Can atopy have a protective effect against cancer?

BACKGROUND

An increased prevalence of allergies and an increased incidence of breast cancer have been observed. The hypothesis that atopy may have a protective effect against the risk of different types of breast cancer was evaluated.

METHODS

In this study, 11,101 patients (11,101 women with a mean age of 55.2±14.7 years) with different types of breast cancer were tested for allergies. Allergies were confirmed based on the retrospective analysis of allergy diagnostic procedures in patients who had been previously diagnosed with breast cancer. The retrospective prevalence rates of active allergic diseases, including allergic rhinitis, bronchial asthma and atopic dermatitis, were assessed. All patients were also analyzed for bronchial asthma and allergic rhinitis according to the relevant guidelines. A group of healthy control patients was used for the comparisons.

RESULTS

The women with breast cancer had a significantly lower incidence of IgE-mediated allergic diseases than the controls. The odds ratios (ORs) for allergic rhinitis, atopic dermatitis, and bronchial asthma were 0.61 (95% CI: 0.57-0.73), 0.17 (95% CI: 0.11-0.44), and 0.73 (95% CI: 0.65-0.83), respectively. The mean serum concentrations of total IgE were significantly lower in the study population of women with breast cancer than in the patients of the control group (39.2 ± 26.2 kU/L vs. 108.5 ± 38.5 kU/L; p = 0.002).

CONCLUSION

Our results suggest that the overall incidence of allergies, especially allergic rhinitis, is lower in patients with certain types of cancer than in individuals who did not have cancer. Further studies are needed to confirm our findings.

The prevalence and characteristics of local allergic rhinitis in Poland

BACKGROUND

Local allergic rhinitis (LAR) is found in some patients with typical symptoms but who have negative skin prick tests and negative IgE to aeroallergens while presenting with positive nasal provocation tests for proper allergens. Little information about the clinical characteristics and prevalence of LAR has been published. The aim of this study was to determine the prevalence and characteristics of LAR in patients with symptoms of chronic rhinitis.

METHODS

In total, 680 patients out of 3400 pre-screened subjects with chronic rhinitis who were at least 5 years old were included from 17 sites in Poland in the study protocol. The following medical history and diagnostic procedures were performed with aeroallergens: skin prick tests, allergen specific serum IgE and nasal provocation tests. In addition to LAR, allergic rhinitis (AR) and non-allergic (NAR) rhinitis were explored and compared.

RESULTS

In total, 621 patients were examined. LAR was diagnosed in 109 (17.6%) patients; AR was diagnosed in 251 (40.4%) patients; and NAR was diagnosed in 261 (42%) patients. In the LAR group, younger, non-smoker patients with allergies to D. pteronyssinus or grass pollen were predominant. Polysensitization was more prevalent in AR patients than in LAR patients. Bronchial asthma was at a similar level in patients diagnosed with AR (38%) and LAR (35%) but was significantly less prevalent in patients diagnosed with NAR (16%). The mean age of disease onset was similar between patients with AR and LAR (17.6 plus or minus 4.8 yrs), and it was significantly lower than that in patients with NAR (24.5 plus or minus 6.9 yrs, p less than 0.05).

CONCLUSIONS

LAR is a significantly understudied problem in patients of various ages with chronic nasal symptoms. Patients with LAR and AR have similar clinical phenotypes.

Fall episodes in elderly patients with asthma and COPD - A pilot study

OBJECTIVE

Evidence of an increased risk of falls in patients with chronic obstructive pulmonary disease (COPD) exists; however, this has not been studied in elderly asthmatic patients. The aim of the study was to determine the incidence of falls in elderly patients who were diagnosed with bronchial asthma compared to subjects with COPD.

METHODS

A 12-month prospective observational study in elderly outpatients with diagnosis of either asthma or COPD was conducted. All of the participants were monitored on the following parameters: falls, comorbidities, drug therapy, and The Berg Balance Scale. The rate of falls was shown as an incidence ratio. Cluster analysis for subgroups with similar features was performed on all patients included in the study. Two clusters of frequent fallers were determined.

RESULTS

The fall incidence rate in falls per person per year was 1.41 (95% CI: 0.86-1.96) in asthmatic patients and 1.49 (95% CI: 1.05-2.11) in the COPD group. Frequent fallers were more prevalent in the COPD group, with 32% in this group compared to 28% in the groups of patients with asthma. In cluster analysis, frequent fallers were grouped into two models characterized by polytherapy, depression symptoms, hospitalizations, coronary disease, dementia, and diagnosis of COPD or asthma.

CONCLUSION

Elderly asthmatic patients presented a high rate of falls, which is comparable to that of patients with COPD.

Twenty years' observation of subcutaneous pollen allergoid immunotherapy efficacy in adults

INTRODUCTION

It is valuable to determine the long-term efficacy of allergen-specific immunotherapy (SIT) and whether it can cure allergy.

AIM

For this study, patients were prospectively observed for 20 years after completion of SIT to determine its effectiveness.

MATERIAL AND METHODS

A total of 1006 patients who underwent SIT for pollen allergy were observed for 20 years to assess the efficacy of SIT. The rhinitis symptom score (RSS) and asthma symptom score (ASS) were measured after SIT completion. The possibility of allergy cure was estimated based on three sets of criteria: group A - neither symptoms nor intake of medication during the analysis period, group B - no symptoms during the analysis period (but possible medication intake), and group C - at most one mild symptom during the analysis period.

RESULTS

After SIT, approximately 25% of patients showed complete relief of allergy symptoms and had no need for symptomatic drug treatment during the pollen season. The level of effectiveness of SIT was similar throughout the treatment period. During the observation period after SIT, RSS ranged from 1.51 to 1.82, and ASS ranged from 1.22 to 1.29. The treatment effect at 10 and 20 years after SIT was comparable, regardless of whether criterion A or B was used. However, the effect of SIT using criterion C was lower than those using criteria A and B for the analyzed time points.

CONCLUSIONS

For this study cohort, SIT had a long-term effect that did not depend significantly on the duration of immunotherapy against pollen.

Local Allergic Rhinitis in Adult Patients with Chronic Nasal Symptoms

BACKGROUND

Local allergic rhinitis (LAR) remains an underdiagnosed condition characterized by the local production of IgE antibodies during the natural exposure to aeroallergens. The prevalence of LAR in adult patients with a previous diagnosis of non-AR was assessed.

