Indoor radon exposure and living conditions in patients with advanced lung cancer in Lublin region, Poland.

OBJECTIVE: Radon (Rn-222) is a noble gas formed in the uranium path (U-238) as a decay product of radium (Ra-226). It is estimated to cause between 3% to 14% of all lung cancers, depending on the national average radon level and smoking prevalence. Radon molecules emit alpha radiation, which is characterized by low permeability through tissues, but due to its remarkably high energy, it has a high potential for DNA damage. The aim of our research was to assess the radon concentration inside the houses of patients with advanced lung cancer and to analyze their socio-economics status. PATIENTS AND METHODS: The measurements of radon concentration were performed in 102 patients with stage 3B or higher lung cancer in the region of Lublin, Poland. One month of radon exposure measurement was performed with alpha-track detectors. In addition, patients filled in a detailed survey about factors that might influence the concentration of radon inside their houses. RESULTS: The average concentration of radon during the exposure of the detector in the residential premises of the respondents was at the level of 69.0 Bq/m3 [37.0-117.0]. A few significant correlations were discovered, e.g., higher levels of radon in countryside houses or in houses equipped with air conditioning. CONCLUSIONS: As radon exposure is a modifiable risk factor for lung cancer, it is extremely important to find factors that may reduce its concentration in dwelling places. Since our research was performed in houses of people with lung cancer, taking corrective actions based on our findings could prevent new lung cancer incidence in patients' flatmates.

CT follow-up of COVID-19 pneumonia in patients requiring hospitalization in the acute phase of the disease.

OBJECTIVE: There are studies discussing the lung CT abnormalities persisting 3-4 months after COVID-19 pneumonia. Very few studies have evaluated the radiological changes in longer perspective, especially in patients with a severe form of the disease. The aim of our study was to show and qualify the persistent CT changes and to evaluate the dynamics of their evolution in convalescent patients after discharge from hospital post moderate and severe COVID-19 pneumonia. PATIENTS AND METHODS: We retrospectively analyzed the lung involvement at acute phase and follow-up time of 6 months in 6 patients with COVID-19 pneumonia using high resolution computer tomography. RESULTS: Radiological changes in the course of SARS-CoV-2 infection persisted in all patients 6 months after the first CT examination. CONCLUSIONS: Our study confirms that the period of 3 months is too short for the follow-up CT examination in patients recovered after severe or moderate COVID-19 pneumonia.

Lung cavitation as a consequence of coronavirus-19 pneumonia.

OBJECTIVE: There are reports confirming that the development of pulmonary cavities is an atypical CT finding in patients after COVID-19 pneumonia. Before the SARS-Cov-2 pandemic, we knew that the most common causes of pulmonary cavities were mycobacterial, fungal or parasitic infections. Rapidly increasing incidence of pneumonia in the course of COVID-19, and thus, tomographic examinations of the lungs proved that one of the rare complications of this disease may also be cavity development. The aim of the study was to assess the incidence of pulmonary cavities in patients after SARS-CoV-2 pneumonia. We also aimed to analyze the changes accompanying the pulmonary cavities in our patients. PATIENTS AND METHODS: We performed a retrospective analysis of 206 lung CT scans of patients with SARS-CoV-2 infection. In 28 of them, prior radiological examination revealed the presence of pulmonary lesions - these patients were disqualified for the study. RESULTS: Out of 178 enrolled patients, 6 developed pulmonary cavities (3.37% of all cases). The most frequent changes coexisting with cavitary lesions in our material were: ground glass opacities, reticular pattern, bronchiolectasis and subpleural bands. CONCLUSIONS: Our study confirms the similar incidence of pulmonary cavities after COVID-19 than previously reported. It also incites the clinicians to pay attention to the possibility of the occurrence of this complication.

Cardiac metastases from a squamous cell lung carcinoma in the absence of local recurrence - a unique case.

