Gamal Agmy

Bronchial and Nonbronchial Systemic Artery Embolization in Management of Hemoptysis: Experience with 348 Patients

Background. We aimed to report our experience with bronchial artery embolization (BAE) in the management of moderate recurrent and/or life-threatening hemoptysis. Methods. We evaluated the demographics, clinical presentation, radiographic studies, short- and long-term efficacy, and complications in patients Who underwent BAE, at a tertiary university hospital, from 2003 to 2012. Results. Three hundred forty-one patients underwent BAE for the management of moderate recurrent or life-threatening hemoptysis. Pulmonary TB and bronchiectasis were the most common etiologies for hemoptysis in our locality. The most common angiographic signs for hemoptysis were hypervascularity and systemic-pulmonary artery shunt. BAE was successful in controlling hemoptysis immediately in 95% of patients and at 1 month in 90% of patients. Recurrence of hemoptysis was observed in 9.6% of patients, and reembolization was indicated in 85% of those cases. Complications of BAE were self-limited acute and subacute complications, while chronic complications were not recorded during this study. Conclusions. TB and bronchiectasis are the commonest etiologies for moderate recurrent or life-threatening hemoptysis in our locality. Hypervascular lesions from the bronchial arteries and nonbronchial systemic arteries represented the major vascular abnormalities. Bronchial and nonbronchial systemic artery embolizations were effective to control both acute and chronic hemoptyses, with no serious complications.

Assessment of transthoracic sonography in patients with interstitial lung diseases

Aim: This study was designed to recognize the sonographic features of interstitial lung diseases (ILD). Furthermore, the possible correlations of these features with the functional and radiological parameters of the disease were assessed. Patients and methods: Forty-two patients with ILD were included; each patient underwent spirometry, Multi Detector CT chest (MDCT) and transthoracic sonography (TS). Fifteen healthy volunteers were also studied as controls. Results: The sonographic features among ILD patients were B lines in 73.8% , abolished lung sliding in 23.8%, irregular and thickened pleura in 47.6%and 35.7% respectively and subpleural lesions in 38.1%.Increasing distance between the B lines was negatively correlated with both of Forced Vital Capacity % predicted , ground glass opacities and positively correlated with reticular opacities patterns on MDCT chest. Conclusion: TS can be used as an additional imaging method for assessment of ILD and as a marker to estimate the severity of disease.

Cancer-related medical emergencies

Tumor cells trapped within pulmonary capillaries may trigger the coagulation cascade and obstruct the pulmonary vessels. The obstruction is primarily due to both the tumor cells and the associated clot, but reactive concentric medial hypertrophy and intimal fibrosis of the pulmonary vessels may also contribute. Such secondary changes may progress to complete and irreversible obstruction of pulmonary vessels, whereas occlusion by pure thrombi or thromboemboli is generally followed by recanalization. When the pulmonary vasculature becomes obstructed, ventilation–perfusion matching becomes impaired and pulmonary vascular resistance increases, which may impair gas exchange and cause Cor pulmonale.

Behηet's disease: case reports

Behcet diseases is not only orogenital ulcerations but also it can have many systemic manifestations.In this article we presented 3 cases of Behcet disease associated with pulmonary artery aneurysms affecting the large branches. Pulmonary artery aneurysms are common and serious vascular complication of Behcet disease.These are usully large and accompanied with intramural thrombi and multiple pulmonary infarctions with a common presentation of haemoptysis. A detailed discussion of pulmonary manifesttions of Behcet disease was demonstrated.

Updates in acute respiratory distress syndrome

(1) ‘Acute lung injury’ no longer exists. Under the Berlin defi nition, patients with PaO2/FiO2, 200–300 would now have ‘mild ARDS.’ (2) Th e onset of ARDS (diagnosis) must be acute, defi ned as within 7 days of some defi ned event, which may be sepsis, pneumonia, or simply a patient’s recognition of worsening respiratory symptoms (Most cases of ARDS occur within 72 h of recognition of the presumed trigger.) (3) Bilateral opacities consistent with pulmonary edema must be present but may be detected on computed tomography or chest radiography. (4) Th ere is no need to exclude heart failure in the new ARDS defi nition; patients with high pulmonary capillary wedge pressures or known congestive heart failure with left atrial hypertension can still have ARDS. Th e new criterion is that respiratory failure is simply ‘not fully explained by cardiac failure or fl uid overload,’ in the physician’s best estimation using the available information. An ‘objective assessment’– meaning an echocardiogram in most cases – should be performed if there is no clear risk factor present such as trauma or sepsis.

Cyclosporine as a treatment in acutely exacerbated interstitial pneumonia: does it add value?

Objective The aim of this study was to evaluate the efficacy of combined therapy of cyclosporine A (CsA) with prednisolone for acutely exacerbated interstitial pneumonia. Patients and method Forty-eight patients who were diagnosed as having interstitial pneumonia were recruited in the study. These patients experienced clinical worsening as demonstrated by any one of the following within the past year: greater than 10% decrease in the percent predicted forced vital capacity, worsening high-resolution CT scan or clinical worsening of dyspnea at rest or on exertion. CsA was given at a dose range of 2 mg/kg/day in addition to corticosteroids. Patients were assessed at baseline and then at 1, 3, 6, and 9 months for response to therapy and for any adverse effect of the treatment. Results Patients were divided according to the underlying systemic disease into either patients with idiopathic pulmonary fibrosis (25 patients) or those with underlying collagen vascular diseases (CVDs; 23 patients). Those with underlying CVDs were divided into either UIP/CVDs (five patients) or nonspecific interstitial pneumonia (NSIP/CVDs) (18 patients). Our results showed an overall better response in the NSIP/CVD group of patients. Follow-up parameters in 14 patients with an improved response showed an improved grade of dyspnea, improved partial pressure of oxygen (PaO 2 ), %forced vital capacity, and diffusing capacity of carbon monoxide (%DL CO ); Krebs von den Lungen 6 (KL6) showed a significant decrease after initiation of CsA treatment when compared with baseline. Furthermore, a benefit of adding CsA to the treatment was the ability to reduce the dose of steroids during the course of treatment.