In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue) 1 pro... more In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue) 1 provide a pathophysiological explanation of the symptoms of this syndrome, but they downplay the importance of the history and physical examination in making the ...
Advances in Experimental Medicine and Biology, 2015
ABSTRACT Beside standard chest tube drainage other less invasive techniques have been used in the... more ABSTRACT Beside standard chest tube drainage other less invasive techniques have been used in the management of patients with an acute episode of spontaneous pneumothorax. The aim of the study was to evaluate the short term effect of spontaneous pneumothorax treatment with small-bore pleural catheter and manual aspiration as compared to large-bore chest tube drainage. Patients with an episode of pneumothorax who required pleural intervention were enrolled in the study and randomly assigned to one of the treatment arms: (1) small-bore pleural catheter (8 Fr) with manual aspiration; (2) standard chest tube drainage (20-24 Fr). Success rate of the first line treatment, duration of catheter or chest tube drainage, and the need for surgical intervention were the outcome measures. The study group included 49 patients (mean age 46.9 ± 21.3 years); with 22 and 27 allocated to small bore manual aspiration and chest tube drainage groups, respectively. There were no significant differences in the baseline characteristics of patients in both therapeutic arms. First line treatment success rates were 64 % and 82 % in the manual aspiration and chest tube drainage groups, respectively; the difference was insignificant. Median time of treatment with small bore catheter was significantly shorter than conventional chest tube drainage (2.0 vs. 6.0 days; p < 0.05). Our results show that treatment of spontaneous pneumothorax with small-bore pleural catheter and manual aspiration might be similarly effective as is chest tube drainage in terms of immediate lung re-expansion.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc
Some drugs are known to induce pleural effusion. Drug-induced pleural effusion is often associate... more 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.
In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue) 1 pro... more In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue) 1 provide a pathophysiological explanation of the symptoms of this syndrome, but they downplay the importance of the history and physical examination in making the ...
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc
Although tuberculosis is one of the most common causes of pleural effusion, diagnosis of tubercul... more Although tuberculosis is one of the most common causes of pleural effusion, diagnosis of tuberculous pleuritis still remains a challenge. This is due to paucity of M. tuberculosis organisms in pleural effusion which results in a relatively low sensitivity of the routinely used diagnostic methods. Thus, different biomarkers in pleural effusion have been extensively studied in order to improve the diagnostic accuracy. Pleural fluid deaminase adenosine activity (ADA) and interferon gamma (IFN-γ) concentration have been shown to be the most reliable and cost-effective markers of tuberculous pleurisy. Hence, these markers have been included in different diagnostic algorithms for patients suspected of tuberculous pleurisy. A high variability of the diagnostic performance and/or more advanced technical demands significantly limit the use of other relatively new diagnostic methods, such as nucleic acid amplification tests (NAATs) and IFN-γ releasing assays (IGRAs). The article presents a cu...
INTRODUCTION One percent of all liver transplantations is performed in subjects with hereditary h... more INTRODUCTION One percent of all liver transplantations is performed in subjects with hereditary homozygous alpha 1-antitrypsin (AAT) deficiency resulting in liver failure. OBJECTIVES To evaluate the role of heterozygous AAT deficiency in the development of liver failure requesting liver transplantation. PATIENTS AND METHODS We performed a prospective investigation in 304 (57% males) consecutive patients evaluated for orthotopic liver transplantation between 2009-2011 in a referral center at a University Hospital. AAT phenotyping, and etiology of liver disease, liver function, cardiopulmonary function tests were assessed in all subjects. RESULTS Viral hepatitis and alcohol were the most common causes of liver cirrhosis in the study group. These entities were responsible for liver cirrhosis in 21% and 12% of patients, respectively. Two hundred and eighty four patients presented with normal protease inhibitor (Pi)MM phenotype. In eleven subjects (4%), AAT phenotyping revealed PiMZ. Thi...
Advances in experimental medicine and biology, Jan 28, 2015
Transcutaneous measurement of oxygen and carbon dioxide pressure (PtcO2 and PtcCO2) is useful in ... more Transcutaneous measurement of oxygen and carbon dioxide pressure (PtcO2 and PtcCO2) is useful in gas exchange monitoring. However, the relationship between PtcO2, pulse oximetry (SaO2) and arterial blood gases (ABG) is unclear. The aim of the present study was to compare PtcO2 and PtcCO2 with SaO2 and ABG, to evaluate the effect of sensor location on the results and stability of PtcO2 and PtcCO2, and to assess the impact of body composition on PtcO2 and PtcCO2. PtcO2 and PtcCO2 were measured in 20 healthy volunteers at three locations: right second intercostal space, lateral surface of the abdomen, and the inner surface of the left arm. The results were recorded 10, 15, and 20 min after sensor fixation and compared with SaO2 and ABG measured 20 min after electrode placement on the chest. Body composition was evaluated by bioimpedance. The findings were that PtcO2 was stable on the chest; but on the arm and abdomen it increased and reached maximum at 20 min. Transcutaneous PCO2 stabi...
