[Invasive aspergillosis in autopsy material of patients treated at the Institute of Tuberculosis and Chest Diseases during the years 1993-2000]. / Inwazyjna aspergiloza w materiale autopsyjnym u chorych leczonych w Instytucie Gruzlicy i Chorób Pluc w latach 1993-2000.

The aim of this paper is an analysis of clinical documentation and results of autopsy of 21 patients (pts) who died of invasive aspergillosis (IA) in the Institute of Tuberculosis and Chest Diseases in years 1993-2000 and the assessment of predisposing factors for IA. In 17 pts IA was the main and in other 4 only an accessory cause of death. All pts were treated with corticosteroids and/or cytostatic drugs--because of lung cancer (11 pts), cancer in other site (2 pts), haematologic disorders (2 pts), Wegener's granulomatosis (1 pt), polymyositis (1 pt), idiopathic pulmonary fibrosis (1 pt) and other diseases (3 pts). In 15 out of 21 pts granulocytopenia was revealed (from 0.008 x 10(9)/L to 0.82 x 10(9)/L) on an average one month before death. In 15 pts IA was limited to the lungs, in 6 others there were also fungal lesions in brain, kidneys, liver, spleen and heart. Pts with disseminated form of IA had significantly lower granulocyte count and were treated with higher doses of corticosteroids than others. Immunosuppressive drugs and granulocytopenia can be regarded as predisposing factors. Fatal course of IA depended also on the late diagnosis.

[Plastic bronchitis and mucoid impaction--uncommon disease syndromes with expectoration mucus plugs]. / Plastyczne zapalenie oskrzeli i zaczopowanie sluzem--rzadkie zespoly chorobowe przebiegajace z wykrztuszaniem odlewów oskrzelowych.

Mucoid impaction and plastic bronchitis are relatively rare disorders caused by the formation of obstructive airway plugs. We observed from February 1999 to June 2000 seven patients with mucoid impaction and one with plastic bronchitis. In the group of mucoid impaction there were 4 patients with bronchial asthma and 3 without history of lung disease. At the admission to hospital all patients suffered from cough, chest pain and effort dyspnea. Two of them expectorated during cough "bronchial casts". The chest X-ray of 5 patients revealed atelectasis of one of the lung's lobes and diffuse opacities in 2 others. In 4 cases during bronchoscopy one bronchus and in another three--numerous bronchi were obstructed with mucoid casts. Removing of the casts caused both the improvement of the patients' condition and withdrawal of atelectasis in 4 cases. In 5 patients the final diagnosis was allergic bronchopulmonary aspergillosis and in two mucoid impaction in the course of asthma without aspergillosis. Plastic bronchitis was observed in 44 years old man, who expectorated white, branching, bronchial casts for three months. On admission he was in respiratory failure. The chest X-ray revealed diffuse alveolar infiltrates and HRCT glass-ground opacities in both lungs and bronchiectasis in the middle lobe. The bronchofiberoscopy disclosed diffuse tracheobronchitis with casts occluding the middle lobe bronchus. Microscopic examination of the removed casts showed aggregates of mucus, macrophages, neutrophils and cells of respiratory epithelium. Precipitins against Aspergillus fumigatus were not found. Staphyloccocus coagulase (-) was cultured from urine and sputum specimens. We administered Vancomycin with Netylmycin, acetylocysteine, oxygen therapy and humid inhalation and the patient recovered. HRCT made six months after admission revelated total withdrawal of glass-ground opacities. The pathogenesis of plastic bronchitis in this case was unclear.

[The relation between lymphocyte profile in BALF and the course of sarcoidosis based on short term observation]. / Zaleznosc miedzy zawartoscia limfocytów w BALF a krótkotrwala obserwacja przebiegu sarkoidozy.

The aim of this study was to assess how the extent of the number and percentage of lymphocytes in BALF and also the CD4 to CD8 ratio can help to predict the short outcome in sarcoidosis. Material consisted of 74 patients, 39 men and 35 women in the age from 23 to 58 years. 11 patients had chest lesions in stage I, 43 in stage II and 20 in stage III. Clinical markers of activity (fever, erythema nodosum) were present in 22 cases. Extrathoracic lesion were present in 31 and abnormal pulmonary function in 30. In all patients BAL was done before treatment and lymphocyte count, percentage and CD4/CD8 ratio was calculated. 50 patients were treated with corticosteroids and 24 were observed without treatment. After 6-12 month of observation regression of sarcoid lesions was observed in 46 of 50 patients treated with corticosteroids and in 17 out of 24 patients observed without treatment. There were no differences in lymphocyte count and percentage in BALF and in the short term outcome between group treated with corticosteroids and without treatment. The patients in whom regression of lesions was observed have however significantly higher CD4/CD8 ratio than others.

