Advances in Respiratory Medicine

302 KiB

Open AccessReview

Zapalenie Płuc i Inne Infekcje Związane z Wentylacją Mechaniczną

by Piotr Bobik and Andrzej Siemiątkowski

Adv. Respir. Med. 2014, 82(5), 472-480; https://doi.org/10.5603/PiAP.2014.0062 - 18 Aug 2014

Cited by 1 | Viewed by 840

One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV). MV enables sufficient gas exchange in patients with severe respiratory insufficiency, thus preserving the proper functioning of organs and systems. However, clinical and [...] Read more.

One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV). MV enables sufficient gas exchange in patients with severe respiratory insufficiency, thus preserving the proper functioning of organs and systems. However, clinical and experimental studies show that mechanical ventilation may cause severe complications, e.g. lung injury (VALI, VILI), systemic inflammatory response syndrome (SIRS), and, on rare occasions, multiple organ failure (MOF). Mechanical ventilation and especially endotracheal intubation are associated also with higher risk of infectious complications of the respiratory system: ventilator-associated respiratory infection (VARI) and ventilator-associated pneumonia (VAP). The complications of the MV listed above have a significant influence on the length of treatment and also on the increase of the costs of therapy and mortality of patients who stay in an ICU. These negative effects of supported breathing are the reasons for intensive research to find new biological markers of inflammation and lung injury, more sensitive and specific diagnostic instruments, more effective methods of therapy, and programs of prevention. The purpose of this article is the presentation of current knowledge concerning VAP-related infections, to allow pulmonologists and general practitioners to become more familiar with the problem. Basic and the most important data concerning the definition, epidemiology, pathophysiology, microbiology, diagnostics, treatment, and prevention of VAP have been included. Additionally, ventilator-associated tracheobronchitis (VAT) was discussed. Full article

145 KiB

Open AccessCase Report

Pokrzywka Powysiłkowa i Obrzęk Naczynioruchowy—Opis Przypadku

by Iwona Stelmach, Anna Sztafińska, Joanna Lechańka, Joanna Balcerak and Joanna Jerzyńska

Adv. Respir. Med. 2014, 82(5), 467-471; https://doi.org/10.5603/PiAP.2014.0061 - 18 Aug 2014

Viewed by 328

Abstract

Urticaria is a heterogeneous group of disorders, with various clinical manifestations and intensity of symptoms. Urticaria can be induced with a wide variety of environmental stimuli, such as cold, pressure, vibration, sunlight, exercise, temperature changes, heat, and water. In a select group of [...] Read more.

Urticaria is a heterogeneous group of disorders, with various clinical manifestations and intensity of symptoms. Urticaria can be induced with a wide variety of environmental stimuli, such as cold, pressure, vibration, sunlight, exercise, temperature changes, heat, and water. In a select group of patients, exercise can induce a spectrum of urticaria symptoms, ranging from cutaneous pruritus and warmth, generalised urticaria, angioedema, and the appearance of such additional manifestations as collapse, upper respiratory distress, and anaphylaxis. Specific provocation tests should be carried out on an individual basis to investigate the suspected cause and proper diagnosis. Modification of activities and behaviour is the mainstay of treatment in patients with physical urticaria. The aim of this study was to emphasise that primary care paediatricians should be able to recognise physical urticaria, supply a patient with rescue medications, and refer him/her to a specialist. In the article, the authors present a 13-year-old girl with typical urticaria lesions and angioedema after exercise. According to the history, physical examination, and provocation test, exercise-induced urticaria and angioedema were diagnosed. Full article

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Open AccessCase Report

Pneumocystozowe Zapalenie Płuc u Zakażonych HIV Przy Współistniejącym Zakażeniu Cytomegalowirusem. Opis Dwóch Przypadków i Przegląd Literatury

by Mateusz Marek Polaczek, Jacek Zych, Karina Oniszh, Janusz Szopiński, Jacek Grudny and Kazimierz Roszkowski-Śliż

Adv. Respir. Med. 2014, 82(5), 458-466; https://doi.org/10.5603/PiAP.2014.0060 - 18 Aug 2014

Cited by 3 | Viewed by 822

Abstract

Pneumocystozowe zapalenie płuc (PCP) jest jedną z wielu infekcyjnych chorób układu oddechowego u zakażonych HIV wywoływaną przez patogen Pneumocystis jiroveci, zaliczany do grzybów. Pneumocystoza jest od ponad 30 lat najczęstszą chorobą wskaźnikową zespołu nabytego niedoboru odporności (AIDS). Najważniejszym czynnikiem ryzyka rozwoju PCP jest [...] Read more.