Advances in experimental medicine and biology, Jan 3, 2014
Interpretation of spirometry strongly depends on the applied predicted values. New Global Lung In... more Interpretation of spirometry strongly depends on the applied predicted values. New Global Lung Initiative (GLI) reference values have recently been published but their influence on spirometry interpretation in children has not been widely evaluated. The aim of the study was to compare the interpretation of spirometry using GLI-2012 vs. Polish-1998) reference values. Spirometry results of 315 Caucasian children aged 4-18 were analyzed. Airway obstruction was defined as FEV1/FVC < LLN (lower limit of normal, 5th percentile -1.64 standard deviation), while restrictive ventilatory pattern as FVC < LLN and FEV1/FVC > LLN). The findings were that FEV1 and FVC expressed as GLI-2012 or Polish-1998 z-scores differed significantly (p < 0.05). The mean FEV1 z-score was -0.68 ± 1.25 vs. -0.13 ± 1.7 and the mean FVC was -0.34 ± 1.08 vs. 0.3 ± 1.15 for GLI-2012 and Rabka-1998, respectively. There was no difference for FEV1/FVC z-scores. Obstructive and restrictive ventilatory patterns...
This review aims to define the role of adenosine deaminase (ADA) and interferon gamma (IFN-gamma)... more This review aims to define the role of adenosine deaminase (ADA) and interferon gamma (IFN-gamma) in the differential diagnosis of pleural effusion with special attention to their source, mechanism of release and methods of measurement in pleural fluid. The diagnostic performance of ADA and IFN-gamma is analyzed, and the advantages and limitations of their use in differentiating between tuberculous and nontuberculous pleural effusion are discussed. Several potential biomarkers of tuberculous pleurisy have been evaluated, but none have been found to be clearly superior to pleural fluid level of ADA or IFN-gamma. The majority of recent studies confirm the high diagnostic utility of pleural fluid ADA and IFN-gamma measurement; hence, these markers are included in different diagnostic algorithms for patients suspected of tuberculous pleurisy. Other relatively new tests show a high variability [nucleic acid amplification tests (NAATs)] or are technically demanding, costly and give equivo...
We report intriguing preliminary observations on the effect of cough on pleural pressure changes ... more We report intriguing preliminary observations on the effect of cough on pleural pressure changes during therapeutic thoracentesis. We found that coughrelated elevation of pleural pressure persisted even when the cough had stopped. Thus, we hypothesize that cough during therapeutic thoracentesis may have a beneficial effect preventing the excessive drop in pleural pressure. The true role of cough-related elevation of pleural pressure is unknown, but it seems to be an interesting subject for further research.
ABSTRACT A spontaneous rupture of the oesophagus (Boerhaave syndrome) is a rare but lifethreateni... more ABSTRACT A spontaneous rupture of the oesophagus (Boerhaave syndrome) is a rare but lifethreatening condition. Vomiting, chest pain, dyspnoea and subcutaneous emphysema are the most commonly reported symptoms. Since severe respiratory distress, sepsis and shock may develop rapidly in the course of the disease, a prompt diagnosis plays a crucial prognostic role in patients with Boerhaave syndrome. We report a case of 79-year-old man presenting with severe chest pain and respiratory distress who was successfully diagnosed and treated with primary surgical repair.
