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Tracheobronchopathia osteochondroplastica (TBO) is a rare disease of unknown etiology characterised by a formation of multiple, cartilaginous and osteocartilaginous submucosal nodules in the trachea and major bronchi. The course of the disease is usually benign but the narrowing of the respiratory tract can lead to chronic non-specific clinical symptoms. We present a case of a 50-year old man with chronic exertional dyspnoea and stenosis of the trachea visible in imaging tests, in whom the symptoms were caused by TBO.

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. Systematic treatment of COPD decreases symptoms and reduces the frequency of exacerbations and hospitalisations because of the disease. It is estimated that only 50% of patients use prescribed drugs systematically. The aim of this study was to identify the factors which can influence adherence to treatment of the patients who were treated due to exacerbation of COPD., Material and Methods: A questionnaire probe was conducted on 49 patients hospitalised at the Regional Lung and Tuberculosis Hospital in Olsztyn, Poland due to COPD exacerbation. The assessed variables were: quality of life and adherence to treatment 30 days after discharge from hospital in relationship with demographic factors, social status, disease and hospitalisation course, and relief after systematic treatment., Results: Most of the patients assessed their health condition as poor and the disease as limiting their everyday social and occupational activity. 30 days after discharge from hospital the adherence rate to therapy was only 67%. There was an association between systematic treatment and the rate of exacerbations (P = 0.045) and hospitalisations (P = 0.005) but also clinical benefit after long-term treatment (P = 0.023). There were no associations between adherence to treatment and sex, place of residence, education or occupation., Conclusions: Lack of systematic treatment is the main risk factor for COPD exacerbations and hospitalisation rate. A subjective sense of relief after drugs is a factor improving patients' compliance.

Introduction: The aim of this study was to evaluate the cellular composition of induced sputum (IS) in sarcoidosis and its role in assessing the disease activity. The safety of the procedure was also determined., Material and Methods: Sputum induction by inhalation of hypertonic saline was performed. Twenty-one samples from the healthy controls, 32 from patients with active disease, and 33 from subjects with inactive disease were analysed., Results: The percentage of lymphocytes in IS was significantly higher in active sarcoidosis than in inactive disease and the control group (9.7% vs. 3.1% vs. 2.9%), and was the highest in the patients with parenchymal changes and active disease (13.3%). The percentage of macrophages was significantly lower in active sarcoidosis than in normal subjects (76.8% vs. 83.4%). It was also significantly lower in IS in active disease and stages II and III than in both subgroups with active and inactive stage I of sarcoidosis. There were no significant differences in the IS cell percentages between the whole sarcoidosis group and the controls. Sputum induction was well tolerated and stopped only four times, two of them because of dyspnoea or the decrease of PEF. The symptoms were well reversible after administering salbutamol., Conclusions: Sputum induction by inhalation of hypertonic saline is safe, but the evaluation of IS differential cell counts is not useful in sarcoidosis diagnosing. However, it could be used in assessing the activity of the disease, especially in patients with interstitial lung changes.

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.

Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assessed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV(1) = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient's status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists' consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease).

Introduction: The evaluation of styles of coping with stress resulting from a somatic disease was always considered controversial, since the stress is a consequence of the complexity of the disease as a stressful event and is linked with every field of human life and activity. The main aim of this study was to evaluate the effectiveness of various styles of coping with stress - task-oriented, emotion-oriented, or avoidance-oriented - used by patients with asthma to cope with their disease and its consequences., Material and Methods: 100 patients with asthma were examined including 15 with mild asthma, 40 with moderate asthma, and 45 with severe asthma. The first group consisted of patients with mild-to-moderate asthma and the second group of patients with severe asthma. The subjects were mainly females (69% women, 31% men) aged from 19 to 75 years, with at least primary level of education. The following questionnaires were used: Coping Inventory for Stressful Situations (CISS), UWIST Mood Adjective Check List (UMACL), and Asthma Control Test (ACT)., Results: Task-oriented style had a positive influence on emotions (p < 0.05) in patients with moderate asthma. Avoidance-oriented style had a positive influence on emotions (p < 0.05) in patients with severe asthma. Emotion-oriented style proved ineffective and had a negative influence on emotions (p < 0.05) in all patients., Conclusions: Coping style plays a key role in the emotional functioning of asthmatics. Moreover, incorporation of an individual style of coping with stress in the therapeutic process is necessary.

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.

