Advances in Respiratory Medicine

332 KiB

Open AccessReview

Piąta Polsko-Francuska Konferencja Pneumonologów Kraków, 8–9 października 2010 roku

by Joanna Domagała-Kulawik

Adv. Respir. Med. 2011, 79(4), 315-316; https://doi.org/10.5603/ARM.27651 - 15 Jun 2011

Viewed by 229

Abstract

Piąta Polsko-Francuska Konferencja Pneumonologów odbyła się w Krakowie [...] Full article

397 KiB

Open AccessCase Report

Bacteriologically Confirmed Pulmonary Tuberculosis in a Patient with Lymphangioleiomyomatosis Accompanying Tuberous Sclerosis Syndrome

by Katarzyna Lewandowska, Karina Oniszh, Ewa Augustynowicz-Kopeć, Piotr Radwan-Röhrenschef and Jan Kuś

Adv. Respir. Med. 2011, 79(4), 309-314; https://doi.org/10.5603/ARM.27648 - 15 Jun 2011

Cited by 1 | Viewed by 260

Abstract

Lymphangioleiomyomatosis (LAM) is a rare disease of unknown origin, that may be sporadic or develop in the course of tuberous sclerosis (TS). Patients do not present immune deficiency, but structural changes in the lung parenchyma (cysts) may encourage various infections, for example tuberculosis. [...] Read more.

Lymphangioleiomyomatosis (LAM) is a rare disease of unknown origin, that may be sporadic or develop in the course of tuberous sclerosis (TS). Patients do not present immune deficiency, but structural changes in the lung parenchyma (cysts) may encourage various infections, for example tuberculosis. Radiologic findings are often difficult to interpret, because of changes related to LAM itself. We present a young women with a history of TS and LAM in whom protracted respiratory tract infection was finally diagnosed as tuberculosis. Initial diagnosis was based primarily on clinical signs and symptoms and treatment was started despite a negative result of sputum microscopy for acid-fast bacilli. In the course of treatment, the diagnosis was supported by genetic test for M. tuberculosis in bronchoalveolar lavage fluid, positive tuberculin skin test, interferon-gamma release assay and finally, positive sputum culture in liquid media. Full article

94 KiB

Open AccessCase Report

Granuloma of Epididymis in a Patient Treated with Intravesical BCG Therapy—Complication of BCG Therapy or Tuberculosis?

by Dorota Michałowska-Mitczuk, Sylwia Brzezińska, Ewa Augustynowicz-Kopeć and Renata Langfort

Adv. Respir. Med. 2011, 79(4), 305-308; https://doi.org/10.5603/ARM.27647 - 15 Jun 2011

Cited by 1 | Viewed by 243

Abstract

We present a case of a 72-year-old man treated for superficial bladder carcinoma from the year 2007. The patient underwent a surgical intervention for transitional cell carcinoma of the bladder, followed by intravesical BCG immunotherapy. Two years later, the right testis and epididymis [...] Read more.

We present a case of a 72-year-old man treated for superficial bladder carcinoma from the year 2007. The patient underwent a surgical intervention for transitional cell carcinoma of the bladder, followed by intravesical BCG immunotherapy. Two years later, the right testis and epididymis were found to be enlarged. A resection was carried out. Histological examination revealed granulomatous infiltration with eosinophillic necrosis in cauda epididymis. No bacteriologic tests of the resected material were performed. Due to a suspected BCG infection or TB, the patient was transferred to the Institute of Tuberculosis and Lung Diseases in Warsaw, for pulmonary evaluation. Chest X-ray, chest CT scan and bronchoscopy were performed but apart from scars in the bronchi suggesting a history of TB, they did not contribute to the diagnosis. Tuberculin skin test was 21 mm. Diagnosis was determined by spoligotyping which found genetic material of Mycobacterium tuberculosis in specimens preserved in a paraffin block. Tuberculosis of the right epididymis and past pulmonary tuberculosis were diagnosed. The patient was treated with rifampin, isoniazid and pyrazynamid. Full article

601 KiB

Open AccessReview

Oparzenia dróg oddechowych

by Piotr Wróblewski, Grzegorz Knefel, Mariusz Trzaska, Marek Kawecki, Mariusz Nowak and Jerzy Kozielski