MATERIAL AND METHODS

Eighty-four patients with perennial nasal allergy symptoms but a negative skin prick test and specific IgE antibodies against common inhalant allergens were included in the study. Nasal provocation tests were performed with the inhalant allergens Dermatophagoides pteronyssinus, Alternaria, and cat allergen, followed by the detection of nasal-specific IgE antibodies in the lavage during the challenge.

RESULTS

LAR was confirmed in 21 (25%) study patients. In the remaining 63 (75%) patients, non-AR was diagnosed. In addition, LAR was found following exposure to D. pteronyssinus in 19 (22.6%) patients, Alternaria in 3 (3.6%) patients, and the cat allergen in 1 (1.2%) patient. In 2 patients, concomitant allergies to D. pteronyssinus and Alternaria were observed.

CONCLUSION

LAR can be a form of chronic perennial rhinitis that has previously been considered to be non-AR.

Prolonged effect of allergen sublingual immunotherapy for house dust mites in elderly patients

BACKGROUND

The prolonged effect of allergen immunotherapy is unknown, especially in older patients.

OBJECTIVE

To analyze the 3-year effect of sublingual allergen-specific immunotherapy (SLIT) to house dust mites in elderly patients with allergic rhinitis.

METHODS

Forty-seven elderly patients (65.78 ± 4.89 years old) underwent SLIT to house dust mites and were monitored for 3 years and compared with a placebo group. SLIT was performed with the use of oral Staloral 300 SR Der p and Der f 50/50% extract (Stallergens Greer, London, United Kingdom) or placebo. Symptoms and medication score, represented by the average adjusted symptom score (AAdSS), serum level of immunoglobulin (Ig) G4 to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Der p 1, and Der p 2, and quality of life, were assessed immediately after SLIT and 3 years later.

RESULTS

The AAdSS was significantly decreased after SLIT, and the level remained low during the 3 years after SLIT compared with placebo. Serum-specific IgG4 against D pteronyssinus, D farinae, Der p 1, and Der p 2 increased during the SLIT trial in the study group. For the 3 years of observation after SLIT, there were no significant changes of specific IgG4 levels against the analyzed allergens compared with results just after SLIT. Quality of life based on the Rhinoconjunctivitis Quality of Life Questionnaire score was significantly decreased in patients who received SLIT, from 1.48 (95% confidence interval 1.33-1.79) to 0.98 (95% confidence interval 0.67-1.07; P < .05) compared with 0.94 (95% confidence interval 0.55-1.04) 3 years after SLIT.

CONCLUSION

The prolonged positive effect after SLIT to house dust mites was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01605760.

Local allergic rhinitis to pollens is underdiagnosed in young patients

BACKGROUND

Local allergic rhinitis (LAR) has been observed in patients without atopy. However, LAR is still underdiagnosed in patients with perennial or seasonal nasal symptoms.

OBJECTIVE

The aim of this study was to determine the prevalence of LAR in young patients with a previous diagnosis of nonallergic rhinitis or suspicion of allergy.

METHODS

A total of 121 patients, ages 12-18 years old, with confirmed nonallergic rhinitis and typical seasonal nasal symptoms were examined. Skin-prick tests; serum and nasal specific immunoglobulin E (IgE) measurements; and nasal provocation tests by using grass (Phleum partense), Artemisia, and birch pollens were performed. A control group of age-matched patients with a diagnosis of seasonal allergic rhinitis underwent the same procedures as the test group.

RESULTS

LAR to grass pollen (P. partense), Artemisia, and birch was confirmed in 17 (16.6%), 6 (5.9%), and 9 (8.9%) of patients, respectively. Polyvalent allergy was established in 21 subjects (20.8%): grass and Artemisia, 11 patients (10.9%); and grass and birch, 10 patients (9.9%). The remaining 48 patients (47.5%) were diagnosed with nonallergic rhinitis. The results of the nasal provocation tests and the concentrations of nasal IgE were similar among the analyzed groups. Furthermore, the concentration of nasal IgE increased faster in patients with LAR than in patients with allergic rhinitis; however, this difference was not statistically significant.

CONCLUSION

LAR is a serious problem in young patients; however, its significance is still unappreciated.

The effect of allergen-specific immunotherapy on offspring

BACKGROUND

The incidence of allergic diseases has increased worldwide. Thus, there is a need for effective primary prevention of allergies.

OBJECTIVE

The aim of the present study was to examine how allergen-specific immunotherapy (ASIT) affects the development of allergies in the generation of children whose parents were subjected to this method of treatment.

METHODS

A total of 194 children with at least one parent with allergy subjected to ASIT were enrolled. These patients were compared with control individuals without ASIT. Their risk of allergy, based on medical history, examination, allergy skin-prick tests, serum total immunoglobulin E and specific immunoglobulin E concentrations was assessed.

RESULTS

The children of parents subjected to immunotherapy showed significantly reduced clinical symptoms of allergic disease. The odds ratios (OR) of any allergic disease and asthma were significantly lower in children with one or both parents with allergy after ASIT compared with the children with parents with allergy and without ASIT: OR 0.73 (95% confidence interval [CI], 0.59-0.86) versus OR 1.85 (95% CI, 1.73-2.2) for any allergic disease and OR 0.63 (95% CI, 0.53-0.79) versus OR 1.36 (95% CI, 1.22-1.67) for asthma.

CONCLUSION

The phenomenon of reducing the risk of allergies in children whose parents were desensitized might be important in the primary prevention of allergies.

Pre-seasonal, subcutaneous immunotherapy: a double-blinded, placebo-controlled study in elderly patients with an allergy to grass

BACKGROUND

There is limited evidence indicating that specific immunotherapy in elderly patients is safe and effective.

OBJECTIVE

To evaluate the safety and efficacy of pre-seasonal specific subcutaneous immunotherapy (SCIT) against grass pollen allergens in patients older than 65 years with seasonal allergic rhinitis and to measure the prime outcome of area under the curve for the combined symptoms and medication score during grass pollen season after 3 years of SCIT in a double-blinded, placebo-controlled trial.

METHODS

This study included 60 65- to 75-year-old patients with seasonal allergic rhinitis and grass pollen allergy. Patients were individually randomized to the active or placebo group. Thirty-three subjects in the SCIT group and 27 subjects in the placebo group were monitored for 3 years. Patients were required to record each use of anti-allergy medication.

