Advances in Respiratory Medicine

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Open AccessCase Report

CT Imaging Features of Thin-Walled Cavitary Squamous Cell Lung Cancer

by Lucyna Opoka, Monika Szturmowicz, Karina Oniszh, Damian Korzybski, Zbigniew Podgajny, Katarzyna Błasińska-Przerwa, Małgorzata Szołkowska and Iwona Bestry

Adv. Respir. Med. 2019, 87(2), 114-117; https://doi.org/10.5603/ARM.2019.0018 - 30 Apr 2019

Cited by 8 | Viewed by 428

Abstract

Primary lung cancer manifesting as a thin-walled solitary cavity, occurs relatively infrequently. The most common histologic type presenting such a pattern is squamous cell cancer, followed by adenocarcinoma, and finally—large cell cancer. Cavitation is typically not seen in small cell lung cancer. Entities [...] Read more.

Primary lung cancer manifesting as a thin-walled solitary cavity, occurs relatively infrequently. The most common histologic type presenting such a pattern is squamous cell cancer, followed by adenocarcinoma, and finally—large cell cancer. Cavitation is typically not seen in small cell lung cancer. Entities indicating malignancy of such lesions include irregular cystic wall, wall nodule formation, nodular septa or increased standard uptake on positron emission tomography (PET). We are presenting a case of a squamous cell lung cancer manifesting on chest CT as a thin-walled septated cavity with irregular margins mimicking a cyst. The lesion was reported unchanged in a follow-up computed tomography after 3 months. A follow-up scan obtained 2 years after initial examination showed thickening of a cyst wall, solid structures within its lumen and thoracic lymph nodes enlargement. Full article

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Open AccessArticle

Hypersensitivity Pneumonitis Recognised in a Single Pulmonary Unit, between 2005 and 2015: Comparison with Recently Proposed Diagnostic Criteria

by Monika Szturmowicz, Inga Barańska, Małgorzata Ewa Jędrych, Iwona Bartoszuk, Piotr Radwan-Roehrenschef, Adriana Roży, Iwona Bestry, Joanna Chorostowska-Wynimko, Renata Langfort and Jan Kuś

Adv. Respir. Med. 2019, 87(2), 83-89; https://doi.org/10.5603/ARM.2019.0014 - 30 Apr 2019

Cited by 13 | Viewed by 541

Abstract

Introduction: Hypersensitivity pneumonitis (HP) is the third most common interstitial lung disease after idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Pathogenesis of HP is related to repeated exposure to inhaled environmental antigens that sensitise the susceptible, genetically predisposed persons. The aim of the [...] Read more.

Introduction: Hypersensitivity pneumonitis (HP) is the third most common interstitial lung disease after idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Pathogenesis of HP is related to repeated exposure to inhaled environmental antigens that sensitise the susceptible, genetically predisposed persons. The aim of the present retrospective study was to summarise the diagnostic methods used in consecutive patients with HP, recognised in a single pulmonary unit, between 2005 and 2015, and to compare them with current diagnostic criteria. Material and methods: 135 patients, 68 males, 67 females, median age 53 years (18–75 years), entered the study. Chest CT features characteristic of HP were defined as: mosaic attenuation of lung parenchyma, air trapping and/or ill-defined centrilobular nodules. Lymphocytosis in BAL was defined as ≥30%. Results: Median time from first symptoms to diagnosis was 12 months. The exposure to one or more allergens was found in 94% of patients, chest CT features characteristic of HP have been reported in 87%, BAL lymphocytosis—in 86%. According to recent diagnostic criteria—in 54% of patients, clinical diagnosis of HP was confident, in 16%—probable, in 26%—possible and in 4%—unlikely. The confirmation of HP with lung biopsy has been obtained in 36% of non-confident cases (16% of the study group). Conclusions: HP diagnosis was confirmed according to current diagnostic criteria in 70% of patients diagnosed between 2005 and 2015. Contradictions to lung biopsy have been the main reason for inability to confirm HP in non-confident cases. Full article

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Open AccessReview

E-Cigarettes or Heat-not-Burn Tobacco Products: Advantages or Disadvantages for the Lungs of Smokers

by Paweł Górski

Adv. Respir. Med. 2019, 87(2), 123-134; https://doi.org/10.5603/ARM.2019.0020 - 18 Apr 2019

Cited by 3 | Viewed by 1029

Abstract

This is a narrative review considering the use of e-cigarettes and heat-not-burn tobacco products. Advantages and disadvantages of both devices, including biological and clinical consequences, were described. The role of these products in limiting tobacco dependence was also discussed. Possible implications for clinical [...] Read more.

