Complete spontaneous regression of a total pneumothorax in a patient with chronic obstructive lung disease.

A 61-year old man presented with a sudden onset of breathlessness. The total left pneumothorax was overlooked on the initial chest radiograph. One month later, the patient had a partial pneumothorax less than 20% on the radiograph, although he did not receive any therapy against pneumothorax, such as oxygen inhalation or needle aspiration. After the observation for one month, the lungs totally expanded. Pulmonary function tests demonstrated severe chronic obstructive pulmonary disease. To our knowledge, this is the first case in which the total secondary pneumothorax showed a spontaneous remission.

An epidemic of silicosis among former denim sandblasters.

Sandblasting denim using silica has emerged as a new cause of silicosis in Turkey. Following the discovery of several cases of silicosis in (young) workers who used this process, the frequency and main occupational risk factors of silicosis among former denim sandblasters in the region of Erzurum (Turkey) were evaluated. Demographic characteristics and information on working conditions were obtained by questionnaire and interview. In addition, spirometry testing was performed and chest radiographs were evaluated according to International Labour Office (ILO) classification of pneumoconioses in 157 former denim sandblasters. All subjects were male, with a mean (range) age of 23 (15-44) yrs. They had worked for a mean (range) of 36 (1-120) months, starting employment at a 17 (10-38) yrs of age. Most subjects (83%) had respiratory symptoms, especially dyspnoea (52%) but also chest pain (46%). Radiological evidence of silicosis (ILO score 1/0 or higher) was present in 77 (53%) out of 145 subjects with interpretable chest radiographs. These subjects had lower forced expiratory volume in one second and forced vital capacity. The risk of silicosis correlated with seniority (i.e. working as a foreman), exposure duration and number of places of work. Considering the high prevalence rate of silicosis in such workplaces, further problems are inevitable in the future unless effective measures are taken.

Comparison of the efficacy of nebulised budesonide with parenteral corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease.

OBJECTIVE: To compare the efficacy and safety of nebulised budesonide and systemic corticosteroid in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD). DESIGN: Randomised, double-blind, placebo-controlled, parallel-group trial. PATIENTS AND INTERVENTIONS: A total of 40 patients who had moderate to severe acute exacerbations of COPD and required hospitalisation were enrolled in the study. The patients were randomised to receive either nebulised budesonide 8mg daily (n = 21) or systemic (intravenous) prednisolone 40mg daily (n = 19). Airway obstruction (peak expiratory flow rate [PEFR]) and gas exchange (arterial partial pressure of oxygen [PaO(2)] and carbon dioxide [PaCO(2)], pH and oxygen saturation [SaO(2)]) were evaluated at 30 min, at 6, 24 and 48 hours, and at day 10. RESULTS: There were no significant differences between groups at baseline. In both groups, differences were significant for PEFR, SaO(2) and PaO(2) (p < 0.001), but not for PaCO(2) and pH, in comparison with their baseline values. There were no significant differences between groups for all parameters (PEFR, PaO(2), PaCO(2), pH and SaO(2)) at all time periods. No adverse events were recorded in either group. CONCLUSIONS: Our study suggests that nebulised budesonide may be an alternative to parenteral corticosteroids in the treatment of acute exacerbations of COPD.