of establishing the optimal intensity of the exercise training, using the target heart rate, symptom scores, walking tests and laboratory exercise tests with or without ventilation or gas exchange measurements. Each of these methods has advantages and disadvantages.The gold standard in exercise capacity evaluation is cardiopulmonary exercise testing (CPET) which brings a high level of objectivity in exercise tolerance evaluation and provides information on mechanisms responsible for its decline; this allows a better training prescription and a correct evaluation of rehabilitation outcomes.
Modern radiotherapy decreased the number and severity of the effects of irradiation on the lung. ... more Modern radiotherapy decreased the number and severity of the effects of irradiation on the lung. Yet, the increased cancer incidence makes the related radiation injuries to remain actual, radiotherapy being frequently used in cancer treatment. Aim of the study consists in analysis of the radiological pattern of radiation induced lung disease due to radiotherapy for breast cancer.MATERIAL AND METHOD: Sixty-eight female patients were evaluated for clinical and radiological suspicion of radiation pneumonitis after radiotherapy for breast cancer between 2001 and 2009 in "Marius Nasta" Institute of Pneumophtiziology, Bucharest. The following procedures were performed: medical history, physical examination, chest radiography and CT-scan (in a subgroup of 27 patients). Radiotherapy toxicity was evaluated based on the RTOG/EORTC (Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer) classification and radiological lesions based on Arriagada classification.RESULTS: Fifty patients (73.5%) were symptomatic (fever, dry cough, dyspnea, chest pain, fatigability), the other 18 were asymptomatic. Symptoms were mild to moderate corresponding to grade 1 (27 patients, 39.7%) or grade 2 (23 patients, 33.8%) according to RTOG/EORTC scale. All patients had radiological lesions: 25 patients (36.7%) had grade 2 lesions (linear opacities), 25 patients (36.7%) had grade 3 lesions (patchy opacities) and 18 patients (26.5%) had grade 4 lesions (dense opacities), according to Arriagada classification. Symptoms were more frequent in patients with extensive lesions on chest radiography. CT-scan, performed in 27 patients, showed more accurate images.CONCLUSIONS: Chest radiography remains the simplest method in screening for radiation pneumonitis and monitoring its outcome. Adverse effects secondary to radiotherapy are usually mild and self-limited, and the most difficult task remains the differential diagnosis with infections and cancer relapse.
Obstructive sleep apnea syndrome (OSAS) may induce metabolic abnormalities through intermittent h... more Obstructive sleep apnea syndrome (OSAS) may induce metabolic abnormalities through intermittent hypoxemia and simpathetic activation. It is difficult to demonstrate an independent role of OSAS in the occurrence of metabolic abnormalities, as obesity represents an important risk factor for both OSAS and metabolic abnormalities. to assess the relations between insulin resistance (IR), insulin sensitivity (IS), OSAS severity and nocturnal oxyhaemoglobin levels in obese, nondiabetic patients with daytime sleepiness. We evaluated 99 consecutive, obese, nondiabetic patients (fasting glycemia < 126 mg/dL, no hypoglycemic or hypolipemiant medication) diagnosed with OSAS (AHI > 5/hour and daytime sleepiness) by an ambulatory six channel cardio-respiratory polygraphy. Hight, weight serum triglycerides (TG), high density lipoprotein-cholesterol (HDL-C) levels were evaluated. Correlations between Apneea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), average and lowest oxyhaemoglob...
ABSTRACT Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, Ma... more ABSTRACT Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public health issue due to a large reservoir of latent infection (1). We present a case of unique clinical presentation of tuberculosis in a patient with COPD. A 70 years old engineer, ex-smoker (55PA), with a history of tuberculosis (1967), systemic hypertension (since 2002), COPD (since 2006), who was admitted in 2009 for high fever, dyspnea, cough and muco-purulent sputum production. Physical examination revealed an underweight (BMI= 16,4 kg/m2) and febrile patient (38.2C), with cough, purulent sputum, pale skin, diaphoresis, dyspnea with orthopnea position, normal breath sounds bilateral with no pulmonary rales. The lab tests showed a mild leukocytosis with inflammatory syndrome (WBC 13.000/μL, ESR 74mm/h). Chest X-ray revealed a patchy condensation in the right upper lobe. Given the results of the investigations, community acquired pneumonia was suspected and antibiotic treatment was started while waiting for the culture results. Repeated cultures from sputum and bronchoalveolar lavage were negative for bacteries, including M. tuberculosis. The patient&#39;s clinical status worsened and the leukocytosis and inflammatory syndrome worsen (WBC -24.400/ μL, ESR-112mm/h, Fibrinogen - 896mg/dL, CRP- 171mg/L). The HRCT-scan revealed the persistence of the patchy condensation in the right upper lobe-figure 1. Bronchiolitis obliterans organizing pneumonia was suspected and corticotherapy was added. Patient&#39;s clinical status worsened again, with the persistence of negative repeated cultures for non-specific bacteria and an exploratory thoracotomy with biopsy was performed. The pathological examination from the right upper and medium lobes showed extensive parenchymatous lesions with necrosis and granulomatous inflammatory infiltrates and fibous-exudative alveolitis, suggestive for pulmonary tuberculosis. The cultures for M. Tuberculosis came positive after 2 months. Treatment for tuberculosis was started immediately, with good outcome. Although a relationship between TB and COPD is likely, unfortunately it can not be assumed (2). So, we should always treat tuberculosis as a life-threatening infectious disease which remains a major global health issue, especially due to dormant bacteria.Reference #1: WHO 2010. Global tuberculosis control-surveillance, planning, financing. Geneva, Switzerland: WHO.Reference #2: Allwood BW, Myer L, Bateman ED A Systematic Review of the Association between Pulmonary Tuberculosis and the Development of ChronicAirflow Obstruction in Adults. Respiration. 2013 May 3DISCLOSURE: The following authors have nothing to disclose: Bianca Paraschiv, Claudia Lucia Toma, Stefan Dumitrache-Rujinski, Liliana Grigoriu, Ionela Nicoleta Belaconi, Codin Saon, Miron Alexandru BogdanNo Product/Research Disclosure Information.