This is a narrative review considering the use of e-cigarettes and heat-not-burn tobacco products. Advantages and disadvantages of both devices, including biological and clinical consequences, were described. The role of these products in limiting tobacco dependence was also discussed. Possible implications for clinical practice were addressed as well. Full article

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Open AccessReview

Cell-Free Tumour DNA as a Diagnostic and Prognostic Biomarker in Non-small Cell Lung Carcinoma

by Barbara Łochowska, Dariusz Nowak and Piotr Białasiewicz

Adv. Respir. Med. 2019, 87(2), 118-122; https://doi.org/10.5603/ARM.2019.0019 - 18 Apr 2019

Cited by 7 | Viewed by 436

Abstract

More than 1 million people dies worldwide due to lung cancer which is the first most incident cancer in males and the third in females. Only early diagnosis makes possible to achieve long-lasting remission or even cure the disease. Unfortunately, no tumour marker [...] Read more.

More than 1 million people dies worldwide due to lung cancer which is the first most incident cancer in males and the third in females. Only early diagnosis makes possible to achieve long-lasting remission or even cure the disease. Unfortunately, no tumour marker to achieve this goal has been identified, yet. One of putative lung cancer markers is free circulating tumor DNA. Its concentration seems to be related to cancer burden. Moreover, it can be subjected to mutational status analysis allowing for introduction of targeted treatment. This led to the idea of liquid biopsy which can substitute for a standard biopsy not feasible in certain clinical circumstances. Assessment of cell free tumour DNA can also inform about progression/recurrence of cancer and may have a prognostic value. Therefore, the aim of this article is to review on free circulating DNA as a potential marker in lung cancer. Full article

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Open AccessArticle

Rapid Oncological Diagnosis of Lung Cancer: Specific Facility Experience

by Rafał Sokołowski, Michał Rząd, Agnieszka Zaręba, Szczepan Cierniak and Karina Jahnz-Różyk

Adv. Respir. Med. 2019, 87(2), 96-102; https://doi.org/10.5603/ARM.2019.0016 - 18 Apr 2019

Viewed by 314

Abstract

Introduction: In order to improve diagnosis procedure by public health service, an organizational solution called Rapid Oncological Therapy has been introduced. The introduction of this program caused criticism of the medical community, and state control authorities showed irregularities in its functioning in medical [...] Read more.

Introduction: In order to improve diagnosis procedure by public health service, an organizational solution called Rapid Oncological Therapy has been introduced. The introduction of this program caused criticism of the medical community, and state control authorities showed irregularities in its functioning in medical clinics. Its aim was to assess this process among lung cancer patients hospitalized in the Clinic for 9 months. Material and methods: After the analysis of imaging tests, the patients were qualified for invasive tests (bronchoscopy, EBUS). Patients with histopathological diagnosis of NSCLC were subjected to molecular diagnostics. After completing the diagnosis and establishing the final diagnosis, the patient's forfeiture was presented at the clinical meeting. Results: The analysis involved 209 patients who had a DILO card issued. 156 patients were diagnosed with lung cancer and qualified for the consulate. Among the histopathological types, NSCLC dominated—80%. SCLC was 17% of the types. By the decision made on medical case conference, 135 patients have been qualified for casual treatment, among others 12% surgical treatment; 47% chemotherapy, 18% radiotherapy; 8% chemo-radiotherapy. An average waiting time for diagnosis process to begin, after DILO card has been issued was 16.33 (±18.78) days, an average hospitalization and diagnosis time was 9.16 (±6.61) days. Around 31.3 (±14.93) days on average have passed from the start of diagnostical hospitalization until beginning of the causal treatment. Conclusions: In a multi-specialist center, it is possible to develop a care model for lung cancer patients, consistent with Rapid Oncological Diagnosis. Full article

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Open AccessArticle

Impact on Survival of Nuclear Atypia in Epithelioid Malignant Mesothelioma

by Mona Mlika, Manel Limam, Aida Benzarti and Faouzi Mezn

Adv. Respir. Med. 2019, 87(2), 90-95; https://doi.org/10.5603/ARM.2019.0015 - 05 Apr 2019

Cited by 3 | Viewed by 380

Abstract

Introduction: Malignant pleural mesothelioma is a rare tumour with a bad prognosis. The only consensual prognostic factors are represented by the stage and the histologic type. Concerning the histologic type, epithelioid mesothelioma is known to have better prognosis in comparison with the sarcomatoid [...] Read more.

