[Changes in lung parenchyma in high resolution computer tomography of patients with type type I sarcoidosis]. / Zmiany w miazszu plucnym w tomografii komputerowej o wysokiej rozdzielczosci u chorych z wezlowa postacia sarkoidozy.

The aim of this study was to describe the high-resolution computed tomography (HRCT) appearances of pulmonary abnormalities in 34 cases of type I sarcoidosis according to radiographic classification--lymphadenopathy only). Abnormalities were seen in 56% cases in which the pulmonary parenchyma appeared on radiographs. Nodules (1-4 mm) were seen in 41%. Other lesions as linear network were--present in 11.8% and ground-glass opacities--in 8.8%. The opacities are clustered in the peribronchovascular spaces, with relative sparing of the lung periphery and predominate in upper and middle lung zones. This study demonstrated the usefulness of HRCT in the correct diagnosis of type I sarcoidosis.

[Histiocytosis X--report of 3 cases with different types of lung changes]. / Histiocytoza X--opis 3 przypadków o róznym przebiegu zmian plucnych.

Three cases of histiocytosis X were described. Diagnosis was confirmed with histological examination of the lung taken during pleuroscopy in 2 cases and--with typical HRCT lung scan in 1 case.

[BAL from two different lung segments indicated by high resolution computed tomography (HRCT) in patients with sarcoidosis. I. Evaluation of alveolitis homogeneity and estimation of HRCT usefulness in selection of lung region for BAL]. / BAL z dwóch róznych segmentów pluc wskazanych badaniem tomografii komputerowej o wysokiej rozdzielczosci (HRCT) u chorych na sarkoidoze. Czesc. I. Ocena homogennosci procesu alveolitis i przydatnosci hrct w wyborze miejsca do BAL.

The aim of the study was: 1) to evaluate the homogeneity of alveolitis by estimation of lymphocytes subsets in double BAL (2 x 120 ml) from two different lung segments: with the most (s.A) and with the least (s.B.) extensive involvement estimated by high resolution computed tomography (HRCT) 2) to examine the usefulness of HRCT as a guide method in selection the most reliable lung region for BAL. Examined group consisted of 28 sarcoid patients with homogeneous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14 M aged 19-54). Twelve patients showed homogeneous distribution of HRCT changes (RD) in lung parenchyma and 16 showed nonhomogeneous distribution of HRCT changes (ND) with domination of pathological changes in upper lobes. Eleven healthy volunteers served as controls. BAL lymphocytes subpopulations (CD3, CD19, NK, CD4, CD8, HLA-DR, CD25,) were estimated by flow-cytometry. Among patients from ND group in BAL from s.A we found the significantly higher (p < 0.01) mean total cell yield, the significantly higher (p < 0.05) mean values of % of lymphocytes (45.2 vs 36.8%) and CD4/CD8 ratio (5.3 vs 4.4) than in BAL from s.B. Also the mean values of absolute number of lymphocytes and lymphocytes CD4, HLA-DR, CD25 in ND group were significantly higher in BAL from s.A than in BAL from s.B. In RD group and in controls no significant differences between BAL findings from s.A and s.B were noticed. Our results suggest that: 1) alveolitis process is not fully homogeneous, it's intensity is greater in upper lobes with most extensive involvement of HRCT changes 2) HRCT can serve as a useful method for selection the most reliable lung region for BAL.

[BAL from two different lung segments indicated by high resolution computed tomography (HRCT) in patients with sarcoidosis. II. The role of T gamma delta lymphocytes (T gamma delta)]. / BAL z dwóch róznych segmentów pluc wskazanych badaniem tomografii komputerowej o wysokiej rozdzielczosci (HRCT) u chorych na sarkoidoze. Czesc II. Rola limfocytów t gamma delta (T gamma delta).

The aim of the study was to evaluate the role of lymphocytes T gd in sarcoidosis by estimation of T gd cells in double BAL (2 x 120 ml) from two different lung segments: with the most (s.A) and with the least (s.B.) extensive involvement evaluated by high resolution computed tomography (HRCT) and in peripheral blood. Examined group consisted of 28 sarcoid patients with homogeneous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14 M aged 19-54). Twelve patients showed homogeneous distribution of HRCT changes (RD) in lung parenchyma and 16 showed nonhomogeneous distribution of HRCT changes (ND) with domination of pathological changes in upper lobes. Eleven healthy volunteers served as controls. Lymphocytes T gd were estimated by flow-cytometry. In peripheral blood of patients with sarcoidosis the mean value of T gd lymphocytes (4.75%) did not differ from control group (5.3%). In all patients the mean values of T gd percentage in BAL from s.A (1.7 + 1.0%) and in BAL from s.B (2.1 + 1.5%) were significantly lower (p < 0.01) than the mean value in peripheral blood (4.75 + 2.4%) and were significantly lower than mean value of T gd cells in BAL from s.B bis (4.2 + 2.7%). Among subgroups ND and RD we did find any significant differences between values of T gd in BAL form s.A and s.B. Our results suggest minimal role of T gd lymphocytes in sarcoid pathogenesis.

