Advances in Respiratory Medicine

218 KiB

Open AccessEditorial

Professor Paul Sadoul (1918–2011) and His Polish Friends. In Memoriam

by Leszek Radwan, Janusz Kowalski, Jan Zieliński, Janusz Hałuszka and Kazimierz Marek

Adv. Respir. Med. 2012, 80(5), 489-491; https://doi.org/10.5603/ARM.27562 - 27 Aug 2012

Viewed by 236

Abstract

Ze smutkiem dowiedzieliśmy się [...] Full article

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Open AccessEditorial

Non-invasive Home Mechanical Ventilation: Qualification, Initiation, and Monitoring

by Mike J. Kampelmacher

Adv. Respir. Med. 2012, 80(5), 482-488; https://doi.org/10.5603/ARM.27564 - 27 Aug 2012

Viewed by 237

Abstract

Following the introduction of non-invasive positive pressure ventilation (NPPV), the number of patients using home mechanical ventilation has increased substantially and continues to rise worldwide. This is primarily explained by both the effectiveness and comfort that are offered by NPPV in most patients, [...] Read more.

Following the introduction of non-invasive positive pressure ventilation (NPPV), the number of patients using home mechanical ventilation has increased substantially and continues to rise worldwide. This is primarily explained by both the effectiveness and comfort that are offered by NPPV in most patients, and particularly in patients with chest wall and neuromuscular diseases. For clinically stable patients the qualification for NPPV largely depends on the presence of complaints or signs of (nocturnal) hypoventilation with accompanying hypercapnia. For patients who are referred by an ICU there are additional prerequisites. In any case, the aims of NPPV should be met and NPPV should be effective. The initiation of NPPV, whether in the clinic or not, should always be tailored to the individual patient. Based on effectiveness, safety, and comfort, the best ventilator has to be chosen. Although with modern interfaces NPPV may be provided continuously, for continuing NPPV over the years, adding manual and/or mechanical cough augmentation techniques is usually mandatory. To control the ongoing effectiveness of NPPV regular monitoring of the patient is essential, and nowadays transcutaneous measurement of CO₂ seems the most reliable and appropriate technique. For trend analysis, downloaded data of modern ventilators may be helpful as well. The ultimate goal of NPPV, to prevent tracheotomy, can only be reached if the patient has continuous access to a centre with expertise in cough augmentation techniques and both nocturnal and diurnal NPPV. Full article

382 KiB

Open AccessCase Report

Interstitial Lung Disease in Patients with Primary Biliary Cirrhosis

by Małgorzata Bartosiewicz, Izabela Siemion-Szcześniak, Małgorzata Jędrych, Piotr Radwan-Röhrenschef, Katarzyna Lewandowska, Renata Langfort, Karina Oniszh, Monika Franczuk and Jan Kuś

Adv. Respir. Med. 2012, 80(5), 471-481; https://doi.org/10.5603/ARM.27559 - 27 Aug 2012

Cited by 1 | Viewed by 259

Abstract

Primary biliary cirrhosis (PBC) is a chronic autoimmune disorder of unknown etiology. The disease affects middle-aged women and is characterized by the destruction of the intralobular bile ducts that causes consequent cholestasis. AMA is a hallmark of PBC, composed mostly of IgG and [...] Read more.

Primary biliary cirrhosis (PBC) is a chronic autoimmune disorder of unknown etiology. The disease affects middle-aged women and is characterized by the destruction of the intralobular bile ducts that causes consequent cholestasis. AMA is a hallmark of PBC, composed mostly of IgG and IgM class. The M2 antibody is the most specific one, with sensitivity range of 54–98% depending on type of test used. PBC is often accompanied by other autoimmune diseases, such as Sjøgrens syndrome, thyroiditis, rheumatoid arthritis, dermatomyositis, polymyositis. Interstitial lung disease (ILD) has been reported in patients with primary biliary cirrhosis but its frequency and nature are poorly understood. We report pulmonary involvement in the course of PBC in 4 middle-aged women. Histopatological examination of lung specimens was available in three patients: two presented with sarcoid—like granulomas, one with lymphocytic interstitial pneumonia (LIP). In one patient the diagnosis of pulmonary fibrosis was based on clinical and radiological features. Because of abnormal pulmonary function tests (PFT) results all the patients were treated with prednisone, one, additionally with azathioprine. The treatment was successful in all of the patients. Full article

