Is the needle still needed? Relationship between laboratory features of pleural effusion and results of lung CT examinations in patients with pneumonia and lung cancer.

INTRODUCTION AND OBJECTIVE: Thoracocentesis is an invasive procedure routinely performed in the diagnosis of causes for the presence of pathological fluid in the pleural cavity. In many patients, a computed tomography scanning (CT) is also performed to diagnose the cause of the presence of fluid in the pleural cavity. The diagnostic value of CT is particularly high in situations in which performing thoracocenthesis could be associated with an increased risk of complications. The aim other study was to assess the relationship between the objective radiological features and the results of laboratory tests of fluid collected by thoracocenthesis in patients with pneumo-nias (n=18) and lung cancer (n=35). MATERIAL AND METHODS: The examined group consisted of the patients with pneumonia (n=18) and lung cancer (n=35) which resulted in the presence of fluid in the pleural cavity. In the patients thoracocentesis, CT lung scanning was also performed, according to the medical indications. Three scans with the greatest amount of fluid were identified, and the mean density of the fluid expressed in Hounsfield units was calculated within the area. These calculations were compared with the results of laboratory fluid tests. RESULTS: The maximum number of Hounsfield units (HU) was significantly lower in the group of lung cancer patients, compared to those diagnosed with pneumonia (74.3% sensi-tivity and 55.6% specificity). The pH of pleural fluid was significantly lower in patients with lung cancer, compared to those with pneumonia (74.3% sensitivity and 66.7% specificity). CONCLUSIONS: According to the results, radiological differentiation of pneumonia and lung cancer resulting in pleural effusion, to some extent is possible; however, the needle is still needed.

Humulus lupus extract rich in xanthohumol improves the clinical course in critically ill COVID-19 patients.

BACKGROUND: The systemic inflammatory response following severe COVID-19 is associated with poor outcomes. Several anti-inflammatory medications have been studied in COVID-19 patients. Xanthohumol (Xn), a natural extract from hop cones, possesses strong anti-inflammatory and antioxidative properties. The aim of this study was to analyze the effect of Xn on the inflammatory response and the clinical outcome of COVID-19 patients. METHODS: Adult patients treated for acute respiratory failure (PaO2/FiO2 less than 150) were studied. Patients were randomized into two groups: Xn - patients receiving adjuvant treatment with Xn at a daily dose of 4.5 mg/kg body weight for 7 days, and C - controls. Observations were performed at four time points: immediately after admission to the ICU and on the 3rd, 5th, and 7th days of treatment. The inflammatory response was assessed based on the plasma IL-6 concentration, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and D-dimer levels. The mortality rate was determined 28 days after admission to the ICU. RESULTS: Seventy-two patients were eligible for the study, and 50 were included in the final analysis. The mortality rate was significantly lower and the clinical course was shorter in the Xn group than in the control group (20% vs. 48%, p < 0.05, and 9 ± 3 days vs. 22 ± 8 days, p < 0.001). Treatment with Xn decreased the plasma IL-6 concentration (p < 0.01), D-dimer levels (p < 0.05) and NLR (p < 0.01) more significantly than standard treatment alone. CONCLUSION: Adjuvant therapy with Xn appears to be a promising anti-inflammatory treatment in COVID-19 patients.

The efficacy of T790M mutation testing in liquid biopsy-Real clinic data.

Osimertnib is still widely used in the treatment of NSCLC patients who have previously received erlotinib, gefitinib or afatinib and have developed resistance to these drugs mediated by the T790M mutation in exon 20 of EGFR gene. We assessed the results of T790M mutation testing in liquid biopsy by Entrogen test and real-time PCR technique in routine clinical practice. Analysis was conducted in 73 plasma samples from 41 patients with locally advanced or metastatic lung adenocarcinoma treated with first- or second-generation of EGFR TKIs. We detected T790M mutation in 18 patients (43.9% of patients, 24.6% positive tests in 73 samples). The incidence of T790M mutation in liquid biopsy was significantly higher in patients with T3-T4 tumors compared to patients with T0-T2 tumors (p = 0.0368, χ2 = 4.36). Median PFS at the time of progression according to RECIST was significantly (p = 0.0444) higher in patients with T790M mutation than in patients without this mutation (22.5 vs. 15 months). Our results confirmed that T790M mutation is more often detected in patients with a large tumor spreading in the chest and with the long duration of response to first- or second generation of EGFR TKIs. The low sensitivity of the real-time PCR technique in T790M mutation detection could be partially compensated by repeating the tests.

Various Forms of Tuberculosis in Patients with Inflammatory Bowel Diseases Treated with Biological Agents.

