Advances in Respiratory Medicine-Aims and Scopes Update

Advances in Respiratory Medicine, which has been published by MDPI since 2022, serves as a platform for hosting pneumological studies [...].

Is the 2016 ESC diagnostic algorithm useful for assessing the prevalence of chronic heart failure in population-based studies?

BACKGROUND

Chronic heart failure (CHF) is a major healthcare problem. However, there are no epidemiological studies assessing the prevalence of CHF in the general population with diagnosis based on algorithms recommended for clinical practice.

AIM

The aim of the HF-Pomorskie survey was to assess the prevalence of three basic components of the 2016 ESC diagnostic algorithm for CHF (symptoms, N-terminal pro B-type natriuretic peptide [NT-proBNP], and abnormalities on echocardiography) and to determine whether this algorithm may be applicable to studies in general population samples.

METHODS

The study was performed in a representative sample of 313 adults (170 women and 143 men) aged between 20 and 90 years (mean 55.2 years [15.3]) in Northern Poland. A questionnaire to determine New York Heart Association [NYHA] class, laboratory tests including NT-proBNP, as well as transthoracic echocardiography and spirometry examinations were performed in all subjects.

RESULTS

Dyspnea (NYHA class II-IV) was reported by 13.7% of recruited participants. Dyspnea and elevated levels of NT-proBNP (>125 pg/ml) were found in 7.7% of all examined subjects, while dyspnea, elevated NT-proBNP levels accompanied by systolic or diastolic abnormalities on echocardiography occurred in 4.8%. In the group without dyspnea (86.3% of all examined subjects), every sixth subject had an elevated level of NT-proBNP. On the other hand, 5.8% of studied subjects reported a previous diagnosis of CHF, which was confirmed using the current ESC algorithm in 78% of them.

CONCLUSIONS

The prevalence of CHF assessed by the 2016 ESC diagnostic algorithm in the representative sample of adults was equal to 4.8%. The clinical algorithm for the diagnosis of CHF is fully applicable to the representative surveys in the general population. However, due to logistic and economic factors, echocardiography examination and NT-proBNP determination can be limited to patients reporting dyspnea or previous diagnosis of CHF.

Evaluation of Conventional Cardiovascular Risk Factors and Ordinal Coronary Artery Calcium Scoring in a Lung Cancer Screening Cohort

(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50-79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.

Analysing COVID-19 treatment outcomes in dedicated wards at a large university hospital in northern Poland: a result-based observational study

OBJECTIVES

Presenting outcomes of patients hospitalised for COVID-19 should be put in context and comparison with other facilities. However, varied methodology applied in published studies can impede or even hinder a reliable comparison. The aim of this study is to share our experience in pandemic management and highlight previously under-reported factors affecting mortality. We present outcomes of COVID-19 treatment in our facility that will allow for an intercentre comparison. We use simple statistical parameters-case fatality ratio (CFR) and length of stay (LOS).

SETTING

Large clinical hospital in northern Poland serving over 120 000 patients annually.

PARTICIPANTS

Data were collected from patients hospitalised in COVID-19 general and intensive care unit (ICU) isolation wards from November 2020 to June 2021. The sample consisted of 640 patients-250 (39.1 %) were women and 390 (60.9 %) were men, with a median age of 69 (IQR 59-78) years.

RESULTS

Values of LOS and CFR were calculated and analysed. Overall CFR for the analysed period was 24.8%, varying from 15.9 % during second quarter 2021 to 34.1% during fourth quarter 2020. The CFR was 23.2% in the general ward and 70.7% in the ICU. All ICU patients required intubation and mechanical ventilation, and 44 (75.9 %) of them developed acute respiratory distress syndrome. The average LOS was 12.6 (±7.5) days.

CONCLUSIONS

We highlighted the importance of some of the under-reported factors affecting CFR, LOS and thus, mortality. For further multicentre analysis, we recommend broad analysis of factors affecting mortality in COVID-19 using simple and transparent statistical and clinical parameters.

The prevalence of dyspnea in the adult Polish population

OBJECTIVES

Dyspnea is one of the most predominant symptom in clinical practice. There is a lack of data about incidents of dyspnea among Polish adults therefore it would be important to establish prevalence of this symptom before COVID-19 pandemic to assess the impact of this infection on the functioning of the adult Polish population in the future. The aim of the study was to establish prevalence of dyspnea in adult Polish population.

MATERIAL AND METHODS

It was an observational-cross-sectional study, with representative sample of adult Poles aged 18-79 years. The 2413 participants were surveyed. Responders were asked if and when dyspnea occurs and what is its severity in relation to 1 of 4 categories (A, B, C, and D) describing the impact of dyspnea on reduced exercise tolerance and daily activities.

RESULTS

The 67.1% of the respondents answered negatively to all question about experiencing dyspnea (females (F) 61% vs. males (M) 74%, p < 0.05). Dyspnea only during intense physical exertion (A), was reported by 22.8% (F 26.2% vs. M 19.2%, p = 0.07). Dyspnea limiting daily activities (B, C and D) was reported by 10.1% (F 13.1% vs. M 7%, p < 0.05). Significant differences in the severity of dyspnea were found between the age groups. People diagnosed with chronic heart failure or lung diseases significantly more often reported dyspnea than people without these conditions.

CONCLUSIONS

Every tenth Pole reported dyspnea limiting performing activities of daily living. Additionally, about 20% of Poles experienced dyspnea considered as "gray area," only during intense physical exertion, that requires deepening and clarifying the medical history. Int J Occup Med Environ Health. 2022;35(6):747-52.

