Epidemiology of malignant pleural mesotheliomas in Croatia in the period from 1989 to 1998.

Malignant pleural mesotheliomas are rare tumors. Their occurrence is often associated with the exposure to asbestos. Asbestos is widely used in various industries as well as for many types of products in everyday use. In Croatia in the period from 1989 to 1998, the rate of incidence was 0.4-1.1/100,000. The highest rate of incidence was in the Districts of Istria (2.9) and Split-Dalmatia (2.5). It is more frequent among males than among females with a ratio of 3.2:1. It rarely occurs before the age of 40 and most of the patients suffering from the disease are more than 65 years old. About 12% of mesotheliomas metastasize into regional lymph nodes and 17% of them into distant organs. The disease unavoidably leads to death and, according to the data obtained in Croatia in the period from 1989 to 1998 the mortality and incidence are very close.

Lung lavage neutrophils, neutrophil elastase and albumin in the prognosis of pulmonary sarcoidosis.

The authors measured the bronchoalveolar lavage fluid (BALF) neutrophils, neutrophil elastase and albumin in 60 patients with pulmonary sarcoidosis, 18 patients with other interstitial lung diseases and 14 healthy controls in order to evaluate its significance in the prognosis of sarcoidosis. The concentrations were measured by enzymoimmunoassay and radial immunodiffusion (LC plates). Obtained values were correlated with some clinical indices, radiological stage and lung function values. The patients were followed up for 22.3 +/- 6.8 months. At the end of observation period the outcome of sarcoidosis has been evaluated upon the findings of chest radiograms and lung function tests. The length of duration of the disease correlated with the lung lavage neutrophil counts (r = 0.2535; p < 0.05). Significantly higher values of BALF elastase were obtained in III radiologic stage than II and I. Patients with high BALF albumin had more often dispnoa (p < 0.05) and chronic forms of the disease (p < 0. 05). The values were high in patients in II and III radiologic stage. Unfavorable outcome of chest radiograms was announced by high BALF albumins (p < 0.05). The measurement of BALF neutrophils, neutrophil elastase and albumin are helpful in clinical management and estimation of the prognosis in patients with pulmonary sarcoidosis.

Double-blind placebo controlled clinical trial of almitrine bismesylate in patients with chronic respiratory insufficiency.

The efficacy and safety of almitrine bismesylate, a new respiratory stimulant, in patients with the hypoxaemic form of chronic respiratory insufficiency caused by chronic bronchitis and emphysema has been assessed. The multicentre trial of 12 weeks duration was double-blind and placebo controlled, with individual and group comparisons. Twenty three patients received almitrine 50 mg b.d. p.o. and 17 took placebo. In the almitrine group a significant increase in PaO2 was achieved (control value 54.4 mm Hg, rising to 59.1 mm Hg after 6 weeks, and to 59.4 mm Hg after 12 weeks). There was also a significant decrease in PaCO2 in the almitrine group after 12 weeks. No correlation was found between the plasma almitrine concentration, PaO2 and PaCO2. Lung function (FVC, FEV1, FEV1/FVC, Raw, TLC, RV, FRC) did not change in either group, but the degree of dyspnoea and performance in the 6 min walking test were significantly improved in the almitrine group. Adverse reactions appeared in 6 out of 23 patients on almitrine bismesylate (headache, urticaria, breathlessness, diarrhoea, chest pain, nausea and vomiting), causing drop out of 4 patients. Thus, almitrine bismesylate can be considered useful in the treatment of patients with chronic respiratory insufficiency.

[Evaluation of allergologic diagnosis in patients with bronchial asthma]. / Evaluacija alergoloske dijagnostike u bolesnika s bronhialnom astmom.

The present paper deals with 16 patients who were referred to the Clinical Hospital for Lung Disease "Jordanovac", Zagreb. On admission they were supposed to have or had already been diagnosed to have bronchial asthma. Numerous data from the patients' history were evaluated as well as the results of allergy tests (skin tests, RIST, RAST, eosinophils in the blood and sputum) and parameters of the functional lung diagnostics (blood gas analysis during rest and exercise, spirometry, flow-volume, body plethysmography). It was established that allergy diagnostics is not carried out as required, even though it is necessary in all chronic obstructive lung diseases. Skin tests, inspite of the problems on the standardization of allergens and the average number of positive reactions in healthy volunteers, represent a significant diagnostic method for the determination of the role of allergic reaction in bronchial asthma. It is necessary to combine them with the determining level for specific IgE in serum (RAST), which would, if the other conditions are satisfactory, be a basis for specific immunotherapy. The value of skin tests is greater since a good correlation between them and bronchial sensibility was found established by specific broncho-provocative testing. The correlation between eosinophils in the blood and the sputum with allergic sensibilization in asthma was not confirmed in this work. For evaluation the localisation and degree of obstruction as well as the effect of therapy in asthma patients the best functional test was found to be the flow-volume.