Foreign Body in the Tracheobronchial Tree as a Cause of Hemoptysis in an Adult Without Risk Factors for Aspiration: A Case Report.

Although aspiration of a foreign body into the trachea and bronchi can occur in all age groups, it is more common in infants and young children. Foreign bodies in the tracheobronchial tree are uncommon in adults and mainly present in patients with dysphagia and an altered level of consciousness. The identification of foreign bodies in the tracheobronchial tree is frequently overlooked or delayed, leading patients to present later with chronic symptoms and potential complications. These complications may include persistent coughing, wheezing, obstructive pneumonitis, bronchiectasis, and abscess formation secondary to recurrent pulmonary infections. This article aims to present the case of a 27-year-old patient without risk factors for aspiration who has experienced recurrent self-limiting hemoptysis episodes for five years. Bronchoscopy revealed a foreign body at the entrance to the middle lobe bronchus. The presence of a foreign body in the tracheobronchial tree should be considered in any patient with recurrent hemoptysis. Bronchoscopy leads to accurate diagnosis, treatment, and prevention of complications.

Association between smoking cessation and alterations in forced expiratory volume in one second (FEV1). A Follow-Up Study from a Greek Tobacco Cessation Clinic.

Background: Cigarette smoking is the most important preventable cause of several diseases such as malignancies, pulmonary and cardiovascular diseases. Smoking cessation is now supported by both behavioral counseling and medical pharmacotherapy and is the only effective approach for slowing down an accelerated decline in forced expiratory volume in one second (FEV1). Our study aims to examine changes in forced expiratory volume in one second (FEV1) after smoking cessation for smokers attending our smoking cessation clinic their correlation to smokers' demographic characteristics. Methods: 114 smokers (48 males and 66 females), with a mean age of 48.36±10.49 years, were enrolled. They were classified in 4 groups, according to their age; <40 years (Group Α), 41-50 years (Group Β), 51-60 years (Group C), >60 years (Group D) and underwent Spirometry on the 1st day of visit, one month (2nd visit) and, 3 months later (3rd visit). Findings: Statistically significant increase in FEV1 values at the 2nd and 3rd visit compared to the 1st visit was observed in smokers who quit smoking in Group Α, B and C (p<0.05). In addition, a statistically significant decrease in FEV1 values at the 2nd and 3rd visit compared to the 1st visit was noticed in smokers who continued smoking in Group B, C and D (p<0.05). Conclusion: Smoking cessation achieved through smoking cessation support led to the improvement of FEV1 values within 3 months. The greatest benefit was observed in smokers under the age of 60.

Role of pulmonary function testing in inflammatory bowel diseases (Review).

Inflammatory bowel disease (IBD) is a term used to describe chronic inflammatory entities of the gastrointestinal system with an unclear etiology. Extra-intestinal manifestations beyond the involvement of the gastrointestinal tract can also occur. Several studies have investigated the alterations of pulmonary function tests (PFTs) in patients with IBD. To the best of our knowledge, the present review article is the first to summarize all the types of PFTs that have been performed in patients with IBD. Contradictory data exist regarding the association of PFT alterations with disease activity. PFT abnormalities can develop in individuals with IBD who have no clear clinical signs or radiological evidence, suggesting that PFTs may be useful in detecting latent respiratory involvement. The most prevalent finding in the PFTs of adults and children with IBD is an impairment in the diffusing capacity for carbon monoxide, although evidence on the other tests, particularly spirometric values, and their connection with disease activity is inconsistent.

Staphylococcus aureus mediastinitis following a skin infection in a non-immunocompromised patient: A case report.

Mediastinitis is a severe inflammation of the structures located in the mid-chest cavity. Three main causes of infective mediastinitis are traditionally recognized: Deep infection of a sternal wound following cardiothoracic surgery, perforation of the esophagus, and the descending necrotizing mediastinitis as a result of odontogenic, pharyngeal or cervical infections. Mediastinitis, as a complication of skin infection with hematogenous spread is infrequent. Methicillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacteria, and is responsible for numerous severe infections. MRSA mediastinitis is a rare infection and is typically associated with complications of sternotomy and retropharyngeal abscesses. Here, the second known case of mediastinitis of a hematogenous origin in a non-immunocompromised 41-year-old patient following primary skin infection, accompanied by sternal osteomyelitis, lung consolidation and pleural effusion is described; MRSA was the responsible pathogen. The clinical course was favorable after 6 weeks of antibiotics administration without drainage or surgical intervention.

