The presence of insomnia and depression contributes to the acceptance of an initial treatment trial of continuous positive airway pressure therapy in patients with obstructive sleep apnea

Sleep and Breathing - The presence of comorbid insomnia and sleep apnea (COMISA) reduces the initial acceptance of continuous positive airway pressure (CPAP) therapy in 39–58% of patients...     

Primary tuberculosis of the thyroid gland: report of three cases.

We report on three cases with rapidly increasing thyroid masses who were referred with the provisional diagnosis of thyroid carcinoma. In the two cases, the diagnosis of tuberculosis was established after thyroidectomy, but in the third case diagnosis was made pre-operatively with acid fast bacilli (AFB) staining and culture from fine needle aspiration (FNA) material. Although rare, tuberculosis of the thyroid gland should be included in the differential diagnosis of thyroid masses. FNA, AFB staining and culture of the aspirate are important diagnostic tools in these cases.     

Prevalence of Pulmonary Hypertension in Patients with Idiopathic Pulmonary Fibrosis: Correlation with Physiological Parameters

The aim of this study was to prospectively evaluate the prevalence of pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF). One hundred thirty-nine patients (101 male, mean age?=?68.6?±?9?years), with confirmed IPF and who were admitted to eight Pulmonary Departments in Greece between November 2005 and December 2006 were included in the study. Pulmonary artery systolic pressure (PASP) was estimated by echocardiography, and PH was defined as PASP?>?36?mmHg. We compared demographics, pulmonary function tests, NYHA functional status, 6-min walk distance (6MWD), B-type natriuretic peptide (BNP), PaO(2), and P(A-a)O(2) at rest data between patients with PH and without PH (PASP?≤?36?mmHg). Increased estimated right ventricular systolic pressure was present in 55% of patients (mean PASP?=?47.1?±?11.2?mmHg vs. 30.3?±?3.8?mmHg, respectively). Patients with PH had a lower but not statistically significant DL(CO) (47.1?±?18.8 vs. 52.5?±?20.1), lower PaO(2) at rest (64.6?±?12.2 vs. 71.1?±?11.3, P?=?0.004), and lower mean 6MWD (282?±?118 vs. 338?±?91, P?=?0.007). Significant differences were also observed in the NYHA functional status between the two groups (P?=?0.02). Statistically significant correlations were observed between PASP and PaO(2) at rest (r?=?-0.331, P?=?0.00), P(A-a)O(2) at rest (r?=?0.494, P?=?0.00)(,) 6MWD (r?=?-0.264, P?=?0.01), SpO(2) at rest (r?=?-0.293, P?=?0.00), SpO(2) at the end of exercise (r?=?-0.364, P?=?0.00), and also BNP values (r?=?0.319, P?=?0.01). Moreover, PaO(2) (P?=?0.02), P(A-a)O(2) (P?=?0.005), and SpO(2) at the end of exercise (P?=?0.023) were independent predictors of the presence of estimated PH. Using Doppler echocardiography as a screening tool for the estimation of PH, we found that PH is common in patients with IPF. Gas exchange parameters at rest and exercise desaturation might indicate underlying PH in IPF.     

A case of a young asymptomatic woman with optic disc drusen and vasculitis

Purpose

We present the case of a young woman with optic disc drusen and peripheral vasculitis.

Methods

Diagnosis was based on fundoscopic, optical coherence tomography as well as fluorescein angiography (FA) findings.

Results

An asymptomatic 34-year-old female patient with no systemic pathology was referred to our hospital from her optician for retinal findings. Fundoscopy revealed mild disc swelling that could be attributed to the presence of optic disc drusen in both eyes. There was fundoscopic evidence of periphlebitis in the periphery confirmed by FA findings.

Conclusions

In our case, the unique feature was the presence of optic disc drusen and retinal periphlebitis. The patient''s disc configuration may have contributed to a predisposition for vasculitis in addition to vessel tortuosity.Key words: Optic disc drusen, Retinal periphlebitis, Optical coherence tomography