A 30-year history of a patient with bronchiectasis

Rozstrzenie oskrzeli charakteryzuje nieodwracalne rozszerzenie oskrzeli, nawracające infekcje dróg oddechowych, kaszel z odkrztuszaniem wydzieliny oraz duszność. Czynniki powodujące powstanie rozstrzeni są różnorodne. Leczenie obejmuje: leczenie przyczynowe, antybiotykoterapię, higienę drzewa oskrzelowego oraz rzadko - leczenie chirurgiczne. Długość czasu przeżycia wiąże się z współwystępowaniem innych chorób oraz rozwojem powikłań rozstrzeni oskrzeli. W artykule przedstawiono przypadek chorego na rozstrzenie oskrzeli. Wykonywane w czasie wieloletniej obserwacji RTG klatki piersiowej oraz analiza objawów i wyników badań czynnościowych płuc wskazują na stopniową progresję choroby leczonej standardowymi metodami.We describe the long-term course of a patient with bronchiectasis. Sequential chest X-rays, symptoms, spirometry and blood gas analysis obtained during the observation period showed gradual progression. Conservative medical management was implemented in the treatment of described patient. Bronchiectasis is a disease characterised by irreversible dilation of airways, repeated respiratory infections, productive cough and dyspnoea caused by a variety of factors. The foundations of therapy include administration of antibiotics, treatment of underlying conditions, bronchial hygene and rarely - surgery. Survival in bronchiectasis depends on presence of comorbidities and complications of lung disease

The coexistence of the impaired exercise tolerance in patients with obstructive sleep apnea with gastroesophageal reflux

Wstęp: U chorych na obturacyjny bezdech senny (OBS) często stwierdza się refluks żołądkowo-przełykowy (RŻP), co pogarsza ich komfort życia i wymaga dodatkowego leczenia. Postanowiono sprawdzić, czy obniżenie tolerancji wysiłku u tych chorych ma związek z występowaniem i zaawansowaniem kwaśnego refluksu żołądkowo-przełykowego. Materiał i metody: Zbadano 18 chorych (6K i 12 M) w wieku średnio 55 ± 9 lat, z ciężką postacią OBS, wskaźnik bezdechów i spłycenia oddychania (AHI) wynosił średnio 44 ± 22. Wszyscy byli leczeni z powodu chorób metabolicznych i/lub nadciśnienia tętniczego lub przewlekłej choroby wieńcowej. U wszystkich chorych, poza ogólną oceną stanu zdrowia, stanu układu krążenia i oddychania, wykonano gastroskopię, 24-godzinne badanie pH w dolnym odcinku przełyku (pHmetria) i 6-minutowy test chodu (6MWT). Wyniki: U 12 badanych rozpoznano RŻP. U 14 chorych gastroskopia wykazała zmiany zapalne przełyku (w tym u 3, u których nie stwierdzono refluksu). Chorzy z RŻP w porównaniu z chorymi bez RŻP mieli nieco bardziej nasilony OBS (AHI — 46 ± 24 vs. 39 ± 18), byli nieco młodsi (53 ± 7 vs. 59 ± 11 lat), bardziej otyli (BMI - 38 ± 5 vs. 36 ± 9 kg/m2), a podczas 6MWT pokonali mniejszy dystans (różnica w odsetku wartości należnej: 78 ± 17% vs. 86 ± 22%) i pod koniec wysiłku mieli niższe wysycenie krwi tętniczej tlenem - SaO2: 91 ± 3% vs. 94 ± 3%. Wnioski: Mimo pewnych różnic w tolerancji wysiłku u chorych na OBS z RŻP i bez RŻP, nie stwierdzono statystycznie istotnych zależności między występowaniem RŻP a upośledzoną tolerancją wysiłku. W celu pełnego wyjaśnienia problemu wskazane byłoby zbadanie większej grupy chorych.Introduction: Gastroesophageal reflux (GERD) is a frequent disease in patients with obstructive sleep apnea (OSA). The aim of the study was to evaluate possible correlation between the impairement of exercise tolerance and GERD. Material and methods: We examined 18 patients with OSA, mean AHI - 44 ± 22; 6 females, 12 males, mean age 55 ± 9 years. All patients were treated for metabolic disorders and for hypertension or coronary artery disease. In all patients gastroscopy was performed with 24h pHmetry and 6MWT. Results: In 12 patients GERD was found, in 14 patients esophagitis was diagnosed (among them there were 3 patients without GERD). Patients with GERD were younger (53 ± 7 vs. 59 ± 11 years) and more obese (BMI - 38 ± 5 vs. 36 ± 9 kg/m2). During 6MWT the distance covered was shorter (in % of normal values) in GERD subjects: 78 ± 17 vs. 86 ± 22%) and desaturation was deeper (91 ± 3 vs. 94 ± 3%). Conclusions: Despite some tendencies the relationship between GERD and impairement of exercise tolerance in OSA patients was not statistically significant. Perhaps study in larger group of subjects will be more reliable

Gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnoea syndrome (OSAS)