A case of invasive aspergillosis (IA) of paranasal sinuses, lung and brain with a fulminant fatal outcome is reported. A 43-year-old man with a history of skin carcinoma of the nasal region and a course of systemic corticosteroids, presented with symptoms of lung infection. Aspergillus fumigatus was cultured from respiratory and nasal samples. Erosion of adjacent bones of the nasal cavity was acknowledged, but no sinus surgery was performed. A computed tomography of the thorax showed thick-walled cavities of different sizes with air and scarce fluid levels in both lungs. Treatment with voriconazole was administered. The patient deteriorated in the ensuing 2 weeks because central nervous system involvement was observed. No aggressive surgical resection was performed and the patient died 2 weeks later. IA was not confirmed by histopathology because no necropsy was performed.

Sarcoidosis is a granulomatous disease of unknown etiology. In sarcoidosis almost all organs can be involved but the disease most often affects the lungs and intrathoracic lymph nodes. Isolated extrapulmonary organs involvement occurs very seldom. We present two cases of sarcoidosis limited to upper respiratory tract--a young woman with laryngeal sarcoidosis and recurrent throat pain, and a woman with disease of the sinuses and pharynx and clinical symptoms of chronic sinusitis poorly responsive to conventional treatment.

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, hospitalization and disability among lung diseases. Its chronic, progressive nature and acute exacerbations influence the quality and expectancy of life of COPD patients. The pulmonary rehabilitation is a basic non-pharmacological intervention in COPD and its role is increasing in recent years. The goal of this work was to evaluate the impact on quality of life patients undergoing 3 weeks pulmonary rehabilitation program., Material and Methods: 132 patients with COPD were admitted to pulmonary rehabilitation program; 70 completed the 3 weeks long program. Pulmonary function tests, exercise endurance, quality of life (St. George's Respiratory Questionnaire) were measured at baseline, 3 weeks, and 3 months., Results: There was significant improvement in quality of life in St. George's Respiratory Questionnaire and exercise endurance (treadmill) measured at 3 weeks and at 3 months. Parameters of lung function tests did not improved after completion of rehabilitation., Conclusions: 3 weeks pulmonary rehabilitation program of patients with COPD was effective in improving exercise endurance and the quality of life. The improvement was noted as well at 3 months post rehabilitation.

Introduction: The aim of the study was to assess the quality of life of patients with asthma who were well and poorly controlled., Material and Methods: 70 patients with diagnosed asthma, aged from 18 to 40, were included into the study between November 2005 and February 2006 at the Specialist Hospital in Chojnice and Allergy out-patient Clinic of Medical University of Gdańsk. The diagnosis and stage of asthma, as well as the assessment of the control of disease was performed by the physician. Quality of life was assessed with the use of St. George Respiratory Questionnaire (SGRQ). Statistical analysis was made with the use of computer statistical program Statistica., Results: According to GINA in 26 patients mild asthma was diagnosed, in 31 - moderated and in 13 - severe disease. 41 patients were assessed as well controlled and 29 - as poorly controlled. Older age and longer duration of the disease were related to severe asthma, p = 0.01 and p = 0.003, respectively. In well controlled patients overall score for SGRQ was 48.86, whereas in poorly controlled was - 74.4. There was a significant difference between the overall quality of life in well and poorly controlled patients with asthma, p = 0.0001. This difference was found in all three domains: for symptoms, activity and impact on life, p = 0.014, p = 0.035 and p = 0.003, respectively., Conclusions: Quality of life is strongly dependent on the control of symptoms in asthmatic patients.

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.

There is a lack of studies evaluating the prevalence of smoking habit among Polish priests. Due to difficulties in receiving permission from catholic authorities to perform questionnaire study we attempted to assess the prevalence of cigarette smoking among priests from one religious congregation. The aim of the study was also to analyze factors influencing smoking habits in this group. The anonymous questionnaire was sent to all Polish Pallotins and students of Pallotin Seminary in Ołtarzew. Only one fourth of them--138 subjects in the age from 20 to 92 yrs (mean age 37.7 yrs)--answered the questionnaire. Among them were 72 priests aged 27-92 yrs. (mean age 50.7 yrs) and 66 students in the age 20-41 yrs (mean age 23.7 yrs.). The rate of current smokers among priests was 13.9%, including 11.1% of daily smokers and 2.8% occasional smokers. The rates of daily and occasional smokers among Seminary students were 4.5% and 6.1%, respectively. Cigarette smoking in the past was reported by 26,4% of priests--8.3% of them had smoked daily, remaining subjects had smoked occasionally. Most of responders considered the fifth commandment of the Decalogue as sufficient reason for abstaining from cigarette smoking. The majority of current smokers attempted to stop smoking, mainly because of wholesome reasons. Near a half of smoking priests and over three fourth of smoking students felt embarrassed to smoke in company of laymen. Every tenth priest and every third student hide his smoking habit from other priests. The study showed low prevalence of cigarette smoking in priests, what resulted mainly from religious reasons.