ABSTRACT ILD Case Report Posters ISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23,... more ABSTRACT ILD Case Report Posters ISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Sarcoidosis is a multisystem inflammatory disorder.Usually the diagnosis is sugestted by clinical symptoms and chest radiography, but further investigations are required. Sometimes the diagnosis is difficult, especially when patient presents with interstitial lung syndrome. We present the case of a 65 years old nonsmoker female diagnosed two years previous with so called &quot;asthma&quot; (obstruction on spirometry but without reversibility and effort dyspnea improved with short courses of corticotherapy). She was admitted in our clinic with dyspnea at rest, with respiratory failure (SaO2 of 81% while breathing ambiant air), weight loss (15 kg in 6 months), nasal dryness and xerostomy, in which clinical examination showed perioral cyanosis, and bilateral pulmonary wheezing. Chest radiography revealed left pleural effusion and diffuse micronodular lung opacities, mainly in the lower lobes. pulmonary function tests showed mild mixed ventilatory dysfunction and decreased DLco (2.76 L). Bronchoscopy with BAL showed no proliferation and lymphocytosis with normal CD4/CD8 ratio on BAL. Ziehl-Neelsen stain was negative for AFB. CT scan showed left pleural effusion, &quot;ground glass&quot; and micronodular infiltration in peribronhovascular and subpleural spaces, isolated adenopathies with maximum axial diameters of 1.3 cm pretracheal, right latero-tracheal, the right hilum and retrocarinal. Also we performed a salivary gland biopsy that was nondiagnostic. thoracotomy with lung biopsy found numerous sarcoid type granulomatous lesions with epithelioid and giant cells, without necrosis, with moderate interstitial fibrosis with lymphocytic infiltration. The diagnosis of type II sarcoidosis was made and systemic corticotherapy was started with good clinical, functional and imaging outcome. Sarcoidosis diagnosis may be delayed because of inconsistency between symptoms, associated diseases, clinical and imaging data, which may require attention because it can be easily overlooked. Case of sarcoidosis in patient with asthma-like symptoms, treated for a long period of time only for obstructive symptoms due to sarcoidosis lesions of the bronchi or obstructive syndrome associated to sarcoidosis.Reference #1: 1DISCLOSURE: The following authors have nothing to disclose: Raluca Geamalinga, Ionela Belaconi, Stefan Dumitrache-Rujinski, Claudia Toma, Miron Alexandru BogdanNo Product/Research Disclosure Information.
ABSTRACT SESSION TYPE: Bronchology Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2... more ABSTRACT SESSION TYPE: Bronchology Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Hydatid disease is not an endemic disease in Romania. Hydatid cyst disease is caused by Echinococcosis granulosus from cestods. Pulmonary hydatid cyst is the second most frequent form of the disease after the liver involvement and, rarely, may be atypical and misdiagnosed.CASE PRESENTATION: We present a case of 27 year-old white man, smoker (7.5 package-years), with a four months history of chronic cough, left chest pain and sweats, who was addmited in our hospital for recurrent hemoptysis. Chest film revealed in the upper left lobe an atypical ovalar homogenous, ill-defined nodular lesion, mimicking a tumoral process in the upper lobe. He had history of close contact with dogs in the previous 12 years. Fiberoptic bronchoscopy reevaluation, performed in Marius Nasta Pneumology Institute, confirmed the definitive diagnosis as ruptured pulmonary hydatidosis by revealing a white gelatinous membrane- like structure protruding from the subsegmentary bronchus of apicoposterior segmental bronchi of the left upper lobe, which was totally removed by aspiration. A control thoracic CT-scan was performed and revealed a small residual cavity in the left upper lobe with a bronchial dilatation. Hydatid serology was positive. Abdominal ultrasonography was normal, with no evidence of hydatid cysts in the liver. The young adult did not require thoracic surgery and made a full clinical and stable recovery under therapy with Albendazole. After 2 years, his chest film is normal.DISCUSSION: Humans may contract the disease by ingestion of eggs from contaminated water, food or from close contact with dogs. Pulmonary hydatid cysts are often asymptomatic and can be, incidentally, diagnosed on plain chest radiographs but CT is the preferred imaging exam.[1] Several cases of pulmonary hydatic cyst opened into the bronchial tree by perforation were described, mostly, in endemic areas, such as Turkey.[2] When a hidatid pulmonary cyst ruptures into the bronchus, the radiologic pattern of the disease may mimic several diseases, such as nodular pulmonary tuberculosis, round pneumonia, lung abscess or, even, tumour of the lungs. [3] Few articles have described the impact of bronchoscopic management of parenchymal lung hydatid cysts complicated by endobronchial involvement in children and adults. Treatment of pulmonary hydatid cyst by endoscopy is an exceptional event.CONCLUSIONS: Our case illustrates an atypical clinical and radiological presentation of pulmonary hidatidosis complicated with rupture into bronchus. Flexible bronchoscopy is a valuable diagnostic procedure which may offer, in the same time, a complete and stable curative treatment.1) Santivanez S, Garcia HH. Pulmonary cystic echinococcosis. Curr Opin Pulm Med 2010;16:257-61.2) Kilinc O, Döskaya M, Sakar A, Yorgancioglu A, Halilçolar H, Caner A, Gürüz Y.- Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey. New Microbiol.2009 Apr;32(2):229-33.3) Köksal D, Altinok T, Kocaman Y, Tastepe I, Ozkara S.- Bronchoscopic diagnosis of ruptured pulmonary hydatid cyst presenting as nonresolving pneumonia: report of two patients. Lung. 2004;182(6):363-8.DISCLOSURE: The following authors have nothing to disclose: Oana Arghir, Elena Dantes, Claudia Toma, Mihai AlexeNo Product/Research Disclosure InformationConstanta Clinical Pulmonology Hospital, Constanta, Romania.
