Giant hiatal hernias.

Dyspnoea is most often caused by disorders of the respiratory and/or cardiovascular systems. Much less often it is brought about by the displacement of abdominal organs into the thoracic cage. Hiatal hernias may give rise to diagnostic difficulties, as both clinical and radiological symptoms suggest different disorders. Computed tomography is the method of choice when making a diagnosis. We have presented a series of 7 cases of giant hiatal hernias, each with a varying course of the disease, clinical symptoms, radiological features and prognoses. In two of the cases, the hernias were of a post-traumatic nature. Four cases of large diaphragmatic hernias were found in elderly patients (over 90 years old). An advanced age and numerous coexisting chronic diseases disqualified most of the patients from surgical treatment despite the hernias' large sizes. In only one case was fundoplication performed with a good end result. Two patients died, and an extensive hernia was the cause of one of the deaths. Upper gastrointestinal symptoms were present only in a few of the patients. An early diagnosis of giant hiatal hernia is crucial for the patients to undergo prompt corrective surgeries.

Clinical Manifestations of Huge Diaphragmatic Hernias.

Translocation of abdominal organs into the thoracic cavity may cause dyspnea, heart disorders, and gastric symptoms. Diaphragmatic hernias can cause diagnostic difficulties, since both clinical and radiological symptoms might imitate different disorders. In these cases computed tomography of the chest is the method of choice. The aim of this study was to assess clinical manifestations, risk factors, and prognosis in patients with huge diaphragmatic hernias with displacement of abdominal organs into the thorax, depending on the action taken. We carried out a retrospective study using data of patients hospitalized in the years 2012-2016. Ten patients were qualified for the study (8 women and 2 men). The mean age of the subjects was 86.5 ± 10.5 years. Thirty percent of the hernias were post-traumatic. All of the patients reported cardiovascular or respiratory symptoms. Upper gastrointestinal symptoms occurred in half of the patients. Twenty percent of patients underwent surgery with a positive outcome, while 30% of patients, who were not qualified for surgery due to numerous co-morbidities, died. The main risk factors predisposing to the occurrence of large diaphragmatic hernias were the following: old age, female gender, and thoracic cage deformities.

[Dyspnea in a patient after open reduction of fracture of the femur].

Acute dyspnoea in the postoperative period requires quick consideration of all possible causes and implementation of the proper treatment. During the differential diagnostic process, other than the most common cardio-pneumological and otolaryngological reasons, we should consider a whole array of rare causes such as neuromuscular illnesses, renal failure, and gastrointestinal diseases. This case is an example of sudden onset of dyspnoea presenting in a 67 year old woman with COPD. The dyspnoea occurred in first postoperative day after open reduction of fracture of the femur. Onset of respiratory insufficiency symptoms and circulatory instability appeared suddenly and advanced quickly, as result of a large Morgagni type retrosternal hernia, requiring urgent thoraco-surgical intervention. In the long term, the effects of this operation were very good.

[Vaccination against influenza in medical staff of Warsaw university hospitals and in students of Warsaw Medical University]. / Szczepienia przeciwko grypie personelu medycznego warszawskich szpitali klinicznych i studentów warszawskiego uniwersytetu medycznego.

BACKGROUND: According to CDC recommendations, medical staff should be vaccinated against influenza each year. The objective of this work was to establish the percentage of medical personnel and students vaccinated against influenza in two Warsaw university hospitals and Warsaw Medical University, to evaluate their level of awareness about the importance of vaccination and to identify reasons for not taking vaccines. MATERIAL AND METHODS: The anonymous questionnaire survey was conducted in the population of 166 physicians, 104 nurses and 254 students. RESULTS: Only 22.3% of physicians, 10.6% of nurses and 13.4% of students regularly take vaccines against influenza. Free of charge vaccination was offered to 19% of physicians, 15% of nurses and 6% of students. Awareness of the need for influenza vaccination and willingness to take free-of-charge vaccination were declared by 42% of nurses. Physicians justified their decisions not to undergo vaccination by no need to vaccinate, laziness and lack of time, nurses by no need to vaccinate and costs, and students by costs and laziness. CONCLUSIONS: The percentage of medical staff of Warsaw university hospitals who regularly take vaccines against influenza is low. In view of the reluctance to take influenza vaccines observed in the study population, there is an urgent need to intensify educational efforts to increase awareness of the importance to be vaccinated.

[Analysis of solitary pulmonary nodules found in chest radiograms]. / Analiza pojedynczych guzków pluca stwierdzonych w radiogramach klatki piersiowej.

INTRODUCTION: The detection of solitary pulmonary nodules (SPNs) has increased due to widespread use of computed tomography; nevertheless, chest radiographs still remain the basic routine examination. The aim of the study was to estimate the detection of SPNs in routine chest X-rays in hospitalized patients and to assess the incidence of malignancy in newly diagnosed SPNs. MATERIAL AND METHODS: We analyzed 5,726 routine chest radiographs of patients admitted to the Department of Internal Diseases, Pneumology and Allergology in 2004 and 2005. Most of the patients were admitted to hospital due to emergency reasons. The malignant nature of the nodules was confirmed by pathological examination. The nature of benign nodules was confirmed either by pathological examination or based on radiological criteria: no growth within 2 years of radiological follow up, regression in control radiograms or CT scans, benign pattern of calcification. RESULTS: Among the 5,726 radiograms we found 116 newly diagnosed SPNs (2.2%). Twenty-four nodules (21%) were malignant: NSCLC in 21 cases and metastases in 3 cases. Fifty-one nodules (44%) were benign. In 19 patients (16%) SPNs proved to be artefacts or erroneously interpreted extrathoracic lesions. In 22 cases (19%) there was no final diagnosis (lack of data, diagnostic procedure renunciation). CONCLUSION: The incidence of newly detected SPNs in chest X-rays was 2.2%. Most SPNs were benign. About 21% of SPNs were diagnosed as malignant.

[Bronchorrhea in a case of pneumonic type of bronchioloalveolar carcinoma]. / Sluzotok oskrzelowy w przebiegu pneumonicznej postaci raka oskrzelikowo-pecherzykowego.

The authors describe a case of 80-years old male hospitalized because of radiological and clinical signs suggestive of right-sided pneumonia. The main complaints of the patient were of productive cough with increasing amounts of watery sputum irregular fever up to 39 degrees C, progressive dyspnea, generalized weakness and loss of weight. Despite extensive use of antimicrobial and antituberculosis agents significant deterioration of patients general condition and the progression of X-ray picture were observed, inflammatory infiltration started to encompass the contralateral lung. Bronchial washing revealed the presence of atypical and neoplasmatic cells of adenous origin type. Since this finding contrasted with the pattern of radiological abnormality that did not show any tumor-like changes, another diagnostic approach was undertaken. Transthoracic fine needle aspiration biopsy revealed cells of non-small cell lung carcinoma. The diagnosis of bronchioalveolar carcinoma established on the basis of clinicoradiologic pattern was confirmed at autopsy. Increasing bronchorrhea was the most prominent symptom.