Prevalence, symptom burden and under-diagnosis of chronic obstructive pulmonary disease in Polish lung cancer screening population: a cohort observational study

OBJECTIVES

Lung cancer screening using low-dose CT may be not effective without considering the presence of comorbidities related to chronic smoking. The aim of the study was to establish the prevalence of chronic obstructive pulmonary disease (COPD) in group of phighlight the potential benefits atients participating in the largest Polish lung cancer screening programme MOLTEST-BIS and attempt to confirm the necessity of combined lung cancer and COPD screening.

DESIGN

Cohort, prospective study.

SETTING

Medical University of Gdańsk, Poland PARTICIPANTS: The study included 754 participants in lung cancer screening trial from the Pomeranian region, aged 50-70 years old, current and former smokers with a smoking history ≥30 pack-years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Questionnaire, physical examination, anthropometric measurements, spirometry test before and after inhaled bronchodilator (400 µg of salbutamol) RESULTS: Obstructive disorders were diagnosed in 186 cases (103 male and 83 female). In the case of 144 participants (19.73%), COPD was diagnosed. Only 13.3% of participants with COPD were known about the disease earlier. According to classification of airflow limitation 55.6% of diagnosed COPD were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 (mild), 38.9% in GOLD 2 (moderate), 4.9% in GOLD 3 (severe) and 0.7% in GOLD 4 (very severe) stage. Women with recognition of COPD were younger than men (63.7 vs 66.3 age) and they smoked less cigarettes (41.1 vs 51.9 pack-years).

CONCLUSIONS

Prevalence of COPD in Polish lung cancer screening cohort is significant. The COPD in this group is remarkably under-diagnosed. Most diagnosed COPD cases were in the initial stage of advancement. This early detection of airflow limitation highlights the potential benefits arising from combined oncological-pulmonary screening.NKBBN.

Clinical Characteristics and Management of Angioedema Attacks in Polish Adult Patients with Hereditary Angioedema Due to C1-Inhibitor Deficiency

Hereditary angioedema (HAE) due to C1-inhibitor (C1-INH) deficiency is a rare disease characterized by recurrent swellings. This study aims to determine (i) the clinical characteristics of the HAE patient population from Poland, and (ii) real-life patients' treatment practices. A cross-sectional study involved 138 adult HAE patients (88 females, 50 males) treated in six regional HAE centers in Poland. Consecutive patients during routine follow-up visits underwent a structured medical interview on the clinical characteristics of the course and treatment of HAE attacks within the last six months. A total of 118 of 138 patients was symptomatic. They reported in total 2835 HAE attacks predominantly peripheral and abdominal, treated with plasma-derived C1-INH (61.4%), icatibant (36.7%) and recombinant C1-INH (1.9%). An amount of 116 patients carried the rescue medication with them while traveling, and 74 patients self-administrated on demand treatment. There were twice as many symptomatic women (n = 78) as there were men (n = 40). Women treated their HAE attacks significantly more often than men. Older patients (≥65 years) reported a longer delay in diagnosis, and practiced the self-administration of rescue medication less frequently in comparison to other patients. Clinical features of the surveyed population are similar to other European, but not Asian, HAE patient groups. Self-administration still remains an unmet medical need. Some distinct HAE patients may require special attention due to the severe course of the disease (females) or a delay in diagnosis (the elderly).

Tachykinin Antagonists Reverse Ischemia/Reperfusion Gastrointestinal Motility Impairment in Rats

BACKGROUND

Supraceliac aortic clamping and unclamping produces ischemia-reperfusion (I/R) injury of the splanchnic organs. The protective effects of tachykinin receptor antagonists, SR140333 (NK₁ receptor), SR48968 (NK₂ receptor), and SB222200 (NK₃ receptor), against I/R-induced inhibition of intestinal motility were tested in rats.

MATERIAL AND METHODS

The intestinal transit of Evans blue was measured in untreated rats and animals subjected to skin incision, I/R (1 h superior mesenteric artery occlusion followed by 24 h reperfusion) or sham operation. Surgical procedures were conducted under diethyl ether anesthesia.

RESULTS

The gastrointestinal transit has not been markedly affected in rats, which were anesthetized or subjected to skin incision in comparison with untreated animals. In contrast, a sham operation and I/R have significantly reduced the intestinal motility. Pretreatment with NK_1-3 blockers (SR140333 [3-30 μg/kg]; SR48968 [3-100 μg/kg]; and SB222200 [10-100 μg/kg]) reversed dose dependently the effects of I/R to the level observed after sham operation only. A combination of NK₁+NK₂+NK₃ inhibitors exerted an additive effect compared with NK₁ and NK₂ antagonists used as single agents. Similarly, combined NK₁+NK₂ were more effective than NK₂ alone. Sham operation and I/R have shifted the in vitro carbachol concentration-response curves to the right in comparison with untreated animals, a phenomenon partially reversed by NK₁-NK₃ pretreatment.

CONCLUSIONS

Single-agent and combined treatment with NK_1-3 antagonists markedly attenuated the gastrointestinal dysmotility evoked by I/R injury. The pretreatment with NK₃ blocker proved to be the most active in this experimental setting.

The protective effect of endothelin receptor antagonists against surgically induced impairment of gastrointestinal motility in rats

Endothelin (ET) receptor antagonists: BQ-123 (ET_A), BQ-788 (ET_B), tezosentan (dual ET receptor antagonist) protect against the development of postoperative ileus (POI) evoked by ischemia-reperfusion (I/R). The current experiments explored whether ET antagonists prevent the occurrence of POI evoked by surgical gut manipulation. Intestinal transit was assessed by measuring the rate of dye migration subsequent to skin incision (SI), laparotomy (L), or laparotomy and surgical gut handling (L+M) in diethyl ether anaesthesized rats (E). Experimental animals were randomly sub-divided into two groups depending on the time of recovery following surgery: viz. either 2 or 24 h (early or late phase POI). E and SI did not affect the gastrointestinal (GI) transit. In contrast, L and L+M significantly reduced GI motility in comparison to untreated group (UN). Tezosentan (10 mg/kg), BQ-123 and BQ-788 (1 mg/kg) protected against development of L+M evoked inhibition of intestinal motility in the course of late phase, but not early phase POI. Furthermore, tezosentan alleviated the decrease in the contractile response of the longitudinal jejunal smooth muscle strips to carbachol in vitro induced by L+M. The serum ET(1–21) concentration was not increased in either the early or the late phase POI groups after surgery compared to control animals. This study indicates that delay in the intestinal transit in late phase of surgically induced POI involves an ET-dependent mechanism.

