Pulmonary & Respiratory Medicine

Background: The commonest cause of mortality in sickle cell disease (SCD) is an acute condition called the acute chest syndrome. Little is known of the long term effects of this condition or of its effect on lung function.
 

Objective: To determine lung function in sickle cell disease (SCD) adults and its relation to acute chest syndrome, baseline haemoglobin and systemic inflammation as estimated by serum C-reactive protein.
 

Methods: The lung function in sickle cell disease (SCD) outpatients was compared to that in asymptomatic age and sex matched controls. Stable haemoglobin and serum C-reactive protein (CRP) were measured.
 

Results: 74 controls of mean age 31 years and 154 sickle cell disease (SCD) outpatients with mean age 31 with 44% males were recruited. Controls and sickle cell disease (SCD) patients did not differ in age or sex. 18% sickle cell disease (SCD) patients had at least one episode of acute chest syndrome and 7% had two or more episodes. Forced vital capacity was lower in sickle cell disease (SCD) patients than controls and 47% of sickle cell disease (SCD) patients had a restrictive ventilatory defect. A further 19% had obstruction but the presence of this abnormality was not related to smoking habit. Patients with a history of two or more acute chest syndrome episodes were more likely to have poor lung function. Haemoglobin was positively correlated with forced vital capacity and inversely correlated C-reactive protein. Multivariate analysis showed that haemoglobin in sickle cell disease (SCD) patients was lower if
patients also had a low forced vital capacity, high serum C-reactive protein, low body mass index, older age or male gender.
 

Conclusions: Abnormal lung function is common in sickle cell disease (SCD) adults. In sickle cell disease (SCD), adult’s low haemoglobin is related to a restrictive ventilatory defect and systemic

inflammation. Severity of stable disease in sickle cell patients is related to poor lung function and systemic inflammation.

Objective: The objective of the study was to estimate the efficacy and safety of Inhaled Tobramycin (IT) as an adjunct to systemic antibiotics in the treatment of severe Nosocomial Pneumonia (NP).

Patients and methods: 25 mechanically ventilated patients (out of 165 screened) were enrolled in the current observational single-center study. They were randomized to receive either IT (300mg, BID; group 1, n=15) as an adjunct to systemic antibiotics or for a correction of the regimen of systemic antibiotics (group 2, n=10). The primary outcome measure was resolution of NP and acute respiratory insufficiency. The CPIS, signs of Systemic Inflammatory Response Syndrome (SIRS) and oxygenation index were used as objective indicators of the clinical progress.

Results: The following signs of IT efficacy were detected in 87% of group 1 patients: a decrease of SIRS and CPIS scores within 2, 3 ± 1, 2 days of IT therapy (p<0,05); decrease of microbes titer to 103-104 CFU/ml (p<0,05); increase of microbes sensitivity to systemic antibiotics in 40% of patients; positive X-ray dynamics in 60% of patients within 9, 0 ± 2, 5 days of IT therapy. No serious side effects of IT were observed.

Conclusion: Administration of IT as an adjunct to systemic antibiotics is efficient and safe in 87% of patients with severe NP caused by multi resistant gram-negative bacteria.

Thymoma is the most common neoplasm of the anterior mediastinum. Patients may be asymptomatic or present with symptoms of local compression, myasthenia gravis or other paraneoplastic syndrome. We present case of a middle aged woman with a large pleural based mass who was relatively asymptomatic Biopsy of the mass revealed thymoma type AB.Work up showed that she has multiple abdominal masses etiology of which is not known. Whenever feasible, surgery is the treatment of choice for thymoma.Our patient is undergoing chemotherapy with the goal that once the tumor size is reduced she will be able to undergo surgery.

Benign metastasizing leiomyomas of the lung remain an infrequently encountered pulmonary pathology with poorly understood pathogenesis and unclear treatment algorithm. They may manifest a spectrum of clinical symptoms and have multiple proposed etiologies. Critical to this diagnosis is adequate tissue biopsy, which additionally may facilitate treatment based on hormonal receptor status.

Complete surgical resection of solitary pulmonary lesions is advocated with targeted endocrine therapy as a proposed means of treating disseminated disease. Long term follow up of these patients is critical to our understanding of the risk of recurrence, malignant transformation and natural history of this disease.