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Introduction: Hypersensitivity reactions to drugs account for 25% of all side effects related to drugs, affecting more than 7% of the population. One in four such reactions is caused by acetylic acid and other non-steroidal anti-inflammatory drugs. Material and Methods: Between 1998 and 2000 epidemiological research was carried out in various centers, with the aim of estimating the frequency of allergy-based diseases in Poland. The objective of the study was to evaluate the frequency of hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs), based on an epidemiological questionnaire, in the Polish adult population. Results: Bronchial asthma was diagnosed in 582 patients (5.4%). Of that group, 75 patients (12.9%) additionally reported symptoms of hypersensitivity to NSAIDs. Aspirin-induced asthma was diagnosed in 11 patients (14.7%) with clinical manifestations of hypersensitivity responses. Frequency of aspirin-induced asthma with clinical symptoms amounted to 1.9% of asthmatics. In the assessment of severity of the disease, aspirin intolerance was the only statistically significant factor (p = 0.0003; odds ratio 28.6 with assumed 95% confidence interval). Conclusions: In the population of adults in Poland, the frequency of aspirin-induced asthma amounted to 0.1%. Hypersensitivity to NSAIDs was observed in 12.9% of asthmatics. In asthmatics with symptoms of hypersensitivity to non-steroidal anti-inflammatory drugs, which takes the course of clinically demonstrable aspirin-induced asthma, the risk of severe asthma is 30-fold higher.

Background: Air trapping evaluated in high-resolution computed tomography (HRCT) reflects changes in small bronchi. We simultaneously evaluated focal and diffuse air trapping in asthmatic patients. Objectives: (1) To evaluate air trapping and bronchial wall thickness in asthmatics. (2) To estimate the relationship between air trapping and bronchial wall thickness, pulmonary function tests (PFTs), age, gender and asthma severity. (3) To compare air trapping between subgroups of asthmatic patients with normal FEV1 % pred. and FEV1/FVC % and controls. (4) To compare air trapping and bronchial wall thickness between aspirin-induced asthmatics (AIA) and aspirin-tolerant asthmatics (ATA). Methods: Both groups (asthmatics and controls) included 30 patients. All patients underwent HRCT and PFTs. Results: Focal (p < 0.0001) and diffuse (p = 0.0004) air trappings and bronchial wall thickness (T: p < 0.0001; T/D: p < 0.0001; WA%: p < 0.0001) were significantly greater in asthmatics. Focal and diffuse air trappings were inversely correlated (p = 0.021). Diffuse air trapping correlated with bronchial wall thickness: T/D (p = 0.047), T (p = 0.037), and WA% (p = 0.048). There was a significant difference in the extent of focal air trapping between a subgroup of asthmatics with normal FEV1 % pred. and FEV1/FVC % and controls (p < 0.0001). There were no significant differences in focal (p = 0.095) and diffuse air trapping (p = 0.186) and bronchial wall thickness (T: p = 0.086; T/D: p = 0.428; WA%: p = 0.428) between AIA and ATA patients. Conclusions: Both focal and diffuse air trappings provide valuable diagnostic information and therefore deserve to be estimated. The lack of significant differences in air trapping and bronchial wall thickness between AIA and ATA patients needs further investigation.

Objective Videothoracoscopic sympathecomy is a widely used treatment modality in patients with severe Raynaud disease, but the reported late results are less than favorable. There have been no direct studies of the long-term effect of sympathectomy on microcirculation in the hands of these patients. Methods In 25 patients with Raynaud disease treated with videothoracoscopic Th2-Th4 sympathectomy, we performed basal laser-Doppler flowmetry and measured the maximal refilling time after 1-minute occlusion measurements preoperatively and at 1 week, 6 months, and 1, 2, 3, and 5 years after the sympathectomy. The results were compared with the same measurements obtained in the group of 50 healthy individuals. Results The patients' symptom severity was assessed by using the visual analogue scale. The basal capillary flow and the maximal refilling time improved after the sympathectomy to a level not different from that seen in the healthy population, and the effect was maintained during the 5-year follow-up period. The patients' symptom severity scores diminished to zero in the early postoperative period and increased to 28% of their initial value 5 years after the operation. Conclusions The videothoracoscopic Th2-Th4 sympathectomy produces excellent and long-lasting improvement of microcirculation function in patients with Raynaud disease. The mild return of symptoms might be due to factors other than the capillary blood flow alterations.

