The results suggest that disclosing information to patients about their post-septoplasty rhinomanometry results may improve subjective nasal breathing, and thus improve their QOL.

BackgroundLung cancer is the most common second primary cancer. We investigated whether the TNF-α-308 and TNF-α-238 polymorphisms were associated with the susceptibility and severity of lung cancer as the second primary cancer (LC2).Material/MethodsThis study included 104 patients from the group LC2. The control subjects included 2 groups. The first control group (LC1) comprised 201 unrelated patients with lung cancer as a first primary cancer. The second control group (HC) comprised 230 healthy blood donors, matched for sex and age to the study group.ResultsThe frequencies of the TNF-α-238 polymorphism GG genotype and the G allele were higher in the LC2 group than in the LC1 group, but the differences did not reach significance (p=0.054 and p=0.057, respectively). Similar differences were found in the TNF-α-238 polymorphism GG genotype and G allele between the LC2 group and the HC group (p=0.054 and p=0.057, respectively). In terms of the different types of lung cancer, patients with a second primary NSCLC (non-small cell lung cancer) more frequently had TNF-α-238 polymorphism GG genotypes and G alleles than patients with a first primary NSCLC (the differences approached statistical significance: p=0.060, p=0.064, respectively). All (100%) patients of group LC2 (n=104) had the GG genotype and the G allele. GG genotype was exclusive and no A allele was found in group LC2.ConclusionsTNF-α-238 polymorphism GG genotype and the G allele could have a promotional effect on the development of NSCLC in the group of patients with LC2.

Scuba diving has become increasingly popular in the last 20 yr. Although it is considered safe, accidents, sometimes with fatal outcomes, do occur. The incidence of diving-related CNS barotrauma is low and it has been reported very infrequently. The clinical presentation may range from minimal dysesthesias to complete quadriplegia, encephalopathy, or death. In this paper we present a case of pneumocephalus in a 36-yr-old male scuba diver that presented with minor neurologic symptoms. A discussion, including a review of the literature, is also presented. The authors recommend that diving-induced neurologic dysbarism syndromes, including pneumocephalus, should be considered a possible cause when a scuba diver presents with neurologic symptoms, even minor ones.

Tuberculosis (TB) is an infectious disease and, apart from protecting patients, attention must be given to protecting the persons who come in contact with them, especially nurses and medical practitioners. A 43-yearold immunocompetent male nurse developed occupationally disseminated TB after contact with patients affected by active TB (culture positive) while working in a psychiatric hospital. The first manifestation of the disease was exudative pericarditis with Mycobacterium tuberculosis (MT) confirmed two months after pericardiocentesis and evacuation of 1200 mL of pericardial effusion. Many lymph nodes showed histologic findings of granulomatous inflammation with necrosis. Treatment with antituberculosis drugs caused complications, including transient short-term medication-induced toxic hepatitis, prolonged fever, left pleural nonspecific effusion, and mononeuritis of the right peroneus nerve. The treatment lasted 14 months and led to permanent consequences, including fibrothorax with restrictive ventilation disorders and reduced diffusion of the alveolar-capillary membrane. This case highlights the need to improve the protection of health care workers who are in contact with TB patients, as well as the usefulness of the tuberculin skin test and QuantiFERON-TB test, which can be used to identify early latent TB. Flego V, et al. OCCUPATIONAL TUBERCULOSIS IN A HEALTH CARE WORKER Arh Hig Rada Toksikol 2014;65:417-422 The incidence of active tuberculosis (TB) among health care workers (HCW) has been reported to be 0.4 % in Germany, 1.0 % in Portugal, or up to 2.5 % in Brazil (1-3), with nurses enduring the highest risk, followed by physicians. Nurses are at a greater risk of acquiring TB if they work in pulmonary medicine or human immunodeficiency virus (HIV) wards, likely due to repeated contact with infected patients (4). The risk of developing TB is highest during the first years of exposure. The predominant clinical presentations are extrapulmonary cases (48 %), followed by pulmonary (44 %) and combination cases (8 %) (5). The most common forms of extrapulmonary TB (EPTB) include pleural, lymph node, osteoarticular, and abdominal TB. Other localisations such as central nervous system, urogenital, breast, chest wall, cutaneous, middle ear, and pericardial TB are rarely observed (6, 7). Pericarditis is a rare manifestation of TB, occurring in approximately 1-2 % of all TB cases (8). TB accounts for up to 4 % of acute pericarditis and 7 % of cardiac tamponade (5). Organisms usually spread to the pericardium from the mediastinal or hilar lymph nodes or from the lungs, and rarely as part of miliary TB. Tuberculous pericarditis (TBP) is a potentially lethal condition, and its prompt treatment can be lifesaving. Effective treatment requires a rapid and accurate diagnosis, which is often difficult. In occupationally exposed staff, pericardial effusion non-responsive to routine therapy should arouse suspicion of occupational TBP. KEY WORDS: antituberculotics; disseminated tuberculosis; extrapulmonary tuberculosis...