Cartas al Director / Arch Bronconeumol. 2013;49(7):314-316 315 al cricoides remanente no posibili... more Cartas al Director / Arch Bronconeumol. 2013;49(7):314-316 315 al cricoides remanente no posibilitaba su completa resolución. La utilización del tubo en T como stent para la luz laringotraqueal, con buen resultado en este caso, puede resultar controvertida y no sigue una indicación precisa. Aunque asegura la vía aérea ante una eventual laringotraqueomalacia o una estenosis 3 , no siempre resulta imprescindible después de una laringotraqueoplastia 4,5 y no está exenta de complicaciones, principalmente granulomas endoluminales entre el 19 y 41% de casos, dependiendo de las series 6 . En conclusión, en tumores benignos de glándulas salivales menores de localización subglótica anterior, en los que no es posible un tratamiento endoscópico, el abordaje externo con resección laringotraqueal parcial y reconstrucción inmediata con plastia muscular sobre stent en T puede resultar una alternativa adecuada, posibilitando la conservación de la voz con relativa baja morbilidad.
ABSTRACTBackground and purpose: Radiotherapy in breast cancer patients is limited by lung tissue ... more ABSTRACTBackground and purpose: Radiotherapy in breast cancer patients is limited by lung tissue tolerance. Two complications involving the lung are known: radiation pneumonitis (RP) and radiation fibrosis. The aim of the study was to evaluate the pattern of bronchoalveolar lavage (BAL) in patients with RP after radiotherapy for breast cancer in symptomatic and asymptomatic patients.Material and methods: Sixty-five female patients (mean age 58.3 yrs) with RP after radiotherapy for breast cancer were included in the study. The majority of patients had previous breast surgery (mastectomy or lumpectomy and axillary dissection) and received doses of radiations of 45-50Gy. All patients had adjuvant chemotherapy with cyclophosphamide, 5-fluorouracil, and epirubicin or methotrexate.Results: All patients had an infiltrate or consolidation on chest radiography confined to the upper lobe of the irradiated lung, as marker of RP. Based on the presence or absence of symptoms, we divided the patients in 2 groups: 49 patients (75.4%) with symptomatic RP (fever, cough, dyspnea, chest pain and fatigue) and 16 patients (24.6%) without any symptom. Symptomatic RP patients had a BAL with significant increase in total cells (18.0±12.2 x106 cells•100mL-1) when compared to BAL in asymptomatic patients (11.9±6.2 x106 cells•100mL-1), p=0.01. Lymphocytosis in BAL was significantly increased in symptomatic group, compared with asymptomatic one (35.4±18.7% vs. 26.1±14.3%, p=0.045), with predominance of T lymphocytes (CD3). It was also a predominance of CD4 lymphocytes in all patients, but the CD4/CD8 ratio was inside normal range in the majority of cases. Five patients had clinical features of bronchiolitis obliterans organizing pneumonia (BOOP) secondary to irradiation with increased percentages of lymphocytes, neutrophils, eosinophils, and mast cells in BAL and one patient without history of atopic disease had a percentage of 40% eosinophils. Only a mild reduction in diffusing capacity for carbon monoxide was seen in both groups on pulmonary function tests. The lung volumes were normal in all patients.Conclusions: Lymphocytic alveolitis was the marker of radiation pneumonitis in all patients. The degree of the inflammatory reaction of the lungs was correlated with the presence of symptoms. The lymphocytic alveolitis consisted mainly of T lymphocytes, with a predominance of CD4 subset in both groups, but the CD4/CD8 ratio remained mostly into normal range.