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Open AccessCase Report

New Onset Diabetes in a Patient with Active Tuberculosis

by Marcin Skowroński, Anna Halicka and Aleksander Barinow-Wojewódzki

Adv. Respir. Med. 2012, 80(5), 467-470; https://doi.org/10.5603/ARM.27558 - 27 Aug 2012

Viewed by 238

Abstract

The present report describes the coincidence of pulmonary tuberculosis (TB) and metabolic disorder such as diabetes. A patient’s bronchoalveolar lavage was found to be positive for acid-fast bacilli (AFB) with following growth of Mycobacterium tuberculosis and complete sensitivity to first line anti-TB drugs. [...] Read more.

The present report describes the coincidence of pulmonary tuberculosis (TB) and metabolic disorder such as diabetes. A patient’s bronchoalveolar lavage was found to be positive for acid-fast bacilli (AFB) with following growth of Mycobacterium tuberculosis and complete sensitivity to first line anti-TB drugs. At the same time, the patient presented with typical diabetes manifestation and subsequently required insulin therapy. Combined treatment resulted in significant clinical im- provement and gradual resolution of both TB and diabetes symptoms. Therefore, we would like to highlight the value of appropriate medical management of these disorders sharing at least some clinical symptoms and signs such as weight loss and fatigue. Moreover, a growing body of evidence indicates that diabetes may play a role as a risk factor for TB. Consequently, the increasing diabetes prevalence may be a danger to TB control. Full article

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Open AccessReview

May a COPD Patient Benefit from Rehabilitation Associated with Pharmacological Treatment?

by Jerzy Kozielski

Adv. Respir. Med. 2012, 80(5), 463-466; https://doi.org/10.5603/ARM.27561 - 27 Aug 2012

Viewed by 257

Abstract

Chorzy na przewlekłą obturacyjną chorobę płuc (POChP) są znacząco nieaktywni fizycznie. Głównym czynnikiem ograniczającym ich zdolność wysiłkową jest duszność. Poprawa zdolności wysiłkowej tych chorych zmniejsza u nich objawy kliniczne, ograniczenie czynności płuc, częstość zaostrzeń oraz poprawia jakość życia i rokowanie, dlatego rehabilitacja ruchowa [...] Read more.

Chorzy na przewlekłą obturacyjną chorobę płuc (POChP) są znacząco nieaktywni fizycznie. Głównym czynnikiem ograniczającym ich zdolność wysiłkową jest duszność. Poprawa zdolności wysiłkowej tych chorych zmniejsza u nich objawy kliniczne, ograniczenie czynności płuc, częstość zaostrzeń oraz poprawia jakość życia i rokowanie, dlatego rehabilitacja ruchowa ogrywa zasadniczą rolę w leczeniu chorych na POChP. Wykazano, że stosowanie leków rozszerzających oskrzela przed wysiłkiem zmniejsza u chorych odczuwaną w jego trakcie duszność i umożliwia stosowanie rehabilitacji ruchowej. W pracy omówiono jej rolę w POChP. Full article

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Open AccessReview

Bronchial Asthma in Obesity—A Distinct Phenotype of Asthma?

by Dariusz Ziora, Piotr Sitek, Edyta Machura and Katarzyna Ziora

Adv. Respir. Med. 2012, 80(5), 454-462; https://doi.org/10.5603/ARM.27560 - 27 Aug 2012

Cited by 2 | Viewed by 220

Abstract

Asthma and obesity have a considerable impact on public health and their prevalence has increased in recent years. Numerous large cross-sectional and prospective studies performed in adults, adolescents, and children throughout the world supports the hypothesis that obesity is an independent risk factor [...] Read more.

