Eosinophilic pleural effusion due to gliclazide.
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Diabetes Mellitus, Type 2↗
Biomedical subjects
D Bouros
Publications and source records attributed to D Bouros.
Significance of alpha-2-macroglobulin, alpha-1-acid glycoprotein, and C-reactive protein in pleural effusion differentiation.
BACKGROUND: The differentiation between exudates and transudates is fundamental when investigating the cause of pleural effusions. Acute-phase proteins could be potentially useful markers in this discrimination. OBJECTIVE: The present study was designed to evaluate whether the acute-phase proteins: alpha(2)-macroglobulin (AMG), alpha(1)-acid glycoprotein (AAG) and C-reactive protein (CRP) are useful in investigating the pleural effusions. METHODS: We prospectively measured the concentrations of the above proteins in the serum and pleural fluid of 84 consecutive patients with various diseases using a nephelometric assay. RESULTS: Pleural effusion AMG, AAG and CRP were all significantly elevated in the group of patients with exudates compared to patients with transudates (p < 0.001, p < 0.001 and p < 0.01, respectively). An AAG value >63 mg/dl in a pleural effusion is predictive of an exudate with a sensitivity of 90% and a specificity 85%. Similarly, an AMG value >44 mg/dl in a pleural effusion is predictive of an exudate with a sensitivity and a specificity of 90% and 60%, respectively. Moreover, pleural AAG was significantly higher in cancerous exudates than in exudates and transudates of all other cause taken together (p < 0.001). Finally, to differentiate the same pleural effusion, the cut-off value of 1.0 mg/dl of pleural CRP has a sensitivity and a specificity of 74% and 74%, respectively. CONCLUSIONS: We conclude that both AAG and AMG concentrations in pleural effusions have a high sensitivity and are therefore useful parameters in distinguishing exudates from transudates, but the latter is inferior due to its unacceptably low specificity.
Adult↗
Miliary sarcoidosis following miliary tuberculosis.
A patient who presented with a miliary radiographic pattern due to tuberculosis and later with a similar miliary pattern due to sarcoidosis is described. The patient, a 47-year-old man, was admitted to the hospital due to coughing, weakness, weight loss and an abnormal chest radiograph with a miliary pattern. A gastric fluid culture was positive for Mycobacterium tuberculosis and he was treated appropriately. He showed complete clinical and radiological remission. One year later he presented with a dry cough and a similar miliary pattern on the chest roentgenogram. Lung biopsy taken by thoracoscopy revealed sarcoidosis. The patient had a complete remission with corticosteroids. To our knowledge, this is the first report describing a miliary pattern as presenting radiological sign in a patient with tuberculosis who subsequently developed a new miliary pattern due to sarcoidosis.
Adrenal Cortex Hormones↗
Frequent genetic alterations at the microsatellite level in cytologic sputum samples of patients with idiopathic pulmonary fibrosis.
Idiopathic pulmonary fibrosis (IPF) is a disease of unknown etiology associated with DNA damage and malignancy. Bronchogenic carcinoma is the cause of death in 10% to 13% of IPF patients. Microsatellite instability (MSI) and loss of heterozygosity (LOH) are frequently detected in cancers. If these genetic alterations could be observed in IPF, they might explain the higher relative risk of lung cancer in this disease. We investigated the incidence of MSI and LOH in sputum cytologic specimens from 26 IPF patients and 26 healthy, matched subjects, using 10 highly polymorphic microsatellite markers. The electrophoretic pattern of each specimen was compared with that of corresponding peripheral blood. Thirteen (50%) patients showed genetic alterations, consisting either of MSI or LOH. Five (19%) patients exhibited MSI and 10 (39%) exhibited LOH in at least one microsatellite marker. Three (12%) patients showed LOH in more than one marker. None of the healthy subjects exhibited genetic alterations in the studied markers. No correlation was found between the detected genetic alterations and age, disease duration, blood gases, or spirometric parameters of the patients. Our findings suggest that the genetic alterations that we studied are frequent in IPF, are apparently unrelated to the severity of the disease, and may be related to tumorigenesis.
Aged↗
Pleurodesis: everything flows.
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Animals↗
Usefulness of thoracoscopic surgery in the diagnosis and management of thoracic diseases.
