Pulmonary & Respiratory Medicine

Fat embolism, which is an important type of non-trombotic embolism, is generally seen as a complication of long bone trauma. It presents with respiratory, circulatory, neurologicalsystem symptoms. This multisystemic diseases may end with mortality. A 27-year-old man referred to our hospital with confusion, dyspneaand fever. His complaints started after a long leg cast applied because of a right tibia fracture 36 hours ago. Chest radiographshowed bilateral reticulonodular densities His arterialbloodgases measurement revealed hypoxemiaand hypocapnia. There was no pulmonary embolismshown in thorax CT angiography, as demonstrating bilateral diffuse infiltrations. Fat embolism was thought in differential diagnosis with a clinical presentation of acute respiratory disease syndrome (ARDS). The ophthalmologistsfound out characteristic fat globules on retinal examination. Intravenous glucocorticoid, oxygen and supportive treatment were administered for the patient. Clinical improvement was observed during follow-up, as his symptoms and radiological findings regressed. Our case revealed respiratory insufficiency (one major criteria), high fever, retinal signs, oliguria and tachycardia (four minor criteria), and high sedimentation rate (one laboratory finding), which met the criteria for FES. We want to present our fat embolism case with characteristic properties of this rarely seen disease with characteristic fat globules on retinal examination.

Background: Chronic obstructive pulmonary disease (COPD) affects 9.1% of the population aged 40-69 in Spain, with wide geographic variation. Acute exacerbations of COPD (AECOPD) are a frequent cause of hospital admission, significantly increasing healthcare costs and affecting the quality of life of patients. Patient characteristics and treatment procedures differ across geographic areas, even across hospitals in the same country.

Objective: To analyze epidemiological and clinical factors associated with hospital admissions for AECOPD in our health area.

Methods: Retrospective study reviewing the medical records of all patients admitted for AECOPD in the Hospital Complex of Santiago de Compostela, between 2007 and 2008. Data are expressed as mean (±standard deviation) or median (interquartile range) values for continuous variables and as frequencies or percentages for categorical variables. Chi-square was used to compare proportions, and Student’s t-test for mean values (Mann-Whitney’s U-test for variables on non-normal distributions).Data analysis was performed with SPSS 15.

Results: We registered 1403 admissions for AECOPD of 757 patients, predominantly male (77% of cases), elderly (60% aged above 75), with moderate to severe forms of the disease, as 56.4% of patients were either in GOLD stage II or III. Smoking history was included in the records of 475 patients (63%), 30% of patients which were active smokers. Charlson index was above 2 in 64% of cases. The most common symptom was dyspnea. Hospital admissions were more common in the winter season. The average stay in the period under study was 12.3 days. 3.6% required admission to the ICU. 6% of patients were readmitted early and 4.8% died during hospitalization. As for baseline therapy, it notably included anticholinergics for 62% and inhaled corticosteroids (ICS) for 60% of patients. 26% followed home oxygen therapy. Smoking cessation care provision took place in 7.9% of cases.

Conclusions: AECOPD patients in our health area are mainly elderly males. Their overall health is not good, with significant comorbidity. The average stay is long. 4.8% die during hospitalization. 5.8% are readmitted within 15 days. 26% follow home oxygen therapy, but this indication is questionable in one in four cases. Smoking cessation care provision during hospitalization should be significantly improved.

A 37 year old male with past medical history of HIV (unknown CD4+ count and viral load, on HAART with questionable compliance), IV drug abuse, presented to ER with complaints of three day cough productive of yellow/ brownish sputum, subjective fevers, chills, chest pain aggravated by coughing and deep breaths, diarrhea, vomiting. He reported being in contact with people who had flu. Vitals showed temperature of 38.3 Celsius, respirations 22/ min, heart rate of 114/min, O2 saturation of 97% which rapidly decompensated to 85% on room air. On physical exam patient was in moderate to acute distress, with rhonchi in bilateral lung fields, tachypneic, tachycardic, occasionally producing blood tinged sputum. Labs showed severe neutropenia with bands, normal hemoglobin and hematocrit, elevated lactate, and anion gap metabolic acidosis. Influenza A test was positive. Blood cultures did not show any growth, and rapid strep test was negative. Gram staining was used to identify bacterial morphology. Repeated arterial blood gas analysis showed increasing A-a gradient with progressively worsening PO2:FiO2 ratio. Chest X-ray showed infiltrates in right upper and left middle lung. He was treated for sepsis secondary to pneumonia with intravenous fluids, azithromycin and ceftriaxone (switched to vancomycin and cefepime) neupogen. Patient went into severe sepsis and septic shock, was intubated and started on vasopressors. He subsequently developed massive hemoptysis with expectoration of approximately 3 liters of blood. Patient expired after 45 minutes of resuscitation, 19 hours after admission.

Objective: We analyze the incidence of postoperative severe airflow limitation after single-stage unifocalization in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries (PA/VSD/ MAPCAs) and comment on the treatment performed.

Methods: From 1994 until 2012, 106 patients with diagnosis of PA, VSD, MAPCAs underwent surgical treatment. Four of them (3.8%) developed in the postoperative course severe airflow complication. Chromosome 22q11 deletion was present in three of them. Median age at the time of unifocalization was 6.2 months (range 21 days – 11 months).