Asthma and obesity have a considerable impact on public health and their prevalence has increased in recent years. Numerous large cross-sectional and prospective studies performed in adults, adolescents, and children throughout the world supports the hypothesis that obesity is an independent risk factor for asthma. The pathogenetic basis for asthma and obesity associations in humans is not well established. Obesity is capable of reducing pulmonary compliance, lung volumes, and the diameter of peripheral respiratory airways, and may influence on airway hyperresponsiveness. The increase of adipose tissue in obese subjects leads to a systemic inflammatory state, which produces a rise in the serum concentrations of several pro-inflammatory cytokines, chemokines and adipokines. The proinflammatory adipokines (leptin, resistin) and anti- inflammatory (adiponectin) may be causally associated with asthma, however human studies are inconclusive. Obese asthma patients very often demonstrate increased asthma severity and relative corticosteroid resistance. Some studies suggest improvements in the disease with weight loss in obese asthma patients. Recently published data suggest that obese asthma patients may represent a distinct phenotype of asthma. Full article

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Open AccessCommunication

The Incidence of Alpha-1-Antitrypsin (A1AT) Deficiency Alleles in Population of Central Poland—Preliminary Results from Newborn Screening

by Joanna Chorostowska-Wynimko, Radosław Struniawski, Beata Popławska and Maria Borszewska-Kornacka

Adv. Respir. Med. 2012, 80(5), 450-453; https://doi.org/10.5603/ARM.27565 - 27 Aug 2012

Viewed by 374

Abstract

Inherited alpha-1 antitrypsin deficiency (A1ATD) is listed among the three most common genetic disorders in Caucasians. It considerably increases the risk of progressive obstructive lung diseases, mostly chronic obstructive pulmonary disease. Data on the A1ATD prevalence in Poland are scarce, no studies with [...] Read more.

Inherited alpha-1 antitrypsin deficiency (A1ATD) is listed among the three most common genetic disorders in Caucasians. It considerably increases the risk of progressive obstructive lung diseases, mostly chronic obstructive pulmonary disease. Data on the A1ATD prevalence in Poland are scarce, no studies with large enough groups representative for whole Polish population have been performed. Here, we present the preliminary data on the incidence of A1AT main deficiency alleles from the newborn screening in Mazovia (Central Poland) region. Real-time PCR genotyping and A1AT blood concentration measure- ment by nephelometry were performed from the dry blood spots (DBS) samples of 658 newborns. Deficiency alleles PI*Z i PI*S were present in 28 children, respectively in 2.8% and 1.5%. Their existence corresponded with significantly lower A1AT blood concentration. Estimated incidence of deficiency alleles was 13.7/1000 (95% CI 5.8–21.5) for PI*Z and 7.6/1000 (95% CI 1.7–13.5) for PI*S. The calculated prevalence for the main deficiency genotype ZZ was 1/5345. The study is on-going. Full article

134 KiB

Open AccessArticle

Gefitinib in Patients with Advanced Non-small-Cell Lung Cancer

by Magdalena Knetki-Wróblewska, Dariusz M. Kowalski, Katarzyna Zajda, Adam Płużański, Paweł Badurak, Anna Janowicz-Żebrowska, Piotr Jaśkiewicz and Maciej Krzakowski

Adv. Respir. Med. 2012, 80(5), 439-449; https://doi.org/10.5603/ARM.27563 - 27 Aug 2012

Cited by 1 | Viewed by 278

Abstract

Introduction: Patients with advanced non-small cell lung cancer (NSCLC) have a very poor prognosis. Individualization of treatment and identification of therapeutic molecular targets may improve outcomes. Gefitinib was introduced recently among several other molecular-targeted drugs of activity in NSCLC. Gefitinib is indicated for [...] Read more.