RESULTS

Thirty-one patients completed 3 years of pre-seasonal SCIT and 24 subjects finished placebo treatment. The median area under the curve for the combined symptoms and medication score after the third grass pollen season after SCIT was significantly decreased from 7.85 (range 3.67-8.98) to 4.63 (range 3.56-7.80) in the active group and did not significantly change in the placebo group. In the active group, the combined symptoms and medication score was decreased by 41%, the symptoms score was decreased by 55%, and the medication score was decreased by 64% after 3 years of immunotherapy.

CONCLUSION

Pre-seasonal SCIT in the elderly is safe and efficacious and elicits an immune response comparable to what is found in studies of younger patients.

Grass pollen sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with seasonal allergic rhinitis

BACKGROUND

This study evaluates the safety and efficacy of specific sublingual immunotherapy (SLIT) against grass pollen allergens in patients >60 years of age with seasonal allergic rhinitis (SAR) and/or asthma. This study sought to assess nasal symptoms during the grass pollen season, reduce medication use, and monitor adverse reactions during immunotherapy.

METHODS

Seventy-eight 60- to 70-year-old patients with SAR and a confirmed grass pollen allergy according to skin-prick tests, nasal provocation, and measurement of serum IgE were included in the study. The patients were individually randomized to the active or placebo groups using a double-blind method. A total of 41 subjects in the SLIT group (5 grass pollen mixture) and 37 subjects in the placebo group were monitored for 3 years. The patients were required to record each use of an antiallergy medication on a diary card.

RESULTS

Thirty-eight patients completed 3 years (preseasonal) of SLIT, and 34 subjects finished the placebo treatment in the same time period. The total nasal symptom score decreased by 64% in the active group and 7% in the placebo group after SLIT. This difference was only significant in the active group (p < 0.05). At the end of therapy, the total medication score of the active group decreased significantly by a maximum of 51% (p < 0.05), whereas the total medication score of the placebo group had an insignificant decrease. None of the study participants had systemic adverse reactions during the study period.

CONCLUSIONS

SLIT in elderly patients with a grass pollen allergy generated a significant clinical improvement in the active group compared with the placebo group for grass pollen season. This therapy was well tolerated.

Epidermal differentiation complex (locus 1q21) gene expression in head and neck cancer and normal mucosa

Epidermal differentiation complex (EDC) comprises a number of genes associated with human skin diseases including psoriasis, atopic dermatitis and hyperkeratosis. These genes have also been linked to numerous cancers, among them skin, gastric, colorectal, lung, ovarian and renal carcinomas. The involvement of EDC components encoding S100 proteins, small proline-rich proteins (SPRRs) and other genes in the tumorigenesis of head and neck squamous cell cancer (HNSCC) has been previously suggested. The aim of the study was to systematically analyze the expression of EDC components on the transcript level in HNSCC. Tissue specimens from 93 patients with HNC of oral cavity and 87 samples from adjacent or distant grossly normal oral mucosawere analyzed. 48 samples (24 tumor and 24 corresponding surrounding tissue) were hybridized to Affymetrix GeneChip Human 1.0 ST Arrays. For validation by quantitative real-time PCR (QPCR) the total RNA from all180 samples collected in the study was analyzed with Real-Time PCR system and fluorescent amplicon specific-probes. Additional set of samples from 14 patients with laryngeal carcinoma previously obtained by HG-U133 Plus 2.0 microarray was also included in the analyses. The expression of analyzed EDC genes was heterogeneous. Two transcripts (S100A1 and S100A4) were significantly down-regulated in oral cancer when compared to normal mucosa (0.69 and 0.36-fold change, respectively), showing an opposite pattern of expression to the remaining S100 genes. Significant up-regulation in tumors was found for S100A11, S100A7, LCE3D, S100A3 and S100A2 genes. The increased expression of S100A7 was subsequently validated by QPCR, confirming significant differences. The remaining EDC genes, including all encoding SPRR molecules, did not show any differences between oral cancer and normal mucosa. The observed differences were also assessed in the independent set of laryngeal cancer samples, confirming the role of S100A3 and LCE3D transcripts in HNC. In HNC of oral cavity only one family of EDC genes (S100 proteins) showed significant cancer-related differences. A number of other transcripts which showed altered expression in HNC require further validation.

Coexistence of angioedema alone with impaired glucose tolerance

BACKGROUND

Most patients with chronic spontaneous urticaria (CSU) exhibit recurrent angioedema. As of yet, the pathogenesis of angioedema in CSU is largely unclear, especially when angioedema occurs in patients who do not develop wheals. Over the past years, we and others have repeatedly observed that patients with recurrent angioedema alone exhibit impaired glucose tolerance.

AIM

To assess blood glucose levels and glucose tolerance in these patients and to compare the results to those of CSU patients who do not develop angioedema.

METHODS

A total of 29 patients with angioedema alone (15 women, mean age 43.2 ± 12.8 years) and 33 CSU patients (17 women, mean age 41.9 ± 17 years) were investigated and compared for clinical features and laboratory values, including fasting and random blood glucose levels, and glycated hemoglobin (HbA1c%). All patients were subjected to oral glucose tolerance testing (OGTT).

RESULTS

Fasting plasma glucose levels, random blood glucose levels and OGTT glucose levels were significantly higher in patients with angioedema alone as compared to CSU patients. Glucose tolerance was impaired in 17 of 29 patients with angioedema alone (58.6%) and only in 2 of 33 CSU patients (6.1%). Patients were found to have an increased risk of high glucose (OR 1.74) and HbA1c (OR 1.83) blood levels and of developing a high BMI (OR 1.97).

CONCLUSION

Recurrent angioedema in patients who do not develop wheals appears to be associated with impaired glucose tolerance and elevated blood glucose levels. We recommend blood glucose measurements in patients with recurrent angioedema alone.

Epidemiology of IgE-dependent allergic diseases in elderly patients in Poland

BACKGROUND

There is a growing allergy problem in elderly patients. The epidemiology of atopic bronchial asthma (BA), allergic rhinitis, and atopic dermatitis (AD) was analyzed in an elderly Polish population.

METHODS

Subject recruitment was conducted at 16 sites representative of Polish rural and urban areas, and 7124 subjects, including 4176 women with a mean age of 67.5 ± 84.9 years and 2948 men with a mean age of 66.1 ± 7.2 years, were screened. Medical examinations, an original questionnaire, skin-prick testing (SPT) with common aeroallergens, and appropriate serum-specific IgE assays were performed.

