Talc slurry pleurodesis via chest tube in department of pulmonology — a 24-case study

 WSTĘP: Pleurodeza chemiczna jest uznaną metodą paliatywnego leczenia uporczywych wysięków gromadzących się w jamach opłucnowych. Celem pracy jest prezentacja własnych doświadczeń z mniej obciążającą formą zabiegu wykonywanego za pomocą zawiesiny talku medycznego podawanego przez dren, wymagającego jedynie znieczulenia miejscowego. W piśmiennictwie polskojęzycznym brak pozycji opisujących doświadczenia z wyżej wymienioną modyfikacją pleurodezy.MATERIAŁ I METODY: W latach 2005–2011 hospitalizowano na Oddziale Pulmonologii i Rehabilitacji Oddechowej Wojewódzkiego Szpitala Chorób Płuc w Wodzisławiu Śląskim 162 chorych u których rozpoznano płyn w jamie opłucnej. Ze względu na uporczywe gromadzenie się płynu u 24 (14,8%) z nich wykonano pleurodezę. Praca zawiera retrospektywną analizę wykonanych zabiegów z uwzględnieniem bezpieczeństwa, skuteczności i przeżywalności pacjentów, podstawy teoretyczne, wskazania, przeciwwskazania, zasady przygotowania pacjenta, przebieg, ocenę skuteczności, własne modyfikacje zabiegu oraz ocenę wartości badania radiologicznego i ultrasonograficznego klatki piersiowej.WYNIKI: Zabieg okazał się skuteczny u 20 chorych, częściowo u 3, u jednego chorego stwierdzono brak skuteczności, a u jednego zgon wewnątrzszpitalny. Najczęstszymi powikłaniami były ból i gorączka o niewielkim nasileniu. Mediana hospitalizacji wynosiła 9 dni. Mediana czasu przeżycia osób zmarłych wyniosła 32 dni, a wśród nadal żyjących chorych 96 dni.WNIOSKI: Pleurodeza zawiesiną talku przez dren z odpowiednią selekcją pacjentów jest zabiegiem stosunkowo skutecznym i bezpiecznym. Zabieg jest możliwy do wykonania w warunkach oddziału pulmonologicznego. INTRODUCTION: Chemical pleurodesis is an accepted palliative therapy for patients with recurrent and symptomatic pleural effusion. The aim of the study is to present our own experiences with a less invasive variant of this procedure performed with talc slurry administered via a chest tube under local anaesthesia. Available medical literature in Polish does not contain information about this type of pleurodesis.MATERIAL AND METHODS: During 2005–2011 in the Pulmonology and Respiratory Rehabilitation Department we hospitalized and diagnosed 162 patients with pleural fluid. Pleurodesis was performed in 24 patients (14.8%) with persistent pleural fluid. In this article we present retrospective analysis of safety, efficacy of treatment and patients’ survival time. We also provide detailed information about this type of pleurodesis: clinical theory, indications, contraindications, patient’s preparation, description of procedure with our modifications and use of chest X-ray and transthoracic ultrasound.RESULTS: The procedure was effective in 20 cases, partially effective in 3 cases and ineffective in one case. In-hospital mortality was 4.2% (one case). We frequently observed mild fever and local pain. Median hospitalization was 9 days. Median survival time was 32 days, whereas in the group of still living patients it was 96 days.CONCLUSIONS: Talc slurry pleurodesis with adequate patient preselection is a relatively effective and safe procedure. The procedure can be performed in a non-surgical pulmonology unit

Increased expression of CCL4/MIP-1β in CD8+ cells and CD4+ cells in sarcoidosis.