Gastroesophageal reflux disease (GERD) is a common cause of chronic cough, heartburn, epigastric or retrosternal discomfort, chest pain and abdominal pain or esophagitis. Our patients with OSAS seldom manifest GERD symptoms. We suspected that obesity and high pressure in abdominal cavity may induce acid gastroesophageal reflux in these patients. The aim of the study was to test the hypothesis that obesity, cigarettes smoking or ventilatory and gas exchange abnormalities provoke GERD. We studied 21 consecutive patients with severe OSAS (mean AHI 44.9±23.8) before CPAP treatment, all without GERD clinical symptoms. Standard polysomnography, gastroscopy and 24-h oesophageal pH monitoring was performed. There were 6 females, 15 males, mean age 57±9 years, mean BMI 38±6 kg/m2. All patients presented with normal spirometric and gas exchange values (mean VC 3.64±1.23 1, 90% of normal, mean FEV1 2.61±0.95 1, 83% of normal, mean FEV1%VC 72%, mean PaO2 68.1±7.7 mmHg, mean PaCO2 40.8±5.8 mmHg, mean pH 7.42±0.02). GERD was diagnosed in 14 patients. Patients with GERD were younger, more often were cigarettes smokers (5/14). We did not fi nd statistically signifi cant differences between severity of OSAS, BMI, ventilatory or gas exchange parameters and GERD

Odosobniony guz włóknisty opłucnej u 75-letniej chorej

A 75-year-old asymptomatic woman with stable coronary heart disease presented tumor in lower left lobe on routine chest radiograph. A CT scan showed a large sharply delineated mass at this site (84 x 52 x 90 mm). There were no signs of infiltration, no abnormalities were seen in mediastinal structures and on the right side. The pedunculated tumor was resected during left thoracotomy (posterolateral incision). Histological examination revealed spindle-like cells and rich collagen net. Mitoses and necrosis were absent. Final diagnosis was: solitary fibrous tumor of the visceral pleura. During 7-year follow-up recurrence was not observed

Gemcitabine Peptide-Based Conjugates and Their Application in Targeted Tumor Therapy

A major obstacle in tumor treatment is associated with the poor penetration of a therapeutic agent into the tumor tissue and with their adverse influence on healthy cells, which limits the dose of drug that can be safely administered to cancer patients. Gemcitabine is an anticancer drug used to treat a wide range of solid tumors and is a first-line treatment for pancreatic cancer. The effect of gemcitabine is significantly weakened by its rapid plasma degradation. In addition, the systemic toxicity and drug resistance significantly reduce its chemotherapeutic efficacy. Up to now, many approaches have been made to improve the therapeutic index of gemcitabine. One of the recently developed approaches to improve conventional chemotherapy is based on the direct targeting of chemotherapeutics to cancer cells using the drug-peptide conjugates. In this work, we summarize recently published gemcitabine peptide-based conjugates and their efficacy in anticancer therapy

Gemcitabine Peptide-Based Conjugates and Their Application in Targeted Tumor Therapy

A major obstacle in tumor treatment is associated with the poor penetration of a therapeutic agent into the tumor tissue and with their adverse influence on healthy cells, which limits the dose of drug that can be safely administered to cancer patients. Gemcitabine is an anticancer drug used to treat a wide range of solid tumors and is a first-line treatment for pancreatic cancer. The effect of gemcitabine is significantly weakened by its rapid plasma degradation. In addition, the systemic toxicity and drug resistance significantly reduce its chemotherapeutic efficacy. Up to now, many approaches have been made to improve the therapeutic index of gemcitabine. One of the recently developed approaches to improve conventional chemotherapy is based on the direct targeting of chemotherapeutics to cancer cells using the drug-peptide conjugates. In this work, we summarize recently published gemcitabine peptide-based conjugates and their efficacy in anticancer therapy

Trzydziestoletnia obserwacja chorego na rozstrzenie oskrzeli

Rozstrzenie oskrzeli charakteryzuje nieodwracalne rozszerzenie oskrzeli, nawracające infekcje dróg oddechowych, kaszel z odkrztuszaniem wydzieliny oraz duszność. Czynniki powodujące powstanie rozstrzeni są różnorodne. Leczenie obejmuje: leczenie przyczynowe, antybiotykoterapię, higienę drzewa oskrzelowego oraz rzadko—leczenie chirurgiczne. Długość czasu przeżycia wiąże się z współwystępowaniem innych chorób oraz rozwojem powikłań rozstrzeni oskrzeli. W artykule przedstawiono przypadek chorego na rozstrzenie oskrzeli. Wykonywane w czasie wieloletniej obserwacji RTG klatki piersiowej oraz analiza objawów i wyników badań czynnościowych płuc wskazują na stopniową progresję choroby leczonej standardowymi metodami

The Coexistence of the Impaired Exercise Tolerance in Patients with Obstructive Sleep Apnea with Gastroesophageal Reflux

Introduction: Gastroesophageal reflux (GERD) is a frequent disease in patients with obstructive sleep apnea (OSA). The aim of the study was to evaluate possible correlation between the impairement of exercise tolerance and GERD. Material and methods: We examined 18 patients with OSA, mean AHI—44 ± 22; 6 females, 12 males, mean age 55 ± 9 years. All patients were treated for metabolic disorders and for hypertension or coronary artery disease. In all patients gastroscopy was performed with 24h pHmetry and 6MWT. Results: In 12 patients GERD was found, in 14 patients esophagitis was diagnosed (among them there were 3 patients without GERD). Patients with GERD were younger (53 ± 7 vs. 59 ± 11 years) and more obese (BMI—38 ± 5 vs. 36 ± 9 kg/m2). During 6MWT the distance covered was shorter (in % of normal values) in GERD subjects: 78 ± 17 vs. 86 ± 22%) and desaturation was deeper (91 ± 3 vs. 94 ± 3%). Conclusions: Despite some tendencies the relationship between GERD and impairement of exercise tolerance in OSA patients was not statistically significant. Perhaps study in larger group of subjects will be more reliable