[Granulomatous pneumonia as a complication of intravesical BCG immunotherapy--a case report]. / Zapalenie ziarniniakowe pluc jako powiklanie leczenia dopecherzowymi wlewkami BCG--opis przypadku.

BCG (Bacillus Calmette-Guerin) comprises an attenuated strain of Mycobacterium bovis and is used for vaccination against tuberculosis. An additional use of BCG is for immunotherapy of cancer in which the vaccine is administered intravesically for the treatment of superficial bladder cancer. The efficacy of immunotherapy with BCG in the prevention of recurrence is estimated at 70-99%, which is higher than for local chemotherapy. The most frequent complications of such treatment include fever and urinary bladder inflammation, while serious complications of haematogenous organ inflammation, especially inflammation of the lungs with the formation of pulmonary caseosus granulomas, are rarely seen. The authors reported a case of a 68-year-old man who was treated with intravesical BCG instillations due to a superficial bladder cancer. The patient underwent transurethral resection of bladder cancer and then periodically received intravesical BCG instillations. A few days after one instillation, systemic symptoms with a high fever appeared. Further examinations showed features of hepatitis and spread pulmonary changes. The patient underwent videothoracoscopy, and a fragment of lung parenchyma was collected. The histopathological examination revealed the presence of granulomas with central caseosus necrosis. Suspecting BCG infection, diagnostics were enhanced to include bacteriological and genetic tests for the presence of acid-resistant bacilli, which finally gave negative results. The authors diagnosed granulomatous pneumonia as a complication of intravesical BCG immunotherapy. Treatment with antituberculous drugs was initiated. After completing pharmacological treatment, radiological control was performed, which showed significant but not complete remission of pulmonary changes.

[Effect of occupational exposure and smoking on spirometric tests and symptoms of chronic bronchitis]. / Wplyw narazenia zawodowego i palenia tytoniu na wyniki badan spirometrycznych oraz objawy przewleklego zapalenia oskrzeli.

The importance of occupational exposure to airborne agents in the development of obstructive lung disease is uncertain. The aim of the study was to evaluate the effects of smoking and of occupational exposure on the lung function and chronic respiratory symptoms. I studied a group of 1239 adults (766 men and 473 women; mean age 44.9 +/- 8.6 yrs; current smokers 42.1%, lifetime nonsmokers 41.6%) working in 5 factories in the Bielsko-Biala area. Simple spirometric test (FEV1, FVC, FEV1%FVC) and a questionnaire on chronic respiratory symptoms, smoking habits and occupational exposures were applied. Respiratory symptoms and lung function were studied in relation to years of occupational exposure and adjusted for smoking habit. Occupational exposure was reported by 35.7% (n = 442) participants (dust 20.6%; gases or fumes 27.6%; mixed exposure 51.8%), with a mean duration of 20.9 +/- 9.2 years. In all cases concentrations of noxious agents did not exceed allowed levels. The symptoms of chronic bronchitis (cough and phlegm) were present in 12.3% and airflow limitation (FEV1% FVC < 0.7) in 6.9% of subjects. The significant relation of respiratory symptoms and bronchial obstruction to smoking was confirmed. No significant association between occupational exposure and ventilatory function or respiratory symptoms was found in a whole group. Smoking--specific analysis showed that current smokers appeared to be more susceptible to the effects of professional exposure. It was expressed in lower lung function indices and significantly higher odds ratios for airflow limitation or chronic respiratory symptoms for smokers exposed compared to nonexposed. Sufficient evidence of health selection processes known as a "healthy smoker" and a "healthy worker" effects were revealed.