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Biomedical subjects

L Pawlicka

Publications and source records attributed to L Pawlicka.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Low doses of rtPA administered as a bolus in treatment of clinically acute massive pulmonary embolism].

12 patients (7 male and 5 female) with confirmed pulmonary embolism (PE) with: angiography-5 cases, conventional contrast-enhanced CT-2 cases, echocardiography-2 cases, autopsy-3 cases were diagnosed as clinically acute PE. Criteria of clinically acute PE were: cardiac arrest-1 case-2 cases, shock-1 case, acute cor pulmonale-9 cases and acute cor pulmonale with shock. All patients were treated with heparin, administered with therapeutic prolongation of aPTT. Clinically acute PE (if possible confirmed with angiography, TC and/or echocardiography) was treated with rtPA administered in 10 minutes lasting bolus in doses 0.6-0.8 mg per kg of body weight (50 mg of rtPA during 10 minutes administered into peripheral veins). In 9 patients with pulmonary hypertension, significant decrease of tricuspidal gradient (measured echocardiographically during several hours after administration of rtPA) was documented. Improvement in PaO2, SaO2 and decrease of heart rate and respiratory rate were also achieved. No serious bleeding complications were observed after mentioned treatment. Control investigations (conventional contrast-enhanced CT and spiral CT) performed several days after rtPA administration revealed thrombus in pulmonary artery. We conclude: I rtPA administered in bolus simultaneously with heparin significantly decreased pulmonaryhypertension; rtPA administered simultaneously with heparin is safe method of treatment of PE; hemodynamic improvement after administration of rtPA is not univocal with full fibrynolitic effect.

Adult↗
PubMed1996

[Massive pulmonary artery embolism complicated by acute pulmonary heart disease].

43-year old woman, with considerable overweight had been admitted to Intensive Medical Care Unit with suspicion of pulmonary embolism (PE). The patient had the limb immobilized in gypsum for last several weeks. This episode was tangled with recurrent thrombosis of deep veins in the left limb, treated with heparin and oral anticoagulants irregularly without sufficient control. Taking into consideration the data of anamnesis, clinical picture and the results of ECG, chest X-ray, gasometric and echocardiographic examination we got much closer to the recognition of PE. Our suspicion of PE was confirmed by the result of pulmonary angiography. Indications for thrombolytic treatment (r-tPA) had been established. During the following hours considerable improvement of general state was observed. The therapy was continued with constant drip infusion of heparin. No prolongation of therapeutic PTT was observed. The deficit of AT III was diagnosed. In this situation the patient was given AT III to obtain normalization of its level and therapeutic extension of PTT. Therefore there were settled indications for the operation of uterus with myoma changes. As the rich thrombolytic material in the leg's vein was found the patient was implanted LGM Filter, with excellent prophylactic effect (no PE in perioperative period). The clinical course of our case enabled to present most of diagnostic, therapeutic and preventive methods applied in venous thromboembolism.

Administration, Oral↗
PubMed1995

Tuberculosis in the autopsy material: analysis of 1500 autopsies performed between 1972 and 1991 in the Institute of Tuberculosis and Chest Diseases, Warsaw, Poland.

SETTING: The present study is based on 1500 autopsies done in the Institute of Tuberculosis and Chest Diseases Warsaw, Poland during the years 1972-81 and 1982-91. OBJECTIVE: To assess the correctness of tuberculosis diagnosis before death in the above mentioned time periods. DESIGN: The autopsy reports were examined for the diagnosis of active tuberculosis proved by microscopy. The form and localisation of tuberculosis was assessed. The postmortem diagnosis was compared with clinical diagnosis. In those cases in which tuberculosis was not recognised before death the possible causes of this failure were analyzed. RESULTS: Active tuberculosis was found in 119 cases, 7.9% of all autopsies. It was localised in the lungs exclusively in 72 cases, in lungs and in extrapulmonary sites in 45 and in extrapulmonary sites only in 2. The frequency of active tuberculosis was the same for the two periods under evaluation. Tuberculosis was however not recognised before death in a much higher proportion of cases in 1982-92 (54%) than in 1972-81 (24%). The main cause of diagnostic failure was connected with atypical localisation of lesions on chest X-ray and with dissemination outside the lungs. Previous tuberculosis was a factor which facilitated the diagnosis of tuberculosis. CONCLUSIONS: In parallel with the decline of tuberculosis incidence in Poland, many doctors lack experience in diagnosing this disease, especially in cases with atypical X-ray presentation and with extrapulmonary localisation. This may lead to late or even very late diagnosis and have a significant impact on the epidemiological situation.

Adolescent↗
PubMed1995

[Indications for prophylactic vena cava filters introduced subcutaneously in patients with thromboembolic disease--preliminary report].