Sarcoidosis is a granulomatous disease with an increased accumulation of T cells in lungs as a result of on-site proliferation and chemotaxis induced by chemokines. It has already been demonstrated that CCL3-5 levels were increased in BAL fluid of sarcoidosis patients. To analyze the expression of CCL3-5 chemokines by T-cell subtypes (CD4+, CD8+, Th1, Th2, Tc1 or Tc2) in the lungs of sarcoidosis patients, fifteen untreated sarcoidosis patients and eighteen control subjects were enrolled in this study. CD4+and CD8+cells were isolated from BAL fluid by positive magnetic selection. The expression of CCL3-5 and other cytokines in CD4+and CD8+cells were measured by flow cytometry. The percentage of CD4+or CD8+cells expressing CCL4 were significantly higher in sarcoidosis patients (22.3% and 58.1%) compared to those seen in healthy subjects (11.1% and 16.5%, P = 0.04 and P = 0.02, respectively). In addition, the expression of CCL3, CCL4 and CCL5 was significantly elevated in CD8+cells (8.9%, 58.1% and 2.1%) compared to CD4+cells (2.1%, 22.3% and 0.7%; P = 0.04, P = 0.009 and P = 0.04, respectively), whereas CCL4 was expressed by significantly more Tc1 than Th1 cells in sarcoidosis patients (P = 0.006). Our study shows the possible role of CD8+cells and CD4+cells in recruiting T cells to the site of inflammation in sarcoidosis through the release of CCL4, either alone or together with Th1/Tc1-associated cytokines

ANALYSIS OF PSYCHOEMOTIONAL STATE AND INTELLECTUAL ABILITIES IN PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE - PRELIMINARY RESULTS

Background: In the literature we can find examples of comorbidity of the diseases of the respiratory tract and mental disorders. Among them a particularly significant position is occupied by chronic obstructive pulmonary disease (COPD) and asthma, which may be accompanied by anxiety, depressive and cognitive symptoms. The present research project was aimed to establish a connection between psycho-intellectual functioning and suffering from the aforementioned diseases. Subjects and methods: The patients were divided into 3 groups. In the asthma group there were 11 people, mean age 54, who met the GINA criteria for asthma. The group of patients with COPD was formed by 12 people, mean age 67. The control group included 13 people, mean age 48. Patients from all the groups underwent spirometry, sputum induction and the following tests: Mini- Mental State Examination (MSSE), Trail Making Test (TMT A and B), Beck Depression Inventory – BDI (Beck et al. 1961) and State- Trait Anxiety Inventory for Adults - STAI 1 and 2. Results: In the TMT tests results were the following: We can presume some deficiency when the time required by a patient to complete the task is longer than 78 seconds for Part A and 273 seconds for Part B. In our research the best mean time was obtained in control group (Part A - 30.04 s, Part B – 67.37 s), then in the asthma group (Part A - 35.54 s, Part B – 98.81 s) and in the COPD group (Part A - 42.80 s, Part B – 107.79 s). In our research study the lowest score for the Beck Depression Inventory was obtained in the control group (mean 6.15), then in asthma (mean 9.63) and in COPD (mean 13.61). Results for State-Train Anxiety Inventory were distributed as follows: mean score in the asthma group was 36.48 in Part 1 and 43.27 in Part 2, in the COPD group 36.41 in Part 1 and 42.66 in Part 2 and in the control group 32.61 in Part 1 and 36.75 in Part 2. Conclusions: In our research the level of anxiety and depression measured by self-assessment questionnaires was higher in the study groups than in the control group. Also cognitive functions were worse than in the healthy controls, especially among COPD patients

