[Effect of cpap therapy on sleep quality in patients with OSAS]. / Efectul terapiei cpap asupra calitutii somnului la pacientii cu saos evaluata prin sleep disturbances index (SDI).

UNLABELLED: For an adequate analysis of sleep quality was assessed a new composed index wich objectively approached variate polisomnographic parameters. We used this new concept--sleep disturbances index-SDI in patients with obstructive sleep apnea (OSAS), before and after the beginning of CPAP therapy. MATERIAL AND METHOD: 41 patients were evaluated and for each one we calculated SDI score. All patients were split in two groups according with apnea-hipopnea index (AHI), and we correlated SDI with AHI as marker of severity of the disease and with Epworth Sleepiness Scale's scores, as an subjective evaluation. After 1 month of CPAP therapy, SDI was reevaluated. RESULTS: SDI is correlating with the severity of the disease: for group 1, with 5 < AHI < 15, SDI= 2.24 +/- 0.88, r = 0.53, p < 0.01 and for group 2, with AHI >15, SDI = 3.23 +/- 0.69, p < 0.01, r = 0.46. There was no significant correlation between SDI and ESS scores (r = 0.23, p < 0.01). SDI lowers significant during CPAP therapy: SDI= 1.48 +/- 0.60, respectiv SDI = 1.90 +/- 1.23. CONCLUSION: The severity of OSAS is correlated with increased SDI, but can be seen interindividual variability. The effect of CPAP therapy is reflecting also in sleep quality.

[Expression of Ki-67 in bronchial asthma]. / Nivelul expresiei factorului de proliferare Ki-67 in astmul bronsic.

UNLABELLED: In this paper we want to study the changes in the expression of cell proliferation factor Ki67 in the respiratory epithelium of patients diagnosed with bronchial asthma. MATERIAL AND METHODS: Twenty one patients with bronchial asthma having different degrees of severity (according to GINA 2002) have been included in our study. Fragments of bronchial mucosa were obtained through fiberbronchoscopy, prepared for histologic examination in view of immune marking with anti-Ki67 antibodies. RESULTS: Microscopic examination revealed a progressive increase in the number of Ki-67 cells in the respiratory epithelium corresponding to the severity of asthma (following FEV1 parameters). CONCLUSION: The increase in the cell proliferation in the respiratory epithelium represents one of the mechanisms that can help in rebuilding the epithelial structure destroyed by the chronic irritation.

Adipokines involvement in lung function.

The last two decades brings many data about white adipose tissue capacity to secrete hormones, named adipokines, which could mediate the relationship between obesity and lung diseases. In this paper we presented some data about adipokines involvement on pulmonary function, with special emphasis on leptin, adiponectin, tumor necrosis factor alpha, vascular endothelial growth factor, resistin, hepatocyte growth factor, interleukin-6, angiotensinogen and apelin.

[Pulmonary fibrosis induced by amiodarone--a pitfall of antiarrhytmic treatment]. / Fibroza pulmonara indusa de amiodarona--o capcana a tratamentului antiaritmic.

Cardiac arrhythmia are one of the major causes of cardiovascular and general morbi-mortality. This is the reason for a very quick and well-guided approach. One of the most used drug for this purpose is amiodarone, due to its high therapeutic potency and despite its risk for adverse effects. The most wellknown adverse effect seems to be the thyroid toxicity but, in reality, the most common ones involve the gastrointestinal and respiratory tract, with lung toxicity as a leader (incidence 6-7%). The two clinical cases which make the central point of this work are clear examples for being interested about amiodarone presence when a pulmonary fibrosis is present.

[Diagnostic difficulties in pulmonary tuberculosis in children]. / Dificultati de diagnostic in tuberculoza pulmonara la copil.

UNLABELLED: Pulmonary tuberculosis in children remains an important cause of morbidity and mortality around the world. AIM: To evaluate the difficulty of diagnosis and the epidemiological, clinical, radiological and bacteriological features of pulmonary tuberculosis in children. MATERIAL AND METHOD: We analyzed in a descriptive and retrospective study, 254 children with pulmonary tuberculosis hospitalized in Pulmonary Pediatric Department of Iasi during Jan 2000 - Dec 2005. The surveyed parameters include: the history of TB contact and BCG vaccination, the social condition, the nutrition status, the size of PPD induration, the clinical aspects, the microbiological results, chest X-ray, Quantiferon test. RESULTS: Of the total number of cases: 65.4% had poor social conditions, 72.8% cases with TB contact, almost all patients with malnutrition I, 53.5% cases with BCG scar = 3 mm, 58.35% children with positive tuberculin skin test, 61.8% cases with acute onset, 24.8% with microbiological confirmation, 63.8% with hilar involvement, 18 cases with positive Quantiferon test. CONCLUSIONS: 1. The early diagnosis of pulmonary tuberculosis in children is often difficult. 2. Pulmonary tuberculosis in children must be a priority of the public health programs for extending the area of diagnostic methods.