Adv. Respir. Med. 2011, 79(4), 298-304; https://doi.org/10.5603/ARM.27650 - 15 Jun 2011

Viewed by 672

Abstract

Oparzenia inhalacyjne są głębokimi urazami obarczonymi znaczną śmiertelnością, które w istotny sposób pogarszają rokowanie chorych z ciężkimi oparzeniami ciała. Zmiany zachodzące pod wpływem urazu inhalacyjnego obejmują: obrzęk i martwicę błony śluzowej oskrzeli, zwiększenie przepływu krwi przez naczynia płucne i wzrost ich przepuszczalności, gromadzenie [...] Read more.

Oparzenia inhalacyjne są głębokimi urazami obarczonymi znaczną śmiertelnością, które w istotny sposób pogarszają rokowanie chorych z ciężkimi oparzeniami ciała. Zmiany zachodzące pod wpływem urazu inhalacyjnego obejmują: obrzęk i martwicę błony śluzowej oskrzeli, zwiększenie przepływu krwi przez naczynia płucne i wzrost ich przepuszczalności, gromadzenie się w świetle oskrzeli wałeczków zbudowanych ze śluzu, obumarłych komórek, włóknika i neutrofili oraz uogólnioną reakcję zapalną mediowaną przez cytokiny. W wyniku opisanych procesów dochodzi do zaburzeń wymiany gazowej w płucach i w konsekwencji do niedotlenienia tkanek. Wprowadzenie standaryzowanych procedur diagnostyki endoskopowej u chorych z podejrzeniem oparzenia dróg oddechowych pozwoliło na szybkie rozpoznanie tego urazu i wdrożenie specjalistycznego leczenia, skutkującego zmniejszeniem liczby zgonów z powodu oparzeń. Stosowane metody terapeutyczne nie zawsze są skuteczne, a przy tym obarczone powikłaniami wynikającymi z instrumentacji dróg oddechowych. Istnieje więc konieczność stałej modyfikacji postępowania i poszukiwania nowych metod leczenia. Obserwowane korzystne efekty wczesnych zabiegów tlenoterapii hiperbarycznej dają nadzieję na szybkie wprowadzenie tej metody do standardów leczenia oparzeń inhalacyjnych. Full article

254 KiB

Open AccessReview

Rola biomarkerów w diagnostyce gruźliczego wysiękowego zapalenia opłucnej

by Joanna Klimiuk and Rafał Krenke

Adv. Respir. Med. 2011, 79(4), 288-297; https://doi.org/10.5603/ARM.27649 - 15 Jun 2011

Viewed by 281

Abstract

Chociaż gruźlicze wysiękowe zapalenie opłucnej stanowi jedną z najczęstszych przyczyn pojawienia się płynu w opłucnej, to jednak potwierdzenie gruźliczej etiologii wysięku nie należy do łatwych. Wynika to ze stosunkowo niewielkiej liczby drobnoustrojów M. tuberculosis w płynie, co stanowi główną przyczynę niskiej czułości rutynowo [...] Read more.

Chociaż gruźlicze wysiękowe zapalenie opłucnej stanowi jedną z najczęstszych przyczyn pojawienia się płynu w opłucnej, to jednak potwierdzenie gruźliczej etiologii wysięku nie należy do łatwych. Wynika to ze stosunkowo niewielkiej liczby drobnoustrojów M. tuberculosis w płynie, co stanowi główną przyczynę niskiej czułości rutynowo stosowanych metod diagnostycznych. Dlatego też przeprowadzono liczne badania nad różnymi, potencjalnymi biomarkerami gruźliczego zapalenia opłucnej, których oznaczanie w płynie z opłucnej mogłoby przyczynić się do poprawy skuteczności diagnostycznej. Wyniki dotychczasowych badań wskazują, że największą czułością i swoistością, a także najkorzystniejszym współczynnikiem “koszt/efektywność” cechuje się oznaczanie aktywności deaminazy adenozyny (ADA) i stężenia interferonu gamma (IFN-γ). Dlatego też badanie ADA i IFN-γ stanowi jeden z ważnych elementów algorytmów diagnostycznych ukierunkowanych na rozpoznanie gruźliczego zapalenia opłucnej. Chociaż wyniki uzyskane dla innych testów diagnostycznych są obiecujące (np. metody identyfikacji swoistych sekwencji kwasów nukleinowych lub też pomiar wydzielania IFN-γ pod wpływem stymulacji antygenami M. tuberculosis), to jednak ich praktyczne zastosowanie ogranicza znaczne zróżnicowanie wyników, a także większe koszty i stopień ich technicznego skomplikowania. W niniejszym artykule omówiono wyniki dotychczasowych badań nad zastosowaniem wielu różnorodnych biomarkerów w diagnostyce gruźliczego wysięku w opłucnej. Full article

