We present a case of a male patient who underwent right-sided pneumonectomy due to central low-grade squamous cell carcinoma of the right lung, chemo-, radio-, and immunotherapy. However, the disease ...progressed. In addition the patient got SARSCoV-2 pneumonia in the left lung, followed by postpneumonectomy empyema. Right-sided uniportal video-assisted thoracoscopy, debridement, and definitive drainage of the pleural cavity were performed.
Diaphragmatic dysfunction is common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the prognostic significance of impaired diaphragmatic movement at rest ...and after exercise.
This was a prospective study of patients with stable COPD. Diaphragmatic movements were examined at rest and after a 6-minute walking test (6MWT) with a convex transducer with a frequency of 3.5-5-7.5 MHz. Maximal movement of the diaphragm was measured in both right and left diaphragm, and the side with higher amplitude was selected for further analysis. Measurements obtained were evaluated for their prognostic value for a composite endpoint of moderate and severe COPD exacerbations and death in 1 year time period was assessed. In addition, postbronchodilator spirometry, symptoms, quality of life, and demographic and clinical information were collected.
A total of 96 patients were analyzed (62.5% male, mean age 65.1 years (standard deviation (SD): 8.1), mean FEV1 (% predicted): 55.8%, SD: 18.3%, mean CAT: 15.6 units, SD: 9.2). Sixty-four patients (67%) presented the composite endpoint. In the multivariate Cox analysis, FVC (HR = 0.944, p = 0.005), CAT score (HR = 1.133, p = 0.011), previous severe exacerbations (HR = 5.446, p = 0.004) and diaphragmatic movement at rest (HR = 0.932, p = 0.033) were found to be predictors of the composite endpoint. This model correctly classified 86.5% (83/96) of the patients.
Non-invasive assessment of diaphragmatic movement by ultrasound measurement both at rest and after exercise could contribute to the assessment of disease severity and prognosis of COPD.
Chronic obstructive pulmonary disease (COPD) is associated with increased lung and systemic inflammation. We aimed to identify associations between easy-to-obtain blood biomarkers and the frequency ...and severity of exacerbations.
Cross-sectional, multicentre study performed in four centres in Spain, Italy, Bulgaria, and Slovenia. Blood samples were obtained for blood cell count, C-reactive protein (CRP), alpha-1 antitrypsin (AAT) and fibrinogen analysis. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and eosinophil/basophil ratio (EBR) were calculated. Firstly, patients were divided into clinical phenotypes according to the Spanish guidelines of COPD, and secondly, patients were classified into 2 groups: non-exacerbators (≤1 ambulatory exacerbation in the previous year) and exacerbators (≥2 ambulatory exacerbations or 1 hospitalisation in the previous year). A multivariate stepwise logistic regression model was performed to identify laboratory parameters associated with exacerbators.
A total of 355 patients with a mean age 66 years (SD=8.9) were included, and 64% were male. The mean FEV1% (forced expiratory volume in the first second) was 55% (SD=20%), and the mean COPD Assessment Test (CAT) score was 15.6 (SD=7.9). One hundred ninety-six (55.2%) patients were classified in the non-exacerbator group, and 159 (44.8%) were exacerbators. Patients in the exacerbators group presented lower haemoglobin levels (p=0.019) and ERB (p= 0.023) but higher CRP levels (p=0.001). In the multivariate analysis, females, higher levels of CRP, lower FEV1% and low EBR were independently related to exacerbators.
Female sex, having a more severe impairment of lung function, higher CRP levels and a lower EBR are associated with an exacerbator phenotype in COPD.
Infectious endocarditis (IE) represents an inflammation of the heart endothelium usually as a result of bacterial colonization after trauma. Splenic abscess is a rare and dangerous extracardiac ...manifestation of IE. An expert multidisciplinary collaboration is necessary for the diagnosis and treatment strategy of this high-risk and challenging disease. Valvuloplasty and splenectomy are the mainstay of radical treatment and offer excellent long-term results. We present two cases with infectious endocarditis, complicated with splenic abscesses, which were successfully operated in the Department of Cardiac Surgery.
Two-year mortality in patients with COPD is expected to be between 10% and 49% depending on the investigated subgroup and specific patients’ characteristics.
To assess the two-year mortality in COPD ...patients following hospitalization for severe exacerbation and to describe the prognostic value of comorbidities and specific patients’ characteristics.
We included 152 consecutive patients hospitalized for COPD exacerbation and signing informed consent. The Metabolic syndrome (MS), diabetes mellitus (DM), and hypovitaminosis D were diagnosed according to international guidelines. Demographic parameters (age, sex, smoking status, and the number of pack-years) were recorded. Quality of life was examined using CAT and mMRC questionnaires. The lung function was assessed by spirometry. Two-year mortality was determined according to data extracted from the national death register.
Two-year mortality rate was 11.8%. The investigated comorbidities – DM, MS, arterial hyper-tension (AH) and vitamin D status were no predictors of the two-year mortality. Mortality was increased in patients with mMRC ≥ 2 (17.2 vs. 1.9%, p = 0.005) and CAT score ≥ 10 (14.2 vs. 0%, p = 0.045). Severe exacerbation during the previous year was a risk factor for the registered two-year mortality (17.5% vs 5.6%, p = 0.021). The two-year mortality was increased in the group with FEV1 < 50%, compared to FEV1 > 50% (18.0 vs. 7.7%, p = 0.049). Cox regression analysis showed a 3.0% increase in the mortality rate for each 1% decrease in FEV1, 6.2% for each 1% decrease in PEF, 7.8% for one year of increasing age, 4% for 1% decrease in the FEV1/FVC ratio and 7.1% for each 1 point increase of CAT (all p-values < 0.05).
