role of multi-detector computed tomography in the assessment of cystic and cavitary pulmonary lesions

Lung cysts and cavities are well defined lesions with definable walls containing air or fluid. The differential diagnosis is broad including congenital, idiopathic, infective or neoplastic lesions. Multidetector row CT is primary non-invasive evaluation of cystic and cavitary lesions. To assess the role of multi-detector computed tomography [MDCT] in evaluation of cystic and cavitary lesions in the lung. The study was conducted on 63 patients with cystic or cavitary pulmonary lesions and subjected to MDCT. The study included 33 patients with infective lesions, 13 patients with idiopathic lesions, eight patients with congenital lesions, seven patients with neoplastic lesions and two patients with pseudocystic lesions proved to be due to diaphragmatic hernias. MDCT is an accurate safe diagnostic modality in assessing cystic and cavitary lung lesions; it can assess wall thickness, size, contents and surrounding parenchyma

Ventilator associated pneumonia: the role of typical, atypical bacteria and fungi; comparison between endotracheal aspirate and bronchoalveolar lavage

Ventilator associated pneumonia [VAP] is defined as pneumonia occurring after the first 48 hours of starting mechanical ventilation. The incidence of VAP varied between 7-70% in different studies. The pathogenesis of VAP usually requires the occurrence of two important processes: bacterial colonization of the aerodigestive tract and the aspiration of contaminated secretion into the normally sterile lower respiratory tract. The principal promise of bronchoscopy for the diagnosis consists of the ability to retrieve uncontaminated lower respiratory secretions and consequently doing quantitative cultures, this should allow a valid differentiation of colonization from infection. The aim of this study was to determine the role of legionella species, mycoplasma pneumoniae, Chlamydia pneumoniae, mycobacterium tuberculosis, fungi, and anaerobes as etiologic agents of VAP and to compare between quantitative Endotracheal Aspirate [EA] and bronchoalveolar lavage[BAL] techniques for the diagnosis of VAP. The study was conducted on 30 patients admitted to the critical care medicine department of Alexandria main university hospital who required invasive mechanical ventilation for at least 48 hours and developed clinical manifestations of VAP. Gram negative bacteria were the most common etiologic pathogens, followed by atypical bacteria. There was no statistically significant difference between both EA and BAL regarding the aetiologic pathogens

Study of some respiratory physiological parameters in patients with chronic renal failure during hemodialysis

Twenty non smoker patients with chronic renal failure on maintenance hemodialysis were studied. Forced vital capacity [FVC] and peak expiratory flow [PEF] decreased significantly after 30 minutes from the start of dialysis followed by insidious increase to levels close to predialysis values at the end of dialysis. Maximal expiratory pressure [PE max] did not show any significant change throughout the dialysis. Serum bicarbonate, base excess and arterial pH increased throughout the dialysis specially after 60 minutes from the start of dialysis till its end. Arterial PCO2 showed minimal changes. However, there was a significant increase after 30 minutes as well as throughout the dialysis. The possible roles of uremic pulmonary edema, peribronchial edema, release of bronchoconstrictor mediators secondary to bioincompatibility of the dialyser membrane, uremic myopathy as well as the possible role of hypoventilation occurring as a compensation for CO2 loss through the dialyser were discussed in explanation for the previously mentioned results