Prevalence of Sleep Apnea in Patients with Carotid Artery Stenosis.

Obstructive sleep apnea (OSA) is a common disease affecting about 13% of men and 6% of women, usually having severe cardiovascular sequalae. OSA is responsible for the systemic inflammatory response and oxidative stress and results in endothelial injury being a risk factor for atherosclerosis. The aim of this study was to estimate the prevalence of OSA among patients with severe carotid artery stenosis. Fifty-five patients (F/M-24/31, mean age 70 ± 7 years, body mass index 28.3 ± 6.3 kg/m2) were enrolled into the study. The patients were qualified for elective surgical treatment of carotid artery stenosis. Polysomnography was performed in all patients the night before surgery. Thirty-six patients underwent surgical endarterectomy and nineteen patients underwent carotid artery stenting. Sleep apnea was diagnosed in 44 (80%) of all patients. The mean apnea-hypopnea index (AHI) was 14.5 ± 12.9. The OSA severity distribution was as follows: 22 mild, 16 moderate, and 6 severe cases. We found that the percentage of carotid endarterectomies was the greatest in mild and moderate OSA. It was approximately twofold greater than that in non-OSA patients. Carotid artery stenting was performed in nearly half of the patients in each of these groups. We conclude that OSA is highly prevalent in patients with carotid artery stenosis scheduled for carotid surgery. Nonetheless, the exact pathogenetic mechanisms underlying mutual interaction between OSA and vascular wall damage remain elusive. OSA is not routinely diagnosed among patients with advanced atherosclerosis. The study results might be an argument for performing polysomnography in patients with carotid artery stenosis.

Primary pulmonary MALT lymphoma - case report and literature overview.

OBJECTIVE: Primary pulmonary lymphomas (PPL) are rarely taken into consideration in the differential diagnosis of lung lesions. The aim of this report is to characterize the symptoms, diagnosis and treatment of primary MALT lymphoma of the lung. CASE REPORT: We present the case of a 48-year-old man who was admitted to hospital with a history of coughing, fever, fatigue and non-specific lesions on his chest X-ray. RESULTS: The patient was treated for pneumonia, but showed no improvement. A computer tomography revealed atypical lesions. After an initial examination and tests, no diagnosis could be established. A thoracotomy with an open lung biopsy was performed and MALT lymphoma was finally diagnosed. The patient underwent chemotherapy and showed a significant improvement. CONCLUSIONS: Primary MALT lymphoma is a rare disease and its diagnosis is difficult. There is no non-invasive test that is specific enough, so a proper diagnosis can only be established by a histopathological examination. The disease has a slow and mild course and the response to treatment is satisfactory.

Low-dose computer tomography as a screening tool for lung cancer in a high risk population.

The aim of the study was to evaluate the usefulness of low-dose computer tomography as a screening tool for early stage lung cancer. The study was performed in 332 individuals aged 55-70 who were asymptomatic, who had not previously suffered from cancer, and who smoked at least ten packs of cigarettes a year. Baseline and repeated LD-CT scans were performed. Pulmonary nodules were classified according to the size and morphology, and the results were categorized as negative (no nodules observed), semi-positive (nodules of 4 mm or smaller in diameter) and positive (nodules 5 mm or larger). Based on the category of the patient, either a repeat low-dose CT, a bronchoscopy with or without a biopsy, or a PET-CT was performed. The baseline screening showed 59 positive results. Eighteen patients were hospitalized and underwent bronchoscopy and biopsy. One of these patients had Stage I non small cell lung carcinoma (NSCLC) and a lobectomy was performed. Three patients had Stage IV NSCLC and were referred for chemotherapy. We identified 103 semi-positive results. Only 25 of those patients had a repeat scan because of noncompliance. We observed no significant growth of diagnosed nodules in a semi-positive group. Low-dose CT can be used as a screening tool for early stage lung cancer. A high percentage of false-positive results are observed. There are difficulties in diagnosing nodules in patients with post-tuberculosis changes. A high rate of noncompliance was noticed.