Advances in Respiratory Medicine

196 KiB

Open AccessReview

Chronic Obstructive Pulmonary Disease Needs Adjectives: “Guiltless” COPD, “Asthma Like” and “Emphysemal” COPD

by Wacław Droszcz

Adv. Respir. Med. 2006, 74(1), 132-134; https://doi.org/10.5603/ARM.28084 - 01 Mar 2006

Viewed by 264

The author proposes an extension of terminology of COPD by introducing to certain situations the adjectives “guiltless” (for patient who never smoked) , “asthma like” (for patients with symptoms with reversible bronchoconstriction and eosinophilia) and emphysemal COPD. The aim of this proposal is [...] Read more.

The author proposes an extension of terminology of COPD by introducing to certain situations the adjectives “guiltless” (for patient who never smoked) , “asthma like” (for patients with symptoms with reversible bronchoconstriction and eosinophilia) and emphysemal COPD. The aim of this proposal is better understanding of certain events in the disease and subsequently proper treatment. Full article

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Open AccessCase Report

Breast Carcinoma and Anaplastic Gastric Carcinoma with Pleural Metastases in Patient after Mastectomy 30 Years Ago

by Justyna Kościuch, Tadeusz M. Zielonka, Bartosz Ziółkowski, Joanna Domagała-Kulawik, Elżbieta Bogacka-Zatorska and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 129-131; https://doi.org/10.5603/ARM.28087 - 01 Mar 2006

Viewed by 248

Abstract

We describe a case of two simultaneous malignancies–anaplastic gastric carcinoma with pleural metastases and left breast carcinoma. These malignancies were recognized in 78–year old woman after right mastectomy performed 30 years ago. Additionaly, during diagnostic procedures rectal polypus found during colonoscopy occurred to [...] Read more.

We describe a case of two simultaneous malignancies–anaplastic gastric carcinoma with pleural metastases and left breast carcinoma. These malignancies were recognized in 78–year old woman after right mastectomy performed 30 years ago. Additionaly, during diagnostic procedures rectal polypus found during colonoscopy occurred to be adenoma tubulovillosum. Her parents died from malignancies–mother from gastric cancer and father from pulmonary carcinoma. One should remember that there is always possibility of simultaneous development of more than one primary malignancies in one patient and neoplastic disease is an important cancer risk factor. This observation confirms the important role of genetic factors in the pathogenesis of malignant diseases. Full article

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Open AccessCase Report

Diagnosis of Tuberculous Lymphadenitis Based on the Fine Needle Aspiration Samples Analysis

by Adam Fangrat, Joanna Domagała-Kulawik, Rafał Krenke, Aleksandra Safianowska, Renata Walkiewicz and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 126-128; https://doi.org/10.5603/ARM.28086 - 01 Mar 2006

Cited by 1 | Viewed by 255

Abstract

Tuberculous lymphadenitis is one of the most common extrapulmonary manifestations of tuberculosis. The most common lymph nodes involved are in the cervical region. Lymphadenitis due to M. tuberculosis generally presents with enlarging neck lymph nodes over weeks or months associated with fever, weight [...] Read more.

Tuberculous lymphadenitis is one of the most common extrapulmonary manifestations of tuberculosis. The most common lymph nodes involved are in the cervical region. Lymphadenitis due to M. tuberculosis generally presents with enlarging neck lymph nodes over weeks or months associated with fever, weight loss and fatigue. Fine needle aspiration (FNA) of affected lymph nodes has been shown to yield a high sensitivity and specificity in the diagnosis of tuberculous lymphadenitis. Specimens should be examined cytologically, as well as by AFB smear and cultures. The time between the onset of symptoms, clinical presentation and final diagnosis is often too long. We present a case of 60 years old man with tuberculous lymphadenitis, initially suspected of lymphoproliferative disease. Full article

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Open AccessCase Report

Przypadek naczyniaka chłonnego w śródpiersiu

by Katarzyna Górska, Tadeusz M. Zielonka, Małgorzata Żukowska, Piotr Korczyński and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 122-125; https://doi.org/10.5603/ARM.28085 - 01 Mar 2006

Viewed by 267

Abstract

47-year-old women was admitted to the clinic for diagnosis of an incidentally X-ray detected enlargement of the medistinum shadow. In the past, the patient had been operated for lymphangioma of the right forearm. Chest computer tomography (CT) showed an abnormal mass in the [...] Read more.

47-year-old women was admitted to the clinic for diagnosis of an incidentally X-ray detected enlargement of the medistinum shadow. In the past, the patient had been operated for lymphangioma of the right forearm. Chest computer tomography (CT) showed an abnormal mass in the front mediastinum with spherical structures, which density could indicate high-protein contents. In the right mammarian gland an oval cyst (23–15 mm), similar in character to the lesion in the mediastinum was found. The lymphangiomatic character of the lesion with the extension up to the superior aperture of the thorax was confirmed with magnetic resonans imaging (MRI). Due to the extensive changes and lack of symptoms, the patient was disqualified for surgical treatment and remains under further observation. Full article

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Open AccessArticle

Serum Concentration of Homocysteine and the Risk of Atherosclerosis in Patients with Obstructive Sleep Apnea Syndrome

by Marta Kumor, Renata Rubinsztajn, Krzysztof Byskiniewicz, Piotr Bielicki and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 117-121; https://doi.org/10.5603/ARM.28083 - 01 Mar 2006

Viewed by 251

Abstract

Aim: to evaluate usefulness of serum homocysteine concentration in assessing the risk of atherosclerosis in patients with OSAS. Materials and methods: 47 patients (mean age 50.6 ± 10.3 years, mean BMI 31.52 ± 6.04 kg/m²), with OSAS confirmed by polisomnography and [...] Read more.

Aim: to evaluate usefulness of serum homocysteine concentration in assessing the risk of atherosclerosis in patients with OSAS. Materials and methods: 47 patients (mean age 50.6 ± 10.3 years, mean BMI 31.52 ± 6.04 kg/m²), with OSAS confirmed by polisomnography and 12 healthy snoring subjects (mean age 42.8 ± 16.8 years, mean BMI 26.9 ± 2.95 kg/m²) were enrolled to the study. OSAS patients were divided into two groups–subjects with normal blood pressure (group A, n = 32, mean age 51.3 ± 10.3 years, mean BMI 30.6 ± 4.4 kg/m²) and subjects with arterial hypertension (group B, n = 15, mean age 52.7 ± 9.8 years, mean BMI 31.4 ± 5.0 kg/m²). None of the study subjects was treated with statins or fibrates. Serum concentration of homocysteine, uric acid, glucose level and lipid profile was evaluated inall subjects. Results: We found significant abnormalities in the lipid profile in all the study groups. The mean concentrations ofcholesterol (mg/dL), triglycerides (mg/dL) and homocysteine (μmol/L) were as follows: 215.0 ± 34.2, 200.0 ± 173.0, 8.2 ± 2.9 in group A, 216.5 ± 43.1, 189.3 ± 138.8, 8.40 ± 1.67 in group B. 195.0 ± 32.9, 154.3 ± 133.0, 9.3 ± 2.1 in the control group. No significant correlation between the homocysteine concentration and level of cholesterol or triglycerides was found. Conclusions: the serum concentration of homocysteine seems not to be a good marker in the evaluation of the risk of atherosclerosis in patients with OSAS. Full article

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Open AccessArticle

The Interpretation of Carbon Monoxide Diffusing Capacity Test Depending of Hemoglobin Concentration

by Renata Rubinsztajn, Katarzyna Wrotek, Rafał Krenke, Tadeusz Przybyłowski and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 113-116; https://doi.org/10.5603/ARM.28082 - 01 Mar 2006

Viewed by 328

Abstract

The carbon monoxide diffusion capacity (DLCO) is among others dependent of the hemoglobin value. The result of DLCO test in patients with anemia change when we adjust DLCO for hemoglobin (Hb) concentration. The aim of the study was to estimate if the differences [...] Read more.