[Difficulties in the treatment of pulmonary tuberculosis in children]. / Dificultati in tratamentul tuberculozei pulmonare la copil.

UNLABELLED: The management of pulmonary tuberculosis in children in Romania is done according to ERS, WHO and IUATLD recommendations, Iasi area being included since 1998 in the pilot study. MATERIAL AND METHOD: We analyzed in a descriptive and retrospective study 254 children with pulmonary tuberculosis admitted to the Iasi Department of Pediatric Lung Diseases in the interval January 2000 - December 2005. The surveyed parameters included: treatment course, side effects of antituberculous drugs, and an assessment of the cases at the end of treatment. RESULTS: This analysis revealed: 98.8% were new cases, 47.2% had received four-drug regimen for the first 2 months, 46.9% 3-drug regimen and 5.9% individualized treatment. Of the four-drug regimen 92.5% cases were treated with ethambutol. Of the 5.9% with individualized treatment 12 cases had tuberculosis and HIV/AIDS, out of which 2 with MDR tuberculosis, and 1 case with virus B hepatitis; all of them had fluoroquinolones added as well as a longer period of treatment. Side effects of antituberculous medication were encountered in 4.1%, most frequent being toxic hepatitis (2.5%). Patient evaluation at the end of treatment was done according to WHO recommendations: treatment was completed in 70.5% of cases, cured: 23.6% of the cases; relapses in 2.8%, deceased in 2.8% cases. CONCLUSIONS: Pulmonary tuberculosis treatment in children is difficult and must take into consideration their age and nutrition status as well as the side effects and drug combinations.

Th1 and Th2 cytokine response in patients with pulmonary tuberculosis and health care workers occupationally exposed to M. tuberculosis.

UNLABELLED: Aiming to detect reliable markers indicating protection from or susceptibility to tuberculosis infection, we investigated both Th1/Th2 cytokines and total IgE plasma levels in health care workers occupationally exposed to M. tuberculosis, in patients with pulmonary tuberculosis and in healthy persons. MATERIAL AND METHOD: The study groups have included 15 health care workers in close contact with TB patients, patients with active pulmonary tuberculosis at diagnosis and after treatment (12 advanced and 10 moderate TB, of which 6 had also pleurisy) and 20 healthy volunteers. Peripheral blood mononuclear cells (PBMC) were stimulated with PPD for 7 days and the release of six cytokines (IL-2, IFN-gamma, TNFalpha, IL-4, IL-5, IL-10) was simultaneously quantified by cytometric bead array (CBA) in culture supernatants. The same method was used to determine the cytokine level in plasma and pleural effusions from TB patients. Six neoplastic pleurisies were included in this investigation as a control group. Total plasma IgE level was measured by chemiluminescence technique. RESULTS: Plasma and pleural fluid cytokine analysis at the outset of tuberculosis disease reflect the same Th1 response dominated by IFN-gamma. In opposition, very low IFN-gamma levels were recorded in neoplastic pleural fluids. Both types of cytokines (Th1 and Th2) were secreted in response to in vitro PPD stimulation of PBMCs and had different evolution in moderate and advanced TB. Thus, IFN-gamma, TNFalpha, IL-4, and IL5 production after 6 months-treatment decreased in moderate TB and increased in severe disease (p < 0.05). Moreover, total IgE plasma levels were higher than the normal value (87 IU/ml) in health care workers and significant amounts were recorded in patients, especially in advanced TB after 6 months of treatment (p = 0.00). CONCLUSIONS: Our results confirm that the quantification of IFNa could be a good marker for the diagnosis of TB pleural effusions but raised the question whether plasma IgE levels might be a reliable marker indicating the transition to disease. Further studies are needed to understand the complex interaction between pro- and anti-inflammatory cytokines that might play an Key words: TUBERCULOSIS, CYTOKINES,

[Nocturnal asthma]. / Astmul nocturn.

