Biljana Lazovic

United in Prevention–Electrocardiographic Screening for Chronic Obstructive Pulmonary Disease

CONFLICT OF INTEREST: NONE DECLARED Introduction P-wave abnormalities on the resting electrocardiogram have been associated with cardiovascular or pulmonary disease. So far, “Gothic” P wave and verticalization of the frontal plane axis is related to lung disease, particularly obstructive lung disease. Aim We tested if inverted P wave in AVl as a lone criteria of P wave axis >70° could be screening tool for emphysema. Material and method 1095 routine electrocardiograms (ECGs) were reviewed which yielded 478 (82,1%) ECGs with vertical P-axis in sinus rhythm. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history and pulmonary function tests. Conclusion Electrocardiogram is very effective screening tool not only in cardiovascular field but in chronic obstructive pulmonary disease. The verticality of the P axis is usually immediately apparent, making electrocardiogram rapid screening test for emphysema.

Hypersensitivity to Etoposide in case of metastatic gestational choriocarcinoma.

Etoposide is commonly used in the treatment of a variety of neoplasms. Hypersensitivity reactions to etoposide are infrequently reported and include hypotension, hypertension, flushing, diaphoresis, chest discomfort, dyspnea, bronchospasm and loss of consciousness. We report the case of a 39-year-old woman who experienced acute bronchospasm, tachycardia, hypoxia and hypotension. The symptoms resolved within an hour after administration of intravenous fluids, methylprednisolone, diphenhydramine and oxygen. Subsequently, the patient was given etoposide phosphate without incident.

Clinical outcome of a FIGO stage IV gestational choriocarcinoma

Choriocarcinoma is the most malignant tumor of gestational trophoblastic disease arising from any gestation. It has a tendency toward relapse as well as metastasis. Here, a case of relapsed high-risk choriocarcinoma (FIGO stage IV, WHO score 12) in a 37-year-old female presenting with vaginal bleedings is described. Relapse developed at the site of the surgical scar from hysterectomy that had been performed 2 years earlier. Although the patient was treated with aggressive chemotherapy, she was in a bad general condition and died from infection and liver insufficiency.

Could lung diffusion level for carbon monoxide be predicted in young elite athletes

Background: Lung diffusion capasity for carbon monoxide is determined with structural and functional characteristics of the lung performance. Elite athletes tend to have higher DLCO values. Aim: To evaluate the anthropometric and training factors influence on carbon monoxide lung diffusion capacity (DLCO) and on transfer coefficient (KCO) in elite athletes, by using the logistic regression model. Methods: From November 2012 to September 2015, 70 randomly selected male Caucasian elite athletes were analyzed. They came to be regularly screened for the respiratory diseases. DLCO and KCO were measured by the single breath method standardized technique; anthropometric values were measured as standing body height (cm) and body weight (kg). Results: The implemented logistic regression model has shown that only the combination of training frequency per week and the weekly amount of training expressed in hours had positive influence on DLCO. Predictors for KCO were not identified. This model was found to be excellent according to classification table, providing 80,0% of agreement for DLCO and 71,0% for KCO, at a cut off value of p=0.50. A set of goodness of fit tests was performed in order to further test the model, and all were nonsignificant, showing that it has correctly predicted the real data: Hosmer and Lemeshow test (p=0.866); Cox and Snell R2 (p=0.420) and Nagelkerke R2 (p=0.561). Conclusion: Training factors have shown to have positive influence on DLCO. Anthropometric features were not found to be significant predictors for DLCO. Further studies are encouraged.

Systemic Lupus Erythematosus Presenting as Acute Lupus Pneumonitis

Systemic lupus erythematosus (SLE) is an autoimmune chronic systemic disease involving skin, joints and/or internal organs, such as lungs, brain and heart. SLE affects predominantly women (female to male ratio 10:1).1 Pulmonary manifestations of SLE can include a wide spectrum of diseases. The most common is lupus pleuritis. Less common is parenchymal involvement, presenting either as acute lupus pneumonitis (ALP) or chronic interstitial lung disease. Possible pulmonary manifestations of SLE are pneumonia, pulmonary embolism, pneumothorax, acute reversible hypoxemia, shrinking lung syndrome and pulmonary haemorrhage.2 It is believed that pulmonary complications are the consequence of the immune complex mediated injury. A 66-year-old woman was presented to the Emergency Department, having severe breath shortness, high temperature and chest pain. She has been suffered from systemic lupus erythematosus for 20 years, and for the last six months was using 10 mg Prednisone and Methotrexate 5 mg once weekly. At the examination, she was found to have elevated body temperature 38.1 ◦C, tachycardia (120 beats/min) and elevated blood pressure (160/90 mm Hg). Her appearance was anorexic, diaphoretic, dyspnoeic, slightly disoriented. Her pupils were round equally with good light reaction, and her extraocular muscles were intact. She had neither neck adenopathy, nor jugular venous distention or meningismus. Precordial examination has shown no murmurs, rubs or gallops. Her breath sounds were decreased, with the right side percussion