The carbon monoxide diffusion capacity (DLCO) is among others dependent of the hemoglobin value. The result of DLCO test in patients with anemia change when we adjust DLCO for hemoglobin (Hb) concentration. The aim of the study was to estimate if the differences between result of DLCO and DLCO/VA before and after adjust the Hb value can change the interpretation of the test in the group with normal and low value of Hb. The study group consist of 25 patients with normal level of Hb (group A) and 21 ones with anemia (group B). All studied have been done spirometry, bodypletyzmografy and DLCO test. All tests were made on the SensorMedics. The DLCO test was made in the single breath diffusing capacity program Results. The values of the Hb in the group A were above 13 g/dl for female and 14 g/dl for man. In the group B the Hb value were less then 10 g/dl. In the group A the middle Hb concentration was 14.49 ± 1.36 g/dl. DLCO and DLCO/VA before and after Hb value adjusted were 91.4 ± 17.98 vs. 90.7 ± 17.58% i 101.5 ± 19.46 vs. 100.7 ± 18.65% (p > 0.05) In the group B the middle Hb concentration was 8.77 ± 0.97 g/dl. DLCO and DLCO/VA before and after Hb value adjusted were: 57.05 ± 17.55 vs. 72.19 ± 25.27% i 67.57 ± 11.18 vs. 84.66 ± 14.62% (p < 0.05). Conclusions: 1. The were non statistically important change in the DLCO test results after consideration on Hb level in the studied group without anemia, so in the patients with normal level of Hb the DLCO test result doesn’t change the interpretation of the test after the consideration on Hb concentration. 2. In patients with anemia we shout adjust the Hb value to the DLCO test because the results with out this can completely change the interpretation of the test and clinical diagnosis. Full article

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Open AccessArticle

Effect of Phosphodiestrase 4 Inhibitor (Rolipram)on Experimental Allergic Asthma-Guinea Pig Model

by Patrycja Nejman-Gryz, Hanna Grubek-Jaworska, Jarosław Glapiński and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 106-112; https://doi.org/10.5603/ARM.28081 - 01 Mar 2006

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Abstract

Selective phosphodiesterases (PDE) inhibitors are the new group of antiasthmatic drugs, which integrate antiinflammatory activity with bronchoconstriction counteraction. Selective inhibitors of phosphodiesterase type 4 are used as alternative or assist drugs in treatment of respiratory system diseases. So far glucocorticosteroids remain the most [...] Read more.

Selective phosphodiesterases (PDE) inhibitors are the new group of antiasthmatic drugs, which integrate antiinflammatory activity with bronchoconstriction counteraction. Selective inhibitors of phosphodiesterase type 4 are used as alternative or assist drugs in treatment of respiratory system diseases. So far glucocorticosteroids remain the most efficient and widely used medicine in the treatment of asthma. However application of glucocorticosteroid is greatly limited because of numerous side effects, what induce to permanent search for new antiasthmatic drugs. Examination new substances are executed on animal models. Guinea pig model is widely used to research course of asthmatic reaction. This model is especially convenient on the ground of that: lung is major shock organ, airway respond to histamine, animals demonstrated early asthmatic reaction (EAR) and late asthmatic reaction (LAR), eosinophils flow in bronchoalveolar space during LAR. In ovalbumin (OA) sensitized guinea pigs hypersensitivity reaction breaks out as a result of OA provocation. Aims of our experiments, execute on guinea pig model were to determine the influence of rolipram (PDE 4 inhibitor) on modulation experimental asthmatic reaction and comparison activity of rolipram versus dexamethasone in attribution to chosen parameters of allergic reaction such as: lung resistance, influx of protein and inflammatory cells in airways, and mastocytes degranulation. Experiments were made on guinea pigs sensitized and provoked with ovalbumin The obtain data indicate that rolipram was effective in reduction the rise of lung resistance during EAR, restricted influx of eosinophils to bronchoalveolar space between 1.5 and 24 h after provocation, and reduced increase of histamine concentration in bronchoalveolar lavage fluid (BALf). Rolipram had no influence on number of neutrophils present in BALf. Dexamethasone in double dose of 1.2 mg/kg effectively bordered the growth of lung resistance during EAR, and broke influx of eosinophils and neutrophils to bronchoalveolar space. Full article

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Open AccessArticle

Macrophage Phenotype in Induced Sputum in Asthma Subjects

by Joanna Hermanowicz-Salamon, Joanna Domagała-Kulawik, Marta Maskey-Warzęchowska and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 101-105; https://doi.org/10.5603/ARM.28080 - 01 Mar 2006

Viewed by 276

Abstract

Macrophages represent the most predominant immune effector cells in the alveolar spaces and conducting airways and are known to express activated phenotype. The study was aimed at assessing the differences in cellular profile and the expression of selected surface markers on sputum macrophages [...] Read more.

Macrophages represent the most predominant immune effector cells in the alveolar spaces and conducting airways and are known to express activated phenotype. The study was aimed at assessing the differences in cellular profile and the expression of selected surface markers on sputum macrophages in asthma and healthy subjects. 17 healthy subjects (never smoked) and 10 mild asthma subjects treated with glucocorticosteroids were enrolled into the study. For macrophage phenotyping a immunocytochemistry method was used with commercially available antibodies anti: CD14, CD71, CD11b and CD54. The nonparametric Mann Whitney U test was applied for data comparison, p value < 0.05 being regarded as significant. The total number of cells were increased in asthma patients 4.81 ± 5.27 × 10⁶/ml vs. healthy 2.8 ± 2.15 × 10⁶/ml and it was statistically significant. Statistically significant increase in the percentage of eosinophils was observed in mild asthma subjects. No differences were found between the proportion in macrophages and lymphocytes. The macrophage phenothype in induced sputum differed in both groups. The expression of CD 11b was higher in asthma group and the difference was statistically significant. The proportion of macrophages with the expression of CD 14, CD 71 and CD54 was comparable in both groups. Macrophage phenotyping during glucocorticosteroid therapy is useful in the assessment of inflammatory process in asthma subject. Full article

252 KiB

Open AccessArticle

Identification of Mycobacteriaceae Species Based on the Hsp-65 Gene Polymorphism Analysis by PCR–RFLP

by Adam Frangrat, Renata Walkiewicz, Aleksandra Safianowska, Hanna Grubek-Jaworska and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 95-100; https://doi.org/10.5603/ARM.28079 - 01 Mar 2006

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Abstract

The polymorphism of the short fragment of the heat shock protein 65 encoding gene was evaluated by the PCR–RFLP technique described by Telenti and further developed by Devallois for identification of mycobac-terial species in routine laboratory work. We analysed 58 strains representing 25 [...] Read more.

