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This report describes a female patient with bronchiectasis, presented to our department with recurrent hemoptysis. Bronchoscopy revealed nothing else but blood arising from the upper lobe bronchus. High resolution computing tomography of the lung (HRCT) revealed bronchiectasis of the upper lobe. A right upper lobectomy was performed. Behind bronchiectasis multiple nodular lesions, 5-10 mm were observed. Histological and immunohistochemical examination revealed findings consistent with peripheral typical bronchial carcinoids.

Endometriosis is a common cause of chronic pelvic pain and infertility affecting women of reproductive age, but the disease in rare conditions may be extragenital so may be present with a variety of symptoms. This is a report of an unusual case of pelvic endometriosis that presented with a recurrent hemothorax.

We describe a case of a male with no symptoms and normal chest X ray, diagnosed with TB. The chest computed tomography revealed a cavity formation on the upper left lobe.

Abstract  The aim of this work was to study whether chronic obstructive pulmonary disease (COPD) subjects exhibited periodic limb movement (PLMs) during sleep. A retrospective case control study was conducted in the referral sleep disorders laboratory in the University of Patras in southwest Greece. A sample of 23 COPD subjects was compared with 14 severe obstructive sleep apnea (OSA) subjects and 18 periodic limb movement disorder (PLMD) subjects. The PLM Index (PLMI) and PLMs Arousal Index (PLMAI) in COPD subjects differ (pp  [ABSTRACT FROM AUTHOR]

On December 2019, a new coronavirus disease (COVID-19) emerged in China and spread worldwide, causing acute severe respiratory syndrome. Due to the increased transmission rate of the virus, it became of great importance the early diagnosis of the disease. The coronavirus pandemic led to the development of numerous tests in order to mass screening population for active viral load and for the identification of antibodies for epidemiological purposes. This review summarizes the different diagnostic tests available to the clinicians for the diagnosis and follow up of the SARS COV-2 infections.

Background Between 2017 and 2018, Greece experienced a measles outbreak, affecting >3000 patients, most of which were unvaccinated. Measles-associated pneumonia (MAP) is the most common serious compilation of the disease, but very few recent reports regarding its presentation are available. Materials and Methods Between January and May 2018, 11 adult patients presented to our department with acute measles virus infection, hypoxia and findings on chest X-ray. Clinical, laboratory and radiological data were collected and assessed. Nine out of eleven patients had hypoxic respiratory failure. Other complications included hepatitis, cholestasis and myositis, which were observed in the majority of patients. All patients received supplementary oxygen administration, whereas five patients required continuous positive airway pressure ventilation. Scoring of the radiological examinations performed was most notable for the presence of reticular opacities and consolidations. Statistical analysis demonstrated a significant association between PaO2/FiO2 values and the presence of reticular opacities, with PaO2/FiO2 decreasing as the mean value of the reticular opacities score increased (P = .02). Conclusion To our knowledge, this is the first report demonstrating an association between PaO2/FiO2 values and the presence of reticular opacities in patients with MAP. MAP should be suspected in any patient presenting with acute onset hypoxaemia and a reticular pattern on radiological examination, especially in outbreak settings. What is known Measles infections are on the rise in Europe, with epidemics affecting several European countries, resulting from suboptimal immunisation. The most common serious complication of measles is pneumonia, which is more common in adult patients and can cause significant morbidity. It is the most common cause of death due to measles. What is new In this report, we present 11 adults with measles-associated pneumonia, who presented with the combination of acute measles virus infection, hypoxia and findings on chest X-ray. To our knowledge, this is the first report demonstrating an association between the severity of hypoxaemia and the presence of reticular opacities on chest imaging studies., (© 2019 John Wiley & Sons Ltd.)

