[Mucoepidermoid carcinoma of the lung--case reports]. / Rak sluzowo-nablonkowy oskrzela--opis przypadków.

Two patients, a young woman and a young man, with mucoepidermoid carcinoma of the lung, who were diagnosed at the Department of Phthisiopneumonology in Zabrze Silesian Medical University in Katowice are described. The principal method of diagnostics in the presented cases were bronchofiberoscopy followed by the histopathological examination of the lesions. There are no cases of massive bleeding as the side effect of this procedures described. This type of carcinoma of the lung is mostly found in young patients, usually without any risk factors of lung cancer, what confirms the rule, that all pulmonological symptoms of unknown origin should be verified by bronchoscopy, because other methods of diagnostics, including TC of chest-like in our patient, may be false-negative. The method of choice in the treatment of mucoepidermoid carcinoma is surgery. One should avoid a through bronchoscope resection, as it may be only partial. Metastases, mostly found in the local lymph nodes, are rarely described.

The influence of laser arytenoidectomy on ventilation parameters in patients with bilateral vocal cord paralysis.

Bilateral vocal cord paralysis is a symptom that may lead to serious breathing problems. The treatment of patients with vocal cord paralysis presents a challenge to otolaryngologists. Many techniques have been developed in an attempt to improve the patient's airway insufficiency. The aim of the study was to evaluate the efficacy of the laser total unilateral arytenoidectomy with posterior cordectomy in patients with bilateral vocal cord paralysis. Thrity-six patients (33 females, 3 male) aged between 24 and 76 (mean 52) were treated by laser arytenoidectomy. The flow-volume loop and pletysmography were performed in all patients before and after the operation. Additionally, a group of 15 patients with unilateral vocal cord paralysis was introduced and analyzed as a special control. Based on the relative increase of the parameters after the surgery, the most useful of them were selected for the evaluation. Also, the character of the laryngeal obstruction was defined. Changes in the flow-volume loop before and after surgery were compared by planned comparison in univariate analysis ANOVA/MANOVA with an isolated control group. As the parameters AREA(EX), FEF50, FEF75, PEF and MMEF(75/25) increased most effectively, they appeared to be the most useful in the evaluation. FIV1/FEF1, FEF50/FIF50 and FEV1/FEV(0,5) allowed the definition of the obstruction as an extrathoracic dynamically variable quantity. The resistances measured during pletysmography diminished significantly after surgery. The introduction of the special control group with unilateral vocal cord paralysis showed that despite the significant improvement after surgery, the patients who had been operated on still had a laryngeal obstruction worse than that of patients from the control group. The laser arytenoidectomy is shown to be a useful and efficacious procedure for bilateral vocal cord paralysis.

[Aerodynamic model of ventilation efficacy in patients after laser arytenoidectomy]. / Aerodynamiczny model zmian wydolnosci wentylacyjnej u chorych po arytenoidektomii laserowej.

The treatment of bilateral vocal cord paralysis presents a challenge to otolaryngologists. All surgical procedures are designed to widen the lumen of the glottis without impairing vocal function and laryngeal closure during swallowing and respiration. The aim of the study was to evaluate the effectiveness of the laser arytenoidectomy by our own method. Based on the analysis of the results of 36 patients operated on due to bilateral vocal cord paralysis the aerodynamic model of ventilation efficacy changes was introduced and then verified. On the basis of the study an increase of the cross-sectional area of the glottis after laser arytenoidectomy can be combined with air flow improvement in upper airways. Thanks to this relation the postoperative ventilation efficiency may be predicted on the basis of its preoperative value and geometrical parameters of the glottis.

[Broncho-alveolar lavage cells are the most significant reservoir of human cytomegalovirus genome]. / Komórki z popluczyn oskrzelowo-pecherzykowych (BAL) istotnym rezerwuarem genomu ludzkiego wirusa cytomegalii.

The aim of the study is to estimate human cytomegalovirus DNA copy number in different compartments (BAL cells, blood leukocytes, serum) in patients with idiopathic pulmonary fibrosis (IPF). There were 16 patients (mean age 40.87 +/-10.97; 9 males, 7 females) with newly diagnosed and so far not treated IPF included in the study. The diagnosis of IPF was confirmed by typical HRCT findings and/or lung biopsy histopathological examination (result of the biopsy: "usual interstitial pneumonia"). There were also 16 adult volunteers (mean age 36.75 +/- 6.43; 12 males, 4 females) included in the study as a control group. Using the real-time quantitative polymerase chain reaction the HCMV DNA copy number was estimated. The prevalence of HCMV DNA positive subjects in the IPF group (75%) was higher, but did not differ significantly from the control group (69%). The HCMV DNA copy number in 1 million BAL cells was significantly higher comparing to blood leukocytes, both in IPF and control group (log10 = 2.7 vs. 1.2 for IPF and 2.8 vs. 0.9 for control, respectively). Higher mean HCMV DNA copy number was observed in IPF patients comparing to control group (log10 = 3.2 for IPF and 2.0 for control) in 1 mL of blood serum. We concluded that the lungs play an important role in human cytomegalovirus latency and infection reactivation and thus could be a cofactor modulating the course of IPF in humans. The contribution of HCMV infection in IPF patients should be taken into account during immunosuppression therapy planning.