The polymorphism of the short fragment of the heat shock protein 65 encoding gene was evaluated by the PCR–RFLP technique described by Telenti and further developed by Devallois for identification of mycobac-terial species in routine laboratory work. We analysed 58 strains representing 25 different mycobacterial species (24 reference strains and 34 clinical isolates). The results obtained by PCR-RFLP and HPLC identification techniques were highly concordant The results were compatible for 87.5% (21/24) reference strains and for 97.1% (33/34) clinical isolates. The PCR–RFLP method allowed for accurate identification mycobacterial species, especially pathogenic strains. Restriction patterns obtained for 25 species of Mycobacteriaceae genus could help in constructing the data base and algorithms used in routine laboratory practice. Full article

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Open AccessArticle

The Mycolic Acids Analysis with Hplc Technique in Drug Susceptibility Testing of Mycobacterium Tuberculosis Strains

by Renata Walkiewicz, Hanna Grubek-Jaworska and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 89-94; https://doi.org/10.5603/ARM.28078 - 01 Mar 2006

Viewed by 288

Abstract

The aim of this study was to evaluate the utility of the quantitative analysis of mycolic acids by HPLC technique in drug susceptibility testing of the M. tuberculosis isolates to the first-line antituberculous drugs: isoniazid and rifampicin. Drug susceptibility of the 30 clinical [...] Read more.

The aim of this study was to evaluate the utility of the quantitative analysis of mycolic acids by HPLC technique in drug susceptibility testing of the M. tuberculosis isolates to the first-line antituberculous drugs: isoniazid and rifampicin. Drug susceptibility of the 30 clinical M.tbc isolates was examined by the mycolic acids analysis with HPLC technique and results were compared to the proportion method on solid L-J medium and liquid medium in MGIT system. In HPLC method drug susceptibility of M. tuberculosis strains was described by TAMA index defined as the ratio of thetotal area under mycolic acids peaks (TAMA) from cultures with drug to the TAMA of control. At critical concentrations of drugs, TAMA indexes of resistant strains were >0.5, and TAMA indexes of susceptible strains were <0.05. The average error of the TAMA analysis was ±9.5% The quantitative analysis of mycolic acids by HPLC gives results compatible with standard proportion method and is a reliable method for determination of drug susceptibility of M. tuberculosis. Full article

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Open AccessArticle

Pulmonary Mycobacteriosis—The Diagnostic Challenge. The Authors’ Experience

by Magdalena Nowacka-Mazurek, Rafał Krenke, Hanna Grubek-Jaworska, Renata Walkiewicz, Aleksandra Safianowska and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 84-88; https://doi.org/10.5603/ARM.28077 - 01 Mar 2006

Cited by 1 | Viewed by 346

Abstract

The diagnosis of NTM-related pulmonary disease is based on clinical symptoms, radiological features and several positive cultures of one and the same NTM species from samples obtained from the respiratory tract. Short hospitalization usually does not enable sufficient diagnostic procedures to meet the [...] Read more.

The diagnosis of NTM-related pulmonary disease is based on clinical symptoms, radiological features and several positive cultures of one and the same NTM species from samples obtained from the respiratory tract. Short hospitalization usually does not enable sufficient diagnostic procedures to meet the diagnostic criteria, andthis may lead to the reduction of diagnostic sensitivity. The aim of the study was to draw attention to NTM-related pulmonary disease, to share the authors' experience in the diagnosing of pulmonary mycobacteriosis and to indicate the possibilities of improving the diagnostic accuracy in this disease. A group of 31 patients with sputum, bronchial washing and/or bronchoalveolar lavage fluid (BALF) NTM-positive cultures was selected from a cohort of 245 patients evaluated for tuberculous and nontuberculous mycobacterial diseases (total number of 1277 specimens were invastigated). In two of them NTM related pulmonary disease was diagnosed (caused by M. kansasii and M. avium) at the course of initial evaluation. In the remaining 29 patients the microbiological data did not allow to establish the diagnosis of mycobacterial lung disease mainly due to a small number of samples from the respiratory tract. From this group 13 patients were reevaluated within 3-6 months from the initial investigation. This allowed to identify two new cases of mycobacteriosis (M. kansasii and M. avium). Thus among 31 patients with NTM positive cultures from respiratory tract specimens 4 patients (4/31, 12.9%) met the diagnostic criteria for mycobacterial disaease. Conclusion: Microbiological analysis of an adequate number of samples in symptomatic patients with radiological features suggestive for NTM-related pulmonary disease increses the diagnostic sensitivity in pulmonary mycobacteriosis. Identification of the species in positive cultures is of great importance. Full article

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Open AccessArticle

The Influence of Influenza Vaccination on Asthma and Chronic Obstructive Pulmonary Disease

by Krzysztof J. Karwat, Monika Szpotańska, Zofia Szulc and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 80-83; https://doi.org/10.5603/ARM.28076 - 01 Mar 2006

Viewed by 280

Abstract

Respiratory infections are the most common causes of exacerbations of asthma and chronic obstructive pulmonary disease (COPD). The influenza vaccinations are recommended in prophylaxis of respiratory infections. The aim of our study was to evaluate the influence of influenza vaccinations on asthma or [...] Read more.

Respiratory infections are the most common causes of exacerbations of asthma and chronic obstructive pulmonary disease (COPD). The influenza vaccinations are recommended in prophylaxis of respiratory infections. The aim of our study was to evaluate the influence of influenza vaccinations on asthma or COPD. 178 patients (55.1% with asthma, 44.9% with COPD) of Out-patient Clinic of Department of Internal Diseases, Pulmonology and Allergology of Warsaw Medical University filled the questionnaires. In 2003/2004 season 43.3% (77) ofallwere vaccinated against influenza. The frequency of vaccinations was significantly higher in patients > 65 years of age 58.4% (45) than in younger ones [41.6% (32)]. The number of exacerbations decreased more than twice comparing the time before and after immunization: 1.7 ± 1.5 and 3.9 ± 2.4 per year respectively (p < 0.00001). Conclusions: The influenza vaccinations is a useful method of decreasing the number of exacerbations in patients with asthma and COPD. The elder patients are vacacinated more often than younger ones. The frequency of vaccinations among patients with asthma and COPD is still not satisfactory. Full article

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Open AccessArticle

Efficacy and Safety of Levofloxacin Treatment of Community—Acquired Pneumonia in Hospitalized Patients

by Krzysztof J. Karwat, Magdalena Grabczak and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 77-79; https://doi.org/10.5603/ARM.28074 - 01 Mar 2006

Viewed by 453

Abstract

The aim of this prospective study was to determine the efficacy and safety of levofloxacin in the treatment of community-aquired pneumonia (CAP) in outpatient with ineffective antibiotic management, requiring hospitalization. The examined group included 25 patients (11 M, 14 F) of mean age [...] Read more.

