Telomerase activity in transthoracic fine needle biopsy aspirates as a marker of peripheral lung cancer.

BACKGROUND: A study was undertaken to evaluate the usefulness of telomerase activity assay in transthoracic fine needle biopsy (TFNB) aspirates collected from peripheral tumours of the lung in predicting the malignant aetiology of lung infiltrations. METHODS: 100 patients with a peripheral infiltration of the lung underwent TFNB of the focal lesion. The aspirates were subjected to standard cytological evaluation. Telomerase activity in the specimens was determined with the PCR-ELISA PLUS method. The sensitivity, specificity, accuracy and predictive value of TFNB were calculated for cytological examination of aspirates alone and cytological examination with additional telomerase activity assessment. RESULTS: Lung cancer was newly diagnosed in 84 subjects and benign peripheral lesions were found in 16. During the first TFNB, lung cancer was identified in 56 cases of cancer (66.7%) while increased telomerase activity was found in 61 cancer aspirates (72.6%). No subject with a benign infiltration had a false positive result from cytological examination, but in one case (6.25%) increased telomerase activity was observed. The diagnostic sensitivity, accuracy and negative predictive value of the combination of cytological examination and telomerase activity assay in TFNB specimens were significantly higher than for cytological examination alone (89.3% vs 66.7%, p = 0.0004; 90% vs 72%, p = 0.001; 62.5% vs 36.4%, p = 0.039), but a combination of the two examinations was associated with a lower specificity of TFNB (96.9% vs 100%, p = 0.002). CONCLUSION: Detection of telomerase activity in aspirates taken during TFNB of a peripheral lung infiltration should be considered as an indication of the risk of malignancy in cases with false negative cytological results.

Prevalence and risk factors for asthma in Poland: results from the PMSEAD study.

BACKGROUND: The prevalence of asthma depends on both hereditary and environmental factors. Knowledge of the effects of environmental and congenital factors on the frequency of occurrence of asthma may provide important clues to its pathogenesis and prevention. OBJECTIVES: The Polish Multicentre Study of Epidemiology of Allergic Diseases was designed to obtain estimates representative of the entire Polish population to assess asthma prevalence and risk factors. METHODS: Thirty-three areas were selected in 11 regions of Poland. Epidemiologic diagnoses of asthma were verified by a single recognized expert in each region on the basis of collected data as well as available medical documentation, in accordance with the 1997 guidelines of the Global Initiative for Asthma. Ambient air concentrations of sulfur dioxide and suspended particulates (black smoke) were measured directly or estimated by statistical modelling. RESULTS: Results were obtained for asthma in 16 238 subjects, including 3268 children (aged 3 to 16 years) and 12 970 adults (17 to 80 years). The overall prevalence of asthma was 8.6% (95% confidence interval [CI], 7.7%-9.6%) among children and 5.4% (95% CI, 5.0%-5.8%) among adults. Several risk factors for asthma were identified: family history of asthma, black smoke, residential exposure to traffic-related air pollution in both children and adults, and damp or overcrowded housing in adults. No statistically significant association was observed for passive smoking in the home, use of gas stoves, pet ownership, or exposure to ambient air pollution with sulfur dioxide. CONCLUSION: Our results show that the prevalence of asthma is associated with several host and environmental factors in the Polish population.

Influence of age and gender on serum eotaxin concentration in healthy and allergic people.

BACKGROUND: Eotaxin is one of the important chemokines that modulate allergic inflammation. In many studies a correlation between an elevated serum concentration of eotaxin, allergen exposure and allergic symptoms has been confirmed. Influence of other factors on eotaxin concentration is feebly recognized. We made an attempt to assess the influence of age and gender on the serum eotaxin level in healthy people and in patients with intermittent IgE-mediated rhinoconjunctivitis (AR). METHODS: The serum eotaxin level was measured in 245 healthy people and 241 patients with AR before the pollen season with the ELISA technique (KITS, R&D USA, pg/ml). The parametric tests and linear regression analysis were used in statistical calculations. RESULTS: There were no differences between the allergic group and the healthy one in the mean age (accordingly: 31.3 +/- 11.6 yrs. vs. 31.6 +/- 12.5 yrs.; p=0.1) and the mean serum eotaxin content (118.1 +/- 44.9 pg/ml vs. 116.3 +/- 34.8 pg/ml; p=0.3). A significant relationship between the serum eotaxin level, gender and age was revealed in both groups and regression models were derived. A linear correlation between age (semi-partial correlation beta = 0.47, p = 0.0000001) and gender (semi-partial correlation beta = 0.3, p = 0.0000001), on the one side, and the serum eotaxin level, on the other, was found for the allergic people. In the control group a similar relationship between the serum eotaxin level and age (semi-partial correlation coefficient beta = 0.63, p = 0.0000001) and gender (semi-partial correlation factor beta = 0.23, p = 0.000006) was observed. CONCLUSIONS: Age and sex significantly influence the serum eotaxin content in healthy people and patients with IgE-mediated rhinoconjunctivitis.

