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P393 Neuroendocrine neoplasms of the lung — 2 clinical cases
Abstracts
I European
Journal
of Internal
Following admission, CT results confirmed a massive left pleural effusion with virtually near total collapse of the left lung. Unfortunately a right main pulmonary artery thrombus extending to the lower lobe artery was also noted. Result and analysis: It is known that absolute ventilation (v), perfusion (q) ratio can range in theory from zero to infinity. Our patient had almost a classical left ventilatory absence. This lead to a v/q ratio of essentially zero in the left lung. There was thus shunting of blood through the left lung. On the other hand the right lung had a v/q ratio of infinity as the perfusion was almost absent. This left a dead air space in the right lung. The terms shunting and dead space are very owe11 illustrated in our example. Difficult management problems were posed. Urgent anticoagulation along with pleural fluid aspiration or drainage was required. This posed very high risk of bleeding at the dram site. On the other hand not anticoagulating gave a high risk of further pulmonary embolus. Critical clinical judgement and important decisions were needed. Aspiration of 400-500 mls of fluid immediately prior to anticoagulation with heparin or warfarin was adviced. This was to improve ventilation in the left lung and thus improve the ~02. The biopsy and immunohistochemisry of the left zygoma revealed a metastatic adenocarcinoma from a likely lung primary. Conclusion: The twists in our case included atypical presentation and rare combination of v/q mismatches. Experienced clinical acumen helped diffuse challenging immediate management option.
P393 Neuroendocrine N. Germano,
neoplasms of the lung - 2 clinical cases M. Carmo, R. Mendonca, .I. Malhado (Lisbon,
P)
The neuroendocrine neoplasms of the lung correspond to 5 to 25% of the pulmonary carcinoma. The histologic classification of pulmonary neuroendocrine carcinomas includes 4 types: typical carcinoid, atpypical carcinoid, large cell neuroendocrine carcinoma and small cell carcinoma. The last two types are the most aggressive, with a 23% and 11% survivor rate prognosis in a 5 year period. The differentiation of the neuroendocrine carcinomas is essential for therapeutic orientation and also for prognosis. The authors will present two clinical cases. The first concerns a young female patient, with bronchial carcinoid tumor associated to Legionella pneumophilia pneumonia. The second refers to a middle-aged male patient with large cell neuroendocrine carcinoma. A theorical revision will be made, revealing the most appropriated diagnosis methods and therapeutic options for the different histologic types.
P394 Pulmonar lymphangioleiomyomatosis: G.A. Piccillo, A. Musco, T. Nicolosi, 0
a case report M. Nicolosi, E. Mondati
(Catania,
Introduction: Lymphangioleiomyomatosis (LAM) is a very rare lung disease of unknown origin affecting women of childbearing age and patients of both sexes struck by tuberous sclerosis. The pulmonary complications are due to proliferation of smooth-muscle cells along the bronchovascular structures, resulting in obliteration of the airways and the development of cysts in the lungs. Clinically it is characterised by ingrowing chest pain, dyspnoea, hemoptysis, chylothorax and pneumothorax. Clinical case; A 22-year-old female patient was admitted to our Division because of sudden dyspnoea, cough and chest pain. At history a grandfather dead for non Hodgkin lymphoma, mother affected with hypertension; menarche at ten years with regular rhythm and flow. The patient appeared very pale and suffering, dyspnoic, polypnoic, extremely anxious, with cramps to upper and lower limbs. Normal BP, EKG, HR, T 37oXC. At respiratory evaluation hypophonesis in left basal pulmonary area coherent with absence of vesicular breathing and decrease of pO2 at
Medicine
14 (2003)
s141
Sl-S159
haemoaeragasanalysis. Chest-X-ray pointed out the presence of important left pleural effusion. Thoracentesis revealed milky white fluid in chest cavity which laboratory test confirmed to be chyle. Laboratory data pointed out moderate anaemia, increase of LDH (1.086 U/L) and ACE (40 fY/L); decrease of total proteins 5.6 g/d1 and Ca+ + 7.6 mg/dl. Chest-CT showed the presence of dilated thoracic duct and few thinwalled cysts in mid and lower lungs. Abdomen CT revealed the presence of ovarian polycystosis. Suspecting LAM we submitted our patient to thoracic duct correction, pleurodesis, chest and lymph nodes biopsies which confirmed the diagnosis of LAM. The patient was treated on total pleurectomy and lymphadenectomy L 1 -L5 and oral progesterone. Discussion: LAM is a devastating disease with poor prognosis. Recently the research has helped to define the genetic and immunohistochemical characteristics of LAM cells and surely it will soon lead to greater insights into the pathogenesis of the disease and more effective treatments.
