Stamatis Katsenos

Recurrent respiratory papillomatosis: a rare chronic disease, difficult to treat, with potential to lung cancer transformation: apropos of two cases and a brief literature review.

Recurrent respiratory papillomatosis (RRP), which is caused exclusively by human papilloma virus (HPV), is a rare condition characterized by recurrent growth of benign papillomata in the respiratory tract. The papillomata can occur anywhere in the aerodigestive tract but most frequently in the larynx, affecting both children and adults. The management of this entity remains still challenging since no specific definitive treatment exists. Nevertheless, novel surgical interventions as well as several adjuvant therapies have shown promising results in the long-term palliative management of this debilitating disease. Despite its mostly benign nature, RRP may cause significant morbidity and mortality because of its unpredictable clinical course and especially its tendency, albeit infrequent, for malignant transformation. In this article, we present two patients with RRP; one underwent bronchoscopic laser ablation in combination with inhaled interferon-alpha administration that led to a long-term regression of the disease while the other patient was diagnosed with transformation to squamous cell lung carcinoma with fatal outcome. We include a review of the current literature with special emphasis on RRP management and the potential role of HPV in the development of lung cancer.

Long-term oxygen therapy in chronic obstructive pulmonary disease: the use of concentrators and liquid oxygen systems in north-western Greece.

Background: Long-term oxygen therapy (LTOT) is the cornerstone mode of treatment in patients with chronic obstructive pulmonary disease (COPD). Objectives: The present study aims to investigate the effect of two oxygen sources (concentrator and liquid oxygen) on quality of life, exercise tolerance and compliance to LTOT in patients with COPD. Methods: The survey included 104 patients with COPD (31 on concentrator treatment and 73 on liquid oxygen). Patients were subjected to pulse oximetry, basic spirometry, measurement of health-related quality of life by the St. George’s Hospital respiratory questionnaire instrument and assessment of dyspnoea severity by the modified Borg category scale. Exercise tolerance was evaluated by the SaO2 value after 3 min of walking. SaO2 was measured before and after treatment with each device. Compliance with therapy was defined by the daily duration of oxygen use. Results: The two LTOT groups did not differ significantly concerning pulmonary function tests (p = 0.49 for FEV1, 0.98 for FVC, 0.15 for FEV1/FVC% and 0.38 for FEF50%), SaO2 before (p = 0.28) and after (p = 0.80) O2 treatment and after the 3-min walking trial (p = 0.47), and St. George’s Hospital respiratory questionnaire score (p = 0.45). The liquid oxygen group was less dyspnoeic before treatment (p = 0.02), but this difference disappeared after treatment (p = 0.95). A highly significant difference (p < 0.001) was noted concerning the daily oxygen use. Complete compliance to LTOT (≧15 h/day) was observed in 12.9 and 42.5%, respectively (p < 0.005). Noise disturbance was noted only in the concentrator group (80%). Conclusions: We conclude that stationary liquid oxygen seems to be a satisfactory alternative mode for LTOT treatment in COPD patients, with higher patient compliance to therapy in comparison with concentrators.

Unilateral Lymphocytic Pleuritis as a Manifestation of Familial Mediterranean Fever

Familial Mediterranean fever (FMF) is an autosomal recessive disease affecting predominantly populations surrounding the Mediterranean basin. It is the most prevalent hereditary periodic fever syndrome characterized mainly by recurrent and short attacks of fever and serositis (pleuritis, arthritis, peritonitis). Unilateral polymorphonuclear exudative pleuritis associated with fever has been reported as the solitary manifestation of the first FMF attack, in < 10% of patients. This case study describes a 30-year-old Greek man with recurrent episodes of lymphocytic exudative pleuritis associated with fever. After a thorough workup (clinical criteria and molecular genetic testing identifying homozygosity polymorphisms of the FMF gene), the diagnosis of FMF was established. Treatment with colchicine, 2 mg/d, eliminated FMF attacks. To our knowledge, this is the first well-documented case report of a patient with FMF presenting with a lymphocytic exudative pleural effusion.

Long-term oxygen therapy in Ioannina.

Background: Long-term oxygen treatment (LTOT) is very important, especially in patients with severe chronic obstructive pulmonary disease (COPD), but its efficacy is closely related to patient compliance. Objectives: The aim of the present study was to investigate the compliance of patients under LTOT in the Prefecture of Ioannina (north-western Greece) and to identify factors that might be involved. Methods: The study included 249 patients treated with LTOT during a 1-year period. They were visited at home by the investigating staff (a chest specialist and a primary care nurse). Compliance to therapy was defined by the daily use of the O2 concentrator (in hours). Patients underwent pulse oximetry, basic spirometry, and trial inhalation of bronchodilators. Results: Only 67 patients (26.9%) complied with therapy, while the daily concentrator use lasted 9.7 ± 6.09 h. SaO2, FEV1 and FVC were negatively correlated to patient compliance. No significant differences concerning LTOT compliance were noted between men and women, urban and rural population, and between smokers, ex-smokers and non-smokers. A chest physician recommended LTOT for the majority of patients (86.3%), while COPD was the main reason for LTOT prescription (74.7%). Nevertheless, compliance to LTOT was not significantly higher when prescribed by a respiratory physician. No specific medical instructions and information was recorded for the majority of the study patients treated with LTOT. Conclusions: Our results suggest that an organized home care program establishing the relative guidelines is necessary for substantial improvement in patient compliance to LTOT in Greece.

