Igor Barišić

A rare case of pulmonary tuberculosis with simultaneous pulmonary and skin sarcoidosis: a case report

BackgroundTuberculosis and sarcoidosis are chronic diseases that rarely occur concomitantly. Sarcoidosis is a multisystem granulomatous disorder characterized pathologically by the presence of non-caseating granulomas in involved tissues. Tuberculosis is infectious disease caused by Mycobacterium tuberculosis characterized by granulomas with caseous necrosis.Case presentationWe present a case of 43-year-old female refugee from Kosovo with microbiological confirmation of pulmonary tuberculosis and pulmonary and skin sarcoidosis at the same time. Three weeks after corticosteroid therapy for pulmonary sarcoidosis was introduced, positive finding of mycobacterium culture of bronchial aspirate was observed. Based on these results, corticosteroid therapy was excluded and antituberculous therapy was introduced for six months. In the meantime, new nodes on face and nose appeared and skin sarcoidosis was diagnosed. The patient was given corticosteroids and colchicine according to the skin and pulmonary sarcoidosis therapy recommendation.ConclusionThe authors of this study suggest that in cases when there is a dilemma in diagnosis between tuberculosis and sarcoidosis we should advance with corticosteroid therapy until we have microbiological confirmation of mycobacterium culture. This case is remarkable because this is a third described case of sarcoidosis and tuberculosis together (the first reported in Asia, the second in South Africa), and to authors knowledge, this is a first case report in Europe.

Interobserver Variations in Diagnosing Asbestosis According to the ILO Classification

Interobserver Variations in Diagnosing Asbestosis According to the ILO Classification Inhalation of asbestos fibres leads to asbestosis of the pleura and the lung, with possible progression to lung cancer and malignant pleural or peritoneal mesothelioma. Asbestosis remains difficult to diagnose, especially in its early stages. The most important role in its diagnosis is that of chest radiographs. The aim of this cross-sectional study was to address interobserver variations in interpreting chest radiographs in asbestos workers, which remain to be an issue, despite improvements in the International Labour Office (ILO) classification system. In our ten-year study, we investigated 318 workers occupationally exposed to asbestos, and in 210 workers with diagnosed asbestos-related changes we compared interpretations of chest radiographs according to ILO by two independent radiologists. The apparent degree of interobserver variation in classifying lung fibrosis was 26.66% for the diameter of changes and 42.2% for the profusion of the changes. In cases with diffuse pleural thickening, the interobserver variation using ILO procedures was 34.93%. This investigation raises the issue of standardisation and objectivity of interpretation of asbestosis according to the ILO classification system. This study has revealed a significant disagreement in the estimated degree of pleural and parenchymal asbestos pulmonary disease. This is why we believe high-resolution computed tomography (HRCT) should also be used as a part of international classification. Interopservacijske razlike u dijagnosticiranju azbestoze prema klasifikaciji ILO

Unusual "traction" exostosis of the femoral diaphysis with sciatic nerve compression.

The osteochondromas are the most common benign bone tumors, causing 10% to 15% of all bone tumors. Because of the low incidence of significant clinical symptoms, they often remain undiagnosed. The osteochondromas are not real neoplasms. They are developmental lesions which are usually called osteocartilaginous exostoses. The cause of their development is an aberrance of the small piece of epiphyseal growth plate cartilage with the herniation through the periosteum which surrounds the growth plate. Subperiosteal bone excrescences are composed of cortical and medullary bone and are covered with hyaline cartilage. The osteochondromas usually do not expand after the end of growth. They can be solitary or multiple. The multiple exostoses are known as the autosomal dominant hereditary skeleton diseases which are caused by EXT gene mutation which results with the abnormal chondrocyte proliferation and maturation, causing the abnormal bone growth. The solitary (isolated) exostoses grow sporadically or secondary to trauma. Sometimes osteochondromas may cause the irritation of the surrounding tissue. Complications can be cosmetic and bone deformations, neurovascular compressions, fractures, and cartilage tissue malignant sarcomatosis transformation. The osteochondromas are usually located on the metaphysis but are very rare on the diaphysis of the bones. The most usual locations of osteochondromas are the long bones of the lower limbs (50%), especially femur (30%), including the distal end of the femur and proximal part of the tibia. A “traction” exostosis is an osteochondroma variant. The mechanism of injury is presumably related to acute or chronic damage to the ligamentous and tendinous attachments. Osteochondroma treatment is individualized. The resection of the exostosis base or its ablation is indicated in patients with severe symptoms. It is important to perform the resection of the covered perichondrium to prevent the recurrence.