Nocturnal asthma is one of the difficult form of asthma. It is associated with significant decline in pulmonary function and increase of airway inflammation at night. The pathophysiological mechanisms underlying the nocturnal aggravation of asthma are intricate. The most important seem to be: nocturnal environmental allergens, exacerbation of airflows and circadian variations of bronchial hyperreactivity, beta adrenergic receptors polymorphism, increased vagal tone. Home PEF monitoring will allow an objective assessment of nocturnal asthma. The physician-patient partnership is important in educating the patient to manage nocturnal episodes. The chrono-therapeutic approach will usually include inhaled or oral corticosteroids with the addition of theophylline, long-acting beta agonists with timing of therapy to give adequate effect during the night.

[Assessing the number of TB cases using the capture-recapture method with two data sources]. / Estimare a numarului de bolnavi de tuberculoza, prin metoda capture-recapture, folosind doua surse de date.

AIM: A more accurate assessment of the number of TB cases in Iasi County using the capture-recapture method. METHODS: TB patients diagnosed in Iasi County are included in the Registry of Tuberculosis, and are microbiologically examined. The Registry of Tuberculosis in Iasi County contains data about the diagnosis and treatment of TB patients that live in this area (notification). The second list includes all the patients smear positive or culture positive for TB. This list will be obtained from the Microbiology Laboratory, from the Clinic of Pulmonary Diseases and the Municipal Hospital of Pascani. RESULTS: There are 1,134 notifications, 763 laboratory, 642 overlap and thus 1,255 patients in total. The overlap between the data sources is 51%. The capture-recapture leads to an estimate of 1,348 patients (95% CI: 1,320-1,375). This means that the estimated exhaustive of the notifications is (1,134/1,348) = 84.1% (95% CI: 82.5-85.9%) and the exhaustive of the lab is (763/1,348) = 56.6% (95% CI: 55.5-57.8%)). CONCLUSION: The capture recapture assessment using two data sources estimated a that the notifications are about 84% exhaustive, like WHO estimations (80%).

[Thoracoscopic pleurodesis in malignant pleural effusions]. / Pleurodeza toracoscopica in pleureziile maligne.

We performed retrospectively study on 136 thoracoscopies done in our clinic in the period January 2000 and December 2004. We reviewed 136 thoracoscopies, 71 patients were male and 65 were female (mean age 58.4 years). Straw colored effusions were present in 78 cases (57%) and hemorrhagic in 58 cases (43%). The surgical procedure consist in diagnostic of thoracoscopy with drainage of pleural effusion, multiply pleural biopsy, pleurodesis and continuous pleural drainage. In our study, the talc powder (5g) was successfully as sclerosing agent. The primary tumor was: lung-63 (46%), breast-26 (19%), mesothelioma-21 (15.5%), stomach-3, ovarian-3, prostate-3, colon-2, lymphoma-1, leukemia-2, plasmocytoma-1 and unknown primary tumor in 11 cases (8%). Adverse effects included-chest pain-35 cases (25%), fever-20 cases (15%), empyema-6 cases (4.5%), prolonged air leak-5 cases (4%), pulmonary infection-2 cases, acute respiratory failure-1 case, malignant invasion of scar-1 patient. For statistical analysis, the success of talc pleurodesis was defined as the absence of pleural fluid on the follow-up chest radiographs. Pleurodesis was successful in 125 cases (92%) of the patients after 1 month-follow-up. Thoracoscopic talc pleurodesis is a safe, economical and effective treatment for malignant pleural effusion.

[Treatment of pulmonary hypertension in COPD: is there hope for the better?]. / Tratamentul hipertensiunii pulmonare (HTP) din BPOC: exista sperante reale de mai bine?

The aim of this study is to prove for a well tolerated medication (clinical and financial) a supplementary effect in improvement prognosis of patients with pulmonary hypertension secondary to COPD, already treated with classical pneumology drugs. Three pts. groups were selected: the first received only classical pneumology treatment, the second with supplementary therapy by IECA and Ca-blockers, the third with supplementary therapy with IECA and nebivolol; the follow-up protocol included clinical and paraclinical status (blood gases, spirometry, ECG, echocardiography, 6 minute walk test) over 3 months. Clinical and paraclinical evolution of the pts. in group 2 and group 3 was significantly better that in pts from group 1. We conclude that addition of IECA + Ca-blocker/IECA + nebivolol therapy at classical pneumology therapy result in a better evolution in pts. with pulmonary hypertension secondary to COPD.