P395 Prevalence A. Drews,
of pathologic lung function in a normal C. Lorenz, E.W. Schmidt (Chemnitz, D)
population
Objective: Chronic lung diseases such as asthma and chronic bronchitis are among the most common diseases in our population. We staged several public events where members of the public had the opportunity of lung function testing and consultation with respiratory physicians. Methods: We conducted 725 lung function tests with participants aged between 10 and 84 years. For comparative reasons we issued a lung function pass to every participant. 87 participants ( 12%) reported cough, dyspnea or wheezing. 34 tests were not readable and 73 participants reported symptoms and did not give a proper history. Results: We found 633 normal lung fuction parameter constellations, 38 obstructive ventilatory disorders (5.5%) and 20 participants with diminished vital capacity (3.2%). Of the 498 non-smokers 26 had obstructive readings (5.2%) and I5 a diminished vital capacity (3.0%). Among the 149 smokers we saw 8 with obstructive ventilatoty disorder (5.4%) and 5 with diminished vital capacity (3.4%). We found 22 people (3.2%) with previously undetected obstructive ventilatory disorder. Conclusion: Compared to other publications we found a lesser proportion of prevalent obstructive ventilatory disorder among a normal population. We consider public lung function testing a valuable means of detecting as well as raising awareness about lung diseases.
P396 Factors predicting hospital stay in chronic obstructive disease (COPD): a three-year experience J. Marco, J. Garcia Ronquillo, .I. Serrano, J. Garcia Soltero, Rodriguez Rosado, S. Plaza, R. Barba (Madrid, E)
pulmonary P. Rondon,
R.
Objective: We run an early discharge unit (expected maximum hospital stay is 5 days). Although an attempt is made at admittance to discard severe cases, some of our patients extend their hospitalisation beyond 5 days (‘failures’). We tried to identify predictive factors of this circumstance and of early re-admittance (ER) defined as that occurring in the next 30 days after discharge. Methods: Retrospective analysis of clinical records from all patients hospitalised at our unit with a diagnosis of COPD. Results: 308 patients were included (mean age 72, 5, 18.4% women). Mean stay was 4.9 days (range O-25). Salient characteristics at admittance were oxygen at home used by 35%, steroid treatment 13%. peripheral oedema 23%, diabetes 14%. ischemic heart disease 8.8%. auricular arrhythmia 7% and obesity 6%. Mean number of drugs at admittance was 4.8 (range O-14) vs. 8.7 at discharge (range O-20). We identified 71 ‘failures’ (23%). On univariant analysis, failure risk was
I European
Journal
of Internal
Following admission, CT results confirmed a massive left pleural effusion with virtually near total collapse of the left lung. Unfortunately a right main pulmonary artery thrombus extending to the lower lobe artery was also noted. Result and analysis: It is known that absolute ventilation (v), perfusion (q) ratio can range in theory from zero to infinity. Our patient had almost a classical left ventilatory absence. This lead to a v/q ratio of essentially zero in the left lung. There was thus shunting of blood through the left lung. On the other hand the right lung had a v/q ratio of infinity as the perfusion was almost absent. This left a dead air space in the right lung. The terms shunting and dead space are very owe11 illustrated in our example. Difficult management problems were posed. Urgent anticoagulation along with pleural fluid aspiration or drainage was required. This posed very high risk of bleeding at the dram site. On the other hand not anticoagulating gave a high risk of further pulmonary embolus. Critical clinical judgement and important decisions were needed. Aspiration of 400-500 mls of fluid immediately prior to anticoagulation with heparin or warfarin was adviced. This was to improve ventilation in the left lung and thus improve the ~02. The biopsy and immunohistochemisry of the left zygoma revealed a metastatic adenocarcinoma from a likely lung primary. Conclusion: The twists in our case included atypical presentation and rare combination of v/q mismatches. Experienced clinical acumen helped diffuse challenging immediate management option.
P393 Neuroendocrine N. Germano,
neoplasms of the lung - 2 clinical cases M. Carmo, R. Mendonca, .I. Malhado (Lisbon,
P)
The neuroendocrine neoplasms of the lung correspond to 5 to 25% of the pulmonary carcinoma. The histologic classification of pulmonary neuroendocrine carcinomas includes 4 types: typical carcinoid, atpypical carcinoid, large cell neuroendocrine carcinoma and small cell carcinoma. The last two types are the most aggressive, with a 23% and 11% survivor rate prognosis in a 5 year period. The differentiation of the neuroendocrine carcinomas is essential for therapeutic orientation and also for prognosis. The authors will present two clinical cases. The first concerns a young female patient, with bronchial carcinoid tumor associated to Legionella pneumophilia pneumonia. The second refers to a middle-aged male patient with large cell neuroendocrine carcinoma. A theorical revision will be made, revealing the most appropriated diagnosis methods and therapeutic options for the different histologic types.