Unlabelled: The pathogenesis of sarcoidosis remains still unknown. Among numerous factors viruses are considered as potential causes. The aim of the study was investigation of human T-cell lymphotopic virus type I (HTLV-I) in sarcoidosis patients. Studied group (I) consisted of 52 patients: 29 women and 23 men aged from 24 to 62 years; mean age 40 years. The diagnosis of sarcoidosis was confirmed by histologic examination in 46 patients and on the base of clinical, HRCT--chest scan and BAL findings in 6 patients. Control group (II) consisted of 92 various pulmonary disorders patients and healthy subjects in the aged from 20 to 83 years; mean age 54 years. In both groups the ELISA test detecting antibodies against HTLV-I/II was performed with the use the diagnostic kit produced by Organon Teknika, Belgium. Results were interpreted by measuring the optical density (OD). The cut-off point 0.386 was established according to the rule defined by kit's producent. The values of OD ranged in group I from 0.061 to 0.384 and in group II from 0.047 to 0.213; thus, no positive results of the test were observed. The values of OD did not differ significantly in both groups (p = 0.59)., Conclusion: In our region the participation of HTLV-I in the pathogenesis of sarcoidosis is doubtful.

The aim of the study was to assess the efficacy of a combination of gemcitabine and cisplatin in advanced non-small cell lung cancer. Twenty-five patients were included (13--IIIB, and 12--IV stage). Gemcitabine--1000 mg/m2 was given intravenously on days 1, 8, and 15, and cisplatin--100 mg/m2 on day 2. In 13 patients partial remission was obtained, in 8--stabilisation, and in 4--progression. Median survival was 12 months (range: 1.5-32 months). Mean time to progression was 6 months. Toxicity was tolerable and included mainly thrombocytopenia, neutropenia and anemia. In 11 patients pain relief was obtained. Furthermore cough, dyspnoea and hemoptysis disappeared in a proportion of patients. These results indicate the efficacy of the combination of gemcitabine and cisplatin regimen in advanced non-small cell lung cancer, and its acceptable toxicity.

32 year-old patient was hospitalized because of disseminated lung lesions. 2 years earlier he manifested chorioditis. Exact disease history suggested suspicion of toxocare infection. The diagnosis was confirmed by serological tests with anti-Toxocara canis antibodies, bronchial lavage and chest CT scan. Administration of 450 mg of dietylokarbamasin (Hetrazan) resulted in complete resolution of pulmonary lesions.

Cigarette smoking by teenagers is conditioned by many factors with psychosocial ones among them. The aim of our study was to define the reasons for cigarette smoking by juveniles in Poland nowadays. The analysis was performed on the basis of questionnaire given to 598 school pupils resting in the summer camps in the Tricity of three neighbouring towns of Gdańsk, Sopot and Gdynia. The study group included 357 females and 241 males, with an age of 8-19 years, on average 14.4. Out of the hole group 111 (18.6%) were smokers. This subgroup, 58 boys and 53 girls (age: 12-19 yrs.; on average 15.4), answered to several questions concerning cigarette smoking. Among remaining 487 non-smokers the prevalence of cigarette smoking among their parents was only assessed. As the main reason for smoking the majority (69.4%) of smokers reported the stress reduction. Pleasure was another frequently reported (29.7%) reason for cigarette smoking. Peers smoking was an important reason for cigarette smoking for 28.8% of school pupils. We found that the example of smoking parents significantly influenced the prevalence of smoking cigarettes among teenagers. The majority (73.9%) of smoking pupils knew the cigarette were harmful. Obtained results show the multiplicity of reasons for cigarette smoking by juveniles resulting mainly from psychosocial factors. There is a great necessity of antismoking programs for school pupils adjusted to specificity of psychology of adolescence as well as the exemplary role of adults creating a life style without cigarette.

