Pneumonologia i alergologia polska最新文献

Self-expandable metallic stents (SEMS) insertion to the oesophagus is the method of choice in palliative treatment of malignant oesophago-respiratory fistulas (ERF). ERF evolve as a result of 0.2-5% of advanced oesopghageal or lung cancer. They also appear after radiotherapy. EFR are serious and lethal complications. SEMS insertion is an effective, safe, technically simple and minimally invasive solution. Potential complications of SEMS include thoracic pain, bleeding, perforation, stent migration, tumour overgrowth or ingrowth and food bolus impaction. The article presents three cases of patients with advanced lung cancer with EFR subjected to SEMS insertion procedure in our centre.

Shortness of breath (dyspnea) and changes present in X-rays of the chest are most frequent symptoms indicating further pulmonary diagnostic. Presented is the case of 71-year-old patient reffered from general practitioner due to exacerbation of dyspnea and abnormalities present in the chest X-ray.The patient has been treated for ischemic heart disease and arrythmia for a couple of years.Three-dimensional CT of the chest revealed a vascular ring of aorta.It is a defect characterized by a faulty flow of large vascular trunks, which built a cardiovascular ring that partially or completely enricle the structure of mediastinum (esophagus, trachea).The observed clinical symptoms are a result of pressure applied to the structure of the mediastinum and its intensity. This cardiovascular defect is diagnosed during early stages of childchood development and for it to be recognized in an adult patient is a casuistic case.

Bronchioloalveolar carcinoma (BAC), a rare form of lung malignancy, is usually seen in non-smokers and women. Three distinct histological forms have been identified viz, mucinous, non-mucinous and mixed or indeterminate. The mucinous variety of BAC may present as a consolidation which is very difficult to differentiate from an infective pneumonia. We present a case of a middle aged female who was evaluated for a "non-resolving consolidation" for a period of two years. She had undergone an inconclusive bronchoscopy and had received several courses of antibiotics including anti-tuberculous therapy without relief. The size of the lesion had remained largely unchanged during this period and there was no significant clinical deterioration in the patient. Transbronchial biopsy done on presentation revealed BAC of the mucinous variety. BAC presenting as a large consolidation without significant change for a period of two years has rarely been documented in the literature.

Introduction: Sensitization to the Hymenoptera venom is one of the main causes of anaphylaxis in Poland. Venom immunotherapy is the only effective treatment in such cases. Comprehensive patient care includes also education. The aim of our study was to assess the state of knowledge and to evaluate the quality of life and the anxiety level in patients allergic to the Hymenoptera venom after anaphylactic reaction.

Material and methods: The survey was carried out in the period of the insects flight in 61 adult subjects (35 wasp and 26 bee allergic), using a validated Vespid Allergy Quality of Life Questionnaire (VQLQ), Hospital Anxiety and Depression Scale, and subjective assessment of anxiety level. The majority of respondents received venom immunotherapy.

Results: Sensitized to the wasp venom had significantly impaired quality of life (VQLQ score) as compared to the bee venom allergic (p = 0.014). The intensity of anxiety decreased with the duration of immunotherapy (p = 0.01). The majority of subjects knew how to recognize and treat anaphylaxis, but only 8% employed an identification card and about 50% implemented rules of the pre-exposition prophylaxis.

Conclusions: History of a severe anaphylaxis to the Hymenoptera venom affected the quality of life. Venom immunotherapy reduced anxiety. We hope that presented surveys and their results might be useful in qualifying for immunotherapy in clinically uncertain cases.

Introduction: Infections caused by multiple drug-resistant pathogens represent an increasingly often encountered challenge in clinical practice. The problem particularly applies to patients with chronic lung diseases resulting in multiple hospitalisations. The aim of this paper was to analyse the incidence of alert pathogens isolated from patients hospitalised in the department of lung diseases, who were divided into three groups: patients qualified for lung transplantation, patients treated for neoplastic diseases and patients with chronic lung diseases.

Materials and methods: Analysis involved microbiological test results of 3950 samples obtained from 3521 patients divided into: 200 patients being qualified for lung transplantation, 1292 patients treated for neoplastic diseases and 2029 patients with chronic lung diseases.

Results: Infection with alert pathogen was found in 155 of 3521 patients (4.4%). Most often isolated infectious agent was P. aeruginosa, which accounted for 27% of infections. Other pathogens were as follows A. baumanii ESBL(-) (13%), S. pneumoniae (12%), E. cloacae ESBL(+) (10%), K. pneumoniae ESBL(+) (10%), S. aureus MRSA (8%), E. faecalis (7%), E. coli ESBL(+) (6%), S. maltophilia ESBL(+) (5%) and E. kobei ESBL(+) (2%). Alert pathogens were found in 31 (15%) of 200 patients being qualified for lung transplantation, 89 (4.4%) of 2029 patients with chronic lung diseases and 35 (2.7%) of 1292 patients treated for neoplastic diseases. Difference between infection frequency in patients being qualified for lung transplantation and the remaining groups was statistically significant (p < 0.01). P. aeruginosa infection was the most frequent in all groups. It constituted 35% in patients being qualified for lung transplantation, 29% in patients treated for neoplastic diseases and 22% in patients with chronic lung diseases.

Conclusions: Infections caused by alert pathogens were found in more than 4% of patients hospitalised in the department of lung diseases between 2007 and 2011. Their frequency was significantly higher in patients being qualified for lung transplantation than in other analysed groups. In all examined groups the most frequently isolated bacteria was P. aeruginosa (27% of all isolates).

