[Contribution of fiber optic bronchoscopy to the etiologic diagnosis of bacterial pneumonia]. / Doprinos fiberopticke bronhoskopije u etioloskoj dijagnostici bakterijskih pneumonija.

In 24 patients with bacterial pneumonia, reliability of the samples routinely taken for etiologic diagnosis (sputum, throat swab, bronchial brushing, bronchoalveolar lavage fluid--BALF, blood, pleural fluid) was determined. Organisms detected in blood, pleural fluid, transbronchial biopsy (TBB) or percutaneous transthoracic needle aspiration biopsy (PTNAB) samples were considered as truly causative, whereas those isolated in at least two various samples from a single patient were considered as presumably causative. Most sensitive diagnostic samples were BALF, TBB and PTNAB (100% each). However, the specificity of BALF was very low (17%). Bronchial aspirate was highly sensitive (95%) but not specific (14%). Bronchial brushing was sensitive (86%) but its specificity low (14%). Sputum was hardly sensitive (40%) and had no specificity. Throat swab had virtually no diagnostic value because of its low sensitivity (10.5%) and specificity (50%).

[IL-1, TNF and IL-6 production by alveolar mononuclear cells in patients with sarcoidosis]. / Stvaranje interleukina-jedan, faktora nekroze tumora i interleukina-sest od strane alveolnih mononuklearnih celija kod bolesnika sa sarkoidozom pluca.

Cytokines produced by locally activated T cells and macrophages have central role in lymphocyte alveolitis and granuloma formation, and it is beleived that they regulate activity and further progression of sarcoidosis. The aim of our study was to evaluate the levels of interleukin-1 (IL-1), tumor necrosis factor (TNF) and interleukin-6 (IL-6) production by bronchoalveolar mononuclear cells in 6 patients With sarcoidosis. The obtained results showed increased IL-6 levels in patients with active disease, IL-1 activity did not follow clinical changes, while TNF was detectible only in one patients.

[Comparative therapeutic effect of bronchodilator aerosols and salbutamol cyclocaps]. / Uporedni terapijski efekti bronhodilatatora u aerosolu i salbutamol ciklokapsa.

In 12 men, atopic asthmatics, the bronchodilator effects have been studied after inhalation of 400 micrograms of salbutamol cyclocaps and bronchodilators in aerosol (40 micrograms of ipratropium bromide, 400 micrograms of fenoterol, 100 micrograms of fenoterol + 40 micrograms of ipratropium bromide and 200 micrograms of salbutamol). Bronchodilators were inhaled in different days at the same time. FEV1 measurements were repeated after 30, 60, 120 and 360 minutes and the values were compared with those obtained prior to inhalation of the drug. Although a better bronchodilator response to salbutamol cyclocaps is statistically insignificant, its longest maintenance make it suitable for the long-term therapy.

[The obstruction syndrome in patients with bronchogenic carcinoma]. / Opstrukcijski sindrom u bolesnika sa bronhogenim karcinomom.

In the period 1985-1990, 760 patients with bronchogenic carcinoma have been examined and treated at the Clinic of Lung Diseases of the Military Medical Academy. Obstruction syndrome was found in 64% of patients of whom 21% with severe obstruction. Pulmonary insufficiency, most commonly of milder, partial type, was found in 19% of patients. Due to the limited lung function as a consequence of chronic obstructive lung disease (COLD) 45 patients with locally demarcated tumours were not operated, surgical resection was not possible. In the operated patients with obstruction syndrome the risk of postoperative complications was increased. COLD and limited lung function most commonly had not been the obstacle for application of radiotherapy of bronchogenic carcinoma.

[Alveolitis in patients with sarcoidosis]. / Alveolitis kod bolesnika od sarkoidoze.

