D. Patakas

Allergenic pollen records (15 years) and sensitization in patients with respiratory allergy in Thessaloniki, Greece

Background:  Very limited allergenic pollen records exist in Greece so far; moreover, there is a lack of investigation on patient sensitization. The above data are necessary for respiratory allergy diagnosis and treatment worldwide.

Buspirone Effect on Breathlessness and Exercise Performance in Patients with Chronic Obstructive Pulmonary Disease

Buspirone is an anxiolytic agent that appears to have no sedative effects. The aim of this study was to assess the effects of buspirone on breathlessness and exercise tolerance in patients with chronic airway obstruction. Sixteen patients, age 56.9 +/- 17.0; forced expiratory volume in 1 s (FEV1) 1.15 +/- 0.42 l; FEV1/forced vital capacity (FVC) 50.7 +/- 15.0%; PaCO2 42.2 +/- 5.5 mm Hg; and PaO2 57.6 +/- 10 mm Hg, underwent a 6-min walking test, an incremental cycle ergometer test, an incremental treadmill walking test with self-assessment of dyspnea on Borgs scale during exercise and an assessment of respiratory drive (P 0.1), timing [inspiration time (TI)/total breathing time (Ttot)], PaO2, PaCO2, FVC, FEV1, following oral administration for 14 days of placebo or buspirone (20 mg daily) in a double-blind, cross-over randomized way. We also used the symptom check list-90-R for the assessment of subjective complaints and symptomatic behavior. A significant improvement in anxiety, depression and obsessive symptoms and complaints was noted after buspirone treatment. The P 0.1, TI/Ttot, arterial blood gases and respiratory mechanics did not change after drug treatment. There was an improvement in exercise tolerance and in the sensation of dyspnea during the buspirone period. Thus, as given in this study, oral buspirone has therapeutic potential in the treatment of dyspnea in patients with chronic lung disease.

Serum Total Antioxidant Status in Severe Exacerbation of Asthma: Correlation with the Severity of the Disease

Oxidative processes, mediated by oxygen free radicals are recognized to contribute significantly to the inflammatory pathology of bronchial asthma. An imbalance between oxidants and antioxidants has also been proposed in this disease. This study examines the serum total antioxidant status (TAS) in asthmatic patients with severe exacerbation of their disease and the probable correlation with clinical or laboratory findings. The TAS was measured in 20 patients (10 men and 10 women, with a mean age of 41.95 ± 20.75 years), using a colorimetric method. On the days of admission and discharge, the forced expiratory volume in 1 sec (FEV1), the partial arterial oxygen pressure (PaO2), and severity criteria were recorded and correlated with TAS at the same time. The TAS was also measured in 10 healthy subjects (8 men and 2 women, mean age of 39 ± 9 years). A statistically significant decrease of TAS was observed on admission day compared to that on discharge day (0.98 ± 0.08 vs. 1.12 ± 0.17 mmol/L, p < 0.001, respectively, paired t‐test) suggesting the presence of oxidative stress during an asthma attack. The TAS on admission was also statistically significantly decreased compared to that of normal subjects (0.98 ± 0.08 vs. 1.19 ± 0.09 mmo/L, p < 0.001, respectively, paired t‐test). A statistically significant correlation was observed between FEV1change and TAS change, from admission to discharge day (r = 0.58, p = 0.007, Pearson correlation). Finally, a statistically significant correlation was found between FEV1change and TAS on discharge day (r = 0.65, p = 0.002). Decreased TAS was found during an asthma attack, probably as a consequence of increased oxidative stress. The TAS change was correlated with severity criteria, such as FEV1. Therefore, it seems that measurement of TAS could be a simple and useful tool in the evaluation of an asthma attack. The supplementary administration of antioxidants in future needs further clarification.

Visceral leishmaniasis infection in a patient with rheumatoid arthritis treated with etanercept

Visceral leishmaniasis (VL) is a severe disease that can develop in immunocompromised patients. Antitumor necrosis factor-α (TNF-α) treatment of rheumatoid arthritis can result in clinical benefits, but with an increased risk of opportunistic infections. Leishmania infection in patients treated with TNF-α antagonists is extremely rare; for this reason, we report a patient with VL after etanercept treatment who had an unfavorable outcome.

A Phase II study of docetaxel and carboplatin in the treatment of non-small cell lung cancer.

