Biomedical subjects
Publications and source records attributed to P Krakówka.
Five cases of Langerhans' cell histiocytosis in adult patients were reviewed. Signs, symptoms, the course of the disease and methods of treatment were presented. Results of tests, including results of organ biopsies that provided definitive diagnosis in most cases, were also analysed.
There were analyzed 23 cases with non-tuberculosis mycobacterium infection, including 19 with mycobacteriosis and 4 with symptoms of colonisation. Among them nine patients were treated less than 6 months, but 14 ones were treated with different antituberculotic schedules during 6-24 months. In 9 patients of this group a sputum negativity was achieved. On the other hand, recurrents of mycobacteriosis was determined in 3 patients. Total observation period was extended from 2 to 6 years.
A case of sinus histiocytosis with generalized lymphadenopathy--Rosai-Dorfman disease--in a 54 year old male is presented. The diagnosis was made by biopsy of the lymph nodes and histopathological examination of the affected organ. Treatment with prednisone and cyclophosphamide induced clinical improvement. The diseases clinical advanced stage and organ localization and the immunosuppressive therapy resulted in a opportunistic infection--pneumocystidosis and death of the patient within half a year after starting of therapy.
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A case of pulmonary lymphangiomyomatosis in a female during menopause is presented. Difficulties in correct histopathological assessment of lung biopsies were met. The diagnosis was made after diagnosis lymph seeping into the pleural cavity. The patient was initially treated with prednisolone, tamoxifen followed by methyl progesterone and after characterizing the patient's hormone profile with danazol. Lymph seeping to the right pleural cavity was treated with pleural drainage and diet limitations. Lymph exudate to the left pleural cavity was controlled with local cytotoxic therapy. After 7 years of therapy and 8 years since the initial symptoms the state of the patient has deteriorated although she can perform every day chores and does not require oxygen therapy. High resolution CT scan disclosed extensive pulmonary changes implying extensive progression of the disease.
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The authors present a case report of a 66 year old male that was admitted due to pulmonary lesions with cavitation localized in the upper left lobe. In the cavity an abnormal mass could be seen. In the differential diagnosis malignancy and tuberculosis were excluded. Fungi were cultured from the bronchial washings and sputum. Their morphological characteristics allowed them to be typed as Aspergillus niger. Slides from the thick, mucoid, black sputum demonstrated typical forms of the fungus. Polarized microscopy demonstrated calcium oxalate crystals. The final diagnosis was pulmonary aspergilloma caused by A.niger complicating a pulmonary abscess in the course of a 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.
Two cases of chronic, cavernous pulmonary tuberculosis with bacilli resistant to several drugs are presented. Both patients were treated with a new antituberculous drug ofloxacin. The agent was used with other antituberculous drugs. Sputum negativization was seen in only one of the patients, while the in other only a decrease of dissemination was observed.
A case of Wegener's granulomatosis in a female with characteristic three organ involvement (upper airway, lung, kidneys) is presented. The changes were also seen in the suprarenal glands. This merits attention due to the fact that such a localization was never previously published. Diagnostic problems were caused by pulmonary changes imitating lung metastasis. The patient was treated three years with prednisolone and cyclophosphamide. Complete remission was seen in the lungs and kidneys, and regression of the left suprarenal involvement was observed.
In the years 1980-1985 sutures were removed endoscopically from stumps and anastomoses in 52 patients operated in the years 1969-1985. The total number of bronchoscopies was 154, in 88 protruding threads into the airway lumen were removed. Interval between removal of first suture and date of surgery ranged from 0.5 to 192 months. Mycotic infection was diagnosed in 5 cases (9.6%). The causative agents being Aspergillus fumigatus and Candida albicans. In all cases removal of protruding threads lead to a complete cure. It was found that incidence of such mycotic infections decreased from 20.2% observed during the years 1962-1979 to 9.6% in the years 1980-1985.
The aim of the study was to determine the therapeutical effectiveness of a new regimen in freshly diagnosed cases of pulmonary tuberculosis. In this model PZA and SM were excluded, but INH administration was prolonged. Instead of INH and RMP a combined drug was given--RIFAMAZIDE (Polfa). Therapy was carried out in three stages: I stage lasting 3 months during which Rifamazide (600 mg RMP, 300 mg INH) and EMB (25 mg per kg b.w.) was given; II stage-during which Rifamazide was given (2 tablets.) for 3 months; III stage--INH monotherapy (300 mg daily) was continued for 6 months. During the first stage all patients were hospitalized at the Institute of Tuberculosis. The second stage was carried out under supervision of an out-patient clinic. During the third stage patients received their INH at their homes. The study group consisted initially of 58 patients, of which 11 were dropped out due to primary resistance, change of therapy, non-compliance, and non-tolerance of drugs. The final evaluation was carried out basing on results from 47 patients. In all patients a negative sputum culture was achieved. In most during the first two months of therapy. All demonstrated improvement in radiological evaluation. In 38 patients the follow-up lasted 2-6 years, in the remaining nine 2 years. Recurrencies were not observed. Good acceptation by the patients of Rifamazide was found.
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.
28 cavernoscopies were carried out in 26 patients. Complete or partial removal of mycetomas was achieved in 18 patients with 20 caverns. Under aerobic conditions Aspergillus fumigatus was cultured from the 28 removed mycetomas in 22 cases (78.6%) and bacterial organisms in 20 (71.4%). Bacteria were isolated from mycetomas that had demonstrable A. fumigatus organisms as well as from those that did not have them. In all infected mycetomas Gram negative rods were cultured, in only 4 cases Gram (+) cocci were found. Only in two cases of mycetomas under anaerobic conditions Gram (+) cocci were cultured. In most patients the organism could be demonstrated in sputum as well as in mycetomas. In 18 patients the pathogenic organism disappeared from sputum after removal of mycetomas. Also following removal of aspergillomas a decrease of sputum production was noted and it changed its character from purulent to mucoid.
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.
27 rural inhabitants with allergic alveoltis were evaluated in order to determine the diagnostic usefulness of clinical, radiological, functional examination, BAL, lung biopsy, presence of serum antibodies against environmental antigens in determining the diagnosis and clinical stage of the disease. The effect of therapy and exposition on lung function tests were also discussed. Corticotherapy in most of the patients produced an improvement of vital capacity. In part of the patients isolation from environmental antigens produced stabilization of respiratory parameters. Small dose continuous corticotherapy in patients with prolonged exposition proved to be beneficial and prevented occurrances of acute relapses, as well as decrease of respiratory functional parameters values.
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