Biomedical subjects

Rafał Krenke

Publications and source records attributed to Rafał Krenke.

13 recordsLinked to original sources

PubMed2006

[Adenosine deaminase activity in tuberculous and malignant pleural effusions].

Measurement of pleural adenosine deaminase activity (ADA) is a useful diagnostic tool for tuberculous pleurisy, but false-positive findings from non-tuberculous effusions have been reported. In order to improve diagnostic value of ADA it is recommended to estimate activity of both ADA1 and ADA2 izoenzymes or 2'-deoxyadenosine/adenosine activity ratio. In order to evaluate ADA as a diagnostic parameter total ADA, with adenosine as a substrate, and 2'-deoxyadenosine/adenosine activity ratio were measured in tuberculous and malignant pleural effusions. Altogether, 26 pleural exudates (11 tuberculous and 15 malignant) were selected. ADA either with adenosine or 2'-deoxyadenosine was determined by colorimetric method of Giusti. Each pleural fluid sample was diluted prior to the assay (1:8) to avoid enzyme inhibition which was observed in nondiluted pleural effusions. The ADA level reached the diagnostic cut-off set for tuberculous effusions (40 U/L) in every 11 tuberculous exudates with the mean value of 85,3+/-47,1 U/L; in 9 of these the 2'-deoxyadenosine/adenosine ratio was less than 0,45. In the malignant group of patients, no one ADA level exceed 40 U/L, being estimated at 10,6+/-7,7 U/L (p<0,001). In 10 of these 15 exudates the 2'-deoxyadenosine/adenosine ratio was undetectable, in four it was less than 0,45 and only in one it was over 0,45. We concluded that ADA measured by the Giusti method proceeded by the dilution 1:8 of the pleural effusion samples very good differentiates tuberculous from malignant pleurisy, without the necessity to determine the 2'-deoxyadenosine/adenosine ratio. The investigation needs to be continued on the more numerous groups of patients.

Adenosine Deaminase↗

PubMed2006

[Diagnostic utility of pleural fluid eosinophilia].

Diagnostic utility of eosinophilic pleural effusion (EPE) is still the matter of controversy. Some earlier studies have showed that pleural fluid eosinophilia considerably reduces the probability of malignancy, while some later analyses were not able to confirm such an observation. To evaluate the diagnostic significance of EPE the retrospective study of all patients with pleural effusion (PE) managed in our hospital between 1995 and 2001 has been undertaken. We analyzed 915 patients with PE and 1086 pleural effusions subjected to a biochemical, cytological and bacteriological examinations. We identified 72 (7,9%) patients with EPE and 82 EPEs liquid (7,5%) among them. The group of patients with EPE consisted of 41 (57%) males and 31 (43%) females; average age 62.2 year (range 21.0-94.0). Etiologic distribution showed the largest subgroup were patients with malignant EPE (n=28, 38.9%) followed by idiopathic EPE (n=12, 16.7%) and parapneumonic EPE (n=11, 15.3%). Looking for predictors of malignancy in EPE we found some differences between malignant and nonmalignant EPE: patients with malignant EPE were older (67.9+/-13.6) then patients with nonmalignant EPE (58.7+/-15.6; p<0.015), and have higher percentage of lymphocytes in PE (47.9+/-16.9 vs. 37.9+/-18.9; p<0.03). Similarly we noticed some differences between two largest groups (malignant and idiopathic PE). Patients with malignant PE were older (67.9+/-13.6 vs. 53.9+/-13.6 yrs; p=0.005), had lower pleural fluid eosinophilia (25.2+/-15.3% vs. 41.4+/-21.0%; p=0.01) and higher percentage of lymphocyte in PE (47.9+/-16.9 vs. 29.6+/-19.1%; p=0.004). We conclude that pleural fluid eosinophilia cannot be considered as predictor of nonmalignant etiology. The older age and the higher number of lymphocytes in EPE might suggest malignant etiology of pleural effusion.