Serological tests available for diagnosis of tuberculosis can provide the valuable informations about host immune response to the mycobacterial infection. The aim of our study was to assess the correlation between clinical, radiological and bacteriological state of pulmonary tuberculosis patients and the serum concentration of IgG antibodies against A60 antigen of Mycobacterium bovis BCG. 110 active pulmonary tuberculosis patients--56 culture positive and 54 culture negative--were involved into the study. In all patients serum level of IgG ati-A60 antibodies was measured with the use of A60-ELISA test. We found that bacteriologically confirmed pulmonary tuberculosis is associated with higher serum level of anti-A60 antibodies. Our study also showed the significantly higher levels of anti-A60 IgG in patients with cavitary and more progressive forms of this disease. We conclude that the greater antigenic challenge in progressive forms of pulmonary tuberculosis stimulates more expressed antibody response.

A was reported case of binocular blindness associated with small cell lung cancer. Most probably this complication was a clinical manifestation of the paraneoplastic syndrome. No tumor response was induced with chemotherapy and patient died due to tumor progression.

The polymerase chain reaction (PCR) and direct culture were applied for detection of Mycobacterium tuberculosis complex in samples obtained from patients with suspicion of pulmonary and extra-pulmonary tuberculosis. In the reaction of amplification IS6110 was applied as a target region, and PCR reaction products were of the size of 123 bp and 317 bp. A total of 278 samples (158 sputum, 36 urine, 25 pleural effusion, 23 bronchial washings, 8 blood, 4 stomach washings, 3 cerebrospinal fluid, 2 fragments of skin, 2 pleural effusion, and 17 others samples) from 181 patients were tested. Mycobacterium tuberculosis complex was detected by PCR in 144 out of 278 samples and by culture in 68 of 278 samples. The PCR test enabled a rapid and sensitive diagnosis particularly in a number of samples which were negative on culture.

A case of eosinophilic granuloma of the lung in a 24 years old male is presented. The initial manifestations were hemoptysis and cough. During hospitalization the bronchoscopy was performed, which revealed granuloma in the right bronchus. Computer tomography showed tumour in the right bronchus, without pulmonary changes characteristic for histiocytosis X. The granuloma was removed by bronchoscopy, but control examination performed after three months showed the residue. Once again residual tumor was removed by bronchoscopy and oral steroids were ordered. Unfortunately the next local residue was observed and the residual tumour was finally removed by thoracotomy. Now patient is free of symptoms.

The aim of this study was to assess the occurrence of non-sporeforming anaerobes in bronchoalveolar lavage in patients with pneumonia coexisting with lung cancer. Material consisted of 40 patients with lung cancer. Bronchoalveolar lavage was performed before administration of antimicrobial treatment and obtained material was cultivated in anaerobic and aerobic conditions. Quantitative assessment of anaerobic bacteria and their susceptibility to common antimicrobial agents were also performed. Peptostreptococcus, Prevotella, Fusobacterium and Bacteroides were the most common anaerobes. Among aerobic bacteria, the most frequent were G-negative bacilli. G-negative anaerobes were susceptible to most tested agents, whereas G-positive rods were resistant to metronidazole and tinidazole. This study demonstrates presence of non-sporeforming anaerobic bacteria in lower respiratory tract infections accompanying lung cancer.

The serum levels of cytokeratin-19 were measured in 116 patients--96 with NSCLC and 20 with non-malignant lung diseases. The reference group consisted of 60 healthy volunteers--30 smokers and 30 non-smokers. Significantly elevated Cyfra 21-1 values were observed in NSCLC. There was not a correlation between of cytokeratin-19 serum levels and histologic types of lung carcinoma. Cyfra 21-1 concentrations generally increased with stage of diseases and the highest were in patients with evidence of distant metastases. In NSCLC, the distribution of Cyfra 21-1 varied significantly according to the performance status of NSCLC patients.

A group of 153 patients with scintigraphically detected autonomic "hot" nodules of the thyroid has been subjected to clinical and histopathological analysis. Substantial part of these patients (30.1%) had hyperthyroidism, partly (in 19.9% of cases) in the form of the thyrocardiac syndrome. A most frequent histopathological lesion found within "hot" nodules was follicular adenoma. The occurrence of malignancy in the form of highly differentiated thyroid carcinoma was observed in 2.6% of cases. The incidence of thyroid carcinoma within "hot" nodules was in our material only two and half times smaller than in a previously analyzed group of patients with "cold" nodules of the thyroid.