Histoplasmosis in an elderly polish tourist - a case report

BACKGROUND

Histoplasmosis is a mycosis caused by soil-based fungus Histoplasma capsulatum endemic in the USA, Latin America, Africa and South-East Asia. The disease is usually self-resolving, but exposure to a large inoculum or accompanying immune deficiencies may result in severe illness. Symptoms are unspecific with fever, cough and malaise as the most common. Thus, this is a case of disease which is difficult to diagnose and very rare in Europe. As a result, it is usually not suspected in elderly patients with cough and dyspnea.

CASE PRESENTATION

This is a case of a 78-year-old patient, admitted to our department due to respiratory failure, cough, shortness of breath, fever and weight loss with no response to antibiotics administered before the admission. Chest CT revealed numerous reticular and nodular infiltrations with distribution in all lobes. The cytopathology of BAL showed small parts of mycelium and numerous oval spores. Considering clinical presentation and history of travel to Mexico before onset of disease, pulmonary histoplasmosis was diagnosed. After introduction of antifungal treatment rapid improvement was achieved in terms of both clinical picture and respiratory function.

CONCLUSIONS

Since the risk of Histoplasma exposure in Europe is minimal, patients, who present with dyspnea, fever and malaise are not primarily considered for diagnosis of histoplasmosis. However, taking into account increasing popularity of travelling, also by elderly or patients with impaired immunity, histoplasmosis should be included into differential diagnosis.

Impact of diabetes mellitus on functional exercise capacity and pulmonary functions in patients with diabetes and healthy persons

BACKGROUND

Chronic diabetic complications may afflict all organ tissues, including those of the respiratory system. The six-minute walk test (6MWT) is an alternative and widely used method of assessing functional capacity and is simple to perform. However, to our knowledge, the impact of diabetes mellitus on 6MWT performance has not been investigated previously. This research aimed to compare the functional exercise capacity and pulmonary functions in patients with diabetes and in healthy persons.

METHODS

The study included 131 participants: 64 patients with type 1 and 2 diabetes mellitus (DM) and 67 healthy participants (CG). All of the participants were nonsmoking and did not have pulmonary disorders that affected the pulmonary function tests or 6MWT. Metabolic parameters and biochemical markers of inflammation were assessed. Full lung function tests and a 6MWT were performed.

RESULTS

In the DM group, the walking distance was 109 m shorter than that in the CG (P < 0.001). Moreover, compared to the CG, the DM group showed lower values of forced expiratory volume in one second (FEV1 (l) 3.6 vs. 2.8, P < 0.001) and total lung capacity (TLC (l) 6.6 vs. 5.6, P < 0.001), as well as a decrease in diffusion capacity (DLCO (mmol/min/kPa), 10.0 vs. 8.6, P < 0.001).

CONCLUSIONS

The 6MWT is a valuable test that complements the assessment of daily physical capacity in patients with diabetes, irrespective of type. Pulmonary function and the capacity for physical exertion varied between patients with diabetes mellitus and the healthy participants in the CG.

Terapia trójlekowa przewlekłej obturacyjnej choroby płuc z jednego inhalatora a przestrzeganie zaleceń terapeutycznych

Przewlekła obturacyjna choroba płuc (POChP) stanowi istotny problem zdrowotny i ekonomiczny, który wiąże się ze zwiększoną chorobowością i umieralnością. Prowadzi do rozwoju niewydolności oddechowej i inwalidztwa oddechowego. Celem wczesnego wykrycia POChP jest zmniejszenie powikłań oddechowych oraz sercowo-naczyniowych. Prawidłowa farmakoterapia zmniejsza nasilenie objawów choroby, poprawia tolerancję wysiłku fizycznego oraz zmniejsza liczbę i stopień ciężkości zaostrzeń. Istotną rolę w procesie terapii chorych na POChP odgrywają długodziałające leki rozszerzające oskrzela (β-mimetyki i cholinolityk). W zaawansowanych postaciach POChP (grupa C i D) możliwe i wskazane jest dodanie do leczenia wziewnych glikokortykosteroidów (wGKS). Takie postępowanie jest korzystne, szczególnie gdy chorzy na POChP mają częste zaostrzenia choroby, wysoką eozynofilię krwi obwodowej lub nakładanie się astmy na POChP. W 2017 roku zarejestrowano pierwszy potrójny lek złożony (w jednym inhalatorze typu pMDI) przeznaczony do leczenia POChP—TRIMBOW (dipropionian beklometazonu/formoterol/bromek glikopironium). Terapia potrójna w jednym inhalatorze LAMA/LABA/wGKS zmniejsza objawy POChP, poprawia status zdrowotny i czynność płuc oraz zmniejsza ryzyko zaostrzeń w porównaniu z monoterapią LAMA i terapią LABA/wGKS. Celem pracy było przedstawienie możliwości terapeutycznych stosowania LAMA/LABA/wGKS w jednym inhalatorze w codziennej praktyce klinicznej.