Introduction: Malignant pleural mesothelioma is a rare tumour with a bad prognosis. The only consensual prognostic factors are represented by the stage and the histologic type. Concerning the histologic type, epithelioid mesothelioma is known to have better prognosis in comparison with the sarcomatoid and biphasic types. Epithelioid mesotheliomas have been reported to be a heterogeneous prognostic group. Our aim was to assess the impact on the survival of different characteristics of epithelioid mesothelioma, including nuclear atypia, mitotic count, MIB-1 index, inflammatory host response, stromal desmoplasia, necrosis, vascular emboli and invasion depth. Material and methods: We performed a study of survival of 30 malignant pleural mesotheliomas according to the different parameters studied. Results: The study included 26 women and 4 men. The mean age of the patients was 61 years. The microscopic exam concluded to an epithelioid mesothelioma in 17 cases, sarcomatoid mesothelioma in 4 cases and biphasic mesothelioma in 9 cases. The 17 cases of epithelioid mesothelioma developed severe nuclear atypia in 6 cases and mild nuclear atypia in 11 cases. The mitotic count and the MIB-1 score were respectively inferior to 5 mitoses/50 HPF and inferior to 10% in 11 cases and were superior to 5 mitoses/50 HPF and superior to 10% in 6 cases. No vascular emboli were recorded. Tumour necrosis was reported in 1 case. The inflammatory host response was severe in 4 cases and mild in 13 cases. The tumoral stroma was desmoplastic in 4 cases. The invasion depth was superior to 0.5 mm in 16 cases. The median overall survival amounted to 180 days. Nuclear atypia was the only feature that had impact on survival in the group of epithelioid mesothelioma. Conclusions: Our results highlight the correlation of nuclear atypia with survival. Full article

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Open AccessCase Report

Arterio-Bronchial Fistula as a Complication of Post-traumatic Subclavian Artery Pseudoaneurysm: Radiological Findings and Outcome

by Ludomir Stefańczyk, Marcin Elgalal, Sergiusz Ustyniak, Michał Polguj and Agata Majos

Adv. Respir. Med. 2019, 87(2), 110-113; https://doi.org/10.5603/ARM.2019.0017 - 02 Apr 2019

Viewed by 338

Abstract

Post-traumatic arterio-bronchial fistula is a rare cause of life-threatening hemorrhage. We present a case of a ten-year-old patient with a post-traumatic subclavian artery pseudoaneurysm complicated by an arterio-bronchial fistula and occlusion of the subclavian artery. The patient was treated with a stent-graft. We [...] Read more.

Post-traumatic arterio-bronchial fistula is a rare cause of life-threatening hemorrhage. We present a case of a ten-year-old patient with a post-traumatic subclavian artery pseudoaneurysm complicated by an arterio-bronchial fistula and occlusion of the subclavian artery. The patient was treated with a stent-graft. We present radiological images of the fistula and the evolution of the changes in subsequent follow-up examinations. Full article

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Open AccessArticle

Smoking Status in Relation to Obstructive Sleep Apnea Severity (OSA) And Cardiovascular Comorbidity in Patients with Newly Diagnosed OSA

by Piotr Bielicki, Anna Trojnar, Piotr Sobieraj and Magdalena Wąsik

Adv. Respir. Med. 2019, 87(2), 103-109; https://doi.org/10.5603/ARM.a2019.0011 - 02 Apr 2019

Cited by 25 | Viewed by 1020

Abstract

Introduction: the relationship between smoking and sleep disturbance has been well documented. Smoking is a common risk factor for both obstructive sleep apnea (OSA) and cardiovascular diseases. The study aimed to: (1) evaluate the incidence of newly diagnosed OSA in patients presenting with [...] Read more.