Pulmonary emphysema is anatomically defined as abnormal persistent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of alveolar walls, without evident fibrosis. High-resolution computer tomography (HRCT) imaging is a valuable tool for diagnosis of this disease. The presence of minute cysts distributed evenly through all lung zones is rarely observed in pulmonary emphysema. In such cases, emphysema should be differentiated from other cystic lung diseases. We present a case of a 45-year-old women admitted to our Department with dyspnoea on exertion. Physical examination revealed no abnormalities. A chest radiograph showed diffused interstitial lesions in both lungs; HRCT revealed multiple oval-shaped cysts equally dispersed in all lung areas. The pulmonary function tests revealed increased lung volumes (total lung capacity 114.6% predicted, residual volume 200.6% of predicted), while both vital capacity and FEV1 were decreased (73.6% and 54.0% of predicted volumes, respectively). Diffused lung capacity was normal. Trans-bronchial biopsy was non contributory. Histiological examination of lung tissue obtained by videothoraco-scopy (VTS) was diagnostic for bullous emphysema. The patient had prescribed ipratropium bromide and teophyline. Differential diagnosis, apart from pulmonary emphysema, should take into consideration lymphangioleiomyomatosis, histiocytosis and sarcoidosis.

The aim of the study was to assess closed pleural biopsy (CPB) as a diagnostic method of pleural effusion. CPB using Cope needle was performed in 62 patients, proceeded by ultrasound examination. It helped to obtain specimen for histological and microbiological examination even with cases of small amount of fluid. In all 62 patients CPB enabled to diagnose 13 cases with neoplasmatic effusions (majority being adenocarcinomas) and 16 cases of tuberculosis in histological and/or microbiological examination. There were 33 cases with non-specific inflammatory changes. In 7 patients we confirmed neoplastic pleural infiltrates in cytological examination of pleural effusion. In 26 patients videothoracoscopy (VTS) was carried out and 20 of those had post-inflammatory changes. In 4 cases, however we confirmed neoplasmatic effusions and in next 2 cases--tuberculosis. Closed pleural biopsy proves to be an efficient method in diagnosis of Tuberculosis and malignant pleural effusions. However, in 23% of cases with post-inflammatory changes, malignancy and tuberculosis were undiagnosed. This in turn implicates the necessity for further diagnostic procedures including VTS.

The aim of the study was to assess the diagnostic yield of transbronchial lung biopsy (TBLB) without fluoroscopic guidance in peripheral lesions of diameter 2,5-6 cm. TBLB was performed in 65 consecutive patients without abnormalities in bronchial tree in standard bronchofiberoscopy and preceded by computed tomography (CT). The CT guidance helped to select the segment of lung to be biopsied. In 39 patients (60%) TBLB enabled to diagnose 36 cases of lung cancer, 2 cases of carcinoid and 1 case of malignant lymphoma. There were 26 cases (including 21 cases of lung cancer) undiagnosed by means of TBLB. In 24 patients the diagnosis was established by means of other methods like transbronchial needle aspiration (TBNA)--5 cases, thin needle biopsy (TNB)--12 cases, open lung biopsy (OLB)--7 cases and in the remaining 2 patients a regression of clinical and radiological features was observed. Transbronchial lung biopsy was found to be efficient diagnostic method in peripheral lesions higher than 2,5cm. However, in 40% of cases this technique doesn't allow to establish a diagnosis. This, in turn implicates the necessity for further diagnostic procedures including TBNA, TNB or even OLB.