[Two cases of bronchial tuberculosis--diagnostic difficulties]. / Dwa przypadki gruzlicy oskrzeli--trudnosci rozpoznawcze.

We present two cases of bronchial tuberculosis. The first one, man aged 45, showed diffuse necrotic changes in bronchoscopic picture described histologically as coagulative necrosis. AFB were not found in sputum smear but only in the cultures. The second patient--19-year old female presented the features of right lung bronchopneumonia. Bronchoscopic examinations showed diffused necrotic infiltration. Tuberculosis etiology was confirmed by positive results of examined brosage, concomitantly with negative Mantoux reaction.

[Concentration of nitric oxide exhaled air (eNO) in patients with COPD and bronchiectasis]. / Stezenia tlenku azotu w powietrzu wydechowym u chorych na przewlekla obturacyjna chorobe pluc oraz rozstrzenie oskrzeli.

UNLABELLED: Exhaled nitric oxide (eNO) concentration measurement may allow for noninvasive estimation of severity of airways inflammation in respiratory tract diseases. Exhaled nitric oxide concentration is a sensitive marker of bronchial inflammation in asthma. The purpose of this study was: to evaluate eNO concentration in patients with COPD and bronchiectasis; to evaluate correlation between eNO concentration and the degree of airways obstruction in patients with COPD as well as correlation between eNO and extent of bronchiectasis in HRCT; to evaluate the effect of smoking on eNO concentration in COPD group. There were two groups of patients and the control group. The first group consisted of 20 patients with COPD (17 men, 3 women aged 41-68 yr). Ten patients were ex-smokers, and ten were current smokers. The second group consisted of 15 nonsmokers (10 men, 5 women aged 45-72 yr) with the diagnosis of bronchiectasis based on high-resolution CT criteria. The control group consisted of 11 healthy, nonsmoking subjects who had no respiratory disease or allergy, aged 28-52 years. Exhaled NO was measured by means of SIEVERS 280 Nitric Oxide Analyser (Boulder, Colorado, USA). RESULTS: The highest eNO concentration was found in patients with bronchiectasis (9.83 ppb +/- 3.09; median 8.0). It was significantly elevated compared to the values found in patients with COPD (5.3 ppb +/- 0.57, median 4.46; p = 0.002) or in the control group (5.17 ppb +/- 0.73, median 4.32; p = 0.007). Ex-smokers with COPD had higher eNO levels (6.3 ppb +/- 0.73; median 5.7) than did active smokers with COPD (4.3 ppb +/- 0.80; median 3.39; p = 0.017). Exhaled NO did not differ between exsmokers and healthy nonsmokers. There was no correlation between eNO and number of packyears (r = -0.022; p = 0.928). The extent of bronchiectasis expressed as CT score did not correlate with eNO concentration. There was also no significant relationship between eNO and FEV1 (r = -0.046; p = 0.87).

[Evaluation of ventilation parameters based on flow volume loop in patients with unilateral vocal cord paralysis]. / Ocena parametrów wentylacyjnych na podstawie krzywej przeplyw-objetosc u chorych z jednostronnym porazeniem struny glosowej.

The vocal cord paralysis as a multidisciplinary problem requires commitment of different medical specialities. The diagnostic difficulties and necessity of laryngoscopic evaluation in cases suspected of vocal cord paralysis were pointed out. The analysis of ventilation parameters (flow-volume loop) was presented. The significant usefulness of inspiratory parameters, especially in upper airway obstruction was emphasized. The most useful parameters and coefficients were shown. Based on another authors data the criteria of airway obstruction classification were presented. The flow volume loop was found as a uniquely suited to the examination of upper airway obstruction. According to this examinations the unilateral vocal cord paralysis was defined as a variable extrathoracic obstruction which does not influence ventilation significantly.

[Chronic obstructive pulmonary disease in inhabitants of Zabrze]. / Przewlekla obturacyjna choroba pluc u mieszkanców miasta Zabrza.

In 2001 a modified MRC questionnaire and spirometry were performed in the inhabitants of Zabrze (Poland). Two hundred and thirty-nine men and 320 women aged 19-69 years were studied. Forty percent of men and 23% of women were smokers. In men but not in women a decline in smoking habit was observed as compared with previous studies in Zabrze carried out in the eighties. More men (32%) than women (19%) gave up smoking. The prevalence of chronic productive cough was closely related to smoking habit. Dyspnea and wheezing were also related to smoking but less strongly than productive cough. The prevalence of COPD (diagnosed according to GOLD criteria) was 10.2%. COPD was more common in smokers than in non-smokers, especially among men (19% and 2% respectively). Persistent productive cough, wheezing and advanced dyspnoea as well as intensive smoking (more than 40 pack years) were strongly connected with the prevalence of COPD. COPD was previously diagnosed in more than 50% of subjects identified as having COPD in this study. Almost 80% of subjects with COPD were not given any treatment in the past year.