125 KiB

Open AccessArticle

MDR, Pre-XDR and XDR Drug-Resistant Tuberculosis in Poland in 2000–2009

by Monika Kozińska, Anna Brzostek, Dorota Krawiecka, Małgorzata Rybczyńska, Zofia Zwolska and Ewa Augustynowicz-Kopeć

Adv. Respir. Med. 2011, 79(4), 278-287; https://doi.org/10.5603/ARM.27646 - 15 Jun 2011

Cited by 3 | Viewed by 357

Abstract

Introduction: Tuberculosis (TB) is a curable disease and its spread can be prevented by using appropriate diagnostics methods and effective treatment. The obstacle to the rapid eradication of the disease from a population may be strainsresistant to essential and most effective antibiotics. In [...] Read more.

Introduction: Tuberculosis (TB) is a curable disease and its spread can be prevented by using appropriate diagnostics methods and effective treatment. The obstacle to the rapid eradication of the disease from a population may be strainsresistant to essential and most effective antibiotics. In many places in the world MDR, pre-XDR and XDR-TB was reported. These forms of TB do not respond to the standard six-month treatment with first-line anti-TB drugs and the therapy should be conducted two years or more with drugs that are less potent, more toxic and much more expensive. Material and methods: This study included MDR-TB strains isolated from 297 patients in 2000–2009. To determine the XDR-TB population structure, the 19 isolates were genotyped by spoligotyping and MIRU-VNTR (mycobacterial interspersed repetitive units-variable number of tandem repeats) method. Results: Among 297 MDR-TB cases, 36 (12.1%) were pre-extensively drug-resistant (pre-XDR), 19 (6.4%) were XDR and 1 (0.3%) was pre-totally drug-resistant (pre-TDR). Four of the 19 XDR isolates exhibit a unique spoligopattern, while the rest 15 belonged to one of 5 clusters. The MIRU-VNTR analysis reduced the number of clustered isolates to 11. Conclusions: The study documented the emergence of pre-extensively and extensively drug-resistant tuberculosis in Poland among patients with multidrug-resistant TB. Genotyping methods showed clonal similarity among XDR strains and may suggest the possible transmission among patients with newly diagnosed and with recurrent TB. Full article

115 KiB

Open AccessArticle

Exhaled Nitric Oxide in Patients with Esophagitis

by Anna Dor-Wojnarowska, Jerzy Liebhart, Marcin Grabowski, Leszek Czapla, Krzysztof Grabowski and Bernard Panaszek

Adv. Respir. Med. 2011, 79(4), 272-277; https://doi.org/10.5603/ARM.27645 - 15 Jun 2011

Cited by 2 | Viewed by 303

Abstract

Introduction: Assessment of nitric oxide (NO) concentration in exhaled air is broadly used to monitor the airway inflammation in asthma. High levels of NO are also observed in paranasal sinuses and gastrointestinal tract (GT). Properly functioning esopahageal sphincters are responsible for maintaining NO [...] Read more.