Cc-chemokine eotaxin as a marker of efficacy of specific immunotherapy in patients with intermittent IgE-mediated allergic rhinoconjunctivitis.

BACKGROUND: Allergen-specific immunotherapy (SIT) is believed to be a valuable remedy in several allergic diseases; however, an accurate immunological marker of the efficacy of this treatment method has not been found yet. Cc-chemokine eotaxin, owing to its selective action on eosinophils, seems to play an important role in the pathophysiology of allergic response. The purpose of this study was to assess the usefulness of eotaxin in monitoring of SIT efficacy in patients with IgE-mediated allergic rhinoconjunctivitis. METHODS: One hundred and twenty-two patients with seasonal IgE-mediated allergic rhinoconjunctivitis due to tree- (birch, n = 42; hazel/alder, n = 14) or grass/cereal- (n = 66) pollen received allergen-specific immunotherapy. Serum eotaxin levels were determined four times in every patient, shortly before immunotherapy (Evaluation 0), immediately after the treatment (Evaluation 1), in the height of pollen season (Evaluation 2) and at least 2 weeks after the pollen season (Evaluation 3). Serum eotaxin levels were simultaneously measured in 59 healthy people from the control group. Changes in serum eotaxin levels were assessed in the healthy and allergic groups. Clinical symptoms of IgE-mediated rhinoconjunctivitis were evaluated and compared with serum eotaxin concentration changes. RESULTS: Mean values of eotaxin concentrations in serum during Evaluations 0-3 did not significantly differ in the healthy subjects and the patients with IgE-mediated rhinoconjunctivitis (P > 0.05). Moreover, no statistically significant differences in the serum eotaxin levels between the visits were observed in the patients who received immunotherapy (P > 0.05); however, immediately after immunotherapy (Evaluation 1) the mean serum level of eotaxin was lowest and closest to the serum eotaxin concentration in the control group at the same visit. No significant correlation between the mean value of the serum eotaxin level in the height of pollen season (r = -0.12, P > 0.05) or mean changes of the eotaxin levels between Evaluations 2 and 1 (r = -0.03, P > 0.05), on the one hand, and the cumulative score of symptoms and drug, on the other, were found. CONCLUSIONS: The results allow to conclude that although eotaxin plays a significant role in the mechanism of antigen-specific immunotherapy, its serum expression remains a poor marker of SIT efficacy.

Competition of IL-1 and IL-1ra determines lymphocyte response to delayed stimulation with PHA.

BACKGROUND: Human peripheral blood mononuclear cells (PBMC) left in microcultures for 24h without mitogen do not respond to subsequent stimulation with PHA. They regain reactivity if the native culture medium is absorbed with other party lymphocytes or partially replaced with the medium from a PHA-stimulated culture. The observations suggest that, during the incubation, some inhibitory agent had accumulated in the culture medium. AIM: The study was performed to determine the nature of the observed phenomenon in respect of the possible role of monocytes and their products IL-1 and IL-1 receptor antagonist (IL-1ra), and to test for immunodiagnostic purposes the significance of quantifying the lymphocyte response to delayed stimulation with PHA in patients suffering from inflammatory prosesses. METHODS: Lymphocyte response to delayed stimulation with PHA, calculated as the lymphocyte-monokine interaction (LM) index, was determined in the microcultures of PBMC isolated from the blood of healthy donors or of patients with acute tonsilitis. The values of LM indices were compared with the ratios of IL-1ra/IL-1beta concentration estimated by enzyme-linked immunosorbent assay method in the culture supernatants. The influences of exogenous IL-1beta, IL-1ra, anti-IL1ra antibodies and antibiotic cefaclor on the monokine concentrations and on the values of LM index were tested. RESULTS AND CONCLUSIONS: The results show that the level of lymphocyte response to delayed stimulation with PHA (LM index) is inversely proportional to the ratio of IL-1ra/IL-1beta concentration in the culture. The low LM values at high IL-1ra/IL-1beta ratios in PBMC cultures from healthy donors, reversed proportions found in patients' PBMC (acute tonsilitis), and the cefaclor-induced reduction of LM value with correlated increase of the IL-1ra/IL-1beta ratio suggest that the LM assay may prove to be useful for immunodiagnostic purposes.

