Relationship between air pollution and metal levels in cancerous and non-cancerous lung tissues.

We aimed to check the relationships between levels of metals (Ca, Cd, Cu, Fe, Hg and Zn) in cancerous and non-cancerous lung tissues and their link to air pollution, expressed as particulate matter (PM) concentrations. The study also examines the influence on metal concentration in the lung tissue of patients' sex and the distance of their homes from the nearest emitter. We found that the general pattern of ascending concentrations in tumor tissue was as follows: Hg < Cd < Cu < Ca < Zn < Fe. In non-affected lung tissue the order of concentrations of Ca and Fe was reversed. With the exception of Cd and Cu, levels of metals were found in higher accumulations in non-cancerous tissue (e.g., Fe 326.423 and Ca 302.730 µg/g d.w) than in tumorous tissue (Fe 150.735 and Ca 15.025 µg/g d.w). Neither the PM10 (PM of a diameter of 10 µm) concentration nor sex revealed any connection with metal concentrations. The shorter the distance from the emitter, the higher the metal concentrations that tended to be observed for almost all metals, but a statistically significant (but weak) relationship was noted only for Cu in tumor tissue (rs: -0.4869).

Can pancreatic tissue cause haemoptysis?

A mature teratoma is a tumour of primary germ cells. It is often found in the mediastinum. The authors describe a case of a young man who demonstrated haemoptysis as the only symptom of a mediastinal tumour. The tumour was removed operatively, sent for histopathological examination and immunohistochemistry. The removed tumour was a mature teratoma including elements of the pancreas. The authors revealed the presence of trypsin in the pancreatic acinar cells. The proteolytic activity of the tumour was taken as the cause of haemoptysis because of enzymatic erosion of lung tissue intimately attached to the tumour. In such cases surgical removal saves life of patients.

Accumulation of metals in cancerous and healthy tissues of patients with lung cancer in Southern Poland.

The aim of this study was to investigate whether the concentrations of metals differ among patients with and without lung cancer with different smoking status and living in industrialized environments. We also evaluated the relationships between metals and blood parameters including hematocrit level (Hct), hemoglobin concentration (Hb), red (RBC) and white (WBC) blood cells numbers. Concentrations of metals were measured with AAS (copper - Cu, iron - Fe, magnesium - Mg, zinc - Zn) and CV-AAS (mercury - Hg). Neither smoking status nor industrialization could be considered as a significant factor for metals accumulation in blood, lungs and tumor tissues, with the exception of mercury which differed in the aspect of industrialization. According to the type of the disease, Fe, Hg and Mg concentrations differed significantly in lungs. Correlations between metals and blood parameters were observed. Additionally, concentrations of Mg, Cu and Zn were correlated between lungs and tumor tissue of patients with cancer as well as they all were related to each other in lungs, tumor and blood tissues.

[Diagnostic difficulties in diagnosis of Hodgkin's disease in a young man--a case report]. / Trudnosci diagnostyczne w rozpoznaniu ziarnicy zlosliwej sródpiersia u mlodego mezczyzny--opis przypadku.

UNLABELLED: Lymphomas are neoplasms of lymphocytes and their precursor cells. This disease develops from lymph nodes or extranodal lymphoid tissue. A common site for such a tumour is the chest. The authors describe the case of a young man, who was admitted do the thoracic surgery department with a mediastinal tumour and an induration of the base of the neck. Initial diagnostic tests gave the wrong diagnosis of actinomycosis. A lack of progress in the therapy and the occurrence of a life-threatening condition led to the implementation of more aggressive diagnostic methods. In biopsies taken during thoracotomy, the patient was finally diagnosed with Hodgkin's lymphoma of nodular sclerosis type. CONCLUSIONS: Mediastinal tumours may cause diagnostic difficulties and, to avoid mistakes, typical histological studies should be complemented by targeted immunohistochemical tests.

[Granulomatous pneumonia as a complication of intravesical BCG immunotherapy--a case report]. / Zapalenie ziarniniakowe pluc jako powiklanie leczenia dopecherzowymi wlewkami BCG--opis przypadku.

