Jerzy Kozielski

An increase in exhaled nitric oxide is not associated with activity in pulmonary sarcoidosis

Exhaled nitric oxide (eNO) concentration measurement may permit the noninvasive estimation of the severity of airways inflammation in respiratory tract diseases. The aim of this study was to evaluate the correlation between eNO concentration and the activity of sarcoidosis, its radiographic staging and lung function abnormalities. eNO concentration was measured using a chemiluminescent analyser in 27 patients with sarcoidosis and 11 control subjects. The mean eNO concentration in patients with sarcoidosis was significantly higher (6.7±0.50 parts per billion (ppb)) than that in the control group (5.17±0.73 ppb). eNO concentration was similar in radiographic stage I, II and III patients (6.53, 7.32 and 6.24 ppb, respectively). No significant difference was found in eNO concentration between the patients with active and inactive disease. Nor did eNO concentration differ between the patients with and without indication for therapy. There was no significant correlation between eNO concentration and forced vital capacity or bronchoalveolar lavage fluid lymphocyte and macrophage counts. There was a weak correlation between eNO concentration and single-breath carbon monoxide diffusing capacity of the lung. Exhaled nitric oxide concentration is elevated in patients with sarcoidosis. This concentration does not depend on the radiographic staging, activity or progression of the disease.

Circulating concentration of markers of angiogenic activity in patients with sarcoidosis and idiopathic pulmonary fibrosis

BackgroundAngiogenesis is an important process involved in the pathogenesis of diffuse parenchymal lung diseases. The aim of the study was to compare the angiogenic profile of patients with sarcoidosis and idiopathic pulmonary fibrosis (IPF) based on analysis of circulating factors.MethodsSerum concentrations of angiopoietin-2 (Ang-2), follistatin, granulocyte-macrophage-colony stimulating factor (GM-CSF), interleukin-8 (IL-8), platelet derived growth factor-BB (PDGF-BB), platelet endothelial cellular adhesion molecule-1 (PECAM-1) and vascular endothelial growth factors (VEGF) were measured in the patients and the healthy subjects.ResultsSerum concentrations of G-CSF, follistatin, PECAM-1 and IL-8 were significantly higher in the IPF patients in comparison with the control group and the sarcoid patients. PDGF-BB concentrations were also significantly higher in serum of IPF patients than in sarcoid patients, but not than in the controls. In contrast, Ang-2 and VEGF concentrations did not differ significantly between the three groups. In the sarcoid patients, irrespective of the disease activity or the radiological stage, serum concentrations of these cytokines were similar to the control group.ConclusionsThese results indicate that differences may exist in angiogenic activity between patients with parenchymal lung diseases. In contrast to sarcoidosis, IPF is characterized by a higher serum concentration of different molecules involved in the angiogenic processes .

Cytological examination of pleural cavity lavage accompanied by the study of gene promoter hypermethylation of p16 and O6-methylguanine-DNA-methyltransferase genes in diagnostics of non-small cell lung cancer metastatic changes into pleura.

Aim of the study Metastases of non-small cell lung cancer (NSCLC) into pleura disqualify a patient from surgery and present a bad prognostic index. The aim of the study was to find out whether washing out the pleural cavity in such cases and examining obtained washings for presence of cancer cells will help to detect early NSCLC metastases into pleura, and also whether negative results of the cytology determine whether hypermethylation of these genes will increase the sensitivity of this examination. Material and methods The study consisted of the examination of 76 patients, including 59 operated on for NSCLC and 17 operated on for other reasons. Pleural washing fluid collected during the surgery was subjected to cytological examination as well as examined to determine the presence of promoter region hypermethylation of p16 and MGMT genes. Results Positive cytological results of pleural lavage were confirmed in 4 persons (7%) with NSCLC. The presence of promoter region hypermethylation of one or both examined genes was found in 3 patients (18%) in the control group and in 47 (80%) in the study group. Sex, occupational exposure, smoking cigarettes, and NSCLC histological type did not have an influence on the presence of cancer cells or hypermethylation in the pleural lavage fluid. Positive cytology results were more frequent at the T4 stage of NSCLC. Hypermethylation was more frequent in the research group (p < 0.01). Cancer cells and hypermethylation did not occur more frequently in pleural lavage fluid of patients with metastases into pleura. Conclusions The cytological examination and promoter region hypermethylation assessment of the p16 gene and MGMT gene in pleural lavage cells do not allow one to detect early metastasis of NSCLC into pleura.

