General reviews

Abstract

Early diagnosis of lung cancer by non-invasive methods has a low sensibility: 60% of peripheral cancers could be diagnosed by computed tomography, 60% of the central ones by sputum cytology. More specific for detecting central microinvasive lesions could be bronchoscopy with autofluorescence, but this is a method with a low number of patients to be performed on, because of the specific technique. For all these reasons there are some other methods to be tried in this respect - one of them is to find one or more molecules - tumoral markers - which have to be specific in establishing the risk of developing lung cancer, to make an early diagnosis of cancer and to predict the evolution under treatment. The detecting tumoral markers in sputum, blood, bronchoalveolar lavage was not so largely explored related to the final goal - the possibility of identifying and quantifying the most specific ones for the screening of lung cancer.

The present paper has as purpose to make an review of tumoral markers - "classical" markers as: CEA, NSE, TPA, β2 microglobulina, CA 125, CA 15-3 - considered not such a high sensibility and specificity for lung cancer screening versus new molecules, studied intensively as: SCC-Ag, CYFRA 21-1, ferritin, sIL-2R, CCK-BB, glycosyltransferases. Those new molecules have a higher sensibility, but also could have a higher specificity for each type of lung cancer.

Key words: lung cancer, non small, biomarkers

Abstract

The aim of this paper is to compare the new polysomnography staging manual according to American Academy of Sleep Medicine with Rechtschaffen & Kales rules, underlying the newly introduced aspects and illustrated with polysomnographic images. The new rules simplify the staging but increase the time of electrodes application. They were established on the base of low levels of evidence, without being

included in the multicenter statistical validation. For the first time in literature are given details about the criteria for the interpretation of sleep in children, but there are problems still remain unanswered, such as those regarding the scoring of hypopnea. In Romania, the main problem is primarily limited access to investigation and the deficit of health professionals.

Key words: polysomnography, methodology, scoring, American Academy of Sleep Medicine rules, Rechtschaffen & Kales rules.

Abstract

Developing new treatments for chronic obstructive respiratory disease is still a far away dream. Naturally, researchers focused on improving efficiency of existent molecules. A new beta-2 adrenergic class was born recently: the ultra-LABA's. First player that was already adopted in current practice is indacaterol. Indacaterol is a beta-2 adrenergic rapidly acting, with an onset of action in 5 minutes, like salbutamol and formoterol but with a sustained bronchodilator effect, that last for 24 hours, like tiotropium. Indacaterol clinical study program, INERGIZE, followed three main directions: prove superiority over placebo, evaluate indacaterol among others established bronchodilators routinely used in COPD management and establish long term safety profile. In patients with moderate-severe COPD, indacaterol, both 150 and 300 μg showed a rapidly and sustained improvement in pulmonary function, increasing FEV1 with 130-180 ml (p<0.001) versus placebo (Inlight 1). Comparing to salmeterol, there was a superior improvement in FEV1, that starts from day 1 and last unchanged till the end of study (p<0.01 vs salmeterol; Inlight 2). Over 12 mcg formoterol twice daily, 300 μg indacaterolul, once daily showed superiority in improving pulmonary (p<0.001 vs formoterol; Involve), that is present form day 2, with no ceiling effects over one year, unlike formoterol. As an outcome for secondary objectives, indacaterol proved superior improvement in breathlessness at 12 weeks, (TDI score, p<0.01 vs formoterol). Regarding exacerbations, indacaterol was at least as effective in reducing exacerbations, as formoterol. Open-label study over tiotropium, INHANCE, compared indacaterol, 150 and 300 μg, with tiotropium, 18 μg, both once daily, for 6 month. At 12 weeks, primary objective for all indacaterol studies, both indacaterol doses showed FEV1 improvement of 180 ml versus 140 ml for tiotropium (p≤0.01). % of patients with improvement in TDI score > 1 unit at the end of the study was in favour of indacaterol 300 μg (p≤0.01). Authors conclusion was that once daily indacaterol is at least as effective as tiotropium, in its symptoms and health status. The availability of a new once daily bronchodilator, that maximize efficiency of beta-2 adrenergics may provide clinicians with more flexibility in treating COPD, and may increase adherence to treatments for patients.

Keywords: Indacaterol, ultra-LABA's, COPD, asthma

Abstract

Bronchiectasis is a complex pathology which consists of some important morphopathological changes in the lumen of the bronchi that consecutively determines recurrent pulmonary infections with a diversity of germs. The repeated episodes of infection are associated with chronic colonization of the respiratory system with certain pathogen microorganisms and play an important role in the maintenance of the

chronic inflammatory syndrome, as well as the decline of the pulmonary function. This chronic inflammation is represented by a series of physiopathological changes (the raised number of neutrophiles, macrophages, alteration in the expression of pro-inflammatory cytokine and

adhesion molecules). The first hand treatment of patients with infected bronchiectasis the antibiotic treatment, followed by anti-inflammatory treatment and adjuvant therapy. The use of macrolides in the long term treatment schemes has confirmed their role in the reduction of the chronic inflammatory syndrome associated with this disease, moreover its association with the anti-inflammatory medication has significantly improve the patient's health status.

Key words: bronchectasis, treatment, antibiotics.