[Ten years experience of the sleep laboratory at the Institute of Tuberculosis and Lung Disease in Warsaw]. / Dziesiec lat doswiadczen pracowni zaburzen oddychania w czasie snu w Instytucie Gruzlicy i Chorób pluc.

Between 1991-2000 2052 patients (81% men and 19% women) were referred to our Sleep Laboratory because of OSA suspision. In 1194 (58%) subjects (88% men and 12% women) diagnosis of obstructive sleep apnoea (OSA, AHI > 10) was confirmed. In 430 of them (36%) mild OSA (AHI 11-25), in 243 (20%) moderate OSA (AHI 26-40), and in 521 (44%) severe OSA (AHI > 40) was diagnosed. Epworth sleepiness scale score in those groups was 10.4, 10.5 and 13.0 points respectively. 908 (76%) of patients with OSA were submitted to nCPAP treatment. Effective CPAP pressure ranged from 5 to 20 milibars, mean 8.4 mbars. In 21 patients upper airway resistance syndrome (UARS) was diagnosed. Central sleep apnoea, most frequently of Cheyne-Stokes respiration type was diagnosed in 13 patients. The most common diseases accompanying OSA were: systemic hypertension (46%), coronary heart disease (29%), diabetes (12%), and COPD (9%). Majority of OSA patients (61%) were obese (BMI > 30 kg/m2), 32% were over weight (BMI 25-30 kg/m2). Only 7% had normal body weight (BMI 20-25 kg/m2). Long-term (more than one year) compliance to treatment was found in 70% of patients prescribed CPAP.

[Cytokines TNF-alpha and GM-CSF in BAL from two different segments of lungs defined by high resolution computerized tomography (HRCT) in patients with sarcoidosis]. / Cytokiny TNF-alpha i GM-CSF w BAL z dwóch róznych segmentów pluc wskazanych badaniem tomografii komputerowej o wysokiej rozdzielczosci (HRCT) u chorych na sarkoidoze.

The aim of the study was to evaluate the concentrations of TNF-alpha and GM-CSF in double BAL (2 x 120 ml) from two different lung segments: (s.A) from upper lobe with the most and (s.B) from lower lobe with the least extensive involvement estimated by high resolution computed tomography (HRCT). Examined group consisted of 28 non-smoking sarcoid patients with homogenous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14M aged 19-54). In examined patients 16 had nonhomogenous distribution (ND) and 12 had regular distribution (RD) of HRCT changes. Eleven healthy volunteers served as controls. In patients with sarcoidosis we observed the significantly higher concentrations (p < 0.01) of TNF-alpha (3.18 pg/ml, 2.64 pg/ml) and GM-CSF (1.01 pg/ml, 0.95 pg/ml) respectively in BAL fluid from s.A and s.B in comparison with BAL from s.Abis and s.Bbis in control group (TNF-alpha: 0.46 pg/ml, 0.47 pg/ml and GM-CSF: 0.28 pg/ml, 0.31 pg/ml respectively). Mean concentration of TNF-alpha in BAL from s.A (3.77 pg/ml) in ND group was significantly higher than in BAL from s.B in RD group (2.91 pg/ml). TNF-alpha in BAL from s.A in active sarcoidosis was higher than in BAL from s.A and s.B in non-active sarcoidosis. Concentrations of TNF-alpha in BAL from both s.A and s.B correlated positively with CD4/CD8 ratio, percentage of lymphocytes, lymphocytes HLA-DR+ and absolute number of CD4 cells and negatively with CD8 cells estimated in BAL from these lung segments. In patients with indications to therapy the level of GM-CSF in BAL from s.A (1.44 pg/ml) was significantly higher (p < 0.05) than in BAL from s.A (0.64 pg/ml) in patients without indications to treatment. We conclude that TNF-alpha and GM-CSF may be involved in sarcoidosis pathogenesis and TNF-alpha may be useful in estimation of sarcoidosis activity.

[Selection of bronchoscope type for removal of foreign bodies from the lower respiratory tract based on personal experience]. / Wybór rodzaju bronchoskopu w usuwaniu cial obcych z dolnych dróg oddechowych na podstawie wlasnych doswiadczen.

32 patients, in whom bronchoscopy was performed due to the removal of foreign body from the lower respiratory tract were described. Age of the patients clinical symptoms and a time lapse between aspiration and removal of foreign body from the lover respiratory tract and localization of foreign body in the particular bronchus were analysed. We conclude, that rigid bronchoscopy is still more useful and safe method of foreign body removing from the lower respiratory tract.

