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Vedolizumab, an anti-integrin antibody, is effective for moderate to severe ulcerative colitis and Crohn's disease treatment with a good safety profile due to its gut selective mechanism of action. Upper respiratory tract vedolizumab adverse events are common; however, they are mild and do not require treatment withdrawal. Herein, we present a 39-year-old patient under vedolizumab treatment for ulcerative colitis who presented acute severe interstitial lung injury that necessitated vedolizumab withdrawal and systemic steroids administration.

Pulmonary embolism is a common clinical entity related to high mortality. About 200,000 to 300,000 patients die every year due to pulmonary embolism. The purpose of this article is to describe a case of a patient who on the second postoperative day after undergoing thromboembolectomy of the left femoral artery, manifested a massive pulmonary embolism. Due to cardiorespiratory collapse a combined treatment via extracorporeal life support (ECLS) and parallel catheter thrombolysis was decided and performed. By cardiorespiratory improvement and final stabilization the patient was successfully weaned from ECLS and the system was successfully removed. After a reasonable postoperative time the patient was dismissed in good overall condition. Keywords: Pulmonary embolism, Extracorporeal membrane oxygenation, Thrombolysis, Catheter thrombolysis

We present a rare case of a 74 year old female with unruptured aneurysm of the left coronary sinus of Valsalva accompanied with patent foramen ovale and atrial fibrillation. This rare combination was detected during diagnostics for a cardiac etiology stroke. The left coronary sinus of Valsalva was reconstructed using an autologous pericardial patch, the left atrial appendage closed, left atrial ablation performed with cooled radiofrequency and the patent foramen ovale sutured directly. The patient was dismissed on the 12th postoperative day after having an uncomplicated postoperative course.

Introduction: COPD and impaired glycemic control are characterized by systemic inflammation. Etiologic correlation between them is under investigation. Objective: The aim of this study is to examine the prognostic value of HbA1c levels in an acute exacerbation of COPD (AECOPD) as well as in COPD disease9s morbidity and mortality during the following year. Methods: Levels of HbA1c were recorded in patients admitted to the hospital for an AECOPD. Values above 6.5 % were considered high. All subjects were followed up for one year, their vital status and new AECOPD events were recorded. The study outcomes included duration of hospital stay, need for mechanical ventilation, time to next AECOPD and death. Results: Thirty-seven patients optimally treated were included. HbA1c was high in 7 (18.9%) patients. There was no difference in the duration of hospital stay between patients with low an high HbA1c levels (p=0.149). Though 57% of patients with high levels of HbA1c required mechanical ventilation vs 13% of patients with low HbA1c levels (p=0.012). In the follow up year no significant difference was observed in the time of the next AECOPD, the time of the next hospitalization for AECOPD and one-year mortality between the two study groups (p=0.258, p=0.929, p=0.076 respectively, Log Rank test). Conclusion: Preliminary data indicate that HbA1c levels >6.5% could be used as a prognostic biomarker of an exacerbation9s severity and could possibly be extended to to predicting one year mortality. Increased HbA1c levels are likely to reflect an increased inflammatory state which amplifies the risk of COPD disease9s adverse effects.

Situs inversus totalis (SIT) is a rare clinical entity which is characterized by a complete reverse anatomy of the thoracic cage and abdomen. There are a few reports of patients with SIT and lung cancer. The number of the cases that have been treated surgically is also very small. We report a case of an 80 years old patient who underwent left lower lobectomy after staging with uniportal video-assisted thoracoscopic surgery (VATS) and mediastinoscopy.

SummaryBackground Asthma control refers to the extent to which the manifestations of asthma have been reduced or eradicated by treatment. Interleukin-13 (IL-13) has a central role in Th2 response and serves as a possible therapeutic target in uncontrolled asthma. Fraction of exhaled nitric oxide (FeNO) and sputum eosinophils have modest performance in the evaluation of asthma control. Objective To assess the diagnostic performance of sputum IL-13 for the evaluation of asthma control and furthermore to investigate the performance of sputum eosinophils and FeNO. Methods One hundred and seventy patients with asthma were studied. All subjects underwent assessment of asthma control by asthma control test (ACT), lung function tests, FeNO measurement and sputum induction for cell count identification and IL-13 measurement in supernatants. Results IL-13 (pg/mL) levels in sputum supernatant differed significantly among patients with well-controlled asthma and those with not well-controlled asthma [median IQR 78 (66–102) vs. 213 (180–265), P < 0.001]. Receiver operating characteristic (ROC) analysis showed that, for the whole study population, the diagnostic performance of IL-13 was superior to both sputum eosinophils and FeNO levels [area under the curve (AUC) 0.92, 95% CI 0.87 to 0.95 vs. AUC 0.65, 95% CI 0.58 to 0.72 vs. AUC 0.65, 95% CI 0.55 to 0.72, respectively]. Conclusion The diagnostic performance of sputum IL-13 was superior to both sputum eosinophils and FeNO levels for the identification of well-controlled asthma. Sputum IL-13 levels could serve as a useful biomarker for asthma control assessment.

