Sex differences of continuous positive airway pressure treatment on flow-mediated dilation in patients with obstructive sleep apnea syndrome.

INTRODUCTION: There is growing research evidence suggesting the presence of endothelial dysfunction and systemic inflammation in patients with obstructive sleep apnea syndrome (OSAS). Continuous positive airway pressure (CPAP) is the most effective method for treating OSAS; nonetheless, the effects of CPAP on the aforementioned pathophysiologic pathways as well as on the systemic disease that result or coexist with the OSAS remain elusive. AIM: To assess the effect of 3-month CPAP therapy on endothelial-dependent dilation, plasma levels of inflammatory markers, blood pressure (BP), and glucose control on male and female patients with OSAS. METHODS: Our study group consisted of 40 (24 males and 16 females) patients with no prior history of cardiovascular disease, with an apnea-hypopnea index ≥15, who were assigned to receive CPAP treatment. Measurements of flow-mediated dilation (FMD), 24-hour ambulatory BP, and blood analysis were performed at baseline and 3 months after CPAP therapy. RESULTS: Baseline FMD values were negatively correlated with the apnea-hypopnea index (r=-0.55, P=0.001). After 3 months of CPAP, there was an increase in the FMD values (5.40%±2.91% vs 3.13%±3.15%, P<0.05) and a significant reduction in the patients' 24-hour systolic BP (122.82±11.88 mmHg vs 130.24±16.75 mmHg, P<0.05), diastolic BP (75.44±9.14 mmHg vs 79.68±11.09 mmHg, P<0.05), and pulse pressure (47.38±9.77 mmHg vs 52.72±11.38 mmHg, P<0.05); daytime systolic BP (125.76±12.69 mmHg vs 132.55±17.00 mmHg, P<0.05) and diastolic BP (77.88±10.39 mmHg vs 82.25±11.01 mmHg, P<0.05); nighttime systolic BP (118.17±13.16 mmHg vs 126.22±17.42 mmHg, P<0.05) and pulse pressure (46.61±10.76 mmHg vs 52.66±11.86 mmHg, P<0.05); and C-reactive protein and HbA1c levels (0.40 [0.40-0.70] mg/L vs 0.60 [0.40-0.84] mg/L and 5.45%±0.70% vs 5.95%±1.08%, respectively; P<0.05). When divided by sex, only male patients produced similar statistically significant results, while female patients failed to show such associations. CONCLUSION: Our results suggest that CPAP therapy improves the endothelial function, the BP, and the glucose control in male patients with OSAS. Further research is warranted in order to verify these results and to further elucidate the impact of CPAP on the cardiovascular risk of male and female patients with OSAS.

Usefulness of endobronchial ultrasound (EBUS) in the diagnosis of peripheral pulmonary lesions in a general hospital.

AIM: To investigate the efficiency of guided bronchoscopy compared to blind techniques in the study of non-visible pulmonary lesions. MATERIALS AND METHODS: A one-year, retrospective, study was conducted comparing two populations: Biopsies were either performed conventionally (FB-B) with the help of static images and the second where biopsies were performed after guidance (FB-EBUS). A 20-MHz radial-type ultrasound probe was used to obtain images. Sampling techniques, like bronchial brushing and transbronchial biopsies, were conducted in both populations by two separate bronchoscopists. If diagnosis was not achieved a surgical biopsy or observation followed. RESULTS: Forty patients appeared with non-visible lesions and were included in this study. Twenty were examined with the use of FB-EBUS and in 20 cases FB-B was conducted. At the FB-EBUS population a pathologic lesion was visualized in 16 cases (80%) and in 15 cases (75%) a diagnosis was achieved. All lesions that weren't visualized had a diameter less than 30 mm. At the FB-B population a diagnosis was achieved in 11 cases (55%). In pulmonary lesions with a diameter more than 30 mm, the diagnostic yield was 87, 5% using guidance and 61, 5% using FB-B and in lesions less than 30 mm 66, 67% and 42, 85% respectively. Moreover, left lower lobe was the most promising to obtain a diagnosis. CONCLUSION: Our results suggest that in patients with a non-visible pulmonary lesion a diagnostic strategy involving the choice of EBUS-guided biopsy is a reasonable and effective choice.