[BALF from two different lung segments indicated by high resolution computer tomography (HRCT) in patients with sarcoidosis. III. Correlation between pulmonary function tests and HRCT changes and BAL cell count]. / BAL z dwóch róznych segmentów pluc wskazanych badaniem tomografii komputerowej o wysokiej rozdzielczosci (HRCT) u chorych na sarkoidoze. Czesc III. Korelacje pomiedzy badaniami czynnosciowymi a rozlegloscia zmian w HRCT oraz parametrami komorkowymi BAL.

In 28 patients with sarcoidosis patients (14 F, 14 M aged 19-54) lymphocytes subpopulations were estimated in double BAL from two lung segments: with the most (s.A) and with the least (s.B.) extensive involvement estimated by high resolution computed tomography (HRCT). HRCT score for whole lung correlated negatively with DCO (r = 0.46, p < 0.05), D/VA (r = -0.46 p < 0.05), Cstat (r = -0.57, p < 0.05) and Cdyn (r = 0.-057, p < 0.01). HRCT-score for lung segments A and B did not correlate with BAL-cell count and lymphocytes subsets from these segments. The relationship between percentage of lymphocytes HLA-DR in BAL from s.A and d(A-a)O2 (r = 0.38, p < 0.05) and the relationship between absolute number of CD25 in BAL from s.A and DCO (r = -0.38, p < 0.05) were observed. The percentage of lymphocytes in BAL from s.B correlated negatively with D/VA (r = -0.40, p < 0.05) and the percentage of HLA-DR lymphocytes in BAL from s.B. correlated negatively with Cdyn (r = -0.45, p < 0.05). Our results suggests usefulness of HRCT in estimation of sarcoidosis advancement but not in it's activity and indicate the careful interpretation the relationships between BAL results from only one lung segment and pulmonary function parameters.

[Pulmonary function tests and bronchoalveolar lavage in sarcoidosis patients with 1changes and without changes in high resolution computed tomography]. / Badania czynnosciowe pluc i sklad komórkowy popluczyn oskrzelowo-pecherzykowych u chorych na sarkoidoze 1 ze zmianami i bez zmian w tomografii komputerowej wysokiej rozdzielczosci.

In 20 sarcoidosis patients with I0 of radiological changes the high resolution computed tomography (HRCT), pulmonary function tests (spirometry, diffusion capacity, static compliance) and broncho-alveolar lavage (BAL) were performed. In 8 patients with pathological changes detected in HRCT and in 12 patients without HRCT changes the similar pulmonary function disturbances and BAL-cell count were observed.

[Cytokines TNF-alpha and GM-CSF in BAL from two different segments of lungs defined by high resolution computerized tomography (HRCT) in patients with sarcoidosis]. / Cytokiny TNF-alpha i GM-CSF w BAL z dwóch róznych segmentów pluc wskazanych badaniem tomografii komputerowej o wysokiej rozdzielczosci (HRCT) u chorych na sarkoidoze.