The two-year mortality of COPD patients following a severe exacerbation was relatively low. Chronological age, FEV1, history for severe exacerbation during the previous year, reduced quality of life, and low BMI were all associated with increased mortality. Disease Grade C, mMRC < 2, and CAT score < 10 were associated with a favourable prognosis.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and healthcare costs worldwide. Lung cancer is the second most common cancer and is the leading cause of ...cancer mortality, accounting for almost 25% of all cancer deaths. This study aims to investigate the prevalence of COPD in patients with lung cancer (LC).
This is a cross-sectional observational study. Consecutive patients with suspected LC in a respiratory clinic were studied. The method of verification of the lung abnormalities (fibrobronchoscopy and/or transthoracic biopsy) was performed. Postbronchodilator spirometry was performed. An FEV1/FVC ratio < 0.7 was diagnostic for the presence of COPD. The association between the presence of COPD and LC with other routine tests (laboratory tests, blood gas analysis, CT) was also analyzed.
A total of 65 patients with verified LC were included. 48.4% of the LC patients in this study had COPD. There was no significant difference in the prevalence of COPD in the different subgroups of non-small cell cancer: unspecified non-small cell cancer – 62.5%, squamous cell cancer – 50%, adenocarcinoma – 45.8% (p = 0.33). Patients with COPD and LC had lower FEV1 (56.9 vs. 70.5%, p = 0.01) but not FVC (71.6 vs. 74.6%, p = 0.67). The presence of COPD in LC patients was associated with lower leukocytes (8.8 vs. 11.3 x109, p = 0.018). Squamous cell cancer was associated with a higher number of leukocytes compared to adenocarcinoma (11.0 vs. 8.4 x109, p = 0.026), although smoking showed no clear association with histology.
Nearly half (48.4%) of the patients with LC also had COPD.
Cardiac disorders are common in patients with chronic obstructive pulmonary disease (COPD). They worsen shortness of breath and physical capacity and reduce the quality of life. Ultrasound assessment ...of cardiac function could contribute to assessing the severity of the disease. This study aimed to assess the prognostic significance of echocardiographic parameters on the rate of exacerbations and mortality.
This was a prospective study of patients with COPD without exacerbation in the previous 1 month. Patients over 40 years of age, current or former smokers with more than 10 pack-years of smoking, and postbronchodilator FEV1/FVC < 0.7 were included. All patients underwent two-dimensional transthoracic Doppler echocardiography at rest by an experienced cardiologist. Echocardiographic parameters were evaluated for prognostic significance on a composite endpoint of moderate and severe exacerbations and death for 1 year. Data from postbronchodilator spirometry, symptoms, quality of life, and demographic and clinical information were also collected.
A total of 96 patients were analyzed with a mean FEV1 of 55.8%. A total of 64 patients (67%) reached the composite endpoint. A significantly higher proportion of patients with deceleration time deviations (86.2 vs. 58.2%, p = 0.0055) and increased septal thickness (55.6 vs. 24.6%, p = 0.0099) reached the primary endpoint at one-year follow-up. Echocardiographic disorders showed a correlation with the quality of life, but not with lung function.
Non-invasive assessment of cardiac function by echocardiography could be included in the complex assessment of disease severity in COPD patients.
Non-invasive ventilation (NIV) is considered a fundamental method in treating patients with various disorders, requiring respiratory support. Often the lack of beds in the intensive care unit (ICU) ...and the concomitant medical conditions, which refer patients as unsuitable for aggressive treatment in the ICU, highlight the need of NIV application in general non-monitored wards and unusual settings – most commonly emergency departments, high-dependency units, pulmonary wards, and even ambulances. Recent studies suggest faster improvement of all physiological variables, reduced intubation rates, postoperative pulmonary complications and hospital mortality with better outcome and quality of life by early well-monitored ward-based NIV compared to standard medical therapy in patients with exacerbation of a chronic obstructive pulmonary disease, after a surgical procedure or acute hypoxemic respiratory failure in hematologic malignancies. NIV is a ceiling of treatment and a comfort measure in many patients with do-not-intubate orders due to terminal illnesses. NIV is beneficial only by proper administration with appropriate monitoring and screening for early NIV failure. Successful NIV application in a ward requires a well-equipped area and adequately trained multidisciplinary team. It could be initiated not only by attending physicians, respiratory technicians, and nurses but also by medical emergency teams. Ward-based NIV is supposed to be more cost-effective than NIV in the ICU, but further investigation is required to establish the safety and efficacy in hospital wards with a low nurse to patient ratio.
Esophageal carcinoma is an extremely aggressive cancer with an early distant spread, high rate of local recurrence, and low overall survival. Herewith we present 3 patients with advanced moderately ...and low differentiated adenocarcinomas, who underwent neoadjuvant chemotherapy (nCT) (two patients) and combined nCT with neoadjuvant radiation therapy (nRT) (one patient), followed by radical surgery. Subtotal esophageal resection, proximal gastric resection, and intrathoracic right gastroesophagoplasty a modo Ivor-Lewis were performed in the first two patients, while total gastrectomy, distal third esophageal resection, splenectomy and left intrathoracic esophagojejunoplasty a modo Roux were performed in the third one. A literature review of the role of neoadjuvant chemoradiotherapy (nCRT) as part of a trimodality therapy for advanced esophageal carcinoma is presented.
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