Not all abolished lung sliding are pneumothorax: the case of a particular lung atelectasis

INTRODUCTION

Lung ultrasound (LUS) is expanding from the field of emergency medicine, also to the pneumological specialist field, becoming part of the diagnostic procedure of lung consolidation.

CASE PRESENTATION

A 78-year-old male was admitted to our emergency department for exertional dyspnea. LUS was performed, thus showing at right hemitorax air interface, A lines pattern, pleural sliding abolished on the whole hemitorax, thus suggesting a pneumothorax, but no evidence of lung point. A scan of lower lung segment showed an absence of the diaphragmatic excursion, suggestive for hemiparalysis of the diaphragm muscle, then confirmed by a subcostal scan. Moreover, at the lower segment of right hemitorax there was mild pleural effusion allowing the visualization of a round-shaped parenchymal consolidation with the absence of air bronchograms.

CONCLUSIONS

LUS allowed the visualization of a particular and rare disease such as anthracosis-associated rounded atelectasis, thus leading to a more correct and faster patient management.

Cytokine modulation in patients with idiopathic pulmonary fibrosis undergoing treatment with steroids, immunosuppressants, and IFN-γ 1b

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease of unknown etiology and pathogenic mechanisms. From an etiopathogenic point of view, alveolar macrophages play a key role in accumulation of fibroblasts and deposition of collagen and extracellular matrix by releasing specific cytokines and inflammatory mediators. IPF seems to be also associated with circulating fibrocytes, which might be involved with an abnormal pulmonary vascular repair and remodeling. Based on its hypothesized pathologic mechanisms, anti-inflammatory, anti-fibrotic and immunosuppressive therapies are often used. For these reasons, Interferon-g (IFN-g) has been used to exploit its activity on macrophages and fibroblasts. The aim of this study was to investigate the response to corticosteroids and/or IFN-g 1b treatments based on pulmonary function tests and on inflammatory cytokine patterns of expression on bronchoalveolar lavage (BAL), at baseline and during and after the therapies. Unlike previous studies, we analyzed a period of therapy longer than 1 year. Our results demonstrated the effectiveness of IFN-γ in a group of IPF patients in whom the treatment was prolonged for over a year. These data suggest a positive role of IFN-γ; treatment in patients in the initial stage of the disease.

Evolution of soil organic matter changes using pyrolysis and metabolic indices: a comparison between organic and mineral fertilization

The aim of this study was to evaluate chemical and biochemical changes of organic matter in fertilized (ammonium nitrate) and amended (vermicompost and manure) soils using pyrolysis and metabolic indices. The metabolic potential [dehydrogenase (DH-ase)/water soluble organic carbon (WSOC)], the metabolic quotient (qCO2) and the microbial quotient (Cmic:Corg) were calculated as indices of soil organic matter evolution. Pyrolysis-gas chromatography (Py-GC) was used to study structural changes in the organic matter. Carbon forms and microbial biomass have been measured by dichromate oxidation and fumigation-extraction methods, respectively. Dehydrogenase activity has been tested using INT (p-Iodonitrotetrazolium violet) as substrate. The results showed that organic amendment increased soil microbial biomass and its activity which were strictly related to pyrolytic mineralization and humification indices (N/O, B/E3). Mineral fertilization caused a greater alteration of native soil organic matter than the organic amendments, in that a high release of WSOC and relatively large amounts of aliphatic pyrolytic products, were observed. Therefore, the pyrolysis and metabolic indices provided similar and complementary information on soil organic matter changes after mineral and organic fertilization.

In COPD patients, body weight excess can mask lean tissue depletion: a simple method of estimation

Although a great number of studies have been carried out on the relationship between chronic obstructive pulmonary disease (COPD) and low body weight, the identification of the most suitable warning signs of this wasting condition is still under debate. It has been indicated in earlier studies that body weight alone is of limited diagnostic value concerning this clinical condition in as far as a great number of COPD patients are usually overweight. For this reason, the aim of the current research was to find parameters that take into consideration the fact that body composition should be taken into account instead of weight only, and to assess whether COPD can be considered a "protein wasting disease", defining sensitive and significant indices of lean tissue depletion in relationship to the severity of the clinical symptoms. One hundred and seventy-five stable COPD outpatients with differing degrees of bronchial obstruction and arterial blood gas abnormalities were consecutively recruited: anthropometric measurements and body composition analysis were carried out; 60 healthy subjects with normal pulmonary function, matched for sex, age and anthropometric parameters, were considered as controls. The data obtained showed a lower prevalence (9%) of underweight COPD patients in comparison with normal weight (37%) and overweight (54%) patients. In COPD patients, the phase angle measured by bioelectrical impedance analysis, whose deterioration is a good indicator of protein mass depletion, was altered by 19%, thus allowing the identification of currently malnourished subjects included in the overweight COPD patients group. In addition, significant correlations (p = 0.000) were found between the same nutritional variable, respiratory function and gas-exchange parameters, thus confirming that the more severe the stage of the pulmonary disease, the higher the degree of protein breakdown, regardless of body weight.

[The hypotriglyceridemic effects of polyunsaturated fatty acids: pathogenetic hypothesis]

A large number of experimental and clinical studies focused the attention on the role played by omega-3 polyunsaturated fatty acids on the primary prevention of vascular diseases of atherosclerotic origin, especially influencing plasma triglycerides decrease. Aim of the present work was to investigate whether a relationship between triglyceride synthesis and human energy metabolism could exist, in order to explain the hypotriglyceridemic effect of omega-3 fatty acids that could be due to any thermogenic action. Eight male subjects aged 45 years (from 20 to 62) were studied, selected on the basis of high levels of triglycerides (536.7 +/- 204.3 mg/dl), normal or high levels of total serum cholesterol (219.4 +/- 51.2 mg/dl), normal or low HDL-cholesterol (33.6 +/- 6.3 mg/dl) and moderate obesity (BMI 30.3 +/- 1.7). Anthropometric parameters (body weight, height, waist to hip ratio), body composition measurements (fat free mass, fat mass), biochemical parameters were evaluated before and 10-days after PUFAs supplementation (student t paired test) at the compressive dose of 60 mg/kg BW bis in die. At the end of the observation significant decrease of triglycerides was documented (p < 0.005), while total and HDL-cholesterol did not vary significantly, although improved values were noticed. No change in anthropometric, body composition and energy metabolism parameters was demonstrated, except for respiratory quotient and substrates oxidation: a significant increment of respiratory quotient value (p < 0.05) due both to augmented carbohydrates oxidation (p < 0.05) and correspondent lipid oxidation reduction (p < 0.05) and correspondent lipid oxidation reduction (p < 0.05) without any change in the daily total calorie consumption. In conclusion, from a clinical point of view it is possible to hypothesize, even if in a small number of subjects, that PUFAs hypotriglyceridemic effect could derive from a reduced substrate availability, due to the higher carbohydrate oxidation. In other terms, considering the metabolic cascade of triglyceride synthesis, the augmented drug-induced carbohydrate consumption could provoke a reduced availability of products of intermediate metabolism useful to triglycerides hepatic synthesis.