Chronic obstructive pulmonary disease and cardiovascular diseases

Przewlekła obturacyjna choroba płuc (POChP) jest wiodącą przyczyną zachorowalności i umieralności na świecie. Chorzy na POChP należą do grupy zwiększonego ryzyka chorób sercowo-naczyniowych, osteoporozy i raka płuca. Chociaż pewne związki między POChP a miażdżycą mogą być wynikiem palenia papierosów, to dane epidemiologiczne sugerują, że upośledzenie funkcji płuc jest niezależnym od palenia tytoniu czynnikiem ryzyka śmierci z powodu chorób serca i naczyń. Zjawisko to może być spowodowane wspólnym uwarunkowaniem genetycznym, a także wpływem ogólnoustrojowej reakcji zapalnej u chorych na POChP na przyspieszony rozwój miażdżycy naczyń. W pracy przytoczono również wstępne dane dotyczące możliwości modyfikacji przebiegu POChP poprzez zastosowanie statyn.Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Patients with COPD are at increased risk of cardiovascular diseases, osteoporosis and lung cancer. Although some of the associations between COPD and atherosclerosis may be the result of common risk factors such as smoking, epidemiological evidence suggest that impaired lung function is a risk factor for increased cardiovascular death, independent of tobacco use. This phenomenon may be related to common genetic predisposition for atherosclerosis and emphysema. Chronic obstructive pulmonary disease, like atherosclerosis, is a disease of systemic inflammation and may hasten the progression of atherosclerosis and contribute to the higher rate of death in COPD. This article reviews close relationship between COPD and cardiovascular diseases, mainly atherosclerosis. The authors also present some preliminary data suggesting a possible influence of statin therapy on the clinical course of COPD

Suppression of chronic nocturnal cough during continuous positive airway pressure (CPAP) treatment in a patient with asthma and obstructive sleep apnea syndrome

bezdechu śródsennego (OBŚ). Jest coraz więcej doniesień wskazujących na zależność przewlekłego nocnego kaszlu od występowania zaburzeń oddechowych w czasie snu charakterystycznych dla zespołu OBŚ. Przedstawiono przypadek 59-letniego otyłego mężczyzny (BMI 38,6 kg/m2) cierpiącego na astmę i przewlekły nocny kaszel, który nie ustępował mimo stosowania optymalnego leczenia przeciwastmatycznego. Na podstawie badania czynności oddechowej w czasie snu rozpoznano zespół OBŚ o umiarkowanym nasileniu i rozpoczęto leczenie za pomocą aparatu utrzymującego ciągłe dodatnie ciśnienie w drogach oddechowych (CPAP), uzyskując ustąpienie nocnego kaszlu. Korzystny efekt zastosowania CPAP w zapobieganiu napadom nocnego kaszlu potwierdzono także po roku stosowania dodatniego ciśnienia w drogach oddechowych. Opis tego przypadku wskazuje, że uzasadnione jest uwzględnianie zespołu OBŚ w diagnostyce przewlekłego nocnego kaszlu, w tym także u chorych na astmę. Zastosowanie CPAP, zapobiegające wystąpieniu okresów spłyconego oddechu i bezdechów śródsennych, może prowadzić również do ustąpienia przewlekłego nocnego kaszlu. Pneumonol. Alergol. Pol. 2011; 79, 2: 121-126Sleep disruption is a common feature both in the patients with chronic cough and in the patients with obstructive sleep apnea syndrome (OSAS). There is increasing body of evidence that chronic nocturnal cough may be related to OSAS. We describe a 59 years old, obese man (BMI 38,6 kg/m2) with asthma and chronic nocturnal cough not responding to the optimal anti-asthmatic treatment. On the basis of nocturnal polysomnography moderate form of the OSAS has been diagnosed and the treatment with continuous positive airway pressure (CPAP) has been started. All the nocturnal symptoms, including cough, disappeared. The effect of CPAP in preventing nocturnal cough persisted at the follow-up visit after a year since diagnosis. This case indicates that nocturnal cough may be an important symptom of the OSAS and CPAP treatment - by abolishing sleep apneas and hypopneas - may also prevent chronic cough during sleep. Pneumonol. Alergol. Pol. 2011; 79, 2: 121-12