Adult↗

PubMed2006

[The role of fiberoptic bronchoscopy in the diagnostic algorithm of solitary pulmonary nodule].

The role of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodule is controversial. The aim of the study was to evaluate the results of routine bronchoscopy performed in patients with peripheral lung nodule of 5-40 mm in diameter. From 60 patients with peripheral lung nodule, who underwent routine diagnostic fiberoptic bronchoscopy between 2003 - 2005, we selected 36 patients in whom the final discrimination between malignant and benign tumor was achieved based on either pathological examination or radiological criteria (lack of growth within 2 years of radiological follow up). There were 22 (61%) patients with malignant tumor and 14 (39%) with benign nodule. All malignant tumors were lung carcinomas. In 10 of these patients we found macroscopic abnormalities during bronchoscopy and in 9 of them pathologic examination of specimens collected during the procedure could confirm malignant tissue. In two patients with benign lung nodule a second lung lesion (in different lung lobe) which proved to be lung cancer was identified during fiberoptic bronchoscopy. Sensitivity, specificity and diagnostic accuracy of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodules were 41%, 100%, and 64% respectively. Abandoning fiberoptic bronchoscopy in the diagnostic algorithm in patients with peripheral lung nodules seems unjustified, although its limitations should be taken into account.

Adolescent↗

PubMed2006

[Influence of bronchoscopy on nitric oxide in exhaled air].

UNLABELLED: Nitric oxide has been extensively studied as a noninvasive marker of airway inflammation, especially in asthma. Assuming, bronchoscopy can produced not only systemic but also local inflammatory response we hypothesized that bronchofiberoscopy can be responsible for an increase in nitric oxide synthesis with resulting increase in fractional concentration of exhaled nitric oxide (FE(NO)). Seventeen subjects (10 M, 7 F), at mean age of 53.8+/-14.1 yrs undergoing diagnostic bronchoscopy participated in the study. The indications for bronchoscopy were as follows: lung cancer (n=5; 29%), interstitial lung diseases (n=3; 18%), slowly resolving pneumonia (n=3; 18%), hemoptysis (n=3; 18%), differential diagnosis of asthma/ dyspnea (n=3; 18%). During bronchoscopy bronchial washing (n=7) and bronchoalveolar lavage (BAL) (n=10) has been performed. FE(NO) has been analyzed on-line with chemiluminescence analyzer (NIOX, Aerocrine, Sweden) according to American Thoracic Society guidelines, before and at 1, 2, 3 and 24 hours after bronchoscopy. Mean FE(NO) before bronchoscopy was 19.7+/-4.5 ppb (mean +/- SEM), post - bronchoscopy a decrease with a nadir at second hour (12.1+/-1.5 ppb, p<0.05) was observed, FE(NO) 24 hours after bronchoscopy was not different than baseline (18.4+/-2.5 ppb). There were no differences in the FE(NO) profile in BAL patients when compared to those in whom only the bronchial washing has been performed. CONCLUSIONS: Bronchoscopy leads to a significant decrease in exhaled nitric oxide. The underlying mechanisms are unclear. Future studies including analysis of other inflammatory markers are needed to explain these changes.

Asthma↗

PubMed2006

[Holter ECG monitoring during research bronchofiberoscopy in patients with asthma].