The role of endobronchial ultrasound in lung cancer diagnosis and staging: a comprehensive review.

Endobronchial ultrasound (EBUS) technology is a relatively new bronchoscopic method of visualizing the tracheobronchial tree, the surrounding pulmonary parenchyma, and the mediastinal structures, with a particular role in lung cancer diagnosis, staging, and treatment. There are 2 types of probes used in EBUS: the peripheral or radial probe (RP) and the linear or convex probe (CP) EBUS, which have technical differences and distinct diagnostic abilities. Both are used for EBUS-guided biopsies and transbronchial needle aspirations (TBNA), which increases the diagnostic yield over conventional bronchoscopic techniques, thus providing advanced information on staging, diagnosis, and treatment. Complications of EBUS are rare, and they are usually related to the underlying biopsy procedure and the operator's experience. EBUS examination duration is usually short, and it can be performed as an outpatient procedure. Interestingly, EBUS combinations with other current and evolving techniques, eg, electromagnetic navigation, are feasible and have a role in therapeutic interventions and molecular diagnostics. In conclusion, EBUS is a safe and accurate technique that is comparable with current criterion standard procedures, eg, mediastinoscopy. More training is required for the vast majority of respiratory physicians, and precise diagnostic algorithms are needed so that more patients benefit from this development.

Fatal Hemoptysis due to Chronic Cavitary Pulmonary Aspergillosis Complicated by Nontuberculous Mycobacterial Tuberculosis.

A 51-year-old man, with a history of severe COPD and bilateral pneumothorax, who was under treatment for pulmonary tuberculosis due to mycobacterium avium, was admitted due to high-grade fever, weight loss, cough, and production of purulent sputum, for almost one month without any special improvement despite adequate antibiotics treatment in outpatient setting. A CT scan revealed multiple consolidations, fibrosis, scaring, and cavitary lesions in both upper lobes with newly shadows which were fungus balls inside them. Aspergillus flavius was isolated in three sputum samples, a diagnosis of chronic cavitary pulmonary aspergillosis was made, and treatment with intravenous amphotericin B was started. An initially clinical improvement was noted, and a first episode of minor hemoptysis was treated with conservative measures. Unfortunately a second major episode of hemoptysis occurred and he died almost immediately. Aspergilloma is defined as the presence of a fungus ball inside a preexisting pulmonary cavity or dilated airway and is one of the clinical conditions associated with the clinical spectrum of pulmonary colonization. Tuberculosis is the most common underling disease. Hemoptysis is the most common symptom. Antifungal antibiotics, surgical interventions, bronchial arteries embolization, and intracavity infusion of antibiotics have been proposed without always adequate sufficiency.

Findings and limitations of focused ultrasound as a possible screening test in stable adult patients with blunt abdominal trauma: a Greek study.

Our objective is to underline the place of FAST (focus assessment by sonography for trauma) ultrasonography (US) in the investigation of blunt abdominal trauma. We retrospectively examined the ultrasound findings in 1,999 haemodynamically stable adult patients. These people were admitted to the emergency room (ER) for possible blunt abdominal trauma. All were stable at admission and a FAST ultrasound examination was made. Initial findings were compared with the clinical course after at least 24 h of observation time and CT results. Among the 1,999 US examinations, abnormalities were found in 109 (5.5%) cases. Among them, 102 had free peritoneal fluid, and in 58 examinations, ruptures, lacerations or haematomas were demonstrated. Despite its limitations, such as in cases involving uncooperative patients, excessive bowel gas, obesity and empty bladder, the FAST technique seems to be an accurate method to evaluate the possibility of abdominal blunt trauma in stable patients. Because of the high negative predictive value of the FAST technique in stable patients with blunt abdominal trauma, we recommend that a stable patient with negative ultrasound results at admission remain under close observation for at least 12 or preferably 24 h before being discharged.

Multiple lung abscesses due to acinetobacter infection: a case report.