Galectin-3 and cyclin D1 expression in non-small cell lung cancer

<p>Abstract</p> <p>Introduction</p> <p>Lung cancer is a major cause of mortality and morbidity worldwide. Galectin-3 is multifunctional protein, which is involved in regulation of cell growth, cell adhesion, cell proliferation, angiogenesis and apoptosis. Cyclin D1 together with other cyclin plays an important role in cell cycle control. Cyclin D1 regulates the G1-to-S phase transition. The aim of this study was the evaluation of correlations between clinicopathological findings and cyclin D1 and galectin-3 expression in non-small cell lung cancer (NSCLC). We wanted also to analyze the prognostic value of cyclin D1 and galectin-3 expression. Moreover we tried to evaluate the correlations between galectin-3 and cyclin D1 expression in tumor tissue.</p> <p>Materials and methods</p> <p>We used the immunochemistry method to investigate the expression of galectin-3 and cyclin D1 in the paraffin-embedded tumor tissue of 47 patients (32 men and 15 women; mean age 59.34 ± 8.90). years. We used monoclonal antibodies to cyclin D1 (NCL-L-cyclin D1-GM clone P2D11F11 NOVO CASTRA) and to galectin-3 (mouse monoclonal antibody NCL-GAL3 NOVO CASTRA).</p> <p>Results</p> <p>Galectin-3 expression was positive in 18 cases (38.29%) and cyclin D1 in 39 (82.97%). We showed only weak trend, that galectin-3 expression was lower in patients without lymph node involvement (p = 0.07) and cyclin D1 expression was higher in this group (p = 0.080). We didn't reveal differences in cyclin D1 and galectin-3 expression in SCC and adenocarcinoma patients. We didn't demonstrated also differences in galectin-3 and cyclin D1 expression depending on disease stage. Moreover we analyzed the prognostic value of cyclin D1 expression and galectin-3 in all examinated patients and separately in SCC and in adenocarcinoma and in all stages, but we didn't find any statistical differences. We demonstrated that in galectin-3 positive tumors cyclin D1 expression was higher (96.55% vs 61.11%, Chi²Yatesa 7.53, p = 0.0061) and we revealed negative correlation between cyclin D1 and galectin-3 expression (R Spearman -0.458, p = 0.0011). In squamous cell lung cancer we didn't observed correlations between these both examinated markers (R = -0.158, p = 0.460), and in adenocarcinoma the negative correlation was very strong (R = -0.829 p = 0.000132).</p> <p>Conclusions</p> <p>We didn't reveal any important correlations between clinicopathological findings and galectin-3 and cyclin D1 expression and in non small cell lung cancer. We didn't observed also prognostic value of cyclin D1 or galectin-3 expression. But we showed higher cyclin D1 expression in galectin-3 negative tumor tissues. We revealed also differences in correlations between galectin-3 and cyclin D1 expression in two main histopathological types of NSCLC.</p

Suppresion of Chronic Nocturnal Cough during Continuous Positiveairway Pressure (CPAP) Treatment in a Patient with Asthma Andobstructive Sleep Apnoea Syndrome

Sleep disruption may develop in patients suffering from chronic cough and in patients with obstructive sleep apnoea syndrome (OSAS). An increasing number of reports are being published that suggest a relationship between chronic nocturnal cough and the occurrence of breathing disorders during sleep characteristic of OSAS. We report a case of a 59-year-old obese male (BMI 38.6 kg/m2) suffering from asthma and chronic nocturnal cough irresponsive to optimal asthma treatment. Based on an examination of the patient’s breathing function during sleep we established the diagnosis of moderate OSAS and initiated continuous positive airway pressure (CPAP) treatment, as a result of which the cough resolved. The successful outcome of using CPAP in preventing episodes of nocturnal cough was further confirmed after a year of CPAP use. This case report justifies the inclusion of OSAS in the differential diagnosis of nocturnal cough, including nocturnal cough in asthma patients. The use of CPAP, which prevents the development of apnoeas and hypopnoeas, may also lead to the resolution of chronic nocturnal cough

Nocturnal Hypoventilation in the Patients Submitted to Thoracic Surgery

Introduction. Nocturnal hypoventilation may occur due to obesity, concomitant chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and/or the use of narcotic analgesics. The aim of the study was to evaluate the risk and severity of nocturnal hypoventilation as assessed by transcutaneous continuous capnography in the patients submitted to thoracic surgery. Materials and Methods. The material of the study consisted of 45 obese (BMI 34.8 ± 3.7 kg/m2) and 23 nonobese (25.5 ± 3.6 kg/m2) patients, who underwent thoracic surgery because of malignant (57 patients) and nonmalignant tumors. All the patients received routine analgesic treatment after surgery including intravenous morphine sulfate. Overnight transcutaneous measurements of CO2 partial pressure (tcpCO2) were performed before and after surgery in search of nocturnal hypoventilation, i.e., the periods lasting at least 10 minutes with tcpCO2 above 55 mmHg. Results. Nocturnal hypoventilation during the first night after thoracic surgery was detected in 10 patients (15%), all obese, three of them with COPD, four with high suspicion of moderate-to-severe OSA syndrome, and one with chronic daytime hypercapnia. In the patients with nocturnal hypoventilation, the mean tcpCO2 was 53.4 ± 6.1 mmHg, maximal tcpCO2 was 59.9 ± 8.4 mmHg, and minimal tcpCO2 was 46.4 ± 6.7 mmHg during the first night after surgery. In these patients, there were higher values of minimal, mean, and maximal tcpCO2 in the preoperative period. Nocturnal hypoventilation in the postoperative period did not influence the duration of hospitalization. Among 12 patients with primary lung cancer who died during the first two years of observation, there were 11 patients without nocturnal hypoventilation in the early postoperative period. Conclusion. Nocturnal hypoventilation may occur in the patients after thoracic surgery, especially in obese patients with bronchial obstruction, obstructive sleep apnea, or chronic daytime hypercapnia, and does not influence the duration of hospitalization