P394 Pulmonar lymphangioleiomyomatosis: G.A. Piccillo, A. Musco, T. Nicolosi, 0
a case report M. Nicolosi, E. Mondati
(Catania,
Introduction: Lymphangioleiomyomatosis (LAM) is a very rare lung disease of unknown origin affecting women of childbearing age and patients of both sexes struck by tuberous sclerosis. The pulmonary complications are due to proliferation of smooth-muscle cells along the bronchovascular structures, resulting in obliteration of the airways and the development of cysts in the lungs. Clinically it is characterised by ingrowing chest pain, dyspnoea, hemoptysis, chylothorax and pneumothorax. Clinical case; A 22-year-old female patient was admitted to our Division because of sudden dyspnoea, cough and chest pain. At history a grandfather dead for non Hodgkin lymphoma, mother affected with hypertension; menarche at ten years with regular rhythm and flow. The patient appeared very pale and suffering, dyspnoic, polypnoic, extremely anxious, with cramps to upper and lower limbs. Normal BP, EKG, HR, T 37oXC. At respiratory evaluation hypophonesis in left basal pulmonary area coherent with absence of vesicular breathing and decrease of pO2 at
Medicine
14 (2003)
s141
Sl-S159
haemoaeragasanalysis. Chest-X-ray pointed out the presence of important left pleural effusion. Thoracentesis revealed milky white fluid in chest cavity which laboratory test confirmed to be chyle. Laboratory data pointed out moderate anaemia, increase of LDH (1.086 U/L) and ACE (40 fY/L); decrease of total proteins 5.6 g/d1 and Ca+ + 7.6 mg/dl. Chest-CT showed the presence of dilated thoracic duct and few thinwalled cysts in mid and lower lungs. Abdomen CT revealed the presence of ovarian polycystosis. Suspecting LAM we submitted our patient to thoracic duct correction, pleurodesis, chest and lymph nodes biopsies which confirmed the diagnosis of LAM. The patient was treated on total pleurectomy and lymphadenectomy L 1 -L5 and oral progesterone. Discussion: LAM is a devastating disease with poor prognosis. Recently the research has helped to define the genetic and immunohistochemical characteristics of LAM cells and surely it will soon lead to greater insights into the pathogenesis of the disease and more effective treatments.
P395 Prevalence A. Drews,
of pathologic lung function in a normal C. Lorenz, E.W. Schmidt (Chemnitz, D)
population
Objective: Chronic lung diseases such as asthma and chronic bronchitis are among the most common diseases in our population. We staged several public events where members of the public had the opportunity of lung function testing and consultation with respiratory physicians. Methods: We conducted 725 lung function tests with participants aged between 10 and 84 years. For comparative reasons we issued a lung function pass to every participant. 87 participants ( 12%) reported cough, dyspnea or wheezing. 34 tests were not readable and 73 participants reported symptoms and did not give a proper history. Results: We found 633 normal lung fuction parameter constellations, 38 obstructive ventilatory disorders (5.5%) and 20 participants with diminished vital capacity (3.2%). Of the 498 non-smokers 26 had obstructive readings (5.2%) and I5 a diminished vital capacity (3.0%). Among the 149 smokers we saw 8 with obstructive ventilatoty disorder (5.4%) and 5 with diminished vital capacity (3.4%). We found 22 people (3.2%) with previously undetected obstructive ventilatory disorder. Conclusion: Compared to other publications we found a lesser proportion of prevalent obstructive ventilatory disorder among a normal population. We consider public lung function testing a valuable means of detecting as well as raising awareness about lung diseases.
P396 Factors predicting hospital stay in chronic obstructive disease (COPD): a three-year experience J. Marco, J. Garcia Ronquillo, .I. Serrano, J. Garcia Soltero, Rodriguez Rosado, S. Plaza, R. Barba (Madrid, E)
pulmonary P. Rondon,
R.
Objective: We run an early discharge unit (expected maximum hospital stay is 5 days). Although an attempt is made at admittance to discard severe cases, some of our patients extend their hospitalisation beyond 5 days (‘failures’). We tried to identify predictive factors of this circumstance and of early re-admittance (ER) defined as that occurring in the next 30 days after discharge. Methods: Retrospective analysis of clinical records from all patients hospitalised at our unit with a diagnosis of COPD. Results: 308 patients were included (mean age 72, 5, 18.4% women). Mean stay was 4.9 days (range O-25). Salient characteristics at admittance were oxygen at home used by 35%, steroid treatment 13%. peripheral oedema 23%, diabetes 14%. ischemic heart disease 8.8%. auricular arrhythmia 7% and obesity 6%. Mean number of drugs at admittance was 4.8 (range O-14) vs. 8.7 at discharge (range O-20). We identified 71 ‘failures’ (23%). On univariant analysis, failure risk was