The assessment of functional capacity is a significant part of the preoperative evaluation of patients proposed for both thoracic and abdominal surgery. The cardiopulmonary exercise test (CPET) is the most comprehensive exercise test currently used. It provides an objective assessment of the patient's training level and an individualised risk profile for complications and guides the perioperative care. This article provides a brief description of the roles of CPET in thoracic surgery. Guidelines recommend it for perioperative assessments because of its prognostic value, its utility in the postoperative period and in pulmonary rehabilitation programmes.
Lung hydatidosis can remain latent for a long time, and symptoms may occur when the cysts grow to a certain size or when symptoms arise secondary to complications such as rupture or superinfection with bacterial organisms or fungi. A variety of signs denoting different appearances of complicated and/or uncomplicated pulmonary hydatid cysts have been described on chest radiographs and computed tomography scans. Aspergillosis is one of the most common fungal infections associated with pre-existing pulmonary cavities. The coexistence of aspergillosis and hydatid cyst is rare. Citrobacter infections usually occur in patients with underlying co-morbidities or immunosuppression. We presented a case of pulmonary echinococcosis with multiple bilateral cysts in which several consecutive episodes of cysts rupture and concomitant Aspergillus and Citrobacter pulmonary infections have been documented.
Because of an increased prevalence of infections with resistant Gram-negative bacteria, finding optimal treatment regimens for these cases is one of the major healthcare concerns. Providencia is a Gram-negative bacteria belonging to the Enterobacteriaceae family. This article aims to describe an effective antibacterial regimen used for treating ventilator-associated pneumonia (VAP) with species of Providencia that are resistant to all antimicrobial classes. We present the case of a 74-year-old woman suffering from VAP caused by pandrug-resistant Providencia. The patient received high-dose intravenous meropenem (1 g every 12 h, infused over 4 h), intravenous amikacin (1,500 mg every 48 h) and nebulised amikacin (250 mg every 6 h). The dosages were calculated based on weight and renal function (GFR = 13.69 ml/min/1.73). After 23 days of treatment, following improvement in clinical signs (including fever), a drop in leucocytes counts, a higher than 80% reduction in procalcitonin levels (0.12), together with confirmed microbial eradication (negative sputum cultures), the antibacterial regimen was discontinued. In conclusion, when dealing with an infection with a pan-resistant microorganism, using combinations of antibiotics in high doses can be an option. These treatment regimens have the potential of overcoming in vitro resistance, leading to clinical improvement and microbial eradication.
Analysis of the respiratory rehabilitation effects on body composition, performed for 10 patients with respiratory pathology.
Materials and method
In our pilot study were included patients with respiratory disease, for which bioelectrical impedance analysis was performed before and after an outpatient respiratory rehabilitation (RR) programme. The RR programme consisted of 20 sessions of exercise for lower limb (cycling and walking on a treadmill) and upper limb (weights).
Ten patients followed the rehabilitation programme (five patients with chronic obstructive pulmonary disease, two with bronchiectasis, one with cystic fibrosis, one with lung cancer and one with idiopathic pulmonary fibrosis). Following the rehabilitation, they presented an important decrease in total body fat distribution (average total body fat distribution before RR – 31.38% and after RR – 27.09%, p = 0.000) and also segmental body fat distribution; we found an increase of total muscle mass after RR programme (average total muscle mass distribution before RR – 53.03 kg and after the RR – 56.84 kg, p = 0.000) and segmental muscle mass. The average body weight of the patients measured before and after the rehabilitation programme remained relatively constant in absolute value (81.8 kg and 81.3 kg after RR), probably by decreasing fat mass and increasing muscle mass. The RR programme had also a positive effect on increasing exercise tolerance (with 88.5 m at 6-min walk test) and dyspnoea improvement (decrease of mMRC scale with 1.5 points).
The RR programme has modified the body composition by increasing muscle mass and decreasing fat mass in the respiratory patients, with positive effects on symptoms and exercise tolerance.
