Late Diagnosis of Foreign Body Aspiration in Adults: Case Series and Review of the Literature.

BACKGROUND: Tracheobronchial foreign body (FB) aspiration (FBA) is a life-threatening emergency mostly observed in childhood and advanced age. With early diagnosis, the FB can be removed using bronchoscopic methods without causing irreversible damage. METHODS: This was a single-center, retrospective observational study. Subjects diagnosed with FBA via either bronchoscopic methods and/or radiological findings, having no medical history of aspirated FB, and who were detected to have aspirated FB for longer than 30 days were included in the study. Medical records and radiological and bronchoscopic findings of the subjects were investigated from the hospital information database system. RESULTS: Of the 255 patients with FBA, 17.6% (N = 45) were diagnosed late. The mean age was 53 y; 28% were female, and 60% of the subjects had a history of ever smoking. The estimated residence time of the FB in the bronchial system was 22.8 months. The most common complaints were cough and shortness of breath. Forty-two percent of the aspirated FBs were organic material. FB artifact could be observed in 6.7% of posteroanterior chest radiographs and 65% of thorax computed tomography (CT) scans. Rigid bronchoscopy had been primarily preferred as therapeutic interventional procedure. It was also found that the artifact most frequently resided in the right bronchial system and was most commonly found in the right lower lobe, while granulation tissue was formed in 85% of the subjects. CONCLUSIONS: The findings of the present study demonstrate that subjects tended to forget the FBA, leading to insidious respiratory system symptoms, with recurrent infections. In cases with an endobronchial mass lesion image on thorax CT, clinicians should consider the possibility of FBA. Delayed diagnosis of both organic and inorganic FB may cause granulation tissue.

The Role of Serum Galectin-3 Levels in Patients with Sarcoidosis.

INTRODUCTION: Galectin-3 is a multifunctional protein, the levels of which increase in the presence of diseases that progress with pulmonary fibrosis. This study investigated the role of galectin-3 levels in the staging and assessing of the severity of sarcoidosis. METHODS AND SUBJECTS: Seventy-three subjects were studied; 25 were healthy individuals and 48 patients had pathologically confirmed diagnosis of sarcoidosis in which other potential causes had been ruled out. Galectin-3 levels were measured and compared in terms of such parameters as hemogram, biochemistry, age, body mass index, and smoking status. RESULTS: The mean galectin-3 levels of the sarcoidosis patients (14.87 ± 5.57) were significantly higher than those in the healthy subjects (11.81 ± 2.67), and the mean galectin-3 levels differed significantly among different stages of the disease (p < 0.05). The serum galectin-3 level in patients with stage 2, 3, and 4 sarcoidosis was found to be higher than in patients with stage 0 and 1 sarcoidosis and the control group. In addition, serum galectin-3 levels in the sarcoidosis patients had significant positive correlations with blood urea nitrogen, alkaline phosphatase, white blood cells, red blood cell, hemoglobin, and neutrophil levels (34.9% [p < 0.05]; 40.1% [p < 0.05]; 41.2% [p < 0.01]; 43.3% [p < 0.01]; 34.7% [p < 0.05]; and 40.6% [p < 0.01], respectively) and a significant negative correlation with the platelet distribution width levels (p < 0.05). CONCLUSION: Serum galectin-3 levels are significantly elevated in sarcoidosis patients with parenchymal involvement at stage 2 or higher, suggesting that serum galectin-3 levels can be used to estimate disease severity in sarcoidosis.