Radiotherapy in breast cancer patients is limited by lung tissue tolerance. Two complications inv... more Radiotherapy in breast cancer patients is limited by lung tissue tolerance. Two complications involving the lung are known: radiation pneumonitis (RP) and radiation fibrosis. The aim of the study was to evaluate the pattern of bronchoalveolar lavage (BAL) in patients with RP after radiotherapy for breast cancer in symptomatic and asymptomatic patients. Sixty-five female patients (mean age 58.3 yrs) with RP after radiotherapy for breast cancer were included in the study. The majority of patients had previous breast surgery (mastectomy or lumpectomy and axillary dissection) and received doses of radiations of 45-50Gy. All patients had adjuvant chemotherapy with cyclophosphamide, 5-fluorouracil, and epirubicin or methotrexate. All patients had an infiltrate or consolidation on chest radiography confined to the upper lobe of the irradiated lung, as marker of RP. Based on the presence or absence of symptoms, we divided the patients in 2 groups: 49 patients (75.4%) with symptomatic RP (fe...
Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseat... more Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseating epithelioid cell granulomas. In sarcoidosis, the most common radiological findings are mediastinal and bilateral hilar lymph node enlargement. We present a case of sarcoidosis with a rare radiological aspect of pulmonary hilar tumor mass.A 54-year-old female patient, active smoker (40 packs/year), with a history of cutaneous lupus, was admitted in our institute for progressive dyspnea and dry cough. At admission physical examination and laboratory tests were normal. Pulmonary function tests diagnosed an obstructive syndrome. Chest X-ray showed a tumor mass of the right pulmonary hilum. Transbronchial biopsy was nondiagnostic. HRCT-scan showed a tumor mass in the right hilum, which raised the suspicion of a lung cancer. PET-CT scan revealed a high metabolic activity of the tumor mass and of a paratracheal right lymphadenopathy. Lymph node biopsy by mediastinoscopy showed noncaseating ...
ABSTRACT Diffuse Lung Disease Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Su... more ABSTRACT Diffuse Lung Disease Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Granulomatosis with polyangiitis (Wegener&#39;s), abbreviated as GPA, is an antineutrophil cytoplasmic antibody (ANCA) - associated vasculitides which have mainly upper and lower airways, and renal involvement. We present the case of a 70 years-old female patient, nonsmoker, with no previous significant medical history, admitted for a history of 2 weeks of cough, sputum production, and arthralgia which associated hemoptysis in the last 4 days. Physical exam revealed no fever, pale skin, bilateral basal crackles on pulmonary auscultation, SaO2 95% (air ambient and rest), normal blood pressure and pulse, no peripheral edema, no signs of peripheral thrombosis. Routine laboratory showed moderate iron deficiency anemia (Hemoglobin 7.8g/dL, Hematocrit 24.7%, and serum iron level 27mcg/dL), elevated ESR (88mm/H), microscopic proteinuria and hematuria on urianalysis. Chest radiography and CT-scan revealed bilateral patchy consolidation with air bronchogram and no necrosis. Lung function tests showed only a mild restrictive pattern (mild reduction in VC and FEV1) with normal DLco (85.7% predicted). Bronchoscopy showed no bronchial lesions and BAL had 93.4% neutrophils and severe alveolar hemorrhage syndrome. The clinical status of the patient deteriorates rapidly in 4 days from hospital admission and respiratory failure developed. Urgent thoracotomy with lung biopsy was performed, and immediately after the biopsy the immunosuppressive treatment with pulse therapy with Methylprednisolone and Cyclophosphamide was given to the patient. The lung biopsy showed polyangiitis with granulomatosis, confirming the diagnosis of GPA. PR3-ANCA (c-ANCA) antibodies came positive. After treatment, patient&#39;s clinical status improved in a few days and was discharged from the hospital after 10 days. She continued the immunosuppressive treatment as outpatient. GPA can be a severe disease with a fatal outcome without a rapid diagnosis and a correct management, usual in a specialized center. Prompt diagnosis of GPA is very important due to the fact that the immunosuppressive therapy may save the life of the patient.Reference #1: Hogan SL, Falk RJ, Chin H, et al. Predictors of relapse and treatment resistance in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis. Ann Intern Med 2005; 143:621.Reference #2: Hogan SL, Falk RJ, Nachman PH, Jennette JC. Various forms of life in antineutrophil cytoplasmic antibody-associated vasculitis. Ann Intern Med 2006; 144:377.Reference #3: J. Charles Jennette, M.D., and Ronald J. Falk, M.D. N Engl J Med 1997; 337:1512-1523DISCLOSURE: The following authors have nothing to disclose: Claudia Toma, Ionela Belaconi, Stefan Dumitrache-Rujinski, Liliana Grigoriu, Alina Croitoru, Miron BogdanNo Product/Research Disclosure Information.
The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem... more The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem, autoimmune diseases characterized by necrotizing small and medium vessel vasculitis and the association with ANCA. The diagnosis and management of these patients may be challenging due to the variability of clinical features, the possibility of life-threatening events (acute renal failure or pulmonary hemorrhage) and the relative rarity of these syndromes. ANCA-associated vasculitis include granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. The treatment requires significant immunosuppression and there are frequent treatment related side effects. Although the standard protocol with cytotoxic agents and glucocorticoids has dramatically improved patient outcome, its toxic profile remains a major problem. Recent progress in evidence base and consensus in understanding the pathogenic mechanism and the quantification of disease acti...