Measurement of intrapleural pressure is useful during various pleural procedures. However, a pleu... more Measurement of intrapleural pressure is useful during various pleural procedures. However, a pleural manometer is rarely available. The aim of this study was to (1) construct an electronic pleural manometer, (2) assess the accuracy of the measurements done with the new device, (3) calculate the costs of the manometer construction and (4) perform an initial evaluation of the device in a clinical setting. Only widely accessible elements were used to construct the device. A vascular pressure transducer was used to transform pressure into an electronic signal. Reliability of the measurements was evaluated in a laboratory setting in a prospective, single-blind manner by comparing the results with those measured by a water manometer. Functionality of the device was assessed during therapeutic thoracentesis. The cost of the new pleural manometer was calculated. We built a small, portable device which can precisely measure intrapleural pressure. The measurement results showed very high agreement with those registered with a water manometer (r = 0.999; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The initial evaluation of the electronic manometer during therapeutic thoracentesis showed it was easy to use. The total time needed for 6 measurements after withdrawal of different volumes of pleural fluid in 1 patient did not exceed 6 min. The total cost of the device was calculated to be &amp;amp;amp;amp;amp;amp;amp;amp;lt;2,000 EUR. In the face of very limited offer of commercially available pleural manometers, it is possible to successfully construct a self-made, reliable, electronic pleural manometer at modest costs. The device is easy to use and enables data display and storage in the personal computer.
The high diagnostic yield and favorable safety profile of endobronchial ultrasound-guided transbr... more The high diagnostic yield and favorable safety profile of endobronchial ultrasound-guided transbronchial forceps biopsy of the mediastinal lymph nodes have been recently demonstrated. We report an unusual technical problem during endobronchial ultrasound-guided transbronchial forceps biopsy that could be a prerequisite for severe complications. A rupture of the steering band precluded closure of the forceps jaws opened in the subcarinal lymph node. A solution to the problem is presented, together with other procedure-related complications reported in the literature. The report emphasizes that a dysfunction of the forceps steering band can result in severe complications when it occurs during transbronchial sampling of mediastinal lesions.
In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue) 1 pro... more In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue) 1 provide a pathophysiological explanation of the symptoms of this syndrome, but they downplay the importance of the history and physical examination in making the ...
Advances in Experimental Medicine and Biology, 2015
ABSTRACT Beside standard chest tube drainage other less invasive techniques have been used in the... more ABSTRACT Beside standard chest tube drainage other less invasive techniques have been used in the management of patients with an acute episode of spontaneous pneumothorax. The aim of the study was to evaluate the short term effect of spontaneous pneumothorax treatment with small-bore pleural catheter and manual aspiration as compared to large-bore chest tube drainage. Patients with an episode of pneumothorax who required pleural intervention were enrolled in the study and randomly assigned to one of the treatment arms: (1) small-bore pleural catheter (8 Fr) with manual aspiration; (2) standard chest tube drainage (20-24 Fr). Success rate of the first line treatment, duration of catheter or chest tube drainage, and the need for surgical intervention were the outcome measures. The study group included 49 patients (mean age 46.9 ± 21.3 years); with 22 and 27 allocated to small bore manual aspiration and chest tube drainage groups, respectively. There were no significant differences in the baseline characteristics of patients in both therapeutic arms. First line treatment success rates were 64 % and 82 % in the manual aspiration and chest tube drainage groups, respectively; the difference was insignificant. Median time of treatment with small bore catheter was significantly shorter than conventional chest tube drainage (2.0 vs. 6.0 days; p &lt; 0.05). Our results show that treatment of spontaneous pneumothorax with small-bore pleural catheter and manual aspiration might be similarly effective as is chest tube drainage in terms of immediate lung re-expansion.
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc
Some drugs are known to induce pleural effusion. Drug-induced pleural effusion is often associate... more 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.
In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue) 1 pro... more In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue) 1 provide a pathophysiological explanation of the symptoms of this syndrome, but they downplay the importance of the history and physical examination in making the ...
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc
Although tuberculosis is one of the most common causes of pleural effusion, diagnosis of tubercul... more Although tuberculosis is one of the most common causes of pleural effusion, diagnosis of tuberculous pleuritis still remains a challenge. This is due to paucity of M. tuberculosis organisms in pleural effusion which results in a relatively low sensitivity of the routinely used diagnostic methods. Thus, different biomarkers in pleural effusion have been extensively studied in order to improve the diagnostic accuracy. Pleural fluid deaminase adenosine activity (ADA) and interferon gamma (IFN-γ) concentration have been shown to be the most reliable and cost-effective markers of tuberculous pleurisy. Hence, these markers have been included in different diagnostic algorithms for patients suspected of tuberculous pleurisy. A high variability of the diagnostic performance and/or more advanced technical demands significantly limit the use of other relatively new diagnostic methods, such as nucleic acid amplification tests (NAATs) and IFN-γ releasing assays (IGRAs). The article presents a cu...
