Cień krągły pojedynczy w płucu. Podejście praktyczne w podstawowej opiece zdrowotnej

Pojedynczy cień okrągły w płucu (SPN) jest to zmiana płucna o średnicy do 3 cm uwidoczniona w miąższu płuca, której nie towarzyszy powiększenie węzłów chłonnych wnęk, niedodma lub wysięk w jamie opłucnej. SPN często jest uwidaczniany przypadkowo podczas rutynowego zdjęcia klatki piersiowej lub podczas badania tomograficznego klatki piersiowej. W pracy przedstawiono zasady rozpoznawania i różnicowania pojedynczego guzka płuca. Forum Medycyny Rodzinnej 2011, tom 5, nr 3, 217–22

Nowe spojrzenie na montelukast - lek antyleukotrienowy

Leki antyleukotrienowe stanowią stosunkowo nową grupę leków o działaniu przeciwzapalnym. Od kilku lat z powodzeniem są stosowane w leczeniu chorych na astmę i astmę z współistniejącym alergicznym nieżytem nosa. Znajdują również zastosowanie w przypadku innych schorzeń o podłożu alergicznym (pokrzywka, atopowe zapalenie skóry). Odznaczają się szerokim profilem bezpieczeństwa oraz nieznacznymi działaniami niepożądanymi. Z tego względu mogą stanowić uzupełnienie lub alternatywę dla glikokortykosteroidów

Uporczywy kaszel — trudności diagnostyczno-terapeutyczne w codziennej praktyce lekarskiej

A cough is natural, defensive and desirable reflex which provides clearance of secretionsand prevents the lower airways from the aspiration of foreign bodies. Chronic cough, lastingespecially more than 8 week is a significant problem for patients and it is a commoncause of looking for medical advice from various medical specialists. The persistent coughcauses perception of discomfort by patients, disorders of other organs and reduces qualityof life. The complex etiology of chronic cough in some situations can lead to difficulties withrecognition a cause of persistent cough. The diagnosis of long-lasting cough occasionallyneeds interdisciplinary cooperation of different medical specialties. This article describesbasic etiological and clinical aspects of chronic cough and giv es simple advices how todiagnose and treat patients whit this symptom.   Kaszel stanowi naturalny odruch obronny organizmu. Jest pożądan ym odruchem umoż­liwiającym usuwanie nadmiaru wydzieliny oraz zapobiegającym pr zedostawaniu się ciał obcych do dolnych odcinków dróg oddechowych. Kaszel, szczególnie, uporczywy, przewlekły, trwający powyżej ośmiu tygodni stanowi znaczący problemem dla chorego i częstą przyczynę wizyt u lekarzy różnych specjalności. Uporczywy kaszel powoduje znaczący dyskomfort, dolegliwości z różnych narządów oraz wyraźnie obniża jakość życia. Etiologia kaszlu bywa złożona, dlatego w niektórych sytuacjach trudno wykryć jego przyczynę. Diagnostyka upo­rczywego kaszlu wymaga czasami interdyscyplinarnego działania i współpracy klinicystów różnych specjalności. W pracy omówiono podstawowe aspekty etiopatogenetyczne, kliniczne oraz podano podstawowe zasady leczenia uporczywego kaszlu

Rozpowszechnienie palenia tytoniu i przewlekłej obturacyjnej choroby płuc w Polsce

  Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the world, is responsible for considerable morbidity and deterioration of quality of life of patients. COPD is characterized by persistent air flow limitation. Some risk factors, with tobacco smoking as the most serious one, lead to a chronic, systemic inflammation that plays the main role in the pathogenesis of COPD and comorbidities, including cardiovascular diseases. There is evident correlation between the duration and intensity of smoking and severity of COPD. Smoking cessation is the most effective in slowing down the progression of COPD and improving the control of asthma and is related to a decrease of death risk in both diseases. In this paper the authors discuss prevalence of smoking and COPD in Poland.Przewlekła obturacyjna choroba płuc (POChP) jest powszechnie występującym schorzeniem układu oddechowego. Choroba zajmuje czwarte miejsce w świecie wśród najczęstszych przyczyn zgonów, jest przyczyną pogorszenia jakości życia chorych. Głównym czynnikiem odpowiedzialnym za rozwój choroby jest palenia tytoniu. Choroba charakteryzuje się upośledzeniem przepływu powietrza przez drogi oddechowe. Czynniki ryzyka, w tym przede wszystkim palenie tytoniu, prowadzą do rozwoju przewlekłego, ogólnoustrojowego procesu zapalnego, który pełni główną rolę w patogenezie zarówno POChP, jak i wielu chorób towarzyszących, w tym sercowo-naczyniowych. Istnieją dowody pomiędzy długością i intensywnością palenia tytoniu a ciężkością POChP. Zaprzestanie palenia tytoniu jest efektywną metodą spowolnienia progresji choroby i poprawy jej kontroli. W pracy autorzy przedstawili dane dotyczące rozpowszechnienia palenia tytoniu i POChP w Polsce

Difficulties in management of tuberculous pneumonia in a patient with liver failure in the course of chronic hepatitis B and concomitant failure of the transplanted kidney