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been recently utilised in the diagnosis and management of thoracic diseases. In this article we report our series of patients with established indications for VATS treatment. METHODS: Over the past 6 years we performed 104 VATS procedures for diagnostic and therapeutic purposes in 95 men and 39 women. The specific indications for VATS were: lung biopsy for undiagnosed diffuse lung disease, mediastinal biopsy and cysts, pleural effusion, empyema, pneumothorax and bullous lung disease, pericardial effusion and cyst, parvertebral abscess and solitary pulmonary nodules. RESULTS: There was no operative mortality. Postoperative non-fatal complications were seen in 7 cases. The overall median duration of chest tube drainage was 2.5 days and the mean postoperative stay 3 days. In diffuse lung disease a tissue diagnosis was obtained in all cases. Definitive diagnosis in the patients with undiagnosed pleural effusion was obtained in 90% of cases and the overall diagnostic rate was 98.5%. The success rate of the empyema (stage II) treatment and the therapeutic procedures is 100% after a mean follow-up of 12 months (range 6-30). Conversion to thoracotomy was needed in 6 cases. In all patients the postoperative pain was controlled with intake of non-narcotic analgesics with satisfactory results. CONCLUSIONS: VATS is worth considering and has been established as procedure of choice, with exceptional results in various chest diseases such as undiagnosed pleural effusions, recurrent, post-traumatic or complicated spontaneous pneumothorax, stage II empyema, accurate staging for lung cancer in the resection of peripheral solitary pulmonary nodule less than 3 cm, and lung biopsy for pulmonary diffuse disease.
Adult↗
Current classification of idiopathic interstitial pneumonias.
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Cryptogenic Organizing Pneumonia↗
Formoterol and beclomethasone versus higher dose beclomethasone as maintenance therapy in adult asthma.
A total of 132 adult asthmatics who were symptomatic on 500 microg x day(-1) inhaled beclomethasone dipropionate (BDP) were studied in an open-label randomized, parallel group, 12 week, clinical trial. The addition of 12 microg formoterol fumarate solution aerosol (pressurized metered dose inhaler) b.i.d. to BDP at a dose of 500 microg x day(-1) was compared with a higher dose of 1,000 microg x day(-1) BDP. Mean morning premedication peak expiratory flow rate (PEF) during the final week of treatment (primary end-point) increased in both groups compared to baseline. The estimated treatment difference of 20.4 L x min(-1) (95% confidence interval 3.2-37.6) after 12 weeks of treatment was statistically significant (p<0.05) in favour of the formoterol/BDP group. The overall mean morning premedication PEF for the entire treatment period was higher in the formotero/BDP group (p=0.002). The overall number of puffs of rescue medication and asthma symptom scores were less in the formotero/BDP group (p<0.01). Safety and tolerability evaluations were satisfactory in both groups. In conclusion, the results suggest that the addition of formoterol fumarate to the existing dose of an inhaled corticosteroid should be considered as an alternative to increasing the dose of inhaled corticosteroid in the inadequately controlled asthmatic.
Administration, Inhalation↗
Surgery and the respiratory muscles.
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Abdomen↗
Q fever pneumonia: appearance on chest radiographs.
PURPOSE: To determine the radiographic features of Q fever pneumonia. MATERIALS AND METHODS: Chest radiographs in 85 patients admitted to the hospital during a 7-year period with Q fever pneumonia were retrospectively reviewed by two observers. RESULTS: The most commonly recorded abnormalities were segmental (n = 53 [62%]) and lobar (n = 15 [18%]) areas of opacity. Segmental pneumonia was observed as a unilateral single area of opacity in 38 (72%) patients. It was more frequently located in the upper lobes. The left upper lobe was involved in 31% of patients, the right upper lobe, in 23%; and the right lower lobe, in 27%. Lobar pneumonia was less frequently observed as a single lesion in eight (53%) of 15 patients; It was located in the left upper lobe in 31% and in the right middle lobe in 27% of patients. There was no correlation between the extent of pulmonary involvement and the course of the disease; the outcome was favorable in all patients. Complete resolution of the radiographic findings occurred in a mean of 39 days. CONCLUSION: The radiographic differentiation of Q fever pneumonia from the other community-acquired pneumonias is not possible. Clinical, serologic, and epidemiologic data provide the best basis for diagnosis.
Adult↗
Pneumoconiosis among Cretan dental technicians.
Pneumoconiosis among dental technicians has recently emerged as an area of research in interstitial lung disease. This study was carried out to estimate the prevalence of pneumoconiosis in Greek dental technicians on the island of Crete. Fifty-one of the 58 dental technicians of the Heraklion Dental Technicians' Association completed an exposure history questionnaire and underwent a clinical examination, including chest radiographs, and spirometric assessment of lung volume and diffusing capacity. Values were compared with 51 control subjects. Five dental technicians showed radiological evidence of pneumoconiosis. Mean lung function values of the dental technicians, even in those with pneumoconiosis, were not significantly different from controls. No significant changes in lung function parameters were associated with smoking, exposure to metals and other contaminants. Dental technicians, however, reported more respiratory symptoms than controls (p = 0.008). Symptoms were associated to the absence of a ventilation system. We concluded that occupational exposure in dental technicians in Crete did not affect lung function. The prevalence of pneumoconiosis in this study was 9. 8%.
