HDR endobronchial brachytherapy (HDRBT) in the management of advanced lung cancer--comparison of two different dose schedules.

PURPOSE: The aim of this work is to compare the results of various treatment protocols used in palliative HDRBT with the view of analyzing differences in survival and diminishing breathing difficulties. MATERIAL AND METHODS: A total of 648 patients with advanced lung cancer were divided into two groups according to their clinical stage and the Zubrod-ECOG-WHO score. 303 (46.8%) patients received a total dose of 22.5 Gy in 3 fractions once a week, and 345 (53.2%) patients received a single fraction of 10 Gy. They were under clinical and endobronchial observation taking into consideration survival rates, local remission and duration of symptom relief such as dyspnoea, breathing, cough and haemoptysis. RESULTS: There was no difference in the length of survival time between the two groups of patients (log-rank test, p=0.055). Patients showing improvement (objective response) survived longer than those who showed no change or progression (F Cox, p=0.000001). In multivariate analysis the other statistically important prognostic factors were: clinical stage of primary tumor (F Cox, p=0.000002), Zubrod-ECOG-WHO score (F Cox, p=0.002) and age of patients (F Cox, p=0.004). CONCLUSIONS: The two treatment protocols showed similar efficiency in overcoming difficulties in breathing. Prognostic factors that significantly correlated with survival length were: grade of remission after treatment, clinical stage and performance status.

[Brachytherapy in the treatment of lung and tracheal cancer: current indications, methods, results]. / Brachyterapia raka pluca i tchawicy--wskazania, metody, wyniki leczenia.

Lack of improvement in treatment results of lung cancer leads to searching for new methods. One of the most distressing symptoms for lung cancer patients is airway obstruction due to the tumor, commonly resulting in dyspnea, postobstructive pneumonia, cough, or hemoptysis. Removal of endobronchial obstruction leads to quick improvement of clinical status and Quality of Life. Brachytherapy HDR of tracheal and lung cancer is a well-established method for the local treatment of patients with inoperable tumors of the tracheobronchial system. It seems that another promising treatment method of lung cancer is interstitial brachytherapy using permanent implants. The paper presents principles of brachytherapy, indications for this treatment and treatment results of tracheal and lung cancer. Indications for radical, palliative and interstitial treatment are discussed, respectively. Selected results of brachytherapy as an independent treatment and that combined with teletherapy, radical and, palliative are presented separately. Most commonly recognized complications are discussed which include: fatal pulmonary hemorrhage and fistula formation.

[Oral appliances in the treatment of snoring]. / Ustne aparaty protetyczne w leczeniu chrapania.

There are many methods of snoring treatment from conservative and prosthetic to surgical. The snoring sound is produced by vibration of the soft tissues of the pharynx, soft palate and also uvula. Snoring occurs in 50% of the adult male population and it can be isolated or sign of the obstructive sleep apnoea syndrome. Oral appliances modify the position of the mandibule, the tongue and other structures in oral cavity. Oral appliances are recommended for the treatment of snoring and mild obstructive sleep apnoea syndrome. That is why we constructed the study to assess wheather oral appliances correct snoring. 12 mails (aged 43-57) with intensive snoring for at least 50% of the sleep time were qualified to the treatment with oral appliances. The decision about the type of the device were made by ENT surgeon and maxillo-facial surgeon. The various oral appliances were used; some of which were modyfied by us. During the treatment snoring was tested with Poly-Mesam device. The best results were obtained with the use of devices that correct the position of soft palate and uvula. All the devices decreased snoring significantly. They were tolerated by the majority of patients.

[Cystic fibrosis diagnosed in 36-year old man]. / Mukowiscydoza rozpoznana u 36-letniego chorego.

UNLABELLED: Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasians. There is considerable variability in the clinical presentation and course of cystic fibrosis. Adult patients with mild symptoms are increasingly being diagnosed with CF. We present a case of a man diagnosed with CF at age 36 years. The diagnosis was suspected because of recurrent nasal polyposis, bronchiectases, male infertility, and a positive sweat tests. One CFTR mutation was identified. CONCLUSIONS: 1. Cystic fibrosis should be included into the differential diagnosis of chronic respiratory symptoms in adults. 2. CF patients diagnosed in adulthood usually have milder clinical course of the disease.

[Adenocarcinoma of the lung with metastases to the pituitary and both adrenal glands]. / Gruczolakorak pluca z przerzutami do przysadki mózgowej i obu nadnerczy.

A case of lung adenocarcinoma with metastases in both adrenals and pituitary gland in 52-year old patient is presented. Adrenal glands metastases were diagnosed on a base of CT scans. Pituitary metastases caused gradual loss of vision. MR imaging showed a lesion in the sella and suprasellar areas and suggested meningioma. Right frontal craniotomy with the partial removal of the tumor was performed. Three days later the patient died. Histopathological results of the pituitary masses revealed adenocarcinoma.