Concentraciones de proteínas de estrés térmico, L-arginina y dimetilarginina asimétrica en pacientes con síndrome de apnea obstructiva del sueño / Heat Shock Proteins, L-Arginine, and Asymmetric Dimethylarginine Levels in Patients With Obstructive Sleep Apnea Syndrome

Objetivo: La inflamación del endotelio vascular y el aumento del estrés oxidativo son factores patogénicos importantes del síndrome de apnea obstructiva del sueño (SAOS). El objetivo de este estudio fue determinar las concentraciones de las proteínas de estrés (HSP) 27, HSP70 y HSP90, L-arginina y dimetilarginina simétrica (ADMA) en pacientes con SAOS y establecer su relación con factores de riesgo cardiovascular (CV). Material y métodos: En el estudio se incluyó a 40 pacientes con SAOS, 26 de los cuales presentaban factores de riesgo CV tradicionales (obesidad, hipercolesterolemia, diabetes, hipertensión y tabaquismo) y 14 no los presentaban, y 20 sujetos de control que no padecían SAOS. A todos los pacientes se les realizó una evaluación polisomnográfica completa y se extrajeron muestras de sangre en la mañana siguiente al estudio diagnóstico. Resultados: No se observaron diferencias significativas entre grupos en las concentraciones séricas de HSP27 y HSP70. En los pacientes con SAOS, con o sin factores de riesgo CV, se observaron aumentos significativos de las concentraciones de HSP90 y ADMA y disminuciones significativas de las concentraciones de L-arginina, en comparación con los sujetos de control, aunque no hubo diferencias entre los subgrupos. En todos los pacientes con SAOS, las concentraciones séricas de HSP70 se correlacionaron positivamente con porcentajes de tiempo con saturación <90% (r = 0,349; p = 0,027). Las concentraciones séricas de L-arginina se correlacionaron negativamente con el número de desaturaciones (r=-0,360; p=0,022) y el índice de apnea-hipopnea (r=-0,354; p = 0,025) y positivamente con la saturación de oxígeno media (r = 0,328; p = 0,039). Conclusión: Las concentraciones séricas de HSP90 y ADMA aumentaron y las de L-arginina disminuyeron en pacientes con SAOS, independientemente de los factores de riesgo CV que presentasen. Estos resultados indican la presencia de estrés oxidativo y disfunción endotelial en pacientes con SAOS

Objective: Vascular endothelial inflammation and enhanced oxidative stress are important factors in the pathogenesis of obstructive sleep apnea syndrome (OSAS). The aim of this study was to determine the levels of heat shock protein (HSP) 27, HSP70, HSP90, L-arginine, and asymmetric dimethylarginine (ADMA) in patients with OSAS and determine their relationship with cardiovascular (CV) risk factors. Material and methods: Forty patients with OSAS, comprising 26 with and 14 without traditional CV risk factors (obesity, hypercholesterolemia, diabetes, hypertension, and smoking), and 20 control subjects without OSAS were included. All patients underwent a full polysomnographic evaluation, and blood samples were obtained in the morning after the night the diagnostic study was performed. Results: No significant differences were found in serum HSP27 and HSP70 levels between the groups. HSP90 and ADMA levels increased significantly, whereas L-arginine levels decreased significantly in patients with OSAS, both with and without CV risk factors, compared with controls, but were not different among the subgroups. In all patients with OSAS, serum HSP70 levels were positively correlated with a percent time with saturation <90% (r = .349, P = .027). Serum L-arginine levels were negatively correlated with desaturation number (r = -.360, P=.022) and apnea-hypopnea index (r=-.354, P = .025) and positively correlated with mean oxygen saturation (r = .328, P = .039). Conclusion: Serum levels of HSP90 and ADMA increased, whereas those of L-arginine decreased in patients with OSAS regardless of CV risk factors. These findings indicate the presence of oxidative stress and endothelial dysfunction in patients with OSAS

Linfoma de células B traqueal primario causante de obstrucción recurrente de vías aéreas centrales / Primary Tracheal B-cell Lymphoma Causing Recurrent Central Airway Obstruction

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Efecto de la hipoxia sobre el metabolismo de la glucosa en pacientes no diabéticos con síndrome de apnea obstructiva del sueño / Effect of Hypoxia on Glucose Methabolism in Nondiabetic Patients With Obstructive Sleep Apnea Syndrome

