Validity of diurnal sleep recording performed by an ambulatory device in the diagnosis of obstructive sleep apnoea.

The objective of this study was to compare the results of oxygen desaturations and sleep apnoea during a daytime nap (D) versus nocturnal sleep (N) evaluation, recorded by a portable multichannel monitoring device in patients with a clinical suspicion of obstructive sleep apnoea (OSA). Two polysomnographic studies were performed, by means of the Healthdyne NightWatch System, in 82 subjects (mean age 57.9 years). No difference was found in the apnoea + hypopnoea index (AHI) and mean SaO2 between D and N recordings. At an AHI threshold of 20, in the D recordings, compared to the N ones, the sensitivity was 91% and the specificity 100%. A good correlation was found for AHI and oxygen desaturation index (ODI) between the two experimental conditions (r = 0.89 and 0.79, respectively). Our study shows that D recordings seem to be accurate for OSA diagnosis in the majority of patients with a clinical suspicion of sleep apnoea syndrome.

Unusual case of pulmonary rickettsiosis in non-Hodgkin's lymphoma.

A case report of boutonneuse fever with pulmonary complications in a patient with non-Hodgkin's lymphoma (NHL) is described. The patient was hospitalized for persistent hypertermia and marked dyspnea, with radiographic findings of bilateral involvement of the lungs. The confirmation of the diagnosis was obtained by means of serum analyses (Weil-Felix serodiagnosis and IFA); the patient responded to doxycycline with progressive improvement of her general health condition. In this case the occurrence of a NHL could justify the lower reactivity and the facilitated diffusion of rickettsiosis in the patient.

Prevalence and clinical feature of the "overlap syndrome", obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), in OSA population.

PURPOSE: The association of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), defined overlap syndrome by Flenley, is frequent. Aims of the present study were to assess the frequency of overlap syndrome in 168 consecutive OSA patients, and to evaluate the functional pulmonary hemodynamic, and polysomnographic consequences of this association by comparing Overlap patients with OSA patients. METHODS: From the results of the pulmonary and polysomnographic investigation, patients were classified as OSA patients (group 1), having an apneas/hypopneas index (AH/I) > 15/hr, and Overlap patients (group 2), i. e. OSA patients with an obstructive spirographic pattern (FEV1<60%, FEV1/FVC<65%, RV>130%, RV/TLC>140% of predicted value) not reversible after beta2 agonist inhalation. Group 1 consisted of 135 Patients (115 males, 20 females, age 56+/-10 yr, BMI 32+/-6 Kg/m(2)); the group 2 included 33 patients (30 males, 3 females, age 56+/-11 yr., BMI 34 +/- 6 Kg/m(2)). RESULTS: The OSA and Overlap patients were similar in most respects: age, BMI, clinical characteristic. In awake Overlap patients had lower PaO(2), higher PaCO(2) and Ppa (p<0.001), and an obstructive spirographic pattern, as compared to OSA patients. During sleep the overlap group had a higher AH/I and a lower mean SaO(2) (p<0.05), a reduction of the sleep efficency (p<0.05), and a reduction in the duration of 1NREM and REM sleep stage (p<0.05), as compared to group 1. CONCLUSION: In conclusion, an associated COPD is observed in more than 19% of OSA patients. Overlap patients are at increased risk of developing pulmonary hypertension and show a poorer quality of sleep as compared with OSA patients. The possibility of developing cor pulmonale should be given particular attention in the diagnosis and follow-up of Overlap patients.

Langerhans' cell granulomatosis and Hodgkin's lymphoma. Report of a case.

A 48-year-old female with a history of accentuated dyspnea, pleural thickening in anteromedial portion with left patchy parenchymal shadowing invading adjoining parasternal structure of the rib cage, presented 13 months later marked superclavicular, anterior mediastinic and parahilar left lymphadenopathy. Open surgical biopsies on the pleural lesion invading the hypodermic tissues of parasternal region showed morphological and immunocytochemical patterns of Langerhans' cell histiocytosis (LCH). 13 months later the superclavicular lymph node biopsy diagnosed Hodgkin's lymphoma (HD), mixed cellularity type II, stage AE. On a total of 29 cases with association of LCH and HD, the described case in the second case that shows morphologically demonstrated LCh with subsequent development of HD. It is postulated that the development of HD in a patient with LCH, might represent malignant evolution of this hyperplastic process.

Community-acquired pneumonia: is there difference in etiology between hospitalized and out-patients?

Since March 1991 a prospective 1-year study of patients with community-acquired, radiologically verified, pneumonia (CAP) was performed at the Divisione Pneumologica, Ospedali Riuniti Bergamo, and at the Centro Pneumo-Allergologico, Bergamo, Italy. The study included 119 out-patients and 60 in-patients, with a median age of 37.4 and 49.8 years respectively. There were not statistically significant differences between the patients included with respect to the various months. The most common underlying illnesses were: chronic obstructive pulmonary disease (20.7%), diabetes (7.3%) and malignancy (3.4%). We found a quite different etiology of CAP between out- and in-patients. By far the most common etiologic agent in out-patients was Mycoplasma pneumoniae (32.8%), while in in-patients was Legionella pneumophila (11.7%). 5 patients had a double infection. There were no distinctive clinical and radiological features found to be diagnostic for any etiologic agent. Hospital stay averaged 12.1 days. 35% of the patients included in the study were been treated by beta-lactam, often parenterally, nevertheless 88 pathogens of the 100 identified were resistant to this antimicrobial therapy. We believe that there should always be a macrolide, erythromycin or the latest ones such as azythromycin, in the treatment of CAP, owing to their efficiency, ease of use and lower cost.