RESULTS

Suspicion of atopy was diagnosed in 1900 of the 7124 analyzed patients (26.7%), including 1117 women (26.7% of women) and 783 men (26.6% of men). The average morbidity associated with age and sex in this population was 5.9% (95% CI, 5.1-6.4) for BA, 1.6% (95% CI, 15.9-19.3) for AD/eczema, 12.6% (95% CI, 10.8-14.6) for seasonal allergic rhinitis, 17.1% (95% CI, 15.9-19.7) for perennial allergic rhinitis, and 6.4% (95% CI, 5.1-7.3) for polymorphous atopic disease. The most frequent positive results were recorded for the following allergens: mixed grass, Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Alternaria.

CONCLUSION

This study confirms the high prevalence of allergic rhinitis and BA in elderly Polish patients. These findings are comparable with those involving groups of younger individuals with allergies.

The safety of specific immunotherapy for patients allergic to house-dust mites and pollen in relation to the development of neoplasia and autoimmune disease: a long-term, observational case-control study

BACKGROUND

Specific immunotherapy (SIT) safety has been well documented. However, the prolonged late side effects in patients who terminated SIT several years previously have been reported on in only a limited number of studies. The aim of this study was to perform a 20-year post-SIT observational evaluation for the assessment of any manifestation of serious immunological disease.

MATERIALS AND METHODS

In total, 1,144 patients (521 women and 623 men), with a mean age of 22.8 ± 16.9 years (at the moment of SIT completion) and who had atopic bronchial asthma and/or allergic rhinitis, were observed 20 years after immunotherapy. New neoplastic and autoimmune disease cases were monitored. The SIT group was compared to a control group consisting of 1,154 allergic patients who had never received SIT and had only had symptomatic treatment.

RESULTS

There was an inverse association between SIT treatment and the prevalence of new chronic myeloid leukemia and chronic lymphoblastic leukemia cases (OR 0.32, 95% CI 0.18-0.81 and OR 0.58, CI 0.44-0.78, respectively). In other neoplastic diseases, however, prevalences similar to those observed in the control group were confirmed. There were also no significant differences in the autoimmune disease prevalence between the analyzed groups.

CONCLUSION

The results of this long-term observational study indicate a lack of a significant prevalence for new instances of neoplastic and autoimmune diseases, which suggests that SIT in the long term is indeed safe.

The influence of hospitalizations due to exacerbations or spontaneous pneumothoraxes on the quality of life, mental function and symptoms of depression and anxiety in patients with COPD or asthma

BACKGROUND

Patients with bronchial asthma or chronic obstructive pulmonary disease (COPD) frequently have a low quality of life (QoL) in addition to depression symptoms. The aim of this study was to compare the QoL, depression symptoms, mental function and anxiety in patients with asthma or COPD exacerbations or spontaneous pneumothoraxes (SP) to patients with stable disease.

MATERIALS AND METHODS

Patients with a confirmed diagnosis of severe (III degree) bronchial asthma or COPD were included in this study. Prospective observations of asthma or COPD exacerbations or SP were performed over a three-year period. QoL was assessed using St. George's Respiratory Questionnaire (SGRQ). In addition, the AQ20 questionnaire (AQ20), the Hospital Anxiety and Depression Scale (HADS) and the Mini-Mental State Examination (MMSE) were administered.

RESULTS

A total of 233 patients (112 with asthma and 121 with COPD; mean age 57.9 ± 11.9 years) were included in the study. Patients with COPD or asthma had a low QoL as estimated by the SGRQ (mean ± SD: 27.5 ± 12.9 and 25.1 ± 10.2 for asthma and COPD, respectively). Asthma exacerbations, COPD exacerbations or SP requiring hospitalization were associated with lower SGRQ scores over the three-year observation period (41.5 ± 11.7, 57.9 ± 14.3 and 65.3 ± 11.4, respectively). The mean MMSE score significantly decreased after an asthma exacerbation compared to the baseline (29.9 ± 2.1 versus 27.2 ± 3.1; p < 0.05). The mean MMSE score decreased after COPD exacerbations (28.5 ± 0.9 versus 26.9 ± 1.2; p < 0.05) and after COPD with an SP event (28.8 ± 1.2 versus 24.1 ± 2.2; p < 0.05).

CONCLUSION

Low QoL and mental impairment were observed in patients with asthma and COPD. In addition, the QoL significantly decreased following hospitalizations due to exacerbations or SP.

Characteristics of atopic bronchial asthma in seniors over 80 years of age

BACKGROUND

Asthma in the elderly is an important public health problem. The aim of this study was to assess the prevalence and characteristics of asthma in seniors.

MATERIALS AND METHODS

The study involved 105 people of at least 80 years of age (mean age of 84.1 ± 3.9 years) selected from a group of 1860 individuals. Spirometry, the methacholine test, allergy diagnosis, a measurement of exhaled nitric oxide, and administration of the asthma quality of life questionnaire (AQLQ) were performed.

RESULTS

The average morbidity of asthma in the study population of elderly people (at least 80 years of age) was 5.6% (105 people) of the confidence interval (95% CI: 5.1-6.0). In the study group, 34% of the elderly asthmatics had uncontrolled asthma, 47% had partly controlled asthma, and only 24% had fully controlled asthma. Allergy to house dust mites was predominant. The average total score on the AQLQ was 4.12 ± 0.72 (arithmetic mean ± standard deviation) for the seniors, which was significantly lower than the score for the young.

CONCLUSION

The pathogenesis, natural history, and value of the basic diagnostic methods of asthma in the elderly are similar to those observed in younger age groups.

Montelukast as an add-on therapy to inhaled corticosteroids in the treatment of severe asthma in elderly patients

BACKGROUND

Severe asthma remains a worldwide medical problem. However, this disease has not been adequately explored in the elderly. This study was performed to determine how the addition of montelukast to antiasthmatic therapy improves the control of severe asthma in elderly patients.

METHODS

Elderly patients (>60 years old) with diagnoses of severe asthma were observed over 24 months of therapy: the first 12 months using inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) and the second 12 months with oral montelukast added in two-thirds of the patients, with the remaining third representing the control group. The primary efficacy endpoint of the study was the percentage of days without asthma symptoms in the first 12 months of treatment compared with the percentage after adding montelukast therapy.