Early diagnosis of tuberculosis is of major clinical importance. Among 4733 clinical specimens collected from 3363 patients and subjected to Ziehl-Neelsen microscopy, 4109 were inoculated onto Löwenstein-Jensen slants and 3139 in Bactec/9000MB. Polymerase Chain Reaction (PCR) was performed in 3139 specimens, whereas, a genotypic assay was directly applied in 93 Mycobacterium tuberculosis complex PCR-positive for isoniazid and rifampicin resistance detection specimens (GenoType MTBDRplus). Recovered M. tuberculosis isolates (64) as well as, 21 more sent from Regional Hospitals were tested for antimycobacterial resistance with a phenotypic (manual MGIT-SIRE) and a genotypic assay (GenoType MTBDRplus). PCR in the clinical specimens showed excellent specificity (97.4%) and accuracy (96.8%), good sensitivity (70.4%), but low positive predictive value (40.3%). MGIT-SIRE performed to M. tuberculosis did not confer a reliable result in 16 isolates. Of the remaining 69 isolates, 15 were resistant to streptomycin, seven to isoniazid, seven to ethambutol and five to rifampicin. GenoType MTBDRplus correctly detected isoniazid (seven) and rifampicin-resistant M. tuberculosis strains (five), showing an excellent performance overall (100%). Susceptibility results by the molecular assay applied directly to clinical specimens were identical to those obtained from recovered isolates of the corresponding patients. Combining molecular and conventional methods greatly contribute to early diagnosis and accurate susceptibility testing of tuberculosis., (Copyright © 2017 Sociedade Brasileira de Microbiologia. Published by Elsevier Editora Ltda. All rights reserved.)

The development of antibodies for diagnostic and therapeutic applications in inflammatory diseases is a major focus for biotechnology and pharmaceutical companies. Production of monoclonal antibodies requires the development of fast, high-throughput methodologies for screening and selecting appropriate candidate antibodies for development. Capture (sandwich) enzyme linked immunosorbent assay (ELISA) provides a quick and reliable method that could be used for hybridoma screening of potential candidates accompanied with surface plasmon resonance (SPR) biosensor technology for identifying high affinity biomolecular interactions. A sensitive, cost-effective, robust and accurate capture ELISA for detection of murine monoclonal antibodies in culture supernatants was developed. This assay was optimized for high sensitivity and specificity with a capture anti-mouse polyclonal antibody. Using serial dilutions of a defined murine IgG antibody, a linear dose-response was observed between 2 and 1200 ng/ml antibody with a coefficient of determination r2 of 0.98. The detection limit of the assay was established as 2ng/ml (12.5pM). A similar concentration-dependent doseresponse was also observed using serial dilutions of antibody-containing supernatants from anti-alpha glycophorinproducing hybridomas (detection limit 1:2000). Specific capture of antibodies from supernatants in a similar setting was also confirmed using SPR biosensor technology and correlated well with the immunoassay results. The latter technology can be performed in order to provide quick screening results and kinetic analysis of antibody binding interactions aiming at identifying candidates with high affinity and specificity.

We present a case of an idiopathic pulmonary artery aneurysm in an asymptomatic patient who was treated for an irrelevant medical condition. Pulmonary artery aneurysms (PAA) are quite rare and can either be congenital or acquired. Congenital aneurysms are usually associated with cardiac malformations leading to pulmonary hypertension. Acquired aneurysms can be idiopathic or associated with infections (tuberculosis, syphilis), trauma, pulmonary valvular stenosis, or collagen diseases. Pulmonary artery aneurysms are not common and an idiopathic pulmonary artery aneurysm is a rare finding that could be diagnosed incidentally.

Inhalation of metal dusts and fumes can induce a wide range of respiratory disorders, including granulomatosis, chemical pneumonitis and pulmonary interstitial disease. Laryngeal cancer is the most common cancer of the upper aerodigestive tract. We present a patient with occupational lung disease whose chest CT showed miliary nodular pattern, with concurrent laryngeal cancer who had been engaged in type printing for 22 years. Histology of the laryngeal lession showed squamous cell laryngeal cancer. Histology of the nodules showed a foreign body granulomatous response with several foreign body cells, most probably due to exposure to numerous inorganic (lanthanides, elements such us La, Ce, Nd, Sm, EU, Tb, Lu) and organic particles (such us acrylates, epoxy- and urethane-acrylates).