Pulmonary adverse events due to immune checkpoint inhibitors: A literature review.

Cancer immunotherapy aims to stimulate the immune system to fight against tumors, utilizing the presentation of molecules on the surface of the malignant cells that can be recognized by the antibodies of the immune system. Immune checkpoint inhibitors, a type of cancer immunotherapy, are broadly used in different types of cancer, improving patients' survival and quality of life. However, treatment with these agents causes immune-related toxicities affecting many organs. The most frequent pulmonary adverse event is pneumonitis representing a non-infective inflammation localized to the interstitium and alveoli. Other lung toxicities include airway disease, pulmonary vasculitis, sarcoid-like reactions, infections, pleural effusions, pulmonary nodules, diaphragm myositis and allergic bronchopulmonary aspergillosis. This review aims to summarize these pulmonary adverse events, underlining the significance of an optimal expeditious diagnosis and management.

Solitary Fibrous Tumor of the Pleura as a Cause of Type II Respiratory Failure.

Solitary fibrous tumor of the pleura is a rare type of tumor originating from the mesenchyma of the pleura. It is traditionally a benign lesion. However, in some cases malignant features have been observed. The majority of solitary fibrous tumors of the pleura are noticed by accident on chest X-ray, while the main symptoms include cough, thoracic pain and dyspnea. When growing within the thoracic cavity, these tumors exert pressure on vital adjacent tissues and large vessels. In addition, these tumors can be accompanied with paraneoplastic syndromes that are completely resolved after tumor resection. Respiratory failure is a rare complication of this tumors, which is reported in a handful of cases. Herein, we report a rare case of a benign solitary fibrous tumors of the pleura in a 75-year-old woman complicated with type II respiratory failure.

Cytomegalovirus pneumonia in an immunocompetent host with primary ciliary dyskinesia: A case report.

Primary ciliary dyskinesia (PCD) is an autosomal-recessive inherited disease caused by mutations in genes involved in ciliary structure and function leading to impaired mucociliary clearance and repeated or chronic, usually bacterial, infections of the upper and lower airways and decreased lung function and bronchiectasis. Cytomegalovirus (CMV) is a DNA virus that usually causes subclinical infection and in 10% of the patients causes a mononucleosis-like syndrome. CMV is a causative agent of serious illness in vulnerable immunocompromised groups such as transplant recipients, patients with immunodeficiency or malignancy and neonates. Life-threatening infection due to CMV, including CMV pneumonia, is not common in immunocompetent patients. In this report we describe a case of an otherwise immunocompetent woman, suffering from PCD, who developed severe CMV pneumonia.

Simultaneous Pleural and Pericardial Effusion as First Clinical Manifestations of Giant Cell Arteritis: A Case Report.

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of unknown aetiology occurring in the older patients and affecting mostly the cranial branches of the arteries originating from the aortic arch. GCA is associated with polymyalgia rheumatica (PMR). Clinical features of the disorder include headache, scalp tenderness, jaw claudication, temporal artery abnormalities on physical examination, vision changes, and symptoms associated to PMR. Systemic manifestations include fever, anorexia and weight loss while less rare manifestations are related to the nervous system, the respiratory system, the pericardium and extra-cranial large vessels. Here we report a rare case of simultaneous pleural and pericardial effusion as the first manifestations of GCA. The diagnosis was made with a temporal artery biopsy. Such a diagnosis should, therefore, be considered in older patients presenting with pleuropericardial manifestations, even in the absence of typical clinical features.

Bronchial Fibroepithelial Polyp With Severe Hemoptysis as First Manifestation: A Case Report.