RESULTS

A total of 512 elderly, asthmatic patients were included in the study: seventy-one (13.9%) patients had well-controlled asthma, 211 (41.2%) had partly controlled asthma, and 230 (44.9%) had uncontrolled asthma. During the first year of treatment using ICS and LABA, an increase in the median percentage of days without asthma was observed from 50.1% to 62.1%, as well as a decrease in the percentage of days with short beta-receptor agonist use, from 52.2% to 46.8%. These differences were significantly greater after 12 months, when montelukast was added to the therapy (78.4% and 39.5%, respectively). This improvement was not observed in the control group. After 2 years of observation, the median number of asthma exacerbation incidents per patient decreased from 1.6 per year to 1.2 per year when montelukast was added.

CONCLUSION

Severe asthma in elderly patients is very poorly treated, with this population exhibiting very low compliance with antiasthmatic therapy. Adding montelukast provides benefits and improved control; however, it does not resolve severe asthma control problems.

Improved activity and mental function related to proper antiasthmatic treatment in elderly patients with Alzheimer's disease

Alzheimer's disease (AD) and bronchial asthma are common diseases in elderly patients. Untreated chronic diseases, such as chronic obstructive pulmonary disorder, diabetes, heart failure, and asthma can be associated with declining cognitive function. The objective of this study was to evaluate the influence of asthma therapy performed according to Global Initiative for Asthma (GINA) guidelines (GINA. Global strategy for asthma management and prevention. Report. Available online at http://www.ginasthma.com/Guidelineitem.asp??l1=2&l2=1&intId=60 last accessed Oct. 2009) on cognitive function and functional status in patients diagnosed with AD. A total of 302 participants who were diagnosed with bronchial asthma and mild or moderate AD (138 women and 164 men) with a mean age of 68.2 ± 5.1 years were included in the study. Cognitive function was assessed based on the Mini-Mental State Examination (MMSE) and the clock drawing test at the beginning of the study, after 6 months, and after 1 year. Results were compared with a control group of patients with AD but not asthma. Several patients (68.9%) had uncontrolled asthma (confirmed at the beginning of the study) and AD. After 1 year of antiasthmatic treatment, the mean MMSE score increased significantly from the baseline values of 17.2 ± 3.2 to 19.5 ± 2.1 (mean ± SD; p < 0.05). This change was significant compared with the control group. Significant improvement in instrumental activity was observed after 1 year of treatment in patients with asthma. Finally, 63.6% of patients met the criteria of well-controlled asthma. Adequate treatment of chronic asthma could improve some cognitive and instrumental activities. Asthma in patients with AD is commonly underdiagnosed and undertreated.

The improvement of cognitive functions in patients with bronchial asthma after therapy

BACKGROUND

The severity of asthma in older people is frequently underestimated because of underdiagnosis and undertreatment. There are a number of reasons for this. In elderly patients, chronic diseases can be related to declining cognitive function. This situation could influence diagnosis and treatment. The objective of this study was to evaluate the influence of appropriate asthma therapy on cognitive function.

METHODS

A total of 359 participants diagnosed with bronchial asthma, 219 women and 140 men with a mean age of 69 ± 4.03 years, were included in this study. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) at the beginning of this study and after 1 year. Patients were divided into three subgroups based on their initial MMSE scores dementia, mild cognitive impairment (MCI), and good cognition.

RESULTS

At the beginning of this study, 31.2% of patients presented uncontrolled asthma, 46.2% exhibited partly controlled asthma, and 25.1% had well-controlled asthma. A significant improvement in control over the patients' asthma was observed over the course of this study. After 1 year of treatment, the mean MMSE score significantly increased in initially demented patients, from 18.2 ± 3.1 (mean ± SD) to 21.9 ± 2.1 (p < .01); in subjects with MCI, from 25.4 ± 0.9 to 27.2 ± 1.2; and in patients with good cognition, from 27.4 ± 0.7 to 29.7 ± 0.4 (chi-square test, p < .01).

CONCLUSION

Proper control of asthma in patients with cognitive impairments can improve some cognitive functions.

HLA status in patients with chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is the most common form of chronic urticaria. A considerable amount of data supports an immunological basis for CSU. Some research has focused on the association between chronic urticaria and specific human leukocyte antigen (HLA) alleles. The aim of this study was to investigate the HLA status of Polish patients diagnosed with CSU.

METHODS

The standard complement-dependent microlymphocytotoxicity assay and PCR amplification with sequence-specific primers were used to analyze HLA alleles in 115 patients diagnosed with CSU, and the results were compared to those from 162 healthy, genetically unrelated individuals.

RESULTS

Among the HLA-A alleles, A-33 occurred significantly more often in the control group (p < 0.01). Analysis of the HLA-B allele frequencies revealed the prevalence of the B44 antigen in the study group (p < 0.0001). Frequencies of HLA-C alleles and HLA-DQ did not differ significantly between the groups. Among the HLA class II alleles, DRB1*04 was observed significantly more often in the study population (p < 0.001), mainly in the autoimmunological subtype of urticaria.

CONCLUSION

HLA alleles may be involved in CSU development or play a protective role in CSU.

Adherence to asthma therapy in elderly patients

OBJECTIVES

To assess the adherence to antiasthmatic therapy by the use of questionnaire and objective methods in elderly people, as well as to evaluate the association between cognition, depressive symptoms, functional status, and compliance.

METHODS

Patients aged 65 to 102 with chronic asthma under therapy were analyzed retrospectively to evaluate adherence using the Modified Morisky (MM) scale and a visual analog scale (VAS). In the second part of the study, a 1-year monitoring of asthma based on electronic diary and assessment of drug usage was performed. The MM scale and VAS as well as the estimation of cognition, depression symptoms, and functional status were carried out at the beginning and at the end of the observations.

RESULTS

Among 117 participants at the beginning of the study, only 9% and 21% had high adherence to therapy according to the MM scale and VAS, respectively. After 1 year of monitoring, the compliance assessed by the MM scale increased from 3.08 +/- 0.97 to 3.85 +/- 1.01 and by the VAS from 44% +/- 7.8% to 90% +/- 5.9%. Adherence by electronic diary and drug packages was lower than in both MM scale and VAS. Cognition status correlated with the results of MM and VAS tests but did not influence other methods of assessment. There was a statistical correlation between depression symptoms, cognition, and adherence (p >.01) in contrast to functional status. Compliance correlated with asthma control tests and PEFR.