The aim of this prospective study was to determine the efficacy and safety of levofloxacin in the treatment of community-aquired pneumonia (CAP) in outpatient with ineffective antibiotic management, requiring hospitalization. The examined group included 25 patients (11 M, 14 F) of mean age 70 ± 17.5 years with abnormalities in X-ray on admission to hospital. Risk factors for pneumonia and previous antibacterial therapy were analyzed. In the hospital they were treated for 7 days with levofloxacin 500 mg twice a day administred intravenously. Body temperature, blood cell count, ESR, CRP, AST, ALT, LDH, CPK, creatine, urea, potassium, sodium, ABG, and ECG were measured on admission and in the 3-rd and 7- th day of therapy. The chest X-rays were performed and analyzed on hospital discharge. 18 patients were aged > 65 yrs, cardiovascular diseases co-existed in 14, COPD in 9, smoking habit in 12, renal failure in 3, diabetes in 3 and alkohol addiction in 1 cases. On admission 4 patients had respiratory failure, 10 hypoxaemia. During therapy a decrease of body temperature (p < 0.001), concentration of CRP (p < 0.004) and LDH (p < 0.03), CPK (p < 0.04) and increase of PaO₂ (p < 0.012) were observed. The changes of other parameters were not statistically significant. We did not observe any changes in ECG. On discharge from the hospital in 16 patients complete regression and in 6 patients partial regression of lesions in chest X-ray examination were observed. In 3 patients levofloxacin therapy was noneffective: in 2 because of persistent high body temperature after 3 days of treatment and in 1 patients because of recurrent of fever. Adverse events were mild. Transient exacerbation of renal failure was observed in 3 patients. Our study demonstrates that levofloxacine ni dose 2 × 500 mg given intravenously for 7 days is effective and safe in treatment of CAP in patients with previously ineffective antibacterial therapy. Full article

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Open AccessArticle

Maximal Respiratory Pressures and Exercise Tolerance in Patients with COPD

by Marta Maskey-Warzęchowska, Tadeusz Przybyłowski, Katarzyna Hildebrand, Katarzyna Wrotek, Joanna Wiwała, Justyna Kościuch and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 72-76; https://doi.org/10.5603/ARM.28075 - 01 Mar 2006

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Abstract

Many authors reported respiratory muscle function impairment in patients with chronic obstructive pulmonary disease (COPD). Impaired respiratory muscle function may contribute exercise intolerance which is frequently observed in this disease. Aim of the study: was to determine the influence of respiratory muscle function [...] Read more.

Many authors reported respiratory muscle function impairment in patients with chronic obstructive pulmonary disease (COPD). Impaired respiratory muscle function may contribute exercise intolerance which is frequently observed in this disease. Aim of the study: was to determine the influence of respiratory muscle function on exercise capacity in patients with COPD. Methods: 23 patients with stable COPD aged 62.7 ± 9.3 years (6F, 17M; mean post-bronchodilator FEV₁ = 47.9 ± 12.4% value predicted) participated in the study. Exercise capacity was assessed by the six-minute walk test and the incremental cardiopulmonary exercise test (CPET) on a treadmill. Maximal respiratory pressures (PI_max, PE_max) were evaluated before and directly after CPET. Results: The mean peak oxygen uptake (VO₂max) was 27.2 ± 6.1 mlO₂/min/kg and the mean distance walked during the 6 MWT was 569.4 ± 101.7 m. Both PImax and PEmax decreased significantly after maximal exercise (71.4 ± 23.0 vs. 63.6 ± 22.2 cm H₂O, p = 0.001 and 124.9 ± 46.5 vs. 112.3 ± 46.6 cm H₂O, p = 0.02 respectively). No correlation between VO₂max and the 6-minute walk distance and the maximal respiratory pressures was found. We observed a negative correlation between the 6-minute walk distance and the difference between the pre- and post CPET maximal inspiratory pressure. Conclusions: respiratory muscle function is impaired in patients with COPD but this does not affect exercise performance. Exercise causes a decrease of the respiratory muscle strength. Full article

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Open AccessArticle

Bronchial Obstruction Reversibility Test in the Assessment of COPD Severity—Controversies

by Marta Maskey-Warzęchowska, Monika Pankowska and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 68-71; https://doi.org/10.5603/ARM.28073 - 01 Mar 2006

Viewed by 384

Abstract

The GOLD and ERS/ATS guidelines recommend the post-bronchodilator FEV₁ (% predicted) to define the severity of chronic obstructive pulmonary disease (COPD). Yet in various publications authors analyze the pre-bronchodilator value or do not clearly state which value was used when the bronchial [...] Read more.

The GOLD and ERS/ATS guidelines recommend the post-bronchodilator FEV₁ (% predicted) to define the severity of chronic obstructive pulmonary disease (COPD). Yet in various publications authors analyze the pre-bronchodilator value or do not clearly state which value was used when the bronchial reversibility test was performed. The guidelines established by the Polish Respiratory Society (PRS) do not specify if performing the reversibility test is necessary to estimate the COPD severity and suggest a reversibility test evaluation which differs from that in the ERS/ ATS and GOLD recommendations. Aim: to assess the changes in the degree of severity of COPD in the classification based upon the pre- and post-bronchodilator FEV₁ and to compare the interpretation of the reversibility test as suggested by GOLD and ATS/ ERS and the PRS. Methods: 145 COPD patients (67F, 78M, mean age 67.5 ± 8.9 yrs) with a negative bronchial obstruction reversibility test (salbutamol 400 μg) were enrolled to the study. For each patient the degree of COPD severity using the pre- and postbronchodilator FEV₁ was established. The pre- and post-bronchodilator classifications were compared. Differences in the interpretation of the reversibility test according to the GOLD and ATS/ ERS and the Polish guidelines were analyzed. Results: In 22 subjects (15.2%) the degree of disease severity changed after salbutamol. The changes were most frequent in the group of severe and very severe COPD (77.3% of changes). In 1 patient (0.7%) post-bronchodilator severity was greater than before salbutamol intake. In 7 patients (4.8%) the post-bronchodilator FEV₁/FVC exceeded 70%, thus excluding the diagnosis of COPD. Of all the 145 negative (according to the ATS/ ERS and GOLD criteria) reversibility tests in 24 cases (16.6%) the test was positive when the criteria recommended by PRS were applied. Conclusions: the bronchial obstruction reversibility test is essential in the diagnosis and assessment of severity of COPD. Despite poor obstruction reversibility in this disease the use of pre-bronchodilator FEV₁ in the assessment of COPD severity may be misleading and is an obstacle in the comparative analysis of studies in the domain of this disease. Differences in the guidelines for the management of COPD may also hinder comparative studies and influence epidemiologic data. Full article