In 20 patients with pulmonary sarcoidosis bronchoalveolar lavage (BAL) was performed. The cellular content was analysed and lymphocyte subpopulation was determined using monoclonal antibodies. The patients with more than 28% of BAL T lymphocytes are classified as patients with high intensity alveolitis (n = 8) and those with less than 28% of T lymphocytes as low intensity alveolitis (n = 12). Of the total number of BAL T lymphocytes in high intensity alveolitis CD 3+ T cells were 88.8 +/- 8.4% and in low intensity alveolitis 68.2 +/- 13.8% (p < 0.001). In high intensity alveolitis the number of CD 4+ T cells was increased and the number of CD 8+ T cells was decreased which caused the increased index CD 4:CD 8; 9.8 +/- 8.7. In low intensity alveolitis this ratio was 2.2 +/- 1.2. Effects of smoking were also analysed. In smokers the total number of BAL cells was higher 184.0 +/- 47.2 x 10(4) ml of BAL, and in nonsmokers 101.3 +/- 65.1 x 10(4) ml of BAL (p < 0.001). Smoking has no effects on the characteristics of the cellular elements and subpopulation of BAL lymphocytes in patients with sarcoidosis. In 7 patients T lymphocyte subpopulation in the peripheral blood were determined too. Patients with high intensity alveolitis had the increased index CD 4:CD 8 in the peripheral blood compared with low intensity alveolitis.

[Tissue polypeptide antigen and tumor trypsin inhibitor in pleural effusions of various etiologies]. / Tkivni polipeptidni antigen i tumorski tripsinski inhibitor u pleuralnim izlivima razlicite etiologije.

In 47 patients with pleural effusions of different etiology concentrations of the tissue polypeptide antigen (TPA) and tumour trypsin inhibitor (TATI) were measured. Malignant disease was found in 24 patients and benign one in 23 patients. In a group of patients with malignant pleural effusion the average concentration of TPA was 3102 U/L and of TATI 76.8 ug/L. In a group of patients with nonmalignant effusion these concentrations of TPA were 2381.8 U/L and of TATI 28.3 ug/L. Higher concentration of TPA was found in pleural effusion of malignant nature with specificity of 96% but with a small sensitivity of 12.5% and positive predictive value of 43%. TATI concentrations were also higher in malignant pleural effusion with good sensitivity and specificity (78%, 50% respectively) and positive predictive value of 66%.

[Pulmonary function tests in the diagnosis of upper respiratory tract obstruction]. / Testovi plucne funkcije u dijagnostici opstrukcije gornjih disajnih puteva.

The results of small spirometry, airway resistance and flow volume loop were compared in 10 patients with upper airway obstruction, 11 patients with chronic pulmonary obstructive disease and 15 healthy examinees. Our results have shown that for detection and differentiation of upper airway obstruction and chronic obstructive pulmonary disease the most reliable values give the following parameters and relations: MIF 50% less than or equal to 100 l/min, MEF 50% greater than or equal to 1, FEV1/ /PEF greater than or equal to 10 ml/l/min, FEV1/FEV0.5 greater than or equal to 1.5 and FEV1/ /FEV1 greater than or equal to 1.

[Controlled trial of short-term chemotherapy in pulmonary tuberculosis, final study]. / Kontrolisano ispitivanje kratkotrajne hemoterapije plucne tuberkuloze, konacni izvestaj.

178 new cases of tuberculosis of the lungs and pleura have been treated within the period of four years (1985-1988) in military medical institutions of the Y.P.A. The patients were classified by random selection in two therapeutical groups. Two six-month regimens were applied with the same drugs except for the fourth one which was used in the initial period only (EHRZ and SHRZ). Both applied therapeutical combinations were equally successful. All patients achieved negative cultures at least three months after onset of chemotherapy. Relapses occurred in 4 (2.3%) of patients during the period of follow-up for at least 2 and the most 5.5 years after the end of therapy. The toxic effects were tolerable. The drug resistance was found in 25 of 134 (18.6%) patients, the most common to one drug.

[Results of combined therapy of small cell bronchogenic carcinoma in a 5-year period (1984-1988)]. / Rezultati kombinovanog lecenja bronhogenog karcinoma malih celija u petogodisnjem periodu (1984-1988).

Within the five-year period (1984-1988) the oat cell bronchogenic carcinoma was diagnosed and treated in 151 patients. Analysed were 74 patients having received complete treatment. Patients with disseminated form received only polychemotherapy in 6 cycles (cyclophosphamide, doxorubicin, vincristine and etoposide) and those with limited disease also received additional, local-regional radiotherapy of 45-50 Gy. In complete respondents preventive brain irradiation was applied. In selected patients with initial forms of the disease surgical resection with additional polychemotherapy were applied. The best survival showed respondents with limited disease and operated patients. Average survival of the whole group was 72 weeks. One year survived 31 out of 74 (41.9%) patients and two years survived 10 out of 74 (13.5%) patients.