CONCLUSION

Low adherence to antiasthmatic treatment is common in elderly people. Proper monitoring of asthma by the use of diary or assessment of drugs packages with estimation of depression symptoms and cognition status could increase the compliance and asthma control in this group of patients.

[Difficulties in determining of the equivalent doses of inhaled glucocorticoids]

Inhaled glucocorticoids are the most effective anti-inflammatory medicines used to treat asthma. Determination of equivalent dose is important, because different preparations vary in potency and bioavailability. Despite the large knowledge about the effect of inhaled glucocorticoids the data of their dosing are not consistent and continue to be verified in clinical studies. The authors discuss some of the indicators of pharmacodynamic and pharmacokinetic properties that may help determine the effectiveness, safety and equivalence of different doses of inhaled corticosteroids.

[Calcyphylaxis in a patient with end-stage renal disease in the course of systemic lupus erythematosus, diagnostic problems--case report]

Calcyphylaxis consists in vascular calcium deposition and skin necrosis, which appears in the final stage of renal failure. Advanced forms of systemic connective tissue disease such as lupus erythematosus, especially with concomitant vasculitis, leading to renal failure and uremia may be conducive to calcyphylaxis. We are presenting a case of a 50-year-old male requiring chronic peritoneal dialysis since the age of 43, due to end-stage renal disease resulting from chronic glomeluronephritis. The patient presented to our Dermatology Department with large and painful coalescent cutaneous lesions on both lower extremities, fingertips and lips. Both clinical picture and disease history indicated systemic vasculitis that was previously unrecognized. Additional examinations revealed the following markers of inflammation: leukocytosis (11 G/I) with normal level of eosinophils, CRP > 0.6 mg/I, ESR 120 mm/h, and IgG 20 g/l, without any source of infection. Indirect immunofluorescence showed the absence of antineutrophil cytoplasmic antibodies (ANCA) on polynuclear leucocytes. A distinct fluorescence pattern observed in liver sinusoids was suggestive of the presence of some form of anti-granulocyte antibodies. Anti-nuclear antibodies (ANA) were detected in serum (1:1000) with homogenous and microgranular fluorescence pattern. Anti-extractable nuclear antigen panel (ENA), C3/C4 levels, anti-smooth muscle, anti-dsDNA and anti-glomerular basement membrane (GBM) antibodies were within normal limits. Lupus band test revealed IgA and IgG deposits at the dermis-epidermis junction. Histopathological examination of the skin showed calcification complicated by small vessel thrombosis, however, it was non-specific for vasculitis. Our case represents an example of calcyphylaxis associated with a widespread medial vascular calcification in a patient with end stage renal disease secondary to systemic lupus erythematosus. Although renal dialysis itself is known to trigger calcyphylaxis, there have been few reports in literature suggesting that collagen vascular disease may also contribute to this process.

[Nongenomic effects of glucocorticoids, an important mechanism of inhaled glucocorticoids action in asthma]

Authors describe the clinical implications of nongenomic effects of glucocorticoids, important also for the inhaled drugs. Data suggest that these rapid actions of glucocorticoids are important in the pharmacotherapy of asthma, particularly for prevention and treatment of acute exacerbations. Their influence on remodeling is also considered.

[Nongenomic effects of glucocorticoids]

The review describes current advances in the knowledge on the mechanisms of glucocorticoid (GC) action. According to the classic genomic model, GCs bind to intracellular receptors and subsequently regulate (directly or indirectly) gene transcription and synthesis of proteins responsible for inflammatory processes. The nongenomic effects of GCs, occur rapidly within seconds or minutes of drug administration, are mediated via a cytosolic but first of all by membrane GC receptors and lead to activation of multiple signal transduction pathways of protein kinases (MAPK, Src, PI3K), cation channels or G protein- -coupled receptors. Nongenomic effects may also occur without receptor involvement. The elucidation of nongenomic actions provides new insights for the understanding of their anti-inflammatory and immunosuppressive GC effects.

The diagnostic utility of S-100B protein and TPA in patients with ischemic stroke

OBJECTIVE

The aim of the study is to asses blood plasma concentrations of S-100B protein and Tissue Polypeptide Antigen (TPA) in patients with confirmed ischemic stroke and to correlate these concentrations with stroke severity.

METHODS

S-100B protein and TPA blood plasma concentrations were determined in 47 patients with acute ischemic infarction and in the control population. S-100B protein was assessed on the 1th day, TPA on the 1th, 7th and 14th day. The clinical status was documented using Scandinavian Stroke Scale. The functional deficit after the stroke was scored by Barthel Index.

RESULTS

The analysis of the entire examined group in relation to the control population showed elevated concentrations of S-100B protein (0.47 ng/ml vs. 0.19 g/ml). The highest concentrations were in the severe stroke group (0.89 ng/ml). The assessment of TPA blood plasma concentrations showed higher ones in the examined group of patients: 225.7 U/l on the 1st day; 96.1 U/l on the 7th day; 125.64 U/l on the 14th day after the stroke in relation to the control population.

CONCLUSION

The analysis of obtained results showed significant increase of S-100B protein blood plasma concentrations in patients with severe stroke and TPA in patients with mild stroke. S-100 protein blood plasma concentration assessed on the 1st day after the ischemic stroke is the parameter presenting the highest diagnostic utility and its value above 0.6 ng/ml was obtained only in patients with severe stroke.

[The importance of bisoprolol in prevention of heart left ventricular hypertrophy in patients with long term L-thyroxin suppressive therapy, after the operation of differentiated thyroid carcinoma]

INTRODUCTION

Patients with differentiated thyroid carcinoma have to undergo radical surgical treatment, which includes total thyreoidectomy, radioiodine therapy and a life-time suppressive therapy with L-thyroxine. The aim of this study was a prospective evaluation of left ventricular hypertrophy during L suppressive-thyroxine treatment in patients treated for differentiated thyroid carcinoma.

MATERIAL AND METHODS

The examined group comprised 50 patients with differentiated thyroid carcinoma, treated by total thyroidectomy and 131I therapy. Echocardiographic measurements were needed for estimation of left ventricular mass and its index, according to recommendations of American Echocardiography Society.