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Open AccessArticle

The Influence of 3 Weeks Therapy with Continuous Positive Airway Pressure on Serum Leptin and Homocysteine Concentration in Patients with Obstructive Sleep Apnea Syndrom

by Renata Rubinsztajn, Marta Kumor, Krzysztof Byśkiniewicz and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 63-67; https://doi.org/10.5603/ARM.28072 - 01 Mar 2006

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Abstract

Obstructive sleep apnea (OSA) is one of the most often sleep disturbance. Not treated patients have 2–3 times more risk for death because of the cardiovascular diseases. Leptin and homocysteine are the risk factors for cardiovascular diseases. Treatment by nCPAP has positive influence [...] Read more.

Obstructive sleep apnea (OSA) is one of the most often sleep disturbance. Not treated patients have 2–3 times more risk for death because of the cardiovascular diseases. Leptin and homocysteine are the risk factors for cardiovascular diseases. Treatment by nCPAP has positive influence for health care and reduction of hyperten-sion in this group. The aim of this study was to evaluate an effect of 3 weeks nCPAP therapy on a serum leptin and homocysteine con-centrations in patients with OSA. Material and methods: The study group consisted of 48 male patients in the age x = 51.2 ± 7.5 years old, OSA was diagnosed by polisomnographic study The leptin concentration was evaluated by RIA methods (HUMAN LEPTIN RIA KIT), the homocysteine concentration was evaluated by Axis Homocysteine EIA test. Patients were treated by nCPAP during 3 weeks. Only 29 patients were effectively treated for this time. The compliance was: 5.07 ± 1.81 h. Results: In the group of 29 patients the serum leptin and homocysteine concentration before and after treatment were 11.05 ± 5.59 ng/mL vs. 11.07 ± 7.16 ng/mL i 10.98 ± 2.79 μmol/L vs. 10.34 ± 2.99 μmol/L. In the all study group the statistical important correlation between leptin and AHI, mean and minimal saturation overnight, fibrinogen econcentration, BMI, WHR, waist circumference, heart rate and between homocysteine and heart rate were observed. Conclusions: 3 weeks therapy does not have any effect on leptin and homocysteine concentrations in the studied group of patients with OSA. Serum leptin concentration correlates with AHI, TMB90, as well as with mean and minimal saturation during a sleep. This indicates a potentially higher risk of cardiovascular diseases in the studied group. Full article

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Open AccessArticle

Familial Clustering of Symptoms Typical for OSAS

by Piotr Bielicki, Tadeusz Przybyłowski, Wacław Droszcz, Krzysztof Byskiniewicz, Piotr Korczyński and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 59-62; https://doi.org/10.5603/ARM.28071 - 01 Mar 2006

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Abstract

The aim of the study was to compare the incidence of obstructive sleep apnoea syndrome (OSAS) symptoms in relatives of subjects with OSAS and in relatives without OSAS but with clinical symptoms of this disease. The study group consisted of 186 relatives of [...] Read more.

The aim of the study was to compare the incidence of obstructive sleep apnoea syndrome (OSAS) symptoms in relatives of subjects with OSAS and in relatives without OSAS but with clinical symptoms of this disease. The study group consisted of 186 relatives of patients with OSAS and 117 relatives of patients with symptoms of OSAS in whom the disease was not confirmed by polysomnography. They were all mailed a questionnaire with questions concerning anthropometric data, the presence of symptoms typical for OSAS and the presence of concomitant diseases. Analysis of the obtained data revealed an increased frequency of snoring, sleep apnea and nycturia in the relatives of patients with OSAS when compared to relatives of patients without OSAS, but the difference was not statistically significant. The incidence of daytime OSAS symptoms was significantly higher in the group of relatives of patients with OSAS. No differences in the incidence of arterial hypertension, ischaemic heart disease and diabetes mellitus were found. Full article

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Open AccessArticle

Obstructive Sleep Apnoea Syndrome in Younger and Older Age Gropus—Differences and Similarities

by Piotr Bielicki, Krzysztof Byśkiniewicz, Marta Kumor, Piotr Korczyński and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 56-58; https://doi.org/10.5603/ARM.28070 - 01 Mar 2006

Viewed by 309

Abstract

The prevalence of OSA rises with age, however it is also diagnosed in patients below the age of 35 years. Aim of the paper was the camparison of the severity and clinical features of OSA in young and elderly subjects. The study was [...] Read more.

The prevalence of OSA rises with age, however it is also diagnosed in patients below the age of 35 years. Aim of the paper was the camparison of the severity and clinical features of OSA in young and elderly subjects. The study was a retrospective analysis of 561 subjects aged > 65 yrs and 319 subjects aged < 35 yrs who were investigated in our Sleep Laboratory between 1992–2005 due to snoring or daytime sleepiness. They all underwent full polisomnography or a limited recording. In patients with diagnosed OSA (AHI > 10) we initiated CPAP therapy. Results: OSA was diagnosed in 383 (63.3%) older patients and in 144 (45.1%) younger patients. BMI was significantly higher in younger subjects than in older (32.2 ± 6.9 vs. 28.9 ± 5.1 kg/m²). The prevalence of OSA amongwomen was significantly higher in older patients than in younger (26.4 vs. 5.8%). Younger patients with OSA had a significantly higher AHI (42.7 ± 32.1 vs. 32.2 ± 18.4) and a longer duration ofapneas expressed as percentage of total sleep time spent in apnea (31.6 ± 23.2 vs. 26.5 ± 17.7%). CPAP therapy was initiated in 185 older patients and 41% of them continue therapy. In younger group patients CPAP therapy was started in 51 patients and 47% of them continue therapy. The mean therapeutic pressure was significantly higher inyounger patients with OSA (9.2 ± 2.2 vs. 8.2 ± 2.2 cmH₂O). Conclusions: 1/ OSA is more frequent in elderly patients ; 2/ in young patients OSA is more severe and requires higher pressures in CPAP therapy; 3/ OSA among women is four time more frequent in older patients than in younger. Full article

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Open AccessArticle

Obstructive Sleep Apnea in Shift Workers

by Marcin Paciorek, Krzysztof Byśkiniewicz, Piotr Bielicki and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 51-55; https://doi.org/10.5603/ARM.28069 - 01 Mar 2006

Viewed by 284

Abstract

The aim of the study was to compare intensity of sleep disordered breathing in standard nocturnal polisomnography (PSG) and diurnal PSG after night shift in shift workers with obstructive sleep apnea syndrome. Methods: 25 shift workers (24 M, 1 F), aged 45.4 ± [...] Read more.