Chronic obstructive pulmonary disease (COPD) and lung cancer (LC) occupy first place among diseases with high incidence and mortality and become a genuine health problem through costs for the medical system. COPD is considered an independent risk factor for LC, in addition to smoking and occupational exposure. Prevention policies and early diagnosis and treatment may contribute to the decrease in the incidence of both diseases. This article reviews the epidemiological overlaps between the two diseases and the particular features of the diagnosis and treatment of LC in COPD patients.
Cardiac arrhythmias represent one of the consequences of obstructive sleep apnea (OSA). The gold standard of moderate–severe symptomatic OSA treatment is positive pressure therapy [continuous positive airway pressure (CPAP)]. The use of CPAP in patients with cardiac arrhythmias and OSA may contribute to the maintenance of sinus rhythm.
To assess the effects of the CPAP therapy in addition to pharmacological and/or ablative interventions in maintaining the sinus rhythm in patients with cardiac arrhythmias and moderate–severe OSA.
Materials and methods
Patients diagnosed with cardiac arrhythmias [atrial fibrillation (AF)/flutter] and high pretest OSA suspicion (at least two items out of the following: snoring, witnessed apneas, obesity and excessive daytime sleepiness), performed a cardiorespiratory polygraphy (nasal flowmetry, pulse oximetry, thoracoabdominal movements, snoring and body position) for positive diagnosis and OSA severity assessment. Patients with moderate–severe OSA underwent CPAP titration with consecutive therapy indication (CPAP therapy plus pharmacological and/or ablative intervention). At 1 year, patients who used CPAP (group A) and those without CPAP (group B) were re-evaluated for the presence or absence of cardiac arrhythmias.
Sixty-three patients with AF/flutter and high pretest suspicion of OSA performed cardiorespiratory polygraphy. Sixty patients (39 men) were diagnosed with OSA, out of which 40 (26 men) had moderate–severe OSA (apnea–hypopnea index, AHI ≥ 15/h) and underwent CPAP titration. At 1 year of follow-up, 17 patients (42.5%) were found adherent to the CPAP therapy (group A) and 23 (57.5%) did not use CPAP (group B). The two groups were similar in terms of age, body mass index, daytime sleepiness (assessed by Epworth Sleepiness Scale) and oxygen desaturation index, and statistically significant differences were recorded for the values of AHI and the time spent below SaO2 <90% (t90%), statistically significant higher (p < 0.01, respectively p < 0.04) in group A compared to group B. At 1 year, in group A, more patients had sinus rhythm compared to those with AF/flutter (13, respectively 4). In group B, 8 patients were in sinus rhythm and 15 with AF/flutter.
The CPAP therapy added to standard therapy (pharmacological therapy and/or ablative procedures) in patients with moderate–severe OSA and installed cardiovascular disease (arrhythmias) has a favourable effect on maintaining the sinus rhythm at 1 year of follow-up.
Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma represent about 95% of lung tumours. However, the lung is the site of numerous types of tumours that may have an epithelial, mesenchymal, neuroendocrine, or lymphohematopoietic origin. With minor exceptions, both the clinical manifestations and the imaging characteristics are non-specific; many of the low-incidence tumours have common features with the high-incidence tumours. This article presents a group of low-incidence pulmonary tumours that pose multiple difficulties in terms of diagnosis due to non-specific symptomatology and non-specific imaging aspect. This article aims to correlate the histological data with imaging aspects to facilitate diagnostics. Because these tumours are rare and because they present in a variety of forms, problems may occur when establishing a diagnosis and trying to predict their behaviour. It is challenging to differentiate common lung tumours from rare ones based on clinical, radiological, or histological features. Only the presence of the imaging particularities, such as the location of the lesion, the association with certain patterns (appearance of ground glass, the “halo” sign, the presence of calcifications), and the histological/immunohisto-chemical profile can lead to the establishment of a correct diagnosis.
Telemedicine remains a challenge for many diseases. Chronic obstructive pulmonary disease is a common illness already benefitting from a multitude of interventions in this area. They are discussed by the authors from the point of view of the benefits and limitations of telemedicine's involvement in the diagnosis and therapy of this chronic obstructive disease.