RESULTS

During two-years long suppressive therapy we observed a significant rise in left ventricular mass. In woman group left ventricular mass was increased from 168+/-39 g to 204+/-45 g (p<0.001) and in men from 205+/-60 to 320+/-21 g. Likewise, left ventricular mass index was increased in women group from 96+/-18 g/m(2) to 116+/-25 g/m(2) (p<0.001) and in men group from 107+/-37 g/m(2) to 158+/-28 g/m(2). Simultaneous treatment with bisoprolol caused a regression of left myocardial hypertrophy. Already after 6 months of simultaneous treatment with L-thyroxin and bisoprolol, for left ventricular mass was reduced to normal: in woman 165+/-35 g, and in men to 178+/-38 g. Analogous results were obtained left ventricular mass index. After 6 months it was reduced to 94+/-12 g/m(2) in woman and in men to 132+/-32 g/m(2).

CONCLUSIONS

1. In differentiated thyroid cancer patients, treated postoperatively with L-thyroxine suppressive therapy, left ventricular hypertrophy is observed already during the first year of suppressive therapy and progresses during the next year of treatment. 2 Addition of a beta-adrenergic antagonist to suppressive doses of L-thyroxine causes a regression of left ventricular hypertrophy, thus, beta-adrenergic antagonists should be administered in this group of patients.

Concentration of endothelin in plasma and BALF fluid from asthmatic patients

The bronchoconstrictive peptide endothelin-1 (ET-1) has been demonstrated in the airway epithelial and endothelial cells. In this study we investigated the pathophysiological significance of endothelin-1 in asthma. We addressed the issue by assessing the concentration of ET-1 in plasma and bronchoalveolar lavage fluid (BALF) in patients with a different intensity of asthma. Twenty one asthmatic patients (11 men,10 women) and 6 healthy control subjects (C) were included in the study. Eleven asthmatic patients were classified as moderate persistent asthma (SA), all of them were atopic, and another 10 were mild persistent asthmatics (AA). Lung function tests were carried out in all patients investigated. The ET-1 concentration was determined by an ELISA method in plasma and BALF. We found that the SA patients had the highest level of ET-1 (SA - 11.4 +/-3.6 fmol/ml; AA - 7.1 +/-2.7 fmol/ml; C - 5.6 +/-1.8 fmol/ml) in BALF. The same concerned the ET-1 level in plasma (SA - 27.8 +/-3.8 fmol/ml; AA - 18.1 +/-4.3 fmol/ml; C - 17.3 +/-3.0 fmol/ml). A positive correlation between the plasma ET-1 level and lung function indices was observed. We conclude that the higher levels of ET-1 in more severe asthma suggest that endothelins may contribute to the pathophysiology of the disease, its severity, and the regulation of bronchial tone.

[Cachexia in chronic pulmonary obstructive disease]

Weight loss is a characteristic feature of chronic obstructive pulmonary disease (COPD) and a negative, independent predictor of outcome. It is a consequence of a misbalance between protein synthesis and breakdown resulting from increased energy requirement unbalanced by dietary intake. A depletion of fat-free mass is seen, especially in muscles (up to 60% of their mass) and leads to the loss of their power and endurance. The impairment of quality of life is very distinct. So far, there is no systemic treatment in cachectic patients with COPD, anti-catabolic treatment by polyunsaturated fatty acid may be of significance but needs further investigation.

[Asthma in the elderly--estimation of natural disease course]

Bronchial asthma in the elderly is the significant medical problem because it is often underdiagnosed and insufficiently treated. The aim of the study was the assessment of natural course of bronchial asthma and its diagnostic procedures and treatment in patients after 65 yrs. The study group consisted of 181 patients suffering from asthma, at mean age 69 +/- 2.1 yrs. Apart from retrospective analysis, spirometry, skin tests and serum IgE concentration were performed.

RESULTS

The mean duration of asthma was 23 +/- 7.2 yrs and in most cases time of proper diagnosis was prolonged. 49% of elderly patients bad a positive history to atopy. In spirometry the mean value of FEV1 was 2.78 +/- 1.3 l/s. House dust mites were the most common allergen confirmed by skin prick tests and specific serum IgE level.

CONCLUSION

The observations proved underdiagnosis and insufficient treatment of asthma in the elderly. Positive skin test and specific IgE observed in a large group of elderly objects can indicate atopic mechanism in these cases.

[Pyoderma gangrenosum after a pacemaker implantation--case report]

We are presenting a 71-years old male patient with chronic skin lesions that appeared at multiple site of pacemaker implantations in the upper thorax. In spite of many treatment trials, no significant improvements were accomplished. Expanded dermatological tests including serial histopathological examinations were necessarily performed. Based on test results and clinical presentations, the diagnosis of pyoderma gangrenosum was made. Immediate steroid therapy allowed dramatic improvement of the chronic inflammatory condition. The patient is still undergoing a close dermatological and cardiological follow-up. Replacement of the pacemaker into the abdomen is currently being considered.

[Pathomechanism of cachexia in chronic obstructive pulmonary disease]

Weight loss is a characteristic for advanced chronic obstructive pulmonary disease (COPD), but its mechanism remains unexplained. The decrease of lean body mass is due to a negative energy balance with a noncatabolic hypermetabolic state. Pulmonary inflammation or tissue hypoxia might contribute to it, the decrease in protein content is accompanied by an increase in reactive oxygen forms. Tumor necrosis factor (TNF) has been implicated, other candidates are cytokines IL-1B and IL-6. Activation of apoptosis may be noticed. Pulmonary inflammation and changes in serum leptin may be interrelated. Other hormonal disturbances involve serum IGF-1 level decrease, increase of insulin resistance, raised catecholamine and cortisol levels and other mechanisms which need further investigations. Up to now the attempts undertaken to counteract the observed hormonal changes failed to success.

[Allergen specific-IgG4 in circulating immune complexes in patients with inhalant allergy undergoing specific immunotherapy]

The mechanism of action of specific immunotherapy (SIT) is still not definitely clear. The problem of the presence of allergen specific-IgG4 in circulating immune complexes (CIC) of patients with inhalant allergy is being discussed. The aim of the study was to determine the allergen specific-IgG4 serum levels and concentration in CIC in patients with inhalant allergy who underwent specific immunotherapy with relevance to its clinical benefits. The trial was carried out on 57 patients with seasonal allergic rhinitis (SAR) and 55 with perennial allergic rhinitis (PAR). Each of them underwent 3-year specific immunotherapy with Allergovit (Nexter-Allergopharma) or Novo Helisen Depot (Nexter-Allergopharma). 56 patients with pharmacologically treated allergic rhinitis served as a control group. Serum levels of allergen specific-IgG4 (as-IgG4), IgE, as-IgE and as-IgG4 concentration in CIC were measured in each patient and correlated with the clinical score of the disease activity. Nonparametric tests (the U Mann-Whitney test, Kruskall-Wallis test and Spearman's correlation rang test) were used. Serum levels of as-IgG4 and bound in CIC were statistically higher in the SIT group than in the control group and differed significantly between SAR and PAR groups. Immunotherapy caused significantly higher concentrations of as-IgG4 in CIC in PAR group than in SAR patients. No significant associations were found between studied immunological indices and clinical effects of SIT. Specific immunotherapy of allergic rhinitis is connected with the increase of as-IgG4 serum level and its concentration in circulating immune complexes.

