Angiogenic activity of sera from interstitial lung disease patients in relation to clinical and radiological changes.

OBJECTIVE: Clinical symptoms and radiological changes are useful in monitoring patients with interstitial lung diseases (ILD). Neovascularization participates in the pathogenesis of idiopathic pulmonary fibrosis and other ILD. The objective of the study was to examine the relationships between angiogenic activity of sera from ILD patients and clinical or radiological status. MATERIAL AND METHODS: Serum samples were obtained from 83 patients with sarcoidosis, 31 with idiopathic pulmonary fibrosis (IPF), 29 with hypersensitivity pneumonitis (HP), 16 with collagen diseases with pulmonary manifestation (CD), 13 with scleroderma (SCL), 14 with Wegener's granulomatosis (WG), 12 with pulmonary Langerhans cell histiocytosis (HIS), 12 with pneumoconiosis (PNC), 10 with drug-induced lung disease (DLD), 5 with cryptogenic organizing pneumonia (COP), and from 36 healthy volunteers. As an angiogenic test we used a cutaneous angiogenesis assay according to Sidky and Auerbach. Clinical status was evaluated using a special questionnaire. In all patients chest radiographs were performed. RESULTS: The angiogenic properties of sera from ILD differed depending on the clinical diagnosis. The strongest proangiogenic effect was induced by sera from patients with HP (mean number of new vessels 16.8), CD (16.6), sarcoidosis (16.3), IPF (16.2), and PNC (15.7). In the case of DLD (13.2), the effect was comparable to healthy controls (13.5). In contrast, sera from SCL (mean number of the vessels 10.5) and HIS patients (10.8) significantly inhibited angiogenesis compared with controls. The angiogenic activity of sera from patients with hilar or mediastinal lymph nodes involvement was higher than that of sera from patients with lung fibrosis. There were also differences in the serum angiogenic activity in relation to the severity of dyspnea. CONCLUSIONS: The data showed that sera from ILD patients constitute a source of mediators modulating angiogenesis, but the pattern of reaction is different in various diseases. Sera from HP, sarcoidosis, IPF, and CD patients demonstrated the strongest proangiogenic activity. However, sera from SCL and HIS inhibit angiogenesis. Angiogenic activity of examined sera was related to the clinical and radiological changes.

Cellular components of the bronchoalveolar lavage correlate with lung function impairment and extrapulmonary involvement markers in active sarcoidosis.

Sarcoidosis is a chronic inflammatory multiorgan disease of unknown origin. Our previous study demonstrated a significant correlation between the relative count of non CD4(+), non CD8(+) lymphocytes in bronchoalveolar lavage of active sarcoidosis patients and proangiogenic activity of BAL homogenates. The aim of the present study was to evaluate in a group of 40 patients with active sarcoidosis the possible relationship between the intensity of alveolitis, particularly the non CD4(+), non CD8(+) lymphocyte subset, and other parameters characterizing the level of pulmonary (lung function tests) and extrapulmonary (spleen longitudinal dimension) disease activity. We found that the relative count of non CD4(+), non CD8(+) lymphocytes in BAL correlated positively with spleen size (r=0.50, P<0.01) and negatively with static compliance (r=0.43, P<0.05). We concluded that the lymphocytes belonging to the non CD4(+)non CD8(+) subset participate in the inflammatory process in sarcoidosis. However, more detailed phenotypic and functional characteristics of this cellular population are needed.

[Atypical radiologic image of pulmonary sarcoidosis as a diagnostic problem]. / Nietypowy obraz radiologiczny w sarkoidozie pluc jako problem diagnostyczny.

Sarcoidosis is a multisystem disorder of unknown cause frequently presenting with hilar lymphadenopathy, pulmonary infiltration, ocular and skin lesions. Multiple circular or oval pulmonary dentisties appear in the less than 5% of patients. We describe 4 sarcoidosis cases with multiple or single tumor lesion. These patients were referred to our department with initial diagnosis of metastatic or primary lung malignancy. Two of them presented the picture of multiple tumors and two had single peripheral lung mass with hilar lymphadenopathy. This report shows difficulties in the diagnosis of the interstitial lung diseases when the radiological pattern mimics malignancy.

[Seasonal fluctuation in peptic ulcer occurrence: a disappearing phenomenon?]. / Sezonowosc wystépowania peptycznego wrzodu zoladka i dwunastnicy--zjawisko zanikajçe?

Some studies suggest that seasonal fluctation of peptic ulcer occurrence is not common these days. The retrospective analysis of 4858 endoscopies performed in Srodmiejski Hospital in Warsaw confirmed this conclusion. There is no significant differences in frequency of peptic ulcer occurrence in particular seasons.

[Evaluation of respiratory muscle strength in patients with interstitial lung changes based on simultaneous measurement of esophageal and mouth pressure]. / Ocena sily miesni oddechowych u chorych ze zmianami sródmiazszowymi pluc na podstawie jednoczasowego pomiaru cisnienia w przelyku i w jamie ustnej.