Distribution and characteristics of COPD phenotypes - results from the Polish sub-cohort of the POPE study

Background

This study aimed to examine the distribution of predefined phenotypes, demographic data, clinical outcomes, and treatment of patients who were included in the Polish cohort of the Phenotypes of COPD in Central and Eastern Europe (POPE) study.

Patients and methods

This was a sub-analysis of the data from the Polish cohort of the POPE study, an international, multicenter, observational cross-sectional survey of COPD patients in Central and Eastern European countries. The study included patients aged >40 years, with a confirmed diagnosis of COPD, and absence of exacerbation for at least 4 weeks before study inclusion. A total of seven Polish centers participated in the study.

Results

Among the 430 Polish COPD patients enrolled in the study, 61.6% were non-exacerbators (NON-AE), 25.3% were frequent exacerbators with chronic bronchitis (AE CB), 7.9% were frequent exacerbators without chronic bronchitis (AE NON-CB), and 5.1% met the definition of asthma-COPD overlap syndrome (ACOS). There were statistically significant differences among these phenotypes in terms of symptom load, lung function, comorbidities, and treatment. Patients with the AE CB phenotype were most symptomatic with worse lung function, and more frequently reported anxiety and depression. Patients with the ACOS phenotype were significantly younger and were diagnosed with COPD earlier than those with other COPD phenotypes; those with the ACOS phenotype were also more often atopic and obese.

Conclusion

There is significant heterogeneity among COPD patients in the Polish population in terms of phenotype and clinical outcome. The non-exacerbator phenotype is observed most frequently in Poland, while the frequent exacerbator with chronic bronchitis phenotype is the most symptomatic.

Modelling of Diffusing Capacity Measurement Results in Lung Microangiopathy Patients

Background: Lung microangiopathy is a little known negative influence of diabetes mellitus on the functioning of the lungs. In current medical practice lung microangiopathy is diagnosed by comparing two measurements of lung diffusing capacity – once with the subject standing and once with the subject lying down. The necessity to take two measurements is inconvenient.

Objectives: The aim of this study is to design a supportive method for diagnosing lung microangiopathy. This will be based on routinely performed pulmonary measurements as well as on investigation of process modelling and data processing.

Methods: A model of the diffusion of oxygen from the alveoli to the blood has been described with a set of differential equations. The idea of the proposed model is based on the physiological analysis of the oxygen flow (caused by a concentration gradient) and on general knowledge regarding the kinetics of associating oxygen with haemoglobin. The model parameters are estimated using diffusing capacity and alveolar volume measurements – routinely performed in pulmonary tests.

Results: The model parameter estimates proved good candidates for the binary classification of the presence or absence of micro-angiopathy. The proposed classification procedure, based on parameter values and established diagnostic thresholds, gives sensitivity Sens = 79.34% and specificity Spec = 87.08%. The results of classification with the use of diffusing capacity measurement are worse: Sens = 62.12% and Spec = 79.89%.

Conclusions: The proposed classification procedure is based on the model parameters. These have proved to be sensitive indicators of lung microangiopathy. Close to 80% of micro-angiopathy cases have been classified as such. Less than 20% were false alarms. The oxygen pathway model allows for simulations. Blood saturation and oxygen partial pressure have been simulated for the organism’s various needs for oxygen, both for the normal and the impaired alveoli-capillary barrier.

Psychooncology in Poland

Psycho-oncology is an interdisciplinary field of medicine that deals with the psychological aspects of cancer. Psycho-oncology is a sub-discipline of clinical oncology, psychiatry, clinical psychology and health psychology. It was formally established in 1975. In Poland, the Polish Psycho-Oncology Association deals with the issues of psycho-oncology since 1992. Despite the dynamic development of psycho-oncology, in Poland psychological help for people with cancer covered under the health insurance is not sufficient. The main tasks facing the Polish psycho-oncology is: to define psycho-oncologist profession and to make it administratively independent profession, to identify psycho-oncological benefits under the health insurance and to determine standards of psycho-oncological care in the National Program of Cancer Prevention.

Recurrent haemoptysis as a symptom of severe pulmonary vein stenosis-a rare complication of catheter ablation in atrial fibrillation

A pulmonary vein stenosis is a known adverse event of catheter ablation in atrial fibrillation. However, it should be considered due to high frequency of such procedures. Haemoptysis, a symptom of severe stenosis, is often misdiagnosed as other different diseases. We present a case report of a 52‐year‐old patient with recurrent haemoptysis, dyspnoea, and fatigue, which turned out to be complication after catheter ablation. Successful treatment with drug‐eluting stent (DES) was implemented with vast clinical improvement and follow‐up.

Pulmonary capillary permeability and pulmonary microangiopathy in diabetes mellitus

Significant increase in permeability surface (PS) in patients with diabetes confirms pulmonary microcirculation damage in these patients.

Respiratory bronchiolitis-interstitial lung disease

Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a rare, mild inflammatory pulmonary disorder that occurs almost exclusively in current or former heavy smokers, usually between the third and sixth decades, most likely with no gender predilection. The onset is usually insidious with exertional dyspnea and persistent cough, which may be non-productive, developing over a course of weeks or months. RB-ILD may also be diagnosed in asymptomatic patients with functional impairment and chest radiograph or high-resolution computed tomography (HRCT) abnormalities. Histologically, RB-ILD is characterized by the accumulation of yellow-brown pigmented macrophages within the lumens of respiratory bronchioles and alveolar ducts, associated with a patchy submucosal and peribronchiolar chronic inflammation. Common findings also include mild bronchiolar and peribronchiolar alveolar fibrosis that expands contiguous alveolar septa and leads to architectural distortion as well as centrilobular emphysema. Chest radiographs in patients with RB-ILD typically show fine reticulonodular interstitial opacities, while on HRCT central and peripheral bronchial wall thickening, centrilobular nodules, and ground-glass opacities associated with upper lobe centrilobular emphysema are most frequently reported. Pulmonary function testing may be normal but usually demonstrates mixed, predominantly obstructive abnormalities, often combined with hyperinflation and usually associated with a mild to moderate reduction in carbon monoxide diffusion capacity (DLco). The course of RB-ILD is heterogeneous. Some patients respond favorably to corticosteroids and/or smoking cessation, but often there is no functional improvement and the disease progresses despite smoking cessation and treatment.