[DHR brachytherapy as palliative treatment of advanced lung cancer in patients treated previously on another cancer]. / Paliatywna brachyterapia HDR chorych na raka pluca leczonych w przeszlosci z powodu innego nowotworu.

PURPOSE: To analyze treatment results of palliative HDR brachytherapy in patients with advanced lung cancer treated previously on another cancer. From May 1999 to May 2001 24 patients with diagnosis of lung cancer were treated with HDR brachytherapy in Greatpoland Cancer Center. All patients were treated for another cancer in the past. All patients became disqualified from surgical treatment and radical radiotherapy due to advance stage of diseases. High dose brachytherapy of 22.5 Gy counted in distances 1 cm from tube axis was used. Control group consisted of 56 lung cancer patients without past history of another malignancy treated with brachytherapy in the same period. Patients were observed during a period of 12 months in terms of local remission rates and survival time depends on chosen clinical factors. Median survival time in the first group of patients was 5.6 months and 8.9 months in the control group. Patients with the history of prior cancer lived shorter (log-rank test, p = 0.003). Significant correlation was observed between survival rate and remission rate achieved in 1th month after the end of treatment (log-rank test, p = 0.001). CONCLUSIONS: 1. Past history of cancer decreases survival of patients with advanced lung cancer treated palliatively with HDR brachytherapy. 2. HDR brachytherapy of advanced lung cancer provides improvement of dyspnoea in most of patients. 3. The most important prognostic factor for survival was remission achieved within 1th month after the end of brachytherapy.

[Bacterial flora from bronchoalveolar lavage and occurrence of class IgG and IgA antibodies to Chlamydia pneumoniae in patients with chronic obstructive pulmonary disease (COPD)]. / Flora bakteryjna popluczyn oskrzelowo-pecherzykowych oraz wystepowanie przeciwcial klasy IgG i IgA dla Chlamydia pneumoniae u chorych na przewlekla obturacyjna chorobe pluc (POCHP).

Bronchoalveolar lavage taken from 46 patients (ranging in age from 21 to 71 years, mean 50.6 +/- 13.9) was examined for aerobic and anaerobic bacterial flora. Sera taken from 39 of patients as well as sera taken from 25 healthy blood donors of similar age (P = 0.99) were examined to determine IgG and IgA antibodies to C. pneumoniae. Bacterial flora was routinely cultured and determined using ATB computer system (bioMérieux,). IgG and IgA antibodies were tested by the enzyme immunoassays (Labsystems, Finland, Helsinki). Sera containing anti -C. pneumoniae IgG antibodies with titers of 45 EIU or higher and IgA with titers of 12 EIU or higher were considered positive. 143 of aerobic and 74 of anaerobic bacterial strains were cultured. Streptococci group viridans, pneumococci, enteric bacilli, Haemophilus spp., Prevotella spp., Actinomyces spp., Bifidobacterium spp. and Veilonella spp. were most often cultured. 66.6% of patients had IgG or IgA antibodies, in contrast, to the control group in which 60.0% and 44.0% of examined blood donors had IgG and IgA antibodies respectively. COPD patients were more frequently positive for specific anti-C. pneumoniae antibodies than the healthy donors (p = 0.003). The difference in a seropositivity rate of specific IgA and IgG antibodies was significant (p = 0.00002 and p = 0.003 respectively). Bronchoalveolar lavage of patients suffering from COPD can be contaminated with high number of aerobic and anaerobic bacterial species, and immunological status of the patients indicated persistent infection caused by C. pneumoniae more often than in controls.

[Social aspects of tobacco smoking among Polish students]. / Aspekty spoleczne palenia tytoniu wsród mlodziezy akademickiej.

UNLABELLED: The aim of the paper was evaluation of social aspects of tobacco smoking among Polish students. MATERIAL AND METHODS: The data from 671 students of Medical University and University in the age between 19 and 25 were collected using a specially prepared questionnaire. The following factors were analyzed: age and causes of first attempt of smoking, frequency of tobacco smoking in relation to the kind of high school and sex; students' behaviors connected with tobacco smoking and the knowledge of the consequences. RESULTS: 53.8% tried to smoke at least once. 23.09% of the students smoked regularly (10.73%) or occasionally (12.36%). University students smoked significantly more often than medical students--32.79% and 18.64% (p < 0.05), respectively. Males smoked more frequently than females (insignificant difference). The first smoking experience usually occurred at the age of 18, but males started to smoke earlier (between 10 and 14) than females (between 18 and 21)--significant differences. The age of 18 was the most common time when smoking became regular. Most smokers (80%) were aware of tobacco-dependent health disturbances. CONCLUSION: 1. Every fifth student of medicine and every third University student smoke cigarettes. 2. Anti-tobacco prevention should be started very early--before the age of 10 and continued up to the age of 21. Special attention should be taken at the age of 18 years as this time was found to be especially dangerous for development of addiction.