Number: 5146 Publication Number: P3353 Abstract Group: 1.1. Clinical Problems Title: To treat or ... more Number: 5146 Publication Number: P3353 Abstract Group: 1.1. Clinical Problems Title: To treat or not to treat with corticosteroids radiation induced pneumonitis
ABSTRACTPulmonary rehabilitation is a comprehensive therapeutic intervention with proven efficacy... more ABSTRACTPulmonary rehabilitation is a comprehensive therapeutic intervention with proven efficacy in relieving symptoms and increasing exercise tolerance in patients with chronic respiratory diseases.One of the main components of a pulmonary rehabilitation program is lower limbs exercise training. There are several ways of establishing the optimal intensity of the exercise training, using the target heart rate, symptom scores, walking tests and laboratory exercise tests with or without ventilation or gas exchange measurements. Each of these methods has advantages and disadvantages.The gold standard in exercise capacity evaluation is cardiopulmonary exercise testing (CPET) which brings a high level of objectivity in exercise tolerance evaluation and provides information on mechanisms responsible for its decline; this allows a better training prescription and a correct evaluation of rehabilitation outcomes.
Modern radiotherapy decreased the number and severity of the effects of irradiation on the lung. ... more Modern radiotherapy decreased the number and severity of the effects of irradiation on the lung. Yet, the increased cancer incidence makes the related radiation injuries to remain actual, radiotherapy being frequently used in cancer treatment. Aim of the study consists in analysis of the radiological pattern of radiation induced lung disease due to radiotherapy for breast cancer.MATERIAL AND METHOD: Sixty-eight female patients were evaluated for clinical and radiological suspicion of radiation pneumonitis after radiotherapy for breast cancer between 2001 and 2009 in "Marius Nasta" Institute of Pneumophtiziology, Bucharest. The following procedures were performed: medical history, physical examination, chest radiography and CT-scan (in a subgroup of 27 patients). Radiotherapy toxicity was evaluated based on the RTOG/EORTC (Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer) classification and radiological lesions based on Arriagada classification.RESULTS: Fifty patients (73.5%) were symptomatic (fever, dry cough, dyspnea, chest pain, fatigability), the other 18 were asymptomatic. Symptoms were mild to moderate corresponding to grade 1 (27 patients, 39.7%) or grade 2 (23 patients, 33.8%) according to RTOG/EORTC scale. All patients had radiological lesions: 25 patients (36.7%) had grade 2 lesions (linear opacities), 25 patients (36.7%) had grade 3 lesions (patchy opacities) and 18 patients (26.5%) had grade 4 lesions (dense opacities), according to Arriagada classification. Symptoms were more frequent in patients with extensive lesions on chest radiography. CT-scan, performed in 27 patients, showed more accurate images.CONCLUSIONS: Chest radiography remains the simplest method in screening for radiation pneumonitis and monitoring its outcome. Adverse effects secondary to radiotherapy are usually mild and self-limited, and the most difficult task remains the differential diagnosis with infections and cancer relapse.
Obstructive sleep apnea syndrome (OSAS) may induce metabolic abnormalities through intermittent h... more Obstructive sleep apnea syndrome (OSAS) may induce metabolic abnormalities through intermittent hypoxemia and simpathetic activation. It is difficult to demonstrate an independent role of OSAS in the occurrence of metabolic abnormalities, as obesity represents an important risk factor for both OSAS and metabolic abnormalities. to assess the relations between insulin resistance (IR), insulin sensitivity (IS), OSAS severity and nocturnal oxyhaemoglobin levels in obese, nondiabetic patients with daytime sleepiness. We evaluated 99 consecutive, obese, nondiabetic patients (fasting glycemia < 126 mg/dL, no hypoglycemic or hypolipemiant medication) diagnosed with OSAS (AHI > 5/hour and daytime sleepiness) by an ambulatory six channel cardio-respiratory polygraphy. Hight, weight serum triglycerides (TG), high density lipoprotein-cholesterol (HDL-C) levels were evaluated. Correlations between Apneea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), average and lowest oxyhaemoglob...