Optimal medication should be characterized by good bioavailability, rapid onset of action, a long period of therapeutic activity, with preserved high safety profile and the lowest possible risk of side effects. Therefore, in addition to traditional drug administration routes, such as oral or injection, novel methods for drug applications, for example in the form of a nasal application have been developed. Because of the anatomy of the nose, drugs administered intranasally can be rapidly absorbed and, depending on the nature of the active substance, may act locally on the mucosa or can have a significant systemic effect. Most nasal drugs are developed in the form of solution administered as aerosol. In some cases, these solutions are thixotropic. They are able to change their physical properties under agitation to facilitate supply of the drug and its adhesion to the mucosa. Intranasal corticosteroids represent the mainstay of treatment for any form of chronic allergic rhinitis (AR) and moderate to severe periodic AR, especially with impaired nasal obstruction and frequent occurrence of symptoms. The article discusses the rheological properties of intranasal corticosteroids, their role in therapy and efficacy in the everyday clinical practice.

Introduction: COPD is one of the most frequent respiratory diseases responsible for patients' disability and mortality. In 2005 a single primary care practice, COPD was diagnosed in 183 out of 1,960 eligible subjects ≥ 40 years (9.3%). The aim of this study was to assess mortality rate and causes of deaths in this group after 6 years.

Material and methods: In 2011 we invited all 183 patients with COPD recognised in 2005. We performed spirometry, physical examination, questionnaire of respiratory symptoms, smoking habits, concomitant diseases and treatment. Information about deaths was taken from primary care register, furthermore, family members were asked to deliver medical documentation or death certificate.

Results: In 2011 we studied only 74 subjects (40.4%), 43 subjects died (23.5%) and 66 subjects were lost from the follow-up (36.1%). Cardiovascular diseases were the most frequent causes of deaths - 21 subjects (48.8%) (heart attack - 8 patients and stroke - 8 patients). Respiratory failure in the course of COPD exacerbation was the cause of 10 deaths (23.3%). Neoplastic diseases lead to 9 deaths (20.9%) (lung cancer 7 patients). Renal insufficiency was responsible for one death (2.325%), and the causes of 2 deaths remained unknown (4.65%). Subjects who died (predominantly males) were older, had higher MRC score and lower FEV₁.

Conclusions: Study performed six years after COPD diagnosis revealed that 23.5% of subjects died. The main causes of deaths were the following: cardiovascular diseases (mainly heart attack and stroke), COPD exacerbations and lung cancer (more than 75%). Death risk in COPD patients was associated with age, male sex, dyspnoea and severity of the disease.

Introduction: Bird fancier's lung (BFL) is a type of hypersensitivity pneumonitis occurring in response to avian antigens (usually inhaled proteins in bird feathers and droppings). The diagnosis is based on a combination of clinical, radiological, and biopsy characteristics. The present study was planned to highlight the clinico-radiological presentation in cases of BFL.

Material and methods: The present study is a retrospective analysis of cases of bird fancier's lung diagnosed in a unit of Vallabhbhai Patel Chest Institute over a period of two years, from 2013-2014. The clinico-radiological features of the subjects were analysed. The diagnosis of BFL was made as per criteria laid down by Mark Schuyler and Yvon Cormier.

Results: There were a total of fifteen cases diagnosed with BFL during the study period, comprising twelve females and three males with a mean age of 54.93 ± 14.21 years. All the studied subjects gave significant history of exposure to pigeons and were non-smokers. The period of symptoms prior to presentation varied from one to eight years. The main symptoms on presentation were exertional breathlessness and cough. Radiologically, diffuse centrilobular nodules, ground glassing - diffuse or patchy predominant in upper lobes, fibrosis with or without traction bronchiectasis, honeycombing, and mediastinal lymphadenopathy were seen. Bronchoscopy showed ill-defined granulomas and chronic interstitial inflammation.

Conclusions: BFL can exhibit a wide range of radiological patterns, and a high index of suspicion must be maintained, with particular attention to detailed exposure history in every case of interstitial lung disease.

Patients with chronic lymphocytic leukemia or non-Hodgkin’s lymphoma are at risk of infectious diseases of respiratory system because of immunodeficiency. Occurrence of organizing pneumonia in leukemic patients is most commonly correlated with bone marrow transplant or treatment with antimitotic agents. There have been only four reported cases of organizing pneumonia related solitarily to leukemia or lymphoma. We present a case of 65-year old gentlemen, diagnosed 8 months earlier with B-cell chronic lymphocytic leukemia with no previous hematologic treatment, who presented symptoms of persistent pneumonia with no significant reaction to antibiotics. Chest computed tomography scans showed well-localized consolidation with ground glass opacities and some air bronchogram, suggesting infectious disease. All results of microbiological examinations were negative. Due to radiological progression of parenchymal consolidation despite two intravenous courses of antibiotics open lung biopsy was performed. The histologic examination of lung specimen revealed structures typical for organizing pneumonia pattern. There was no evidence for leukemic involvement in lung tissue, as no sign for infectious factors from histological staining was observed. In the inferior mediastinal lymph node sample progression of chronic lymphatic leukemia to mixed cell lymphoma was diagnosed. Patient was commenced on prednisone 60 mg/daily with fast improvement. We believe that this is the first case of organizing pneumonia as a reaction to the conversion of B-cell chronic lymphocytic leukemia progression to more malignant stage.