Introduction: the relationship between smoking and sleep disturbance has been well documented. Smoking is a common risk factor for both obstructive sleep apnea (OSA) and cardiovascular diseases. The study aimed to: (1) evaluate the incidence of newly diagnosed OSA in patients presenting with symptoms suggestive of a sleep disorder, (2) assess the relation between smoking status and OSA severity; and (3) compare the prevalence of cardiovascular comorbidities in ever- and never smokers with newly diagnosed OSA. Material and methods: a retrospective analysis of 5353 patients suspected of OSA was performed. OSA was diagnosed on the basis of polysomnography. The influence of smoking status on indices of OSA severity was evaluated and the incidence of self–reported cardiovascular diseases and diabetes mellitus type 2 was analyzed in relation to smoking history. Results: OSA was diagnosed in 3613 patients (67.5%); of these, 21.6% were ever-smokers. Smokers with OSA had a higher apnea-hypopnea index [AHI; 31 (18.4–53.29) vs. 29 (18.3–47.7), p = 0.03], lower mean oxygenation during sleep [92 (90–93) vs. 92 (91–94), p < 0.01] and a higher daytime sleepiness (Epworth Sleepiness Scale score 11.7 ± 5.5 vs. 11.0 ± 5.5, p < 0.001). The most frequent comorbidity was hypertension, followed by obesity, diabetes mellitus type 2 and coronary artery disease, with a statistically higher incidence of hypertension in non-smokers (59.2 vs. 64.7%, p = 0.005). Conclusions: smoking is related with OSA severity and increased daytime sleepiness. Our study confirmed the elevated frequency of cardiovascular comorbidities in OSA patients in general but did not show an increased incidence of these comorbidities in smokers. Full article

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Open AccessArticle

Comparing the Effects of Upper Limb and Breathing Exercises on Six-Minute Walking Distance among Patients with Chronic Obstructive Pulmonary Disease: A Three-Group Randomized Controlled Clinical Trial

by leili Yekefallah, Mohammad Ali Zohal, Ommolbanin Keshavarzsarkar, Ameneh Barikani and Maryam Gheraati

Adv. Respir. Med. 2019, 87(2), 77-82; https://doi.org/10.5603/ARM.2019.0013 - 02 Apr 2019

Cited by 8 | Viewed by 1773

Abstract

Introduction: Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjects with chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises on six-minute walking distance among these patients. Material and methods: [...] Read more.

Introduction: Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjects with chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises on six-minute walking distance among these patients. Material and methods: This three-group randomized controlled clinical trial was conducted in 2017–2018 in Velayat hospital, Qazvin, Iran. Seventy-five patients were purposively selected from the outpatient lung clinic of the hospital and randomly allocated to either the 25-patient groups of upper limb exercise, breathing exercise, or control. The patients in the first group were performing upper limb exercises thrice weekly for one month in the study setting. Their counterparts in the second group were doing pursed-lip and diaphragmatic breathing exercises four times daily for one month at their homes. However, the patients in the control group received no exercise intervention. Six-minute walk test was performed by each participant both before and after the study intervention. The SPSS for Windows program (v. 23.0) was used to analyze the data via the Chi-square test, the paired-sample t test, and the one-way analysis of variance. Results: Before the intervention, the groups did not significantly differ from each other respecting six-minute walking distance. During the study, walking distance in the control group did not change significantly, while it remarkably increased in both the upper limb exercise and the breathing exercise groups (p < 0.05). After the intervention, walking distance in the upper limb exercise group was significantly greater than the breathing exercise group (p < 0.05) and the control group (p < 0.05); however, the difference between the breathing exercise and the control groups was not statistically significant (p > 0.05). Conclusions: Upper limb exercise is more effective than breathing exercise in increasing walking distance among patients with chronic obstructive pulmonary disease. Therefore, upper limb exercise can be used as a safe, simple, and inexpensive rehabilitation technique for these patients. Full article

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Open AccessArticle

Prognostic Value of Red Cell Distribution width and Echocardiographic Parameters in Patients with Pulmonary Embolism

by Mehtap Pehlivanlar Küçük, Funda Öztuna, Yasin Abul, Savaş Özsu, Merih Kutlu and Tevfik Özlü

Adv. Respir. Med. 2019, 87(2), 69-76; https://doi.org/10.5603/ARM.2019.0012 - 02 Apr 2019

Cited by 6 | Viewed by 500

Abstract

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) [...] Read more.

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE. Material and methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW < 15.2%. Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5–40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (±0.43)) and group-2 (RDW < 15.2%, 1.85 cm (±0.53))(p = 0.007). The threshold value for tricuspid jet velocity was >2.35 m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591–0.858, p = 0.033). Conclusions: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism. Full article

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Adv. Respir. Med., Volume 87, Issue 2 (April 2019) – 10 articles , Pages 69-134

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