[Ocular manifestations in sarcoidosis]. / Objawy oczne w przebiegu sarkoidozy.

PURPOSE: The ophthalmic examination of patients with diagnosed systemic sarcoidosis. MATERIAL AND METHODS: 33 patients (17 women, 16 men), aged 22-60 years had ophthalmic examination (visual acuity, anterior and posterior segment evaluation, applanation tonometry). In 8 patients repeated examination was performed (duration of observation: 2-31 months). RESULTS: In 27 patients no characteristic features of ocular sarcoidosis were found. In 6 persons (18.2%) variety of ocular lesions was recognized (nodular infiltrations of the eyelids, chronic uveal inflammation, signs of anterior and posterior uveitis in the past, optic disc oedema). In 3 cases ocular lesions preceded the signs of systemic sarcoidosis. This emphasizes the importance of the routine ophthalmic examination of patients with suspected or proven sarcoidosis.

[Subacute sensory neuronopathy with signs of involvement of anterior horn cells in a patient with small cell lung carcinoma (case report)]. / Podostra neuronopatia czuciowa z objawami uszkodzenia komórek ruchowych rogów przednich w raku drobnokomórkowym pluc (z opisem przypadku).

A 55 years old woman with small-cell lung carcinoma is described. Ten months after the diagnosis was established, subacute sensory neuronopathy with the signs of involvement of anterior horn cells (confirmed by EMG exam) occurred. Since neurological symptoms appeared at the time when anti-cancer treatment was ceased, the diagnosis of paraneoplastic lesion peripheral nervous system was established. Biopsy of sural nerve obtained 3 months after the onset of neurological signs showed nearly complete loss of normal looking myelinated fibers due to the process of axonal degeneration with relatively better preserved unmyelinated fibers. The patient died after 1 year and 2 months from the beginning of the disease because of metastatic tumours in the brain.

[Pulmonary thromboembolism as the main or secondary cause of death in patients treated for small cell lung cancer]. / Zatorowosc plucna jako glówna lub dodatkowa przyczyna zgonu chorych leczonych z powodu drobnokomórkowego raka pluca.

The aim of this study was to assess the frequency of pulmonary thromboembolism in small cell lung cancer (SCLC) patients (pts) treated in the Institute of Tuberculosis and Chest Diseases in the years 1980-1994. The second aim was to assess whether the occurrence of thromboembolism is connected with the progression of cancer. Pulmonary thromboembolism was recognised in 17 out of 845 pts (2.01%) treated for small cell lung cancer, that is in 2.01% of pts. The frequency of thromboembolism was 8% among patients in which autopsy was done. Pulmonary thromboembolism occurred in 7 pts during progressive disease but also in 9 with partial or complete regression of SCLC. The potential role of chemo- and radiotherapy in the development of thromboembolism in the last group was discussed.

[Usefulness of analyzing ANCA changes for diagnosis of Wegener's granulomatosis]. / Przydatnosc oznaczania miana ANCA dla diagnostyki ziarniniakowatosci Wegenera.

UNLABELLED: ANCA were described in 1982 as sensitive and specific markers for active Wegener's granulomatosis (WG). We analysed the results of ANCA test performed in 298 patients hospitalized in Institute of Tuberculosis and Lung Diseases in the period 1990-1998 because of different symptoms and syndromes of respiratory system which could be symptoms of WG. Presence of c-ANCA, p-ANCA and other not well defined types of ANCA in the titer greater than 1:40 in the serum was regarded as positive result of test. We found it in 60 patients. In 47 WG pts ANCA were present in 40 of 42 pts with active disease and 1 of 5 in remission. Further 19 positive results were found in a group of 251 patients with other diseases: 1 of 4 pts with Churg-Strauss syndrome, 1 of 2 with pulmonary renal syndrome, 5 of 28 with connective tissue diseases, 1 of 21 with tuberculosis, 1 of 23 with sarcoidosis, 1 of 6 with histiocytosis, 3 of 11 with hypersensitivity pneumonitis, 1 (lymphoma) of 34 with neoplasms, 1 of 20 with pulmonary fibrosis, 1 of 8 with cardiac failure, 1 of 5 with pleural fluid, 1 of 10 pneumoconiosis and toxic reactions (after furagin), 1 of 6 with BOOP. Sensitivity of ANCA test in our material is 87%, specificity = 95%, and positive prevalence accuracy is 68%. It means that 32% of the patients with positive results could be inappropriate treated as WG. CONCLUSION: ANCA test could be not used as a screening test. Results of ANCA test alone cannot be used as basis for treatment. ANCA test is a helpful tool in diagnosing of WG.