Introduction: Patients with advanced non-small cell lung cancer (NSCLC) have a very poor prognosis. Individualization of treatment and identification of therapeutic molecular targets may improve outcomes. Gefitinib was introduced recently among several other molecular-targeted drugs of activity in NSCLC. Gefitinib is indicated for patients diagnosed with advanced or disseminated NSCLC with an activating mutation in the EGFR (epidermal growth factor receptor) gene. The paper summarize experience with gefitinib in the Department of Lung and Thoracic Tumors of Maria Sklodowska-Curie Memorial Cancer Centre and Institute in Warsaw. Materials and methods: The group of 11 patients diagnosed with advanced NSCLC and activating mutations in the EGFR gene was analyzed. Patients were treated from April 2010 to April 2011. Tolerability, objective response rate (ORR) and progression free survival (PFS), which was calculated by the Kaplan-Meier method, were assessed. Results: Median observation time from the start of gefitinib treatment was 14 months (range 4,8–19 months). The rate of one-year survival in this group of patients was 91% (10 patients) with 54% of patients (6 patients) surviving one year without progression of disease. The ORR rate of 82% and median PFS 11.4 months were reached. No treatment-related deaths were reported. Among the complications skin toxicity (82%) and diarrhea (45%) were most frequently observed, in most cases the Common Toxicity Criteria for Adverse Events (CTCAE) first grade. Conclusions: The results confirm the literature data on the efficacy and safety profile of gefitinib in the treatment of patients with the diagnosis of advanced NSCLC and activating mutation in the EGFR gene. Full article

192 KiB

Open AccessArticle

Six-Minute Walk Test in Sarcoidosis Patients with Cardiac Involvement

by Anna Kowalska, Elżbieta Puścińska, Anna Goljan-Geremek, Justyna Czerniawska, Anna Stokłosa, Marek Kram, Witold Z. Tomkowski and Dorota Górecka

Adv. Respir. Med. 2012, 80(5), 430-437; https://doi.org/10.5603/ARM.27557 - 27 Aug 2012

Cited by 1 | Viewed by 270

Abstract

Introduction: Cardiac involvement in sarcoidosis is of critical importance, due to the poor prognosis if this organ manifesta- tion is left undiagnosed and untreated. The six-minute walk test (6 MWT) is a useful test to evaluate exercise tolerance of sarcoid patients. We aimed [...] Read more.

Introduction: Cardiac involvement in sarcoidosis is of critical importance, due to the poor prognosis if this organ manifesta- tion is left undiagnosed and untreated. The six-minute walk test (6 MWT) is a useful test to evaluate exercise tolerance of sarcoid patients. We aimed to assess the 6 MWT value in diagnosis, course and treatment monitoring of patients with cardiac sarcoidosis. Materials and methods: 47 patients were included: 22 with pulmonary sarcoidosis and cardiac involvement (13 women, 9 men), 25 with pulmonary sarcoidosis, with no changes in the heart (15 women, 10 men), and 18 healthy volunteers as controls (12 women, 6 men). Out of 22 patients with cardiac involvement 11 were treated for heart sarcoidosis with prednisone (9 pts—initial dose 60 mg daily and 2 pts—40 mg daily). 11 pts in this group were not treated. In all patients sarcoidosis was confirmed histopatologically. Magnetic resonance imaging was used to diagnose involvement of the heart. In the studied groups we assessed: heart rate (HR), oxygen saturation, distance in 6 MWT and Borg dyspnea score. Results: Patients with cardiac sarcoidosis desaturated more during exercise (DSaO_2max = 3.5 ± 3.2 vs. 0.38 ± 0.69; p = 0.004) and had a lower increase of HR in first minute during the 6 MWT (DHR₁ = 21.81 ± 11.72 vs. 50.61 ± 12.35; p = 0.0001) when compared to healthy subjects. Significantly lower increase of HR in first minute of 6 MWT was observed in patients with cardiac sarcoidosis when compared to patients with pulmonary sarcoidosis with no cardiac involvement (DHR₁ = 21.81 ± 11.72 vs. 38.8 ± 18.17, p = 0.01). After introduction of treatment in sarcoidosis group, significantly higher (p = 0.02) increase of HR in first minute of 6 MWT as compared to baseline test was observed. Conclusions: The six-minute walk test is useful in diagnosing cardiac involvement in sarcoidosis. The increase in HR during exercise and decrease degree of desaturation were a good predictors of the response to therapy. Full article