Use of Interferon-Gamma Release Assay for Latent Tuberculosis Infection Screening in Older Adults Exposed to Tuberculosis in a Nursing Home

OBJECTIVES: To assess the additive value of a newly marketed interferon‐gamma release assay, QuantiFERON‐TB Gold In‐Tube (QFT‐GIT), to a single tuberculin skin test (TST) for the detection of latent tuberculosis infection (LTBI) in older adults who have been exposed to TB in a nursing home.

Endobronchial Ultrasound: A Useful Tool in the Diagnosis of Bronchogenic Cyst

Diagnosis of bronchogenic cysts is possible with computed tomography, where the cysts are seen usually as well-circumscribed lesions of water density. However, many of the cysts have a soft-tissue density thus rendering them indistinguishable from neoplasms. In this article, we describe a case of bronchogenic cyst presenting as soft-tissue mass that was evaluated and diagnosed by endobronchial ultrasound (EBUS). We discuss the ultrasound image characteristics of the cyst and its histopathology findings. EBUS seems to be a valuable tool in the diagnosis of bronchogenic cysts and also enables their complete aspiration.

Bronchoscopic Long-Term Palliation of a Recurrent Atypical Carcinoid Tumor

Bronchial carcinoid tumors account for 1–2% of all primary lung tumors and are separated into 2 subgroups: typical and atypical carcinoids. Atypical carcinoids as intermediate-grade malignancies can metastasize more frequently, thus exhibiting poorer prognosis than the low-grade typical carcinoid tumors. Surgical resection remains the mainstay of treatment for pulmonary carcinoids. Bronchoscopic treatment using ablation techniques is an effective alternative to surgery in selected patients with typical carcinoid tumors. However, evidence is lacking regarding the effect of bronchoscopic resection of atypical carcinoid tumor and its recurrences. We report the case of a 73-year-old male with frequent endobronchial recurrences of a previously surgically resected atypical carcinoid tumor successfully treated using Nd:YAG laser photoresection. Furthermore, the therapeutic and local staging aspects of the disease are discussed emphasizing the efficacy of bronchoscopic resection strategies and the value of novel bronchoscopic imaging techniques in detailed inspection of the structures of the bronchial wall.

The Challenging Evaluation of Patients with Severe Psoriasis for Latent Tuberculosis: An Important Indication for IGRA

It is well-established that tumour necrosis factor (TNF)-α-antagonist regimens are advisable for the control of moderate to severe psoriasis; however the application of these agents is associated with increased risk of TB reactivation. Screening for latent tuberculosis infection (LTBI) is indispensable prior to treatment inception in order to diminish the risk of active TB. Although tuberculin skin test (TST) still represents a useful tool for LTBI detection, it is difficult to be performed and read in patients with extensive psoriatic lesions. In this paper, we report the case of a 65-year-old male with severe psoriasis, who was evaluated by an interferon-gamma release assay (IGRA) for LTBI diagnosis prior to anti-TNF-α therapy. Furthermore, the physiological aspects of interferon-gamma release assays are discussed emphasizing the value of these novel immunodiagnostic tests (IGRAs) for presumable LTBI in all patients with extensive skin disorders.

Mefloquine-induced eosinophilic pneumonia.

Mefloquine has been widely used for prophylaxis and treatment of patients with chloroquine‐resistant malaria; the drug is usually well tolerated. Rarely, adverse effects may be severe, including gastrointestinal disturbances, neuropsychiatric reactions, cardiovascular manifestations, skin lesions, musculoskeletal symptoms, and bone marrow toxicity. We describe a 67‐year‐old woman with fever, dyspnea on exertion, peripheral blood eosinophilia, and diffuse pulmonary infiltrates on chest radiography. She had taken mefloquine for malaria prophylaxis for an 8‐week trip to South Africa. A thorough work‐up led to the diagnosis of eosinophilic pneumonia caused by the mefloquine. Her condition improved after the drug was discontinued. To our knowledge, this is the first report of mefloquine‐induced eosinophilic pneumonia. Clinicians should be aware of this rare, potential adverse effect of mefloquine.

Gemcitabine-Induced Severe Peripheral Edema in a Patient With Lung Cancer

Gemcitabine, alone or in combination with a platinum-based agent, is indicated for the first-line treatment of patients with locally advanced or metastatic non–small-cell lung cancer. It is generally a well-tolerated drug. Despite its lack of significant toxicity, the most commonly reported side effects include myelosuppression, gastrointestinal disturbances (eg, nausea and vomiting), influenza-like symptoms, skin rash with pruritus, and elevation of liver transaminase enzymes. Peripheral edema has rarely been described as an adverse effect. Herein, we report a patient with advanced non–small-cell lung cancer who experienced severe peripheral edema after gemcitabine administration. Immediate gemcitabine discontinuation and the administration of diuretics resulted in definite regression of peripheral edema.