Introduction. Increased vascularity may lead to loss of heat in the airways and may modulate exhaled breath temperature (EBT). Increased EBT has been associated with uncontrolled asthma. Aim. We wanted to determine whether the measurement of EBT in optimally treated asthmatic patients is influenced by the increased vascular permeability and whether Vascular endothelial growth factor (VEGF) is implicated in the above process. Furthermore, to assess the impact of asthma severity on EBT values. The diagnostic performance of EBT for the identification of inflammatory profiles in induced sputum was also assessed. Methods. 88 stable asthmatic patients optimally treated for at least 6 months were studied (46 with Severe Refractory Asthma, SRA). EBT was measured with the X-halo device. All patients underwent spirometry, sputum induction for the measurement of % inflammatory cells and for the assessment of both VEGF and albumin in sputum supernatant. The airway vascular permeability index was calculated as the ratio of albumin concentrations in induced sputum and serum. Results. EBT (°C) was significantly higher in patients with SRA compared to those with mild to moderate asthma (median IQR 34.2 [32.4–34.6] versus 31.8 [26.3–34.1], p = 0.001). EBT was significantly associated with VEGF levels in sputum supernatant, while SRA was recognized as a significant co-variate. No other significant associations were observed. Finally, in ROC analysis, the diagnostic performance of EBT for the pure eosinophilic or/and neutrophilic profile did not reach statistical significance. Conclusion. EBT is increasing in severe asthma and is significantly modulated by VEGF levels. Despite the above results its performance for predicting cellular profiles is of limited value.

Asthma is a chronic inflammatory airways disorder mainly characterized by heterogeneity. In the more severe forms, a discordance often exists between symptoms and inflammation. Difficulty in managing asthma derives partly from the multiple phenotypes existing and our inability to recognize them. The use of non-invasive, with main representative the fraction of exhaled nitric oxide, or semi-invasive techniques such as induced sputum are effective tools that can help us to guide asthma treatment. In the latest years, several serum biomarkers related to asthmatic inflammation have been used for the better recognition of asthma sub-phenotypes to achieve optimization of therapy and disease outcome. In patients with mild-moderate asthma, as well as patients with more severe asthma, the use of blood eosinophils revealed an acceptable accuracy for the prediction of airway eosinophilia indicating that in future studies may facilitate both individualized treatment and management of asthma. None of the above techniques have been incorporated in clinical practice although sputum eosinophils can be used in patients with severe asthma particularly in specialized centers with great experience. Of great interest are blood eosinophils since current data support their role either as tool for treatment selections or/and as a biomarker of airway eosinophilia.

Method We recruited 170 patients (47 with SRA) from two University asthma clinics. Patients were submitted to pulmonary function testing, measurement of fractional exhaled nitric oxide (FeNO), and sputum induction with calculation of inflammatory cells and measurement of IL-13 in the supernatant. Asthma control test (ACT) was used for evaluation of asthma control (ACT values >19 identified well-controlled asthma). Severe refractory asthma was defined by the ATS criteria.

Popliteal artery entrapment syndrome (PAES) is a rare but important cause of leg ischemia and even disability in young athletes. Entrapment occurs because of an abnormal relationship between the popliteal artery and the surrounding muscular structures in the popliteal fossa. These anomalies lead to decreased blood flow to the affected leg with signs of claudication, coldness, and symptoms of exercise-induced leg pain. In this article, we present a case of a young soldier who presented with the above signs and symptoms in his left foot after exercise. On questioning, he admitted to having chronic lower leg pain. He was diagnosed with PAES in both legs and he was emergently treated with an arterial bypass procedure in the left one. He had no postoperative complications. PAES should be considered in the differential diagnosis of chronic or acute lower leg pain in any young patient. Early diagnosis and treatment can prevent limb loss and lead to a good operative outcome.

