Tracheobronchopathia osteochondroplastica­case report and literature review.

Tracheobronchopathia osteochondroplastica (TBO) is a rare disease of unknown etiology characterised by a formation of multiple, cartilaginous and osteocartilaginous submucosal nodules in the trachea and major bronchi. The course of the disease is usually benign but the narrowing of the respiratory tract can lead to chronic non-specific clinical symptoms. We present a case of a 50-year old man with chronic exertional dyspnoea and stenosis of the trachea visible in imaging tests, in whom the symptoms were caused by TBO.

Arteriobronchial fistula complicating right upper lobectomy.

Bronchial stump fistula (BSF) is a known complication after lobectomy, although its incidence after lobe resection for non-small cell lung cancer usually does not exceed 2%. We present the case of a patient in whom a late BSF developed that led to a fatal pulmonary hemorrhage 4 weeks after right upper lobectomy and 4 hours after emergency readmission. Such a pulmonary hemorrhage could have been prevented by pulmonary artery embolization and intrapericardial pneumonectomy. The decision to perform pneumonectomy as a preventative procedure without overt clinical symptoms was a difficult decision to reach, particularly given the likelihood of being unnecessarily aggressive.

Thymidylate synthase protein expression by IHC and gene copy number by SISH correlate and show great variability in non-small cell lung cancer.

INTRODUCTION: Increased expression of thymidylate synthase (TS) is thought to be associated with resistance to TS-targeting drugs, e.g., pemetrexed. METHODS: TS protein expression (PE) and gene copy number (GCN) were assayed using immunohistochemistry and silver in situ hybridization, respectively, on primary tumors of 189 resected non-small cell lung patients. Associations with pathological and clinical features and prognosis were explored. RESULTS: Median immunohistochemistry H-score was 220 (range, 10-380) on a 0 to 400 scale; 17% of the patients had a TS expression of 300 or more. TS PE expression did not significantly differ by histology and did not significantly associate with disease-free survival (DFS) or overall survival (OS). However, there was a tendency for increased DFS (p = 0.12) and OS (p = 0.12) in PE positive (>median) squamous-cell carcinoma (SCC) patients. Median GCN was 2.5 genes/nucleus (range, 1.4-9.6); 29% of patients had GCN of 3 or more, 7% of 4 or more and 0.8% amplification. GCN differed by histology (p = 0.015); 50% of SCCs having GCN more than 2.5 versus 32% of adenocarcinomas. There was no significant relationship between TS GCN and DFS or OS; however, a trend toward better DFS (p = 0.18) and OS (p = 0.10) with increased GCN in SCCs was observed. TS GCN was significantly correlated with PE (r = 0.30, p = 0.0009). CONCLUSIONS: TS PE and GCN vary widely in non-small cell lung and correlate significantly with each other. TS GCN is higher in SCCs, whereas TS PE does not associate with histological subtypes, clinical features, or survival. Variability of TS PE and GCN may indicate potential benefit from pemetrexed therapy in selected SCC patients.

Changed phagocytic activity and pattern of Fcγ and complement receptors on blood monocytes in sarcoidosis.

We have recently revealed that mycobacterial heat shock proteins (Mtb-hsp), involved in forming of immune complexes (CIs), can induce immune response in sarcoidosis (SA). The complexemia may result from inappropriate phagocytosis and clearance of CIs by monocytes with following persistent antigenemia and granuloma formation. Because an aberrant expression of receptors for Fc fragment of immunoglobulin G (FcγR) and complement receptors (CR) on monocytes can be involved in this process, we have evaluated the expression of FcγRI (CD64), FcγRII (CD32), FcγRIII (CD16) and CR1 (CD35), CR3 (CD11b), CR4 (CD11c) receptors on blood CD14(+) monocytes and its phagocytic activity in 24 patients with SA and 20 healthy volunteers using flow cytometry. We found significantly increased expression of all examined FcγR and decreased expression of CD35 and CD11c on CD14(+) monocytes in SA patients vs controls. Significantly increased percentage of CD14(+)CD16(+)CD35(-), CD14(+)CD64(+)CD35(+), CD14(+)CD64(+)CD11b(+), CD14(+)CD64(+)CD11c(+) and decreased of CD14(+)CD32(-)CD35(+), CD14(+)CD32(-)CD11b(+), CD14(+)CD32(-)CD11c(+) monocytes' phenotypes was revealed in SA. The total number and percentage of phagocyting monocytes was significantly increased in SA as compared with controls. In conclusion, altered expression of FcγR and CR on CD14(+) monocytes and its increased phagocytic activity may be responsible for high antigen load, persistent antigenemia and immunocomplexemia in SA patients.