[Symptomatic eye changes during the course of sarcoidosis]. / Symptomatologia zmian ocznych w przebiegu sarkoidozy.

The authors present ocular changes observed in sarcoidosis. The most frequent features are: symptoms of dry eye and uveitis. Frequency of ocular manifestations leads to the conclusion that ophthalmic examinations ought to be routine procedure at sarcoid patients.

[Diagnostic-therapeutic procedures in ocular sarcoidosis]. / Postepowanie diagnostyczno-terapeutyczne w sarkoidozie narzadu wzroku.

The authors present diagnostic and therapeutic procedure in patients with ocular sarcoidosis.

[Reconstructive surgery of bile ducts from personal material]. / Operacje naprawcze dróg zólciowych w materiale wlasnym.

In the years 1976-1996, 112 patients were treated surgically for the biliary tract injuries, 156 operations were performed upon them. The long term outcome was assessed in 85 patients along with the effectiveness of different surgical techniques. The best results (86.2%) were achieved when the repair was performed immediately on detecting the lesion, the results were less encouraging for the secondary repair. Perioperative mortality was 8.8%.

Effects of CPAP treatment on psychological status in patients with severe obstructive sleep apnoea.

The aim of this study was to evaluate the effects of nocturnal continuous positive airway pressure (CPAP) breathing on the emotional status and cognitive function in 20 patients with severe obstructive sleep apnoea (OSA) (mean +/- SD apnoea/hypopnoea index = 67 +/- 16, mean overnight arterial oxygen saturation = 83 +/- 10%). Psychological tests were performed before, after three, and after twelve months of CPAP treatment. At initial investigation, amongst cognitive functions, the most disturbed were concentration and recent memory. The majority of subjects demonstrated increased mental stress, depression, and anxiety. Anxiety correlated with AHI (r = 0.68). Mental stress correlated with AHI (r = 0.56) and deficiency of Stage 2 NREM sleep (r = -0.55). CPAP treatment resulted in significant improvement in cognitive function; concentration, recent verbal, visual and spatial memory were already seen at three months. No improvement in IQ and in emotional status after three months and one year of treatment was found. It is concluded that in patients with severe OSA CPAP treatment results in a significant early improvement in cognitive function but not in emotional status.

[Effect of positive pressure respiration on diurnal catecholamine excretion by patients with obstructive sleep apnea]. / Wplyw oddychania pod dodatnim cisnieniem na dobowe wydalanie katecholamin przez chorych na obturacyjny bezdech senny.

The aim of the study was to investigate effects of CPAP treatment on diurnal catecholamine excretion in urine in patients with obstructive sleep apnea (OSA). 12 males with severe OSA (mean AHI = 63) were measured in 3 separate 8 hour samples by fluorimetric method. NA levels were higher in OSA patients in all urine samples than in obese, mildly hypertensive males (control group = C). In C group patients NA levels were significantly lower at night than during the day contrary to OSA patients in whom NA levels dropped insignificantly during sleep. In OSA patients NA levels during sleep correlated with severity of apneas (r = 0.42) and night hypoxaemia (r = -0.46). CPAP treatment resulted in significant fall in NA levels during sleep (p < 0.01). A levels did not change after CPAP treatment. We conclude that abnormally high NA level during sleep in OSA patients may be related to sleep fragmentation and hypoxia. CPAP treatment restores normal circadian rhythm of NA excretion.

[Evaluation of the usefulness of palpation and Daniel's biopsy for detection of metastasis to supraclavicular and scalene lymph nodes in patients with lung neoplasms]. / Ocena przydatnosci badania palpacyjnego i biopsji Danielsa w wykrywaniu przerzutów nowotworowych do wezlów znad miesni pochylych i wezlów nadobojczykowych u chorych na raka pluc.

In 169 patients with lung cancer the usefulness of physical examination and Daniel's biopsy in detection of metastases to supraclavicular and scalene lymph nodes were evaluated. In 35 patients with palpable lymph nodes and in 25 patients with nonpalpable lymph nodes metastases were confirmed by histological examination. The sensitivity, the specificity and the likelihood ratio of physical examination in detection lymph nodes metastases were respectively: 58%, 86% and 4.1. In 6 patients (5%) among 119 with nonpalpable lymph nodes the positive Daniel's biopsy was the diagnostic procedure. In 5 patients with non-small carcinoma and in 3 patients with malignant mesothelioma positive results of Daniel's biopsy enabled a change of cancer staging and giving up the eventual surgical operation.