Primary mediastinal seminoma.

We describe three cases of primary mediastinal seminoma, a rare neoplasm histologically similar to the testicular form, which mainly affects men between 30-60 yrs of age. Case No. 1--a 45 year old patient was treated with a combination of radiotherapy and chemotherapy. Twenty six months after the diagnosis, the patient shows a limited residual lesion, a good general health status and was asymptomatic. Case No. 2--a 56 year old patient was admitted for suspected epithelial lung cancer, with subsequent histological diagnosis of seminoma on surgical sample. The exeresis of the lesion was followed by radiotherapy and chemotherapy, the latter interrupted owing to the onset of thrombotic complications resulting in the patient's death. Case No. 3--a 35 year old patient was subjected to diagnostic and therapeutic thoracotomy, with diagnosis of primary mediastinal seminoma. The surgical therapy was followed by a cycle of radiotherapy. Five years later, the general health of the patient is good and he is still asymptomatic. In the discussion we consider the embryogenesis, clinical picture, radiological and anatomicopathological aspects, typical biomarkers of cancer, diagnostic procedures and therapeutic protocols currently followed.

[The importance of measuring plasma carcinoembryonic antigen in small-cell anaplastic carcinoma]. / Il significato del dosaggio dell'antigene carcinoembrionario plasmatico nel carcinoma anaplastico a piccole cellule.

The clinical value of the serum biomarker carcinoembryonic antigen (CEA) was evaluated prospectively in 118 patients with small cell lung cancer (SCLC) entered chemotherapy protocol between 1986 and 1992. Five quantitative categories were determined: less than 2.5 ng/ml and 2.6-5.0 ng/ml (the standard normal), 5.1-20.0 ng/ml, 20.1-100 ng/ml and greater than 100 ng/ml. 70% of patients had levels less than 5 ng/ml and only 19% had levels greater than 20 ng/ml. There was no clearcut relationship of plasma CEA level to stage of disease, in which 61% of patients with extensive disease (59 patients) had levels less than 5 ng/ml and 22% of patients with limited disease (59 patients) had levels greater than 5 ng/ml. There was a modest relationship of CEA levels to presence of metastases, in that 50% of patients with metastases had levels greater than 20 ng/ml. The average survival for the pathologic and normal category was almost similar, ranging from 13.27 to 16.81 months. The correlation between disease extent and survival was more sensitive for lactate dehydrogenase (LDH) than for CEA. So CEA as a tumor marker for SCLC must be applied in conjunction with other biomarkers, particularly LDH and neuron specific enolase (NSE) and is meaningful in only a small proportion of patients.

Cyclophosphamide, epirubicin, etoposide, cis platinum (CEVP) in combination with radiotherapy: evaluation of a protocol adopted for 6 years in 148 cases of small cell lung cancer.

The present study was carried out with the purpose of assessing and evaluating the responsiveness of small cell lung cancer (SCLC) to combined treatment (i.e., chemotherapy and radiotherapy). This approach was applied to all patients observed in our Institution during the last 6 years with the exclusion of patients more than 65 years old, with Karnofsky performance status less than 60, and with concomitant non-neoplastic diseases. One hundred and forty-eight patients were selected and treated with a combination chemotherapy regimen including cyclophosphamide, etoposide, epirubicin and cisplatinum. For patients with limited disease, treatment consisted of 3 cycles of chemotherapy (induction), followed by radiation therapy and then by another 3 cycles of chemotherapy (consolidation). For those with extensive disease, treatment consisted only of 6 consecutive cycles of chemotherapy. Results, besides showing the good activity and tolerability of the chemotherapeutic regimen employed (which induced 80% overall response), indicated that some prognostic factors such as the number of metastatic sites, brain and liver involvement and performance status are essential in determining the outcome of response and, particularly, of survival. In addition, the efficacy and tolerability of the combination chemotherapy-radiotherapy were confirmed, as was the evidence of a synergistic pharmacologic effect between cis-platinum and etoposide.

[Coin lesions: 5 years of percutaneous needle aspiration]. / Coin lesions: cinque anni di agoaspirazione percutanea.

197 patients with either malignant (No. 175) or infections (No. 22) chest coin lesions had lung aspirations using fine-needles, 18 to 22 gauge. All the patients previously had flexible fiberoptic bronchoscopy with negative results. A positive diagnosis of malignancy was established in 138 (70%), with identification of cell type in 51 (37%), and of infectious disease in 11 (50%). The procedure's sensitivity for malignant lesions was 79.3% and the specificity was 96.5%. Complications were minimal (hemoptysis and pneumothorax), although some patients had COPD and hypoxemia.