Original papers

Interstitial lung diseases: an observational study in patients admitted in “Marius Nasta” Institute of Pulmonology Bucharest, Romania, in 2011

Interstitial lung diseases (ILD) are a large group of rare diseases, with difficult diagnosis and management. Very little is known about prevalence, diagnosis and management of ILDs in Romania. This study aims to gather information on how ILDs are diagnosed and managed in Romania, focusing on a tertiary hospital with expertise and equipment needed for accurate diagnosis. We analyzed retrospectively the files of patients admitted with ILD in 2011 in “Marius Nasta” Institute of Pulmonology Bucharest. There were 178 eligible patient files with ILDs and 186 sarcoidosis cases. The ILD diagnosis were: 41 cases idiopathic pulmonary fibrosis (IPF), collagen disease associated ILD (29 cases), hypersensitivity pneumonia (19 cases), alveolar proteinosis (9 cases), cryptogenic organizing pneumonia (9 cases), undefined ILD (46 cases), other (25 cases). The investigations used for the diagnosis were: chest X-ray (100%), spirometry (157 pts, 88.21%), diffusion capacity (127 pts, 71.43%, broncho-alveolar lavage (92 pts, 51.69%), CT scan (141 pts, 79.22%), lung biopsy (26 pts, 14.6%), similar to other European centers, but fewer lung biopsies are performed. There is need for a prospective registration of ILD cases in a national registry, for creating local guidelines for diagnosis of ILDs, to improve the suspicion of ILD and referring of patients to specialized centers. Diagnosis can be improved by a multidisciplinary approach of each case, involving the clinician, the radiologist, the pathologist and the thoracic surgeon.

Keywords: interstitial lung diseases, diagnosis, idiopathic pulmonary fibrosis, undefined interstitial lung disease

Article

Inhaled steroids reduce apnea-hypopnea index in overlap syndrome

Background: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are two of the most common chronic respiratory disorders. Co-existence of both conditions, referred as overlap syndrome (OLS), is associated with substantially high rates of mortality and morbidity. The present study aimed to evaluate the effect of inhaled corticosteroids (ICS) on apneahypopnea index (AHI), an indicator for diagnosis and identifying the severity of OSA, in overlap syndrome.
Methods: We conducted a clinical trial on 60 patients diagnosed with overlap syndrome by employing overnight polysomnography before and after receiving ICS. T student test and Mann-Whitney test were applied to analyze the gathered data including age, AHI, nocturnal oxygen desaturation index and SaO2 (saturated arterial oxygen), daytime (pressure of arterial carbon dioxide) PaCO2 level, forced expiratory volume in one second (FEV1), body mass index (BMI), and waist and neck circumferences.
Results: By 3-month ICS administration, this study demonstrated significant reduction of mean AHI and nocturnal oxygen desaturation index along with remarkable improvement of FEV1, diurnal PaCO2 level and nocturnal SaO2 (P< 0.05). Meanwhile, BMI and waist and neck circumferences measurement showed no noticeable changes. Conclusion: As we have not found any literature demonstrating, this is the first study which has evaluated the effect of ICS on AHI in overlap syndrome. Because of a remarkable improvement in obstructive sleep apneas, this study suggests that ICS might be beneficial in treatment of overlap syndrome.

Keywords: Apnea-hypopnea index, COPD, inhaled corticosteroids, obstructive sleep apnea, overlap syndrome

Article

The impact of 0.5% chlorhexidine oral decontamination on the prevalence of colonization and respiratory tract infection in mechanically ventilated patients.Preliminary study

Aims: To determine the effect of Chlorhexidine (CHX) 0.5% oral decontamination on the incidence of colonization/ infection of lower respiratory tract in critically ill mechanically ventilated patients. Methods: The study was conducted in the multidisciplinary ICU. 30 patients, mechanically ventilated for at least 48 hours, were included. The oral care was performed every 6 hours (6 h CHX group) or 12 hours (12 h CHX group). Tracheal samples were collected every day and the mucosal plaque score (MPS) was also assessed. Results: The MPS score averages were between 3.8 and 6 in the 6 hours CHX group and between 3.6 and 5 in the 12 hours CHX group. There was no positive association between MPS score and frequency of CHX decontamination (p= 0.898). For 60% of patients in 6 h CHX group and for 40% of patients in 12 h CHX group, colonization did not develop until leaving the study. No significant difference were found between groups with respect to frequency of colonization based on its time of onset (p= 0.523). There is a relationship between the isolation of MRSA and CHX oral decontamination at 12 hours (φc =0.392, p=0.032). Conclusions: In our preliminary study, no signifficant differences were found between 6 or 12 hour CHX oral decontamination with respect to MPS score and colonization. However, MRSA is vulnerable to 6 hours CHX decontamination. Larger sample size studies are required to determine the efficacy of CHX in the prevention of colonization or respiratory tract infections in mechanically ventilated patients.

Keywords: colonization, oral decontamination, chlorhexidine, intensive care unit

Article

Modified minimally invasive pectus repair in children, adolescents and adults: an analysis of 262 patients

In order to achieve safe and successful funnel chest treatment even in older patients and reduce postoperative complications, we modified the procedure of minimally invasive pectus repair using the single-piece pectus bar (PSI® Hofer Medical, Austria) with no metal abrasion. The features of modified minimally invasive funnel chest correction (MMIPR) are the following: (a) additional subxiphoidal incision, (b) anterior mediastinalmediastinoscopic mobilization, (c) mediastinoscopy, (d) elevation of the funnel during pectus bar placement, and (e) fixation of the implant ends in a latissimus dorsi muscle bag, below the anterior margin of the muscle. In older funnel chest patients with a stiff thorax, a curved sternum, marked asymmetry or a mixed pigeon/funnel chest, the minimally invasive correction method has to be supplemented by additional surgical measures (MEMIPR) such as partial sternotomy (23%), slit-rib chondrotomy under thoracoscopic guidance (Rokitansky method; 48%), rib resection (5%), and occasionally rib osteotomy. In 8 patients with residual minor deformities we administered an ultrasoundguided Macrolane® injection (5 to 20 cc). 262 patients (mean age: 17.7±7 years) were eligible for analysis. The large majority of them underwent MIPR between the age of 14 and 20 years; 6 patients were older than 40 years. The pectus bar implant was left in the chest for a period of 1.4 to 6.5 years. Modified minimally invasive pectus repair (MMIPR) was performed in 121 patients (mean age: 15.2±5 years). The majority of patients received one pectus bar; 13.2% received two bars. Modified extended minimally invasive pectus repair (MEMIPR) was performed in 141 patients (mean age: 22.5±8 years); two pectus bars were used in 58.1% of cases. We observed no bar dislocation. Minimal bar movements were noted in 1.6% (MEMIPR) and 4.9% (MMIPR) of cases. With the MEMIPR technique, subcutaneous hematoma was observed in 4.1% of patients. No re-thoracotomy was required in the 262 patients who underwent MMIPR or MEMIPR. After a mean period of 3.4 years the implants were removed surgically in 103 patients; recurrences were observed 0.9%. Our procedures of MMIPR and MEMIPR with a single-piece pectus bar permitted safe and successful surgery in patients who required complex funnel chest correction.

Keywords: pectus excavatum, modified extended minimally invasive repair, Rokitansky method, older patients, adults

Article