[Treatment of patients with chronic pulmonary tuberculosis with expectoration--evaluation of effectiveness]

48 patients with chronic pulmonary tuberculosis (10 women and 38 men) aged between 22 and 87 years were treated. They were sputum culture positive from 1 to 12 years (x = 3.6). In chronics all patients but one were resistant to one or more drugs (average to 4 drugs). Control group consisted of 29 patients with recently diagnosed pulmonary tuberculosis sensitive to all drugs. Treatment of chronics based on: selection of drugs according to susceptibility test, using of 4-6 antituberculous drugs, treatment for not less than one year after sputum culture conversion. Control group was treated with standard therapy consisted of 3 or 4 drugs. Out of 48 chronics 13 patients dropped out due to: drug toxicity in 5 cases, noncompliance in 5 cases and death in 3 cases (in 2nd and 5th months of treatment). Of remaining 35 chronics sputum conversion was achieved in 30 cases (85.7%) average after 9 weeks. In control group 3 patients died during 2 weeks of treatment and remaining patients became sputum culture negative after average 6 weeks. Difference is significant (p = 0.006).

[Surgical treatment of patients with multi-resistant pulmonary tuberculosis--case reports]

Two patients with multidrug-resistant pulmonary tuberculosis were surgically treated after 3 and 7 years of unsuccessful chemotherapy. There was pneumonectomy in one case and lobectomy with segmentectomy in the second. Pneumonectomy was complicated by bronchopleural fistula. Both patients become sputum culture negative after surgical treatment but first patient died 5 months after surgery because of acute hepatitis.

[Reasons for chronic expectoration in patients with pulmonary tuberculosis registered in the Central Tuberculosis Registry]

The aim of the retrospective population-based study was to identify reasons for failure of sputum culture negativity from the 12th month on since the start of chemotherapy of pulmonary tuberculosis (PTB). Medical records of 97 patients with PTB (85 men and 12 women) remaining sputum culture positive for over 12 months, reported to the Central TB Registry (1988-1990), were reviewed. The mean age was 46.7 years. There were 39.2% blue collar workers, 18.6% peasants, 21.6% unemployed, 14.4% pensioners. Only 4.1% constituted persons with education above elementary level. 44 patients abused alcohol, 13 of them had severe alcohol related health problems. Initial susceptibility tests were done in 79 subjects, showing resistance to at least one drug in 15. In 21 subjects the new resistance occurred during observation. The mean period until conversion of sputum culture was 23.5 months. Sputum culture conversion was finally achieved in 63 (64.9%) subjects. The reasons for delayed sputum culture conversion were identified in 86 persons. The main reason for long duration of positive sputum culture in 75 (87.2%) subjects was poor compliance. In 7 (8.1%) cases evident treatment error was relevant. Serious adverse reactions to drugs were responsible in 4 (4.6%).

[Bronchiolitis obliterans organizing pneumonia]

Idiopathic BOOP is a clinicopathological entity defined histopathologically by the presence of granulation tissue in bronchioles, alveolar ducts and alveoli. 2 men and 6 women (mean age 47.2 years, range 22-66) with idiopathic BOOP have been observed, the mean period of observation being 31.1 months. In 7 cases the disease started with fever, cough and in 6 with progressive dyspnea. The interval between the onset of symptoms and the beginning of treatment ranged from 2 to 10 months. One woman was asymptomatic. The initial findings were: tachypnoea (6), crackles (7), decreased VC (6), reduced diffusing capacity (6), raised erythrocyte sedimentation rate (7). In 6 cases chest radiographs showed multiple alveolar patchy opacities of various size predominantly in the middle and lower lung zones. HRCT demonstrates peripheral distribution of changes. In one case diffuse reticulonodular infiltrates and in one case solitary tumor-like opacity with cavitation were observed. Seven subjects were given prednisone. Three subjects recovered completely, in 1 clinical and radiological improvement was observed. In 3 cases relapse occurred. The woman with the solitary tumor-like opacity was cured by surgical excision of the lesion.

