Unusual cause of hemoptysis: A case report.

Hemoptysis is defined as bleeding from the lower respiratory tract. It can be life-threatening and requires urgent investigation and intervention. Common causes of hemoptysis include bronchiectasis, tuberculosis, aspergilomas and malignancy. We present an unusual case of hemoptysis in a young woman with a history of surgery for scoliosis 18 years earlier. A 30-years-old woman was admitted to our institution for recurring hemoptysis since one year. She had a history of scoliosis and had undergone antero-lateral Th7 through Th12 spinal fusion surgery 18 years earlier. The hemoptysis was slight and resolved spontaneously or after empirical antibiotic therapy, and was attributed to bronchitis. Computed tomography revealed spinal rod penetration into the lung resulting in injury, while the caudal edge of the rod migrated into the liver and the joining screws had entered the mediastinum. Hemoptysis was due to penetration of the rod into the lung. The patient underwent extensive surgery, which was successful. The case highlights the need for thorough evaluation of patients with hemoptysis. Every incident of hemoptysis, even if minor, should be promptly investigated, because it can be life-threatening.

[Alveolar hemorrhage caused by exposure to pesticides]. / Krwawienie pecherzykowe wywolane ekspozycja na pestycydy.

17 years old boy was admitted because of cough, hemoptysis and mild fever. These symptoms appeared a day after exposure to Decis-pesticide of relatively low toxicity for people. In hospital respiratory failure (pO2 48.5 mmHg) and alveolar haemorrhage (the presence of bloody fluid with hemosiderin loaded macrophages, the signs of alveolar filling in chest HRCT scan and elevation of diffuse capacity) were recognised. All symptoms completely disappeared after 5 month of corticosteroids therapy.

[Clinical presentation of own idiopathic pulmonary fibrosis patients according to international consensus statement]. / Próba zastosowania kryteriów diagnostycznych miedzynarodowej grupy ekspertów do oceny obrazu klinicznego samoistnego wlóknienia pluc w materiale wlasnym.

Clinical presentation of idiopathic pulmonary fibrosis (IPF) restricted, according to current definition to usual interstitial pneumonia (UIP) was presented. 62 patients (39 males and 23 females) were assessed. The diagnosis of IPF/UIP has been based upon a combination of clinical, radiographic and physiologic features in majority of patients. Histologic confirmation from lung biopsy has been obtained in 16% of cases. Mean age of the patients was 64.4 +/- 8.0 years. Mean duration of symptoms was 20.1 +/- 14.1 months. The main symptom was exertional dyspnea. Crepitations were found in 98% of patients. Lung volumes were in normal range in substantial number of patients; TLC in 15 (24%) and FVC in 33 (53%) out of 62 patients. Disturbances of lung function concerned mainly gas exchange (DLCO diminished in 92% of cases) and lung compliance (diminished in all patients). Presentation of clinical, radiographic and physiologic features of IPF/UIP in a homogenous group of patients may be helpful in diagnosis of this common interstitial lung disease.

[Echocardiography improves the chance of conclusive results in spiral computed tomography of suspected pulmonary embolism]. / Echokardiografia okresla szanse diagnostycznego wyniku spiralnej tomografii komputerowej w podejrzeniu zatorowosci plucnej.

While highly specific for detecting thromboembolism in proximal pulmonary arteries, spiral computed tomography (spiral CT) cannot reliably exclude pulmonary embolism. Therefore "negative" spiral CT in patients with high clinical probability of acute pulmonary embolism should be considered as non-conclusive. The goal of our study was to check whether echo/Doppler could stratify patients with suspected pulmonary embolism according to the chance of obtaining a conclusive spiral CT result. Echo/Doppler recordings of 51 patients (27 F, mean aged 50 +/- 19) admitted to ICU with high probability of acute pulmonary embolism were compared with the results of spiral CT of pulmonary artery. Pulmonary embolism was revealed by spiral CT in 36 pts. who at echocardiography were found to have shorter acceleration time (AcT 86 +/- 27 vs 117 +/- 7 ms, p < 0.00001) and right ventricle enlargement (PK 30 +/- 5 vs 25 +/- 2 mm p < 0.0001). The velocity of tricuspid regurgitation (TVPG) could not be measured in 19 patients. Among patients with long AcT (> or = 120 ms) or without right ventricle enlargement 8 of 14 and 14 of 28 patients, respectively had no intrapulmonary clots at spiral CT. Echo/Doppler helps in preselection of patients in whom confirmation of PE with spiral CT is highly probable. In patients without indirect echocardiographic sings of pulmonary embolism, despite high clinical probability the chance of a conclusive spiral CT is 40-50%. This should be kept in mind when selecting the most effective diagnostic strategy in individual cases.