Fibroepithelial polyps are uncommon benign tumors that mostly occur in skin, oral cavity and genitourinary tract. These lesions have common morphological features with other mesenchymal tumors such as angiomyofibroblastoma, aggressive angiomyxoma, and cellular angiofibroma and present with numerous histological appearances. Benign endobronchial tumors are rare. These neoplasms have a slow growth and usually are related to bronchial obstruction. Only a few cases of bronchial fibroepithelial polyps have been reported. Bronchial fibroepithelial polyps might present with airway stenosis resulting in atelectasis and bronchiectasis and the most frequent manifestations are recurrent infection, refractory asthma, dyspnea and hemoptysis. Chronic inflammation is associated with the pathogenesis of fibroepithelial polyps. Treatment varies according to mainly to the size and symptoms. Small lesions presenting with few symptoms can be treated with corticosteroids and antibiotics while invasive techniques including bronchoscopic resection of the polyp or lobectomy are used for larger lesions. We report a case of a bronchial fibroepithelial polyp with severe hemoptysis as the first manifestation. Physicians should always suspect these lesions in the differential diagnosis of hemoptysis and with initial right diagnosis surgical procedures can be avoided.

Correlation Between Serum Levels of 25-Hydroxyvitamin D and Severity of Community-Acquired Pneumonia in Hospitalized Patients Assessed by Pneumonia Severity Index: An Observational Descriptive Study.

Introduction Pneumonia severity index (PSI) is a prognostic index used for estimating the possibility of death due to community-acquired pneumonia. Vitamin D is a fat-soluble vitamin, essential for calcium and phosphate homeostasis. Vitamin D also has antimicrobial properties and according to recent studies, its deficiency may be correlated to an increased frequency of respiratory infections. The serum concentration of 25-hydroxyvitamin D (25(OH)D) is the best vitamin D status index reflecting vitamin D produced in the skin and offered from food and dietary supplements. Methods The study involved patients, who fulfilled the criteria of community-acquired pneumonia. The exclusion criteria were: patients <18 years old, severely immunocompromised patients, patients with tuberculosis, patients with malabsorption disorders, nursing home residents, patients with a history of malignancy, chronic renal or liver disease, patients with congestive health failure or cerebrovascular disease, and patients receiving vitamin D as a supplement. The following parameters, recorded on admission, were evaluated: age, sex, co-morbidity, residence in a nursing home, duration of symptoms, clinical symptoms, confusion, blood gas analysis, chest radiograph (pleural effusion), and laboratory parameters. The patients were classified in risk classes according to the PSI. Blood samples were collected within the first 48 hours of hospitalization. The serum levels of 25-hydroxyvitamin D were determined by electrochemiluminescence binding assay in Roche Cobas 601 immunoassay analyzer and mean serum levels of 25-hydroxyvitamin D in each risk class were calculated. For statistical analysis, the statistical program SPSS for Windows version 17.0 (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL) was used. Results A total of 46 patients, 28 males and 18 females, with a mean age of 71.5±17.57 years, hospitalized with community-acquired pneumonia, were included. Sixteen patients (35%) had a severe deficiency, with 25(OH)D levels <10 ng/ml, 17 patients (37%) had moderate deficiency with 25(OH)D levels between 10-20 ng/ml, and 13 patients (28%) had insufficiency with 25(OH)D levels between 20-29 ng/ml. According to the PSI, four (8.7%) patients with a mean age of 53.75±15.43 years were classified as risk class I, 10 (21.7%) patients with a mean age of 54.7±14.82 years as class II, 10 (21.7%) patients with a mean age of 68.41±3.96 years as class III, 17 (37%) patients with a mean age of 84.82±9.73 years as class IV, and five (10.9%) patients with a mean age of 80.2±9.41 years as class V. The mean levels of 25(OH)D were 19.11±11.24 ng/ml in class I, 16.81±8.94 ng/ml in class II, 16.65±9.18 ng/ml in class III, 14.76±10.22 ng/ml in class IV, and 7.49±4.41 ng/ml in class V. There was a positive correlation between low levels of 25(OH)D and the pneumonia severity and statistically significant difference between the mean levels of 25(OH)D in class V (7.49±4.41 ng/ml) compared to overall mean levels in classes I, II, III and IV (16.15±9.49 ng/ml), with p<0.05. Conclusions According to our results, there was a positive association between low levels of 25-hydroxyvitamin D and community-acquired pneumonia severity assessed by PSI. The determination of 25-hydroxyvitamin-D status, mostly in patients >60 years old, may prevent severe community-acquired pneumonia.

