Smoking Obstructive Sleep Apnea: Arguments for a Distinctive Phenotype and a Personalized Intervention.

BACKGROUND: This is the first study that aims to define smoking, with obstructive sleep apnea (OSA), as a phenotype (SOSA). Moreover, we wanted to demonstrate the deleterious effects of the continuation of smoking on OSA. METHODS: The cross-sectional study highlighted four dimensions of SOSA: the demographic and anthropometric features, the symptoms, the comorbidities, and the sleep study parameters. This study compared these characteristics between current smokers (CS), those who have never smoked (NS), and ex-smokers (ES) with OSA. RESULTS: More men (83.95% in CS, versus 66.67% in NS) and an earlier onset of OSA (average age = 50.05 in CS, versus 52.26 in NS, p = 0.04) were recorded among CS. The distinguishing symptom of CS was daytime sleepiness, with an Epworth score that was significantly higher than in NS. Chronic obstructive pulmonary disease (COPD) was significantly more prevalent in CS (38.27%) than in NS (1.51%) (p < 0.001). The severity of OSA, consisting of a higher apnea-hypopnea index, a higher oxygen desaturation index, and a longer time spent below 90% oxygen saturation during sleep was significantly influenced by smoking. CONCLUSIONS: The SOSA phenotype includes younger male patients with a higher waist circumference, suggesting central obesity. They have a higher prevalence of COPD and a greater severity of OSA, in correlation with the number of pack-years of smoking.

Progressive intraparenchymal lung nodules dissemination in a heavy smoker and seropositive rheumatoid arthritis suspected of tuberculosis relapse.

Anthony Caplan first described rheumatoid lung nodules associated with pneumoconiosis in coal-miners (Caplan, 1953). Intraparenchymal lung nodules were later described in rheumatoid arthritis (RA) patients who were never exposed to coal dust and/or without pneumoconiosis. Rheumatoid lung nodules are usually detected in unselected patients: 0.2% in chest radiography and 4% in high-resolution computed tomography (Nannini et al., 2008). Patients could be reluctant to perform surgical lung biopsy for an accurate histopathological diagnosis. We present a peculiar association between a seropositive RA and a presumptive active tuberculosis (TB) disease in a 59-year-old male patient, ex-smoker with a previously healed pulmonary TB disease. The purpose of this report is to describe an unusual case of a presumptive relapse of the nodular TB disease, which progressed to an extensive nodular bilateral dissemination under anti-tuberculosis therapy, mimicking a metastatic carcinoma. The diagnosis of rheumatoid necrobiotic lung nodules was confirmed after open biopsy left pulmonary was performed. Formalin-fixed paraffin-embedded pulmonary rheumatoid nodules were processed for histology and stained with Masson's trichrome. Central structure of the removed pulmonary nodules is typical of a rheumatoid nodule with central necrosis surrounded by a palisade of macrophages. The accumulation of anthracotic pigment was noticed inside the pulmonary nodules in a RA patient without professional exposure to coal or mineral dust. This rare entity is an appearance of the rheumatoid nodules lung syndrome and anthracosis in a heavy tobacco former smoker.

Smoking, snoring and obstructive sleep apnea.

Obstructive sleep apnea (OSA), with an apnea/hypopnea index (AHI) > or =5 events per hour, is recognized as an important cause of medical morbidity and mortality, being associated with a wide range of significant medical consequences, including arterial hypertension, cardiovascular diseases, metabolic diseases, neurological diseases and psychological effects. Tobacco smoking is considered a predisposing factor for pulmonary and cardiovasculary diseases and a risk factor for developing OSA. Since snoring is frequent in smokers and a common symptom, even a preclinical form of OSA, it is reasonable to speculate that smoking is an independent risk factor for snoring and may be associated with OSA. Current studies have observed there is a synergistic effect between smoking and OSA, both increasing the risk of cardiovascular disease through oxidative stress, endothelial dysfunction and abnormal inflammatory response. OSA, itself could be responsible for nicotine addiction.

[Sternal chondrosarcoma and the complications poststernectomy]. / Condrosarcomul sternal si complicatiile poststernectomie.

Primary tumors of the sternum are unusual, and, of these chondrosarcoma is extremely rare. Prior cases were more frequent in men. It is the consensus that central (axial) skeletal lesions are always suspected of malignancy. It is difficult to deduce from the roengenographic and pathologic findings the presence of a sternal tumor. This case report of primary sternal chondrosarcoma illustrated an extremely rare cartilaginous lesion in a male 64 years old. Extensive sternal excision was indicated despite the apparent benignity of the tumor. This aggressive surgical method facilitated the diagnosis of a malignant tumor with moderate cellular differentiation G2 chondrosarcoma. After surgery done, bilateral pleural empiema occurred.

[Prevalence of sleep apnoea syndrome--the experience of "Marius Nasta" Institute of Pneumology, Bucharest]. / Prevalenta sindromului de apnee în somn--experienta Institutului de Pneumologie "Marius Nasta" Bucuresti.

UNLABELLED: The study is a retrospective one based on the analysis of the records of the patients who have been diagnosed with Sleep Apnoea Syndrome (SAS) in "Marius Nasta" Institute of Pneumology sleep laboratory between 1997-2007. The study demonstrated a SAS prevalence of 64,4% in a specific population. Snoring is the main symptom which brings the patients to the doctor (74,5%); regarding the severity of the disease 62,4% were moderate and severe cases. CONCLUSIONS: Sleep Apnoea Syndrome is a frequent disease, relatively easy to diagnose and to treat. If we want to have real epidemiological data regarding SAS prevalence in Romania we should have large epidemiological studies in all the regions of the country.