The aim of the study was to compare intensity of sleep disordered breathing in standard nocturnal polisomnography (PSG) and diurnal PSG after night shift in shift workers with obstructive sleep apnea syndrome. Methods: 25 shift workers (24 M, 1 F), aged 45.4 ± 9.1 yrs, of mean BMI 31.9 ± 4.02 kg/m² were studied. Noc-turnal PSG and diurnal PSG after night shift were performed in all participants. Results: The mean apnea/hypopnea index (AHI) in diurnal PSG was higher than AHI in nocturnal PSG , 47.8 ± 27.4/h vs. 38.0 ± 24.1/h respectively, (p < 0.05). Not significant tendency towards higher oxygen desaturationindex (ODI) in diurnal PSG was observed, 40.4 ± 25.5/h vs. 31.9 ± 25.8/h respectively. Conclusion: The study demonstrated that there is a significant increase in AHI in diurnal PSG after night shiftcompared to standard night PSG in shift workers with OSAS. This may negatively influence diagnosis and treatment. Full article

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Open AccessArticle

Factors Determining the Decision to Initiate nCPAP Therapy in Patients with Obstructive Sleep Apnea (OSA)

by Krzysztof Byśkiniewicz

Adv. Respir. Med. 2006, 74(1), 45-50; https://doi.org/10.5603/ARM.28068 - 01 Mar 2006

Viewed by 322

Abstract

The aim of the study was to determine the factors which influence the decision to initiate nCPAPtherapy in patients with OSA. 184 patients with OSA were enrolled to the study. They were divided into two groups: group “T” (“treated”) which consisted of 112 [...] Read more.

The aim of the study was to determine the factors which influence the decision to initiate nCPAPtherapy in patients with OSA. 184 patients with OSA were enrolled to the study. They were divided into two groups: group “T” (“treated”) which consisted of 112 patients who were being treated with nCPAP and group “R” (“resigned”) which consisted of 68 patients who refused nCPAP therapy. The main causes of their refusal were: the possibility of surgical treatment, nCPAP intolerance and high costs associated with the purchase of a nCPAP device. The mean age of the patients was comparable in both groups (49.2 ± 8.7 vs. 50.5 ± 10.6 yrs). Patients from group T had a significantly higher body weight and BMI than the patients from group R (106.6 ± 2.1 kg vs. 94.1 ± 20.9 kg, p < 0.0001 and 35.0 ± 6.3 kg/m² vs. 31.1 ± 6.3 kg/m², p < 0.00005 respectively). The patient evaluation included physical examination, a questionnaire concerning symptoms related with OSA and OSA assessment by poly-MESAM, polysomnography (PSG) before and with nCPAP trial therapy. Results: the following parameters obtained in the poly-MESAM recording differed significantly (p < 0.001) between group T and group R: RDI (54.6 vs. 41.7), HRV index (24 vs. 11), SaO₂min (67.0 vs. 75% and SaO₂ mean (84 vs. 88%). Analysis of the baseline PSG did not reveal differences in sleep structure in both groups. We found a significantly higher AHI in group T (63.6 vs. 44.9, p < 0.00005). PSG confirmed a significantly lower SaO₂ min and SaO₂ mean in group T (67.0 vs. 75.0%, p < 0.001 and 89.0 vs. 92%, p < 0.00002 respectively) and also revealed a significantly longer total sleep time with SaO₂ < 90% in this group (183.0 vs. 55.0 min, p < 0.0005). We did not find any differences between both study groups in the parameters obtained in PSG with nCPAP trialtherapy. Conclusions: OSA patients who decide to be treated with nCPAP are more obese, have a higher BMI and demon-strate a more severe disease assessed by PSG. Full article

228 KiB

Open AccessArticle

Influence of Nasal Continuous Positive Airway Pressure on Response to Exercise in Patients with Obstructive Sleep Apnea Syndrome

by Tadeusz Przybyłowski, Piotr Bielecki, Marta Kumor, Katarzyna Hildebrand, Marta Maskey-Warzęchowska, Joanna Wiwała, Justyna Kościuch, Piotr Korczyński and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 39-44; https://doi.org/10.5603/ARM.28067 - 01 Mar 2006

Cited by 1 | Viewed by 330

Abstract

Obstructive sleep apnea syndrome (OSAS) patients are at risk of cardiovascular complications. The aim of this study was to assess the effect of treatment with continuous positive airway pressure (CPAP) on the response to symptom limited exercise test. Methods: twenty nine OSAS patients [...] Read more.

Obstructive sleep apnea syndrome (OSAS) patients are at risk of cardiovascular complications. The aim of this study was to assess the effect of treatment with continuous positive airway pressure (CPAP) on the response to symptom limited exercise test. Methods: twenty nine OSAS patients (1 F, 28 M), mean age 50.7 ± 9.7 yrs with body mass index of 32.6 ± 4.5 kg/m² participated in the study. OSAS was diagnosed by overnight polysomnography. Incremental cardiopulmonary exercise test (CPET) on a treadmill was performed twice: before and after 2–3 weeks of regular treatment with CPAP. Results: mean apnea + hypopnea index (AHI) before therapy was 57.6 ± 12 h⁻¹. CPAP treatment did not change peak oxygen consumption (VO₂max) (38.3 ± 9.0 vs. 38.9 ± 6.9 mlO₂/kg/min, p = ns) or peak heart rate (153.4 ± 21 min⁻¹ vs. 155.5 ± 22 min⁻¹, p = ns). There were no significant changes in ventilation or gas exchange variables. However, a decrease in peak systolic blood pressure from 194.5 ± 24 mmHg to 186.7 ± 27.9 mmHg (p < 0.05) with CPAP treatment was found. During recovery a decrease in heart rate (at 1st minute and minutes 3–6) and mean arterial pressure (MAP) (minutes 4–7) with CPAP treatment was observed. Significant correlations between VO₂max and AHI (r = −0.38, p < 0.05); MAP at peak exercise and: AHI, mean oxygen saturation (SaO₂) during sleep, minutes of sleep with SaO₂ < 90% (T₉₀); MAP at recovery (minutes 3–8) and T₉₀ before CPAP treatment were also noted. Conclusions: OSAS patients are not limited on exercise. Treatment with nasal CPAP attenuates circulatory response to incremental exercise on a treadmill. Full article

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Open AccessArticle

Holter ECG Monitoring during Research Bronchofiberoscopy in Patients with Asthma

by Rafał Krenke, Tadeusz Przybyłowski, Michał Niemczyk, Katarzyna Górska, Katarzyna Hildebrand, Justyna Kościuch and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 32-38; https://doi.org/10.5603/ARM.28066 - 01 Mar 2006

Viewed by 266

Abstract

Bronchoscopy is a very useful tool in asthma research studies. The study was undertaken to evaluate the effect of bronchoscopy, BAL and bronchial biopsies on heart rate and arrhytmias in patients with asthma. Twenty patients (12 M, 8 F, mean age 39.6 ± [...] Read more.