Videothoracoscopy is a useful diagnostic tool in patients with suspicion of malignant pleural effusion, because of both: the high accuracy in diagnosis and the possibility of assessing the extent of pleural involvement and producing the pleurodesis. An analysis of characteristics of 110 patients with suspected pleural dissemination is presented, including final diagnosis established with the use of VTS. In patients with confirmed malignant pleural effusion following characteristics were analyzed: the extent of pleural metastatic involvement, type of the primary malignancy, possibility of re-expansion of the lung and patients survival according to the primary tumor and extent of involvement of the pleura.

The aim of the study was to assess the diagnostic yield of transbronchial needle aspiration (TBNA) in mediastinal or hilar adenopathy in: sarcoidosis, tuberculosis and malignancy. Transbronchial needle aspiration was performed in 53 patients, preeceded by computed tomography (CT). In 22 patients (41,5%) TBNA enabled to diagnose 10 cases of sarcoidosis, 12 cases of neoplastic infiltrates of the lung. There were 31 cases undiagnosed by means of TBNA. In 24 patients the diagnosis was established by means of other methods like bronchoscopy with mucose biopsy (8 cases of sarcoidosis), transbronchial lung biopsy (4 cases of squamous cell carcinoma and adenocarcinoma, 2 cases of sarcoidosis), mediastinoscopy (3 cases of sarcoidosis and 2 cases of Hodgkin's disease), and videothoracoscopy (2 cases of sarcoidosis), transthoracic needle biopsy (1 case of squamous cell carcinoma) and lymph node biopsy (1 case of adenocarcinoma and 1 case of sarcoidosis). In the remaining 7 patients who were followed-up for a period of one year the diagnosis of sarcoidosis was confirmed by clinical, radiological and cytological (BAL) examinations. Transbronchial needle aspiration was shown to be efficient diagnostic method in mediastinal or hilar adenopathy in sarcoidosis and malignancy except lymphoma. Moreover in approximately 60% of cases this technique doesn't allow to establish a diagnosis and in turn implicates the necessity for further diagnostic procedures like mediastinoscopy, or transbronchial or thoracoscopic lung biopsy.

The aim of the study was to assess the diagnostic yield of transbronchial lung biopsy (TBLB) in some of diffuse pulmonary diseases, like: sarcoidosis, organizing pneumonia--(OP), tuberculosis and neoplasmatic infiltrates of the lung. Transbronchial lung biopsy was performed in 123 patients, preceded by high resolution computed tomography (HRCT). The HRCT guidance helped to select the area of lung to be biopsied. In 80 patients (65%) TBLB enabled to diagnose 40 cases of sarcoidosis, 15 cases of OP, 13 cases of neoplasmatic infiltrates of the lung and 5 cases of tuberculosis. There were 43 cases undiagnosed by means of TBLB. In 19 patients the diagnosis was established by means of other methods like videothoracoscopy (8 cases), bronchoscopy with bronchial mucose biopsy (7 cases of sarcoidosis), mediastinoscopy (2 cases of Hodgkin's disease), transthoracic needle biopsy (2 cases of adenocarcinoma). Moreover sarcoidosis was diagnosed in 15 cases by means of clinical, radiological examination and BAL. 9 patients didn't agree for further invasive diagnostics. Transbronchial lung biopsy was shown to be efficient diagnostic method especially in sarcoidosis, OP and neoplasmatic infiltrates of the lung. However, in approximately 35% of cases of diffuse pulmonary diseases this technique doesn't allow to establish a diagnosis. This in turn implicates the necessity for further diagnostic procedures including videothoracoscopic or open lung biopsy.

