Tiberiu Shulimzon

Necrotizing Granulomata in the Lung Preceding Colonic Involvement in 2 Patients with Crohn’s Disease

Extraintestinal involvement, including the chest, is common in the late course of Crohn’s disease. We describe 2 female patients in whom the course of the disease was unique in two aspects: (1) each had a pulmonary mass with granulomatous inflammation and necrosis, and (2) these findings had preceded the colonic involvement by 5 years. This sequence supports some of the theories on the pathogenesis of Crohn’s disease and on its possible relation with sarcoidosis, another idiopathic granulomatous disease.

Elevated insulin-like growth factor-1 and insulin-like growth factor binding protein-2 in malignant pleural effusion

Insulin-like growth factor-1 (IGF-1) and its binding proteins (IGFBPs) are produced by many tissues and are present in serum and other biological fluids. Alterations in sera of IGF-1 and 2 and IGFBPs were demonstrated in patients with malignancy, infection and other diseases causing pleural effusion. In this study the IGF-1 and IGFBP-2 content and the specific electrophoretic patterns of IGFBPs in samples of sera and pleural effusions of 25 patients with malignancy, infection and congestive heart failure were investigated. IGF-1 levels in exudative effusions of malignant solid tumors were significantly higher [(mean - SD), 20.9 - 7.5 nmol/L, n=9] than in lymphoma (11.0 - 5.2 nmol/L, n=5; p<0.05), infection (11.4 - 6.5 nmol/L, n=6; p<0.05) and transudative effusion of congestive heart failure (4.3 - 3.3 nmol/L, n=5; p<0.02). IGFBP-2 was markedly increased in effusions of malignant solid tumors (2.14 - 0.82 mg/L, n=9) compared with exudates of lymphoma, infection and transudates (1.10 - 0.70, 1.22 - 0.32 and 0.93 - 0.52 nmol/L, respectively, p<0.05). Moreover, in effusion of solid tumors, IGFBP-2 levels were higher than those in corresponding sera, which suggests local production of this binding protein. The demonstration of IGFBP-2 in solid tumor cells by immunohistochemistry further supports this possibility. This work demonstrates the existence of the IGF-1/IGFBP system in pleural fluids from different etiologies and implies possible use of IGF-1 and IGFBP-2 as a potential marker of malignant effusions.

Ventilatory Response to Hypercapnia in C5–8 Chronic Tetraplegia: The Effect of Posture

OBJECTIVE To study the effect of posture on the hypercapnic ventilatory responses (HCVR). DESIGN Nonrandomized controlled study. SETTING Rehabilitation hospital and a pulmonary institute. PARTICIPANTS Patients with neurologically stable C(5-8) tetraplegia (n=12) and healthy control subjects (n=7). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Supine and seated forced vital capacity (FVC) and HCVR, and supine and erect blood pressure. RESULTS FVC in the sitting position was reduced in patients with tetraplegia (52+/-13% predicted); supine FVC was 21% higher (P=.0005). In the sitting position, HCVR was lower in patients than in controls (0.8+/-0.4 vs 2.46+/-0.3 L/min/mmHg, P<.001). Supine HCVR was not significantly different between the groups. When HCVR was normalized to FVC, there was still a significant difference between patients and controls in the sitting position. Patients with tetraplegia were orthostatic (mean supine blood pressure 91+/-13 mmHg vs mean erect blood pressure 61+/-13 mmHg, respectively, P<.0001). The magnitude of the orthostatism correlated with that of the postural change in HCVR (r=.93, P<.0001). CONCLUSIONS Respiratory muscle weakness may contribute to the attenuated HCVR in tetraplegia. However, the observation that supine HCVR is still low even when normalized to FVC suggests a central posture-dependent effect on the HCVR, which may be linked to the postural effect on arterial blood pressure.

