Search

Aims: Aim of the study was to determine the role of perfusion chest computed tomography (pCT) in evaluation of pulmonary diabetic angiopathy., Methods: 18 never-smoking patients (10 diabetic patients and 8 healthy controls) underwent chest high resolution CT (HRCT) and then pCT scanning. In both groups, blood tests, biochemical analysis, fibrinogen, HbA(1c), spirometry, diffusion capacity for carbon monoxide (DLCO) and body pletysmography were performed.Following parameters of pulmonary perfusion have been analysed: blood volume (BV), blood flow (BF), mean transit time (MTT), time to peak (TTP) and permeability surface (PS)., Results: there were no statistically significant differences between groups in terms of age, sex, BMI, forced expiratory volume in one second (FEV(1)), DLCO. Chest HRCT revealed no pathologies. Significantly higher values of chest pCT for BF (p=0.05), BV (p=0.05) and PS (p=0.01) have been found in diabetics in comparison to controls. No differences were found in MTT., Conclusions: significant increase of perfusion parameters in diabetes seems to confirm pulmonary microangiopathy. The results indicate that further studies on application of pCT in diabetic patients may be beneficial for better understanding of lung microangiopathy, its diagnosing and monitoring., (2010 Elsevier Ireland Ltd. All rights reserved.)

In some cases it is difficult to define an etiology of lung tumour in the other way than thoracotomy. In these diagnostic difficulties patients with tuberculous tumour are also involved. The aim of the present study was to define if A60-ELISA test, a new valuable tool in the diagnosis of tuberculosis, might be useful in the differential diagnosing of lung tumours. The levels of IgG antibodies against A60 antigen of mycobacteria was measured with the use of the ELISA test. 228 persons were enrolled into the study: 58 healthy controls (Group I), 26 nonmalignant and nontuberculous patients (Group II), 56 patients with the diagnosis of pulmonary tuberculosis bacteriologically confirmed (Group III), 54 pulmonary tuberculosis patients culture negative (Group IV), 16 patients with lung tumour, without histologic diagnosis before thoracotomy (Group V) and 18 patients with defined diagnosis of lung cancer (Group VI). By using 200 U/ml as a cut-off point the test was positive in: 2/58 subjects from Group I, 2/26 from Group II, 44/56 from Group III, 31/54 from Group IV, 3/16 from Group V and 0/18 from Group VI. In three patients from group V having positive result of A60-ELISA test pulmonary tuberculosis was diagnosed when the thoracotomy was performed. We conclude that the new, simple, noninvasive and inexpensive A60-ELISA test migt be the useful tool in the differential diagnosing of lung tumours because of its good sensitivity and specificity in pulmonary tuberculosis. We also consider that in lung tumour patients with the positive result of this test the prophylactic antituberculosis treatment have to be ordered before planned thoracotomy.

Unlabelled: The majority of community acquired pneumonia patients are treated by family doctors, most frequently in empiric way, what delays the treatment when a choice of antibiotic is not proper. In this case the resistance to the antibiotics of the bacteria can occurred and there is more often the necessity of patient admission to the hospital. The aim of the study was to analyse retrospectively the treatment of mycoplasmal pneumonia patients. The material consisted of consecutive 27 patients (17 females and 10 males; average age 31.9 yrs.) treated in the Pneumonology Department of Medical University of Gdańsk in the period from 1995 to 1997 year because of mycoplasmal pneumonia. The etiologic diagnosis was defined first of all on the base of serologic test, measuring the complement-fixing antibodies, beside clinical data. The retrospective analysis revealed that all patients had been admitted to the hospital after previous not effective anti-bacterial or anti-viral treatment as out-patient. At the admission no patients had the temperature exceeding 38 degrees C, myalgia and headache occurred in 44% and 40.7% of patients respectively, splenomegaly was reported in 4 patients. In chest roentgenograms pulmonary infiltrations were observed in all patients, most frequently unilaterally (68% of pts.), in 29% of patients complicated by pleural effusion. The titers of complement-fixing antibodies against Mycoplasma pneumoniae antigen ranged from 1:245 to 1:2000. In the treatment most frequently (70.3% of cases) doxycycline in monotherapy was used. Eight patients were treated with doxycycline together with erythromycine. In 33.3% patients the antimycoplasmal treatment was ordered only on the base of clinical data. The period of hospitalisation ranged from 18 to 34 days, on an average 24 days., Conclusion: In case of mild community acquired pneumonias with not defined ethiology, if the initial antibacterial or antiviral treatment is not effective, tetracyclines or/and erythromycine should be ordered without the necessity to confirm the diagnosis of mycoplasamal pneumoniae with the serological test.

Recent studies indicate clinical value of intra-venous to oral switch therapy. The aim of this study was to analyze our results i.v. Cefotaxime to oral Cefetamet Piroxil switch therapy in lower respiratory tract infections. Group consists 35 patients in whom 27 has bacterial pathogen definitely established. Cefotaxim (Tarcefoksym-Polfa) i.v. has been used for 3-4 days followed with oral Cefetamet Pivoxil (Tarcevis-Polfa). Patients has been treated for 7 days in hospital and then as an out-patients afterwards. Excelent result has been observed in 27 cases (77% of the study group). Mild symptoms of medication intolerance has been observed in 8 patients (23% of all patients). Results of our experience with third generation cefalosporin i.v. to oral switch therapy are satisfactory. This method reduced total cost of treatment, reduced in-hospital days and was very well accepted by patients.