Dynamics of the Lung Function in Asbestos Pleural Disease

Dynamics of the Lung Function in Asbestos Pleural Disease As a rule, asbestosis is a disease of workers who are occupationally exposed to inhalation of asbestos dust, leaving permanent alterations on the lung parenchyma or pleura. In our ten-year study, we investigated 318 workers with pleural asbestosis from whom we took medical history which included occupational exposure to asbestos, radiological examinations and lung function, which is mandatory for the diagnosis and the follow up of the disease. We analysed functional parameters such as forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) and intermediate forced expiratory flow at 25% to 75% (FEF25%-75%). In addition, we investigated the predicted values of functional parameters according to smoking and non-smoking habits. We found a significant reduction in vital capacity, particularly in smokers after 25 years of exposure to asbestos. During the first 15 years, values of vital capacity on the group basis remained inside the 80% of the normal values and were not significant for assessing the dynamics of the lung function. To better assess the effects of occupational asbestos exposure, it is necessary to interpret lung function data not only on the group basis, but also for each subject individually. Dinamika Funkcije Pluća Kod Azbestne Bolesti Azbestoza je bolest izazvana udisanjem azbestnih čestica koje ostavljaju trajne promjene na parenhimu pluća i/ili pleuri. Dijagnoza se postavlja na osnovi anamnestičkih podataka, uvidom u profesionalnu izloženost azbestu i radiološkom obradom te patohistološkom potvrdom promjena na plućima i/ili pleuri. Funkcionalna obrada pluća obavezna je u postavljanju dijagnoze i praćenju bolesti. Tijekom desetogodišnjeg istraživanja funkcionalno smo obradili 318 osoba profesionalno izloženih azbestu s dokazanom azbestozom pleure. Analizirane su vrijednosti funkcionalnih parametara, i to forsiranoga vitalnog kapaciteta (FVC), forsiranoga ekspiracijskog volumena u prvoj sekundi (FEV1) i srednjega ekspiracijskog protoka (FEF25%--75%)). Dokazan je statistički signifikantan pad vrijednosti FVC i FEV1. Dodatno smo istražili vrijednosti funkcionalnih parametara kod naših ispitanika s navikom pušenja i nepušača. U obje skupine prisutno je značajno sniženje vrijednosti vitalnog kapaciteta tijekom istraživanja, s tim da nakon 25 godina izloženosti azbestu kod pušača dolazi do naglog pada vrijednosti vitalnog kapaciteta u odnosu na nepušače. Bitno je uočiti da tijekom prvih 15 godina vrijednosti vitalnog kapaciteta ostaju unutar 80% normalnih vrijednosti te nemaju značenja za praćenje dinamike funkcije pluća kod azbestne bolesti. Individualnim praćenjem profesionalno izloženih radnika ostvaruje se bolji uvid u dinamiku funkcije pluća kod azbestne bolesti.

Mycobacterium shimoidei—cavitary pulmonary disease with favorable outcome

We report a case of cavitary pulmonary disease caused by Mycobacterium shimoidei in 67-year-old female with history of asthma. Even though susceptibility testing was not available, choice of treatment regimen (streptomycin, rifampicin, ethambutol, and clarithromycin), based on a few cases with favorable outcome reported in the literature, resulted with an excellent clinical, microbiological, and radiological response. This is the first report of pulmonary disease caused by M. shimoidei, but also the first ever isolation of M. shimoidei in Croatia.