UNLABELLED: Bronchoscopy is a very useful tool in asthma research studies. The study was undertaken to evaluate the effect of bronchoscopy, BAL and bronchial biopsies on heart rate and arrhytmias in patients with asthma. Twenty patients (12 M, 8 F, mean age 39,6+/-16,3 yrs) with asthma (mean FEV, 81+/-19.5% pred.; mean FEV(1)%VC 69+/-12.3%) participated in the study. Holter ECG monitoring was performed twice: before (1 or 2 days) and on the day of bronchoscopy. Heart rate and cardiac arrhythmias were compared to prebronchoscopy recording at four separate time intervals: during bronchoscopy, first postbronchoscopic hour, second postbronchoscopic hour and total 24 hours. There were no significant differences between mean heart rate at the time of bronchoscopy (88.5+/-14.1 min(-1) vs 83.7+/-11.9 min(-1)), first and second postbronchoscopic hour (80.9+/-15.8 min(-1) vs 85.7+/-13.7 min(-1) and 82.6+/-13.6 min(-1) vs 80.6+/-11.6 min(-1)) as well as total 24 hours (76.1+/-11.2 min(-1) vs 75.9+/-9.4 min(-1)) as compared to prebronchoscopic recordings. Max. heart rate during bronchoscopy was higher as compared to the corresponding time of prebronchoscopic recording (134.5+/-11.5 min(-1) vs 122.5+/-19.6 min(-1), p<0,05). No differences in the number and type of ventricular (VA) and supraventricular arrhythmias (SVA) between the pre- and peribronchoscopic monitoring were observed. Positive correlation between the age and the number of VA during bronchoscopy has been found. CONCLUSION: Bronchoscopic procedures in asthma patients do not increase the risk of cardiac arrhythmias. Some factors influencing the heart rate and number of VA during bronchoscopy can be identified.

Adult↗

PubMed2006

[Pulmonary mycobacteriosis--the diagnostic challenge. The authors' experience].

UNLABELLED: The diagnosis of NTM-related pulmonary disease is based on clinical symptoms, radiological features and several positive cultures of one and the same NTM species from samples obtained from the respiratory tract. Short hospitalization usually does not enable sufficient diagnostic procedures to meet the diagnostic criteria, and this may lead to the reduction of diagnostic sensitivity. The aim of the study was to draw attention to NTM-related pulmonary disease, to share the authors' experience in the diagnosing of pulmonary mycobacteriosis and to indicate the possibilities of improving the diagnostic accuracy in this disease. A group of 31 patients with sputum, bronchial washing and/or bronchoalveolar lavage fluid (BALF) NTM-positive cultures was selected from a cohort of 245 patients evaluated for tuberculous and nontuberculous mycobacterial diseases (total number of 1277 specimens were invastigated). In two of them NTM related pulmonary disease was diagnosed (caused by M. kansasii and M. avium) at the course of initial evaluation. In the remaining 29 patients the microbiological data did not allow to establish the diagnosis of mycobacterial lung disease mainly due to a small number of samples from the respiratory tract. From this group 13 patients were reevaluated within 3 - 6 months from the initial investigation. This allowed to identify two new cases of mycobacteriosis (M. kansasii and M. avium). Thus among 31 patients with NTM positive cultures from respiratory tract specimens 4 patients (4/31, 12,9%) met the diagnostic criteria for mycobacterial disaease. CONCLUSION: Microbiological analysis of an adequate number of samples in symptomatic patients with radiological features suggestive for NTM-related pulmonary disease increses the diagnostic sensitivity in pulmonary mycobacteriosis. Identification of the species in positive cultures is of great importance.

Bronchoalveolar Lavage Fluid↗

PubMed2006

[The interpretation of carbon monoxide diffusing capacity test depending of hemoglobin concentration].

UNLABELLED: The carbon monoxide diffusion capacity (DLCO) is among others dependent of the hemoglobin value. The result of DLCO test in patients with anemia change when we adjust DLCO for hemoglobin (Hb) concentration. The aim of the study was to estimate if the differences between result of DLCO and DLCO/VA before and after adjust the Hb value can change the interpretation of the test in the group with normal and low value of Hb. The study group consist of 25 patients with normal level of Hb (group A) and 21 ones with anemia (group B). All studied have been done spirometry, bodypletyzmografy and DLCO test. All tests were made on the SensorMedics. The DLCO test was made in the single breath diffusing capacity program Results. The values of the Hb in the group A were above 13 g/dl for female and 14 g/dl for man. In the group B the Hb value were less then 10 g/dl. In the group A the middle Hb concentration was 14,49 +/- 1,36g/dl. DLCO and DLCO/VA before and after Hb value adjusted were 91,4 +/-17,98 vs 90,7 +/- 17,58 % i 101,5 +/- 19,46 vs 100,7 +/- 18,65% (p>0,05). In the group B the middle Hb concentration was 8,77 +/- 0,97 g/dl. DLCO and DLCO/VA before and after Hb value adjusted were: 57,05+/-17,55 vs 72,19+/-25,27% i 67,57+/-11,18 vs 84,66+/-14,62% (p< 0,05). CONCLUSIONS: 1. The were non statistically important change in the DLCO test results after consideration on Hb level in the studied group without anemia, so in the patients with normal level of Hb the DLCO test result doesn't change the interpretation of the test after the consideration on Hb concentration 2. In patients with anemia we shout adjust the Hb value to the DLCO test because the results with out this can completely change the interpretation of the test and clinical diagnosis

