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Body composition disorders are observed in chronic obstructive pulmonary disease (COPD) patients and have a significant impact the general condition and outcome in this disease., Aim: The aim of the study was to assess body composition in relation to airway obstruction severity in patients with COPD., Materials and Methods: The study group consisted of 143 patients (58F, 85M) in the middle age The group was divided to two groups: group A FEV1<50% predicted and group B FEV1 ≥50% predicted; both groups were compared. The following anthropometric parameters were assessed: body mass index (BMI), waist/hip ratio and shoulder circumference of the dominant upper limb. Body composition analysis was performed by bioimpedance (Tanita T5896, TANITA Corporation of America, Inc, Arlington Heights, USA)., Results: The mean BMI for the whole group was 27.5±5.1 kg/m2. None of the patients was underweight, 47 (32.9%) had normal BMI, 55 (38.5%) overweight and 41 (28.6%) were obese. Patients in group A had lower BMI, FFMI and muscle mass index (MMI) than patients in group B. We found the correlation between BMI, FFMI, MMI and FEV1 in the studied group., Conclusions: Our results confirm the relationship between airflow limitation and body compositions in COPD patients. We suggest that anthropometric measurements should be a part routine COPD management.

Unlabelled: Chronic obstructive pulmonary disease (COPD) is a significant clinical problem wich is dependent on many environmental factors., The Aim: of the study was to present a characteristic of examined group in the moment of including into the project., Materials and Methods: Based on data obtained from studies conducted in six medical universities in Poland we present the characteristics of 445 patients (M-69%), median age 66.2 years, suffering from COPD with median disease duration 7.7 years. The analysis included: age, education, risk factors, exacerbations and hospitalizations, comorbidities, severity of the disease, drug use and the results of selected tests and the quality of life of patients in relation with their place of residence., Results: Some differences were found among the participating centers. The youngest patients came from Wrocław and the oldest from Katowice. The largest number of patients with higher education were from Warsaw, while the lowest number was noted in Poznań; patients with primary education were most numerous in Lublin. Patients from Warsaw had the highest number of pack-years, smoking history was least relevant in patients from Wrocław. The highest values of spirometrical parameters were observed in Gdańsk, while the lowest--in Poznań. COPD treatment mainly comprised of long-acting beta2 agonists, followed by anticholinergic agents, more than 50% of patients were treated with inhaled glucocorticosteroids. The most common comorbidities were cardiovascular diseases., Conclusions: The study group showed characteristics similar to those of other cohorts of patients with COPD described in the literature, but we found some differences between patients from different centers which participated in the study., (© 2015 MEDPRESS.)

Unlabelled: In the course of various diseases, there is an accumulation of fluid in the pleural cavities. Pleural fluid accumulation causes thoracic volume expansion and reduction of volume lungs, leading to formation of restrictive disorders. The aim of the study was to estimate the volume of pleural fluid by ultrasonography and to search for the relationship between pleural fluid volume and spirometrical parameters., Material and Methods: The study involved 46 patients (26 men, 20 women) aged 65.7 +/- 14 years with pleural effusions who underwent thoracentesis. Thoracentesis was preceded by ultrasonography of the pleura, spirometry test and plethysmography. The volume of the pleural fluid was calculated with the Goecke' and Schwerk' (GS) or Padykuła (P) equations., Results: The obtained values were compared with the actual evacuated volume. The median volume of the removed pleural fluid was 950 ml. Both underestimated the evacuated volume (the median volume 539 ml for GS and 648 ml for P, respectively). Pleural fluid removal resulted in a statistically significant improvement in VC (increase 0.20 +/- 0.35 ; p < 0.05), FEV1 (increase 0.16 +/- 0.32 l; p < 0.05), TLC (increase 0.30 +/- 0.58 l; p < 0.05) and PEF (0.37 +/- 1 l/s; p < 0.05) CONCLUSIONS: Pleural fluid removal causes a significant improvement in lung function parameters. The analyzed equations for fluid volume calculation do not correlate with the actual volume.

Unlabelled: The GOLD 2011 recommendations for chronic obstructive pulmonary disease (COPD) introduce a new classification system to optimize treatment in individual patients. Except for FEV,, this classification incorporates breathlessness measurement using modified medical research council questionnaire (mMRC) or the COPD assessment Test (CAT) and the number of exacerbations. The aim of our study was to compare the GOLD 2010 and GOLD 2011 COPD., Material and Methods: The study group consisted of 143 patients. Based on the post-bronchodilator FEV, only, as recommended in the GOLD 2010 report, there were 24 patients in stage I, 57patients in II, 43 in Ill and 19 in IV, respectively. In all patients, the number of exacerbations per year was noted and dyspnea was assessed with the modified MRC scale. The patients were subsequently graded to group A,B,C,D as proposed in the combined COPD assessment in GOLD 2011., Results: Grading of 51 (35,7%) patients according to the GOLD 2011 criteria was difficult; there were 22 patients in GOLD stage I/II with > or =2 exacerbations per year and 29 patients in GOLD stage Ill/IV with < 2 exacerbations per year. They were grading to more risk group., Conclusion: The new classification according to GOLD 2011 lets on optimizations of the treatment, in most cases of COPD patients but in clinical practice, there may be problems with the classification of the patients with severe airway obstruction without frequent exacerbations and especially those with mild/moderate airflow limitation and frequent exacerbations.

This is a case report of 53 year old male who underwent pancreatoduodenectomy for chronic pancreatitis. Two months after the operation the symptoms of severe malnutrition caused by nutrition digestive disorders developed. The patient was admitted to the hospital with the symptoms of severe malnutrition and general poor medical condition. The patient was put on total parenteral nutrition (TPN) after the preliminary treatment of water-electrolytes imbalance. After 3 days of TPN a severe hypophosphatemia occurred (serum level < or = 0.25 mmol/l). The refeeding syndrome developed despite the use of phosphate supplementation in the hypocaloric TPN regimen. The hypophosphatemia caused the life threatening neurological and cardiovascular symptoms. The patient was put on intensive infusion fluid therapy with phosphate supplementation and transient withdrawal of TPN, which resulted in the patient's recovery. This case confirms the risk of development of refeeding syndrome in the malnourished patients. It indicates the need of close monitoring of phosphate serum level and the need of phosphate supplementation especially during the first days of nutritional treatment in such patients.

A 39-year-old woman, without any previous cardiac history, is reported who developed a myocardial infarction during an attack of allergic asthma. Since childhood she has been treated with short acting beta 2-adrenoceptor agonists because of mild atopic asthma. After exposure to cat's allergen she suddenly developed a severe attack of dyspnea and cyanosis. She improved rapidly after administration of oxygen, glucocorticosteroids, aminophilline and beta 2-adrenoceptor agonist. Laboratory examinations of serum revealed elevation in enzymes activities of aminotransferases, creatinine phosphokinase and troponin I. In spite of absence of typical electrocardiographic changes we suspected myocardial infarction. The diagnosis was confirmed by echocardiography, which showed akinesis of anterior wall of the heart. On the base of relevant literature we discuss the hypothesis of cardiac necrosis in severe attack of asthma and the role of cardiac enzymes, especially troponin, in the process of diagnosis.