Although there are undeniable advantages of treatment of the inflammatory bowel diseases, Crohn's disease, and ulcerative colitis, with biological agents, the increased susceptibility to tuberculosis should not be ignored. Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis complex which includes M. tuberculosis, M. bovis, and M. africanum. Primary tuberculosis is uncommon in the setting of inflammatory bowel disease: reactivation of latent tuberculosis is of greater concern. Consequently, latent infection should be excluded in patients who qualify for immunosuppressive treatments. Apart from the review of the literature, this article also presents three cases of different patterns of tuberculosis that occurred during treatment with infliximab, adalimumab, or vedolizumab. The first case reports a case of tuberculosis presenting as right middle lobe pneumonia. The second case featured miliary tuberculosis of the lungs with involvement of the mediastinal lymph nodes, liver, and spleen. The third patient developed a tuberculoma of the right parietal lobe and tuberculous meningitis. It is important to reiterate that every patient qualifying for a biologic agent should undergo testing to accurately identify latent tuberculosis, as well as precise monitoring for the possible development of one of the various forms or patterns of tuberculosis during treatment.

MMP-9 and MMP-2 regulation in patients undergoing non-oncological and non-vascular elective surgery independent of the use of propofol or sevoflurane.

BACKGROUND: There is debate regarding whether inhaled sevoflurane or intravenous propofol used during anesthesia achieves the best outcome. Propofol has been shown to affect expression of matrix metalloproteinases (MMPs). MMPs are enzymes that play a role in extracellular matrix remodeling, with activity balance disturbances during surgery. The goal of this study was to compare MMP-2/9 concentrations, activity, and tissue inhibitors of metalloproteinases (TIMPs) 1/2 concentrations in blood of who had undergone 2 types of anesthesia: based on volatile sevoflurane and intravenous propofol during non-oncological, non-vascular surgery. METHODS: 39 patients were enrolled into analysis, 20 anesthetized with total intravenous anesthesia with propofol (P), 19 with volatile induction/maintenance of anesthesia with sevoflurane (S). Plasma samples collected before and 24 h after surgery were analyzed for MMP-2/9, and TIMP-1/2 concentrations using ELISAs. Additionally, MMP-2/9 activities were assessed by gelatin zymography. RESULTS: Study revealed increased MMP-9 concentration (ELISA) (P:p = 0.011; S:p = 0.001) and activity (zymography) (P:p = 0.004; S:p = 0.008) in both groups 24 h after surgery. We noticed decreased (both groups) MMP-2 concentration (P:p = 0.044; S:p = 0.027) with MMP-2 activity increase (P:p = 0.002; S:p = 0.006) 24 h after surgery. We observed decreased TIMP-1 plasma concentrations (P:p = 0.002; S:p = 0.000) 24 h after procedures, while TIMP-2 plasma levels remain unchanged (P:p = 0.097; S:p = 0.172). There were no differences between concentration and activity of MMPs and TIMPs in regard to anesthetic used. Meperidine administration correlated with lower MMP-9 activity (R=-0.430; p = 0.006). CONCLUSIONS: Concluding, neither sevoflurane nor propofol used as anesthetics modulate MMP-2 and MMP-9 concentrations and activities during non-oncological, non-vascular elective surgery. Meperidine seems to decrease MMP-9 activity.

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study.

INTRODUCTION: Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device's utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position. MATERIALS AND METHODS: 69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance. RESULTS: Our results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position. CONCLUSIONS: We report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.

Tirapazamine has no Effect on Hepatotoxicity of Cisplatin and 5-fluorouracil but Interacts with Doxorubicin Leading to Side Changes in Redox Equilibrium.

Tirapazamine is a hypoxia-activated prodrug which was shown to exhibit up to 300 times greater cytotoxicity under anoxic in comparison with aerobic conditions. Thus, the combined anticancer therapy of tirapazamine with a routinely used anticancer drug seems to be a promising solution. Because tirapazamine undergoes redox cycle transformation in this study, the effect of tirapazamine on redox hepatic equilibrium, lipid status and liver morphology was evaluated in rats exposed to cisplatin, doxorubicin and 5-fluorouracil. Rats were intraperitoneally injected with tirapazamine and a particular cytostatic. The animals were killed, and blood and liver were collected. Hepatic glucose, total cholesterol, triglycerides, NADH, NADPH glutathione and the activity of glucose-6-phosphate dehydrogenase were determined. Liver morphology and the immune expression of HMG-CoA-reductase were also assessed. Glucose, total cholesterol, triglycerides, bilirubin concentrations and the activity of aspartate and alanine aminotransferases were determined in the plasma. Tirapazamine displayed insignificant interactions with cisplatin and 5-fluorouracil referring to hepatic morphology and biochemical parameters. However, tirapazamine interacts with doxorubicin, thus leading to side changes in redox equilibrium and lipid peroxidation, but those effects are not severe enough to exclude that drug combination from further studies. Thus, tirapazamine seems to be a promising agent in successive studies on anticancer activity in similar schedules.