[LGM inferior vena cava filters--observation of 79 patients]. / Filtry LGM zakladane do zyly glównej dolnej--obserwacja 79 chorych.

The aim of the study was to assess effectiveness and safety of the LGM inferior vena cava (IVC) filters in patients with venous thromboembolic disease. In the Department of Internal Medicine of Institute of Tuberculosis and Lung Diseases in Warsaw 79 LGM IVC filters have been inserted since 1993. Indications for filters placement were as follows: recurrent pulmonary embolism (pe) despite anticoagulation--17 patients (pts), severe bleeding complications of thrombolytic or anticoagulant therapy--11 pts, contraindications for thrombolytic and/or anticoagulant treatment--5 pts, massive pe--14 pts, chronic thromboembolic-major vessel pulmonary hypertension (CTEPH)--30 pts, extensive deep vein thrombosis of lower limbs or vena cava inferior in patients with urgent indications for surgery--24 pts. Each filter placement was preceded by cavography. The diagnostic procedures (mainly ultrasonography) were performed after 3-6 and 12 months in the first year then once yearly during follow-up period. Oral anticoagulants (OA) or low-molecular-weight heparins (LMWH) were instituted in the majority of patients. 58 patients are still alive, 21 patients died. Only two non-fatal episodes of recurrent pe were documented. Other complications were rare and insignificant. We have not observed excess rate of recurrent deep venous thrombosis nor thrombosis at the filter site. The LGM IVC filters are effective and safe in such selectively chosen group of patients.

[Use of temporal vena cava filter in a patient with a high risk of perioperative pulmonary embolism]. / Zastosowanie czasowego filtru zylnego u pacjentki z duzym ryzykiem okolooperacyjnego zatoru tetnicy plucnej.

Intraluminal caval filter placement can be applied in order to prevent pulmonary embolism. When surgery has to be performed in the patient with proximal deep venous thrombosis anticoagulant therapy should be reduced and filter placement is indicated. Temporary filter appears an interesting option, as it can be removed shortly after surgical intervention, when contraindications to anticoagulation no longer exist. However, obligatory removal of a temporary device in case of suspected filter or vena cava thrombosis emerges as a new clinical problem. We present a ease of 20 year old woman with proximal deep venous thrombosis and high risk of pulmonary embolism in whom temporary vena caval filter with heparin infusion were chosen as a method of perioperative pulmonary embolism prevention.

[Clinical significance of pattern types in high resolution computed tomography images of patients with idiopathic pulmonary fibrosis]. / Znaczenie kliniczne typu zmian w obrazie tomografii komputerowej wysokiej rozdzielczosci u chorych na samoistne wlóknienie pluc.

UNLABELLED: The aim of the study was to assess significance of two types of HRCT pattern in patients with idiopathic pulmonary fibrosis (IPF), corresponding to usual interstitial pneumonia. The study population consisted of 34 patients, 11 women and 23 men, mean age 64.5 +/- 10.5 years. The patients were divided into two groups according to HRCT appearance: Group A--reticular pattern with some ground-glass attenuation (30 patients); group B--reticular pattern only (4 patients). Age, level of dyspnea, pulmonary function tests were similar in both groups. Longer history of dyspnea and more frequent finger clubbing (all patients) were found in Group B. 30 patients were followed-up for at least 12 months. In this period 4 out of 27 patients died in Group A, and 2 out of 3 patients died in Group B (p < 0.05). CONCLUSION: HRCT showing reticular pattern only corresponds to late phase of IPF and is connected with very short survival.

[Cytomegalic disease as a cause of disseminated lung lesions in an immunosuppressed patient]. / Cytomegalia jako przyczyna masywnych zmian rozsianych w plucach u chorego w immunosupresji.

A case of disseminated lesions in the lungs was diagnosed just during autopsy as cytomegalic infection. 54-year old patient treated since 10 years because of lymphoplasmacytoid lymphoma of low malignancy was admitted to Institute of Tuberculosis with suspicion of miliary tuberculosis. The high temperature, pemphigus--like skin lesions and disseminated lesions in the chest X-ray appeared immediately after succeeding chemotherapy. Tuberculous bacilli. Aspergillus fumigatus and Pneumocystis carinii were not found in examined materials (BALF, blood, urine, skin and mucous lesions). Patient died after 3 days and typical lesions of cytomegalovirus infection were found only after autopsy in macroscopic picture of the lungs.