[Primary biliary cirrhosis with sarcoid-like infiltrations in the lung]. / Pierwotna zólciowa marskosc watroby z wspólistnieniem ziarniniaków typu sarkoidalnego w plucach.

A women, 50 years old, has been observed for 4 years because of recurrent infiltrations in both lungs. Biopsy of those lesions revealed sarcoid-like granulomas. Tubercle baccilli were not present in those lesions nor in the sputum or bronchial washings. Anti-tuberculosis therapy was without effect. On admission to our hospital she was in good performance state. There was an infiltration in the base of the left lung. Hepatosplenomegaly was observed on USG examination. Aspartate aminotransferase was 49 UI/l, alanine aminotransferase 70 UI/l. Alkaline phosphatase was 167 UI/l and the titer of antimitochondrial antibodies was 1:2000. Primary biliary cirrhosis was suspected, but the patient refused liver biopsy. Prednisone in the dose of 60 mg per day was given to suppress the granuloma formation in the lungs. During this treatment there was a decrease in size of liver and spleen, lung lesion disappeared and the titer of antimitochondrial antibodies decreased to 1:40. After 3 months of treatment the dose of prednisone was reduced gradually. When she was receiving 15 mg of prednisone every other day the titer of antimitochondrial antibodies rose to 1:8000 and the activity of alkaline phosphatase to 448 UI/l. At this time she accepted liver biopsy. Primary biliary cirrhosis was diagnosed. The possible connection between sarcoid-like granulomas in the lungs and the primary biliary cirrhosis is discussed.

Diffuse pulmonary hemosiderosis after exposure to pesticides. A case report.

This report describes the clinical, radiological, microscopical and ligandohistochemical findings in a 17-year-old woman who suffered from an acute onset of pulmonary hemosiderosis after inhalation of pesticides used for the cultivation of strawberries. She complained of headache, dyspnea, rhinitis, weakness and recurrent severe hemoptysis. Chest radiographs revealed bilateral patchy infiltrates, predominantly in the lower parts of both lungs. The consecutive severe anemia was treated by multiple blood transfusions which were repeated every 4-5 days. Open lung biopsies displayed signs of diffuse hemorrhage with hemosiderin-loaded macrophages, some hyaline membranes, focal fibroid deposits with intermingled histiocytes, mild interstitial fibrosis and focal intra-alveolar calcified bodies surrounded by foreign body giant cells. Analysis of endogenous lectins failed to demonstrate expression of binding capacities for maltose, fucose, mannose, lactose and sialic acid, Neither binding capacities for the macrophage-migration-inhibitory factor nor its presence, as analyzed by labeled sarcolectin, could be detected histochemically. The light microscopical findings are consistent with a longer-lasting diffuse pulmonary hemosiderosis; the presence of calcified bodies and foreign body giant cells (including the ligandohistochemical data) argues for a causal role of inhaled substances. The patient's clinical course improved after cyclophosphamide treatment, which restored her ability to work and released her from the need for recurrent blood transfusions.

[Our experience in bronchiolitis obliterans organising pneumonia (BOOP): personal experience]. / Bronchiolitis obliterans orginizing pneumonia--doswiadczenia wlasne.

BOOP is a disease with characteristic histology features which can occur as a secondary lung reaction to the various toxic agents or as a primary idiopathic disease. Idiopathic form of BOOP is a rare disease and may be found in 6-7 patients of 100,000 hospital admissions. We described 3 patients with idiopathic BOOP confirmed by the histologic lung examination. The time from the beginning of symptoms till the microscopical diagnosis ranged from 6 to 12 months. At the beginning of the disease the patients had symptoms compatible with the respiratory infection. In one of the patients the clinical course of the disease had a progressive character. In two patients spontaneous regression of radiological lung lesions was observed. This regression was however only temporary in one of them. In two cases treated by steroids regression of lung lesions was noticed.