ABSTRACT Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, Ma... more ABSTRACT Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public health issue due to a large reservoir of latent infection (1). We present a case of unique clinical presentation of tuberculosis in a patient with COPD. A 70 years old engineer, ex-smoker (55PA), with a history of tuberculosis (1967), systemic hypertension (since 2002), COPD (since 2006), who was admitted in 2009 for high fever, dyspnea, cough and muco-purulent sputum production. Physical examination revealed an underweight (BMI= 16,4 kg/m2) and febrile patient (38.2C), with cough, purulent sputum, pale skin, diaphoresis, dyspnea with orthopnea position, normal breath sounds bilateral with no pulmonary rales. The lab tests showed a mild leukocytosis with inflammatory syndrome (WBC 13.000/μL, ESR 74mm/h). Chest X-ray revealed a patchy condensation in the right upper lobe. Given the results of the investigations, community acquired pneumonia was suspected and antibiotic treatment was started while waiting for the culture results. Repeated cultures from sputum and bronchoalveolar lavage were negative for bacteries, including M. tuberculosis. The patient&#39;s clinical status worsened and the leukocytosis and inflammatory syndrome worsen (WBC -24.400/ μL, ESR-112mm/h, Fibrinogen - 896mg/dL, CRP- 171mg/L). The HRCT-scan revealed the persistence of the patchy condensation in the right upper lobe-figure 1. Bronchiolitis obliterans organizing pneumonia was suspected and corticotherapy was added. Patient&#39;s clinical status worsened again, with the persistence of negative repeated cultures for non-specific bacteria and an exploratory thoracotomy with biopsy was performed. The pathological examination from the right upper and medium lobes showed extensive parenchymatous lesions with necrosis and granulomatous inflammatory infiltrates and fibous-exudative alveolitis, suggestive for pulmonary tuberculosis. The cultures for M. Tuberculosis came positive after 2 months. Treatment for tuberculosis was started immediately, with good outcome. Although a relationship between TB and COPD is likely, unfortunately it can not be assumed (2). So, we should always treat tuberculosis as a life-threatening infectious disease which remains a major global health issue, especially due to dormant bacteria.Reference #1: WHO 2010. Global tuberculosis control-surveillance, planning, financing. Geneva, Switzerland: WHO.Reference #2: Allwood BW, Myer L, Bateman ED A Systematic Review of the Association between Pulmonary Tuberculosis and the Development of ChronicAirflow Obstruction in Adults. Respiration. 2013 May 3DISCLOSURE: The following authors have nothing to disclose: Bianca Paraschiv, Claudia Lucia Toma, Stefan Dumitrache-Rujinski, Liliana Grigoriu, Ionela Nicoleta Belaconi, Codin Saon, Miron Alexandru BogdanNo Product/Research Disclosure Information.
ABSTRACT ILD Case Report Posters ISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23,... more ABSTRACT ILD Case Report Posters ISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Sarcoidosis is a multisystem inflammatory disorder.Usually the diagnosis is sugestted by clinical symptoms and chest radiography, but further investigations are required. Sometimes the diagnosis is difficult, especially when patient presents with interstitial lung syndrome. We present the case of a 65 years old nonsmoker female diagnosed two years previous with so called &quot;asthma&quot; (obstruction on spirometry but without reversibility and effort dyspnea improved with short courses of corticotherapy). She was admitted in our clinic with dyspnea at rest, with respiratory failure (SaO2 of 81% while breathing ambiant air), weight loss (15 kg in 6 months), nasal dryness and xerostomy, in which clinical examination showed perioral cyanosis, and bilateral pulmonary wheezing. Chest radiography revealed left pleural effusion and diffuse micronodular lung opacities, mainly in the lower lobes. pulmonary function tests showed mild mixed ventilatory dysfunction and decreased DLco (2.76 L). Bronchoscopy with BAL showed no proliferation and lymphocytosis with normal CD4/CD8 ratio on BAL. Ziehl-Neelsen stain was negative for AFB. CT scan showed left pleural effusion, &quot;ground glass&quot; and micronodular infiltration in peribronhovascular and subpleural spaces, isolated adenopathies with maximum axial diameters of 1.3 cm pretracheal, right latero-tracheal, the right hilum and retrocarinal. Also we performed a salivary gland biopsy that was nondiagnostic. thoracotomy with lung biopsy found numerous sarcoid type granulomatous lesions with epithelioid and giant cells, without necrosis, with moderate interstitial fibrosis with lymphocytic infiltration. The diagnosis of type II sarcoidosis was made and systemic corticotherapy was started with good clinical, functional and imaging outcome. Sarcoidosis diagnosis may be delayed because of inconsistency between symptoms, associated diseases, clinical and imaging data, which may require attention because it can be easily overlooked. Case of sarcoidosis in patient with asthma-like symptoms, treated for a long period of time only for obstructive symptoms due to sarcoidosis lesions of the bronchi or obstructive syndrome associated to sarcoidosis.Reference #1: 1DISCLOSURE: The following authors have nothing to disclose: Raluca Geamalinga, Ionela Belaconi, Stefan Dumitrache-Rujinski, Claudia Toma, Miron Alexandru BogdanNo Product/Research Disclosure Information.