[The use of LGM-type filters inserted into the vena cava in patients with neoplasms. Preliminary report]. / Zastosowanie filtrów typu LGM wszczepianych do zyly glównej dolnej u chorych na chorobe nowotworowa. Doniesienie wstepne.

The aim of the study was to assess effectiveness and safety of inferior vena cava filters in patients with cancer and concurrent thromboembolic disease. The LGM filters were inserted in 10 cancer patients. Diagnosis of malignancy was established prior filter placement in 8 patients and after the procedure in 2 patients. Follow-up physical examination and ultrasound procedures (Echo, Duplex-Doppler) were performed after 1, 3, 6, 12, 24 months. Mean period of observation lasted 12 month. All patients received prolonged anticoagulation either oral anticoagulants or low molecular weight heparins after filter placement. Our results confirm that the LGM filters are effective and well tolerated in patients with malignancies. There were no important complications both early and late related to filter placement and no evidence of recurrent pulmonary emboli.

[Changes in the respiratory system of patients with rheumatoid arthritis--personal observations]. / Zmiany w ukladzie oddechowym u chorych na reumatoidalne zapalenie stawów--obserwacje wlasne.

13 patients with RA admitted to our Institute with symptoms of respiratory involvement were described. Taking under consideration pulmonary function tests, radiological findings and histological examinations, we recognised 7 cases with interstitial lung disease, 3 cases with recurrent respiratory infection with bronchiectasis, 1 case with pleuritis, 1 with Caplan's syndrome and 1 with alveolar haemorrhage. The role of RF, and treatment with gold in the development of interstitial lung disease, as well as character of physiologic abnormalities concerning the small airways and its potential connection with bronchiolitis were discussed.

[Coexistence of obstructive lung diseases and lung cancer]. / Wspólistnienie przewleklej choroby obturacyjnej pluc z rakiem pluca.

Connection between histological type of lung cancer and existence of clinical and spirometric symptoms of COPD was analysed in 110 lung cancer patients (64 small cell, 23 adenocarcinoma, and 23 squamous). It was shown that adenocarcinoma was significantly more frequent among subjects with values of FEV1%VC over 70 than among subjects with small cell and squamous lung cancer. Also subjects with values of FEV1% VC over 70 had significantly higher oxygen blood pressure, and clinical and radiological symptoms of COPD were less intensive than in subjects with values of this index below 70. There was no correlation between histological type of lung cancer and bronchoscopic symptoms of bronchitis and radiological symptoms of emphysema.

[LGM inferior vena cava filters--follow up 50 patients]. / Filtry LGM zakladane do zyly glównej dolnej--obserwacja 50 chorych.

In the Department of Medicine at the Institute of Tuberculosis and Lung Diseases 50 LGM inferior vena cava filters have been inserted since 1993. Indications for filters placement were as follows: recurrent pulmonary embolism (PE) despite anticoagulation-16 patients (pts), severe bleeding complications of thrombolytic or anticoagulant therapy-9 pts, contraindications for thrombolytic and/or anticoagulant treatment-3 pts, massive PE-6 pts, chronic thromboembolic-major vessel pulmonary hypertension (CTEPH)-18 pts, extensive deep vein thrombosis of lower limbs or vena cava inferior in patients with urgent indications for surgery-10 pts. In every patient diagnostic procedures were performed after 1, 3, 6, 12, 24 and 36 months of follow-up period. Only one non-fatal episode of recurrent PE was documented. Other complications were rare and insignificant. The LGM inferior vena cava filters are effective and safe in such selectively chosen group of patients.

[Implantation of LGM inferior vena cava filters in patients with chronic pulmonary hypertension during a course of major vessel thromboembolism--observation of 18 patients]. / Implantacja filtrów LGM do zyly glównej dolnej u chorych z przewleklym, nadcisnieniem plucnym w przebiegu zatorowosci do duzych naczyn--obserwacja 18 chorych.

CTEPH have not been widely recognised until recently. Introduction of the new, sophisticated, non-invasive diagnostic tools accounts for rapid progress in that field. Patients with high pulmonary hypertension have a very poor prognosis. Medical treatment (vasodilators, anticoagulants) does not change outcome. Pulmonary thromboendarterectomy is the only therapeutic option for the patients. It is essential to prevent further episodes of pulmonary embolism both over the long term and during the high risk perioperative period by means of inferior vena cava filters. In the Department of Medicine, Institute of Tuberculosis and Lung Diseases 18 LGM ivc filters have been inserted in patients with CTEPH since 1994. In 7 patients PTE was performed-in 5 cases good result was achieved, 2 patients died after surgery. In the latter group 5 patients died mainly because of severe heart failure. Only one non-fatal episode of pulmonary embolism was observed. It should be concluded that the LGM ivc filters are safe and effective in preventing episodes of pulmonary embolism in patients with CTEPH.