[Pulmonary circulation at rest and during exercise in patients with obstructive sleep apnea before and after one year of treatment with CPAP]. / Krazenie plucne w spoczynku i podczas wysilku u chorych na obturacyjny bezdech senny przed i po rocznym leczeniu za pomoca CPAP.

We studied pulmonary haemodynamics in 19 male patients, mean age 45 +/- 5 years, suffering from severe OSA, mean apnea/hypopnea index (AHI) 68 +/- 17. Pulmonary haemodynamisc were studied using Swan-Ganz thermodilution catheter in the supine position at rest, and at the end of the 7th minute of steady-state exercise (40 W). Investigations were repeated after one year of treatment with nasal CPAP. At rest mean pulmonary artery pressure (PPA), pulmonary wedge pressure (PW) and cardiac output (CO) were normal, PPA = 16.6 +/- 5.7 mmHg, PW = 5.2 +/- 1.8 l/min. Pulmonary vascular resistance (PVR) was slightly elevated = 155 +/- 65 d.sec.cm-5. On exercise only PVR remained unchanged. After a year of treatment PPA changed to 15.8 +/- 4.0 mmHg (NS), Pw-7.5 +/- 3.1 mmHg (NS), CO-4.9 +/- 1.6 L/min (NS), PVR - 145 +/- 35 d.sec.cm-5 (NS). In two patients with resting hypertension PPA dropped from 33 mmHg to 25 mmHg and 28 mmHg to 18 mmHg respectively. Statistical analysis showed no significant change in any of the studied variables after one year of the CPAP therapy.

[Effect of altitude on blood oxygenation during sleep in patients with bronchial asthma]. / Wplyw wysokosci na utlenowanie krwi w czasie snu u chorych na astme oskrzelowa.

The aim of our study was to investigate the severity of overnight arterial blood desaturations in patients with asthma at the altitude of 3200 meters above sea level. 12 asthmatics and 12 healthy controls were investigated. Three overnight pulsoximetries were performed in all subjects, one at the lowland and on the 1st and 5th night at the altitude. Mean SaO2 at the lowland was significantly lower in asthmatics than in the controls (p < 0.01). After the ascent to high altitude severe fall in mean SaO2 was noted in both groups (from 94.3% to 85.8% in asthmatics and from 97.1% to 88.7% in controls) (p < 0.001 for both groups). After few days of acclimatization mean SaO2 rose to 88.8% in asthmatics and to 91.3% in controls, but was still significantly lower than at the lowland (p < 0.001 for both groups). At the altitude differences in mean SaO2 between two groups were not statistically significant. We conclude that severity of overnight desaturations at high altitude do not vary between asthmatics with impaired respiratory function and healthy subjects.

[Effect of CPAP and BiPAP assisted breathing on pulmonary hemodynamics in patients with obstructive sleep apnea]. / Wplyw oddychania za pomoca CPAP lub BiPAP na hemodynamike plucna u chorych na obturacyjny bezdech senny.

CPAP breathing increases alveolar and intrathoracic pressures. We aimed to investigate the effects of CPAP and BiPAP breathing on pulmonary haemodynamics in patients with OSA. Ten male patients with OSA (AHI = 48 +/- 22) were studied. In each patient intravascular and esophageal pressures were measured and mean transmural pulmonary artery and transmural wedge (Pwtm) pressures were calculated. After baseline recordings patients were submitted to 25 min. of CPAP and BiPAP breathing in random order. The pressure of 10 cm H20 for CPAP and 10/4 cm H20 for BiPAP was used. At baseline pulmonary arterial pressures and flow were normal. CPAP breathing resulted in an increase in mean pulmonary intravascular pressure from 15.5 +/- 1.8 mmHg to 17.1 +/- 2.3 mmHg (p < 0.05). Transmural pressure did not change. There was also no change in the cardiac output (CO) and pulmonary vascular resistance (PVR). At some time points pulmonary arterial pressures were higher during CPAP breathing than during BiPAP breathing (p < 0.01). BiPAP breathing had no effect on intravascular and transmural pressures, CO and PVR. We conclude that CPAP breathing increase pulmonary intravascular but not transmural, true, pressure. BiPAP breathing does not change pulmonary haemodynamics what may be of importance as pulmonary circulation is concerned.