Background: The frequency and grade of pulmonary complications after radiotherapy for breast cancer are still debated. This study evaluated changes in pulmonary function tests (PFTs) after radiotherapy in women with breast cancer., Patients and Methods: Thirty-five consecutive eligible women with breast cancer underwent pulmonary function testing before and 3 months after adjuvant radiotherapy. Twenty-one of them also received chemotherapy., Results: A significant decrease of forced vital capacity, forced expiratory volume in one second and carbon monoxide diffusing capacity was observed in the women treated with locoregional adjuvant radiotherapy and chemotherapy, whereas no decrease of the above parameters was evidenced in women treated exclusively with local adjuvant radiotherapy., Conclusion: Local adjuvant radiotherapy is not associated with any reduction in lung function parameters, however, locoregional adjuvant radiotherapy combined with chemotherapy shows a significant reduction in PFTs 3 months after radiotherapy completion.

The aim of this study was to retrospectively review the indications, results and complications of flexible fiberoptic bronchoscopy (FFB) in an University teaching Hospital. Also, we present the radiological findings for the major causes according to computed tomography of the chest performed within 48 h of fiberoptic bronchoscopy. A total of 4,098 FFBs were performed from January 1, 2003 to December 30, 2007. For diagnostic purposes, 3769 FFBs performed (92%) and for therapeutic purposes 329 FFBs (8%) performed. Haemoptysis was the most common indication for FFB (21%), followed by fever/suspected infection (19%) and chronic cough (18%). The most common results of the diagnostic workup was nonspecific inflammation of the tracheobronchial tree (31% for haemoptysis, 38.7% for fever and 48.5% for chronic cough), with malignancy ranking second (17%, 26.1% and 26% respectively). The cytological results showed adenocarcinoma to be the most common lung cancer in both sexes (37.3% for men and 39.7% for women). The mortality rate was 0.04% and the frequency for major and minor complications was 0.56% and 0.33%, respectively. In conclusion, flexible fiberoptic bronchoscopy is a safe procedure and can play a major role in both diagnosis and treatment, as long as the requisites of preparation and supervision are followed.

The aim of this work was to study whether chronic obstructive pulmonary disease (COPD) subjects exhibited periodic limb movement (PLMs) during sleep. A retrospective case control study was conducted in the referral sleep disorders laboratory in the University of Patras in southwest Greece. A sample of 23 COPD subjects was compared with 14 severe obstructive sleep apnea (OSA) subjects and 18 periodic limb movement disorder (PLMD) subjects. The PLM Index (PLMI) and PLMs Arousal Index (PLMAI) in COPD subjects differ (p<0.05) from severe OSA patients. The PLMAI differ (p < 0.05) between COPD and PLMD subjects. Spearman's correlation showed a positive statistical significant correlation between PLMI and PLMAI in the entire population and in COPD subjects. There was no statistical significant correlation between sleep-related symptoms and the occurrence of PLMs disorder in COPD patients. In our study, PLMs with associated arousals are often seen in COPD subjects. Further prospective studies will be necessary to clarify the mechanisms whereby the reduction in PLMs in COPD patients improved their sleep and quality of life.

Urinothorax is a rather rare cause of pleural effusion and its potential mechanism is urinary tract obstruction or trauma that results in urine leakage and accumulation inside the pleural space. Patients with non-Hodgkin lymphoma could present with pleural effusion due to mediastinal lymphadenopathy or extrathoracic manifestation such as urinary tract obstruction, the latter described in our case report. Physicians must be aware even of the more occult mechanisms of pleural fluid accumulations which could point to extrathoracic manifestations of involvement.