Immune complexes IgE/IgG in airborne allergy: increase during pollen season

In the present study we addressed the question of IgE/IgG immune complex serum level in 92 patients with respiratory allergy in relation to their clinical status. Twenty patients with allergy to insect stings and 22 healthy volunteers were also investigated. IgE/IgG immune complexes and IgG anti-IgE antibodies were estimated using double antibody solid-phase immunoassays in IgG serum fractions isolated by protein A affinity chromatography or in fractions obtained by Sephacryl S-300 gel filtration. Three people (14%) from the control group, two patients (10%) with insect allergy and 41 patients (45%) from the group with airborne allergy exhibited an increased serum level of IgE/IgG immune complexes (chi2, p <0.05). IgG anti-IgE serum level was also significantly higher in the examined group of patients with airborne allergy than in the control group. None of the factors analyzed, including the kind of allergic disease, the type of inhalant allergen (pollen or house dust antigens), the severity of allergy judged from the frequency and intensity of symptoms for 1 year preceding blood sampling and the symptoms exhibited during blood sampling, showed a statistically significant relation to the level of IgE/IgG immune complexes or IgG anti-IgE, when the whole group of patients with respiratory allergy was analyzed. A distinct difference between patients investigated during and outside of the pollen season was found in patients with isolated pollen allergy. The latter exhibited an increase of IgE/IgG immune complexes (57% vs. 29%) significantly more often, which indicates the possible involvement of IgE/IgG immune complexes in the pathogenesis of pollen allergy.

[Bronchoconstriction symptoms mimicking bronchial asthma--report of two cases]

Two patients sent to the clinic with incorrectly diagnosed asthma have been presented. In both cases the bronchospastic symptoms was caused by the obstacle in the airways. The authors concluded that there is a great necessity to conduct the discriminating diagnosis of bronchospastic symptoms.

[Circulating immune complexes in airborne allergy--a protective role?]

Circulating immune complexes (KI) were analyzed in 78 patients with airborne allergy and compared to 34 persons of control group. KI were isolated by precipitation with 3% polyethylene glycol. KI-IgG, KI-IgA, KI-IgM were measured by radial immunodiffusion, KI-IgE by an immunofluorometric assay. Staphylococcal Protein A (SpA) binding to KI was measured by ria. Relations between the level of various KI and the diagnosis of allergic disease, the kind of allergen (related also to the exposition) and the symptoms of atopy were evaluated. Serum levels of KI-IgE, KI-SpA, and KI-IgM were distinctly elevated in airborne allergy, with the positive correlation between KI-SpA and KI-IgM. KI-IgE were related to the kind of sensitizing allergen and to the exposition to the pollen allergens. Most distinct differences in KI level were observed not in relation to the kind of disease or of the sensitizing allergen, but in relation to the symptoms and intensiveness of atopy. Patients showing a greater number and intensiveness of symptoms exhibited higher levels of KI-SpA. However, one of the symptoms scored (dyspnea) was connected with the decreased level of KI-SpA in these patients. We interpret the results in favour of the hypothesis of the dual role of KI in airborne allergy. We propose a protective role for KI-Spa, which contain IgG and may bind IgE, thus protecting the target organs of allergy.

[Nedocromil in treating chronic bronchial asthma of a moderate course]

Randomized, double blind, placebo controlled clinical studies aimed at evaluating the efficiency of nedocromil sodium (Tilade) in the form of metered dosimeter aerosol. Studies involved patients with moderate chronic bronchial asthma controlled with beta 2-agonists and theophylline in the form of sustained release preparations. Forty patients completed the studies. All patients were examined clinically (staging of the symptoms and doses of drugs) and spirometrically prior to and after 4 and 8 weeks of the treatment with nedocromil sodium. Statistically significant clinical improvement and spirometric improvement as well in patients treated with nedocromil sodium were noted. It may be concluded that nedocromil sodium is effective and well tolerated adjuvant therapy in the bronchial asthma.

[IgE-containing immune complexes in bronchial asthma]

Level of circulating immunological complexes and their immunoglobulin content have been determined in 36 asthmatic patients, including 15 patients with atopic asthma and 21 patients with infectious asthma. A technique of staphylococcal protein A binding has shown, that the level of the circulating immunological complexes is increased in patients with infectious bronchial asthma. An amount of IgE in these complexes has been increased in both atopic and infectious bronchial asthma. However, a level of IgE-containing immunological complexes has been higher in the atopic asthma, then that in infectious form of the disease. An increased IgA content in the immunological complexes has been noted in the infectious asthma.

[Migration inhibition test with thyroid membrane antigen in Graves-Basedow disease and nodular goiter]

The evaluation of the migration inhibition test with thyroid membrane antigen was carried out in 20 patients with Graves' disease, 13 patients with neutral nodular goiter and 13 healthy subjects. A significant inhibition of migration by thyroid antigen as compared to the control group was demonstrated only in the patients with Graves' disease (the value of the migration index was 0.57 +/- 0.07). The respective value was 0.79 +/- 0.16 in patients with nodular goiter and 0.85 +/- 0.11 in healthy subjects. The results obtained indicate the practical value of the migration inhibition test in diagnosing the thyroid diseases having an autoimmune background.

[Assessment of various personality features in patients with bronchial asthma using the Woodworth and Buss-Durke tests]

Certain personality features were assessed in patients with bronchial asthma with particular reference to the aggressiveness and psychic maturity. The aggression level in patients with bronchial asthma was found to be lower than in the control group. It seems that the main effect on the intensity of this emotional disorder group. It seems that the main effect on the intensity of this emotional disorder is exerted by negative environmental factors, while the endogenic factors, among them the health state, seem to be of lower importance.