Feasibility of Confocal Laser Microscopy in CT-Guided Needle Biopsy of Pulmonary and Mediastinal Tumors: A Proof-of-Concept Pilot Study

This report describes the use of confocal laser microscopy (CLM) with CT-guided transthoracic needle biopsy (TTNB) for the diagnosis of heterogeneous large mediastinal and lung tumors. The procedure was performed in five patients diagnosed with a mediastinal mass and five patients diagnosed with a lung mass. CLM was used before CT-guided TTNB. Fluorescein administration allowed for the identification of blood vessels in both locations. Malignant cells were identified in mediastinal masses. Complications included one case of pneumothorax. In large tumors, CLM allows vascularized tissue to be differentiated from necrotic and fibrotic areas before biopsy.

Enfermedad pulmonar relacionada con IgG4 - Tres casos no tratados con resultado benigno

IgG4-related disease is a fibroinflammatory disease in which the organs involved share similar pathological findings. Chest disease has been recently clinically and radiologically characterized. Most reports advocate prompt immunosuppressive therapy and describe a fast and good response. We report 3 cases of untreated IgG4-related lung disease that on follow-up have been clinically asymptomatic and radiologically stable or improved. In some cases of IgG4-related lung disease immunosuppressive therapy may not be warranted.

Therapeutic Bronchoscopy: “Can” Does Not Necessarily Mean “Should”

We read with interest the report by Ost et al 1 on behalf of the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) Bronchoscopy Registry in CHEST (May 2015). Th e authors meticulously summarize data from 15 leading medical centers in North America and the United Kingdom on bronchoscopic interventions to treat malignant obstruction of central airways. 1 Registries allow clinicians to learn from the pooled experience of others. Th e practitioner must then adapt this experience to his or her local environment (eg, operator skills, available equipment, and reimbursement).

National asthma observational survey of severe asthmatics in Israel: the no-air study

BackgroundAsthma is considered a global public health issue requiring a significant medical expenditure as a result of its high prevalence and the low rate of disease control.ObjectiveThis is the first nationwide survey of severe asthma patients carried out in Israel. In this study we aimed to assess health resources utilization, compliance with treatment and disease-control in a subgroup of patients with severe asthma in Israel.Material and methodOne hundred and twenty-three patients with a diagnosis of asthma for more then one year, as well as a hospitalization during the last 12 months due to asthma exacerbation or maintenance systemic steroids therapy, were included in this non-interventional observational study.ResultsAsthma was uncontrolled in 43.9%, partly controlled in 50.4% and well controlled in only 5.7%. The majority of the patients (83%) were compliant with drug treatment.ConclusionThe fact that 83% of the asthma patients included in this study were compliant with their asthma therapy was not manifested in asthma control. Therefore concrete tools are required for achieving and maintaining asthma control, especially in the treatment of the most severe asthmatic patients.

Long-term Imaging of the Lungs After Sealant Bronchoscopic Lung Volume Reduction.

Purpose: The aim of the study was to assess the pulmonary temporal changes after bronchoscopic lung volume reduction (BLVR) using sealants for treatment of emphysema. Materials and Methods: We retrospectively assessed all chest computerized tomography (CT) and F-18 fluorodeoxyglucose (FDG) positron emission tomography CT scans of patients treated at our institution with BLVR. Results: Eleven patients were treated with sealants: 4 with biological sealants and 7 with synthetic sealants. The first CT scan after biological sealant treatment showed no abnormalities in 8 lobes and 5 nodules, and 3 consolidations in 7 lobes. All findings resolved within 3 months, except for a nodule that decreased after 2 months and remained stable for 9 years. The first CT scan after utilizing the synthetic sealant showed abnormalities in each treated lobe: 19 nodules/masses (16 cavitary, 3 solid) and 3 consolidations. Follow-up CT scans were available for 16 nodules/masses: 1 resolved, 12 slowly decreased in size, 1 remained unchanged, and 2 grew. Of 3 consolidations 1 resolved and 2 decreased in size. FDG positron emission tomography CT scans performed in 2 patients showed FDG uptake higher than mediastinal background activity in 2 nodules in the same patient. Conclusions: Pulmonary changes after BLVR are variable. After treatment with biological sealants, most findings resolve within 3 months. In contrast, after synthetic sealants, although the majority regress over time, some show waxing and waning in growth that can mimic malignancy. FDG uptake in some of these lesions is suggestive of chronic inflammation. Radiologists should be aware of the spectrum of these pulmonary changes to avoid misdiagnosis of lung cancer.