Search

Background: The diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is essential but polysomnography (PSG) is expensive and time consuming. Oximetry has been used as a less expensive indicator of OSAHS. The aim of the study was to evaluate the clinical utility of the combination of oximetry with four different questionnaires: Stop, Stop Bang (S-B), Berlin questionnaire (BQ), Epworth Sleepiness Scale (ESS) in order to identify patients at risk for OSAHS compared with in-laboratory PSG. Methods: Patients visiting a sleep clinic were prospectively studied. They completed Stop, S-B, BQ and ESS. Home oximetry and in laboratory PSG were performed within 3–20 days. Results: A total of 204 patients were included in the study (77.5% males, mean age 51.8±13.8 years, BMI 32.8±6.2 kg/m 2 , SaO 2 % awake 95.7±2). S-B had the highest sensitivity (Se) (97.5%) and negative predictive value (NPV) (62.5%) but the lowest specificity (Sp) (9%), whereas ESS had the best Sp (75%) and positive predictive values (PPV) (81.4%). The predictive values of questionnaires improved as the severity of OSAHS worsened. The predictive values of oximetry were high for severe but low for mild and moderate OSAHS. For that oximetry was combined with different sleep questionnaires in different OSAHS severity groups, but with no improvement in the predictive values. Conclusions: Oximetry may be used as a tool for identifying severe OSAHS. For mild and moderate disease the combination of questionnaires did not improve the diagnostic accuracy and especially for symptomatic patients with negative results, the need of PSG is essential.

Tuberculosis has not been eradicated despite the huge effort of the medical community, due to immigration and AIDS. The large amount of immigrants in Greece and their subsequent residency in specific reception centers (Hotspots) require thorough evaluation of their symptoms in order to prohibit highly contagious diseases like tuberculosis. A 28-year-old female refugee from Afghanistan, with a free medical history, came in Greece and stayed in Samos. Due to a steadily worsening dyspnea for 2 months and cough with purulent sputum antibiotics/inhaled bronchodilators were prescribed. An X-ray revealed a mild enlargement of the left hilum. The patient was transferred and admitted to our department due to respiratory failure and fever. The CXR revealed a large opacity of the left lung and CT complete atelectasis of the LUL and LLL with presence of semiliquid secretions in the left main bronchus. There was leukocytosis (polymorphonuclear). Ampicillin/sulbactam, azithromycin and bronchodilators were firstly prescribed. Blood samples cultured no microorganism, tests for viral hepatitis and HIV were negative. The bronchoscopy revealed white, soft plaques in the mucosa of the trachea and the left main bronchus. The endobronchial biopsies were negative for malignancy and the cultures from bronchial secretions were negative for bacterial microorganisms and mycobacterium. The molecular test (PCR) in bronchial secretions detected M. tuberculosis complex. The antibiotics were discontinued and an anti-TB treatment was set (HREZ). Due to the detection of isoniazid resistance, moxifloxacin and amikacin were added to the treatment. The patient was transferred to MDR-TB Unit and discharged 2 months later with a marked improvement. She went to Germany with instructions for treatment continuation. Tuberculosis can imitate any disease. High suspicion and prompt diagnosis are required in order not only to cure but also to eliminate the spread of this highly contagious and fatal disease. A national TB programme must be implemented effectively to refugee and displaced population.

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.

As diffuse alveolar hemorrhage is defined the clinical pathological syndrome characterized by hemoptysis, diffuse alveolar infiltrates, acute respiratory failure and anemia. It is a life-threatening condition and a medical emergency. Causes are multiple and variable. A 75-year-old male, ex-smoker, with known coronary artery disease and paroxysmal atrial fibrillation treated with aspirin, presents due to low grade fever and bloody sputum. Hemodynamically stable, without respiratory failure, but with multiple alveolar infiltrates on chest imaging and anemia. Initially treated as lower respiratory tract infection with intravenous antibiotics while anticoagulant treatment was interrupted. Full laboratory testing for anemia, collagen vascular diseases and specific and nonspecific infections was performed. Anemia was normochromic, normocytic, without findings of hemolysis. Diffuse bilateral alveolar infiltrates were revealed on thorax computer tomography. Diagnostic bronchoscopy was performed with negative results for either infection or malignancy, while bronchoalveolar lavage analysis revealed siderophages 81% of alveolar macrophages. The patient underwent full pulmonary function testing, which revealed obstructive respiratory disease with a low diffusion capacity. Due to continuing life threatening anemia, despite blood transfusions, in combination with the results of the laboratory tests, the patient was started on high dose intravenous corticosteroids, followed by intravenous cyclophosphamide every 28 days for five cycles. Rapid improvement was achieved with elimination of chest CT infiltrates and normalization of blood tests and pulmonary function tests. At present peros treatment with azathioprine and low dose corticosteroids is given. Diffuse alveolar hemorrhage is a clinical pathological syndrome caused by different pathophysiological mechanisms, including capillary failure stress, diffuse alveolar damage and capillaritis. The most common cause is capillaritis associated with systemic autoimmune diseases, mostly ANCA-related vasculitides. The presence of diffuse alveolar hemorrhage, with pulmonary capillaritis without clinical or serological findings of a systemic autoimmune disease is known as isolated pauci-immune pulmonary capillaritis. The treatment is based on corticosteroids and cyclophosphamide.