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Open AccessArticle

The Impact of Timeliness of Care on Survival in Non-small Cell Lung Cancer Patients

by Elżbieta Radzikowska, Kazimierz Roszkowski-Śliż and Piotr Głaz

Adv. Respir. Med. 2012, 80(5), 422-429; https://doi.org/10.5603/ARM.27556 - 27 Aug 2012

Cited by 7 | Viewed by 268

Abstract

Introduction: It is uncertain whether timeliness improves clinical outcomes in lung cancer patients. The goal of the study was to analyse the influence of patient’s and doctor’s delays on survival of unselected population of NSCLC patients. Material and methods: From 1995 to 1998, [...] Read more.

Introduction: It is uncertain whether timeliness improves clinical outcomes in lung cancer patients. The goal of the study was to analyse the influence of patient’s and doctor’s delays on survival of unselected population of NSCLC patients. Material and methods: From 1995 to 1998, 8705 squamous cell lung cancer patients and 1881 adenocarcinoma patients were registered in Pulmonary Outpatients Clinics in all parts of Poland and subsequently in National Tuberculosis and Lung Diseases Research Institute Register (NTLDRIR). Results: The median time from first symptom(s) to the beginning of a treatment was 92 days (mean—138.5 days).The median waiting time between first symptom(s) and first visit to a doctor’s was 30 days (mean 57 days) and from first visit to a doctor’s to referral to a chest physician—was 17 days (mean 41 days). Diagnosis of the NSCLC was established in a mean time of 71 days (median 40 days), but chest physician diagnosed patients in a mean time of 51 days (median 28 days). The multivariate analysis revealed that ECOG performance status (PS) 2 (HR = 1.4) and 3+4 (HR = 2.23), clinical stage of the disease II (HR = 1.32), III (HR = 1.41), and IV (HR = 1.82) were independent negative predictors of survival. Non-surgically treated patients had worse prognosis than patients treated surgically (HR = 3.03). Lack of patient’s delay had a significant positive impact on survival (HR = 0.88), particularly for patients in PS 0+1 (HR = 0.9) and 3+4 (HR = 0.9). Lack of doctor’s delay was a negative predictive factor of survival (HR = 1.14). It was observed particularly in patients in performance status 2 (HR = 1.28). Conclusions: The patient’s delay and lack of doctor’s delay had a negative impact on survival of NSCLC patients. Full article

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Open AccessArticle

Impact of Social Risk Factors on Treatment Outcome in Patients with Culture Positive Pulmonary Tuberculosis (CPPTB)

by Izabela Siemion-Szcześniak and Jan Kuś

Adv. Respir. Med. 2012, 80(5), 412-421; https://doi.org/10.5603/ARM.27555 - 27 Aug 2012

Cited by 1 | Viewed by 251

Abstract

Introduction: The aim of the study was to evaluate the impact of social risk factors on treatment outcome among culture- positive patients treated for active pulmonary tuberculosis in three separate districts—Warsaw, Gdansk and Siedlce—in years 1995 and 2000. Materials and methods: We retrospectively [...] Read more.