[Low doses of rtPA administered as a bolus in treatment of clinically acute massive pulmonary embolism]. / Male dawki rtPA podawane w bolusach w leczeniu klinicznie masywnego zatoru tetnicy plucnej.

12 patients (7 male and 5 female) with confirmed pulmonary embolism (PE) with: angiography-5 cases, conventional contrast-enhanced CT-2 cases, echocardiography-2 cases, autopsy-3 cases were diagnosed as clinically acute PE. Criteria of clinically acute PE were: cardiac arrest-1 case-2 cases, shock-1 case, acute cor pulmonale-9 cases and acute cor pulmonale with shock. All patients were treated with heparin, administered with therapeutic prolongation of aPTT. Clinically acute PE (if possible confirmed with angiography, TC and/or echocardiography) was treated with rtPA administered in 10 minutes lasting bolus in doses 0.6-0.8 mg per kg of body weight (50 mg of rtPA during 10 minutes administered into peripheral veins). In 9 patients with pulmonary hypertension, significant decrease of tricuspidal gradient (measured echocardiographically during several hours after administration of rtPA) was documented. Improvement in PaO2, SaO2 and decrease of heart rate and respiratory rate were also achieved. No serious bleeding complications were observed after mentioned treatment. Control investigations (conventional contrast-enhanced CT and spiral CT) performed several days after rtPA administration revealed thrombus in pulmonary artery. We conclude: I rtPA administered in bolus simultaneously with heparin significantly decreased pulmonaryhypertension; rtPA administered simultaneously with heparin is safe method of treatment of PE; hemodynamic improvement after administration of rtPA is not univocal with full fibrynolitic effect.

[Initial prospective evaluation of cancer incidence in relation to metabolism of antipyrine and family history in patients with lung cancer]. / Wstepna prospektywna ocena zachorowan na nowotwory w zaleznosci od metabolizmu antypiryny I zwiazków rodzinnych z chorym na vaka ptuca.

Our previous studies revealed faster antipyrine metabolism among lung cancer patients and their first degree relatives in comparison with subjects without cancer history in their families. After 8 years 39-70% previously investigated first degree relatives of lung cancer patients and 55-73% previously investigated healthy subjects without cancer in their families were examined. One lung cancer case was noticed in the group of relatives and this subjects had very fast antipyrine metabolism. Also 2 cases of non-smoking related cancer were observed in subjects with intermediate antipyrine metabolism. Only one case of non-smoking related cancer was noticed among controls and this subjects had rather slow antipyrine metabolism.

[Indications for prophylactic vena cava filters introduced subcutaneously in patients with thromboembolic disease--preliminary report]. / Wskazania do zastosowania profilaktycznego filtrów wprowadzanych przezskórnie do zyly glównej dolnej u chorych z zylna choroba zakrzepowo-zatorowa--doniesienie wstepne.

In 10 patients with thromboembolic disease 1 Gunther filter and 9 LGM filters were inserted. Indications for filter placement were: pulmonary hypertension caused by recurrent pulmonary embolism in 3 cases; planned surgery in 2 patients with pulmonary embolism and deep venous thrombosis; recurrent pulmonary embolism despite of anticoagulant treatment in 2 cases, previously performed thrombo-endarterectomy in 1 case; contraindications for anticoagulant treatment in 1 case and complications of anticoagulant therapy also in 1 case. No serious complications after filter placement were observed.

[Lung carcinoids diagnosed as small cell lung cancers--important diagnostic problem]. / Rakowiaki pluca mylnie rozpoznane jako raki drobnokomórkowe--istotny problem diagnostyczny.

The four cases of bronchial carcinoids were presented. Based on bronchoscopic biopsies the initial diagnosis of small cell lung cancer was established in them. The analysis of medical history was strongly suggested for carcinoid but not for small cell carcinoma. In each of them thoracotomy was performed and correct diagnosis of carcinoid was estimated based on resected tumour. The diagnostic criteria for bronchial carcinoid were discussed.

[Implantation of a LGM suprarenal vena cava filter--case report]. / Implantacja filtru LGM powyzej ujscia zyl nerkowych--opis przypadku.

In the case of 53 years old woman LGM filter was inserted over renal veins. Indications for those procedures were: vena cava thrombosis in distal part of vena cava what not allowed to place filter below renal veins, malignancy, planned surgery, proximal deep vein thrombosis and past history of pulmonary embolism. Indications for suprarenal placement of vena cava filters and results of such as procedure were discussed.