A 62-year-old woman with liver failure in the course of chronic hepatitis B and concomitant failure of the transplanted kidney was treated for tuberculous pneumonia. The treatment was initiated with rifampin, isoniazid and pyrazinamide. Both renal and hepatic side effects required modification of this scheme. After 1 month of treatment sputum smears tested for acid-fast bacilli converted to a negative result and the chest X-ray demonstrated complete resolution of pulmonary infiltrates. Further therapy resulted in serious deterioration of the liver failure and fatal outcome.A 62-year-old woman with liver failure in the course of chronic hepatitis B and concomitant failure of the transplanted kidney was treated for tuberculous pneumonia. The treatment was initiated with rifampin, isoniazid and pyrazinamide. Both renal and hepatic side effects required modification of this scheme. After 1 month of treatment sputum smears tested for acid-fast bacilli converted to a negative result and the chest X-ray demonstrated complete resolution of pulmonary infiltrates. Further therapy resulted in serious deterioration of the liver failure and fatal outcome

Hepatic hydrothorax - complication of end-stage hepatic cirrhosis

62-year-old woman admitted to the hospital with dyspnoea, elevated body temperature, cough for two days. Patient has been treated for alcoholic hepatic sclerosis for 12 years and hepatitis C infection for 5 years. The chest X-ray revealed hydrothorax of right pleura. Continuous drainage of the right pleura was applied. In spite of intensive treatment effusion excuded 1000 ml/day making pleurodesis impossible, and eventually pleuro-peritoneal shunt was performed. Shunt drainage however turned out to be insufficient to evacuate the pleural fluid. The shunt was removed and continuous pleural drainage was reopen. Due to subsequent disseminated intravascular coagulation, patient was treated with fresh frozen plasma, heparin, blood and platelets. The clinical status alleviated, but patient still required chest tube because of the refractory hydrothorax.62-year-old woman admitted to the hospital with dyspnoea, elevated body temperature, cough for two days. Patient has been treated for alcoholic hepatic sclerosis for 12 years and hepatitis C infection for 5 years. The chest X-ray revealed hydrothorax of right pleura. Continuous drainage of the right pleura was applied. In spite of intensive treatment effusion excuded 1000 ml/day making pleurodesis impossible, and eventually pleuro-peritoneal shunt was performed. Shunt drainage however turned out to be insufficient to evacuate the pleural fluid. The shunt was removed and continuous pleural drainage was reopen. Due to subsequent disseminated intravascular coagulation, patient was treated with fresh frozen plasma, heparin, blood and platelets. The clinical status alleviated, but patient still required chest tube because of the refractory hydrothorax

Case report of Churg-Strauss syndrome - signs and symptoms suggesting disseminated neoplasmatic disease

Churg-Strauss syndrome (CSS) is characterized by asthma, sinusitis, hypereosinophilia and eosinophilic infiltrates, with particular pulmonary, gastrointestinal, neural and cardiovascular involvement. We presented a case of CSS complicated by weight loss, pulmonary embolism and non-traumatic rib fractures. The case confirms that the clinical course of the disease is highly heterogeneous.Churg-Strauss syndrome (CSS) is characterized by asthma, sinusitis, hypereosinophilia and eosinophilic infiltrates, with particular pulmonary, gastrointestinal, neural and cardiovascular involvement. We presented a case of CSS complicated by weight loss, pulmonary embolism and non-traumatic rib fractures. The case confirms that the clinical course of the disease is highly heterogeneous

Usefulness of exercise test and peak inspiratory flow (PIF) measurement in diagnosis and management of bronchial asthma

The purpose of this manuscript is to define the benefit of exercise test and peak inspiratory flow (PIF) measurement in adult patients with bronchial asthma. Seventy-seven patients – forty-seven from examined group (21 women, 26 men) and thirty patients from control group (8 women, 22 men) participated in this study. Exercise tests (ET) were performed in all subjects in the beginning of the study (ET1) then repeated two months later (ET2) only to the examined group. Patients exercised on a bicycle ergometer for 8-10 minutes to increase the hart rate to submaximal level. Spirometry were performed before and after the study and 5, 10, 15 and 20 minutes later. Symptoms of asthma after exercise and forced expiratory flow in one second (FEV1) decrease more then 15% of predicted value confirmed the diagnosis(positive test result).Thirty patients (74,4%) from examined group had positive results in ET1 and twelve (25,5%) – negative. Four patients (10%) were positive in ET2 and thirty-six (90%) – negative. ΔFEV1 decrease in ET2 was (-14,78%), in ET2 (-4,45%)

Difficult-to-treat asthma - an uncontrolled disease. Is there any relation to the experience from palliative medicine?

Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in spite of intensive treatment (corticosteroids and long-acting β2-agonists) for at least 6 months and is connected with severe obturation in the bronchotracheal tree. It still creates an important global medical and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms, exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging idea to apply palliative medicine to help patients with this type of asthma. Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60) diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All patients’ spirometries and additional factors were assessed. Results. The median predicted value of FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 lower than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists (SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized: obesity and hypertension. Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant part in the course of asthma. It seems to be necessary to introduce a unified system of registering and managing patients with severe and difficult-to-treat asthma. That palliative care is very important for selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned clinical trials.Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in spite of intensive treatment (corticosteroids and long-acting β2-agonists) for at least 6 months and is connected with severe obturation in the bronchotracheal tree. It still creates an important global medical and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms, exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging idea to apply palliative medicine to help patients with this type of asthma. Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60) diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All patients’ spirometries and additional factors were assessed. Results. The median predicted value of FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 lower than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists (SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized: obesity and hypertension. Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant part in the course of asthma. It seems to be necessary to introduce a unified system of registering and managing patients with severe and difficult-to-treat asthma. That palliative care is very important for selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned clinical trials