Objective: The aim of the study was to examine the quality of the characteristics of Erectile Dysfunction (ED) in men with Obstructive Sleep Apnea Syndrome (OSAS) and to investigate whether there is an improvement with the use of continuous positive airway pressure (CPAP) therapy., Materials and Methods: Fifteen men with OSAS and sexual dysfunction have been investigated in this follow-up study. The treatment period was for 12 weeks and the therapeutic CPAP levels were determined during the full night of the therapeutic titration., Results: In our 15 treated patients, the International Index Erectile Function (IIEF) total and all domain scores had increased after the CPAP treatment compared to the baseline, except for that of sexual desire domain., Conclusions: CPAP therapy can improve the sexual function in ED patients with OSAS.

Pulmonary alveolar microlithiasis is a rare disease characterized by widespread intra-alveolar calcification of both lungs that is asymptomatic in the early stages. The disease typically follows a protracted course, and death can occur in 5 to 41 years after the initial diagnosis. Rheumatic fever is a multisystemic inflammatory disease that afflicts the child and juvenile population, and it is still very common in developing countries. Valve failure is the condition most linked to increased morbidity and mortality rates in this population and is the most severe complication of rheumatic fever, with consequent onset of chronic heart valve disease. We present a case of a female patient with a potential diagnosis of pulmonary alveolar microlithiasis with concurrent rheumatic valvular disease.

Skin prick tests (SPTs) play an important role in the diagnosis of bakers asthma and epidemiological field studies on frequencies of sensitization to wheat or rye flour. In many epidemiological studies the investigators have tried to reveal the determinants of specific sensitization, and atopy appears to be a very strong determinant for sensitization to flour allergens. Age and gender have not reported to be determinants of sensitization. Only one study found that sensitization in wheat flour with skin prick test was significantly associated with cigarette smoking. Few data are available on sensitization to wheat flour in populations without occupational exposure to bakery allergens. The aim of this study was to investigate the sensitization of wheat flour and other baking allergens (oat, barley, and rye flour) in traditional bakers and in cleaners in a big hospital in the same area. In addition the correlation of atopy with specific sensitization and the correlation of specific sensitization with age, sex, working hours, working years, smoking status and pack/years with use of skin prick tests.

Aseptic (avascular) necrosis of the femoral head in adults has been associated with a variety of disease entities. It is also recognized as a potential complication of systemic corticosteroid therapy. Inhaled corticosteroids are the first line anti-inflammatory agents for the long term treatment of asthma. However, long term treatment of asthma with inhaled corticosteroids has been accompanied by concern about both systemic and topical side effects. The most worrying potential systemic effects are adrenal insufficiency, growth suppression, glaucoma and osteoporosis. Fluticasone proprionate may be prescribed at higher doses to relieve respiratory symptoms in the belief that it generates fewer side effects than other inhaled steroids. Studies have shown that fluticasone is safer than beclomethasone or budesonide, with limited oral absorption and extensive hepatic first pass metabolism leading to a lower systemic bioavailability. However growth retardation and asymptomatic adrenal suppression in children receiving high-dose fluticasone have been reported. We report a rare case of avascular osteonecrosis of the femoral head associated with the use of long term inhaled fluticasone propionate along with the intranasal application of triamcinolone acetonide.

Background: The aim of this study was to evaluate the significance of albumin in bronchial washing fluid (BWF) and its relationship to three tumor markers (CEA, CA 19-9 and NSE)., Methods: Serum and BWF samples were collected in a group of 60 patients. Albumin and tumor markers in the BWF and serum of three groups: a control group (CG), a chronic bronchitis group (CBG) and a lung cancer group (CaG), were analyzed in a prospective cross-sectional study. The diagnostic yields of the tests in each environment (serum and BWF) were evaluated by using as cutoff points the values of the corresponding 90th percentile of CG and CBG taken together., Results: A significant difference in albumin level (p < 0.001) was noted in the BWF of patients with cancer compared with the other two groups. In addition, a significant difference in CEA level (p < 0.001) was observed in the serum of cancer patients compared with the other two groups. The cutoff values for CEA in serum and albumin in BWF were 2.20 ng/mL and 2.00 g/dL, respectively. The areas under the corresponding ROC curves were 93% and 97%. Combination of CEA-serum and albumin-BWF by logistic regression analysis increased their diagnostic value., Conclusion: Measurement of albumin levels in BWF could be a useful additional diagnostic tool to differentiate malignant from non-malignant lung diseases. Moreover, the combined measurement of CEA in serum and albumin in BWF could be of aid in the follow-up of lung cancer patients.