[Frequency of complications after transthoracic fine-needle biopsy of lung tumors]. / Analiza czestosci powiklan transtorakalnej biopsji cienkoiglowej guzów pluc.

Transthoracic fine-needle biopsy (TFNB) is a valuable method of recognizing changes in lungs, especially suspected of cancer. Such operations are cheap, don't demand expensive instruments and are possible to perform in each pneumonology ward, especially if they are an ideal supplement for bronchofibroscoping examination. The possibility of quick and effective performance of transthoracic biopsy shortens the diagnostics considerably. From January 1997 to April 1999 there were performed 406 operations of TFNB. There were 334 people operated on (294 men--74.5%; 85 women--25.5%), average age for the whole group of patients--62.8 (+/- 10.4 years). The patients were divided into two groups considering hospitalization places: I--patients from (not transported for operation)--135 (40.4%), II--patients transported for operation from another hospitals--199 (59.6%) The examination was performed under control of rtg apparatus (7600 OEC Medical System with mobile x-ray tube on a C-arm and laser localizer). The usual complication was an pneumothorax--52 cases (12.8%); drained--16 cases (3.9%). An average depth of inserting in an early pneumothorax is 6.56 (+/- 0.73), in a late pneumothorax--8.6 cm (+/- 1.75), (p = 0.0015). An average depth of inserting in a drained pneumothorax was 8.9 cm (+/- 2.17), in a non-drained pneumothorax 7.7 cm (+/- 1.3) (p = 0.024). Patients that had to be transported for the operation had pneumothoraxes that needed to be drained considerably more often: 14 cases in 199 comparing to 2 in 135 among patients not demanding to be transported (p = 0.02). Pneumothoraxes appeared more often after indicating tumors of smaller size, from 3 cm--21.6%; 3.1-6 cm--13.3% (p = 0.036). From another complications one could notice: hemoptysis--4 cases; subcutaneous emphysema--1 case; fever and shivers--1 case; hypotonia--2 cases; cough--1 case. Those complications were treated symptomatically or vanished themselves.

[The effect of inhaled ambroxol treatment on clinical symptoms and chosen parameters of ventilation in patients with exacerbation of chronic obstructive pulmonary disease patients]. / Wplyw leczenia wziewna postacia ambroksolu na objawy kliniczne i wybrane parametry wentylacji u chorych hospitalizowanych z powodu zaostrzenia przewleklej obturacyjnej choroby pluc.

It was a randomised, double-blind, placebo controlled comparative study of the clinical symptoms and chosen parameters of ventilation of inhaled ambroxol in patients hospitalized with exacerbation of chronic obstructive pulmonary disease (COPD). Eligible patients--30 patients (13 men and 17 women) aged of mean value 70.5 +/- 6.9 years who fulfilled the clinical traits of exacerbation of chronic bronchitis entered the study. 15 patients were treated with inhaled ambroxol and 15 were treated with placebo. Moreover all patients were treated with concomitant medications typical for exacerbation of COPD (systemic steroids, intravenous infusions with euphillin, antibiotics, Berodual nebulizations and oxygen therapy). Spirometry and data related to clinical symptoms were taken at the beginning of the study and after 1 and 3 days and after the end of the treatment. At the end of the treatment period in both groups (inhaled ambroxol therapy vs. placebo) there wasn't found statistically significant difference in the number of cough and dyspnoe attacks. There was found the difference in FEV1 and FEF 50 in both groups, but improvement in patients treated with ambroxol was statistically significantly faster, that can influence the cost of treatment. Moreover there were not found important adverse events in ambroxol group.

[Retroperitoneal fibrosis with coincidence of fibrosis in mediastinum]. / Zwlóknienie zaotrzewnowe wspólistniejace ze zwlóknieniem w sródpiersiu.

Retroperitoneal fibrosis is a disease with replacement of normal retroperitoneal tissue with isolated fibrotic plaque placed around aorta and entrapping ureters. In 15% of patients an fibrotic process can be found outside the retroperitoneum. The most common localisation outside retroperitoneum is mediastinum, however, it can occur in every organ. The patient usually is diagnosed due to symptoms connected to compression of the ureters. We report the case of 41-year-old woman with chronic obstructive pulmonary disease complaining of nonspecific, dull, noncolicky pain localized to the back and abdomen. Finally we recognised retroperitoneal fibrosis. The diagnosis was proven by lumbar mass biopsy.

[Blood serum eotaxin and eosinophil cationic protein in asthmatic patients]. / Stezenia eotaksyny i eozynofilowego bialka kationowego w surowicy chorych na astme oskrzelowa.

