[Clinical signs and therapy of Candida-albicans infections in patients hospitalized with lung diseases].
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Biomedical subjects
Publications and source records attributed to V Dangubić.
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In 20 patients with pulmonary sarcoidosis bronchoalveolar lavage (BAL) was performed. The cellular content was analysed and lymphocyte subpopulation was determined using monoclonal antibodies. The patients with more than 28% of BAL T lymphocytes are classified as patients with high intensity alveolitis (n = 8) and those with less than 28% of T lymphocytes as low intensity alveolitis (n = 12). Of the total number of BAL T lymphocytes in high intensity alveolitis CD 3+ T cells were 88.8 +/- 8.4% and in low intensity alveolitis 68.2 +/- 13.8% (p < 0.001). In high intensity alveolitis the number of CD 4+ T cells was increased and the number of CD 8+ T cells was decreased which caused the increased index CD 4:CD 8; 9.8 +/- 8.7. In low intensity alveolitis this ratio was 2.2 +/- 1.2. Effects of smoking were also analysed. In smokers the total number of BAL cells was higher 184.0 +/- 47.2 x 10(4) ml of BAL, and in nonsmokers 101.3 +/- 65.1 x 10(4) ml of BAL (p < 0.001). Smoking has no effects on the characteristics of the cellular elements and subpopulation of BAL lymphocytes in patients with sarcoidosis. In 7 patients T lymphocyte subpopulation in the peripheral blood were determined too. Patients with high intensity alveolitis had the increased index CD 4:CD 8 in the peripheral blood compared with low intensity alveolitis.
In 47 patients with pleural effusions of different etiology concentrations of the tissue polypeptide antigen (TPA) and tumour trypsin inhibitor (TATI) were measured. Malignant disease was found in 24 patients and benign one in 23 patients. In a group of patients with malignant pleural effusion the average concentration of TPA was 3102 U/L and of TATI 76.8 ug/L. In a group of patients with nonmalignant effusion these concentrations of TPA were 2381.8 U/L and of TATI 28.3 ug/L. Higher concentration of TPA was found in pleural effusion of malignant nature with specificity of 96% but with a small sensitivity of 12.5% and positive predictive value of 43%. TATI concentrations were also higher in malignant pleural effusion with good sensitivity and specificity (78%, 50% respectively) and positive predictive value of 66%.
The results of small spirometry, airway resistance and flow volume loop were compared in 10 patients with upper airway obstruction, 11 patients with chronic pulmonary obstructive disease and 15 healthy examinees. Our results have shown that for detection and differentiation of upper airway obstruction and chronic obstructive pulmonary disease the most reliable values give the following parameters and relations: MIF 50% less than or equal to 100 l/min, MEF 50% greater than or equal to 1, FEV1/ /PEF greater than or equal to 10 ml/l/min, FEV1/FEV0.5 greater than or equal to 1.5 and FEV1/ /FEV1 greater than or equal to 1.
178 new cases of tuberculosis of the lungs and pleura have been treated within the period of four years (1985-1988) in military medical institutions of the Y.P.A. The patients were classified by random selection in two therapeutical groups. Two six-month regimens were applied with the same drugs except for the fourth one which was used in the initial period only (EHRZ and SHRZ). Both applied therapeutical combinations were equally successful. All patients achieved negative cultures at least three months after onset of chemotherapy. Relapses occurred in 4 (2.3%) of patients during the period of follow-up for at least 2 and the most 5.5 years after the end of therapy. The toxic effects were tolerable. The drug resistance was found in 25 of 134 (18.6%) patients, the most common to one drug.
Within the five-year period (1984-1988) the oat cell bronchogenic carcinoma was diagnosed and treated in 151 patients. Analysed were 74 patients having received complete treatment. Patients with disseminated form received only polychemotherapy in 6 cycles (cyclophosphamide, doxorubicin, vincristine and etoposide) and those with limited disease also received additional, local-regional radiotherapy of 45-50 Gy. In complete respondents preventive brain irradiation was applied. In selected patients with initial forms of the disease surgical resection with additional polychemotherapy were applied. The best survival showed respondents with limited disease and operated patients. Average survival of the whole group was 72 weeks. One year survived 31 out of 74 (41.9%) patients and two years survived 10 out of 74 (13.5%) patients.
The concentration of neuron-specific enolase (NSE) was measured in the serum and pleural fluid of 42 patients with pleural effusions of different etiology. High levels (above 13.0 micrograms/l) of NSE in pleural fluid of 9 patients with malignant disease were observed (sensitivity 57%). However, pleural fluid NSE levels were also increased in 14 with non-malignant diseases (specificity 45%). Increased pleural fluid NSE activity is not specific for malignancy.
Bronchoalveolar lavage through fiberoptic bronchoscope was performed in the right middle lobe or lingula of 8 patients with clinically and radiologically active sarcoidosis and 5 healthy persons. Pellet cells were analysed. Lymphocyte subsets were detected with monoclonal antibodies by fluorescent microscopy or flow cytometry (EPICS-C, Coulter). In patients with sarcoidosis lymphocyte proportion is elevated (29.88 +/- 4.32) as compared to healthy persons (5.2 +/- 3.4). We detected an increase of CD 3 lymphocytes (86.38 +/- 6.71) and CD 4 helper-inducer T lymphocytes compared to the total number of lymphocytes and, likewise, of the CD 4/CD 8 ratio--5.62 +/- 0.94. CD 8 suppressor-cytotoxic T lymphocytes are decreased (13.0 +/- 1.3 as compared to the healthy persons 22.0 +/- 3.84), which is a relative decrease because due to an increase of the total lymphocyte number, an increase of CD 8 T lymphocytes (3.85 +/- 0.41 as compared to the healthy persons 1.09 +/- 0.59) still exists, compared to the total number of pellet cells.
The 188 patients with pulmonary embolism were treated at the Clinic for Pulmonary Diseases of the M.M.A. in the period 1979-1989. Clinical symptoms and signs, diagnostic procedures and therapy of pulmonary embolism are analysed. The diagnosis is difficult and is suggested by the predisposing factors, symptoms and signs of the disease as well as indirect diagnostic procedures. The contribution of perfusion lung scintigraphy is precious. Deep venous thrombosis of the lower extremities, the source of pulmonary embolism, is commonly clinically absent. The complete cure without complications was achieved in 156 (83%) patients. The most common complications were: early and late recurrences, hematuria and peptic bleeding. The lethal outcome occurred in two cases of basic disseminated malignant disease.
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There have been examined 145 patients with hemoptyses and normal x-ray findings. The majority of patients were males, smokers, more than 45 years old. Bronchoscopically the most common findings have been signs of inflammation and blood traces. The most common cause of hemoptyses has been chronic bronchitis in patients older than 45 years, and bronchoectasis in younger patients. Bronchogenous carcinoma was discovered in 8 patients: in 5 by bronchoscopic examination at hemoptysis occurence and in 3 by subsequent follow up after 8, 15 and 20 months. Pulmonary vessel malformations have been discovered in 9 patients, and cardiac diseases have been the cause of hemoptysis in 7 patients. The cause of hemoptysis remained undetected in 33 (22.8%) patients.