The differential effects of green tea on dose-dependent doxorubicin toxicity.

BACKGROUND: Doxorubicin (DOX) is an anticancer drug displaying cardiac and hepatic adverse effects mostly dependent on oxidative stress. Green tea (GT) has been reported to play a protective role in diseases resulting from oxidative stress. OBJECTIVE: The objective of this study was to evaluate if GT protects against DOX-induced oxidative stress, heart and liver morphological changes, and metabolic disorders. METHODS: Male Wistar rats received intraperitoneal injection of DOX (1.0 or 2.0 mg/kg b.w.) for 7 weeks or concomitantly GT extract soluble in drinking water. RESULTS: There were multidirectional effects of GT on blood metabolic parameters changed by DOX. Among all tested biochemical parameters, statistically significant protection of GT against DOX-induced changes was revealed in case of blood fatty acid-binding protein, brain natriuretic peptide, and superoxide dismutase. CONCLUSION: DOX caused oxidative stress in both organs. It was inhibited by GT in the heart but remained unchanged in the liver. DOX-induced general toxicity and histopathological changes in the heart and in the liver were mitigated by GT at a higher dose of DOX and augmented in rats treated with a lower dose of the drug.

[Pneumocephalus and pneumorrhachis after chest wall injury]. / Odma sródczaszkowa i kanalu kregowego u chorego z urazem klatki piersiowej.

UNLABELLED: Pneumocephalus and pneumorrhachis are rare findings, and may result from a variety of causes, including severe asthma or trauma. We describe a case, where intracranial and intraspinal air was found after trauma to the chest wall. CASE REPORT: A 24-yr-old patient suffered multiple trauma in a traffic accident, including a closed head injury and bursting fractures of theTh 7, 8 and 9 vertebral bodies with laceration of the spinal cord. Reposition of the spinal column was complicated by wound infection and septic shock. Intraoperatively, accidental extubation led to migration of gastric contents and was complicated by possible rupture of the oesophagus. Postoperative CT scan revealed the presence of air within the mediastinum, cranium and the entire spinal canal. The osteosynthetic material was removed, and the air quickly reabsorbed. The paraplegic patient was discharged from ITU in a satisfactory condition. DISCUSSION: The most probable cause of the complication was traumatic rupture of the oesophagus and penetration of air via lacerated dura mater, to the spinal canal and the cranium. Conservative treatment was successful and led to complete (beside paraplegia) recovery.

Computed tomography perfusion examination is helpful in evaluating the extent of oropharyngeal and oral cavity cancer.

BACKGROUND: Squamous cell cancer (SCC) of the head and neck, like other malignancies, should be reported with regard to TNM classification and treated accordingly. Sole anatomic imaging has its drawbacks, as early lesion detection often remains challenging, non-neoplastic processes can mimic malignancies and there are doubts concerning the extent of tumour. The purpose of this study was to perform assessment of head and neck squamous cell cancer and surrounding tissue, in order to examine the relationship between perfusion measurements derived from CT perfusion imaging (CTP) and histologic evaluation of resected tissue. MATERIAL/METHODS: We prospectively evaluated 21 primary SCC of the oral cavity and oropharynx, using contrast enhanced CT of the head and neck followed by CTP examination at the level of tumour. Blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability (PS) values were calculated with use of manually drawn regions of interest (ROIs) over the lesions and on the contralateral side. Results were compared with histologic analysis of resected tissue. RESULTS: CTP was possible in all twenty one patients, but one did not undergo surgery. Of the remaining twenty, four had retromolar trigone cancer, nine had tongue cancer and seven had tonsil cancer. We found significant differences between infiltrated and healthy tissue. Differentiation was most reliable by using blood flow (BF), permeability surface (PS) and blood volume (BV). CONCLUSIONS: CTP shows promise in distinguishing benign and malignant processes, primarily by means of BF, BV and PS.

The modern methods of gastric imaging.

The major aim of the review is presenting contemporary diagnostic methods applied in gastric imaging as well as their place in clinical treatment. The authors discuss both conventional and modern methods. Although the method of double contrast barium meal is still the most important in stomach diagnostics, the modern methods such as EUSG, CT and MRI are becoming more and more meaningful not only in evaluating gastric neoplastic pathological changes. All applied diagnostic procedures should not be competitive but complementary and constitute an excellent means in hands of an experienced clinicist and radiologist.