Mycobacterium tuberculosis complex and mycobacterial heat shock proteins in lymph node tissue from patients with pulmonary sarcoidosis.

We demonstrated that not whole Mycobacterium tuberculosis but its particular antigens, hsp70(Mtb), hsp65(Mtb), and hsp16(Mtb), are present in lymph node tissues of patients with sarcoidosis (SA). hsp16(Mtb) occurs in the early stage of SA, whereas hsp70(Mtb) occurs in stage II of SA. hsp65(Mtb) is highly expressed in the capillary vessels in lymph node tissues in patients with SA.

Comparative analysis of DR and DQ alleles occurrence in sarcoidosis and tuberculosis in the same ethnic group: preliminary study.

BACKGROUND: Pathologic similarities between sarcoidosis (SA) and tuberculosis (TB) suggest M. tuberculosis antigen(s) as causative agents. It seems likely that in the genetically different predisposed hosts, the same antigen(s) may cause the development of sarcoid or tuberculous Th1 response. AIM AND MATERIALS/METHODS: To test a difference in haplotypes associated with both diseases, we compared the distribution of DRB1, DQA1 and DQB1 alleles in 45 SA patients, 62 TB patients and in 143 healthy volunteers, using a PCR-SSP method. RESULTS: Our results revealed that DRB1*03/*11, DQB1*02, DQA*0501 in Stage I of SA with Löfgren's syndrome (Ls) and DRB1*15, DQA1*0102/*0103 in Stage II of SA were more common, whereas DQA1*0102 (Ls) and DRB1*16/*04/*08, DQB1*03/*04/*05/*06, DQA1*0301 (Ls, Stage II) were less common than in the controls. Nevertheless, after Bonferroni correction, only DRB1*04, DQB1*02/*03/*05/*06, DQA1*0102/*0301/*0501 differed significantly. In TB group, DRB1*16/*14, DQB1*05, DQA1*0303 were more frequent and DRB1*11, DQB1*02, DQA1*0201/*0505 less frequently present as compared to the controls, but frequency of DRB1*16, DQB1*02/*05 and DQA1*0303/*0505 only was significantly different after correction. After correction in both Stages of SA, DRB1*11 was more common and DRB1*16/*04/*14, DQB1*03/*05, DQA1*0301/0302/*0303 were less frequent than in the TB group. DQB1*02, DQA1*0201/*0501 (Ls) and DRB1*15/*13 (Stage II) were more frequently present in SA than in TB, but after correction, only DRB1*15, DQB1*02, DQA1*0501 were significantly different. CONCLUSIONS: We identified associations of HLA class II alleles in SA and TB with expression pattern specific and different for each group. In most cases, in SA patients frequency of HLA class II alleles occurrence is opposite to the frequency in TB patients.

[Effect of neoadjuvant chemotherapy on complications in patients undergoing surgical treatment for non small cell lung cancer]. / Wplyw przedoperacyjnej chemioterapii na powiklania po leczeniu operacyjnym chorych na niedrobnokomórkowego raka pluca.