Pneumocystozowe zapalenie płuc (PCP) jest jedną z wielu infekcyjnych chorób układu oddechowego u zakażonych HIV wywoływaną przez patogen Pneumocystis jiroveci, zaliczany do grzybów. Pneumocystoza jest od ponad 30 lat najczęstszą chorobą wskaźnikową zespołu nabytego niedoboru odporności (AIDS). Najważniejszym czynnikiem ryzyka rozwoju PCP jest obniżenie liczby limfocytów T CD4⁺ poniżej 200 komórek/mcL. Objawy kliniczne choroby to: przewlekły kaszel, duszność i osłabienie. W badaniu gazometrycznym krwi tętniczej lub arterializowanej krwi kapilarnej często stwierdza się hipoksemię, a w tomografii komputerowej o wysokiej rozdzielczości — obraz matowej szyby. Leczeniem z wyboru jest parenteralne podawanie trimetoprimu z sulfametoksazolem, U chorych w średnim i ciężkim stanie zaleca się systemowe podawanie glikokortykosteroidów. Współistnienie zakażenia wirusem cytomegalii (CMV) pogarsza rokowanie chorych. Narządowego zajęcia w przebiegu zakażenia CMV należy poszukiwać u chorych z liczbą komórek T CD4⁺ poniżej 50/mcL. Kwestią sporną pozostaje leczenie zakażenia CMV u chorych z rozpoznanym PCP. Uważa się, że w większości przypadków zakażenie CMV pozostaje bezobjawowe. Glikokortykosteroidy podawane w przypadkach PCP o cięższym przebiegu mogą pogarszać rokowanie i promować rozwój objawowego cytomegalowirusowego zapalenia płuc. W pracy przedstawiono dwa przypadki PCP, które były pierwszym objawem zakażenia HIV. W obu udowodniono również zakażenie CMV. Full article

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Open AccessCase Report

Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) with Hard Palate and Bronchial Perforations Treated with Rituximab—A Case Report

by Joanna Kosałka, Stanisława Bazan-Socha, Anna Zugaj, Maria Ignacak, Joanna Żuk, Barbara Sokołowska and Jacek Musiał

Adv. Respir. Med. 2014, 82(5), 454-457; https://doi.org/10.5603/PiAP.2014.0059 - 18 Aug 2014

Cited by 2 | Viewed by 298

Abstract

We present a case of a 57-year-old woman suffering from granulomatosis with polyangiitis (GPA), who in the seventh months of immunosuppressive treatment (cyclophosphamide) progressed with new pulmonary changes and perforations of the hard palate and bronchi. Rituximab was introduced resulting in B-cell depletion [...] Read more.

We present a case of a 57-year-old woman suffering from granulomatosis with polyangiitis (GPA), who in the seventh months of immunosuppressive treatment (cyclophosphamide) progressed with new pulmonary changes and perforations of the hard palate and bronchi. Rituximab was introduced resulting in B-cell depletion and disappearance of anti-PR3 antibody. Palatal holes have substantially diminished and all bronchial perforations disappeared, covered by fibrous tissue. In the fourth month after rituximab administration, large scarring obstruction of the right main bronchus with upper and middle lobes atelectasis emerged. Because of increasing dyspnoea, stenotic bronchus was re-opened by bronchoscopy. Intervention was complicated by bilateral pneumothorax and later, on the seventh day, by fatal pulmonary bleeding. To our knowledge, this is the first report of GPA refractory to cyclophosphamide complicated by palatal and bronchial perforations. Full article

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Open AccessCase Report

Immediate Hypersensitivity Reaction with Mango

by Ashok Shah and Kamal Gera

Adv. Respir. Med. 2014, 82(5), 445-453; https://doi.org/10.5603/PiAP.2014.0058 - 18 Aug 2014

Cited by 4 | Viewed by 557

Abstract

Hypersensitivity to the fruit mango is extremely rare and can exhibit either as immediate or delayed reactions. Since 1939, only 22 patients (10 with immediate type I reactions and 12 with delayed) have been documented with allergy to mango. History of atopy and [...] Read more.