Adult↗
Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema. A randomized, double-blind study.
Intrapleural administration of fibrinolytic agents has been shown to be effective and safe in the treatment of loculated parapneumonic pleural effusions. However, controlled studies of the possible role of the activity of urokinase (UK) through the volume effect are lacking. We therefore investigated the hypothesis that UK is effective through the lysis of pleural adhesions and not through the volume effect. Thirty-one consecutive patients with multiloculated pleural effusions were randomly assigned to receive either intrapleural UK (15 patients) or normal saline (NS) (16 patients) for 3 d, in a double-blind manner. All patients had inadequate drainage through a chest tube (< 70 ml/24 h). UK was given daily through the chest tube in a dose of 100.000 IU diluted in 100 ml of NS. Controls were given the same volume of NS intrapleurally. Response was assessed by clinical outcome, fluid drainage, chest radiography, pleural ultrasonography (US) and/or computed tomography (CT). Clinical and radiographic improvement was noted in all but two patients in the UK group but in only four in the control group. The net mean volume drained during the 3-d treatment period was significantly greater in the UK group (970 +/- 75 ml versus 280 +/- 55 ml, p < 0.001). Pleural fluid drainage was complete in 13 (86.5%) patients in the UK group (two patients were treated through video-assisted thoracoscopy) but in only four (25%) in the control group. Twelve patients in the control group were subsequently treated with UK and six of them had complete drainage; the remaining six patients had complete drainage after video-assisted thoracoscopy. Our results suggest that UK is effective in the treatment of loculated pleural effusions through the lysis of pleural adhesions and not through the volume effect.
Adult↗
Microsatellite DNA instability and loss of heterozygosity in pulmonary sarcoidosis.
In the present study we investigated the incidence of microsatellite instability (MI) and loss of heterozygosity (LOH) in sarcoidosis, a multisystem disease of unknown origin. We examined sputum cytological specimens from 30 patients with sarcoidosis and 30 healthy, matched subjects, using 10 highly polymorphic microsatellite markers located at several chromosomal arms. The electrophoretic pattern of each specimen was compared with the corresponding pattern of peripheral blood and any difference in the mobility of the microsatellite alleles was interpreted as MI-positive. LOH was scored as decrease in intensity of one allele relative to the other as determined from comparison of sputum and normal (blood) DNA. We found that 14 (47%) sarcoidosis patients showed genetic alterations, either MI or LOH. Six (20%) patients exhibited MI and nine (30%) exhibited LOH in at least one microsatellite marker. One of the patients exhibited MI in two microsatellite markers and three (10%) showed LOH in more than one marker. One patient showed complete deletion of the chromosomal arm 17q11.2-q21. None of the healthy subjects exhibited any genetic alteration in the studied markers. No correlation was found between the genetic alterations detected and age, disease duration, blood gases, or spirometric parameters of the patients. Our findings suggest that MI is a detectable phenomenon in sarcoidosis and seems not to be related with the severity of the disease. The detection of LOH indicates the presence of putative tumor suppressor genes at loci examined, which may play an important role in the etiopathogenesis of sarcoidosis.
Adult↗
Front-line treatment of advanced non-small-cell lung cancer with docetaxel and gemcitabine: a multicenter phase II trial.
PURPOSE: To evaluate the tolerance and efficacy of the combination of docetaxel and gemcitabine in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Fifty-one chemotherapy-naive patients with NSCLC were treated with gemcitabine 900 mg/m2 intravenously on days 1 and 8 and docetaxel 100 mg/m2 intravenously on day 8 with granulocyte colony-stimulating factor (150 microg/m2, subcutaneously) support from day 9 to day 15. Treatment was repeated every 3 weeks. RESULTS: The patients' median age was 64 years. The World Health Organization performance status was 0 to 1 in 39 patients and 2 in 12 patients. Fifteen patients (29%) had stage IIIB disease, and 36 (71%) had stage IV; histology was mainly squamous cell carcinoma (59%). A partial response was achieved in 19 patients (37.5%; 95% confidence interval, 24% to 50%); stable disease and progressive disease were each observed in 16 patients (31.4%). The median duration of response and the time to tumor progression were 5 and 6 months, respectively. The median survival was 13 months, and the actuarial 1-year survival was 50.7%. Grade 4 anemia and thrombocytopenia were rare (2%). Four patients (8%) developed grade 3 or 4 neutropenia, and all were complicated with fever; there was no treatment-related death. Grade 3 or 4 diarrhea occurred in three patients (6%), grade 2 or 3 neurotoxicity in four patients (8%), grade 2 or 3 asthenia in 10 patients (20%), and grade 2 or 3 edema in 10 patients (20%). CONCLUSION: The combination of docetaxel/gemcitabine is well tolerated, can be used for outpatients, and is active for the treatment of advanced NSCLC. This treatment merits further comparison with other cisplatin- or carboplatin-based combinations.