We investigated the efficacy of docetaxel (D) in combination with carboplatin (C) in the treatment of non-small cell lung cancer (NSCLC) patients. Since 1996, 123 with inoperable NSCLC were enrolled in the study; 120 (108 males, 12 females; mean age 58.0+/-8.3 years) were evaluated. Of those, 46 patients had squamous carcinoma, 44 adenocarcinoma, 11 large cell carcinoma and 19 undifferentiated tumours. Eligibility criteria included, documented inoperable NSCLC, WHO performance status (PS) 0-1, age up to 70 years, and normal renal and hepatic function. A total of 622 cycles of chemotherapy (CHT) (median 7 (95% CI 6.2-7.47), courses per patient) were administered. Each cycle consisted of 100 mg/m(2) of docetaxel in a 2-h infusion with C at a dose of area under the curve (AUC) of 6 on day 1. This regimen was repeated every 28 days up to eight cycles. Of the patients, five (4%) achieved complete response, 49 (40%) partial response, 47 (39%) had stable disease and 19 (15%) had progressive disease. The median survival was 12 months for all patients, 12 for the four patients with stage IIb disease, 18 for the patients with stage IIIa disease, 20 for the 29 patients with stage IIIb disease, and 11 for the 65 stage IV patients. The median time to progression was 8 months (90 patients). Toxicity was, grade 3/4 neutropenia, 18 patients (15%); grade 3/4 anaemia, 6 patients (5%); and tolerable peripheral neuropathy, 16 patients (13.3%). Responders received radiotherapy (total dose, 50 Gy in 4 weeks) between the 6th and 8th cycle. Among responders with initial stage IIIb disease, 7 (5%) underwent surgical resection. Patients with early progression of the disease received the same dose of radiotherapy between 2nd and 3rd cycle. The study is ongoing, and six patients (5%) are still alive (after 3 years). Preliminary results indicate that the D/C combination is very active in the treatment of NSCLC with tolerable toxicity. It appears that this drug combination is also good as neoadjuvant therapy in inoperable NSCLC patients.

Mortality from Occupational Exposure to Relatively Pure Chrysotile: A 39-Year Study

Background: Asbestos exposure is related to serious adverse health effects. However, there is disagreement about the relationship between chrysotile exposure and mesothelioma or lung cancer. Objectives: Our aim was to investigate the mortality rate among workers exposed to relatively pure chrysotile in an asbestos cement factory. Patients and Methods: In an asbestos cement plant opened in 1968, we prospectively studied all 317 workers. A quantity of 2,000 tons of chrysotile, with minimal amphibole contamination, was used annually until 1 January 2005. Asbestos fiber concentration was measured regularly. Date and cause of death were recorded among active and retired workers. Results: Asbestos fiber concentration was always below permissible levels. Fifty-two workers died during the study. The cause was cancer in 28 subjects; lung cancer was diagnosed in 16 of them. No case of mesothelioma was reported. Death was attributed to cardiovascular diseases in 23 subjects and to liver cirrhosis in 1. Overall mortality rate was significantly lower than that of the Greek general population, standardized mortality ratio (SMR) was 0.71 (95% CI 0.53–0.93). Mortality due to cancer was increased (SMR 1.15, 95% CI 0.77–1.67), mainly due to lung cancer mortality (SMR 1.71, 95% CI 0.98–2.78), but not significantly. Conclusions: Occupational exposure to relatively pure chrysotile within permissible levels was not associated with a significant increase in lung cancer or with mesothelioma. Decreased overall mortality of workers indicates a healthy worker effect, which – together with the relatively small cohort size – could have prevented small risks to be detected.

Hering-Breuer Reflex in Normal Adults and in Patients with Chronic Obstructive Pulmonary Disease and Interstitial Fibrosis