Hypersensitivity to the fruit mango is extremely rare and can exhibit either as immediate or delayed reactions. Since 1939, only 22 patients (10 with immediate type I reactions and 12 with delayed) have been documented with allergy to mango. History of atopy and geographical region may influence the type of reaction. Immediate reactions occured most often in patients with history of atopy, while delayed reactions developed in non-atopic individuals. Clustering of delayed hypersensitivity reports from Australia and immediate reactions from Europe has been documented. We report a 50-year-old man with immediate type I hypersensitivity to mango, who developed cough, wheezing dyspnoea, generalised itching and abdominal discomfort after ingestion of mango. Life threatening event can also happen making it imperative to diagnose on time, so as to prevent significant morbidity and potential mortality Full article

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Open AccessGuidelines

Methodological Recommendations for the Diagnostics of EGFR Gene Mutations and ALK Gene Rearrangement in the Selection of Non-Small-Cell Lung Cancer Patients to Molecularly Targeted Therapies

by Paweł Krawczyk, Joanna Chorostowska-Wynimko, Rafał Dziadziuszko, Jacek Jassem, Maciej Krzakowski, Renata Langfort, Elżbieta Puacz, Bartosz Wasąg and Kamila Wojas-Krawczyk

Adv. Respir. Med. 2014, 82(5), 437-444; https://doi.org/10.5603/PiAP.2014.0057 - 18 Aug 2014

Viewed by 260

Abstract

Badania molekularne mające na celu wykrycie mutacji genu EGFR i rearanżacji genu ALK wykonuje się rutynowo w zaawansowanym niedrobnokomórkowym raku płuca (NDRP) w celu właściwej kwalifikacji chorych do terapii ukierunkowanych molekularnie. Przedstawiamy polskie zalecenia metodyczne prowadzenia diagnostyki molekularnej nieprawidłowości w genach EGFR i [...] Read more.

Badania molekularne mające na celu wykrycie mutacji genu EGFR i rearanżacji genu ALK wykonuje się rutynowo w zaawansowanym niedrobnokomórkowym raku płuca (NDRP) w celu właściwej kwalifikacji chorych do terapii ukierunkowanych molekularnie. Przedstawiamy polskie zalecenia metodyczne prowadzenia diagnostyki molekularnej nieprawidłowości w genach EGFR i ALK. Zalecenia te opisują szczegółowo wskazania kliniczne do wykonania testów, rodzaj materiału oraz sposób postępowania z nim, a także wymagania stawiane laboratoriom wykonującym diagnostykę molekularną. Full article

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Open AccessCommunication

Detecting Mycobacterium tuberculosis Complex DNA, Based on Post-Mortem Examination of Hilar Lymph Nodes with Real-Time PCR: Initial Study

by Wojciech Rzechorzek, Michalina Szańkowska, Benedykt Szczepankiewicz, Agata Cyran-Chlebicka and Aleksandra Safianowska

Adv. Respir. Med. 2014, 82(5), 430-436; https://doi.org/10.5603/PiAP.2014.0056 - 18 Aug 2014

Cited by 2 | Viewed by 279

Abstract

Introduction: According to the WHO, almost a third of the world population are thought to be infected with Mycobacterium tuberculosis. Some studies of the prevalence of latent tuberculosis infection (LTBI) have already been performed in Poland, showing that almost a quarter [...] Read more.