Introduction: The aim of the study was to evaluate the impact of social risk factors on treatment outcome among culture- positive patients treated for active pulmonary tuberculosis in three separate districts—Warsaw, Gdansk and Siedlce—in years 1995 and 2000. Materials and methods: We retrospectively reviewed medical records of patients who were notified in 1995 and 2000 and were treated in hospitals and dispensaries. Alcohol abuse and homelessness were recognized as risk factors associated with tuberculosis and nonadherence to treatment. Treatment outcome was evaluated using treatment indicators defined by the World Health Organisation: cured, treatment completed, treatment defaulted, treatment failure and “other” results of treatment. Results: Seven hundred and eight patients with culture positive pulmonary tuberculosis were included (373 in 1995 and 335 in 2000). There were 85 patients with risk factors in 1995 and 101 patients in 2000. 80 of participants in 1995 and 69 in 2000 abused alcohol, 5 and 32 were classified as homeless, respectively. Among alcohol abusers treatment success rates according to the WHO definition (either bacteriologic cured or treatment completed) were 45.1% in 1995 and 53.6% in 2000. Among patients not abusing alcohol treatment success rates were 63.8% and 54.1%, respectively. The differences were statistically significant (p = 0.005 in 1995 and p = 0.0186 in 2000). In 1995 forty percent of homeless patients had succeeded treatment, while the rate of treatment success among non-homeless was 60%. Because of small number included in homeless group the difference was not statistically significant (p = 0.6532). In 2000 treatment success rate among homeless participants was 25% and among non-homeless—57.1%, which was highly statistically significant (p = 0.001). Conclusions: Alcohol abuse and homelessness were associated with bad treatment outcome among patients with pulmonary tuberculosis. Interventions to improve treatment adherence in patients considered to be at risk for default are necessary. Full article

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Open AccessArticle

Profile of Adults Suffering from Asthma in Poland—Results of PulmoScreen Study

by Grzegorz M. Brożek, Marcin Nowak, Władysław Pierzchała and Jan E. Zejda

Adv. Respir. Med. 2012, 80(5), 402-411; https://doi.org/10.5603/ARM.27554 - 27 Aug 2012

Cited by 1 | Viewed by 263

Abstract

Introduction: Adult patients with diagnosis of asthma remain largely under the care of primary care physicians (general practitioners). Thus, they play an important role in diagnosing and treating this population. The aim of the study was to characterize of adults with asthma [...] Read more.

Introduction: Adult patients with diagnosis of asthma remain largely under the care of primary care physicians (general practitioners). Thus, they play an important role in diagnosing and treating this population. The aim of the study was to characterize of adults with asthma remaining under the care of Polish general practitioners (GP) as well as to evaluate the use of diagnostic tools and treatment in light of GINA recommendations. Material and methods: This questionnaire study included a representative sample of 1852 general practitioners (GPs) who were asked to complete questionnaires on the diagnosis and treatment of their patients with asthma. Results: Altogether 1250 GPs provided information about 10,981 patients. Controlled asthma had 21.2% patients, 46.9% partly controlled, and 31.9% uncontrolled asthma. Allergy skin prick tests were performed in 64.8%, bronchial reversibility tests in 58.1% and bronchial provocation tests in 9.8% of patients. Spirometry results were obtained for 41.9% of patients. In the last year 16.6% of patients underwent emergency intervention due to asthma exacerbation and 18.1% required hospitalization. Conclusions: In Polish asthma patients the frequency of allergological and pulmonological visits as well as the frequency of spirometric assessment are poorly associated with asthma control level. The diagnostic tests recommended by international and national guidelines for the management of asthma are performed too seldom. Hospitalizations and emergency interventions related to asthma exacerbations are found in a large portion of patients and depend on their gender and asthma control level. Asthma has a negative impact on everyday activity in more than half of patients. Proper assessment of the level of causes asthma control according to GINA guidelines poses problems to Polish general practitioners. Full article

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Open AccessArticle

The Use of Multi-Color Flow Cytometry for Identification Offunctional Markers of Ntregs in Patients with Severe Asthma

by Łukasz Kraszula, Eusebio Makandjou-Ola, Maciej Kupczyk, Piotr Kuna and Mirosława Pietruczuk

Adv. Respir. Med. 2012, 80(5), 389-401; https://doi.org/10.5603/ARM.27553 - 27 Aug 2012

Viewed by 285

Abstract

Introduction: At present, severe asthma is a particular clinical problem. An important role is attributed to dysfunction of nTreg subpopulations of lymphocytes in the pathogenesis of asthma. Therefore, the purpose of this study was to identify markers of nTreg cell function in [...] Read more.