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 measurement of antimycobacterial antibodies levels provides important informations about infection with tubercle bacilli and the development of tuberculosis. A tuberculin test as a manifestation of cellular immunity, has lost in diagnostic value. The aim of the present study was to assess the correlation between the level of IgG antibodies against A60 antigen of Mycobacterium bovis BCG and tuberculin reactivity. 213 persons were involved into the study: 104 subjects without history of tuberculosis in the past (Group I) and 109 active pulmonary tuberculosis patients (Group II)--56 culture positive patients and 53 culture negative patients. In all subjects the A60-ELISA test with the use of Immune kit was performed. All subjects were also tuberculin tested by the Mantoux technique using 2 units of tuberculin Rt23. We found that the levels of anti-60 antibodies in patients with active pulmonary tuberculosis were significantly higher than in controls (median value 43 U/ml and 237.5 U/ml respectively; p = 0.0001). We observed 47.1% and 74.3% tuberculin positive subjects in Group I and Group II respectively. We did not find relationship between the level of IgG anti-A60 antibodies and tuberculin reactivity in tuberculin-positive and tuberculin-negative subjects both in controls and active pulmonary tuberculosis patients. We conclude: 1. There is no correlation between A60-ELISA results and tuberculin reaction status. 2. The serological test can better than tuberculin test differentiate subjects with non-active tuberculous infection from active disease.

Unlabelled: The purpose of the study was to evaluate prevalence of COPD in sea-port workers who has been employed with handling phosphoric compounds, sulphur compounds and grain. Smoking habits has been also analysed. Study group consists of 238 persons working in Gdańsk sea-port. Protocol of the study has included: medical history, detailed description of work place, smoking habit analysis and spirometric study. As a spirometric parameters FEV1, FVC, FEV1%VC, PEF, MEF25%VC, MEF50%VC and MEF75%VC has been assessed. In study group 106 persons worked with phosphoric compounds handling, 42 persons with sulphuric compounds handling and 90 persons with grain handling. COPD had been diagnosed in 55 persons--43 smokers and 12 non-smokers. Mean values of FEV1% in groups with equal 10-20 years time-work has been compared. Typical COPD features has been present in 37 persons--25 smokers and 12 non-smokers. COPD has been defined based on medical history, physical examination and no response o FEV1 after bronchodilatator application (Berodual)., Conclusion: Smoking habits in Gdańsk sea-port workers has been more important factor in COPD development than work place toxicities.

The aim of this study was to estimate the influence wheat bran enriched diet on incidence of duodenogastric reflux and symptoms in patients suffering from irritable bowel syndrome with predominant constipation. Duodenogastric reflux was examined in 31 patients by means of the cholangioscintigraphy. The results of this investigation were compared with the symptom score before and after 12 weeks of treatment with wheat bran. The incidence of duodenogastric reflux was not decreased post bran consumption. Bowel dysfunction symptom score was significantly lower in both subgroups-with and without duodenogastric reflux. However dyspeptic symptom score was not significantly lower in these groups.

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.

At the beginning of 80-ties new system BACTEC for mycobacteria culture has been introduced. So time of this culture has been shortened to 1-3 weeks. At the end 80-ties Polymerase Chain Reaction (PCR) technique was started and at present it is used in many laboratories in order to get information about genetic material of mycobacteria in different biological samples. Most often insertive factor IS 6110, located in chromosome Myc. tub. complex, is used. DNA amplification occurs in three stages: 1) DNA denaturation. 2) addition of starters (primers): 3) elongation of starter with d NTP synthesis. PCR technique identifies genetic material (DNA) of mycobacterium which is presented in a given biological sample. Positive PCR result not necessarily means that active disease takes place.

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.

In 66 patients with manifestations of functional dyspepsia and in nine volunteers duodenogastric reflux was studied by the cholangio-scintigraphic method. The results of the study were compared with the presence of the symptoms and sings and their intensity expressed in degrees, and with histopathological changes of gastric mucosa. In the symptomatic group the incidence of reflux was 42.4%. No reflux was found in the group of healthy volunteers. No relationship was demonstrated between duodenogastric reflux and the intensity of dyspeptic manifestations, nor between the reflux and the intensity of inflammatory changes in gastric mucosa.

In a group of 20 patients with active pulmonary sarcoidosis and in 20 healthy subjects, serum levels were determined of angiotensin I converting enzyme, immunoglobulins, and of the third and fourth complement components. An increased level of IgG and IgM was found in patients with sarcoidosis, as compared with the control group. High ACE levels were observed in the second and third phase of the disease. A tendency was also observed for simultaneous increase of IgG and ACE levels in patients with sarcoidosis.

Haemorrhage from oesophageal varices is one of the most common reason of death of patients with liver cirrhosis. The possibility of treatment and prevention of the haemorrhage by endoscopic sclerotherapy (ES) has become one of the achievements of contemporary medicine. Nevertheless there are some complications described after this procedure, the most severe being the pulmonary embolia. In our study we analyzed the pulmonary circulation by perfusion scintigraphy after ES. Among twelve patients treated by ES we found two cases of disturbed pulmonary perfusion. We did not find clinical or gasometric changes in these patients. We suggest there should be done pulmonary perfusion monitoring after ES.

The effect of 6 weeks of nifedipine 30-60 mg/d on platelet aggregation and lipid parameters has been studied. A diminution in ADP-, adrenaline- and collagen-induced aggregation was observed. In the case of adrenaline- and collagen-stimulated aggregation the decrease was statistically significant. It was found that platelets which aggregated markedly during the placebo treatment were most strongly inhibited by nifedipine. The changes in lipid parameters were not significantly correlated with changes in aggregation.

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.