Pneumonologia polska最新文献

A case of a 7 year old boy with chronic inflammatory changes of the bronchial tree in the course of a type H congenital tracheo-esophageal fistula is presented. The diagnosis was made basing of findings during bronchofiberoscopy. Radiological examination of the upper GI tract did not reveal the abnormality. The fistula was closed surgically.

The authors present a case report of a 66 year old male that was admitted due to pulmonary lesions with cavitation localized in the upper left lobe. In the cavity an abnormal mass could be seen. In the differential diagnosis malignancy and tuberculosis were excluded. Fungi were cultured from the bronchial washings and sputum. Their morphological characteristics allowed them to be typed as Aspergillus niger. Slides from the thick, mucoid, black sputum demonstrated typical forms of the fungus. Polarized microscopy demonstrated calcium oxalate crystals. The final diagnosis was pulmonary aspergilloma caused by A.niger complicating a pulmonary abscess in the course of a pneumonia.

Gold salts are used mainly in the therapy of rheumatoid diseases. Thanks to their immunoregulative and antiinflammatory properties they may be used in treatment of chronic bronchial asthma. In order to study the efficacy of gold salts in such therapy the authors studied the effect of Solganal B (Schering) in 8 patients with chronic steroid dependent bronchial asthma. In 6 patients a clinical improvement was observed enabling to lower the steroid dose. Basing on this pilot study we believe that gold salts have an beneficial effect on the course of chronic bronchial asthma.

A case of post-traumatic chylothorax in a 84 year old man with ILD is presented. The chylothorax was successfully treated after 6 months, which was confirmed at post-mortem, during which a solitary plasmocytoma of the left kidney was also diagnosed.

22 normal volunteers, 57 patients with obstructive changes and 34 with restrictive type changes were studied. The following parameters were analyzed: maximal inspiratory and expiratory pressures, occlusion pressure and components of the breathing pattern. The patients were divided according to the degree of airway resistance and fall of vital capacity. All patients compared with the healthy volunteers demonstrated higher minute ventilation, and a higher neuro-muscular respiratory drive as shown by the VT/Ti index and occlusion pressure. The breathing pattern did not correlate significantly with the different abnormalities of respiratory function in the studied groups. In the patients with obstructive changes a weak correlation was found between the occlusion pressure and airway resistance. In patients with restrictive type changes a weak correlation between occlusion pressure, static and specific compliance was found. The occlusion pressure was a more specific parameter characterizing respiratory drive compared with the VT/Ti index. Disturbances of pulmonary mechanics have a small but significant effect on respiratory control.

47 patients with pulmonary abscesses were analysed. The type of bacteria cultured from the sputum, type of chemotherapy and clinical outcome were assessed. Most of the patients (34) were already treated prior to admission to the Department. Most often with doxycycline and gentamycin. The following organisms were cultured: Streptococcus viridans, Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae. Antibiotic therapy was always instituted according to the antibiogram. Most often amikacin and cefamandole was given. The mean duration of hospitalization was 48 days. 44% of the patients were fully cured, in 40% only an improvement was seen. 7 patients expired (16%)--all of these patients were addicted to alcohol or had malignancy.

Two cases of mycoplasma pneumonias are presented. Initially this etiology was not suspected. Prior to hospitalization they were treated with cefamandole and carbenicillin and cephradine with gentamycin without any improvement in the clinical state of the patients. After serological tests finding a high titer of serum antibodies (1: 2560) the therapy was altered in the first patient to minocycline (in a dose of 200 mg per day for 16 days) and in the second to doxycycline (in a dose of 200 mg per day for 10 days). The first patient improved clinically after two days of altered therapy, the second after 10 days. Both patients were discharged fully recovered after 32 and 36 days of hospitalization.

A retrospective analysis of 14,461 patients examined at the Bronchological Unit in the years 1978-1988 was carried out in order to assess the incidence of bronchial tuberculosis confirmed histopathologically. 46 cases met the selection criteria (19 females, age range 21-75 years, mean 56.2 +/- 18.8. years, 27 males, age range 21-85 yrs, mean 50.0 +/- 17.4 yrs). Only in 22 patients acid fast bacilli were cultured. Analysis of endoscopical changes was carried out according to the Jaroszewicz-Krakówka classification. Most often diffuse inflammatory changes were seen.

In 195 cases of pulmonary tuberculosis in 70% changes in the bronchi were found. They were either active (45%) or inactive (25%). In 10% of the cases severe changes were found, this percentage did not decrease in the past 15 years. Most often bronchial findings were seen in elder women. In 4 cases bronchial cancer was co-existent. Difficulties in differential diagnosis in such cases were underlined.