Background: Smoking is one of the biggest health problems worldwide. Several studies that have been recently conducted in Greece demonstrated a high prevalence of smoking among young people. The purpose of the current study is to describe the smoking habit of Greek male young people at the time of their conscription in the army. Methods: In this study, 1,285 Greek army conscripts that were recruited from September 2013 to November 2014 were included. Their ages ranged from 18 to 28 years. A questionnaire was used for data collection. The questions were based on the Global Tobacco Surveillance System (GTSS). Results: In total, 50.62% of soldiers (647 persons) answered that they had smoked at least 100 cigarettes in their lives, while 40.08% (589) answered negatively. 45.62% reported that they started smoking at the age of 16–20 years and 20.89% reported starting smoking at the age of 10 to 15. Only 1.82% reported starting smoking before the age of 10 and only 1.36% after the age of 20. Hence, the majority of the soldiers started smoking between 10 and 20 years old. Conclusions: The prevalence of smoking and secondhand smoking in young Greek males is high. Early guidance should be provided in order to prevent smoking initiation.

A new term was introduced in 2005 from the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA): health-care associated pneumonia (HCAP) which seems to have been established in Greek medical society. Patients who are included in this subcategory of community acquired pneumonia (CAP) present increased rates of multi-drug resistant pathogens and as a result the initial empirical antibiotic treatment is often ineffective. This could be the cause of increased mortality and so, it is advised to provide broad-spectrum antibiotic treatment that covers multi-drug resistant pathogens. However there are many studies that object to this category and prove that the broad-spectrum management leads to overtreatment, resistance and increased mortality. In this review we refer to these studies leading to the questioning of this subcategory. It seems that the classic triad can include all pneumonia categories. However, there is certainly the need to include also new conditions that concern the great increase of elderly patients and the need for evaluation of the functional status and the aspiration that were not till now taken into account.

Smoking represents one of the largest public health problems due to its detrimental effects on multiple organs of the human body and its association with a variety of chronic and/or lethal diseases. Most smokers start smoking in their youth when growth has not been yet completed and they are more susceptible to the harmful components of tobacco. Purpose of this review was to present current data about the extent of tobacco use in childhood and adolescence, the situations facilitating smoking initiation at an early age and the available policies aiming to prevent early age smoking and to promote smoking cessation in non-adult individuals. Data were collected from the international PubMed database and through research in Google Scholar. Smoking rates among children and adolescents are alarming. Health care specialists should be aware of the real reasons leading to early age smoking, which are mainly the influence of family and its economic status, social life and internet. However, psychological reasons contribute also to early smoking initiation. Interventions in these fields should be achieved in order to prevent children and adolescents from smoking. For those who unfortunately smoke many smoking cessation programs exist worldwide and can help young people to quit smoking. However their results are often controversial. The significant increase of smoking among children and adolescents should be dealt with well-designed national smoking prevention and cessation programs after analyzing thoroughly the causes of young people smoking initiation. Both of these programs, but mainly the one aiming to the prevention part, should be practiced with the cooperation of all social parts, while school should have a central role.

SummaryBackgroundVascular endothelial growth factor (VEGF) is considered to be the most important angiogenic factor in asthma. Cysteinyl leukotrienes (Cyst-LTs) have been implicated in vascular permeability in asthma. Cyst-LTs receptor antagonists modulate vascular permeability by reducing VEGF expression.ObjectiveWe aimed to determine the levels of VEGF and Cyst-LTs in sputum supernatants of patients with asthma and to investigate possible associations within them and with airway vascular permeability (AVP) index. Possible confounding factors were also assessed.MethodsOne hundred twenty one patients with asthma (38 with severe refractory asthma, 41 smokers) and 30 healthy subjects (15 smokers) were studied. All subjects underwent lung function tests, and sputum induction for cell count identification and VEGF, Cyst-LTs, measurement in supernatants. AVP index was also assessed.ResultsBoth VEGF & Cyst-LTs (pg/ml) levels were significantly elevated in patients with asthma compared to normal subjects (median, interquartile ranges 845 [487–1034] vs. 432 (327–654) and 209 [171–296] vs. 92 [75–114] respectively, p