Médecine pulmonaire et respiratoire

The occurrence of a bronchopleural fistula (BPF) continues to represent a challenging management problem, and is associated with high morbidity and mortality. Bronchoscopic closure of BPF with instillation of n-butyl-cyanoacrylate glue is an effective, economical, minimally invasive and safe technique for managing BPFs. We present a case that was successfully treated with this method.

Setting: Department of Pulmonology, Delhi heart and Lung Institute, New Delhi Objective: Asthma is considered as a disease of childhood but may continue in the elderly or elderly may be diagnosed as asthmatic for the first time. Asthma in elderly may differ from the young with respect to diagnosis and management on account of psychosocial, economic differences and age related changes which may further be enhanced because of comorbidities and interactions between drugs used for comorbidities. Design: 100 patients of bronchial asthma attending the Department of Pulmonary Medicine, Delhi Heart and Lung Institute, New Delhi, India. Young and elderly asthmatics were compared with regards to Symptoms, Severity (GINA guidelines), Accessibility to treatment, Co-morbidities, Inhalational techniques, Compliance and factors affecting compliance and; Outcome measures. These patients were followed up periodically for the above said parameters. Results: Salient differences noted in elderly vs. young were: higher GINA scoring (Moderate Persistent: 30% vs 10%), baseline non-compliance (60% vs 30%), non-compliance due to cost and memory (80% vs 26.7%), incorrect technique of inhalation (69.6% vs 42.4%), comorbidities (98% vs 38%) and concomitant drug usage (68% vs 40%). There were differences in the symptoms and quality of life indicators. There was significant improvement in various parameters in both groups, especially the young if counseled properly. Conclusion: Significant differences exist between elderly and young asthmatics.

The significant adverse sequelae of Obstructive Sleep Apnea Syndrome (OSAS) include a higher incidence of stroke, myocardial infarction and neurocognitive deficits. A link between the intermittent hypoxia of OSAS and endothelial dysfunction may explain many of the macrovascular and microvascular complications of OSAS. The pathogenesis of endothelial dysfunction involves an alteration in the levels of pro-inflammatory and pro-atherogenic mediators. As a form of ischemia/reperfusion injury to the endothelium, intermittent hypoxia induces reactive oxygen species and dysregulatesbolites including pathways of nitric oxide synthesis. In addition, hypercoagulability and altered leucocyte migration contribute to the sp vasoactive metaectrum of endothelial dysfunction. The tools for measurement of endothelial dysfunction and its clinical implications are discussed. Endothelial dysfunction can be in part reversed with continuous positive airway pressure. Thus, early recognition and aggressive treatment of OSAS may prevent associated endothelial dysfunction and subsequent complications of this syndrome.