We present a case of an obese young man who developed ischemic hepatitis, severe coagulopathy, acute renal failure, and encephalopathy. Heart failure and hypovolemia were absent. Oxygen arterial saturation was very low, between 77% and 99% during the day, with no history of respiratory failure. A diagnosis of obstructive sleep apnea was made clinically and confirmed by performing formal polysomnography. The polysomnographic study showed multiple episodes of apneas and hypopneas with severe oxygen desaturation. The patient was treated with continuous positive airway pressure through a nose mask and clinical manifestations related to profound nocturnal desaturation were ameliorated. He was discharged 32 days after admission with normal results of laboratory tests. This case report is presented to support the hypothesis that hypoxic hepatitis was directly related to severe arterial hypoxemia.

Background: The global distribution of drug resistant tuberculosis reflects the quality of tuberculosis control worldwide and is still a major public health-problem. To our knowledge, no data exists in literature about resistance to anti-tuberculosis drugs in Greece., Methods: The aim of this study was to determine the prevalence of resistance to the main anti-tuberculosis drugs in newly and previously treated tuberculosis patients, in the region of Patras, in Greece and to evaluate the contribution of foreign-born and human immunodeficiency virus (HIV) positive cases to drug resistance., Results: A total of 207 initial isolates of Mycobacterium tuberculosis were analysed. All clinical specimens submitted for cultural diagnosis were collected before chemotherapy commenced. The age of the patients varied from 16 to 78 years old. Sex distribution was 144 males (69.56%) and 63 females (30.43%). Nineteen patients (9.17%) were recent immigrants in Greece. All the patients were HIV-negative. One hundred-one initial isolates of Mycobacterium tuberculosis (48.79%) were susceptible to all first-line anti-tuberculosis drugs, isoniazid, streptomycin, ethambutol and rifampicin. The prevalence of primary mono- and poly-drug resistance was lower (isoniazid 5.79%, streptomycin 4.34%, ethambutol 1.93%, isoniazid + streptomycin 3.38%, isoniazid + ethambutol 0.9%, isoniazid + streptomycin + ethambutol 1.44%) when compared with the prevalence of secondary (acquired) mono- and poly-drug resistance (isoniazid 8.69%, streptomycin 10.14%, ethambutol 3.86%, isoniazid + streptomycin 3.86%, isoniazid + rifampicin 1.44%, isoniazid + streptomycin + ethambutol 4.83%, isoniazid + streptomycin + rifampicin 1.44%). No primary mono - resistance to rifampicin, or primary multi - drug resistance (defined here as Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin) were observed., Conclusions: According to our data, overall drug resistance was high. Fortunately, multi-drug resistance tuberculosis was not common but special efforts are needed to monitor the prevalence of drug resistance and to ensure adequate treatment in all the population.

