Advanced chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and the fourth cause of death in the world. Its advanced forms (severe - in case of FEV1 indicator below 50% of the norm and very severe — below 30%) usually lead to respiratory disability and premature death. The prognoses of those suffering from severe forms of COPD are no different from patients with lung cancer. The course of the disease is highly influenced by its exacerbation and co-morbidities, such as cardiovascular diseases, diabetes, lung cancer and peptic ulcer. Treatment aims at stopping the progress of disease, preventing its exacerbation and relieving tiresome symptoms, mainly dyspnoea, chronic cough and decreasing tolerance of effort.Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and the fourth cause of death in the world. Its advanced forms (severe - in case of FEV1 indicator below 50% of the norm and very severe - below 30%) usually lead to respiratory disability and premature death. The prognoses of those suffering from severe forms of COPD are no different from patients with lung cancer. The course of the disease is highly influenced by its exacerbation and co-morbidities, such as cardiovascular diseases, diabetes, lung cancer and peptic ulcer. Treatment aims at stopping the progress of disease, preventing its exacerbation and relieving tiresome symptoms, mainly dyspnoea, chronic cough and decreasing tolerance of effort

Review of Polish and international guidelines on hormonal therapy in localized prostate cancer

Prostate cancer is the second most common male malignancy in Poland. We present guidelines of Polish and international oncology and urology societies on hormonal therapy for localized prostate cancer

Anaphylaxis as a causative factor in loss of consciousness in an elderly woman. Mastocytosis - a case report

A female patient, 72-years-old with recurrent systemic hypotension, was admitted to the Allergology Department. She had long been diagnosed with urticaria pigmentosa. She also had a history of planoepithelial vaginal cancer, mitral valvular insufficiency and osteoporosis. Recurrent episodes of anaphylaxis and mastocytosis were diagnosed at the Department of Allergology. It is important to consider a systemic hypersensitivity reaction in differential diagnosis even in elderly patients, since it may mimic other medical emergencies. The unusual and broad spectrum of symptoms in mastocytosis usually requires the cooperation of different specialists.A female patient, 72-years-old with recurrent systemic hypotension, was admitted to the Allergology Department. She had long been diagnosed with urticaria pigmentosa. She also had a history of planoepithelial vaginal cancer, mitral valvular insufficiency and osteoporosis. Recurrent episodes of anaphylaxis and mastocytosis were diagnosed at the Department of Allergology. It is important to consider a systemic hypersensitivity reaction in differential diagnosis even in elderly patients, since it may mimic other medical emergencies. The unusual and broad spectrum of symptoms in mastocytosis usually requires the cooperation of different specialists

Pulmonary bleedings

Krwawienia z dróg oddechowych towarzyszą najczęściej zaawansowanym stadiom przewlekłych schorzeń układu oddechowego. Nasilone krwawienie, oprócz związanego z nim bezpośredniego zagrożenia, wywołuje na ogół u chorych poczucie silnego lęku i znacznie obniża jakość ich życia. Istotne jest zatem szybkie rozpoznanie przyczyny krwawienia i niezwłoczne podjęcie właściwego leczenia. Doraźne postępowanie obejmuje zabezpieczenie drożności oskrzeli, uspokojenie chorego, dożylne podanie 10–40 ml 10-procentowego roztworu NaCl, podanie leków przeciwkaszlowych i hamujących fibrynolizę, a także inhalacje roztworem epinefryny. Wskazane jest wykonanie bronchoskopii, co pozwala ustalić przyczynę i miejsce krwawienia, odessać zalegającą krew, usunąć skrzepy i podjąć próbę zatamowania krwawienia. W wybranych przypadkach należy rozważyć zabieg operacyjny. W leczeniu wspomagającym krwawień z dróg oddechowych stosuje się preparaty nasilające hemostazę i zwiększające biosyntezę protrombiny. Skuteczną metodą leczenia nawracających krwawień jest embolizacja naczyń tętniczych. W krwawieniach towarzyszących nowotworom układu oddechowego metodą z wyboru jest radioterapia wiązką zewnętrzną lub brachyterapia.Pulmonary bleedings typically accompany advanced chronic diseases of the respiratory system. Massive bleedings, apart form imminent threats, is associated with strong patient fear and considerably deteriorates quality of life. Immediate diagnosis and active therapy are therefore essential. Emergency measures include facilitating bronchial passage, sedation, intravenous injection of 10–40 ml of 10% NaCl solution, antitussive and antifibrinolitic agents, as well as epinephrine inhalations. Bronchoscopy should be attempted to establish the cause and localisation of bleeding, to allow blood aspiration and clot removal. In selected cases surgical intervention should be considered. Supportive therapy includes antihemostatic agents and compounds stimulating prothrombin synthesis. Effective palliative measure of recurrent pulmonary bleeding is vessel embolisation. Bleeding related to advanced lung cancer should primarily be managed with externalbeam irradiation or brachytherapy

