[Pseudomonas aerogunosa pneumonia in patients treated at the Hospital for Chest Diseases]. / Zapalenia pluc wywolane przez paleczke ropy blekitnej u chorych leczonych w Szpitalu Chorób Pluc.

Retrospective analysis of pneumonia caused by Pseudomonas aeruginosa was made in 66 patients, treated in hospital. Nosocomial pneumonia was diagnosed in 11 (17%) patients. In 51 patients coexisting lung diseases were present: mainly COPD and bronchiectasis. Strains of Pseudomonas aeruginosa were susceptible mostly to imipenem, meropenem, aztreonam, ticarcillin-clavulanic acid, ceftazidime, ciprofloxacin, amikacin, piperacillin-tazobactam, netilmicin. Duration of treatment in hospital was very long--59% were treated over 30 days. Combined antibacterial therapy was applied in 35 (53%) patients and monotherapy, often with different antibiotics--in 31 (47%) patients. Treatment was successful in 45 (68%) patients. In 9 patients the results of treatment was not successful: mainly because of empyema in 7 pts. Twelve (18%) patients (with coexisting COPD--6 and lung cancer--6) died. We can support current recommendations for treatment of Pseudomonas aeruginosa infection with combination of aminoglycosides or fluoroquinolones plus one of remaining antipseudomonal antibiotics. Treatment failures occurred mainly in patients with severe coexisting diseases and/or empyema.

[Cough, bronchoconstriction and bronchial hyperreactivity in relation to treatment with angiotensin-converting enzyme]. / Kaszel, obturacja i nadreaktywnosc oskrzeli podczas stosowania inhibitorów konwertazy angiotensyny.

In the paper available information concerning the influence of treatment with angiotensin converting enzyme inhibitors (ACE-I) on cough, bronchial hyperreactivity and bronchoconstriction are reviewed. Cough occurs in 0.7% to 19% of patients treated with angiotensin converting enzyme inhibitors according to various reports. In the mechanism of angiotensin converting enzyme inhibitor-induced cough accumulation of bradykinin and substance P due to decreased degradation of this mediators caused by ACE-I may be involved. Part of tussive effect may be mediated via prostaglandins and histamine. In a few studies symptoms of airway obstruction and asthma worsening in relation to treatment with this drugs was reported. However, majority of reports suggest safety in taking ACE-I by patients with asthma. The only effective method to relieve angiotensin converting enzyme-induced cough is a drug withdrawal. The change of drugs within the whole class of ACE-I does not bring effect.

[Comparison of the influence of celiprolol, metoprolol and atenolol on pulmonary ventilation in patients with asthma]. / Porównanie wplywu Celiprololu, Metoprololu i Atenololu na wentylacje pluc u chorych na astme oskrzelowa.

Usage of beta-blocking agents in patients with bronchial asthma is restricted due to their ability to precipitate bronchospasm. Celiprolol beta1-selective beta-blocker with associated beta2-agonist activity gives brand new possibilities of treatment with beta-blockers in asthmatics. The aim of the study was to compare the pulmonary effects of single dose of celiprolol (200 mg), atenololol (25 mg), metoprolol (50 mg) and placebo. Ten stable asthmatic patients, aged 21-60 years (mean age 44.1 yrs.) were studied. During four separate visits with 3 days wash-out period physical examination, ECG recordings were done and lung function tests (FEV1, FVC, FEF25-75), blood pressure, heart rate and saturation were recorded. All parameters were measured again after 45, 90, 150 and 210 minutes from the beginning of the visit. On the contrary to metoprolol and atenolol single dose of celiprolol and placebo did not significantly affect respiratory functions (FVC--area under curve). There was significant decrease of FEV1 calculated as area under curve (AUC) after application of metoprolol in comparison to celiprolol. There were no significant changes in FEV1 after use of atenolol and celiprolol. Celiprolol ian dose 200 mg can be safely used in asthmatic patients.

[Staphylococcal pneumonia--analysis of material from patients treated at the Hospital for Lung Diseases in the years 1981-1994]. / Gronkowcowe zapalenia pluc--analiza materialu chorych leczonych w Szpitalu Chorób Pluc w latach 1981-1994.

Retrospective analysis of staphylococcal pneumonia was made in 182 patients, aged 18-88 years /61% more than 60 years old/ treated in hospital in years 1981-1994. Majority of these patients had various concomitant diseases, mostly chronic bronchitis and lung cancer. Strains of Staphylococcus aureus were sensitive mainly to amoxycillin--clavulanic acid, roxitromycin, amikacin, netilmicin, clindamycin, cefamandol, chloramphenicol, rifampicin and resistant mostly to penicillin /90% of strains/, ampicillin, tetracyclines. In many cases initial antibacterial treatment was inadequate in relation to sensitivity pattern of staphylococci--hence many changes of antibiotics were observed in the course of the therapy. Newer antistaphylococcal drugs were applied only in the last years of the study. Despite these therapeutical drawback outcome of staphylococcal pneumonia was good in 85% of patients; 14% of patients died /mainly as a consequence of comorbidities/. Successful therapy of staphylococcal pneumonia requires early recognition of possibility of infection due to Staphylococcus aureus and adjustment of drugs to probable or actual sensitivity of these pathogens.