Adult↗
Microsatellite DNA instability in COPD.
STUDY OBJECTIVES: Cigarette smoking is the prime cause of COPD; however, only a few smokers develop the disease. In a previous study, we demonstrated that microsatellite DNA instability (MSI) is a detectable phenomenon in sputum cells of COPD patients. Therefore, we hypothesize that this genetic alteration may indicate susceptibility to COPD. DESIGN: In order to investigate this hypothesis, we compared smokers who developed COPD with smokers who did not develop COPD (referred to as non-COPD smokers). SETTING: Seven highly polymorphic microsatellite markers were targeted on the DNA of sputum cells and of WBCs. PATIENTS AND PARTICIPANTS: We studied 60 non-COPD smokers and 59 severe COPD patients with a similar smoking history (mean +/- SD) of 48+/-25 and 54+/-33 pack-years, respectively (p = 0.77). Non-COPD smokers were tested once; COPD smokers were tested twice, with an interval of 24 months between tests. RESULTS: MSI was detected in 14 COPD patients (24%) but in none of the non-COPD smokers. In 10 COPD patients, MSI was exhibited by one microsatellite marker; in the remaining 4 COPD patients, MSI was exhibited by two different alleles. The most commonly affected marker was THRA1 on chromosome 17 (43%). No significant differences were found between MSI-positive and MSI-negative COPD patients for clinical or laboratory parameters, survival, and development of lung cancer. No change in the microsatellite alleles was found between the tests performed with a 24-month interval. CONCLUSIONS: This study demonstrated that MSI was found exclusively in the sputum cells of smokers with COPD. The results support the hypothesis that MSI could be part of the complex genetic basis of COPD, and it could be a marker of the genetic alteration caused by smoking that allows COPD to develop.
Case-Control Studies↗
Utility of fibrinolytic agents for draining intrapleural infections.
Multiple studies have shown that the intrapleural instillation of fibrinolytic agents provides an effective and safe mode of treatment for complicated parapneumonic effusions and empyemas that decrease the need for surgical interventions. Although most investigators use streptokinase and urokinase, the technique of instillation is not standardized. The usual dose of streptokinase is 250,000 IU, but doses range from 50,000 to 220,000 IU for urokinase. Reported success rates range from 38% to 100%, but outcomes depend on the stage of progression of the parapneumonic effusion when fibrinolytics are employed. Fibrinolytics are more effective in complicated parapneumonic effusions than in established empyemas. Although complications of fibrinolytic therapy rarely occur, they result most often from allergic reactions to streptokinase. Urokinase is safer but more expensive. More randomized, comparative, controlled studies are needed to further define the most effective mode of fibrinolytic therapy for subgroups of patients with pleural infection.
Drainage↗
Respiratory muscle function in endocrine diseases.
This review reports evidence showing that the function of the respiratory muscles (RMs) is affected in endocrinopathies and emphasizes that clinicians should look for RM weakness in hormone inbalances. Although there is a potential pathophysiological mechanism for affecting RM in diabetes insipidus, hypoparathyroidism, Cushing's disease, pheochromocytoma, adrenalin deficiency or androgen disorder, no study was found in the available literature. Therefore, investigations are urgently needed in these diseases. Controversial results have been reported in acromegaly, hypopituitarism, diabetes mellitus and steroid-induced (iatrogenic) RM myopathy. Obviously, these are areas for further research. Respiratory muscle dysfunction has been well documented in thyroid disease and there is general agreement that both hypo- and hyperthyroidism are associated with reversible respiratory muscle weakness.
Endocrine System Diseases↗
Fibrinolytics in the treatment of parapneumonic effusions.
Intrapleural instillation of fibrinolytic agents has been shown, in a number of studies, to be an effective and safe mode of treatment in complicated parapneumonic effusions and empyema, minimizing the need for surgical intervention. Streptokinase and urokinase are the fibrinolytics used, but the technique of instillation is not yet standardized. The usual dose of streptokinase is 250,000 IU, 100,000 IU for urokinase. Fibrinolytics are diluted in 30-100 mL normal saline and the success rate ranges 50-100%, depending on the stage of pleural effusion. Generally, fibrinolytics are more successful if used early in the process of pleural infection (in complicated parapneumonic effusions rather than in empyemas). Adverse reactions are rare, of the allergic type and more frequent for streptokinase. Urokinase is safer but more expensive.
Empyema, Pleural↗