Eotaxin belongs to CC class of chemokines and is a potent eosinophil chamoattractant. Activated eosinophils are able to release many cytotoxic proteins, including eosinophil cationic protein (ECP), which has central role in allergic inflammation. The aim of this study was to assess eotaxin and ECP levels in plasma of atopic asthma patients in stable period of the disease. 19 patients with asthma and 10 healthy controls took part in this study. ELISA test was used to measure eotaxin (kits from R&D, pg/ml) and ECP (kits from Pharmacia, mg/l) levels. Plasma eotaxin level (mean +/- SD) was 176.52 +/- 50.3 (range 89-288) in asthma patients and 101.42 +/- 49.4 (range 35-206) in control group (p < 0.001). Plasma ECP concentration was 16.7 +/- 6.4 (6.3-28) and 16.8 +/- 17.1 (3.1-61.6), respectively (n.s). There was correlation between plasma eotaxin and ECP levels (Pearsons correlation co. r = +0.5, p < 0.05) and between eotaxin and FEV1 (Pearsons correlation co r = -0.4, p < 0.05) in asthma patients. We suggest that measurement of eotaxin and ECP levels as well may be useful indicator of disease.

[Comparison evaluation of cost-effectiveness in bronchial asthma patients]. / Porównawcza ocena skutecznosci i kosztów leczenia chorych na astme oskrzelowa.

A choice of a proper drug and method for clinically successful therapy in patients with bronchial asthma has to be based on results of experimental and clinical studies and cost analysis. Some problems connected with cost-effectiveness analysis are presented in relation to glucocorticosteroids, agonist of beta2-adrenoreceptors and allergen-specific immunotherapy.

[Adhesion molecules LFA-1(CD-11a), Mac-1(CD-11b) of t-lymphocytes in bronchoalveolar lavage fluid and blood in patients with chronic respiratory tract disease]. / Czasteczki adhezyjne LFA-1(CD11a), Mac-1(CD11b), ICAM-1(CD54) limfocytów T pochodzacych z plukania oskrzelowo-pecherzykowego i krwi u chorych na przewlekle choroby ukladu oddechowego.

Adhesion molecules play an important role in inflammatory processes and influence on recruitment of effector cells. The aim of our study was to assess the percentage of T-lymphocytes expressing LFA-1, Mac-1 and ICAM-1 in bronchoalveolar fluid (BALF) and blood of patients with sarcoidosis, atopic bronchial asthma and chronic bronchitis. The reference group consisted of patients with haemoptysis or suspected of having bronchial carcinoma. Expression of adhesion molecules was revealed by /APAAP/ alkaline phosphatase anti alkaline phosphatase method. The highest percentage of lymphocytes expressing all adhesions molecules in BALF and blood was observed in patients with chronic bronchitis. Reductions of T-cells in BALF of patients with bronchial asthma and sarcoidosis may reflect of their direct binding in inflammatory sites. This studies confirm the involvement of adhesion molecules in maintenance of chronic inflammatory processes in the respiratory tract.

[Serological screening examinations of atypical pathogens (Mycoplasma pneumoniae, Chlamydia pneumoniae) in respiratory tract infection]. / Serologiczne badanie przesiewowe atypowych czynników (Mycoplasma pneumoniae, Chlamydia pneumoniae) w zakazeniach ukladu oddechowego.

Lower respiratory tract infections are a heterogeneous group of disorders induced by plenty of pathogens. Atypical bacteria play an important role in the respiratory tract pathology. In our study 90 patients with acute infection of the respiratory tract were examined in serological screening test for Mycoplasma pneumonia and Chlamydia pneumoniae. It was confirmed that in 21 patients with community acquired pneumonia Mycoplasma pneumonia antibodies were detected in 38% and Chlamydia pneumoniae in 10%. In our opinion this screening serological tests are useful for early diagnosis of atypical bacterial infections of the respiratory tract.

Eotaxin in serum of patients with asthma or chronic obstructive pulmonary disease: relationship with eosinophil cationic protein and lung function.