Współistnienie sarkoidozy i nasieniaka jądra—Opis przypadku

Celem pracy jest przedstawienie przypadku 30-letniego chorego na nasieniaka jądra (T1 Nx Mx) leczonego operacyjnie, u którego w przebiegu choroby wystąpiły zmiany rozsiane w płucach. W badaniu tomografii komputerowej o wysokiej rozdzielczości klatki piersiowej wykonanym po zabiegu orchidektomii stwierdzono obecność licznych, rozsianych zmian drobnoguzkowych w obu płucach. W celu diagnostyki zmian płucnych wykonano wideotorakoskopię prawej jamy opłucnej. Na podstawie wyniku badania histopatologicznego pobranych wycinków wykluczono rozsiew nowotworu do miąższu płuc. Stwierdzono natomiast ziarniniaki nabłonkowato-komórkowe typu sarkoidalnego. Jednoczasowe współistnienie raka jądra oraz zmian rozsianych o typie sarkoidalnym jest opisywane sporadycznie. Rozpoznanie nie jest jednoznaczne. Nie w pełni wyjaśniono, czy tego typu zmiany w miąższu płuc powstały w przebiegu sarkoidozy, czy odzwierciedlają jedynie odczyn sarkoidalny przeciwko antygenom nowotworowym.

[Coexistence of sarcoidosis with seminoma--a case report]

A 30-year-old patient, with diagnosis of seminoma (T1 Nx Mx) was treated radically with orchidectomy. In chest CT performed postoperatively numerous diffuse nodules were revealed in both lungs. Lesions were situated particularly in the upper and middle pulmonary zones. In order to verify the nature of pulmonary abnormalities videothoracoscopy of the right pleural cavity was performed with specimen collection. Histopathological examination excluded the possibility of cancer metastases to pulmonary parenchyma and revealed the presence of sarcoid-like granulomas. Coexistence of seminoma and diffuse sarcoid-like abnormalities is only sporadically described. Up till now it has not been unequivocally explained whether the pulmonary abnormalities develop in the course of idiopathic sarcoidosis or only reflect a sarcoid-like reaction to cancer antigens.

Pulmonary Actinomycosis—A Case Report

Pulmonary actinomycosis is a rare disease caused by Actinomyces sp. Its symptoms and radiological findings are not characteristic, so the diagnosis might be difficult to establish. We report a case of a 59 year old male, who developed bronchopulmonary Actinomycosis due to poor dental hygiene. The infectious process affected lung parenchyma and infiltrated chest wall causing multifocal sternal osteolisis and multiple cutaneous fistulas. The radiological findings sugested neoplasmatical process. The diagnosis was based on histopatological findings of fistular scrapes. The material contained Actinomyces colonies. Afler 6 months of antibiotic therapy the patient’s state improved and the cutaneous fistulas healed. Radiological finding revealed partial resolution of the lung infiltration.

[Pulmonary actinomycosis - a case report]

Pulmonary actinomycosis is a rare disease caused by Actinomyces sp. Its symptoms and radiological findings are not characteristic, so the diagnosis might be difficult to establish. We report a case of a 59 year old male, who developed bronchopulmonary Actinomycosis due to poor dental hygiene. The infectious process affected lung parenchyma and infiltrated chest wall causing multifocal sternal osteolisis and multiple cutaneous fistulas. The radiological findings sugested neoplasmatical process. The diagnosis was based on histopatological findings of fistular scrapes. The material contained Actinomyces colonies. Afler 6 months of antibiotic therapy the patient's state improved and the cutaneous fistulas healed. Radiological finding revealed partial resolution of the lung infiltration.

Role of quantitative chest perfusion computed tomography in detecting diabetic pulmonary microangiopathy

AIMS

Aim of the study was to determine the role of perfusion chest computed tomography (pCT) in evaluation of pulmonary diabetic angiopathy.

METHODS

18 never-smoking patients (10 diabetic patients and 8 healthy controls) underwent chest high resolution CT (HRCT) and then pCT scanning. In both groups, blood tests, biochemical analysis, fibrinogen, HbA(1c), spirometry, diffusion capacity for carbon monoxide (DLCO) and body pletysmography were performed.Following parameters of pulmonary perfusion have been analysed: blood volume (BV), blood flow (BF), mean transit time (MTT), time to peak (TTP) and permeability surface (PS).

RESULTS

there were no statistically significant differences between groups in terms of age, sex, BMI, forced expiratory volume in one second (FEV(1)), DLCO. Chest HRCT revealed no pathologies. Significantly higher values of chest pCT for BF (p=0.05), BV (p=0.05) and PS (p=0.01) have been found in diabetics in comparison to controls. No differences were found in MTT.

CONCLUSIONS

significant increase of perfusion parameters in diabetes seems to confirm pulmonary microangiopathy. The results indicate that further studies on application of pCT in diabetic patients may be beneficial for better understanding of lung microangiopathy, its diagnosing and monitoring.

Diabetic pulmonary microangiopathy - fact or fiction?