Acinetobacter species are well-known causes of nosocomial infections. Recent increasing evidence emphasize on the role of these pathogens in community-acquired infections.We report a case of a 16-yr-old female with fever, sore throat, productive cough, malaise and the presence of lung consolidation with multiple abscesses on radiographic examination. The patient had no significant medical history. After a detailed diagnostic work-up the diagnosis of community acquired Acinetobacter pneumonia with multiple lung abscesses was made. The Acinetobacter stain was susceptible to a variety of antimicrobial agents and the patient's condition improved rapidly. A new computed tomography chest scan, three months later, confirmed full recovery.The presence of lung abscesses due to Acinetobacter infection is an extremely uncommon manifestation of the disease. This case underlines the emergent role which these, often multi-drug resistant, bacteria may play in the future, perhaps in community infections as well.

Penis deformity after intra-urethral liquid paraffin administration in a young male: a case report.

BACKGROUND: Self-induced injections of liquid substances mainly for penis enlargement is a well-documented but still rather uncommon practice in the western world. CASE PRESENTATION: Herein we present the case of a 30-year-old male who self-inflicted, twice in a six-month-period, intra-urethral liquid paraffin and tied up his penis with a cord in order to achieve both enlargement and elongation. He arrived in our emergency department suffering from suprapubic pain; physical examination revealed a rather unique deformity of the penis. He finally refused any treatment and absconded. CONCLUSION: Side effects after paraffin administration are various and sometimes severe. Most of the times surgical treatment is needed and radical excision together with follow-up seems the best modality. Such practices emphasize on the public's misbelieves and that some aspects of sexual medicine are yet covered with the veil of misconception.

Tracheal diverticulum in an asymptomatic male: a case report.

INTRODUCTION: An air filled lesion can be a diagnostic dilemma and a careful investigation must be following to clarity any underlining pathology. CASE PRESENTATION: A 62-year old male, ex smoker, with a history of chronic cough was examined with helical CT tomography and an air filled lesion was demonstrated at the right paratracheal region at the thoracic inlet. A narrow connection to trachea lumen was also visible, a critical element to establish the diagnosis of ttracheal diverticulosis. CONCLUSION: This malformation is a rare anomaly with two types, the congenital and the acquired one. It must be included into the differential diagnosis of any air filled lesion at the thoracic inlet. Computed tomography scans (with thin section and reconstructed images) seem the proper imagine. Bronchoscopy can also visualize the diverticulum although sometimes the connection with trachea can't be detected. In most cases is asymptomatic and needs no special treatment. A possible danger of repeated respiratory infections and insufficient intubation and/or ventilation must be in mind.

Right-sided Bochdalek Hernia Presenting as a Solitary Pulmonary Nodule.

Bochdalek hernia is a well-known disorder, which represents visceral herniation through a posterior diaphragmatic defect. In this report we present an adult man with a right-sided Bochdalek hernia mimicking a solitary pulmonary nodule. Furthermore, we perform a brief review of the literature, with emphasis on novel imaging techniques that establish the diagnosis. In conclusion, Bochdalek hernia should be considered in the differential diagnosis of a posterior diaphragmatic or paraspinal opacity. Correct diagnosis is of paramount importance and can be easily established by non-invasive imaging techniques.

Drug-induced pulmonary toxicity in a patient treated with mesalazine and azathioprine for ulcerative colitis.

We report a case of an 18-yr-old male with high-grade persistent fever, productive cough, malaise, diarrhea and associated abnormal findings on chest radiography. The patient suffered from ulcerative colitis receiving mesalazine and azathioprine. After a further and scrutinized work-up the diagnosis of drug-induced pulmonary toxicity was made. His condition was improved after discontinuing both drugs and the administration of corticosteroids. This is a rarely reported case of eosinophilic pneumonia. Although it has not been reported previously, the possibility of mesalazine and azathioprine synergism cannot be excluded. The clinical, aetiological, diagnostic and therapeutic aspects of the disease are discussed demonstrating the paramount importance of bronchoalveolar lavage in the diagnosis of this disorder. One should be aware of this entity in patients with inflammatory bowel disease.