Introduction: According to the WHO, almost a third of the world population are thought to be infected with Mycobacterium tuberculosis. Some studies of the prevalence of latent tuberculosis infection (LTBI) have already been performed in Poland, showing that almost a quarter of the Mazovia population could be infected. It also indicated a higher prevalence of LTBI among seniors. Those studies were based on indirect diagnostic methods. Material and Methods: We randomly collected hilar lymph nodes from decedents aged 40 years and older during post-mortem examination. We excluded patients with previous confirmed tuberculosis. In addition, an autopsy was performed in all patients. Finally, we used real-time PCR Xpert MTB/RIF (Cepheid, USA) for the specific capture of mycobacterial DNA. Results: Twenty-two of 23 patients had a negative result of the real-time PCR examination and no signs of caseous necrosis in hilar lymph nodes. We found the only positive sample in a patient with histopathological signs of tuberculosis (the presence of caseous necrosis in the specimens obtained from lymph nodes and lung). Due to the change of cartridges from version G3 to G4, further reactions were inhibited and no more post-mortem samples were tested. Conclusions: Real-time PCR Xpert MTB/RIF was capable of detecting M. tuberculosis complex DNA in a patient with tuberculosis recognised on autopsy. In the remaining patients, no M. tuberculosis complex DNA was found, in accordance with negative results of histological examination. Since the technology of cartridges has changed, it is no longer possible to use real-time PCR Xpert MTB/RIF (Cepheid USA) on post-mortem material. Full article

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Open AccessArticle

Prognostic Value of Serum C-Reactive Protein (CRP) and Cytokeratin 19 Fragments (Cyfra 21-1) but Not Carcinoembryonic Antigen (CEA) in Surgically Treated Patients with Non-Small Cell Lung Cancer

by Monika Szturmowicz, Piotr Rudziński, Aneta Kacprzak, Renata Langfort, Iwona Bestry, Beata Broniarek-Samson and Tadeusz Orłowski

Adv. Respir. Med. 2014, 82(5), 422-429; https://doi.org/10.5603/PiAP.2014.0055 - 18 Aug 2014

Cited by 15 | Viewed by 422

Abstract

Introduction: The aim of the study was to assess the prognostic value of cytokeratin 19 fragments (Cyfra 21-1), carcinoembryonic antigen (CEA) and C-reactive protein (CRP) in surgically treated NSCLC patients. Material and Methods: 50 NSCLC patients (25 adenocarcinoma, 21 squamous cell [...] Read more.

Introduction: The aim of the study was to assess the prognostic value of cytokeratin 19 fragments (Cyfra 21-1), carcinoembryonic antigen (CEA) and C-reactive protein (CRP) in surgically treated NSCLC patients. Material and Methods: 50 NSCLC patients (25 adenocarcinoma, 21 squamous cell and 4 adenosquamous), clinical stages I and II, age 42–89 years, entered the study. CEA, Cyfra 21-1 and CRP concentrations were measured in serum taken before surgery, CEA and Cyfra 21-1 in 50 patients, CRP—in 46 patients. The survival was calculated from the date of surgical treatment until death or until the end of the observation time. The results were expressed as medians (95%CI). Results: Cyfra 21-1 concentration was 2.1 (0.7–14.5) ng/mL. Survival time in the patients with Cyfra 21-1 ≤ 2 ng/mL, and > 2 ng/ /mL was 79 (14.85–88.2) and 29 (5.7–87.6) months, (p < 0.026). CEA concentration was 2.68 (0.87–72.7) ng/mL, significantly higher in adenocarcinoma than in squamous cell lung cancer — 4.38 ng/mL (1.67–41.35) vs. 2.2 ng/mL (1.0–6.1), p = 0.002. CRP concentration was 5.45 (0–122.6) mg/L. Significant dependence was found between CRP and pathological tumour size (pT). Median CRP values in pT1, pT2 and pT3+4 tumours were: 2.8 mg/L, 6.9 mg/L and 23.5 mg/L, respectively. Survival time of the patients with CRP ≤ 10 mg/L and CRP > 10 mg/L was 79 (14.85–88.2) and 29.5 (5.7–87.6) months, respectively (p = 0.045). CRP > 10 mg/L and Cyfra 21-1 > 2 ng/mL were the only significant preoperative prognostic indicators (HR 2.08 and 2.04, respectively). Among the postoperative parameters, pathological stage of disease (p-stage) and pT were the significant prognostic indicators (HR 2.1 and 2.42, respectively). Conclusions: In the present study, concerning surgically treated NSCLC patients, preoperative CRP > 10 mg/L and Cyfra 21-1 > 2 ng/mL were the only negative prognostic indicators, while pT and p-stage were significant postoperative prognostic indicators. Full article