[Bradykinin levels in BAL fluid in patients with sarcoidosis]. / Stezenie bradykininy w popluczynach oskrzelowo-pecherzykowych u chorych na sarkoidoze.

In 14 patients with sarcoidosis and in 9 healthy controls the bradykinin level was estimated in broncho-alveolar lavage fluid. The statistically significantly higher bradykinin concentrations was found in sarcoid patients than in controls. No relationship was found between level of bradykinin in BAL and lymphocytes % and no relationship was found between bradykinin level and pulmonary function parameters.

Control of breathing in obstructive sleep apnoea and in patients with the overlap syndrome.

In some patients obstructive sleep apnoea (OSA) may co-exist with chronic obstructive pulmonary disease (COPD) and respiratory failure; the so-called "overlap syndrome". Obstructive, hypercapnic patients have both blunted ventilatory and mouth occlusion pressure responses during CO2 stimulation. The purpose of this study was to compare the pattern of breathing and CO2 response between OSA patients and those with the overlap syndrome. Twenty obese men with OSA and normal lung function (Group A), 11 obese men with overlap syndrome (Group B) and 13 healthy nonobese subjects (Group C) were examined. Lung function tests, breathing pattern, mouth occlusion pressure (P0.2) at rest, and respiratory responses during CO2 rebreathing were investigated. Diagnosis of OSA was established by standard polysomnography. There were no statistical differences between Groups A and B in apnoea & hypopnoea index (62 vs 54), mean arterial oxygen saturation (SaO2) during sleep (85 vs 84%) and in body mass index (BMI) 34.3 vs 36.3 kg.m-2. Minute ventilation, mean inspiratory flow and P0.2 at rest were increased in both groups of patients in comparison to controls. During CO2 rebreathing, group A had normal ventilatory and P0.2 responses, similar to controls, (2.7 +/- 1.1 vs 2.1 +/- 0.4 l.min-1.mmHg-1 and 0.7 +/- 0.3 vs 0.71 +/- 0.25 cmH2O.mmHg-1, respectively). However, Group B had significantly decreased ventilatory and P0.2 responses to CO2 (0.71 +/- 0.23 l.min-1.mmHg-1 and 0.34 +/- 0.17 cmH2O.mmHg-1, respectively). This comparison showed that patients with OSA had normal CO2 response when awake, whereas those with overlap syndrome had diminished CO2 response when awake.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical picture and outcome of conservative treatment for obstructive sleep apnea]. / Obraz kliniczny i wyniki leczenia zachowawczego obturacyjnego bezdechu sennego.

The aim of the study was to assess the clinical picture of patients with obstructive sleep apnea (OSA) and to investigate the long term effectiveness of treatment with continuous positive airway pressure (CPAP). 170 subjects were investigated with Mesam 4 screening device. Full polysomnography was performed in suspected patients confirming the diagnosis (AHI > 10) in 72 cases (69M, 3F), mean age 46.7 +/- 8.4 yrs, mean weight 110 +/- 19 kg. Snoring (100%) apneas (96%), excessive daytime sleepiness (98%) and nocturia (73%) were the most common symptoms. Application of CPAP therapy resulted in elimination of apneas, improvement in sleep architecture and in arterial blood oxygen saturation. Apnea index decreased from 63 +/- 22 to 4 +/- 4. First night compliance to CPAP was about 95%. OSA symptoms rapidly regressed. Follow-up examination was performed in 45 patients who used CPAP for more than 1 year. All subjects presented with improvement in quality of life, all but one were using CPAP almost every night (mean 6.6 +/- 0.9 night per week). The most common side effects of CPAP were uncomfortable nose mask (42%), throat dryness (27%) and eye irritation (24%) We concluded that CPAP treatment in OSA occurs to be effective, long term compliance is high, side effects are benign and mostly due to poorly fitting mask.

[Mediastinal seminoma--diagnostic difficulties]. / Nasieniak sródpiersia--trudnosci diagnostyczne.

A case report of a seminoma of extragonadal localization--of the mediastinum--is presented. In specimens obtained during mediastinoscopy sarcoid lesions were detected. Parasternal mediastinotomy allowed to sample larger fragment of the tumor and the final diagnosis was made.