In 10 patients with thromboembolic disease 1 Gunther filter and 9 LGM filters were inserted. Indications for filter placement were: pulmonary hypertension caused by recurrent pulmonary embolism in 3 cases; planned surgery in 2 patients with pulmonary embolism and deep venous thrombosis; recurrent pulmonary embolism despite of anticoagulant treatment in 2 cases, previously performed thrombo-endarterectomy in 1 case; contraindications for anticoagulant treatment in 1 case and complications of anticoagulant therapy also in 1 case. No serious complications after filter placement were observed.

Adult↗
PubMed1995

[Recurrence of pulmonary sarcoidosis].

From September 1960 to December 1992, 2021 patients with pulmonary sarcoidosis were registered in our Sarcoidosis Clinic. 462 patients were treated with steroids. Treatment was initiated either because of radiological evidence of disease progression after 6 months observation, lack of radiological improvement together with abnormalities of pulmonary function, presence of extra-pulmonary lesions. In 42 cases (9% of treated group); 19 men and 23 women, mean age 35 years, relapse of disease was observed from 6 months to 6 years after completion of treatment. At the entry to the first treatment 11 patients were assessed as having stage I disease, 30 as stage II and one as stage III. In 16 subjects of this group (38%), extra-pulmonary lesions were presents; skin lesions in 8 cases and enlarged peripheral lymph nodes in 6. After initial treatment, radiological and clinical improvement was observed in 32 patients. The second treatment results in radiological improvement in 38 patients, 10 are being still treated. In 4 cases a second relapse was noted. In three patients regression of pulmonary changes was achieved, in one case stabilization of the disease was observed.

Adrenal Cortex Hormones↗
PubMed1995

[Implantation of a LGM suprarenal vena cava filter--case report].

In the case of 53 years old woman LGM filter was inserted over renal veins. Indications for those procedures were: vena cava thrombosis in distal part of vena cava what not allowed to place filter below renal veins, malignancy, planned surgery, proximal deep vein thrombosis and past history of pulmonary embolism. Indications for suprarenal placement of vena cava filters and results of such as procedure were discussed.

Colonic Neoplasms↗
PubMed1995

[Comparison of the degree of regression of small cell lung neoplasm in clinical-radiologic evaluation with levels of neuron specific enolase (NSE) in serum].

NSE was estimated using Pharmacia test and radioimmunologic method in the serum of 41 SCLC patients before treatment, at the time of maximal tumor response and in some patients also during progression. The level of 12,5 ng/l was regarded as the upper limit of normal. Elevated NSE levels before treatment were found in 12 out of 20 patients with limited disease and in 19 out of 21 patients with extensive disease. Complete remission (CR) was observed only in patients with limited disease and in those in whom NSE serum level was below 50 ng/l. Elevated NSE serum levels decreased in all those in whom partial remission (PR) or CR of tumor was obtained. Decrease of elevated NSE levels was however also observed in some patients with no significant regression of tumor. The decrease of serum NSE level seemed to be a good prognostic factor even in this last group. NSE serum level increased in 7 out 10 patients where progressive disease after PR was found. In 3 patients however NSE level persisted in normal values despite progression. The significance of this fact was discussed.

Adult↗
PubMed1994

[Neoplastic metastasis in lungs simulating primary tumor of the respiratory system].

16 patients with clinical and radiological symptoms suggesting lung disease were described. Metastatic character of process was documented in 7 of them during life and in 9 after death. The pulmonary symptoms without any signs of primary tumor lasted from few months to 3 years. Two patients revealed primary tumor in ovary, 1-in uterus, 4-in thyroid gland, 2-in prostata, 2-in breast, 2-in pancreas, 1-in bone, one in testicle, and 2-in kidney.

Adult↗
PubMed1993

Inhaled budesonide vs prednisone in the maintenance treatment of pulmonary sarcoidosis.

The aim of this investigation was to compare inhaled budesonide with oral prednisone in maintenance treatment of pulmonary sarcoidosis. A double-blind controlled study was performed in 40 patients with stage II or III pulmonary sarcoidosis. After initial systemic 6 weeks treatment with prednisone (40 reduced to 20 mg daily) patients were allocated either to the systematically (S) or topically (T) treated group. S patients continued with 10 mg prednisone daily, T patients were given inhaled budesonide 1.6 mg daily. The progress of treatment was assessed by serial radiography, spirometry, serum Angiotensin Converting Enzyme (ACE) activity and plasma cortisol levels. All patients completed the 12 months treatment. Using the numerical score to assess changes on the chest radiograms S patients improved by 1.7 +/- 0.66 points; T patients improved by 1.15 +/- 0.81 points. Spirometric changes were not statistically significant. Serum ACE fell from 107 +/- 51 U/L in the S group and 92 +/- 40 U/L in the T group to 46 +/- 11 U/L and 38 +/- 21 U/L respectively during the initial phase of treatment. In the maintenance phase ACE levels remained lower than the initial ones in both groups. Morning plasma cortisol levels studied in 10 patients (5 in each group) decreased significantly during the initial phase. Thereafter cortisol levels remained low in the S patients returning to the lower limit of normal values in the T patients. We conclude that inhaled budesonide may be a safe and effective alternative to oral steroids in the maintenance treatment of pulmonary sarcoidosis especially in the early stage of the disease.