Teleconsultation services at referential centres are an important area of telemedicine development. The implementation of such scenarios brings high-level competencies to peripheral hospitals through telecommunication links. Pulmonary teleconsultations were one of the key aspects of Krakow Centre of Telemedicine (KCT) activities conducted in 2002-2003. The role of the referential centre for respiratory medicine was played by the Division of Interventional Pulmonology, Jagiellonian University Medical College. Peripheral centres were pulmonary wards situated in local hospitals or policlinics located 20-80 km from Krakow. These hospitals were equipped with PC-based telemedical workstations and ISDN lines (256 kbps). Dedicated software (Telenegatoscope) was used for real-time discussions among physicians on medical images (X-rays, CTs) sent from peripheral centres to the referential centre. Images inserted in light boxes were cropped at peripheral centres with a high-resolution digital camera. During the pilot phase, about 40 pulmonary patients were referred via telemedical links to the University Hospital. The frequency of soliciting a second opinion at the referential centre was analyzed for each main type of disease. Top positions are currently occupied by diagnoses of lung cancer, pleural fluid of unknown origin, asbestosis and tuberculosis. About 70% of the patients referred for virtual consultation were admitted for further diagnostics and treatment in an ambulatory or inpatient mode at the Division of Interventional Pulmonology. The review of teleconsultations results indicates that teleconferencing contacts, even if conducted through relatively limited bandwidth, may bring considerable benefits to patients requiring complex diagnostic and sophisticated, procedures available at the referential university hospital.

In about 5% of asthmatics patients despite of recommended by GINA 2002 treatment present sudden unexpected severe exacerbations. They are included into group of severe and difficult asthma. Based on the statement of Polish experts the diagnostic procedures and management of severe and difficult asthma was presented.

We have described a case of a 70-year-old woman, treated for a pancreas cancer, which was diagnosed for many months because of atypical skin lesions, lymphadenopathy and progressing cachexia. Despite many autoimmunological, serological, histopathological, bacteriological and mycological examinations there was no diagnosis. Finally the case of extrapulmonary tuberculosis involving skin, lymph nodes, kidneys and bones was diagnosed. After the introduction of antituberculotic therapy we are observing some clinical improvement and regression of symptoms.

A case of synchronous primary cardiac dedifferentiated liposarcoma and papillary renal carcinoma is presented. The occurrence of typical areas of round cell liposarcoma made the pathological diagnosis of the sarcoma relatively easy; however the neoplasm was not diagnosed correctly before the autopsy. Cardiac liposarcoma is a very rare primary malignant neoplasm and its diagnosis based on image procedures may be extremely difficult especially at non-advanced stage of disease.

The aim of this review was to present the evidence of the role of the measurement of bronchial hyperresponsiveness in monitoring of asthma. Airway hyperresponsiveness can be assessed during regular clinic visit and it is related to the severity of asthma and airway inflammation. The indirect markers of airway hyperresponsiveness, such as AMP or hypertonic saline may more accurately reflect airway inflammation and remodelling than routine symptoms and lung function monitoring. Monitoring of patients with asthma is a key aspect of optimal asthma management and the measurement of airway hyperresponsiveness may improve asthma control.

Background: Acetylsalicylic acid (ASA) and other nonsteroid anti-inflammatory drugs (NSAIDs) are reported to account for 21–25% of all adverse drug reactions. Some asthmatics may react to ASA and other NSAIDs with acute bronchoconstriction, profuse rhinorrhea and skin flushing. This is a distinct clinical syndrome called aspirin-induced asthma (AIA). The prevalence of AIA among asthmatic patients in Poland has not been previously assessed. Methods: A questionnaire survey of 12 970 adults of both sexes, randomly selected from the population of Poland. Results: The prevalence of AIA in the general population of Poland was estimated as 0.6%. Thirty patients (4.3%; 95% CI: 2.8–5.8) of 703 asthmatics (5.4% of general population) reported symptoms attesting to hypersensitivity to aspirin. In 27% of them the reactions were precipitated by aspirin, whereas in the remaining subjects by other NSAIDs. Conclusions: The prevalence of AIA in Poland is 4.3%, being somewhat lower than in Finland and Australia, where it was recently reported to account for 8.8 and 10.9% of the adult asthmatics, respectively. These figures indicate that aspirin hypersensitivity might be a significant community problem.