[Use of nasal intermittent positive pressure ventilation in treatment of exacerbation of chronic respiratory insufficiency]. / Zastosowanie wentylacji wspomaganej przez nos w leczeniu zaostrzenia przewleklej niewydolnosci oddychania.

A case of a 45 year old male with COPD is presented. In the past the patient required twice mechanical ventilation. During a current hospitalization Nasal Intermittent Positive Pressure Ventilation (NIPPV) was successfully applied. The treatment was carried out continuously for 8 days, during the next 7 days for 15 hours per day, during the next 8 days only at night time. A clinical improvement was seen. NIPPV was used for a shorter period of time than the classical mechanical ventilation. It was also less expensive.

[Pulmonary hemodynamics in obstructive sleep apnea or overlap syndrome]. / Krazenie plucne u chorych na obturacyjny bezdech senny i u chorych z zespolem nakladania.

We studied pulmonary haemodynamics at rest and on exercise in 44 consecutive patients with moderate to severe obstructive sleep apnea (OSA), mean AHI > 40. The diagnosis was confirmed by standard polysomnography (PSG). According to history and results of spirometric measurements patients were divided to two groups, pure OSA and OSA complicating chronic obstructive pulmonary disease (overlap syndrome). In 34 pts with OSA (31 M, 3 F), means: age 45 +/- 8 years, body weight 108 +/- 22 kg, BMI49, VC 107 +/- 16% of N, FEV1 101 +/- 15% of N, PaO2 71 +/- 10 mmHg, PaCO2 39 +/- 3 mmHg, PSG showed AHI 66 +/- 15. Pulmonary haemodynamics at rest were within normal limits: PPA 16 +/- 5 mmHg, PW 7 +/- 3 mmHg, CO 4.5 +/- 1.5 l/min, PVR 184 +/- 92 dyne.s.cm-5. On low grade exercise (40 W) PPA increased to 31 +/- 10 mmHg, Pw to 12 +/- 6 mmHg and CO to 8.6 +/- 4.0 l/min, PVR remained unchanged. In eight pts abnormal rise in PPA on exercise resulted from the increase in driving pressure (PPA-Pw). In 2 pts it was due to abnormal increase in wedge pressure. In ten male pts presenting with COPD means: age 53 +/- 8 y, body weight 109 +/- 11 kg, BMI49, VC 53 +/- 14% of N, FEV1 36 +/- 16% of N, PaO2 57 +/- 10 mmHg, PaCO2 47 +/- 7 mmHg, PSG showed AHI 63 +/- 20. All pts presented with pulmonary hypertension (PH) at rest, PPA ranging from 21 to 37 mmHg, mean 26 +/- 5 mmHg. We conclude that patients with OSA have normal PPA at rest, 1/2 of them have PH on exercise due to restriction of pulmonary arterial bed and/or left ventricle dysfunction. Pts with overlap syndrome have moderate resting PH resulting from alveolar hypoxia.

Hand-scoring of MESAM 4 recordings is more accurate than automatic analysis in screening for obstructive sleep apnoea.

The MESAM 4 system, developed to monitor breathing sounds, heart rate, arterial oxygen saturation (Sao2) and body position, was proposed as a screening method for obstructive sleep apnoea (OSA). The aim of the study was to assess the accuracy of hand-scoring versus automatic-scoring in screening for obstructive sleep apnoea. The study population consisted of 56 patients, 51 males, and 5 females, mean age 47 +/- 10 yrs, suspected of having obstructive sleep apnoea. Full polysomnography and MESAM 4 recordings were performed simultaneously. The apnoea+hypopnoea index was hand-scored in polysomnography and in MESAM 4. The hand-scoring in MESAM 4 was based on analysis of breathing sounds, heart rate and Sao2 changes taken together. The automatic-scoring system of MESAM 4 calculated oxygen desaturation index, heart rate variation index and intermittent snoring index. The diagnosis of obstructive sleep apnoea (apnoea+hypopnoea index > or = 10) was established by polysomnography in 37 patients. Sensitivity and specificity of hand-scored MESAM 4 diagnosis were 100 and 63%, respectively. Sensitivity and specificity of MESAM 4 diagnosis with automatic-scoring were: from oxygen desaturation index 100 and 27%; from heart rate variation index 81 and 74%; and from intermittent snoring index 92 and 16%, respectively. We suggest that hand-scoring of MESAM 4 is more accurate than automatic-scoring in screening for obstructive sleep apnoea.