Vitamin D status of severe COPD patients with chronic respiratory failure

Introduction: The aim of the study was to measure the concentrations of vitamin D in serum of COPD patients with chronic respiratoryfailure in comparison to healthy control group. The correlation between the levels of vitamin D in serum and the selectedclinical, spirometric and blood gas parameters was the additional aim of the study. Material and methods: The study included 61 patients with diagnosed COPD in stadium of chronic respiratory failure (45 menand 16 women) and 37 healthy controls (19 men and 18 women). The following procedure were performed in all studied subjects:detailed history (especially: daily activity, diet, tobacco and alcohol use), post-bronchodilator spirometry, assessment of 25(OH)Din serum and for COPD group only blood gas analysis. Recruitment for the study was conducted from November to April. Statisticalanalysis was performed using the following statistical methods: t-Student test, Mann-Whitney U test, Spearman correlationtest and Chi-kwadrat test. Results: There was no significant differences between COPD and control group for the levels of 25(OH)D in serum. Median andlower; upper quartile were respectively following: 24,75 nmol/l (16,9; 36,4) vs. 24,06 nmol/l (16,3; 37,2), p=0,69. Vitamin Ddeficiency was present in 60 COPD patients (98,3% of all patients) and in 36 control group subject (97,3% of all healthy volunteers).The difference was not statistically significant. The levels of vitamin D in serum did not significantly correlated with anyof studied parameters (spirometry, blood gas, age, the level of activity, BMI, tobacco smoke exposure and others). However, thelevel of activity in COPD group correlated positively with spirometry values and negatively with age and number of exacerbations. Conclusion: The results of the study showed that in autumn-winter time in Poland there are very frequent deficiency of vitaminD in serum not only in COPD patients in respiratory failure stage but also in elderly healthy persons. However, in contrary toexpectations the deficiency of vitamin D in COPD patients with respiratory failure were similar to that seen in healthy persons

Is it possible to predict, whether BAL salvage is going to be diagnostic?

Introduction: Bronchoalveolar lavage (BAL) is used in the diagnosis of interstitial lung diseases. BAL is diagnostic when ≥ 60%of the instilled volume is recovered. There are no reliable markers useful to predict whether BAL volume is going to be diagnostic.Our goal was to search for pulmonary function markers which could anticipate whether the recovered volume of instilled fluidwould be ≥ 60% of administered volume. Material and methods: BAL volumes and quality were analyzed in the context of disease, medical condition and lung functiontest results of the subjects hospitalized at the Pulmonology Ward from January 2015 to October 2016. The patients’ average agewas 61 (29–89). Results: Among 80 procedures, diagnostic BAL (≥ 60%) has been obtained in 58 cases. The analysis of the group of patients withan interstitial lung disease confirmed that there is a correlation between decreasing BAL recovered volume and an increase ofRV[%pred] (r = –0.34) and RV/TLC[%pred] (r = –0.41); p < 0.05. There was no significant correlation with DLCO. RV/TLC[%pred]was the parameter with the highest predictive value for an anticipated correct BAL recovery. The curve analysis of the receiveroperating characteristic (ROC) showed a diagnostic accuracy (AUC 0.73, 95% CI 0.61–0.86). Conclusions: Pulmonary hyperinflation may have a predictive role in anticipating a proper recovery of the BAL fluid volume

The role of interleukin 17 cytokine family in inducing allergic inflammation in the pulmonary tract

IL-17 family is a group of proinflammatory cytokines produced by activated memory T-cells. These cytokines play an important role in the development of cellular and humoral mechanisms of immunological responses lying at the basis of allergic disorders. The aim of this paper is to present the current knowledge on the role of interleukin 17 cytokine family in the pathogenesis of allergic disorders of the respiratory tract. IL-17A (as well as IL-17F) plays role in the development of airway hyperresponsiveness through activation of allergen-specific T-cells. Levels of IL-17A are elevated in sputum of asthmatic patients and correlate with airway hyperresponsiveness to methacholine. However, it remains fact, that the main effect of IL-17A in the pulmonary tract is recrutation of polymorphonuclear leukocytes, depending on CXC chemokine release from stromal cells. IL-17E evokes different immunological responses. This cytokine participates in the development of Th2-cell-dependent immunological response and the coexisting pathological tissue changes. These actions take place mainly through the induction of synthesis of the Th2 cell-derived cytokines (IL-4, IL-5, IL-13) and the development of eosinophilic inflammation. It is thought, that the character of the immunological response evoked by different cytokines of IL-17 family depends on the differences between the spatial structure of their fragments including disulfi de bridges and that these differences determine their receptor interactions and biological functions