Objetivo: El síndrome de apnea obstructiva del sueño (SAOS) puede fomentar la hiperglucemia y la resistencia a la insulina. Nuestro objetivo es investigar el efecto del SAOS sobre la glucosa plasmática en ayunas, la hemoglobina glucosilada (HbA1c) y la proteína C reactiva (PCR) en pacientes no diabéticos. Material y métodos: Se determinaron los parámetros de analítica hemática de 90 pacientes no diabéticos consecutivos en los que se realizaron evaluaciones polisomnográficas en nuestro laboratorio del sueño. Un total de 61 de estos pacientes con una glucemia en ayunas normal fueron clasificados según el índice de apnea-hipopnea (IAH) como casos leves (n = 16, 26,2%), moderados (n = 18, 29,5%) o graves (n = 27, 44,2%) de SAOS. Se efectuaron determinaciones de la glucosa plasmática en ayunas, la HbA1c y la PCR. Resultados: La media de edad de los pacientes fue de 47,7 ± 11,2 años, y el 72% eran varones. Los niveles de HbA1c y de glucosa en ayunas presentan una correlación positiva con el IMC (r = 0,503, p = 0,00; r = 0,258, p = 0,045). No se detectó relación alguna de la HbA1c con el índice de apnea ni con el IAH, mientras que sí se observó una correlación positiva de la glucosa en ayunas con la PCR (r = 0,262, p = 0,042; r = 0,258, p = 0,045). Los niveles de HbA1c, glucosa en ayunas y PCR muestran una correlación negativa con los valores de SpO2 mínima (con valores de r = –0,302, p = 0,018; r = –0,368, p = 0,004; r = –0,365, p = 0,004, respectivamente). Los niveles de HbA1c, glucosa en ayunas y PCR muestran una correlación positiva con el índice de desaturación medio (tiempo durante el que la SpO2 es < 90% según la pulsioximetría) (r = 0,263, p = 0,041; r = 0,311, p = 0,015; r = 0,283, p = 0,027) (AU)

Conclusiones: Aunque no se detectó relación alguna entre el aumento de los niveles de HbA1c o de glucosa y la gravedad del SAOS en los pacientes con SAOS no diabéticos, sí se detectó una correlación con la hipoxia nocturna. Esto podría poner de manifiesto el efecto de la hipoxia nocturna sobre el metabolismo de la glucosa en los pacientes con SAOS (AU)

Aim: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia and insulin resistance. Our aim is to investigate the effect of OSAS on the fasting plasma glucose, glycosylated hemoglobin (HbA1c), and C reactive protein (CRP) in nondiabetic patients. Materials and methods: Blood parameters of consecutive 90 non diabetic patients whom polysomnografic evaluations were done in our sleep laboratory was evaluated. Among these 61 patients with normal fasting blood glucose were classified due to their apne-hipopnea index (AHI) as mild (n=16, 26.2%), moderate (n=18, 29.5%) and severe (n=27, 44.2%) OSAS. The fasting plasma glucose, HbA1c and CRP were measured. Results: Mean age of the patients was 47.7±11.2 years, 72% male. HbA1c, fasting glucose levels show positive correlation with BMI (r=0.503, P=0.00; r=0.258, P=0.045). No relation of HbA1c to apnea index nor AHI was detected while positive correlation of fasting glucose and CRP was detected (r=0.262, P=0.042; r=0.258, P=0.045). HbA1c, fasting glucose and CRP levels show negative correlation with minimum SpO2 levels (by order of r=–0.302, P=0.018; r=–0.368, P=0.004; r=–0.365, P=0.004). HbA1c, fasting glucose levels and CRP levels show positive correlation with mean desaturation index (time duration in which SpO2<90% by pulse oxymeter) (r=0.263, P=0.041; r=0.311, P=0.015; r=0.283, P=0.027). Conclusions: Although no relation in between increased HbA1c or glucose levels and severity of OSAS was detected in nondiabetic OSAS patients, the correlation with the night hypoxia was detected. This could also show the effect of night time hypoxia on glucose metabolism in OSAS patients (AU)