[Liver abscess in the course of ulcerative colitis]

The case of 19 year old female patient treated because of the ulcerative colitis. The abscess of the liver has appeared in this patient. This kind of complication has been never described in medical literature.

[Pattern of breathing and obstruction pressure in patients with airway obstruction after inhalation of bronchodilators]

The neuromuscular drive is increased in patients with an airway obstruction. The aim of the study was to estimate an influence of beta-agonist on breathing pattern and mouth occlusion pressure (P0.1) in patients with reversible and nonreversible airway obstruction. Ventilatory function tests, pattern of breathing analysis, mouth occlusion pressure (P0.1) and inspiratory impedance (P0.1/Vt/Ti) were measured in 23 obstructive patients and 20 healthy subjects. In all patients these measurements were repeated 20 minutes after bronchodilator inhalation (0.2 mg fenoterol). During quiet room-air breathing in patients we observed increased Vt, Vt/Ti comparing with healthy persons. The time of inspiration (Ti) and total time (Ttot) were shortened in comparison to our control group. P0.1 and inspiratory impedance were significantly increased (P0.1 3.6 +/- 1.6 vs 1.6 +/- 0.3 cm H2O, p < 0.01 and P0.1/Vt/Ti 6.6 +/- 2.3 vs 3.8 +/- 1.0 cm H2O/L/s). Measurements performed after bronchodilator inhalation revealed decrease of P0.1 and P0.1/Vt/ Ti in patients responsive to beta-agonist (delta FEVI > 15%). In unresponsive patients (delta FEVI < or = 15%) such decrease in neuromuscular respiratory drive was not observed. We conclude that diminishing of increased neuromuscular respiratory drive in patients with reversible obstruction is a consequence of airway resistance decreasing. It seems to be an additional, advantageous for a patient, effect of bronchodilator inhalation.

[Pulmonary reaction after furazidin (Furagin). Case report]

For the first time in Poland we present the case of pulmonary reaction to furazidin which is by chemical structure closely related to nitrofurantoin. 63 years old woman presented generalized symptoms of acute hypersensitivity reaction induced by furazidin as well as features of chronic pulmonary fibrosis. After few months of treatment with this drug patients complained of weight loss, dyspnea on effort, non-productive cough, chills and fever. Radiological and functional evaluation of respiratory system confirmed features of lung fibrosis. Drug provocation test was positive. In vitro furazidin in low concentrations stimulated proliferation of patient's lymphocytes. After cessation of treatment we have observed rapid improvement of clinical, radiological, biochemical and functional parameters.

[Tuberculosis of the bones and joints]

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.

[Results of 3-stage treatment: (I) corticotherapy, (II) linear acceleration and (III) orbital decompression in 206 patients with malignant Graves ophthalmopathy]

There is no, so far, a rational method of therapy based upon the etiology of autoimmune Graves' ophthalmopathy. As a malignant Graves' ophthalmopathy we defined the most severe eye changes leading to the sight loss or permanent disability of vision which are classified as exceeded class 3c according to the eye changes classification of the American Thyroid Association [27]. The aim of the study was to develop the most efficacious method of therapy for malignant Graves' ophthalmopathy. The material consisted of 206 patients treated according to the 3-stage method: 1-st--corticotherapy, 2-nd--radiotherapy, including linear accelerator, 3-rd--orbital decompression. Moreover, in four patients plasmapheresis was applied and in additional five cyclosporine was administered. In all 206 patients the estimation of the results of the treatment was based on the Donaldson ophthalmopathy index [4]. It has been proved that corticotherapy combined with linear accelerator radiotherapy has been the most efficacious method of treatment. It has also the least number of side effects. Orbital decompression as the 3-rd stage of treatment was employed in those cases in which the previous two stages of medical therapy were unsuccessful.

[Lymphoid interstitial pneumonia]

Interstitial lymphoid pneumonia is a rare disease characterized by diffuse infiltration of lung tissue by lymphocytes and plasmocytes. The diagnosis can be only achieved by histopathological examination of the biopsied pulmonary tissue. It should be differentiated from malignant processes of the lymphatic system. Immunosuppression is the main line therapy, with prednisone, azatioprine and cyclophosphamide.