Adult↗

PubMed2006

[Diagnosis of tuberculous lymphadenitis based on the fine needle aspiration samples analysis].

Tuberculous lymphadenitis is one of the most common extrapulmonary manifestations of tuberculosis. The most common lymph nodes involved are in the cervical region. Lymphadenitis due to M. tuberculosis generally presents with enlarging neck lymph nodes over weeks or months associated with fever, weight loss and fatigue. Fine needle aspiration (FNA) of affected lymph nodes has been shown to yield a high sensitivity and specificity in the diagnosis of tuberculous lymphadenitis. Specimens should be examined cytologically, as well as by AFB smear and cultures. The time between the onset of symptoms, clinical presentation and final diagnosis is often too long. We present a case of 60 years old man with tuberculous lymphadenitis, initially suspected of lymphoproliferative disease.

Antitubercular Agents↗

PubMed2004

[Lymphocyte and lymphocyte subsets in pleural fluid--comparison of malignant and non-malignant disorders].

The role of lymphocytes in host defence in neoplastic disorders is known. Accumulation of lymphocytes in pleural cavity frequently occurs in different diseases. The aim of the study was to evaluate: 1) the frequency of lymphocyte predominance in different malignant and non-malignant pleural effusions; 2) lymphocyte phenotype and the ratio between helper (CD4+) and cytotoxic/suppressor (CD8+) lymphocytes in malignant and non-malignant effusions. Patients with mesothelioma, lung cancer, lymphoma and metastatic neoplasms were analysed. Analysis was performed on fluids with or without malignant cells. Non-malignant fluids were obtained from patients with: congestive heart failure, liver cirrhosis, pneumonia and tuberculosis. Lymphocytes were the predominant cell type in neoplastic effusions. For further analysis effusions with more than 10% of lymphocytes were included: 12 malignant and 9 non-malignant. For lymphocyte subpopulations analysis, the monoclonal antibodies anti-CD4 and anti-CD8 and APAAP method was used. We observed lower percentage of CD4+ lymphocytes (47%) and higher percentage of CD8+ (39%) lymphocytes in malignant when compared to non-malignant fluids (58% vs 31% respectively). The CD4+/CD8+ ratio was significantly lower in pleural fluid in cases with neoplastic disease when compared to benign cause of pleural involvement (1.03 vs 1.85). Our observations suggest the potential role of lymphocytes, especially CD8+ cells in local response in malignancy in pleural disease.

Adult↗

PubMed2004

[Diagnostic usefulness of selected tumor markers (CA125, CEA, CYFRA 21-1) in bronchoalveolar lavage fluid in patients with non-small cell lung cancer].