OBJECTIVE: Metastatic tumors of the heart are much more frequent than primary tumors. In this paper, we present the uncommon case of heart metastases of a squamous cell lung carcinoma. CASE REPORT: The study is a description of a unique case of cardiac metastases from lung cancer in the absence of local recurrence. The patient had a squamous cell lung carcinoma and underwent pulmonectomy two years before, followed by four cycles of chemotherapy. RESULTS: We report this case to raise the awareness of cardiac manifestations of neoplastic diseases that are usually underdiagnosed. CONCLUSIONS: According to our knowledge, there is no such case described in the literature. Heart metastases are significantly underdiagnosed. Although the survival prognosis is very poor, earlier diagnosis could provide the chance to start the treatment and to prolong patients' life.

A single-institution retrospective analysis of the differences between 7th and 8th edition of the UICC TNM staging system in patients with advanced lung cancer.

OBJECTIVE: The TNM (Tumor, Node, Metastasis) classification of Union for International Cancer Control is a system describing the anatomical extent of the solid tumors that leads to staging and decision on the type of treatment. The latter TNM system (2017) as compared to the previous version (2010) has brought numerous changes. Our aim was to examine whether significant changes in the new TNM edition have altered the components of the TNM classification in patients and the stage of the disease to which they are ascribed. PATIENTS AND METHODS: The study is retrospective and is based on radiological examination reports and case reports of 100 patients of the Department of Pneumonology, Allergology and Oncology of the Medical University in Lublin, Poland. One hundred randomly selected patients, who were hospitalized at the Clinic between 2013 and 2018 with primary lung cancer were enrolled in the study. The chi-square test, Mann-Whitney U test, Kruskal-Wallis test and an appropriate post-hoc test were used in statistical analysis. RESULTS: It was calculated that the T descriptor evaluated as per TNM in revision 8th in comparison to revision 7th changed in 41% of patients, the M descriptor - in 29% of patients, which resulted in change in staging in 11 patients. In spite of this scale amendments, only three patients could be treated differently because of the change in the stage of the disease. CONCLUSIONS: Changing the treatment method, including withdrawal from surgery, can help avoid unnecessary treatment, but on the other hand, may potentially reduce the patient's chances of survival by depriving them of the possibility of radical treatment.

Pulmonary function between 40 and 80 years of age.

Spirometry is the most frequently performed lung function test. To determine a normal range of spirometry results, reference formulas are used. Predicted values play an important role in establishing whether the volumes measured in an individual fall within a range to be expected in a healthy person of the same gender, height, and age. Such standards enable to assess the development of the respiratory system in the youth, the early recognition of the influence of a disease on the respiratory system and the influence of environmental factors on lung function. The objective of the present study was to estimate lung function prediction equations and to identify appropriate normal reference values for the Lublin Region local population of adults. We addressed the issue by analyzing the data from a lung function screening program conducted in the Lublin Region of Poland. Pulmonary function of adults aged 40-80 years was assessed from the measurements of forced vital capacity (FVC) and forced expired volume in the first second (FEV(1)) in 136 adults. Reference values of FVC and FEV(1) for females and males were calculated by linear multiple regressions with age and height used as predictors. Different equations were compared to show their reliability when applied to the local population. The results were as follows. In females, the mean FEV(1) was 2.856 +/-0.534 (L) (113.7 +/-14.3%) and the mean FVC was 3.517 +/-0.662 (L) (118.5 +/-14.1%), in males, 3.913 +/-0.773 (L) (110.9 +/-15.1%), 4.922 +/-0.941 (L) (112.1 +/-14.1%), respectively. The estimated prediction equations were: for the FVC - for females - FVC (L) = 0.0528 (height) - 0.0262 (age) - 3.676 and for males - FVC = 0.0756 (height) - 0.0649 (age) - 4.904; and for the FEV(1) - for females - FEV(1) (L) = 0.0378 (height) - 0.0282 (age) - 1.799 and for males - FEV(1) (L) = 0.0553 (height) - 0.0553 (age) - 2.874. Units are years for age and centimeters for height. In conclusion, the analysis of the lung function data showed that there were significant difficulties in determining the appropriate reference values of FEV(1) and FVC. The predicted FEV(1) and FVC values derived from equations based on the ECSC (1) reference populations are considerably lower than those calculated in the present study, re-emphasizing the need to be cautious when applying the ECSC reference values for the local Lublin population. There seems to be a need for a constant refinement of spirometric standards.