Background: Hypoxemia stimulates endothelin-1 (ET-1) secretion. The reduction in alveolar ventilation during sleep is considered sufficient to account for the hypoxemia observed in patients with respiratory diseases., Objective: The aim of this study was to evaluate the arterial ET-1 levels and their relationship with pulmonary hypertension in patients with interstitial lung disease (ILD) during sleep., Methods: We examined 38 patients with ILD using formal polysomnography (electroencephalogram, electrocardiogram, airflow, respiratory muscle movement, oximeter) to detect the presence of nocturnal, nonapneic, oxyhemoglobin desaturation. All patients desaturated below a baseline sleep saturation of 90% for 5 minutes or more, reaching a nadir saturation of at least 85%. Each patient had already undergone right heart catheterization with a Swan-Ganz catheter for measuring hemodynamic parameters. Sampling of arterial blood from a radial artery line for determination of blood gases and ET-1 values was performed simultaneously, after 5 minutes of the first desaturation., Results: At rest, arterial ET-1 levels were higher in ILD patients (1.73 +/- 0.37 mgr/mL) than in controls (1.22 +/- 0.15 mgr/mL) ( p < 0.001). Also, the patients with pulmonary hypertension (Pa > 20 mm Hg) presented significantly higher arterial ET-1 levels (1.86 +/- 0.32 mgr/mL) than those without pulmonary hypertension (1.31 +/- 0.13 mgr/mL) ( p < 0.001). Arterial ET-1 levels were significantly correlated with mean pulmonary arterial pressure (PAP) (r = 0.749, p < 0.001), and arterial oxygen partial pressure (PaO2) (r = 0.79, p < 0.001). At sleep, during desaturation, arterial ET-1 levels significantly increased in all patients (2.46 +/- 0.13 mgr/mL) as compared with resting values ( p < 0.001). Arterial ET-1 levels were significantly correlated with PAP (r = 0.657, p < 0.001) and PaO2 (r = 0.93, p < 0.001)., Conclusions: According to our study, arterial ET-1 is markedly increased in ILD patients, especially in those with pulmonary hypertension.

High-resolution computed tomography (HRCT) is a useful method for quantifying the extent of emphysema. Few reports have mentioned the relationships between HRCT scans and pulmonary function tests in chronic obstructive pulmonary disease (COPD). For diagnosis, COPD requires chronic airflow limitation and emphysema and/or chronic bronchitis. We examined 20 who were previous smokers with middle to moderate COPD. All were normocapnic with mean arterial oxygen pressure (PaO2) 77,52 +/- 16,789 mmHg. Forced spirometry, somatic plethysmography and cardiopulmonary exercise test were performed in each patient. HRCT was performed in both full inspiration and full expiration at three levels through the upper (at the aortic arch), lower (2 cm above the diaphragm), and middle lung (midpoint between upper and lower) levels. During expiration all pulmonary function parameters correlated with the HRCT grade in the middle right and left part of the lungs. The middle right part of the lung during expiration correlated statistically significant with MVV (r = -0.681, p = 0.001), forced vital capacity (FVC) (r = -0.477, p = 0.027), forced expiratory volumein 1 sec (FEV1) (r = -0.632, p = 0.002), resistance (r = 0.674, p = 0.001), residual volume (RV) (r = 0.733, p = 0.001), total lung capacity (TLC) (r = 0.696, p = 0.001), functional residual capacity (FRC) (r = 0.752, p = 0.001) and peak oxygen consumption during exercise (VO2) (r = -0.493, p = 0.023). The middle left part of the lung during expiration correlated statistically significant with MVV (r = -0.673, p = 0.001), FVC (r = -0.493, p = 0.027), FEV1 (r = -0.629, p = 0.003), resistance (r = 0.593,p = 0.005), RV (r = 0.601, p = 0.005), TLC (r = 0.546, p = 0.012), FRC (r = 0.594, p = 0.006) and peak VO2 (r = -0.525, p = 0.015). Forced expiratory volume in 1 sec (FEV1), which is a well-established measure of airflow obstruction, correlated with the HRCT grade (1) in the middle left part of the lung during inspiration (r = -0.468, p = 0.035) and during expiration (r = - 0.629, p = 0.003) (2) in the lower right lung during inspiration (r = -0.567, p = 0.007) and during expiration (r = -0.558, p = 0.008) (3) in the lower left lung during inspiration (r = -0.542, p = 0.011) and during expiration (r = -0.558, p = 0.008) (4) in the upper right lung during expiration (r = -0.469, p = 0.037) (5) in the upper left lung during expiration (r = -0.463, p = 0.035) and (6) in the middle right lung during expiration (r = -0.632, p = 0.002). According to our results HRCT was a valuable tool for evaluating the severity of COPD--especially the middle right and left part of the lungs, during expiration--and correlated well with pulmonary function tests.