History of sports medicine in east European countries

The purpose of this article is to provide a historical background of medicine, science and sports with the focus on the development of modern sports medicine in European countries, with an accent on Eastern European countries that have a long sports medicine tradition. The development of modern sports medicine began at the end of 19th and the beginning of 20th century, and it has been associated with social and cultural changes in the world of medicine, science and sports. Advanced medical knowledge, skills and practices, and the progress of scientific achievements enabled sports people to improve their performance level. Increased popularisation and commercialisation of sports have resulted from urbanization and city lifestyle, leading to the lack of physical activity and increased psychological pressure. In addition, the growing need and interest in sports and successes in professional sports have become a symbol of international recognition and

Extremely rare variant of the single coronary artery.

A 58-year-old male patient was admitted for coronary angiography two months after he suffered non-ST elevation myocardial infarction (NSTEMI) of the lateral wall. A coronary angiography (Fig. 1A) showed presence of a single coronary artery arising from the right sinus of Valsalva, comprising three clustered, separated coronary artery ostia (“triple-barrel”), and absence of significant stenosis. A 64-slice multidetector cardiac computer tomography confirmed this rare variant of the single coronary artery (Fig. 1B–C), as well as the benign anterior course of aberrant LAD to the pulmonary artery (Fig. 1D). Echocardiography demonstrated absence of other cardiac abnormalities. The patient was discharged with optimal medical therapy. Figure 1 Single coronary artery arising from the right sinus of Valsalva, demonstrated by coronary angiography (A) and confirmed by multidetector cardiac computer tomography (B). “Tripple-barrel” pattern of ostium of the single coronary artery ... Single coronary artery (SCA) is a very rare congenital coronary artery anomaly with the estimated incidence of 0.02% in adult patients, usually associated with other cardiac anomalies such as Fallot tetralogy, transposition of great arteries, persistent truncus arteriosus and pulmonary atresia [1]. The current classification system of SCA was proposed by Lipton et al. [2] and the variant of SCA found in our patient is the rarest. Isolated single coronary artery is usually asymptomatic and the prevailing opinion is that it is not prone to the development of atherosclerosis [3]. Possible myocardial ischemia and sudden cardiac death are thought to be associated with interarterial course of aberrant LAD between aorta and the pulmonary artery with subsequent compression [4]. In our patient, isolated SCA was associated with anterior course of LAD and absence of significant atherosclerotic plaques, although the patient had previously suffered NSTEMI.

Rapidly vanishing lung pseudotumor in a patient with acute bilateral bronchopneumonia

INTRODUCTION Rapidly vanishing lung pseudotumor (phantom tumor) refers to the transient well-demarcated accumulation of pleural fluid in the interlobar pulmonary fissures. Most frequently their appearance is associated with congestive heart failure, but also other disorders like hypoalbuminemia, renal insufficiency or pleuritis. Its rapid disappearance in response to the treatment of the underlying disorder is a classical feature of this clinical entity. CASE REPORT A 47-year-old woman, chronic smoker with symptoms of shortness of breath, orthopnea, chills, cough, weakness and the temperature of 39.2 degrees C was admitted to our hospital. A posteroanterior chest X-ray revealed cardiomegaly with the cardiothoracic ratio of > 0.5, blunting of both costophrenic angles and an adjacent 6 x 5 cm well-defined, rounded opacity in the right interlobar fissure. Transthoracic 2-dimensional echocardiography demonstrated left ventricular hyperthrophy with a systolic ejection fraction of 25% and moderate mitral regurgitation. The patients symptoms resolved rapidly after diuresis, and repeated chest X-ray four days later showed that the right lung opacity and pleural effusions had vanished. CONCLUSION The presented case underlines the importance of the possibility of vanishing lung tumor in patients with left ventricular failure and a sharp oval lung mass on the chest X-ray. This is the way to avoid incorrect interpretation of this finding causing additional, unnecessary, costly or invasive imaging, interventions and drugs.