The aim of the study was to evaluate the concentrations of TNF-alpha and GM-CSF in double BAL (2 x 120 ml) from two different lung segments: (s.A) from upper lobe with the most and (s.B) from lower lobe with the least extensive involvement estimated by high resolution computed tomography (HRCT). Examined group consisted of 28 non-smoking sarcoid patients with homogenous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14M aged 19-54). In examined patients 16 had nonhomogenous distribution (ND) and 12 had regular distribution (RD) of HRCT changes. Eleven healthy volunteers served as controls. In patients with sarcoidosis we observed the significantly higher concentrations (p < 0.01) of TNF-alpha (3.18 pg/ml, 2.64 pg/ml) and GM-CSF (1.01 pg/ml, 0.95 pg/ml) respectively in BAL fluid from s.A and s.B in comparison with BAL from s.Abis and s.Bbis in control group (TNF-alpha: 0.46 pg/ml, 0.47 pg/ml and GM-CSF: 0.28 pg/ml, 0.31 pg/ml respectively). Mean concentration of TNF-alpha in BAL from s.A (3.77 pg/ml) in ND group was significantly higher than in BAL from s.B in RD group (2.91 pg/ml). TNF-alpha in BAL from s.A in active sarcoidosis was higher than in BAL from s.A and s.B in non-active sarcoidosis. Concentrations of TNF-alpha in BAL from both s.A and s.B correlated positively with CD4/CD8 ratio, percentage of lymphocytes, lymphocytes HLA-DR+ and absolute number of CD4 cells and negatively with CD8 cells estimated in BAL from these lung segments. In patients with indications to therapy the level of GM-CSF in BAL from s.A (1.44 pg/ml) was significantly higher (p < 0.05) than in BAL from s.A (0.64 pg/ml) in patients without indications to treatment. We conclude that TNF-alpha and GM-CSF may be involved in sarcoidosis pathogenesis and TNF-alpha may be useful in estimation of sarcoidosis activity.

[Mesenteric lipoblastoma in 13-month-old boy]. / Lipoblastoma krezki u 13-miesiecznego chlopca.

A case of lipoblastoma of mesentery in 13-month-old normally growing up boy was presented. During routine examination due to upper respiratory airways viral infection large abdominal tumor was found. Preoperative diagnostics let us establish its the most probable macro- and microscopic character and the tissue limits. Radical operation was performed. During the 5-month follow up period after the surgery there were not evident complications, we did not find any signs of tumor recurrence.

[High resolution computed tomography in the diagnosis of lung disease in a 13-year-old boy]. / Ocena zmian miazszu plucnego u 13-letniego chlopca na podstawie tomografii komputerowej o wysokiej rozdzielczosci.

The paper describes a case of a 13-year-old boy, who clinically manifested symptoms of respiratory failure. High resolution computed tomography (HRCT) was used in diagnosis. It allows evaluate injury of the respiratory system in all parts of the lungs and bronchid tree. There was correlation between HRCT and bronchoscopy, spirometry and bronchography. We conclude that HRCT was a very effective and safe diagnostic method in the presented case.

[A rare case of 75-year survival in a woman with Turner syndrome]. / Rzadki przypadek 75-letniego przezycia chorej z zespolem Turnera.

The authors presents the rare case of survival time of 75-year-old woman with Turner syndrome. The skeletal and the circulatory systems changes on the radiograms are presented.

[Filling of the lower segment of the large intestine with fluid to facilitate ultrasonic examination in diseases of the small pelvis]. / Wypelnienie plynem dolnego odcinka jelita grubego jako usprawnienie badania ultradzwiekowego w chorobach miednicy malej.

Small pelvis space is difficult to examine ultrasonographically as several important organs are localized in relatively small area. The most difficult is the interpretation of the standard USG examination of the abdomen in case of pathologies of the end of large intestine, when filled with feces. In such cases repeated ultrasonographic examination is recommended. Authors propose, that this segment of the colon should previously be filled with fluid. Such a technique improves the level of diagnosis or exclusion of any pathology. Forty two patients were examined with the above technique. Authors think, that it is a progress in ultrasonography of pelvic organs.

[Diagnosis of choledochal cysts in children with special reference to ultrasonographic examination]. / Rozpoznawanie torbieli dróg zólciowych u dzieci ze szczególnym uwzglednieniem badania ultrasonograficznego.

Early diagnosis of the choledochal cysts in childhood, especially obstructing bile outflow to the duodenum, is an important clinical problem; often leading to serious complications--if not treated. Authors treated 5 children with choledochal cysts. Three out of them have been treated surgically. Ultrasound examination is sufficient to diagnose the disease, if the cyst is connected with intrahepatic bile ducts. If such a case is not possible to be imaged, cholescintigraphy and thin-needle biopsy with contrast filling are necessary to confirm the diagnosis.

[Extramedullary hemopoiesis presenting as a tumor of the posterior mediastinum in a patient with hemolytic anemia]. / Pozaszpikowe ogniska krwiotworzenia pod postacia guza sródpiersia tylnego u chorego na niedokrwistosc hemolityczna.