ABSTRACT SESSION TYPE: Bronchology Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2... more ABSTRACT SESSION TYPE: Bronchology Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Hydatid disease is not an endemic disease in Romania. Hydatid cyst disease is caused by Echinococcosis granulosus from cestods. Pulmonary hydatid cyst is the second most frequent form of the disease after the liver involvement and, rarely, may be atypical and misdiagnosed.CASE PRESENTATION: We present a case of 27 year-old white man, smoker (7.5 package-years), with a four months history of chronic cough, left chest pain and sweats, who was addmited in our hospital for recurrent hemoptysis. Chest film revealed in the upper left lobe an atypical ovalar homogenous, ill-defined nodular lesion, mimicking a tumoral process in the upper lobe. He had history of close contact with dogs in the previous 12 years. Fiberoptic bronchoscopy reevaluation, performed in Marius Nasta Pneumology Institute, confirmed the definitive diagnosis as ruptured pulmonary hydatidosis by revealing a white gelatinous membrane- like structure protruding from the subsegmentary bronchus of apicoposterior segmental bronchi of the left upper lobe, which was totally removed by aspiration. A control thoracic CT-scan was performed and revealed a small residual cavity in the left upper lobe with a bronchial dilatation. Hydatid serology was positive. Abdominal ultrasonography was normal, with no evidence of hydatid cysts in the liver. The young adult did not require thoracic surgery and made a full clinical and stable recovery under therapy with Albendazole. After 2 years, his chest film is normal.DISCUSSION: Humans may contract the disease by ingestion of eggs from contaminated water, food or from close contact with dogs. Pulmonary hydatid cysts are often asymptomatic and can be, incidentally, diagnosed on plain chest radiographs but CT is the preferred imaging exam.[1] Several cases of pulmonary hydatic cyst opened into the bronchial tree by perforation were described, mostly, in endemic areas, such as Turkey.[2] When a hidatid pulmonary cyst ruptures into the bronchus, the radiologic pattern of the disease may mimic several diseases, such as nodular pulmonary tuberculosis, round pneumonia, lung abscess or, even, tumour of the lungs. [3] Few articles have described the impact of bronchoscopic management of parenchymal lung hydatid cysts complicated by endobronchial involvement in children and adults. Treatment of pulmonary hydatid cyst by endoscopy is an exceptional event.CONCLUSIONS: Our case illustrates an atypical clinical and radiological presentation of pulmonary hidatidosis complicated with rupture into bronchus. Flexible bronchoscopy is a valuable diagnostic procedure which may offer, in the same time, a complete and stable curative treatment.1) Santivanez S, Garcia HH. Pulmonary cystic echinococcosis. Curr Opin Pulm Med 2010;16:257-61.2) Kilinc O, Döskaya M, Sakar A, Yorgancioglu A, Halilçolar H, Caner A, Gürüz Y.- Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey. New Microbiol.2009 Apr;32(2):229-33.3) Köksal D, Altinok T, Kocaman Y, Tastepe I, Ozkara S.- Bronchoscopic diagnosis of ruptured pulmonary hydatid cyst presenting as nonresolving pneumonia: report of two patients. Lung. 2004;182(6):363-8.DISCLOSURE: The following authors have nothing to disclose: Oana Arghir, Elena Dantes, Claudia Toma, Mihai AlexeNo Product/Research Disclosure InformationConstanta Clinical Pulmonology Hospital, Constanta, Romania.
Cartas al Director / Arch Bronconeumol. 2013;49(7):314-316 315 al cricoides remanente no posibili... more Cartas al Director / Arch Bronconeumol. 2013;49(7):314-316 315 al cricoides remanente no posibilitaba su completa resolución. La utilización del tubo en T como stent para la luz laringotraqueal, con buen resultado en este caso, puede resultar controvertida y no sigue una indicación precisa. Aunque asegura la vía aérea ante una eventual laringotraqueomalacia o una estenosis 3 , no siempre resulta imprescindible después de una laringotraqueoplastia 4,5 y no está exenta de complicaciones, principalmente granulomas endoluminales entre el 19 y 41% de casos, dependiendo de las series 6 . En conclusión, en tumores benignos de glándulas salivales menores de localización subglótica anterior, en los que no es posible un tratamiento endoscópico, el abordaje externo con resección laringotraqueal parcial y reconstrucción inmediata con plastia muscular sobre stent en T puede resultar una alternativa adecuada, posibilitando la conservación de la voz con relativa baja morbilidad.
ABSTRACTBackground and purpose: Radiotherapy in breast cancer patients is limited by lung tissue ... more ABSTRACTBackground and purpose: Radiotherapy in breast cancer patients is limited by lung tissue tolerance. Two complications involving the lung are known: radiation pneumonitis (RP) and radiation fibrosis. The aim of the study was to evaluate the pattern of bronchoalveolar lavage (BAL) in patients with RP after radiotherapy for breast cancer in symptomatic and asymptomatic patients.Material and methods: Sixty-five female patients (mean age 58.3 yrs) with RP after radiotherapy for breast cancer were included in the study. The majority of patients had previous breast surgery (mastectomy or lumpectomy and axillary dissection) and received doses of radiations of 45-50Gy. All patients had adjuvant chemotherapy with cyclophosphamide, 5-fluorouracil, and epirubicin or methotrexate.Results: All patients had an infiltrate or consolidation on chest radiography confined to the upper lobe of the irradiated lung, as marker of RP. Based on the presence or absence of symptoms, we divided the patients in 2 groups: 49 patients (75.4%) with symptomatic RP (fever, cough, dyspnea, chest pain and fatigue) and 16 patients (24.6%) without any symptom. Symptomatic RP patients had a BAL with significant increase in total cells (18.0±12.2 x106 cells•100mL-1) when compared to BAL in asymptomatic patients (11.9±6.2 x106 cells•100mL-1), p=0.01. Lymphocytosis in BAL was significantly increased in symptomatic group, compared with asymptomatic one (35.4±18.7% vs. 26.1±14.3%, p=0.045), with predominance of T lymphocytes (CD3). It was also a predominance of CD4 lymphocytes in all patients, but the CD4/CD8 ratio was inside normal range in the majority of cases. Five patients had clinical features of bronchiolitis obliterans organizing pneumonia (BOOP) secondary to irradiation with increased percentages of lymphocytes, neutrophils, eosinophils, and mast cells in BAL and one patient without history of atopic disease had a percentage of 40% eosinophils. Only a mild reduction in diffusing capacity for carbon monoxide was seen in both groups on pulmonary function tests. The lung volumes were normal in all patients.Conclusions: Lymphocytic alveolitis was the marker of radiation pneumonitis in all patients. The degree of the inflammatory reaction of the lungs was correlated with the presence of symptoms. The lymphocytic alveolitis consisted mainly of T lymphocytes, with a predominance of CD4 subset in both groups, but the CD4/CD8 ratio remained mostly into normal range.