Administration, Inhalation↗
PubMed1993

[Tuberculosis as a cause of death in patients treated in the institute of tuberculosis in 1976-1991].

This study aimed at assessing the reasons why tuberculosis-which can be successfully treated today-is still the cause of death in some patients treated at the Institute of Tuberculosis in the last 15 years. The material consisted of clinical documentation and the results of autopsy of 30 patients who died of tuberculosis between 1976-1991. It was found that 19 out of 30 patients were not treated with antituberculous drugs or were treated only during few days because tuberculosis was diagnosed too late (in 15 patients after death). In 6 patients the treatment failed due to side effects of drugs and in 5 immunosuppressed patients, disease progressed despite the treatment. Difficulties in tuberculosis diagnosis were caused by atypical appearance of the disease in the chest X-ray (localization in the middle and lower lobes in 15 cases, absence of cavities in 22 cases) and in the extrapulmonary regions (11 cases). The main obstacle was the failure to cultivate tubercle bacilli from numerous specimens of the sputum in 10 out of 23 patients in whom the cultures were done.

Adult↗
PubMed1993

[Usefulness of microscopic examination of bronchial cellular material for lung cancer diagnosis and determination of cell type].

Results of microscopical examination of airway material (sputum, bronchoscopy) were analysed in 563 patients with lung cancer. Bronchoscopic material was examined from all patients, while sputum only from 352. Sputum was always analysed prior examination of bronchoscopic material cancer cells were found in material from lower airways in 366 patients (65%), correct cell typing was achieved in 286 (78.1%). Cancer cells were present in the sputum in 28.1% of the analysed patients and in 60% of the material obtained during bronchoscopy. In 178 patients with squamous cell lung cancer, cancer cells were found in 64.9% while correct cell typing was found in 83.4%. In 183 patients with small cell lung cancer, neoplastic cells were found in 72.6% of the cases while correct cell typing was achieved in 88.7%. In 144 patients with adenocarcinoma cancer cells were found in 53.4% while correct typing was present in 64.9%. In 18 cases of large cell lung cancer, cancer cells were present in 50%, and correct cell typing was achieved in 22.2%. Differences were statistically significant between small cell lung cancer and adenocarcinoma. Correct cell typing was statistically more often significant in patients with squamous cell lung cancer or SCLC in comparison with the other types. Significant results of positive cytology was found when analysing localisation of the tumor. In cases of central tumor cytology was positive in 60% of the cases, while in peripheral tumors it was positive only in 43.9% of the cases. The size of the tumor did not affect the sensitivity of the cytological examination.

Adenocarcinoma↗
PubMed1992

[Comparison of the effectiveness of budesonide and prednisone in the maintenance treatment of pulmonary sarcoidosis].

The aim of this investigation was to compare inhaled budesonide vs oral prednisone in the maintenance phase treatment of pulmonary sarcoidosis. Double-blind controlled study was performed in 40 patients with stage II or III pulmonary sarcoidosis. After initial systemic 6 weeks treatment with prednisone (40 reduced to 20 mg daily) patients were allocated either to systematically (P) or topically (B) treated group. P patients continued with 10 mg prednisone daily, B patients were given inhaled budesonide 1.6 mg daily. The progress of treatment was assessed by serial radiography, spirometry, serum ACE activity and plasma cortisol levels. All patients completed the 12 months treatment. Using a numerical score to assess changes on the chest radiograms P patients improved by 1.7 +/- 0.66 points; B patients improved by 1.15 +/- 0.81 points. Spirometric changes were insignificant. Serum ACE fell from 107 +/- 51 U/L in the P group and 92 +/- 40 U/L in the B group to 46 +/- 11 U/L and 38 +/- 21 U/L respectively during the initial phase of treatment. In the maintenance phase ACE levels remained lower than initial ones in both groups. Morning cortisol plasma levels studied in 10 patients (5 in each group) decreased significantly during the initial phase. Thereafter cortisol levels remained low in the P patients returning to the lower limit of normal values in the B patients. We conclude that inhaled budesonide may be a safe and effective alternative to oral steroids in the maintenance treatment of pulmonary sarcoidosis especially in the early, stage II, disease.

Administration, Inhalation↗
PubMed1989

[The frequency and course of fibrotic changes in patients with sarcoidosis].

Basing on observations of 960 patients with pulmonary sarcoidosis the authors found fibrotic changes of pulmonary parenchyma in only a few, the incidence being 3.2. Improvement in radiological examination following steroid therapy was seen in 50%, of respiratory function in 30%. Although both examinations do not fully correlate with each other, they are however supplementary with each other, and should be regarded as important criteria of functional involvement and therapy outcome.

Adult↗