Lack of association between serotonin transporter gene polymorphism 5-HTTLPR and smoking among Polish population: a case-control study

<p>Abstract</p> <p>Background</p> <p>A better understanding of the genetic determinants of tobacco smoking might help in developing more effective cessation therapies, tailored to smokers' genotype. Insertion/deletion polymorphism in the promoter region of the serotonin transporter gene (<it>5-HTTLPR</it>) has been linked to vulnerability to smoking and ability to quit. We aimed to determine whether <it>5-HTTLPR </it>genotype is associated with smoking behavior in Caucasians from Northern Poland and to investigate other risk factors for tobacco smoking.</p> <p>Methods</p> <p><it>5-HTTLPR </it>genotypes were determined in 149 ever smokers (66 females; mean age 53.0 years) and 158 gender and ethnicity matched never smoking controls (79 females; mean age 45.0 years) to evaluate the association of this polymorphism with ever smoking status. Analysis of smokers was performed to evaluate the role of <it>5-HTTLPR </it>in the age of starting regular smoking, the number of cigarettes smoked daily, pack-years, FTND score, duration of smoking, and the mean length of the longest abstinence on quitting. Genotype was classified according to the presence or absence of the short (<it>S</it>) allele vs. the long (<it>L</it>) allele of <it>5-HTTLPR </it>(i.e., <it>S/S </it>+ <it>S/L </it>vs. <it>L/L</it>). Logistic regression analysis was also used to evaluate correlation between ever smoking and several selected variables.</p> <p>Results</p> <p>We found no significant differences in the rates of <it>S </it>allele carriers in ever smokers and never smokers, and no relationship was observed between any quantitative measures of smoking and the polymorphism. Multivariate analysis demonstrated significant association between the older age (OR = 4.03; 95% CI: 2.33–6.99) and alcohol dependence (OR = 10.23; 95% CI: 2.09–50.18) and smoking.</p> <p>Conclusion</p> <p><it>5-HTTLPR </it>seems to be not a major factor determining cigarette smoking in Poles. Probably, the risk of smoking results from a large number of genes, each contributing a small part of the overall risk, while numerous non-genetic factors might strongly influence these genetic undergrounds of susceptibility to smoking.</p

The incidence of chronic obstructive pulmonary disease in advanced non-small cell lung cancer patients

Background and aim. Lung cancer is one of the most common tumours and the cause of cancer-related deaths in European countries. In the past few years, a significant morbidity of chronic obstructive pulmonary disease (COPD) has been noticed in this group of patients. Cigarette smoking is the strongest risk factor for both conditions. The palliative care of lung cancer patients is often based solely on the tumour symptoms' management, whereas some patients would benefit from the combined treatment including the treatment for COPD. The aim of this study was to evaluate the incidence of COPD in advanced (TNM = IIIB and IV) non-small cell lung cancer (NSCLC) patients. Material and methods. The study was a retrospective analysis. One hundred four patients (28 women and 76 men, aged from 47 to 74 years, mean: 63.2 years) with advanced NSCLC were included in the study. Results. Chronic obstructive pulmonary disease (according to GOLD criteria) was diagnosed in 26 cases (25%), including 1 mild, 17 moderate and 8 with severe or very severe disease. Chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other types (p = 0.009). Conclusions. Coexistence of lung cancer and COPD is frequent. Therefore, it is important to consider the treatment for COPD in palliative care of advanced lung cancer patients.Background and aim. Lung cancer is one of the most common tumours and the cause of cancer-related deaths in European countries. In the past few years, a significant morbidity of chronic obstructive pulmonary disease (COPD) has been noticed in this group of patients. Cigarette smoking is the strongest risk factor for both conditions. The palliative care of lung cancer patients is often based solely on the tumour symptoms' management, whereas some patients would benefit from the combined treatment including the treatment for COPD. The aim of this study was to evaluate the incidence of COPD in advanced (TNM = IIIB and IV) non-small cell lung cancer (NSCLC) patients. Material and methods. The study was a retrospective analysis. One hundred four patients (28 women and 76 men, aged from 47 to 74 years, mean: 63.2 years) with advanced NSCLC were included in the study. Results. Chronic obstructive pulmonary disease (according to GOLD criteria) was diagnosed in 26 cases (25%), including 1 mild, 17 moderate and 8 with severe or very severe disease. Chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other types (p = 0.009). Conclusions. Coexistence of lung cancer and COPD is frequent. Therefore, it is important to consider the treatment for COPD in palliative care of advanced lung cancer patients