The influence of sensitivity to fungal allergens on the development and course of allergic diseases of the respiratory tract

W badaniach epidemiologicznych i diagnostycznych, przeprowadzonych w ostatnich latach z zastosowaniem testów skórnych lub oceny stężenia sIgE, wykazano wzrost rozpowszechnienia nadwrażliwości na mykoalergeny. U chorych z atopią w znacznym stopniu nie wyjaśniono roli nadwrażliwości na alergeny grzybów zarówno w kontekście jej rozpowszechnienia, jak i znaczenia klinicznego. Chociaż reakcja alergiczna na alergeny grzybów jest ważnym czynnikiem powodującym powstanie objawów ze strony układu oddechowego, uważa się, że inne czynniki, takie jak zwiększone narażenie na metabolity grzybów - w tym mykotoksyny oraz inne substancje o działaniu immunosupresyjnym i drażniącym - mogą również mieć znaczenie. Nadwrażliwość na alergeny grzybów jest czynnikiem ryzyka rozwoju ciężkich postaci astmy oskrzelowej oraz potencjalnie zagrażających życiu zaostrzeń tej choroby, występowania ciężkiej niewydolności oddechowej i związanych z tym hospitalizacji na oddziałach IOM. Ostatecznie jednak nie wyjaśniono roli mykoalergenów jako kluczowego, egzogennego czynnika odpowiedzialnego za rozwój astmy oskrzelowej. Zgodnie z opinią niektórych badaczy, obecność nadwrażliwości na alergeny grzybów wiąże się ściśle z istnieniem odrębnego fenotypu ciężkiej postaci astmy oskrzelowej. Nie rozstrzygnięto, czy w tym fenotypie astmy stopień nasilenia objawów jest spowodowany kolonizacją dróg oddechowych przez niektóre gatunki grzybów, czy też jest wynikiem nadmiernej odpowiedzi układu immunologicznego na zarodniki grzybów obecne w powietrzu. W pracy przedstawiono krytyczny przegląd aktualnego stanu wiedzy na temat rozpowszechnienia zależnej od IgE nadwrażliwości na mykoalergeny oraz związków między jej występowaniem a rozwojem i przebiegiem chorób alergicznych na podstawie najnowszej literatury. Dokonano również próby oceny znaczenia tych związków dla rozwoju nowych metod leczenia chorób alergicznych układu oddechowego w przyszłości.Several epidemiological and diagnostic studies reported increasing prevalence of allergic reactivity to fungi assessed with the use of skin testing or IgE detection. The role of sensitization to fungi in relation to the prevalence and clinical importance in atopic patients remains largely unknown. Although an allergic reaction to fungal allergens is suggested as an important contributing factor in the development of respiratory symptoms, other mechanisms, such as increased exposure to fungal metabolites, mycotoxins and other compounds of immuno-supressant or irritant properties, may also be important. Sensitivity to fungal allergens has been recognized as a risk factor for the development and persistence of asthma, asthma severity and potentially fatal asthma exacerbations, the increased number of episodes of respiratory arrest and admissions to intensive care unit. Thus far, the role of fungi as the dominant exogenous trigger of asthma has not been completely explored. Some authors suggest, that sensitization to fungal allergens is related with specific phenotype of severe asthma. It remains to be clarified, whether this association is caused by colonization of the airways with fungi or an extreme response to exogenous spores. This review critically discusses the present state of knowledge on the prevalence of IgE-mediated allergy to fungi, as well as the contribution of sensitization to fungi to the allergic manifestations, on the basis of the recent literature. We also try to assess the importance of these connections for the future treatment of allergic disorders of the respiratory tract

A patient with desquamative interstitial pneumonia as a rare case of idiopathic interstitial pneumonia