Background: It has been suggested that the Hering-Breuer reflex (HBR) is unimportant in adults during normal tidal breathing and that it is elicited only if tidal volume is increased above a certain critical threshold. Objective: The aim of this study was (1) to study the occurrence of the HBR in adults with normal pulmonary function and (2) to examine if changes in lung mechanics have any effect on the HBR. Methods: We examined 11 adults with normal pulmonary function, 8 patients with chronic destructive pulmonary disease (COPD) and 3 with interstitial fibrosis (IF). All subjects were lightly sedated with fentanyl, intubated and ventilated with a Servo-900 ventilator. Inspiratory and expiratory flow (and after integration, volume) and mouth pressure were recorded from the endotracheal tube with a pneumotachograph and a pressure transducer. Pressure support ventilation was applied in all patients and functional residual capacity (FRC) was measured with the N2 washout method. Mean (Temean) and maximal expiratory time (Temax) were determined for each individual for 20 breaths. Following several breaths to establish a stable baseline the airway was occluded at end inspiration by a shutter. A positive HBR was interpreted as longer Teocc than Temax (Teocc/Temax, %). Occlusion was maintained until negative airway pressure occurred and the occlusion time (Teocc) was measured. We attempted occlusions after the addition of 5 cm H2O positive end-expiratory pressure (PEEP) and subsequently with 10, 15 and 20 cm H2O PEEP. Teocc was measured of progressively larger lung volumes. To examine the HBR sensitivity in the three groups, we plotted the lung volumes of occlusion against the corresponding Teocc/Temax. Results: The ratio Teocc/Temax increased from 167.5 ± 82.5 at normal FRC to 474 ± 200.2 s (PEEP20). On the contrary, in patients with COPD, Teocc/Temax increased from 125.2 ± 34 to 193.7 ± 74.2 (p < 0.05). Conclusions: The HBR was positive in all subjects. COPD patients were found to be less sensitive to volume changes when compared with normal controls and with IF patients.

Airway Function in Stage I and Stage II Pulmonary Sarcoidosis

Airway function was studied in 39 patients with stage I sarcoidosis and in 20 patients with stage II sarcoidosis. All of our patients were nonsmokers. Characteristic functional changes of restrictive lung disease was observed in 4 patients with stage II sarcoidosis. Specific airway conductance and % FEV1 were abnormal in 3 patients with stage II sarcoidosis. Abnormal small airway function was demonstrated in several patients with stage I and stage II sarcoidosis, always by multiple tests. Frequency dependence of dynamic compliance was demonstrated in 40% of stage I and 50% of stage II sarcoidosis. Maximal flow (Vmax50, Vmax25) was decreased respectively in 36 and 30% of patients of stage I sarcoidosis and in 56 and 62% of patients with stage II sarcoidosis. The ratio of closing volume to vital capacity was increased above corrected predictions in 30% of stage I and 44% of stage II sarcoidosis. delta Vmax25 decreased and Visov/VC (%) increased in more than 50% of patients. Upstream airway resistance was abnormally increased in 50% of patients with stage I and in 73% with stage II sarcoidosis. These results suggest that small airway dysfunction is common in early sarcoidosis without restrictive defect.

Efficacy and safety of erythromycin as sclerosing agent in patients with recurrent malignant pleural effusion.

Objectives:The aim of pleurodesis in malignant pleural effusions is to prevent reaccumulation of the fluid, symptoms, and avoid the need for repeated hospitalization for thoracentesis. The purpose of this study was to evaluate the efficacy and safety of erythromycin as a pleural sclerosing agent. Methods:Over a 2-year period, 34 patients with a symptomatic, recurrent, malignant pleural effusion who referred for chest tube drainage and pleurodesis were included. They had not received prior intrapleural therapy and had predicted survival of at least 1 month. All underwent pleural drainage and chemical pleurodesis with erythromycin. Complications and response to pleurodesis, according to clinical and radiographic criteria after 90 days, were recorded. Results:The overall response was 88.2%. Complete response (no reaccumulation of pleural fluid after 90 days) was observed in 27 patients (79.4%). Partial response (reaccumulation of fluid but without symptoms, not requiring drainage) was observed in 3 (8.8%). No response (symptomatic reaccumulation of fluid that required drainage) was observed in 4 (11.8%). All patients experienced pleurodynia that was treated with administration of paracetamol and/or dextropropoxyphene. Sinus tachycardia and concurrent mild systemic hypertension were observed 2 and 4 hours after pleurodesis. Both of them were attributed to pleurodynia as there was remission with analgesics. Conclusions:This study suggests that erythromycin is effective and safe as a sclerosing agent for pleurodesis in patients with recurrent malignant pleural effusions.

15-Year aeroallergen records. Their usefulness in Athens Olympics, 2004

Introduction: About 5–25% of 16 000 athletes involved in preparation for the Athens 2004 Olympics may encounter respiratory allergy (asthma and rhinoconjunctivitis) triggered by exposure to aeroallergens (pollen and fungi spores).