A well know good relation between nasal and oesophageal inspiratory pressures exists in healthy and in COPD patients "sniff manoeuvres. Similar results are obtained using "gasp" maneuvers. The aim of the study was to appreciate the usefulness of "gasp" for evaluation of inspiratory muscles strength in ILD patients. 18 ILD patients were examined: group A consisted of 9 pts (8M+IF) aged 35 +/- 8.6 yrs, with static compliance > 70% pred. (mean 98.6 +/- 16.3), group B consisted of 9 pts (6M + 3F) (aged 52 +/- 13.0) with static compliance < 70% pred. (mean 37.2 +/- 12.0), Pmo and Poe (Milic-Emili method) were measured simultaneously during breathing with Pflex device (1.7 mm diameter). Results were stored in a computer for further analysis. In all patients spirometry, plethysmography and maximal inspiratory (MIP) and maximal expiratory (MEP) pressure measurements were performed. Poe and Pmo in group A were nearly the same (8.16 +/- 1.82 vs. 8.35 +/- 2.74 kPa), but in the group B Pmo was lower than Poe (4.81 +/- 1.59 vs. 6.19 +/- 2.03 kPa; p < 0.0005). We conclude that "gasp" - Pmo is a useful method for inspiratory muscle strength measurement only in ILD patients with normal static compliance but in ILD patients with decreased compliance "gasp" - Poe measurement in necessary.

[Evaluation of angiogenic activity in sera from patients with interstitial lung diseases]. / Ocena aktywnosci angiogennej surowic chorych na sródmiazszowe choroby pluc.

Angiogenesis is a process of new blood vessels' formation occurring in many physiological and pathological conditions. Neovascularisation is the principal vascular response in chronic inflammation and concomitant fibrotic process. Microvascular changes in various organ sites in sarcoidosis (BBS) and some of the symptoms of the disease may be related to microangiopathy. Moreover, vascular alterations were also observed in lung specimens from idiopathic pulmonary fibrosis (IPF) and avian fanciers lung (AFL) patients. The present study was aimed at testing the effects of serum from 43 patients with ILD (24 BBS, 8 AFL, 8 IPF, 3 DIPF--drug induced pulmonary fibrosis) and 11 healthy controls on angiogenic capability of normal blood peripheral mononuclear cells (PBMC) in the murine intradermal angiogenesis assay (according to Sidky and Auerbach). The data demonstrated that sera from ILD patients significantly enhanced angiogenic capacity of normal PBMC as compared to control sera (p < 0.001). The effect was more pronounced for AFL patients than for BBS and IPF ones (p < 0.05). Sera from DIPF did not stimulate angiogenesis compared to control sera. The data showed that sera from ILD patients constitute sources of mediators participating in angiogenesis. This phenomenon may play role in pathogenesis of chronic immunological processes in lung.

[Lung and pleural changes caused by exposure to asbestos]. / Zmiany plucne i oplucnowe wywolane ekspozycja na azbest.

Asbestos exposure results in an increased risk of nonmalignant as well as of malignant pulmonary and pleural disease. The asbestos-related disease are inexorably progressive (cancer) or insidious (fibrosis), untreatable and widespread in the industrialized and urban world. The identification of these diseases is important because therapy and prognosis differ from the other pulmonary fibrosis. The case reports indicate that careful clinical and histologic examination allows proper diagnosis. Two patients with asbestos-related disease after asbestos exposure are described.

[Tuberculosis of the bones and joints]. / Gruzlica kosci i stawów.

The incidence of tuberculosis has increased over the last several years. Bones and joints tuberculosis makes 20% of all extrapulmonary locations of tuberculosis. In Poland this form of tuberculosis is underdiagnosed. We present three cases with tuberculosis of bones, joints and lung to remind the basic principles of diagnosis and treatment.

Thrombin clotting time and fibrin polymerization in liver cirrhosis.

The thrombin clotting time and the fibrin polymerization test were performed in 64 patients with liver cirrhosis. Each test was made with thrombin diluted with 150 mmol/l sodium chloride and 25 mmol/l calcium chloride. The thrombin-in-NaCl clotting time was found to be prolonged in 39% of cirrhotic patients, whereas fibrin polymerization was defective in 65% of them. Dilution of thrombin with calcium chloride diminished the number of abnormal results of both tests in patients with liver cirrhosis. Among the performed tests most sensitive test proved to be the polymerization of fibrin induced by thrombin diluted with sodium chloride.

A randomized study comparing low dose ciprofloxacin and ofloxacin in the treatment of lower respiratory tract infections.

An open, randomized study was carried out to compare the efficacy of ciprofloxacin, 250 mg twice daily, and ofloxacin, 200 mg twice daily, in hospitalized patients with lower respiratory tract infections such as bacterial exacerbation of chronic bronchitis or community-acquired pneumonia. Fifty patients were treated in each group. The duration of treatment was 10 to 12 days. Microbiological examinations were carried out on sputum samples taken before, during and after treatment. In both groups, the clinical results were considered to be excellent, with clinical cure in 98% of the patients treated with ciprofloxacin and in 90% of patients treated with ofloxacin. Eradication of the initial sputum isolate was achieved in 98% of the patients of the ciprofloxacin group and in 82% of the patients of the ofloxacin group.