[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.

[Microbial analysis of clinical material taken from patients at the Oncology Center, Maria Sklodowkda-Curie Institute in Warsaw in 1997]. / Mikrobiologiczna analiza materialu klinicznego pobranego od pacjentów Centrum Onkologii--Instytutu im. Marii Sklodowskiej-Curie w Warszawie w 1997 roku.

An analysis was carried out of the microbiological investigations of clinical material samples obtained from the patients of two oncology centres belonging to the Warsaw Oncology Centre. Microorganisms cultured from urine, blood, catheters, smears of wounds and other materials were analysed. From 4839 clinical material samples from the Ursynów centre 1755 bacterial strains were isolated. From 423 samples from the centre in Wawelska Street 171 strains were obtained. In infections of patients from the centres the number of Gram-positive cocci was twice that of Gram-negative rods. In the investigated clinical material S. aureus was the most frequently isolated Gram-positive coccus, while E. coli was the most frequent species among Gram-negative bacteria. In the infections of oncological patients a considerable frequency was noted of yeast-like fungi, especially C. albicans. Particularly disquieting was the increasing number of isolates of C. glabrata and C. krusei strains resistant to fluconazole.

[Invasive pulmonary aspergillosis caused by Aspergillus ochraceus]. / Inwazyjna aspergiloza pluc wywolana przez Aspergillus ochraceus.

Invasive pulmonary aspergillosis (IPA) is a frequent complication in patients with severe neutropenia resulting from cytotoxic chemotherapy. In Europe, Aspergillus fumigatus is most common pathogen of IPA. In our case, IPA was recognised in 54 year old female suffering from acute lymphoblastic leukemia with pancytopenia. The patient developed severe granulocytopenia during chemotherapy. Chest radiograph revealed progressive bilateral infiltrations with cavitation. In sputum culture Aspergillus ochraceus was found. The results of precipitating tests were positive for A. ochraceus and A. fumigatus. Treatment with amphotericin B was used successfully leading soon to clinical improvement, yet radiological lesions remained largely unchanged. The patient received itraconazole, which was very effective and caused almost complete regression. Two episodes of IPA recurrence were treated with antifungal therapy with good results.

[Treatment of patients with pulmonary aspergilloma with itraconazole]. / Leczenie itrakonazolem chorych z grzybniakami kropidlakowymi pluc.

The study aimed to assess effectiveness of itraconazole in treating pulmonary aspergilloma. Treatment with this triazole derivative was employed in 11 patients with pulmonary aspergilloma. Nine patients underwent a complete 6 month treatment at 200-400 mg dose. The treatment was discontinued in lesions 2 patients who demonstrated progression of lesions. Haemoptysis withdrew in 5 patients, the same number of patients displayed negative fungus culture. Only in 1 patient radiological appearances improved and negative sputum culture as well as cessation of haemoptysis were observed. No significant adverse reactions were reported for any patients. Six months after completion of the treatment haemoptysis recurred in 2 patients, renewed growth of A. Fumigatus was quoted for 3 patients and intensified precipitating test results for 2 patients. Only 1 patient improved within all the required parameters. The results of the conducted study indicate that itraconazole by infiltrating lung cavity inhibits fungus growth on the surface of aspergilloma, which, in isolated cases can lead to aspergilloma necrosis. The results of itraconazole treatment are not sufficiently satisfactory to justify application of itraconazole in routine treatment of pulmonary aspergilloma.

[Pneumonia in patients after extracorporeal circulation]. / Zapalenia pluc u chorych po operacjach w krazeniu pozaustrojowym.

Hospital infections are still an important problem of to-days medicine. The most common and dangerous one is pneumonia. The purpose of this study was to determine the cause of pneumonia in patients operated on under extracorporeal circulation. It was proved that micro-organisms responsible for pneumonia in our patients were Pseudomonas sp. and Staphylococcus aureus. No correlation between the bacterial flora cultured from the air in operating theatre and post-op. ward and bacterial flora responsible for pneumonia was found. It can be infer that pulmonary infections were rather caused by hospital cross-infections or endogenic infections in colonized patients.

[Usefulness of CT examination in diagnosing aortic dissecting aneurysms and their complications]. / Przydatnosc tomografii komputerowej (KT) w rozpoznawaniu tetniaków rozwarstwionych aorty i ich powiklan.

Authors discussed the most frequent CT signs of aortic dissection, such as: double- and multichannel aorta, intimal flap, displacement of calcifications into the aortic lumen, distortion of true aortic lumen, aortic dilatation and aortic wall thickening. Authors describe also the CT pictures of complications of aortic dissection: hematomas, rupture of aneurysm, false aneurysm, organs ischaemia and infection. CT is very useful modality in detection of aortic dissection and its complications.

[Pulmonary infections in patients with lung cancer during antineoplastic therapy]. / Zakazenia u chorych na raka pluca w czasie leczenia przeciwnowotworowego.

