[Transbronchial needle aspiration as a diagnostic method of mediastinal adenopathy]. / Przezoskrzelowa aspiracyjna biopsja iglowa w diagnostyce chorób przebiegajacych z powikszeniem wezlów chlonnych sródpiersia.

The aim of the study was to assess the diagnostic yield of transbronchial needle aspiration (TBNA) in mediastinal or hilar adenopathy in: sarcoidosis, tuberculosis and malignancy. Transbronchial needle aspiration was performed in 53 patients, preeceded by computed tomography (CT). In 22 patients (41,5%) TBNA enabled to diagnose 10 cases of sarcoidosis, 12 cases of neoplastic infiltrates of the lung. There were 31 cases undiagnosed by means of TBNA. In 24 patients the diagnosis was established by means of other methods like bronchoscopy with mucose biopsy (8 cases of sarcoidosis), transbronchial lung biopsy (4 cases of squamous cell carcinoma and adenocarcinoma, 2 cases of sarcoidosis), mediastinoscopy (3 cases of sarcoidosis and 2 cases of Hodgkin's disease), and videothoracoscopy (2 cases of sarcoidosis), transthoracic needle biopsy (1 case of squamous cell carcinoma) and lymph node biopsy (1 case of adenocarcinoma and 1 case of sarcoidosis). In the remaining 7 patients who were followed-up for a period of one year the diagnosis of sarcoidosis was confirmed by clinical, radiological and cytological (BAL) examinations. Transbronchial needle aspiration was shown to be efficient diagnostic method in mediastinal or hilar adenopathy in sarcoidosis and malignancy except lymphoma. Moreover in approximately 60% of cases this technique doesn't allow to establish a diagnosis and in turn implicates the necessity for further diagnostic procedures like mediastinoscopy, or transbronchial or thoracoscopic lung biopsy.

[Value of closed pleural biopsy in diagnosis of pleural effusion]. / Przydatnosc biopsji oplucnej igla tnaca w diagnostyce wysieku oplucnowego.

The aim of the study was to assess closed pleural biopsy (CPB) as a diagnostic method of pleural effusion. CPB using Cope needle was performed in 62 patients, proceeded by ultrasound examination. It helped to obtain specimen for histological and microbiological examination even with cases of small amount of fluid. In all 62 patients CPB enabled to diagnose 13 cases with neoplasmatic effusions (majority being adenocarcinomas) and 16 cases of tuberculosis in histological and/or microbiological examination. There were 33 cases with non-specific inflammatory changes. In 7 patients we confirmed neoplastic pleural infiltrates in cytological examination of pleural effusion. In 26 patients videothoracoscopy (VTS) was carried out and 20 of those had post-inflammatory changes. In 4 cases, however we confirmed neoplasmatic effusions and in next 2 cases--tuberculosis. Closed pleural biopsy proves to be an efficient method in diagnosis of Tuberculosis and malignant pleural effusions. However, in 23% of cases with post-inflammatory changes, malignancy and tuberculosis were undiagnosed. This in turn implicates the necessity for further diagnostic procedures including VTS.

The impact of teleconsultations at a referential centre on the management of pulmonary patients.

Teleconsultation services at referential centres are an important area of telemedicine development. The implementation of such scenarios brings high-level competencies to peripheral hospitals through telecommunication links. Pulmonary teleconsultations were one of the key aspects of Krakow Centre of Telemedicine (KCT) activities conducted in 2002-2003. The role of the referential centre for respiratory medicine was played by the Division of Interventional Pulmonology, Jagiellonian University Medical College. Peripheral centres were pulmonary wards situated in local hospitals or policlinics located 20-80 km from Krakow. These hospitals were equipped with PC-based telemedical workstations and ISDN lines (256 kbps). Dedicated software (Telenegatoscope) was used for real-time discussions among physicians on medical images (X-rays, CTs) sent from peripheral centres to the referential centre. Images inserted in light boxes were cropped at peripheral centres with a high-resolution digital camera. During the pilot phase, about 40 pulmonary patients were referred via telemedical links to the University Hospital. The frequency of soliciting a second opinion at the referential centre was analyzed for each main type of disease. Top positions are currently occupied by diagnoses of lung cancer, pleural fluid of unknown origin, asbestosis and tuberculosis. About 70% of the patients referred for virtual consultation were admitted for further diagnostics and treatment in an ambulatory or inpatient mode at the Division of Interventional Pulmonology. The review of teleconsultations results indicates that teleconferencing contacts, even if conducted through relatively limited bandwidth, may bring considerable benefits to patients requiring complex diagnostic and sophisticated, procedures available at the referential university hospital.

Talc powder vs doxycycline in the control of malignant pleural effusion: a prospective, randomized trial.

BACKGROUND: Malignant pleural effusion is a common problem in advanced cancers, contributing to the poor quality of life in this group of patients. The aim of the study was to assess the efficiency of talc powder and doxycycline in pleurodesis in patients with malignant pleural effusion in comparable conditions. MATERIAL/METHODS: Of 52 patients screened, 33 entered the trial. They were randomized to the talc group (n=18) and the doxycycline group (n=15). Both groups were comparable with regard to age, sex and the most important variables influencing effectiveness of the procedure, i.e. primary malignancy and stage of metastatic involvement of the pleura. Efficiency of pleurodesis was prospectively assessed. RESULTS: The analysis of short-term effectiveness of pleurodesis in the first 33 patients has shown a highly significant difference in favor of talc powder (p=0.009); this difference was the reason for terminating the randomization. Further observation has revealed in the doxycycline group an increasing number of patients with fluid reaccumulation, as time went by; this was not observed in the talc group. A statistical analysis of the long-term effectiveness of both agents studied has shown a more significant difference in favor of the talc powder (p=0.00003). CONCLUSIONS: Talc powder is superior to doxycycline in achieving pleurodesis in patients with malignant pleural effusion, in both short- and long-term observations.