Neoadjuvant chemotherapy before resection is being the standard of care for stage IIIA non-small cell lung cancer in many institutions. The risk of complications in patients undergoing thoracotomy after induction chemotherapy remain controversial. We reviewed our experience. From 1998 to 2003, 29 patients underwent pulmonary resection after induction chemotherapy for advanced non-small cell lung cancer. Pneumonectomies were performed for 16 (55.2%) patients (2 right sleeve pneumonectomy and 1 pneumonectomy with wedge excision of tracheal carina), lobectomies for 11 (37.9%) patients (3 right upper sleeve lobectomy), segmentectomies for 1 (3.45%) patient and explorative thoracotomy for 1 (3.45%) patient. There were 3 (10.3%) postoperative deaths, all after right pneumonectomy; 2 caused by pneumonia of the left lung, 1 caused by pulmonary embolism in patient after re-thoracotomy for hemothorax. The postoperative complications included pneumonia in 2 patients, postoperative bleeding in 2, hemothorax in 1, prolonged intubation in 1, vocal cord paralysis in 2, cardiac arrhythmia in 2, atelectasis in 1 and residual air space in 1, resulting in 41,4% morbidity. Most of complications occurred after right pneumonectomy (45.5%). The mortality of patients who had received induction chemotherapy was higher than that of a comparative group of 1529 who underwent lung resection or only exploration without induction chemotherapy during the same period, and the difference was significant (10.3% vs 4.1%; p = 0.01). Morbidity differences were. not significant (p = 0.94).

[Anaerobic bacteria in bronchoalveolar lavage fluid (BAL) after thoracic surgery]. / Wystepowanie bakterii beztlenowych w popluczynach pecherzykowo-oskrzelikowych u chorych po operacjach torakochirurgicznych.

Purpose of this study was to find out what kind of anaerobic bacteria were in lower respiratory tract and how often they were present there considering patients after thoracic surgery. Also, what is susceptibility of bacteria to antibiotics. Research covered 30 patients after operation. Material for research was bronchoalveolar lavage (BAL) taken during bronchoscopy. Collected sample was cultivated in anaerobic and aerobic conditions. Anaerobic bacteria were found in 28 samples (93%). Totally there were 100 anaerobic bacteria strains. The most common Gram-negative rods were from genus Prevotella (24 strains, 24%) and Bacteroides (15 strains, 15%). Gram-negative bacteria except Bacteroides characterised biggest susceptibility to imipenem, piperacillin/tazobactam, amoxicillin/clavulanate, ampicillin/sulbactam, piperacillin, clindamycin and metronidazol. Bacteroides were susceptible to imipenem, piperacillin/tazobactam and metronidazol. Among Gram-positive anaerobic bacteria mostly were isolated from cocci Peptostreptococcus (18 strains, 18%) and were susceptible to all antibiotics. Gram-positive rods were in most cases represented by Actinomyces (12 strains 12%) and were highly susceptible to all antibacterial means except metronidazol (100% is resistant).

[Results of treatment for chronic pleural empyema]. / Wyniki leczenia przewleklego ropniaka oplucnej.

UNLABELLED: The aim of the study was to assess the results of the treatment in 97 patients with chronic pleural empyema treated in the department of thoracic surgery between 1988 and 1997. The majority of patients were between 30 and 50 years old. Most of the group were men and more than a half had a concomitant disease, which may predispose to empyema development. Nevertheless all the empyemas were in the chronic phase 1/3 of patients were successfully treated only with closed chest tube drainage and the remaining group with lung decortication. The Gram-negative bacterial flora dominated in the culture from empyema sac. Spirometric values and blood gas analysis showed significant reduction of lung function before the treatment. We found the relation between an early institution of closed tube drainage and the shorter stay at the hospital. Moreover in a significant proportion of patients pleural drainage was a sufficient way of treatment. CONCLUSIONS: Drainage of the empyema should be performed at early phase of the disease. It should be recommended that pleural drainage precede the surgical management of empyema. Delate of surgical intervention is the main cause of the high mortality rate in empyema following esophageal perforation.

[Solitary splenic metastases from lung cancer--one-time surgical procedure]. / Izolowane przerzuty do sledziony u chorego na raka pluca--jednoczasowe leczenie chirurgiczne.

Splenic metastasis from lung cancer is a rare clinical event, most often diagnosed at the time of an autopsy. We report a case of a 68 year old man with splenic metastasis from the primary lung cancer. Staging procedures before the resection of the primary lung tumor detected the splenic lesion. Upper left lobectomy and splenectomy were done by the left postero-lateral thoracotomy with phrenotomy. The rarity of solitary spleen metastasis from lung cancer and the treatment are discussed.