Bronchoscopy is a very useful tool in asthma research studies. The study was undertaken to evaluate the effect of bronchoscopy, BAL and bronchial biopsies on heart rate and arrhytmias in patients with asthma. Twenty patients (12 M, 8 F, mean age 39.6 ± 16.3 yrs) with asthma (mean FEV₁ 81 ± 19.5% pred.; mean FEV₁%VC 69 ± 12.3%) participated in the study. Holter ECG monitoring was performed twice: before (1 or 2 days) and on the day of bronchoscopy. Heart rate and cardiac arrhythmias were compared to prebronchoscopy recording at four separate time intervals: during bronchoscopy, first postbronchoscopic hour, second postbronchoscopic hour andtotal 24 h. There were no significant differences between mean heart rate at the time of bronchoscopy (88.5 ± 14.1 min⁻¹ vs. 83.7 ± 11.9 min⁻¹), first and second postbronchoscopic hour (80.9 ± 15.8 min⁻¹ vs. 85.7 ± 13.7 min⁻¹ and 82.6 ± 13.6 min⁻¹ vs. 80.6 ± 11.6 min⁻¹) as well as total 24 h (76.1 ± 11.2 min⁻¹ vs. 75.9 ± 9.4 min-1) as compared to prebronchoscopic recordings. Max. heart rate during bronchoscopy was higher as compared to the corresponding time of prebron-choscopic recording (134.5 ± 11.5 min⁻¹ vs. 122.5 ± 19.6 min⁻¹, p < 0.05). No differences in the number and type of ventricular (VA) and supraventricular arrhythmias (SVA) between the pre- and peribronchoscopic monitoring were observed. Positive correlation between the age and the number of VA during bronchoscopy has been found. Conclusion: Bronchoscopic procedures in asthma patients do not increase the risk of cardiac arrhythmias. Some factors influencing the heart rate and number of VA during bronchoscopy can be identified. Full article

221 KiB

Open AccessArticle

Influence of Bronchoscopy on Nitric Oxide in Exhaled Air

by Katarzyna Hildebrand, Rafał Krenke, Tadeusz Przybyłowski, Adam Frangrat, Katarzyna Górska and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 26-31; https://doi.org/10.5603/ARM.28065 - 01 Mar 2006

Cited by 1 | Viewed by 363

Abstract

Nitric oxide has been extensively studied as a noninvasive marker of airway inflammation, especially in asthma. Assuming, bronchoscopy can produced not only systemic but also local inflammatory response we hypothesized that bronchofiberoscopy can be responsible for an increase in nitric oxide synthesis with [...] Read more.

Nitric oxide has been extensively studied as a noninvasive marker of airway inflammation, especially in asthma. Assuming, bronchoscopy can produced not only systemic but also local inflammatory response we hypothesized that bronchofiberoscopy can be responsible for an increase in nitric oxide synthesis with resulting increase in fractional concentration of exhaled nitric oxide (FE_NO). Seventeen subjects (10 M, 7 F), at mean age of 53.8 ± 14.1 yrs undergoing diagnostic bronchoscopy participated in the study. The indications for bronchoscopy were as follows: lung cancer (n = 5; 29%), interstitial lung diseases (n = 3; 18%), slowly resolving pneumonia (n = 3; 18%), hemoptysis (n = 3; 18%), differential diagnosis of asthma/dyspnea (n = 3; 18%). During bronchoscopy bronchial washing (n = 7) and bronchoalveolar lavage (BAL) (n = 10) has been performed. FE_NO has been analyzed online with chemiluminescence analyzer (NIOX, Aerocrine, Sweden) according to American Thoracic Society guidelines, before and at 1, 2, 3 and 24 h after bronchoscopy. Mean FE_NO before bronchoscopy was 19.7 ± 4.5 ppb (mean ± SEM), post–bronchoscopy a decrease with a nadir at second hour (12.1 ± 1.5 ppb, p < 0.05) was observed, FE_NO 24 h after bronchoscopy was not different than baseline (18.4 ± 2.5 ppb). There were no differences in the FE_NO profile in BAL patients when compared to those inwhom only the bronchial washing has been performed. Conclusions: Bronchoscopy leads to a significant decreasein exhaled nitric oxide. The underlying mechanisms are unclear. Future studies including analysis of other inflammatory markers are needed to explain these changes. Full article

205 KiB

Open AccessArticle

Exhaled Nitric Oxide in Patients with Obstructive Sleep Apnea Syndrome

by Tadeusz Przybyłowski, Piotr Bielicki, Marta Kumor, Katarzyna Hildebrand, Marta Maskey-Warzęchowska, Adam Frangrat, Katarzyna Górska, Piotr Korczyński and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 21-25; https://doi.org/10.5603/ARM.28064 - 01 Mar 2006

Cited by 5 | Viewed by 283

Abstract

Exhaled nitric oxide has been extensively investigated as a non-invasive marker of airway inflammation. Some authors have suggested that morning FE_NO in obstructive sleep apnea syndrome (OSAS) patients is elevated due to inflammation of upper airways, while others have not found any [...] Read more.

Exhaled nitric oxide has been extensively investigated as a non-invasive marker of airway inflammation. Some authors have suggested that morning FE_NO in obstructive sleep apnea syndrome (OSAS) patients is elevated due to inflammation of upper airways, while others have not found any differences between patients and healthy subjects. The purpose of this study was to analyze concentration of exhaled nitric oxide (FE_NO) in OSAS patients. Methods: 119 (99 M, 20 F) consecutive patients of sleep laboratory participated in this study. Standard overnight sleep studies with polysomnography or portable screening device were carried out in the whole group: OSAS was diagnosed in 66 patients and 53 no-OSAS served as controls. FE_NO was measured on-line with a flow rate kept at 0.045–0.055 l/s, according to the recommendations of ATS using a chemiluminescence analyzer twice: before the sleep study (8–10 p.m.) and after termination of data collection (6–8 a.m.). There were no differences in age between patients and controls. Respiratory disturbance index (RDI) was 40.3 ± 24.9 in patients and 3.7 ± 2.8 in con-trols (p < 0.001). In OSAS patients both evening and morning FENO was significantly higher compared to controls(23.1 ± 14.8 ppb vs. 16.8 ± 9.8 ppb and 22.4 ± 13.2 ppb vs. 15.3 ± 8.1 ppb respectively, p < 0.05). Weak but statistically significant correlations for the whole group between morning FE_NO and mean and minimum arterial oxygen saturation (SaO₂) during sleep and number of study minutes with SaO₂ < 90% were observed. Lower evening FE_NO in OSAS patients with coexisting arterial hypertension when compared to normotensive OSAS patients was also noticed (19.1 ± 10.8 ppb vs. 27.1 ± 19.1 ppb; p < 0.05). Conclusions: The increase in FE_NO in OSAS patents may be caused by repetitive apneas and hypoxemia during sleep. Full article

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Open AccessArticle

The Role of Fiberoptic Bronchoscopy in the Diagnostic Algorithmof Solitary Pulmonary Nodule

by Marta Dąbrowska, Rafał Krenke, Joanna Domagała-Kulawik, Małgorzata Żukowska, Barbara Górnicka, Jerzy Bogdan and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 16-20; https://doi.org/10.5603/ARM.28063 - 01 Mar 2006

Viewed by 326

Abstract

The role of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodule is controversial. The aim of the study was to evaluate the results of routine bronchoscopy performed in patients with peripheral lung nodule of 5–40 mm in diameter. From 60 patients with [...] Read more.