Samoistne śródmiąższowe zapalenia płuc to niejednorodna grupa chorób o podobnych objawach klinicznych. Podstawą ich obecnie stosowanej klasyfikacji są w głównej mierze różnice w obrazie histologicznym, jednak istotnym dopełnieniem całości procesu diagnostycznego, pomagającym w ustaleniu precyzyjnego rozpoznania, jest obraz tomograficzny o wysokiej rozdzielczości. Jedną z rzadziej występujących form samoistnego śródmiąższowego zapalenia płuc jest złuszczające śródmiąższowe zapalenie płuc występujące częściej u mężczyzn obciążonych wywiadem nikotynowym w 4.–5. dekadzie życia. W pracy przedstawiono przypadek 50-letniego mężczyzny przyjętego na Oddział Pneumonologii Śląskiego Uniwersytetu Medycznego w celu dalszej diagnostyki przewlekającego się obustronnego zapalenia płuc, z objawami upośledzonej tolerancji wysiłkowej, produktywnym kaszlem i stanami podgorączkowymi. Na podstawie wykonanych badań dodatkowych, zgodnych z zalecanym algorytmem postępowania diagnostycznego, obejmujących również wideotorakoskopię z pobraniem wycinków tkankowych, dokonano ostatecznego rozpoznania złuszczającego śródmiąższowego zapalenia płuc. Po zastosowaniu steroidoterapii systemowej obserwowano remisję choroby.The idiopathic interstitial pneumonias are a heterogeneous group of diseases that have similar clinical symptoms. The new classification is based mainly on differences in histologic patterns, however high-resolution computed tomography is a significant tool that helps in making a firm diagnosis. Desquamative interstitial pneumonia is relatively rare form idiopathic interstitial pneumonia. It affects mainly men in their fourth or fifth decade of life who have a history of smoking. We report a case of 50-years-old man admitted to hospital for further diagnosis of prolonged bilateral pneumonia. His main complaints were fatigue, productive cough and subfebrile body temperature. Having performed additional diagnostic procedures including videothoracoscopy, what was in accordance with contemporary guidelines, we achieved a final diagnosis of desquamative interstitial pneumonia. Treatment with systemic corticosteroids resulted in disease remission

Functional links between the upper and lower airways in allergic diseases of the respiratory tract

Zapalenie alergiczne układu oddechowego, pomimo tradycyjnego podziału na alergiczny nieżyt nosa i astmę oskrzelową, zazwyczaj nie ogranicza się do błony śluzowej jednego odcinka tego układu, często wykazując charakter uogólniony. Liczne, pochodzące z badań naukowych, dowody na istnienie związków pomiędzy alergicznym nieżytem nosa a astmą oskrzelową doprowadziły do stworzenia "koncepcji jednej choroby". Ujmuje ona górne i dolne drogi oddechowe jako łączną jednostkę, pozostającą pod wpływem procesu zapalnego, który podtrzymują i nasilają wspólne mechanizmy. Celem niniejszej pracy było krytyczne przedstawienie współczesnego stanu wiedzy na temat związków czynnościowych pomiędzy górnymi i dolnymi drogami oddechowymi, z uwzględnieniem wyników badań własnych. W pracy podjęto również próbę oceny znaczenia tych związków dla rozwoju diagnostyki i leczenia chorób alergicznych układu oddechowego.Traditionally, allergic rhinitis and bronchial asthma are described as distinct and separate entities. However, progress made in recent years has brought some great changes in the understanding of pathophysiology of allergic disorders. It has become clear that both of these disorders are characterised by similar triggers, inflammatory cells and mediators involved in their pathogenesis and treatment modalities. The link between these two airway disorders has led to the development of the socalled "integrated airway hypothesis". According to this hypothesis allergic rhinitis and bronchial asthma are regarded as different facets of a generalised inflammatory process involving, although in a different degree, both the upper and lower airways. This review critically discusses the present state of knowledge on the links between the upper and lower airways in asthma and rhinitis on the basis of the recent literature and our own experience. We try to assess the importance of these links for the future diagnosis and treatment of allergic disorders of the respiratory tract