[Personal experience in the diagnosis and treatment of pulmonary embolism]. / Nasa iskustva u dijagnostici i lecenju plucnog embolizma.

The 188 patients with pulmonary embolism were treated at the Clinic for Pulmonary Diseases of the M.M.A. in the period 1979-1989. Clinical symptoms and signs, diagnostic procedures and therapy of pulmonary embolism are analysed. The diagnosis is difficult and is suggested by the predisposing factors, symptoms and signs of the disease as well as indirect diagnostic procedures. The contribution of perfusion lung scintigraphy is precious. Deep venous thrombosis of the lower extremities, the source of pulmonary embolism, is commonly clinically absent. The complete cure without complications was achieved in 156 (83%) patients. The most common complications were: early and late recurrences, hematuria and peptic bleeding. The lethal outcome occurred in two cases of basic disseminated malignant disease.

[Neuron-specific enolase in pleural effusions of various etiologies]. / Neuron-specificna enolaza u pleuralnim izlivima razlicite etiologije.

The concentration of neuron-specific enolase (NSE) was measured in the serum and pleural fluid of 42 patients with pleural effusions of different etiology. High levels (above 13.0 micrograms/l) of NSE in pleural fluid of 9 patients with malignant disease were observed (sensitivity 57%). However, pleural fluid NSE levels were also increased in 14 with non-malignant diseases (specificity 45%). Increased pleural fluid NSE activity is not specific for malignancy.

[Analysis of immunocompetent cells in bronchoalveolar lavage in patients with sarcoidosis]. / Analiza imunokompetentnih celija u bronhoalveolnom lavatu bolesnika sa sarkoidozom.

Bronchoalveolar lavage through fiberoptic bronchoscope was performed in the right middle lobe or lingula of 8 patients with clinically and radiologically active sarcoidosis and 5 healthy persons. Pellet cells were analysed. Lymphocyte subsets were detected with monoclonal antibodies by fluorescent microscopy or flow cytometry (EPICS-C, Coulter). In patients with sarcoidosis lymphocyte proportion is elevated (29.88 +/- 4.32) as compared to healthy persons (5.2 +/- 3.4). We detected an increase of CD 3 lymphocytes (86.38 +/- 6.71) and CD 4 helper-inducer T lymphocytes compared to the total number of lymphocytes and, likewise, of the CD 4/CD 8 ratio--5.62 +/- 0.94. CD 8 suppressor-cytotoxic T lymphocytes are decreased (13.0 +/- 1.3 as compared to the healthy persons 22.0 +/- 3.84), which is a relative decrease because due to an increase of the total lymphocyte number, an increase of CD 8 T lymphocytes (3.85 +/- 0.41 as compared to the healthy persons 1.09 +/- 0.59) still exists, compared to the total number of pellet cells.

[Problems in the treatment and care of bronchogenic carcinoma]. / Neki problemi lecenja i zbrinjavanja bronhogenog karcinomo.

At the Military Medical Academy about 400-500 patients are hospitalised yearly due to bronchogenic carcinoma which represents about 35-40% of all hospitalized patients. Within a five-year period (1983-1987) there have been examined and treated 887 patients, 406 military and the rest socially insured from Belgrade, Serbia Proper and other regions of Yugoslavia. All types of antitumorous therapy have been applied depending on histologic type and degree of spreading of the disease. After completion of active antitumorous therapy patients were followed up and controlled examinations were performed at the out-patient service with symptomatic therapy at home and temporary hospitalization at the M.M.A. More than 300 patients were hospitalised in the terminal stage of the diseases for general care and symptomamic therapy for approximately 30 days.

[Hemoptysis in patients with normal roentgenologic findings]. / Hemoptizije u bolesnika sa normalnim rendgenskim nalazom.

There have been examined 145 patients with hemoptyses and normal x-ray findings. The majority of patients were males, smokers, more than 45 years old. Bronchoscopically the most common findings have been signs of inflammation and blood traces. The most common cause of hemoptyses has been chronic bronchitis in patients older than 45 years, and bronchoectasis in younger patients. Bronchogenous carcinoma was discovered in 8 patients: in 5 by bronchoscopic examination at hemoptysis occurence and in 3 by subsequent follow up after 8, 15 and 20 months. Pulmonary vessel malformations have been discovered in 9 patients, and cardiac diseases have been the cause of hemoptysis in 7 patients. The cause of hemoptysis remained undetected in 33 (22.8%) patients.