Extramedullary hemopoietic focus is a rare cause of tuberous enlargement of the posterior mediastinum. A 62-year-old man who had been diagnosed as having congenital spherocytic anemia 20 years ago, was admitted to hospital with initial diagnosis of pneumonia. Chest X-ray disclosed inflammatory infiltration in the lower lobe of the right lung and a tumor in the posterior mediastinum. Pneumonia subsided following treatment with antibiotics. Spiral computer tomography with concomitant transthoracic biopsy of the lesion, confirmed the presence of tumor located on the right side of the spinal column, as well as the presence of two minor focci on its opposite side. Cytological examination revealed extramedullary hemopoiesis. Differential diagnosis of tumor in posterior mediastinum, should take into consideration the possibility of extramedullary hemopoietic focci.

[Coincidence of 20210A prothrombin variant and factor V Leiden predisposing to venous thromboembolism]. / Wspólwystepowanie wariantu 20210A genu protrombiny i czynnika V Leiden predysponujace do zylnej choroby zakrzepowo-zatorowej.

Coexistence of inherited and environmental risks leads to the high hazard of venous thromboembolism. In such cases, there might be difficulties in the diagnosis and treatment of recurrent episodes. The importance of Factor V Leiden and prothrombin variant 20210A in the pathogenesis of venous thromboembolic disease, is widely accepted, but the carriership of thrombophilic genes' variants is usually not sufficient for the development of the disease. We report two cases of familial thrombophilia with concurrent presence of prothrombin variant 20210A and factor V Leiden. In a 28-year-old woman: pregnancy, immobilization, obstetric intervention appeared to precipitate the thromboembolic complication. In the second patient, the genetic studies revealed both thrombophilic mutations which could predispose to the recurrent venous thromboembolism, previously thought to be idiopathic. We discuss diagnostic and therapeutic difficulties in such patients.

[Pulmonary lymphangioleiomyomatosis as a very rare interstitial lung disease]. / Limfangioleiomiomatoza jako jedna z bardzo rzadkich przyczyn chorób sródmiazszowych pluc.

Lymphangioleiomyomatosis (LAM) is a rare lung disease affecting premenopausal women characterized by an abnormal proliferation of smooth muscle cells that leads to the obstruction of airways, lymph and blood vessels. We present a case of a 46-year-old woman who was admitted to our department with dyspnoea and dry cough. The patient had a history of spontaneous pneumothorax 2 years prior to admission. Physical examination revealed dull percussion note on the lower right side of the chest. The chest X-ray film showed diffuse interstitial parenchymal infiltration and flattened costodiaphragmatic angle on the right side. The high resolution computerized tomography (HRCT) scan showed the numerous air filled cysts, about 25 mm in diameter with thin regular walls and liquid in the right pleural cavity. The effusion in a pleural cavity was chylous. Airway obstruction (FEV1/FVC 57% of predicted), markedly elevated residual volume (140%), and decreased DLCO were observed in functional pulmonary tests, and she underwent diagnostic videothoracoscopy. Pulmonary biopsy specimens confirmed diagnosis of LAM. The patient has been under careful observation, no treatment was instituted. The patient remains clinically stabile. During the last six months of observation she has normal sex hormone levels, therefore there exists a possibility of postmenopausal remission of symptoms.

Genetic polymorphisms associated with acute pulmonary embolism and deep venous thrombosis.

Frequently an inherited predisposition to thrombosis remains clinically silent until an additional environmental factor intervenes. The present study aimed to assess distribution of inherited risk factors of venous thrombosis in patients with venous thromboembolism (VTE). The prevalences of factor V Leiden (FV Leiden), prothrombin factor II G20210A (FII G20210A), C677T and A1298C of methylenetetrahydrofolate reductase (MTHFR) mutations were studied in 149 VTE patients and 100 controls. The following key risks were established: previous deep venous thrombosis or pulmonary embolism (23.5%), bed rest (34.2%), immobilisation of lower limb (10.1%), hospitalisation (30.9%) and obesity (28.9%). In 29 (19%) patients and in three (3%) controls FV Leiden was found. A significant association between VTE and FV Leiden was established. There were six (4%) carriers of the FII G20210A among VTE patients and one in the controls. No associations between VTE and MTHFR polymorphisms (C677T, A1298C) were found. In three of 149 patients both FV Leiden and FII G20210A polymorphisms were observed. The mean protein C activity was slightly, though nonsignificantly, smaller in VTE patients. In conclusion, there was a positive association between venous thromboembolism and factor V Leiden. Only a weak trend favouring a relationship between prothrombin factor II G20210A and venous thrombolism was present. No associations between common polymorphisms of methylenetetrahydrofolate reductase and venous thromboembolism were found.