Two patterns of NK activity changes following blood donation: decrease in the beginners and restoration in regular blood bank donors.

NK cell activity of peripheral blood lymphocytes was determined in voluntary blood bank donors in a standard 4-hr 51Cr-release cytotoxicity assay. When blood donors were divided into groups according to the total amount of blood they had donated in the past, decreased NK activity was found in "moderate" donors who had donated between 3 and 9 l of blood, but not in those who had donated < or = 3 or more than 9 l of blood before testing. This observation was the rationale for a study on the effects of regular blood donations on NK activity in randomly selected voluntary blood bank donors re-tested over a period of time. The study demonstrated decreased NK activity in the second measurement in donors who had donated up to 6 l of blood before the study, and an increase in NK activity between the first and the second testing in those who had donated more than 6 l of blood. This result, together with data obtained at the population level, suggests that some compensatory mechanism(s) regulate NK activity in the course of regular blood donation.

The influence of ABO blood groups, Rh antigens and cigarette smoking on the level of NK activity in normal population.

In this study we have examined the influence of ABO and Rh blood groups as well as the effect of cigarette smoking on the level of NK activity in healthy men. Blood bank donors and age-matched non-donors have been evaluated independently. As far as ABO blood groups are concerned, higher NK activity in individuals with AB blood group in comparison with those with group A and those with groups A, B, and O taken together have been demonstrated. No effect of Rh antigens on NK activity has been found. Similarly, there was no influence of cigarette smoking on NK activity. Consistently lower values of NK activity in blood bank donors in comparison with non-donors have been shown.

Opposite effect of donor-specific immunization by blood or splenocytes on the survival of heart tissue transplants in strong versus weak histoincompatible combination in mice.

Recipients of allogeneic heart tissue were pretreated intravenously with blood or injected intraperitoneally with spleen cells. In H-2 incompatible donor-recipient combination (BALB/c----CBA/H) donor-specific immunization, both with blood and spleen cells, resulted in acceleration of graft rejection. On the other hand, increase in graft survival was observed following donor-specific but not third-party blood pretreatment in mice compatible in H-2 complex but bearing different minor histoincompatible antigens (BALB/c----DBA/2).

The influence of blood donation on antibody-dependent cellular cytotoxicity (ADCC) in voluntary blood bank donors.

K cell activity by peripheral blood lymphocytes was found to be significantly decreased in voluntary blood bank donors, this decrease being particularly evident when cytotoxicity was expressed in lytic units. When blood donors were divided into groups in relation to the total amount of blood donated, the deepest decline of ADCC was found in the group of "moderate" (3-6 l of blood withdrawn) donors. A single blood donation was followed by a transient decrease in the K cell activity and returned to normal values in about two months.

The effect of blood donation on natural killer activity in man.

Natural killer (NK) activity by peripheral blood mononuclear cells was determined in 122 male blood bank donors and 51 age-matched normal individuals. The results of a 4 hr 51Cr specific release assay demonstrated that NK activity was significantly decreased in blood donors and was dependent on the total volume of blood donated--the lowest values were observed in active long-term blood donors. It was shown also that depression of NK activity was accompanied by a decrease in total lymphocyte count in blood.

Relationship between natural killer (NK) activity and eosinophil, neutrophil and lymphocyte level in human blood.

Natural Killer (NK) activity by blood lymphocytes from healthy males was determined in 4-h-51Cr release assay with K562 target cells. Individuals with a high ratio of neutrophils to lymphocytes had a significantly lower NK activity compared with that of those with a low ratio of neutrophils to lymphocytes. On the other hand, no correlation of NK activity with absolute lymphocyte count was observed. Eosinophilia in blood was found to be accompanied by increased NK activity. Some biological aspects of these interdependences are discussed.

Transfusions of syngeneic blood do not seem to induce suppressive effect on antitumor or transplantation immunity in mice.

There was no prolongation of allogeneic heart survival or acceleration of tumor development in mice pretransfused with syngeneic blood. Analogous transfusion of donor-specific (allogeneic) blood, without additional immunosuppression, resulted in prolongation of allogeneic heart survival. These results argue against participation of some immunologically unspecific mechanisms in immunosuppressive effect of blood transfusion on transplantation immunity in this model.