Elevated levels of serum glucose have deleterious effects on the walls of blood vessels, leading to microangiopathy. Such a destructive process involves also pulmonary circulation, where it is referred to as diabetic pulmonary microangiopathy. This hypothesis has been confirmed in histopathologic examinations of pulmonary parenchyma, as well as in pulmonary function tests. However, so far there have been no clinical implications of these findings. Another phenomenon requiring further discussion involves diabetics with clinically silent respiratory dysfunction. That may result from significant vascular and ventilation reserves that compensate for partial loss of pulmonary parenchyma in the course of diabetes. In this review, we present an overview of the available publications on pulmonary microangiopathy and its influence on the functioning of the respiratory system.

Mikroangiopatia płucna w przebiegu cukrzycy

Cukrzyca jest schorzeniem metabolicznym, charakteryzującym się przewlekłą hiperglikemią oraz nieprawidłową przemianą węglowodanów, białek i tłuszczów. To zaburzenie metabolizmu wynika z upośledzonego wydzielania insuliny, niewłaściwego oddziaływania insuliny na tkanki lub współistnienia obu mechanizmów jednocześnie. Długotrwała cukrzyca prowadzi do rozwoju mikroi/ lub makroangiopatii, co może wywierać niekorzystny wpływ na czynność wielu narządów. Mikroangiopatia dotyczy szczególnie narządu wzroku (retinopatia), nerek (nefropatia) i obwodowego układu nerwowego (neuropatia). Mało poznany pozostaje wpływ mikroangiopatii cukrzycowej na czynność płuc. Nieliczne dostępne badania donoszą o ograniczeniu rezerw wentylacyjnych układu oddechowego i upośledzeniu pojemności dyfuzyjnej płuc dla tlenku węgla u chorych na cukrzycę zarówno typu 1, jak i 2. Może to świadczyć o uszkodzeniu bariery pęcherzykowo-włośniczkowej w płucach w przebiegu cukrzycy. W pracy przedstawiono przegląd dostępnego piśmiennictwa dotyczącego mikroangiopatii płucnej i jej wpływu na stan czynnościowy układu oddechowego.

Accuracy of Spirometry Performed by General Practitioners and Pneumonologists in the Pomeranian Region in the ‘COPD Prevention’ NHF Programme

Introduction: Spirometry is the key test in diagnosing and severity assessment of chronic obstructive pulmonary disease (COPD). Despite the simplicity of the test, the discrepancy between results obtained by general practitioners and specialists is noted, what may lead to under- or overestimating of COPD prevalence. The aim of the study was to evaluate the quality of spirometry testing and interpretation performed by general practitioners and pulmonologists. Material and methods: Physicians from 56 healthcare units in the region of Pomerania were included. The participants (both GPs and pulmonologists) were trained in methodology and interpretation of spirometry tests. Then they were asked to choose 10 spirograms and send them for evaluation. Presence of patients’ personal details and signature of staff member, contents of graphs and tables, accuracy of the test and correctness of interpretation were evaluated. In statistical analysis c-square test was used. Results: The response from 14 healthcare units was received including 142 spirograms from GPs and 80 from pulmonologists. All spirograms contained personal details, gender, age, body weight and height as well as results of spirometry in form of tables and diagrams with predicted and measured values. Pulmonologists signed the spirograms more often than GPs (91% v. 77%, p < 0.001) and more often presented results of properly performed tests (75% v. 45%, p < 0.0001). However, in their group there were more interpretation errors (73% v. 91%, p < 0.05). Methodological mistakes revealed during the study were usually: too short and not enough dynamic inspiration and expiration. In some cases spirograms with expiration lasting 1.3 s were considered normal. The most common interpretation mistakes included: diagnosis of mixed-type ventilatory defects, wrong classification of obstruction level and lack of interpretation. In two cases result was found to be normal despite the lack of forced expiratory volume in one second value. Conclusions: The results indicate the necessity of continuous training in spirometry testing and interpretation by both general practitioners and specialists and nurses.

[Lung microangiopathy in diabetes]

Diabetes mellitus (DM) is the metabolic disorder, which is characterised by persistent hyperglycaemia and abnormal metabolism of carbohydrates, proteins and lipids. These metabolic disorders result from impaired insulin secretion, altered tissue sensitivity to insulin or the coexistence of both these mechanisms. Chronic DM usually results in micro- and macroangiopathy, which in turn may have a negative impact on the function of internal organs. Microangiopathy specifically affects eyes (retinopathy), kidney (nephropathy) and peripheral nervous system (neuropathy). Little is known about the influence of diabetic microangiopathy on lung function. A few available papers describe lung function and lung diffusing capacity for carbon monoxide (DLCO) impairment in patients with both DM type 1 and type 2. Reduction of DLCO can indicate, however, that DM leads to alveolar-capillary barrier damage in the lung. In this paper authors review available literature on microangiopathy and its influence on the lung function.

[Accuracy of spirometry performed by general practitioners and pulmonologists in Pomeranian Region in the "Prevention of COPD" NHS program]

INTRODUCTION

Spirometry is the key test in diagnosing and severity assessment of chronic obstructive pulmonary disease (COPD). Despite the simplicity of the test, the discrepancy between results obtained by general practitioners and specialists is noted, what may lead to under- or overestimating of COPD prevalence. The aim of the study was to evaluate the quality of spirometry testing and interpretation performed by general practitioners and pulmonologists.

MATERIAL AND METHODS

Physicians from 56 healthcare units in the region of Pomerania were included. The participants (both GPs and pulmonologists) were trained in methodology and interpretation of spirometry tests. Then they were asked to choose 10 spirograms and send them for evaluation. Presence of patients' personal details and signature of staff member, contents of graphs and tables, accuracy of the test and correctness of interpretation were evaluated. In statistical analysis c-square test was used.