[Pneumonia and empyema in a patient with common variable immunodeficiency]

A case of common variable immunodeficiency in a patient with recurrent respiratory bacterial infections is presented. The patient was successfully treated with fresh frozen serum. The authors discussed different models of substitution therapy in primary antibody deficiency.

[Comparative studies of cyclic 11, 12 erythromycin carbonate (davercin) and erythromycin a levels in lung tissue, serum and bronchial secretions]

A comparison of serum, pulmonary tissue and bronchial secretory levels of erythromycin and cyclic--11,12 carbonate of erythromycin (Davercin--Polfa) was carried out in 55 patients with lung cancer. All patients received erythromycin and Davercin 80 hours prior surgery, during which a small fragment of pulmonary tissue was removed for further evaluation. Concentration of both antibiotics was determined microbiologically. Better penetration of Davercin to the pulmonary tissue was found, as well as higher tissue concentration. The study demonstrates the advantage of Davercin over erythromycin in treating bacterial infections of the respiratory system.

Morphology of arteries, veins, and capillaries in cancer of the larynx: scanning electron-microscopical study on microcorrosion casts

Morphology of blood vessels in cancer of the larynx, which as other solid tumors has great neoangiogenic abilities, was studied on microcorrosion casts in SEM. Most evident changes of the endothelial patterns were seen on the casts of capillaries, venules, and veins. Capillaries, especially the newly formed, are the most numerous constituent of the vascular bed in all zones of cancer of the larynx. These vessels exhibit great morphological differentiation varying from the single, blind-ended pipes via relatively long hairpin loops spirally twisted in the long axis, to strongly spiralled and convoluted loops, resembling pseudoglomeruli. The newly formed capillaries deriving predominantly from the host's capillaries, venules, and veins have a embryonal character. It seems reasonable to presume that the neoangiogenesis process triggered by active influence of the tumor angiogenesis factor, is in principle, a repetition of the mechanism of the embryonal angiogenesis.

Scanning electron microscopic studies on blood vessels in cancer of the larynx

The injection replication method was used in a study of the vascular system in cancer of the larynx. Following maceration, clean microcorrosion casts of the blood vessels of larynx cancer were examined in a scanning electron microscope (SEM). The effective filling of the whole vasculature, including its finest capillaries, makes it possible to obtain really three-dimensional pictures of the tumor blood vessels in the SEM. These SEM pictures allow a more detailed and profound analysis of the behavior and arrangement of blood vessels in three basic, angioarchitectonically differentiated zones of the tumor.

Scanning electron microscopical study of tracheal vascularization in guinea pig

In view of a considerable increase of the tracheal injuries brought about by intubation, further detailed information on microcirculation of the trachea is needed. For this purpose, the normal microvascularization of the guinea pig trachea was investigated in microcorrosion casts viewed in a scanning electron microscope. The trachea is supplied by longitudinal vascular bundles running at both sides of the organ, including both longitudinal tracheoesophageal arteries and veins. They are the source of a segmental vascularization of the trachea. Due to numerous arteriovenous anastomoses and anastomoses occurring within respective arterious and venous vascular systems, a constant blood flow within submucous capillary plexus and the tracheal wall is provided. A characteristic feature of tracheal vascularization is a very rich, dense network of veins, which form well-developed plexuses, particularly in tracheal segments covered by skeletal cartilages.

Scanning electron microscopy of the cochlear vasculature

Studies on the vascularization of the cochlea with conventional injection methods that use light microscopy have failed in viewing both the overall three-dimensional picture, as well as the detailed construction of the cochlea vascular blood vessels. This basic shortcoming can be omitted by the use of scanning electron microscopy (SEM) on corrosion casts, which only presently has been introduced. The use of a commercial resin (Mercox) as an injected medium, followed by application of macerating fluids, provides clean and completely filled casts of the cochlea vascular system, which can then be inspected by SEM. This method not only confirms the general findings about cochlea vascularization but gives the opportunity to view the overall picture, as well as the detailed pattern of the intricate cochlear capillary beds.