162 pulmonary infection episodes were observed in 94 patients with lung cancer undergoing antineoplastic therapy. 80 (40%) episodes occurred during leukopenia. Elevation of leucocyte count was seen in 12 episodes only. Elevated body temperature was the only sign in 20 episodes, of which in 7 cases microorganisms were cultured from the blood. Purulent pulmonary infections were observed in 71 episodes, in 66 the causative agent was identified. Purulent urinary tract infections were observed in 29 episodes, of which in 28 the microorganisms were identified. A coexistent pulmonary and urinary tract infection was seen in 13 cases, of which in all the causative agent was identified. Purulent infections of the nasopharyngeal mucosal membranes were observed in 16 cases, while herpes zoster in 13. The most often isolated organism in these cases were: Gram negative rods (E. coli, Klebsiella sp., Proteus sp., Hemophilus influenzae); less commonly Gram positive bacteria were isolated, mainly Staphylococcus aureus. Candida sp. was the most common fungus that was isolated from these patients. In four cases Candida was isolated from blood.

[Difficulties in diagnosing a case of chronic necrotic aspergillosis with an unfavorable course]. / Trudnosci diagnostyczne w przypadku przewleklej martwiczej aspergillozy o niepomyslnym przebiegu.

A case of chronic necrotic aspergillosis was discussed. Diagnostic and therapeutic difficulties were described in patient with an insufficiency of immune response mainly in polymorphonuclear leukocytes function.

[Symptoms and functional disorders of the respiratory system caused by exposure to tea dust]. / Objawy i zaburzenia czynnosciowe ukladu oddechowego wywolane ekspozycja na pyl z herbaty.

A case report is presented of a female worker of a tee packing factory, with a 5 years history of tea dust exposition and symptoms of reversible airway obstruction and early allergic alveolitis. The results of spirometric and lung mechanics demonstrated reversible airway obstruction with co-existent restrictive changes, lowering of CO diffusing capacity (DLc0). Bronchial provocation tests with tea dust were carried out thrice and all were positive. The authors believe that the etiological factor of above mentioned changes were Aspergillus niger spores found in tea dust. Tea dust and the patient's sputum cultured for fungi revealed massive growth of A. niger. Serological tests revealed additionally, antibodies to A. niger and tea dust extracts. The authors discuss the possible mechanisms of airway disturbances in this patient.

[A case of skin cryptococcosis in systemic lupus erythematosus]. / Przypadek kryptokokozy skóry w przebiegu ukladowego tocznia rumieniowatego.

Here is presented a case of woman treated by immunosuppressive preparations because of systemic lupus erythematosus with ski manifestations as tubercles and ulcerations on skin of trunk and extremities. On the basis of histological examination of tubercle skin specimens and mycological examinations of material obtained from skin ulcerations cryptococcosis was diagnosed. Disease was limited to skin that was an entry of infection. Patient was treated by Amphotericin B administered intravenously and Flucitosine per os. Amphotericin B was also applied topically. The results of cultures became gradually negative, up to total disappearance of fungus cells in direct specimens, prepared from examined material. After treatment continuing for 5 months only discoloured scars were observed on sick skin.

[Pulmonary aspergilloma caused by Aspergillus niger]. / Grzybniak kropidlakowy pluc wywolany przez Aspergillus niger.

The authors present a case report of a 66 year old male that was admitted due to pulmonary lesions with cavitation localized in the upper left lobe. In the cavity an abnormal mass could be seen. In the differential diagnosis malignancy and tuberculosis were excluded. Fungi were cultured from the bronchial washings and sputum. Their morphological characteristics allowed them to be typed as Aspergillus niger. Slides from the thick, mucoid, black sputum demonstrated typical forms of the fungus. Polarized microscopy demonstrated calcium oxalate crystals. The final diagnosis was pulmonary aspergilloma caused by A.niger complicating a pulmonary abscess in the course of a pneumonia.

[Further studies on the occurrence of mycoses in the bronchial stump and bronchial anastomosis or trachea]. / Dalsze badania nad wystepowaniem grzybicy kikuta oskrzela oraz grzybicy zespolenia oskrzela lub tchawicy.

In the years 1980-1985 sutures were removed endoscopically from stumps and anastomoses in 52 patients operated in the years 1969-1985. The total number of bronchoscopies was 154, in 88 protruding threads into the airway lumen were removed. Interval between removal of first suture and date of surgery ranged from 0.5 to 192 months. Mycotic infection was diagnosed in 5 cases (9.6%). The causative agents being Aspergillus fumigatus and Candida albicans. In all cases removal of protruding threads lead to a complete cure. It was found that incidence of such mycotic infections decreased from 20.2% observed during the years 1962-1979 to 9.6% in the years 1980-1985.

[Bacterial infections in pulmonary aspergilloma]. / Bakteryjne zakazenia grzybniaków kropidlakowych pluc.

28 cavernoscopies were carried out in 26 patients. Complete or partial removal of mycetomas was achieved in 18 patients with 20 caverns. Under aerobic conditions Aspergillus fumigatus was cultured from the 28 removed mycetomas in 22 cases (78.6%) and bacterial organisms in 20 (71.4%). Bacteria were isolated from mycetomas that had demonstrable A. fumigatus organisms as well as from those that did not have them. In all infected mycetomas Gram negative rods were cultured, in only 4 cases Gram (+) cocci were found. Only in two cases of mycetomas under anaerobic conditions Gram (+) cocci were cultured. In most patients the organism could be demonstrated in sputum as well as in mycetomas. In 18 patients the pathogenic organism disappeared from sputum after removal of mycetomas. Also following removal of aspergillomas a decrease of sputum production was noted and it changed its character from purulent to mucoid.