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Open AccessArticle

Stratification of Patients with COPD According to the 2011 GOLD Report

by Iwona Grzelewska-Rzymowska, Joanna Patora-Mikołajczyk and Paweł Górski

Adv. Respir. Med. 2014, 82(5), 415-421; https://doi.org/10.5603/PiAP.2014.0054 - 18 Aug 2014

Cited by 1 | Viewed by 319

Abstract

Introduction: The authors aimed to compare the distribution of COPD based on the new GOLD grading with stadium based exclusively on spirometry. Material and Methods: Eligible patients had an average age of 64.8 years and smoked at least 10 pack-years. COPD [...] Read more.

Introduction: The authors aimed to compare the distribution of COPD based on the new GOLD grading with stadium based exclusively on spirometry. Material and Methods: Eligible patients had an average age of 64.8 years and smoked at least 10 pack-years. COPD was defined according to GOLD fixed cut-off criterion FEV₁/FVC < 0.70. In all patients postbronchodilator spirometry was performed. Categories were defined with the mMRC dyspnoea scale and CAT scale. COPD exacerbations in the previous year and lung function were evaluated. Statistical comparisons were done using t-student test. Results: 315 COPD patients, 99 (31.4%) women and 216 (68.6%) men, were examined. Mean pack-years in the whole group was 47.1 ± 17.8. In women this figure was less than in men, 43.7 ± 19.2 vs. 49.5 ± 16.5 (p > 0.05), respectively. At study entry, 144 subjects (45.7%) were current smokers, and the majority of them (n-87, 60.4%) belonged to category D—26/66 (54.5%) women and 51/102 (50%) men. Based on spirometry alone, the patients were classified as moderate COPD 144 (45.71%), severe –154 (48.89%), and very severe 17 (5.4%). According to the 2011 GOLD report stratification, 60 patients (19.04%) were graded as category A, 63 (20%) as category B, 24 (7.62%) as category C, and 168 (53.33%) as category D, although 21 (12.5% of them) were in category B, but the number of exacerbations classified them as category D. Conclusions: The COPD population is heterogeneous in reference to the symptoms, value of FEV1, and susceptibility to exacerbations. Clinical symptoms assessed using validated questionnaires characterized COPD patients better than the value of spirometric parameters (which are necessary for diagnosis of this disease). Some patients were difficult to classify, especially those belonging to category C. Full article

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Open AccessArticle

Bronchoscopy in Immediate Diagnosis of Smear Negative Tuberculosis

by Raj Kumar, Mandeep Singh, Nitesh Gupta and Nitin Goel

Adv. Respir. Med. 2014, 82(5), 410-414; https://doi.org/10.5603/PiAP.2014.0053 - 18 Aug 2014

Cited by 6 | Viewed by 306

Abstract

Background: Tuberculosis is a major public health problem. Almost 30% of cases of tuberculosis are known to be sputum smear negative. There is a diagnostic dilemma in such cases leading to inadvertent delays in management of these cases. The present study was planned [...] Read more.

Background: Tuberculosis is a major public health problem. Almost 30% of cases of tuberculosis are known to be sputum smear negative. There is a diagnostic dilemma in such cases leading to inadvertent delays in management of these cases. The present study was planned to assess the role of bronchoscopy in immediate diagnosis of smear negative pulmonary tuberculosis. Material and Methods: The present study is a retrospective analysis of 132 sputum smear negative tuberculosis suspects who underwent bronchoscopic evaluation during the period 2002–2013. The diagnosis of tuberculosis was based on the finding of bacilli in aspirate or in tissue biopsy or the demonstration of caseous necrosis on tissue biopsy. Results: The present study showed that bronchoscopy could lead to immediate, accurate diagnosis in 68.2% of suspected smear negative cases. Bronchial aspirate and bronchoalveolar lavage alone were diagnostic in 51.5% of such cases while tissue biopsy added to the yield in another 16.5% cases. Conclusions: The results of the present study suggests an important place of bronchoscopy in immediate diagnosis of suspected smear negative tuberculosis, thus avoiding inadvertent delays in diagnosing and instituting appropriate treatment. Full article