Evaluation of Immature Platelet Fraction in Lower Respiratory Tract Infections: A Retrospective Study.

Introduction Immature platelet fraction (IPF) is a parameter of an automated hematologic analyzer and is related to platelet size and cytoplasmic RNA content. It reflects thrombopoiesis and is often used as the marker of platelet activity. IPF has been evaluated mostly in hematologic disorders and has also been evaluated in patients with gestational hypertension, sepsis, autoimmune diseases and in hospitalised patients with neutrophilia. Platelets, asides from the maintenance of hemostasis, release inflammatory mediators that can modify leukocyte and endothelial responses to various inflammatory stimuli. Lower respiratory tract infections are the leading cause of death from infections worldwide. The role of platelets in lower respiratory tract infections has been reported in many studies. IPF, which is related to platelet activation, has not been evaluated in patients with lower respiratory tract infections. Methods The study involved patients who fulfilled the criteria of community-acquired pneumonia (CAP) and aspiration pneumonia (AP). In addition, age and sex-matched healthy controls were involved. Whole blood samples were collected from healthy controls and from the patients on admission. The mean IPF% and C-reactive protein (CRP) levels were measured in patients with CAP, in patients with AP and in healthy controls. The mean IPF% values in patients with infection were compared to mean IPF% values in healthy controls. The mean IPF% values were compared to mean CRP levels in patients with infection. Additionally, the mean IPF% values in patients that died in the first 14 days were compared to the mean IPF% values in patients that were alive. The statistical analysis of data was performed with the Statistical Package for the Social Sciences (SPSS) for Windows, Version 13.0 (SPSS Inc, Chicago, IL).  Results The study population consisted of 45 patients (27 patients with CAP and 18 patients with AP), 27 males and 18 females, with a mean age of 72.11 ± 16.4 years and 39 healthy controls, 22 males and 17 females with a mean age of 64.2 ± 14.8 years. The mean CRP levels in patients with infection were 155.2±119.1 mg/dl. The mean IPF% value of patients with infection was 2.76 ± 2.27 and the mean IPF% value of controls was 1.72 ± 0.77 (p < 0.006). The IPF% value in patients with CAP was 2.55 ± 2.02 and in patients with AP 3.07 ± 2.64 (p = 0.595). The mean IPF% value in patients with infection had no linear correlation with CRP value in these patients (r = 0.076, p = 0.62). The mean IPF% value in all patients that died in the first 14 days was 3.75 ± 2.44 and the mean IPF% value in all patients alive was 2.35 ± 2.11 (p = 0.06). The mean IPF% value in patients with CAP who died in the first 14 days of hospitalisation was 5.54 ± 3.17 and in patients with CAP who were alive was 1.87 ± 0.72 (p = 0.06). The mean IPF% value in patients with AP who died was 2.63 ± 0.85 and in patients with AP who were alive was 3.41 ± 3.51 (p = 0.554). Conclusions Mean IPF% value is greater in patients with lower respiratory tract infections, including CAP and AP, compared to healthy controls. There is no linear correlation between IPF values and CRP values in patients with lower respiratory tract infections. In addition, there is a difference in mean IPF% value between patients who died in the first 14 days of hospitalisation compared to those who were alive, but not statistically significant.

Malignant conversion of a solitary papilloma in the distal trachea: report of a case.

A solitary papilloma versus the usual multiple lesions of papillomatosis is extremely rare. Even more infrequent is a solitary papilloma of the trachea in an adult patient. In the present report, a case of a solitary papilloma in the distal trachea is presented. After two unsuccessful sessions of laser ablation, resection of the lower one-third of the trachea was performed through a right posterolateral thoracotomy. Postoperative histology results disclosed a malignant degeneration into squamous cell carcinoma. The patient had an excellent outcome after resection of the affected portion of the trachea. There was no evidence of recurrence after 20 months of follow-up.