Results: The first developed malacia and compression of the left bronchus from the distal RV-PA conduit treated with external bronchial stenting with two incomplete costal cartilage rings. The second patient developed recurrent esophagus-left bronchus fistula treated with multiple surgical esophageal and bronchus reconstruction. The third child presented bilateral bronchial malacia treated with bilateral stenting and after with surgical elongation of the neo-left pulmonary artery to avoid external compression. The last developed bilateral bronchomalacia treated with bilateral bronchial stenting and after with RV-PA conduit replacement and endobronchial stenting calibration

Conclusion: Particular categories of patients (22q11 chromosome deletion, neonates/infants, patients with dominant/exclusive collaterals,) may be more predisposed to develop airway limitation. The treatment of the lesion should be individualized according to the supposed pathogenic mechanism. We suggest endoluminal treatment in absence of compression by vascular structures while surgery was used in proven case of extrinsic compression.

Objectives: Considerable evidence exists of the relationship between poor oral hygiene (therefore greater presence of plaque) and risk of pneumonia in special-care populations, including intensive care unit and nursing home settings. However, the effect of poor oral health on the development of community-acquired pneumonia (CAP) remains to be established. We assessed the relationship between CAP and oral health in general adult population.

Study design: Over 1-year period, 1,336 incident cases of CAP and 1,326 controls were enrolled in a populationbased case-control study. A questionnaire on CAP risk factors that included oral health-related questions, including visit to dentist in the last month, bleeding gums, gingivitis, dental dysaesthesia, dental prosthesis, gumboil in the last month, teeth move or lost, and periodontal disease was administered to all participants.

Results: The prevalence of dental dysaesthesia and use of dental prosthesis was significantly higher among patients with CAP than in control subjects (23.3% vs. 19.7%, P = 0.043, and 45.6% vs. 40.8%, P = 0.016, respectively), whereas visit to the dentist in the last month was a preventive factor against the development of CAP (odds ratio 0.71, 95% confidence interval 0.55-0.92, P = 0.008). Results of bivariate analysis were confirmed in the adjusted multivariate logistic regression models.

Conclusions: Poor oral health may contribute to a higher risk for CAP in adult patients. Oral hygiene practices are particularly important in subjects with dental dysaesthesia and dental prosthesis. Not only odontologists but also dental hygienists should be aware of the relationship between oral health and potentially severe lung infection.

We report a case of huge pulmonary hamartoma with atrophied right lower lobe in a 33-year-old female patient. The pulmonary hamartoma was solid, 30 × 16.5 × 14.5 cm in size, which sectioned surface reveals a thick-walled fibrous cyst with multiple yellow nodules protruding into the lumen. The tumour was compressing the right lung and there was no evidence of infiltration into the surrounding structures. It was successfully treated by surgical resection and final histology was pulmonary hamartoma with predominantly fibrous tissue, cartilaginous tissue and leiomyomatous differentiation. We believe this is the largest reported case in literatures yet, and this was successfully resected via a median sternotomy.

The aim of this work was to study the concentration of IL-8 in conjunction with clinical and functional parameters of the COB in adolescents. Surveyed 52 teenagers and young men suffering from COB aged 11 to 21 years old. The control group consisted of 22 healthy individuals. Options for clinical COB 3 subgroups were identified. To examine the extent of production of IL-8, depending on the severity of the disease showed that IL- 8 levels in the serum increased significantly PC. It is noted that higher concentrations of IL- 8 cytokine was observed in patients with severe chronic obstructive bronchitis. ERF also made observations in these patients, depending on the stage and severity of disease. When functional examination in adolescents with COB were indicators showed a reduction in FVC, FEV1, PEF, MEF25, MEF50, MEF75, MEF25-75 which corresponded to a mixed disorders of pulmonary ventilation function with a predominance of obstructive variant. Thus, in patients with COB stradayushih adolescent relationship marked functional performance parameters of pulmonary cytokine status, in particular IL- 8.

In the last decades growing incidence of nontuberkulous mycobacterium (NTM) in HIVnegative patients was registered. Chronic respiratory disease is definitely representing a strong risk factor. In the routine practice lung infections by NTM are often overlooked, resulting in delayed diagnosis. The treatment is not standardized and we are still lacking evidence based trials. Especially, rapid growing NTM, from which M. abcessus is the most widespread, are presenting a real challenge. Here, we report a case of pulmonary nontuberkulous mycobacterial (NTM) infection with M. abscessus. Although the patient was continuously treated after being diagnosed, further progression, unfortunately, could not be prevented.

Background: Airway stenting is a minimal invasive treatment providing a quick relief of symptoms for patients having airway obstruction. While the use of stenting is well documented in the palliative setting, its role in curative setting is unclear. This case report describes a clinical course that relates to this question that affect the daily clinical practice of oncologists.

Patient: A 46 year old man with a history of heavy smoking; 80 pack year, was diagnosed with bilateral NSCLC and received both chemotherapy and radiotherapy. During radiotherapy the patient developed dyspnoea and a stent was placed in the right main bronchus providing immediate relief. Radiotherapy was continued afterwards.