Day 1 :
Co-director, Royal College of Anaesthetists, UK
University of Szeged
Keynote: Compromises airway function and respiratory tissue viscoelasticity in patients with diabetes mellitus
Time : 10:15 - 10:45
Ferenc Petak has completed his PhD from University of Szeged, Hungary and Post-doctoral studies at the Institute for Child Health Research, Australia. He is the Founder and Head of the Cardiopulmonary Research Unit, Department of Medical Physics and Informatics, University of Szeged. He has published more than 100 papers in reputed journals and has been serving as an Editorial Board Member of repute at the journal.
Since structural and functional alterations of matrix proteins following chronically elevated serum glucose level cause adverse structural and functional changes in the collagen-elastin network, the lungs are expected to be among the most affected organs in Diabetes Mellitus (DM). Thus, we aimed at characterizing the alterations in the mechanical properties of the airways and respiratory tissues in patients with DM, and we related the lung function outcomes to those obtained in patients without metabolic disorders. In a prospective consecutive study design, forced oscillation technique was used to measure the input impedance spectra of the respiratory system (Zrs) in cardiac surgery patients with diagnosed DM (Group DM, n=124) and in matched controls (Group C, n=281). The airway resistance (Raw), the tissue damping reflecting tissue resistive properties (G), and the elastance representing respiratory tissue stiffness (H) were identified from the Zrs spectra by a well-validated model fitting. Hemoglobin A1c was significantly higher in Group DM (6.97±0.1 [SE]%) than in group C (5.79±0.2%), confirming the overexpression of glycated hemoglobin in the DM patients. Patient in group DM exhibited significantly elevated Raw (8.8±0.6 vs. 5.7±0.3 [SE] cmH2O.s/l, p<0.001), G (12.4±0.7 vs. 8.6±0.3 cmH2O/l, p<0.001) and H (32.6 ±0.3 vs. 27.5±0.3 cmH2O/l, p<0.001). These findings suggest compromised airway function in DM patient, most probably resulting from the sustained contractile response of the bronchial smooth muscle. The deteriorations in respiratory tissue viscoelasticity in DM may be a consequence of lung volume loss, interstitial edema and/or disturbance in the elastin-collagen fiber–fiber interaction.
Jazan University, Saudi Arabia
Time : 11:15
Abdul Rahman Hakami is currently working as an Assistant Professor of Medicine at Jazan University, Saudi Arabia and also a Researcher in Amsterdam University, Netherlands. He has completed his Internal Medicine in Respiratory Diseases from Sweden and Clinical and Research Fellowship in Interventional Pulmonology and Interstitial Lung Diseases from Amsterdam University, Netherlands.
Introduction: Germ cells tumors are relatively rare, embryologically derived from reproductive cells usually arise in the gonads. Mediastinal germ cell tumor estimated about 1-3% of all germ cell tumors, generally seen in the anterior mediastinum and the metastatic lesions are mostly seen in the posterior mediastinum. The most aggressive germ cell tumor subtypes are choriocarcinoma, embryonic carcinoma and yolk-sac tumors. While seminomas only very rarely spread distantly. The presentations vary ranging from accidental findings on routine radiography to life-threatening respiratory and cardiovascular compromise, can also present as gigantic big intrathoracic germ cell tumor.
Case Report: A 30 years old male patient, not known to have any chronic illness, referred from TB hospital center because history of dyspnea, cough and loss of appetite with weight loss for more than 4 months, no history of chest pain or hemoptysis. Chest X-ray done and showed complete obliteration of the right side of thorax, was suspected pleural effusion and diagnosed as case of pleural TB and empyema, started on ant tuberculosis drugs, antibiotics and received chest drain with a little bloody fluid. Computed hospital of chest with contrast revealed very big mas obliterating the right side of chest, pushing the trachea and mediastinum to the left side with minimal effusion in both sides. Pleural US revealed mass and effusion but no empyema. Differential diagnosis was mediastina mass, adenocarcinoma, thymic carcinoma, lymphomas, fibroma or fibro sarcoma. US guided transthoracic fine needle biopsy from the right side mass revealed mixed germ cell tumor. The patient’s condition had rapidly deteriorated prior the confirming the diagnosis or starting with treatments and died because of difficult airway breathing due to deviated and compressed airway and possible pneumothorax after transthoracic biopsy.
Conclusion: Germ cell tumors are aggressive and rapidly growing cancers, the previous literature reported the nature of the extra gonadal mediastinal germ cell tumor can appear as Giant mass occlude whole lung, compressing the great vessels, adherent to chest wall, pericardium and lung and this make a worse prognosis, The estimated event-free survival at 10 years after combined treatment is 80.4%. Chemotherapy, debulking and pneumoctomy are the treatment for such cases.