RESULTS

The response from 14 healthcare units was received including 142 spirograms from GPs and 80 from pulmonologists. All spirograms contained personal details, gender, age, body weight and height as well as results of spirometry in form of tables and diagrams with predicted and measured values. Pulmonologists signed the spirograms more often than GPs (91% v. 77%, p<0.001) and more often presented results of properly performed tests (75% v. 45%, p<0.0001). However, in their group there were more interpretation errors (73% v. 91%, p<0.05). Methodological mistakes revealed during the study were usually: too short and not enough dynamic inspiration and expiration. In some cases spirograms with expiration lasting 1.3 sec were considered normal. The most common interpretation mistakes included: diagnosis of mixed-type ventilatory defects, wrong classification of obstruction level and lack of interpretation. In two cases result was found to be normal despite the lack of forced expiratory volume in one second value.

CONCLUSION

The results indicate the necessity of continuous training in spirometry testing and interpretation by both general practitioners and specialists and nurses.

Analysis of safety, risk factors and pretreatment methods during rush hymenoptera venom immunotherapy

BACKGROUND

The safety profile of venom immunotherapy is a relevant issue. We evaluated the frequency of severe adverse events (SAE), associated risk factors, retrospective comparison of pretreatment protocols including solely H1 receptor blockers and a combination of H1 and H2 receptor blockers during rush Hymenoptera venom immunotherapy.

METHODS

The study group comprised 118 patients. The treatment was initiated according to a 5-day rush protocol with the use of standardized venom allergens of either wasp or honeybee.

RESULTS

During the rush induction, side effects occurred in 18 patients (15.2%), whereas SAE were present in 7 patients (5.9%). Twelve out of 18 (66.6%) developed anaphylactic reactions on the fourth day of the rush protocol, with the majority of cases at a dose of 40 or 60 microg of the venom extract (p = 0.001). The frequency of SAE was also significantly higher on the fourth day than thereafter (p = 0.0001) as well as in patients allergic to bee venom (p = 0.049). All systemic side effects were more frequent in women (p = 0.0065). However, this relation was not true when SAE were consider (p = 0.11). A higher percentage of SAE was observed in the subjects pretreated with both H1 and H2 receptor antagonists than in those pretreated with H1 blocker only (8.8 vs. 4.1%); however, the difference was not significant.

CONCLUSIONS

Considerable severity of allergic adverse events requires particular attention to patients allergic to bee venom and during rush phase, especially when rapidly increasing doses are administered. Pretreatment with H2 blockers is debatable and warrants further investigation.

[Hyperlucent lung syndrom caused by pulmonary artery hypoplasia in patient with diagnosed asthma--case report]

We present case of 67-years-old, non-smoking woman with unilateral hyperlucent lung syndrome. She has diagnosed asthma and since 1997 she has been treated with inhaled corticosteroids and long-acting beta-agonists without improvement. She complained of a cough, shortness of breath, pulmonary function test reveal irrvesibility airflow obstruction. The routine X-ray chest showed unilateral hyperlucent left lung. Ct-angiography has shown unilateral hypoplasia of pulmonary artery. It indicates that in all cases of uncontrolled asthma should be considered another or coexisting diagnosis.

[Complications in children cured from Hodgkin's disease]

THE AIM of the study was to evaluate the incidence of pulmonary complications in children cured from Hodgkin's disease (HD).

MATERIAL AND METHODS

42 children with HD were treated in the Department of Paediatrics, Haematology, Oncology and Endocrinology, Medical University of Gdansk, between 1994 and 2004. Stages of HD: II--26 children, III--10, IV--6; general symptoms (group B) were present in 50% of patients. Mediastinal involvement was found in 33 children, lung parenchyma infiltration in seven and bronchi involvement in one. In 1/3 of these patients the localization of HD within the chest was massive and symptomatic with signs of the superior caval vein symptoms, cough, dyspnea and cardiac tamponade. The treatment was conducted according to the schemes of the Polish Paediatric Leukaemia /Lymphoma Study Group. Eleven patients required therapy modification including six, in whom the intense line II chemotherapy Salvage 95 was introduced. 29 patients received chest irradiation with doses between J 75 and 36.5 Gy. Pulmonary function was evaluated from the results of clinical examination, 1 chest radiography (CXR), computed tomography, spirometry and lung scintigraphy.

RESULTS

Pulmonary complications occurring as fatigue and diminished physical effort tolerance was observed in only two children. Some of the remaining 40 patients demonstrated asymptomatic abnormalities in the analysed tests. Abnormalities in CXR (upper mediastinal fibrosis, postoperational changes within the diaphragm and pneumonitis) were found in six children, minor ventilation problems in spirometry--in 12 and decreased lung perfusion in five. The scintigraphic signs of lung embolisation were not observed in our material. Most of the pulmonary complications occurred in children with enlarged lymph notes located within the chest, especially these with bulky disease presenting with cardio-pulmonary symptoms. In this group of patients the chest irradiation was performed in all except four children, three patients were also administered aggressive salvage chemotherapy.

CONCLUSION

The pulmonary complications in children after completed therapy of HD are not common and mainly asymptomatic and occur predominantly in patients with massive mediastinal and/or lung involvement at diagnosis. The issue needs further evaluation of a more numerous group of HD survivors and a longer follow-up.

Latent Tetany Masked by Syndroms of Bronchial Asthma and Depressive Syndrome. Case Raport

Tetany, which occurs in young women, poses common diagnostic problem. Two types of tetany are distinguished: one which is characterized by hypocalcemia and which rarely occurs (in person after strumectomy in the course of post-operational hypoparathyroidism) and latent one, which occurs more often. In the literature there is a lack of precise data concerned witch most probably results from its underestimation. Clinical symptoms which appear in latent tetany (normocalcemic) are related to the intracellular magnesium ddiciency and increased respiratory drive. A noncharacteristic clinical picture and the lack of a pathognomonic symptom, cause that despite of the fearly common occurrence, the latent tetany is rarely recognized. In this paper the case of a 53 year old women has been described. The women had the symptoms of gastroesopha­geal reflux of asthma and depressive syndrome, witch masked the symptoms of the latent tetany.