BCG (Bacillus Calmette-Guerin) comprises an attenuated strain of Mycobacterium bovis and is used for vaccination against tuberculosis. An additional use of BCG is for immunotherapy of cancer in which the vaccine is administered intravesically for the treatment of superficial bladder cancer. The efficacy of immunotherapy with BCG in the prevention of recurrence is estimated at 70-99%, which is higher than for local chemotherapy. The most frequent complications of such treatment include fever and urinary bladder inflammation, while serious complications of haematogenous organ inflammation, especially inflammation of the lungs with the formation of pulmonary caseosus granulomas, are rarely seen. The authors reported a case of a 68-year-old man who was treated with intravesical BCG instillations due to a superficial bladder cancer. The patient underwent transurethral resection of bladder cancer and then periodically received intravesical BCG instillations. A few days after one instillation, systemic symptoms with a high fever appeared. Further examinations showed features of hepatitis and spread pulmonary changes. The patient underwent videothoracoscopy, and a fragment of lung parenchyma was collected. The histopathological examination revealed the presence of granulomas with central caseosus necrosis. Suspecting BCG infection, diagnostics were enhanced to include bacteriological and genetic tests for the presence of acid-resistant bacilli, which finally gave negative results. The authors diagnosed granulomatous pneumonia as a complication of intravesical BCG immunotherapy. Treatment with antituberculous drugs was initiated. After completing pharmacological treatment, radiological control was performed, which showed significant but not complete remission of pulmonary changes.

[Nodular lymphoid hyperplasia - a rare case of lymphoproliferative disorder of the lungs]. / Guzkowy rozrost limfoidalny ­ rzadki przypadek chorobylimfoproliferacyjnej w plucach

Nodular lymphoid hyperplasia (NLH) belongs to a very rare, mild, lymphoproliferative disease of unestablished aetiology historically included in the group of pseudolymphomas. Its existence was controversial for many years, until modern techniques of pathomorphological diagnosis approved it as a separate entity of lung disease. It manifests in the form of well limited nodules localized in the lungs, which are mostly identified accidentally. Clinical symptoms are rare and nonspecific; the disease usually occupies only one lung. Pathomorphological diagnosis requires immunohistochemical designation of expressions of numerous antigens in order to exclude malignant lymphoma of the lungs. Surgical resection is used in cases of larger nodules; the smaller ones require periodic observation, and the prognosis is good. The authors describe the case of 65-year-old woman with pulmonary nodules which were detected accidentally in the right lung. The patient was qualified for right-sided videothoracoscopy and removal of the lung nodule. In classic HE staining of the histological material, the presence of lymphoid infiltration of the lungs was revealed, which formed lymph follicles with reactive germinal centres. In order to differentiate from the malignant lymphatic expansion, immunohistochemical designations were made, which showed positive expression of CD20 antigen in the B cell zone, positive expression of the CD3 antigen in the T cells zone, positive expression of CD23 antigen in the lymph follicles, negative expression of bcl-2 in the lymph follicles, and positive expression of MIB-1 in the germinal centres of lymph follicles. Such a histopathological and immunohistochemical picture provided the basis for diagnosis of nodular lymphoid hyperplasia of the lung.

[Is the vascular-endothelial growth factor responsible for the malignancy of lung cancer?]. / Czy naczyniowo-sródblonkowy czynnik wzrostu to winowajca zlosliwosci raka pluca?

Lung cancer is the most common malignancy in the world. Its large ability to regional extension of the tumor and formation of local and distant metastases causes that the number of deaths and cases of disease are almost identical. The reason of this ability lies in the creation process of blood vessels that is angiogenesis, which main stimulus is the vascular-endothelial growth factor (VEGF). VEGF is synthesized by cancer cells in response to ischemia and a key transcription factor regulating the synthesis of VEGF in hypoxic cell is HIF-1 (hypoxia inducible factor-1). By connecting to its receptors on endothelial cells, the vascular-endothelial growth factor causes an increase in vascular permeability and leakage of plasma protein outside the blood vessel. Forming extracellular matrix becomes the target of migrating and proliferating endothelial cells which finally build a blood vessel. The research confirms that the existence of vasculature in the tumor is a necessary condition to the creation of metastases. The study also revealed that increased levels of VEGF in the plasma of patients with lung cancer correlates with disease progression, in this case the existence of distant metastases. In this work, the authors present the role of vascular-endothelial growth factor in the process of angiogenesis and the biology of the lung cancer and antiangiogenic therapy directions.

Activity of Antioxidant Enzymes in the Tumor and Adjacent Noncancerous Tissues of Non-Small-Cell Lung Cancer.