The role of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodule is controversial. The aim of the study was to evaluate the results of routine bronchoscopy performed in patients with peripheral lung nodule of 5–40 mm in diameter. From 60 patients with peripheral lung nodule, who underwent routine diagnostic fiberoptic bronchoscopy between 2003–2005, we selected 36 patients in whom the final discrimination between malignant and benign tumor wasachieved based on either pathological examination or radiological criteria (lack of growth within 2 years of radio-logical follow up). There were 22 (61%) patients with malignant tumor and 14 (39%) with benign nodule. All malignant tumors were lung carcinomas. In 10 of these patients we found macroscopic abnormalities during bronchoscopy and in 9 of them pathologic examination of specimens collected during the procedure could confirm malignant tissue. In twopatients with benign lung nodule a second lung lesion (in different lung lobe) which proved to be lung cancer was identified during fiberoptic bronchoscopy. Sensitivity, specificity and diagnostic accuracy of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodules were 41%, 100%, and 64% respectively. Abandoning fiberoptic bronchoscopy in the diagnostic algorithm in patients with peripheral lung nodules seems unjustified, although its limitations should be taken into account. Full article

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Open AccessArticle

Diagnostic Utility of Pleural Fluid Eosinophilia

by Jacek Nasiłowski, Rafał Krenke, Tadeusz Przybyłowski, Bassem Abouchaz, Barbara Dmowska-Sobstyl, Wacław Droszcz and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 10-15; https://doi.org/10.5603/ARM.28062 - 01 Mar 2006

Viewed by 275

Abstract

Diagnostic utility of eosinophilic pleural effusion (EPE) is still the matter of controversy. Some earlier studies have showed that pleural fluid eosinophilia considerably reduces the probability of malignancy, while some later analyses were not able to confirm such an observation. To evaluate the [...] Read more.

Diagnostic utility of eosinophilic pleural effusion (EPE) is still the matter of controversy. Some earlier studies have showed that pleural fluid eosinophilia considerably reduces the probability of malignancy, while some later analyses were not able to confirm such an observation. To evaluate the diagnostic significance of EPE the retrospective study of all patients with pleural effusion (PE) managed in our hospital between 1995 and 2001 has been undertaken. We analyzed 915 patients with PE and 1086 pleural effusions subjected to a biochemical, cytological and bacteriological examinations. We identified 72 (7.9%) patients with EPE and 82 EPEs liquid (7.5%) among them. The group of patients with EPE consisted of 41 (57%) males and 31 (43%) females; average age 62.2 year (range 21.0–94.0). Etiologic distribution showed the largest subgroup were patients with malignant EPE (n = 28, 38.9%) followed by idiopathic EPE (n = 12, 16.7%) and parapneumonic EPE (n = 11, 15.3%). Looking for predictors of malignancy in EPE we found some differences between malignant and nonmalignant EPE: patients with malignant EPE were older (67.9 ± 13.6) then patients with nonmalignant EPE (58.7 ± 15.6; p < 0.015), and have higher percentage of lymphocytes in PE (47.9 ± 16.9 vs. 37.9 ± 18.9; p < 0.03). Similarly we noticed some differences between two largest groups (malignant and idiopathic PE). Patients with malignant PE were older (67.9 ± 13.6 vs. 53.9 ± 13.6 yrs; p = 0.005), had lower pleural fluid eosinophilia (25.2 ± 15.3% vs. 41.4 ± 21.0%; p = 0.01) and higher percentage of lymphocyte in PE (47.9 ± 16.9 vs. 29.6 ± 19.1%; p = 0.004). We conclude that pleural fluid eosinophilia cannot be considered as predictor of nonmalignant etiology. The older age and the higher number of lymphocytes in EPE might suggest malignant etiology of pleural effusion. Full article

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Open AccessArticle

Adenosine Deaminase Activity in Tuberculous and Malignant Pleural Effusions

by Aleksandra Safianowska, Rafał Krenke, Barbara Dmowska-Sobstyl, Elżbieta Bogacka-Zatorska, Joanna Domagała-Kulawik and Ryszarda Chazan

Adv. Respir. Med. 2006, 74(1), 5-9; https://doi.org/10.5603/ARM.28061 - 01 Mar 2006

Cited by 1 | Viewed by 282

Abstract

Measurement of pleural adenosine deaminase activity (ADA) is a useful diagnostic tool for tuberculous pleurisy, but false-positive findings from non-tuberculous effusions have been reported. In order to improve diagnostic value of ADA it is recommended to estimate activity of both ADA1 and ADA2 [...] Read more.

Measurement of pleural adenosine deaminase activity (ADA) is a useful diagnostic tool for tuberculous pleurisy, but false-positive findings from non-tuberculous effusions have been reported. In order to improve diagnostic value of ADA it is recommended to estimate activity of both ADA1 and ADA2 izoenzymes or 2′-deoxyadenosine/adenosine activity ratio. In order to evaluate ADA as a diagnostic parameter total ADA, with adenosine as a substrate, and 2’-deoxyadenosine/adenosine activity ratio were measured in tuberculous and malignant pleural effusions. Altogether, 26 pleural exudates (11 tuberculous and 15 malignant) were selected. ADA either with adenosine or 2’-deoxyadenosine was determined by colorimetric method of Giusti. Each pleural fluid sample was diluted prior to the assay (1:8) to avoid enzyme inhibition which was observed in nondiluted pleural effusions. The ADA level reached the diagnostic cut-off set for tuberculous effusions (40 U/L) in every 11 tuberculous exudates with the mean value of 85.3 ± 47.1 U/L; in 9 of these the 2′-deoxyadenosine/adenosine ratio was less than 0.45. In the malignant group of patients, no one ADA level exceed 40 U/L, being estimated at 10.6 ± 7.7 U/L (p < 0.001). In 10 of these 15 exudates the 2′-deoxyadenosine/adenosine ratio was undetectable, in four it was less than 0.45 and only in one it was over 0.45.We concluded that ADA measured by the Giusti method proceeded by the dilution 1:8 of the pleural effusion samples very good differentiates tuberculous from malignant pleurisy, without the necessity to determine the 2′-deoxyadenosine/adenosine ratio The investigation needs to be continued on the more numerous groups of patients. Full article

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Adv. Respir. Med., Volume 74, Issue 1 (March 2006) – 27 articles , Pages 5-134

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