Introduction: At present, severe asthma is a particular clinical problem. An important role is attributed to dysfunction of nTreg subpopulations of lymphocytes in the pathogenesis of asthma. Therefore, the purpose of this study was to identify markers of nTreg cell function in patients with severe and mild to moderate asthma. Material and methods: The study included sixty patients with asthma (30 with severe and 30 with mild to moderate asthma). The control group comprised 30 healthy volunteers. The diagnosis of asthma was confirmed accordance with generally accepted recommendations (GINA 2008). nTreg immunophenotype CD4/CD25/CD127/FoxP3/GITR/CD152/CCR5/CCR7 was evaluated by multicolor flow cytometry. Results: We showed a significant reduction in the percentage of nTreg (76%) cells and the expression of CD152 (46.2%) in patients with severe asthma compared with mild-moderate asthma (85.5% and 86.7%; p < 0.05). It was observed that the transcription factor FoxP3 expression in nTreg cells positively correlated with FEV1 in patients with severe asthma (r = 0.53; p < 0.05). It was also found that the ratio nTregCCR5⁺/TeffCCR5⁺ was significantly reduced in patients with severe asthma (0.91) compared with mild-moderate (1.58) asthma and control groups (1.55; p < 0.001). Conclusions: There are phenotypic differences in nTreg lymphocytes between patients with severe and mild-moderate asthma. This fact may confirm nTreg cell dysfunction and indicate that the potential markers (FoxP3, CD152, CCR5), can be used to monitor the effectiveness of treatment of bronchial asthma, especially severe disease. Full article

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Open AccessEditorial

Nieinwazyjna wentylacja mechaniczna w Polsce w 2012 roku

by Małgorzata Czajkowska-Malinowska and Jacek Nasiłowski

Adv. Respir. Med. 2012, 80(5), 386-388; https://doi.org/10.5603/ARM.27552 - 27 Aug 2012

Viewed by 238

Abstract

Wprowadzenie do praktyki klinicznej nieinwazyjnej wentylacji mechanicznej (NWM) dodatnim ciśnieniem należy do przełomowych wydarzeń w medycynie, które można porównać do wprowadzenia interwencji wewnątrzwieńcowych lub leczenia nerkozastępczego. Chociaż pierwsze próby zastosowania NWM miały miejsce w latach 40. XX. wieku [...] Full article

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Open AccessEditorial

Sarkoidoza serca—Nierozwiązany problem kliniczny

by Witold Tomkowski and Małgorzata Dybowska

Adv. Respir. Med. 2012, 80(5), 383-385; https://doi.org/10.5603/ARM.27551 - 27 Aug 2012

Viewed by 212

Abstract

Sarkoidoza jest wielonarządową chorobą ziarniniakową, która powinna być rozpoznawana na podstawie obrazu klinicznego i biopsji zajętych narządów [...]
Full article

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Open AccessEditorial

Rozpoznawanie i postępowanie w astmie w 2012 roku

by Ryszarda Chazan

Adv. Respir. Med. 2012, 80(5), 375-382; https://doi.org/10.5603/ARM.27550 - 27 Aug 2012

Viewed by 207

Abstract

Na astmę choruje około 8.6% dzieci i 5.4% osób dorosłych [...] Full article

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Adv. Respir. Med., Volume 80, Issue 5 (August 2012) – 16 articles , Pages 375-491

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