Lung tissue is directly exposed to high oxygen pressure, as well as increased endogenous and exogenous oxidative stress. Reactive oxygen species (ROS) generated in these conditions play an important role in the initiation and promotion of neoplastic growth. In response to oxidative stress, the antioxidant activity increases and minimizes ROS-induced injury in experimental systems. The aim of the present study was to evaluate the activity of antioxidant enzymes, such as superoxide dismutase (SOD; isoforms: Cu/ZnSOD and MnSOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione S-transferase (GST), along with the concentration of malondialdehyde (MDA) in tumor and adjacent noncancerous tissues of two histological types of NSCLC, i.e., adenocarcinoma and squamous cell carcinoma, collected from 53 individuals with surgically resectable NSCLC. MDA concentration was similar in tumors compared with adjacent noncancerous tissues. Tumor cells had low MnSOD activity, usually low Cu/ZnSOD activity, and almost always low catalase activity compared with those of the corresponding tumor-free lung tissues. Activities of GSH-related enzymes were significantly higher in tumor tissues, irrespective of the histological type of cancer. This pattern of antioxidant enzymes activity could possibly be the way by which tumor cells protect themselves against increased oxidative stress.

Identifying the Infection Control Areas Requiring Modifications in Thoracic Surgery Units: Results of a Two-Year Surveillance of Surgical Site Infections in Hospitals in Southern Poland.

BACKGROUND: Surgical site infection (SSI) is considered to be a priority in infection control. The objective of this study is the analysis of results of active targeted surveillance conducted over a two-year period in the Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra, in southern Poland. PATIENTS AND METHODS: The retrospective analysis was carried out on the basis of results of active monitoring of SSI in the 45-bed Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra between April 1, 2014 and April 30, 2016. Surgical site infections were identified based on the definitions of the European Centre for Disease Prevention and Control (ECDC) taking into account the time of symptom onset, specifically, whether the symptoms occurred within 30 d after the surgical procedure. Detection of SSI relied on daily inspection of incisions by a trained nurse, analysis of medical and nursing entries in the computer system, and analysis of all results of microbiologic tests taken in the unit and in the operating room. RESULTS: In the study period, data were collected regarding 1,387 treatment procedures meeting the registration criteria. Forty cases of SSI were detected yielding an incidence rate of 3%. Most cases (55%) were found in the course of hospitalization and 45% were detected after the patient's discharge. The SSIs were classified as follows: superficial, 37.5%; deep infections, 7.5%; and organ/space infection, 55%. Among patients who were diagnosed with SSI, most were male (77.5%). For patients with an American Society of Anesthesiologists (ASA) score I-II the incidence rate was 2%; ASA score III or more, 3.7%. The incidence rate varied from 0.3% in clean surgical site to 6.5% in clean-contaminated site. CONCLUSIONS: The study validated the usefulness of targeted surveillance in monitoring SSIs in patients hospitalized in thoracic surgery departments. Surgical site infection surveillance identified areas of care requiring modifications, namely, organization of post-discharge and microbiologic diagnostics of infection cases.

Telomerase activity in non-small cell lung cancer.

INTRODUCTION: High telomerase activity has been detected in the majority of malignant neoplasms including lung cancer. The purpose of the study was to attempt to use telomerase activity as a prognostic factor in patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Telomerase activity was analyzed in 47 tissue specimens taken from patients with NSCLC. The control group consisted of 30 specimens of non-cancerous lung parenchyma. Telomerase activity was measured by means of the telomeric repeat amplification protocol (TRAP). RESULTS: Telomerase activity in the neoplastic tissue was significantly higher than in the lung parenchyma that was free from neoplastic infiltration. There was no significant association between telomerase activity and age, gender, tobacco smoking, histological type of the tumor, or staging (pTNM). No association was found between the level of telomerase activity in NSCLC specimens and the two-year survival rate of patients (p = 0.326). A higher level of telomerase activity in poorly differentiated tumors (G3) as compared to moderately differentiated tumors (G2) was detected (p = 0.008). A positive association was identified between telomerase activity in pulmonary parenchyma free from tumor infiltration and the presence of leukocyte infiltration (p = 0.0001). CONCLUSIONS: No association was found between the level of telomerase activity in NSCLC specimens and the two-year survival rate of patients. The study has revealed a positive association between telomerase activity and the grade of differentiation (G) in NSCLC.