Malignant pleural effusion is a common problem in advanced cancers, contributing to the poor quality of life in this group of patients. The aim of the study was to assess the efficiency of talc powder and doxycycline in pleurodesis in patients with malignant pleural effusion in comparable conditions.Of 52 patients screened, 33 entered the trial. They were randomized to the talc group (n=18) and the doxycycline group (n=15). Both groups were comparable with regard to age, sex and the most important variables influencing effectiveness of the procedure, i.e. primary malignancy and stage of metastatic involvement of the pleura. Efficiency of pleurodesis was prospectively assessed.The analysis of short-term effectiveness of pleurodesis in the first 33 patients has shown a highly significant difference in favor of talc powder (p=0.009); this difference was the reason for terminating the randomization. Further observation has revealed in the doxycycline group an increasing number of patients with fluid reaccumulation, as time went by; this was not observed in the talc group. A statistical analysis of the long-term effectiveness of both agents studied has shown a more significant difference in favor of the talc powder (p=0.00003).Talc powder is superior to doxycycline in achieving pleurodesis in patients with malignant pleural effusion, in both short- and long-term observations.

The treatment of chronic severe asthma is unsatisfactory for many patients. The aim of the study was to determine the effects of treatment of steroid-dependent asthma with cyclosporin. We performed a double-blind, placebo-controlled, randomized, parallel group trial on the effect of cyclosporin on pulmonary function, asthma severity and tapering of prednisone in 34 steroid-dependent asthmatics (mean oral prednisone dose: 16 mg.day-1). The study consisted of: 1) baseline period (12 weeks); 2) experimental period divided into two parts: Part I (12 weeks) cyclosporin or placebo treatment; Part II (22 weeks) cyclosporin or placebo treatment and oral prednisone reduction; and 3) follow-up observation (8 weeks). Asthma symptoms score, pulmonary function tests (daily peak expiratory flow (PEF) and bi-weekly forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and maximal mid-expiratory flow (MEF50), biochemical profile and blood cyclosporin levels were monitored throughout the study. Following cyclosporin administration, a slight beneficial effect on some subjective parameters of asthma severity was observed. At the same time, no beneficial effect on pulmonary function was noted. The time trends analysis of mean daily prednisone doses between the treatment groups revealed a statistically significant difference indicating that, during prednisone reduction, cyclosporin seemed to be slightly more efficient than placebo in reducing the requirement for systemic corticosteroid, even though the steroid reduction was accompanied by slight impairment of some pulmonary function. However, there was no significant difference in the final dose reduction between the treatment groups. These data and the known toxicity of the drug suggest a limited place for cyclosporin treatment in steroid-dependent bronchial asthma.

We have recently shown that oral aspirin provocation leads to an increase in LTE4 and a reduction in 11-dehydro-TXB2 levels in urine of patients with aspirin induced-asthma (AIA). To test the hypothesis that cyclooxygenase inhibition and an enhancement of cysteinyl-leukotriene production occurs in the lungs of patients with AIA, we examined the eicosanoid levels in bronchoalveolar lavage fluid obtained 30 min after lysine-aspirin or placebo inhalation in 10 patients with AIA. Eosinophil cationic protein (ECP) levels were determined to evaluate eosinophil activation. Six asthmatics nonsensitive to aspirin (NA) underwent challenge with placebo. The dose of lysine-aspirin inhaled by patients with AIA was equal to that which had produced > or = 20% fall in FEV1. Compared with NA, patients with AIA had: (1) eicosanoid levels, particularly PGE2 and TXB2, elevated and (2) higher number of eosinophils and ECP. The overproduction of eicosanoids could be related to a distinct eosinophilic inflammation in airways of patients with AIA. Inhalation of lysine-aspirin had no effects on 12-HETE and 15-HETE levels, but it markedly depressed cyclooxygenase products and significantly enhanced leukotriene production in the lungs of patients with AIA.

Soon after its introduction into therapy in 1889, aspirin became an extremely successful analgesic and anti-inflammatory agent. Recently, its clinical applications have increased dramatically and include coronary artery disease and several related cardiovascular disorders. Americans consume 16,000 tons of aspirin tablets a year—80 million pills—and spend about $2 billion a year for nonprescription painkillers, many of which contain aspirin or aspirin-like drugs (1).