[Latent tetany masked by syndroms of bronchial asthma and depressive syndrome. Case report]

Tetany, which occurs in young women, poses common diagnostic problem. Two types of tetany are distinguished: one which is characterized by hypocalcemia and which rarely occurs (in person after strumectomy in the course of post-operational hypoparathyroidism) and latent one, which occurs more often. In the literature there is a lack of precise data concerned witch most probably results from its underestimation. Clinical symptoms which appear in latent tetany (normocalcemic) are related to the intracellular magnesium deficiency and increased respiratory drive. A noncharacteristic clinical picture and the lack of a pathognomonic symptom, cause that despite of the fearly common occurrence, the latent tetany is rarely recognized. In this paper the case of a 53 year old women has been described. The women had the symptoms of gastroesophageal reflux of asthma and depressive syndrome, witch masked the symptoms of the latent tetany.

[Assessment of exercise test and bronchial reversibility test as tools for asthma diagnosis in patients with normal spirometry]

The bronchial obturation reversibility test is the corner stone in asthma diagnosis. Patients with signs and symptoms suggestive of asthma but normal spirometry need additional tests like non-specific bronchoprovocations. Exercise-induced bronchi spasm is a feature of asthma and is the basis for exercise-test bronchi provocation in asthma diagnosis. The aim of this study was the comparison of clinical utility of obturation reversibility test and exercise provocation test in asthma diagnosis in patients with normal spirometry values.

METHODS AND MATERIAL

The study was comprised of 77 subjects: 47 suspected to have asthma on history and 30 healthy volunteers. The inclusion criterion was: normal spirometry values. The obturation reversibility test was carried out in the study group. All participants had exercise test based on bicycle ergometer. The burden was adjusted so that the heart rate was at the submaximal level throughout the whole procedure. Spirometry values and peak expiratory flow (mini-Wright meter) were measured right after completion of the test and 5, 10, 15 and 20 minutes after completion of the test. The exercise test was considered positive when FEV1 declined by 15% or PEF declined by 20% in comparison to the initial value, respectively.

RESULTS

The obturation reversibility test was positive in 15 (31.9%) and negative in 32 (68.1%) patients from the study group. In the study group exercise test was positive according to FEV1 decline in 35 (74.5%) subjects, and only in 18 (38.3%) if PEF decline was a criterion. In the control group just 1 (3.3%) test turned out positive by FEV1 change and 3 (10%) were positive if PEF decline was measured. On the basis of positive exercise test and patient history the diagnosis of bronchial asthma was established in 35 (74.4%) patients. Among them--24 had sporadic asthma, 8 mild chronic asthma and 3 moderate chronic asthma.

CONCLUSIONS

1. Exercise test is a valuable diagnostic tool in patients with history suggestive of asthma and normal spirometry results and negative obturation reversibility test. 2. The parameter for the exercise test that best separate asthma and control group was FEV1.

[Malignant mesothelioma of the pleura--diagnostic difficulties]

Malignant mesothelioma of the pleura is a rare neoplasm with a poor prognosis. Noncharacteristic clinical signs, radiological features and similarity to other neoplasma (adenocarcinoma) in a microscopical evaluation lead to often diagnostic problems. Thoracoscopy followed by biopsy is routinely performed and is considered a main diagnostic procedure. Microscopic samples are usually examined by immunohistochemical analysis. In this report, presented is a case of malignant pleural mesothelioma, in which final diagnosis was delayed because of difficulties in diagnosis based on thoracoscopic biopsy.

[Addison's diseases caused by adrenal tuberculosis--case report]

A case of adrenal tuberculosis with acute Addison's disease is described. The disease manifested acute as suprarenal crisis. Metastatic and autoimmunological (antisuprarenal antibodies were not found) etiology was excluded. Computed tomography demonstrated calcifications in both, enlarged adrenals. After antituberculosis treatment and corticosteroid therapy we observed significant improvement in our patient's condition.

[Usefulness of exercise test and peak inspiratory flow (PIF) measurement in diagnosis and management of bronchial asthma]

The purpose of this manuscript is to define the benefit of exercise test and peak inspiratory flow (PIF) measurement in adult patients with bronchial asthma. Seventy-seven patients--forty-seven from examined group (21 women, 26 men) and thirty patients from control group (8 women, 22 men) participated in this study. Exercise tests (ET) were performed in all subjects in the beginning of the study (ET1) then repeated two months later (ET2) only to the examined group. Patients exercised on a bicycle ergometer for 8-10 minutes to increase the hart rate to submaximal level. Spirometry were performed before and after the study and 5, 10, 15 and 20 minutes later. Symptoms of asthma after exercise and forced expiratory flow in one second (FEV1) decrease more then 15% of predicted value confirmed the diagnosis (positive test result). Thirty patients (74.4%) from examined group had positive results in ET1 and twelve (25.5%)--negative. Four patients (10%) were positive in ET2 and thirty-six (90%)--negative. deltaFEV1 decrease in ET2 was (-14.78%), in ET2 (-4.45%) p < 0.0001. There were twenty-nine (96.6%) negative results in control group, only one (3.4%) positive, p < 0.001. During the study no side effects were observed. The comparison of deltaPIF decrease in ET1 (-11.94%) and ET2 (-7.39%) shows significant difference p < 0.05. PIF decrease was not statistically different between control and study group. Results of the study suggest that exercise tests are safe and easy method of diagnosis and management of asthma. PIF measurement seems to be non-useful in diagnosis of bronchial asthma. It must be confirmed in further studies.