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Open AccessArticle

Epidemiological Situation of Tuberculosis in Poland: Part II. What Are the Causes of the Different Epidemiological Situation in Various Regions of Poland?

by Ewa Rowińska-Zakrzewska, Maria Korzeniewska-Koseła and Kazimierz Roszkowski-Śliż

Adv. Respir. Med. 2014, 82(5), 402-409; https://doi.org/10.5603/PiAP.2014.0052 - 18 Aug 2014

Viewed by 274

Abstract

Introduction: The different epidemiological situation of tuberculosis in various regions of Poland (higher and lower notification rates) was described previously by our group. The patients diagnosed with tuberculosis in the higher notification rate areas were younger and there were more cases of [...] Read more.

Introduction: The different epidemiological situation of tuberculosis in various regions of Poland (higher and lower notification rates) was described previously by our group. The patients diagnosed with tuberculosis in the higher notification rate areas were younger and there were more cases of primary tuberculosis (tuberculous pleurisy and tuberculosis of chest lymph nodes) than in the patients diagnosed in the lower notification areas. The aim of the present study was to assess the possible causes of the different epidemiological situation of tuberculosis in various regions of Poland. Material and Methods: Analysis was done at the same regions as in the previous paper. A comparison was made between two groups: Group I, which included three voivodeships with higher rates of notification, from 23.7 to 32.3/100,000 (mean rates in the analysed period of time); and Group II, which included five voivodeships with lower notification rates (mean rates from 12.2 to 18.6/100,000). The wealth of the regions (GDP, gross domestic product per capita), the level of unemployment, and social status of the patients were analysed. We compared the population density in both regions. The results of treatment in both regions were also analysed. Results: We did not find any differences in GDP and unemployment rates between the compared regions. The results of treatment were different in particular regions, but there was no clear tendency for worse results in voivodeships in Group I compared to voivodeships in Group II. However, the number of patients lost from observation was significantly higher in the regions from Group I than in those from Group II. There was also a significantly higher death rate from tuberculosis in younger patients (£ 59 years) from Group I than from Group II. This is additional proof that the epidemiological situation in the two regions was different. Finally, we found that the mean density of population in the regions from Group I was higher than that from Group II. The density of population may influence transmission of tuberculosis. There is also the possibility that the differences in the epidemiological situation in various regions of Poland are caused by historical events. In the past the epidemiological situation of tuberculosis was much worse in the east of Europe than in the west. Just after the Second World War, according to the changes of the Polish territory, many Polish citizens (mainly ancestors of those from Group I) were displaced from the east to the west. Conclusions: In conclusion, the greater number of patients lost from observation, together with the higher density of population in the regions from Group I in comparison with those from Group II, seems to be partly responsible for the difference in the epidemiological situation in the two regions. It is also possible that some patients from Group I are more susceptible to infection and disease caused by Mycobacterium tuberculosis due to their ancestors, who lived in the east of Europe. Full article

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Open AccessEditorial

Zmiany najnowszych Wytycznych Leczenia i Prewencji Astmy—GINA 2014. Na co powinniśmy zwrócić uwagę?

by Izabela Kupryś-Lipińska and Piotr Kuna

Adv. Respir. Med. 2014, 82(5), 393-401; https://doi.org/10.5603/PiAP.2014.0051 - 18 Aug 2014

Viewed by 272

Abstract

W maju 2014 roku, w Światowym Dniu Astmy opublikowane zostały znowelizowane wytyczne leczenia i prewencji astmy, opracowane przez ekspertów Światowej Inicjatywy na Rzecz Astmy (GINA, the Global Initiative for Asthma) [...] Full article

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Adv. Respir. Med., Volume 82, Issue 5 (August 2014) – 12 articles , Pages 393-480

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