Radiotherapy in breast cancer patients is limited by lung tissue tolerance. Two complications inv... more Radiotherapy in breast cancer patients is limited by lung tissue tolerance. Two complications involving the lung are known: radiation pneumonitis (RP) and radiation fibrosis. The aim of the study was to evaluate the pattern of bronchoalveolar lavage (BAL) in patients with RP after radiotherapy for breast cancer in symptomatic and asymptomatic patients. Sixty-five female patients (mean age 58.3 yrs) with RP after radiotherapy for breast cancer were included in the study. The majority of patients had previous breast surgery (mastectomy or lumpectomy and axillary dissection) and received doses of radiations of 45-50Gy. All patients had adjuvant chemotherapy with cyclophosphamide, 5-fluorouracil, and epirubicin or methotrexate. All patients had an infiltrate or consolidation on chest radiography confined to the upper lobe of the irradiated lung, as marker of RP. Based on the presence or absence of symptoms, we divided the patients in 2 groups: 49 patients (75.4%) with symptomatic RP (fe...
Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseat... more Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseating epithelioid cell granulomas. In sarcoidosis, the most common radiological findings are mediastinal and bilateral hilar lymph node enlargement. We present a case of sarcoidosis with a rare radiological aspect of pulmonary hilar tumor mass.A 54-year-old female patient, active smoker (40 packs/year), with a history of cutaneous lupus, was admitted in our institute for progressive dyspnea and dry cough. At admission physical examination and laboratory tests were normal. Pulmonary function tests diagnosed an obstructive syndrome. Chest X-ray showed a tumor mass of the right pulmonary hilum. Transbronchial biopsy was nondiagnostic. HRCT-scan showed a tumor mass in the right hilum, which raised the suspicion of a lung cancer. PET-CT scan revealed a high metabolic activity of the tumor mass and of a paratracheal right lymphadenopathy. Lymph node biopsy by mediastinoscopy showed noncaseating ...
ABSTRACT Diffuse Lung Disease Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Su... more ABSTRACT Diffuse Lung Disease Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Granulomatosis with polyangiitis (Wegener&#39;s), abbreviated as GPA, is an antineutrophil cytoplasmic antibody (ANCA) - associated vasculitides which have mainly upper and lower airways, and renal involvement. We present the case of a 70 years-old female patient, nonsmoker, with no previous significant medical history, admitted for a history of 2 weeks of cough, sputum production, and arthralgia which associated hemoptysis in the last 4 days. Physical exam revealed no fever, pale skin, bilateral basal crackles on pulmonary auscultation, SaO2 95% (air ambient and rest), normal blood pressure and pulse, no peripheral edema, no signs of peripheral thrombosis. Routine laboratory showed moderate iron deficiency anemia (Hemoglobin 7.8g/dL, Hematocrit 24.7%, and serum iron level 27mcg/dL), elevated ESR (88mm/H), microscopic proteinuria and hematuria on urianalysis. Chest radiography and CT-scan revealed bilateral patchy consolidation with air bronchogram and no necrosis. Lung function tests showed only a mild restrictive pattern (mild reduction in VC and FEV1) with normal DLco (85.7% predicted). Bronchoscopy showed no bronchial lesions and BAL had 93.4% neutrophils and severe alveolar hemorrhage syndrome. The clinical status of the patient deteriorates rapidly in 4 days from hospital admission and respiratory failure developed. Urgent thoracotomy with lung biopsy was performed, and immediately after the biopsy the immunosuppressive treatment with pulse therapy with Methylprednisolone and Cyclophosphamide was given to the patient. The lung biopsy showed polyangiitis with granulomatosis, confirming the diagnosis of GPA. PR3-ANCA (c-ANCA) antibodies came positive. After treatment, patient&#39;s clinical status improved in a few days and was discharged from the hospital after 10 days. She continued the immunosuppressive treatment as outpatient. GPA can be a severe disease with a fatal outcome without a rapid diagnosis and a correct management, usual in a specialized center. Prompt diagnosis of GPA is very important due to the fact that the immunosuppressive therapy may save the life of the patient.Reference #1: Hogan SL, Falk RJ, Chin H, et al. Predictors of relapse and treatment resistance in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis. Ann Intern Med 2005; 143:621.Reference #2: Hogan SL, Falk RJ, Nachman PH, Jennette JC. Various forms of life in antineutrophil cytoplasmic antibody-associated vasculitis. Ann Intern Med 2006; 144:377.Reference #3: J. Charles Jennette, M.D., and Ronald J. Falk, M.D. N Engl J Med 1997; 337:1512-1523DISCLOSURE: The following authors have nothing to disclose: Claudia Toma, Ionela Belaconi, Stefan Dumitrache-Rujinski, Liliana Grigoriu, Alina Croitoru, Miron BogdanNo Product/Research Disclosure Information.
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