Introduction: Assessment of nitric oxide (NO) concentration in exhaled air is broadly used to monitor the airway inflammation in asthma. High levels of NO are also observed in paranasal sinuses and gastrointestinal tract (GT). Properly functioning esopahageal sphincters are responsible for maintaining NO in the GT. So far, it has been unknown how much the GT disorders and especially the disorder of esophageal motility can affect FeNO (fractional exhaled nitric oxide) measurements. The aim of the study was to assess whether the gastroesophageal reflux disease has any impact on the level of NO in the exhaled air in patients who do not suffer from any airway diseases. Material and methods: Gastroscopy with biopsy was performed in 51 patients, in whom asthma, allergic rhinitis and atopy were excluded. In 13 of them, no esophageal pathology was found and they were considered as the control group. In the remaining 38 patients, the severity of esophagitis was evaluated according to the Los Angeles classification. Results: The concentration of NO in the exhaled air of patients with endoscopic gastroesophageal changes did not differ significantly from NO concentration in patients without inflammatory changes in the stomach and esophagus (p = 0.68). The presence of the hiatal hernia did not affect the FeNO concentration either (p = 0.67). There was no statistically significant correlation between the NO level and infection with Helicobacter pylori (p = 0.18). Conclusions: The gastroesophageal pathologies did not affect the NO concentration in exhaled air significantly. Full article

159 KiB

Open AccessArticle

Interferon-Gamma Assay T-SPOT.TB in the Diagnostics of Latent Tuberculosis Infection

by Dagmara Borkowska, Zofia Zwolska, Dorota Michałowska-Mitczuk, Maria Korzeniewska-Koseła, Anna Zabost, Agnieszka Napiórkowska, Monika Kozińska, Sylwia Brzezińska and Ewa Augustynowicz-Kopeć

Adv. Respir. Med. 2011, 79(4), 264-271; https://doi.org/10.5603/ARM.27644 - 15 Jun 2011

Cited by 5 | Viewed by 365

Abstract

Introduction: Diagnostics of latent tuberculosis infection (LTBI) has been based on a century-old tuberculin skin test (TST). However, a positive reaction can result not only from infection with Mycobacterium tuberculosis, but also from BCG vaccination or cross-reaction with nontuberculous mycobacteria. T-SPOT.TB assay [...] Read more.

Introduction: Diagnostics of latent tuberculosis infection (LTBI) has been based on a century-old tuberculin skin test (TST). However, a positive reaction can result not only from infection with Mycobacterium tuberculosis, but also from BCG vaccination or cross-reaction with nontuberculous mycobacteria. T-SPOT.TB assay is a new test to diagnose tuberculosis infection by measuring in vitro T-cell interferon-gamma release in response to two Mycobacterium tuberculosis-specific antigens: ESAT-6 and CFP-10. Material and methods: T-SPOT.TB assay was performed on samples of whole blood (n = 137) from March to September 2010. Tuberculin skin test was carried out in 96 participants. A positive TST result was considered to be an induration of 10 mm or more. Results: Of the 137 patients tested, T-SPOT.TB assay results were positive in 37 (27%), negative in 98 (71.5%) and indeterminate in only 2 (1.5%) persons. We analyzed T-SPOT.TB and TST results in 96 patients who were subjected to both tests. Concordance between T-SPOT.TB and TST results (a 10-mm skin reaction interpreted as positive) was 79%. Fifteen (15.6%) patients had a positive TST result and a negative T-SPOT.TB, and 5 (5.2%) patients had a negative TST result and a positive T-SPOT.TB. We observed a good correlation between positive T-SPOT.TB results and the diameter of induration of ≥15 mm in TST results. Conclusions: T-SPOT.TB offers a more accurate approach than TST in the identification of tuberculosis infection. The study showed that the test T-SPOT.TB is a good diagnostic tool in identifying persons with tuberculosis infection. For a full confirmation of this assessment, it is necessary to examine more cases. Full article

69 KiB

Open AccessEditorial

Interferon-Gamma-Based Tests as a New Tool in the Diagnostics of Latent Tuberculosis

by Urszula Demkow

Adv. Respir. Med. 2011, 79(4), 261-263; https://doi.org/10.5603/ARM.27643 - 15 Jun 2011

Cited by 1 | Viewed by 242

Abstract

Despite increasing advances in the diagnostics and treatment of tuberculosis (TB) [...] Full article

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Adv. Respir. Med., Volume 79, Issue 4 (June 2011) – 9 articles , Pages 261-316

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