Lung cancer in patients under the age of 40 years

Aim of the study In the paper clinical cases of individuals diagnosed with lung cancer below the age of 40 years have been analyzed. Material and methods The analysis included: sex, age, clinical symptoms found before and at the moment of diagnosis, character of changes visible in radiological imaging, time that passed from the first symptoms to reporting to a doctor and to establishing a diagnosis, type of diagnostic method used in establishing the final diagnosis, histopathologic type of cancer, degree of cancer progression. Results The results have been compared with a peer group who had been diagnosed 20 years earlier. Currently 7% of patients were diagnosed at the age of 25 or younger, whereas in the previous cohort patients in this age constituted 2%. The predominant pathological type was adenocarcinoma (currently 33%, previously 4%) in contrast to the earlier group in which 57% of patients had small cell lung cancer (57%). The incidence is equally distributed between both sexes, although there is an evident increase in female lung cancer cases. In the majority of patients the clinical presentation is a peripheral mass on chest X-ray. 20% of patients present pleural effusion on diagnosis. Patients reported the following complaints: breathlessness, chest pain, weight loss and fatigue. The majority of cases were diagnosed in advanced stages on the basis of a bronchoscopy acquired specimen. Time course from symptoms to diagnosis tends to be shorter than 20 years ago.

Left ventricular dysfunction in patients with interstitial lung diseases

To the Editors: The paper by Papadopoulos et al. 1 describes the failure of systolic left ventricular (LV) function in patients with idiopathic lung fibrosis (IPF). Not much is known about LV systolic and diastolic function failure in IPF patients or its influence on rates of survival. In 1998, Vizza et al. 2 examined a large group of patients with advanced lung diseases and estimated that 6% of them had LV failure, in particular patients with primary pulmonary hypertension and Eisenmengers syndrome. However, in a patient group with interstitial lung diseases (ILD) the proportion was lower and reached 3.6%. In 2007, we studied LV systolic function in 18 patients with lung fibrosis and heavy respiratory insufficiency 3. The patients fulfilled the American Thoracic Society (ATS)/European Respiratory …

Repeated lung infections. Scimitar syndrome

A 25 year old, nonsmoking white male was admitted to the Emergency Department following suicidal aspirin poisoning. After gastric lavage and X-ray examination, he was transferred to the Pulmonology Department with suspicion of right lung partial atelectasis, probably due to aspiration of a foreign body. He had a history of repeated bronchial infections with dyspnoea, since early childhood. There was no available medical documentation from a period of hospitalization at the age of 12 yrs. On admission to the Pulmonology Department, the patient was in good general condition. He complained of cough and dyspnoea on exercise. His body temperature was 37.6° C. Physical examination revealed a narrow right hemithorax, and wheezes and rhonchi, especially in the right CASE FOR DIAGNOSIS

Cardiovascular safety of two bronchodilators’ fixed-dose combination: indacaterol and glycopyrronium

Combination therapy with anticholinergics and β2-agonists should be used in COPD patients after failure of previous monotherapy with one of these drugs. Synergistic effect of both mechanisms of bronchodilation can maximize the efficacy of separately administered drugs. The effectiveness of the combination of LABA and LAMA is already confirmed, nevertheless the question about the safety profile of this therapy is still remaining, particularly with regard to the cardiovascular system. The paper discusses the overall safety profile of the combined preparation compare to placebo as well as the active comparators, especially the cardiovascular safety of fixed-dose formulation. Based on the data it has been demonstrated, that the combination of two ultra-long-acting bronchodilators with different complementary mechanisms of action increases the effectiveness of COPD therapy without affecting the safety.