Numerous studies have been performed to determine diagnostic or prognostic utility of tumor markers in patients with lung cancer. The aim of the study was to evaluate the diagnostic usefulness of the tumor markers CA 125, CEA and CYFRA 21-1 in bronchoalveolar lavage fluid (BALF) in patients with non-small cell lung cancer (NSCLC). BAL was performed in 13 patients with NSCLC during diagnostic bronchofibroscopy. The control group consisted of 12 patients with sarcoidosis and 13 healthy volunteers. Tumor markers were determined in BALF supernatants using electrochemiluminescence technique (Elecsys 1010, Roche). To determine optimal cut-off values of tumor markers in BALF ROC curve was used. CEA and CA 125 concentration in BALF were significantly higher in NSCLC patients than in healthy volunteers and patients with sarcoidosis. CYFRA 21-1 in BALF was higher in NSCLC patients than in healthy volunteers, but no significant difference was found between NSCLC and sarcoidosis patients. The cut-off values of BALF concentration of CA 125, CEA and CYFRA 21-1 were 95 IU/mL, 3 ng/ml and 3 ng/ml, respectively. The sensitivity and specificity of CEA and CA 125 in BALF were 100%, 84% and 92%, 80%, respectively. In conclusion, we suggest that among the chosen markers, determination of CEA in BALF is the most useful in diagnosis of NSCLC. It may be a complementary method in diagnosing of patients in whom tumor cannot be visualized by bronchofibroscopy. These results need confirmation in larger groups of patients.

Adult↗

PubMed2002

[Correlation between bronchoscopically visible aspects and histopathologic results in patients with suspected lung cancer].

The aim of our study was to determine correlation between bronchoscopically visible lesions and histopathologic classification and whether cytology and histopathology can complement each other in diagnosis of pulmonary neoplasm. Fibroptic flexible bronchoscopy was performed in 208 patients who where suspected of having lung cancer--abnormal chest x-ray or hemoptysis. Material for histopathologic examination was obtained from bronchial brushings, bronchial forceps biopsy and bronchial washings. Positive results were classified as non--small cell or small cell carcinomas. All patients were questioned about smoking history. In 165 patients there were visible signs of neoplasm in bronchoscopic examination: tumor, necrosis, infiltration, compression. Histopathology was positive in 90 cases:small cell carcinoma 32%, non-small cell carcinoma 68%. In 23 cases material for histopathologic examination was obtained from both bronchial brushings and foceps biopsies: results were compatible in 78%. Bronchial brushings identified neoplasm in three additional cases. In analysed group of 208 patients cancer cells were found in 43%. Examination of bronchial brushings coplements forceps biopsy in diagnosing and typing lung neoplasms and could be performed more frequently in patients undergoing fiberoptic bronchoscopy.

Biopsy↗

PubMed2002

[Hemothorax with high number of eosinophils following warfarin overdose].

Some drugs are known to induce pleural effusion. Drug-induced pleural effusion is often associated with pleural fluid eosinophilia. Anticoagulant therapy may induce pleural effusion by at least two different mechanisms: bleeding complication (haemothorax) and allergic or toxic reaction. Authors describe 76-yr-old male with warfarin-induced pleural effusion. Since INR was 15.5, and the value of pleural effusion Hct exceeded significantly 50% of Hct value in blood, spontaneous haemothorax due to warfarin overdose was diagnosed. Pleural fluid analysis revealed relatively high percentage of eosinophils (13%), but it was probably secondary to the presence of numerous red blood cells in the effusion. The authors discuss different mechanisms of drug-induced pleural effusion, with special attention to eosinophilic pleural effusion and review the literature on the spontaneous haemothorax as a complication of anticoagulant therapy.

Aged↗

PubMed2002

[Tracheobronchopathia osteochondroplastica].

Tracheobronchopathia osteochondroplastica (TO) is a rare disease of unknown etiology affecting mainly the trachea and large bronchi. It is characterized by the presence of multiple submucosal osseus and/or cartilaginous nodules. The authors report a case of 74-year-old woman in whom fiberoptic bronchoscopy, performed because of hemoptysis, revealed typical feature of TO. Besides the typical nodules protruding into the lumen of trachea and main bronchi, a small soft nodule in the larynx was found. On histological examination it was showed to be polyp with regions of inflammation and necrosis. The direct relation between such a laryngeal polyp and TO seems to be very unlikely.

Aged↗