This study was undertaken to investigate the correlation between the serum ECP and the serum eotaxin level, and disease activity as evaluated with pulmonary function in patients with asthma or chronic obstructive pulmonary disease (COPD). 20 patients with stable asthma and 15 patients with COPD, and 15 subjects of the control group took part in this study. The analysis of ECP was performed according to the manufacturer's directions (Pharmacia Diagnostics AB, Uppsala, Sweden). The ELISA test was used to measure eotaxin levels in sserum (kits from R&D, USA). The levels of ECP were 16.9+/-6.3 microg/L in patients with asthma, 15.1+/-9.3 microg/L in patients with COPD and 11.8+/-6.2 microg/L in the control group (P<0.05). There was no significant difference in the asthma ECP level compared with the ECP level in COPD. There was a significant difference between the ECP plasma level in asthma compared with the ECP plasma level in the control group (p<0.05). The levels of eotaxin were 175.8+/-49.3 pg/mL in the control group. There was a correlation of ECP and the eotaxin level in asthma patients (r=+0.5, p<0.05). The percentage fall in FEV1 correlated with eotaxin level in asthma (r=-0.3, p<0.05) and with the eotaxin level in COPD (r=-0.5, p<0.05). Serum outcomes of eotaxin and ECP levels appear to be a useful indicator of atopic asthma, and might provide complementary data disease monitoring. Therefore, further investigations are required to clarify whether serum eotaxin measurements have a role in the clinical evaluation in COPD.

[Long-acting beta-2-adrenergic agonists in bronchospasm therapy]. / Agonisci receptorów beta 2-adrenergicznych o przedluzonym dzialaniu w leczeniu stanów bronchospastycznych.

Inhaled long-acting beta 2-agonists are widley used in the treatment of asthma as regular prophylaxis, but not as rescue medication for the relief of acute symptoms. Comparison of salmeterol and formoterol in the review is focused on practical applications and some adverse reactions during long-time treatment.

[Eosinophil cationic protein in children with allergic diseases of the respiratory tract in exacerbation and remission of symptoms]. / Eozynofilowe bialko kationowe u dzieci chorych na alergiczne choroby ukladu oddechowego w okresie zaostrzenia i remisji objawów.

The role of eosinophil cationic protein (ECP) in allergic inflammatory reaction has been documented in experimental and clinical studies, but a clinical usefulness is still discussed. In the study serum level of ECP has been evaluated in children with allergic diseases of the respiratory system in exacerbation and remission of symptoms for purpose of monitoring of disease course. In 111 children aged 12.0 +/- 3.3 yrs with atopic bronchial asthma and/ or allergic rhinits ECP serum concentrations have been determined in following groups: children with grass pollen hypersensitivity (group P, 17 female and 41 male), children with hypersensitivity to D. pteronyssinus and D. farinae (group D, 16 female and 37 male) and controls without allergic hypersensitivity with negative prick skin tests (19 children, 11 female and 5 male). All children have been qualified to immunotherapy with pollen or mite allergens (Allergovit or Novo-Helisen, Nexter, Allergopharma) and ECP evaluation was performed before, during and after therapy. Serum ECP and IgE levels have been determined with CAP-system (Pharmacia) and obtained results related to clinical symptoms. In all analyzed children serum total IgE has been significantly increased in relation to controls. Serum ECP levels have been increased during clinical exacerbation of symptoms in observed children and parallel with clinical score of symptoms, especially during pollen season. Authors conclude that a degree of increase of serum ECP level is parallel with clinical score of symptoms, especially during highest exposition to pollen allergens. Observed changes of serum ECP levels during immunotherapy suggest the close relationship with allergic inflammatory reaction and indicate clinical usefulness for monitoring of this process.

[Comparison of reproducibility of selected allergologic tests in vitro]. / Porównanie zgodnosci wybranych testów alergologicznych in vitro.

The aim of our study was the comparative evaluation of allergological tests in "in vitro" examinations. We conclude the similar results in both allergological tests: Allergodip (Allergopharma) and CAP FEIA (Pharmacia).

[Efficacy and tolerance of fenspiride in adult patients with acute respiratory tract infections]. / Ocena skutecznosci i tolerancji fenspirydu u doroslych chorych na ostre zapalenie dróg oddechowych.

Fenspiride is an antiinflammatory drug targeted for the respiratory tract. In our study clinical efficacy and tolerance of drug were evaluated in 392 adult patients with acute respiratory tract infections. According to clinical criteria all observed symptoms were classified as mild, moderate and severe. The most of observed patients were included into moderate symptom score. Cough and nose obturation were dominant symptoms. All noticed changes in the upper respiratory tract were decreased after fenspiride therapy in 7 days trial. In 168 observed patients systemic and in 60 local acting antibiotics were successfully applied. Excellent tolerance of fenspiride was documented in 59% and good tolerance --in 34% of patients. Observed adverse reactions were classified as mild and in 20 patients fenspiride was rejected. Authors suggest that fenspiride therapy is save and successful in patient with acute respiratory tract infection. Good results in patients with bronchitis in decreasing of bronchospasm indicate fenspiride as a good tool in bronchial infection.