Increased Serum Hepatocyte Growth Factor (HGF) Levels in Patients with Idiopathic Pulmonary Fibrosis (IPF) or Progressive Sarcoidosis

Background: Endogenous Hepatocyte Growth Factor (HGF) is required for self-repair of injured liver, kidneys and lungs. It also exerts a regenerative effect on epithelium. HGF can inhibit both the initiation and progression of lung fibrosis in Idiopathic Pulmonary Fibrosis (IPF). However available literature data on the role of HGF in sarcoidosis are scarce and conflicting. The aim of our study was to estimate and compare the serum concentrations of HGF both in patients with IPF and sarcoidosis and in healthy controls. Material and methods: In 43 patients with sarcoidosis, 17 patients with IPF and 20 healthy controls serum HGF concentrations were measured using multiplex bead based sandwich immunoassay. Results: In patients with IPF mean concentrations of HGF (1286.2 ± 238.3 pg/ml) were significantly higher than in controls (819.8 ± 61.0 pg/ml, p<0.05), but not significantly higher than in sarcoidosis patients (990.0 ± 52.2 pg/ ml). In all patients with sarcoidosis the mean levels of HGF did not differ significantly from levels obtained in control group. However, the mean levels of HGF in 18 patients with progressive sarcoidosis (1260.7 ± 83.7 pg/ml) were significantly higher (p<0.001) than in 25 patients with non-active, stable sarcoidosis (802.7 ± 34.8 pg/ml) and controls (p<0.05). Conclusion: The role of serum HGF as a potential biomarker in sarcoidosis needs further explorations to answer the question if increased HGF serum levels can predict deterioration of the disease or reflect lung epithelial injury by granulomatous inflammation.

Hyponatraemia - evaluation of prevalence in patients hospitalized in the Pulmonary Department and prognostic significance in lung cancer patients.

INTRODUCTION It is known from clinical practice that data concerning plasma sodium concentration and its influence on patient prognosis are underestimated. The aim of this study was the evaluation of the prevalence and influence of hyponatraemia on prognosis in patients with lung diseases, particularly with lung cancer. MATERIAL AND METHODS Retrospective analysis of data obtained from a single Pulmonary Department was performed. A total of 449 patients divided in two groups, were analysed. The first group consisted of all lung cancer patients (n = 290) hospitalized in the analysed period. The second group included patients with hyponatraemia but without diagnosed lung cancer (n = 159). The prevalence of hyponatraemia, including severity (mild, moderate or severe), was evaluated. Histological types of lung cancer as well as comorbidities were taken into account. RESULTS Hyponatraemia was found in 46.9% of patients with lung cancer, including mild (serum sodium 135-130 mEq/L), moderate (129-125 mEq/L) and severe hyponatraemia (< 125 mEq/L) in 66.9%, 25% and 8.1, respectively. In patients without lung cancer and with recognized hyponatraemia, mild, moderate and severe hyponatraemia were found in 81.8%, 13.2% and 5%, respectively (mainly in obstructive and interstitial lung diseases). Hyponatraemia was observed in 52.6% of patients with non-small cell lung cancer (NSCLC) and in 45.2% of patients with small cell lung cancer (SCLC). There was no statistical significance in prevalence of hyponatraemia between histological types of lung cancer. In patients with lung cancer and hyponatraemia compared to patients with lung cancer but without hyponatraemia, a significant increase of in-hospital mortality was found (28.7% vs. 7.8%, respectively) p < 0.001. CONCLUSIONS Hyponatraemia was a common abnormality found in approximately 50% of lung cancer patients. Hyponatraemia was a significant prognostic factor associated with poor prognosis.

Pulmonary lesions in the course of gastric cancer — two cases of Bard’s syndrome

The Bards syndrome is a medical condition related to miliary dissemination of gastric cancer to the lungs. Difficulties in diagnosis are associated with the need of differentiation between numerous diseases, which may manifest as disseminated lesions in the lung parenchyma on chest X-ray. Despite the advanced proliferative process, primary focus of neoplasm frequently remains subclinical. Metastatic lesions cause many symptoms in the respiratory system, suggesting primary pulmonary pathology. The Bards syndrome should be always taken into account in differential diagnosis of disseminated lesions, particularly due to prevalence of gastric cancer. The study presents two cases of patients with disseminated pulmonary lesions, corresponding to gastric cancer metastases on radiological imaging.