INTRODUCTION One percent of all liver transplantations is performed in subjects with hereditary h... more INTRODUCTION One percent of all liver transplantations is performed in subjects with hereditary homozygous alpha 1-antitrypsin (AAT) deficiency resulting in liver failure. OBJECTIVES To evaluate the role of heterozygous AAT deficiency in the development of liver failure requesting liver transplantation. PATIENTS AND METHODS We performed a prospective investigation in 304 (57% males) consecutive patients evaluated for orthotopic liver transplantation between 2009-2011 in a referral center at a University Hospital. AAT phenotyping, and etiology of liver disease, liver function, cardiopulmonary function tests were assessed in all subjects. RESULTS Viral hepatitis and alcohol were the most common causes of liver cirrhosis in the study group. These entities were responsible for liver cirrhosis in 21% and 12% of patients, respectively. Two hundred and eighty four patients presented with normal protease inhibitor (Pi)MM phenotype. In eleven subjects (4%), AAT phenotyping revealed PiMZ. Thi...
Advances in experimental medicine and biology, Jan 28, 2015
Transcutaneous measurement of oxygen and carbon dioxide pressure (PtcO2 and PtcCO2) is useful in ... more Transcutaneous measurement of oxygen and carbon dioxide pressure (PtcO2 and PtcCO2) is useful in gas exchange monitoring. However, the relationship between PtcO2, pulse oximetry (SaO2) and arterial blood gases (ABG) is unclear. The aim of the present study was to compare PtcO2 and PtcCO2 with SaO2 and ABG, to evaluate the effect of sensor location on the results and stability of PtcO2 and PtcCO2, and to assess the impact of body composition on PtcO2 and PtcCO2. PtcO2 and PtcCO2 were measured in 20 healthy volunteers at three locations: right second intercostal space, lateral surface of the abdomen, and the inner surface of the left arm. The results were recorded 10, 15, and 20 min after sensor fixation and compared with SaO2 and ABG measured 20 min after electrode placement on the chest. Body composition was evaluated by bioimpedance. The findings were that PtcO2 was stable on the chest; but on the arm and abdomen it increased and reached maximum at 20 min. Transcutaneous PCO2 stabi...
Advances in experimental medicine and biology, Jan 3, 2014
Interpretation of spirometry strongly depends on the applied predicted values. New Global Lung In... more Interpretation of spirometry strongly depends on the applied predicted values. New Global Lung Initiative (GLI) reference values have recently been published but their influence on spirometry interpretation in children has not been widely evaluated. The aim of the study was to compare the interpretation of spirometry using GLI-2012 vs. Polish-1998) reference values. Spirometry results of 315 Caucasian children aged 4-18 were analyzed. Airway obstruction was defined as FEV1/FVC < LLN (lower limit of normal, 5th percentile -1.64 standard deviation), while restrictive ventilatory pattern as FVC < LLN and FEV1/FVC > LLN). The findings were that FEV1 and FVC expressed as GLI-2012 or Polish-1998 z-scores differed significantly (p < 0.05). The mean FEV1 z-score was -0.68 ± 1.25 vs. -0.13 ± 1.7 and the mean FVC was -0.34 ± 1.08 vs. 0.3 ± 1.15 for GLI-2012 and Rabka-1998, respectively. There was no difference for FEV1/FVC z-scores. Obstructive and restrictive ventilatory patterns...
This review aims to define the role of adenosine deaminase (ADA) and interferon gamma (IFN-gamma)... more This review aims to define the role of adenosine deaminase (ADA) and interferon gamma (IFN-gamma) in the differential diagnosis of pleural effusion with special attention to their source, mechanism of release and methods of measurement in pleural fluid. The diagnostic performance of ADA and IFN-gamma is analyzed, and the advantages and limitations of their use in differentiating between tuberculous and nontuberculous pleural effusion are discussed. Several potential biomarkers of tuberculous pleurisy have been evaluated, but none have been found to be clearly superior to pleural fluid level of ADA or IFN-gamma. The majority of recent studies confirm the high diagnostic utility of pleural fluid ADA and IFN-gamma measurement; hence, these markers are included in different diagnostic algorithms for patients suspected of tuberculous pleurisy. Other relatively new tests show a high variability [nucleic acid amplification tests (NAATs)] or are technically demanding, costly and give equivo...
We report intriguing preliminary observations on the effect of cough on pleural pressure changes ... more We report intriguing preliminary observations on the effect of cough on pleural pressure changes during therapeutic thoracentesis. We found that coughrelated elevation of pleural pressure persisted even when the cough had stopped. Thus, we hypothesize that cough during therapeutic thoracentesis may have a beneficial effect preventing the excessive drop in pleural pressure. The true role of cough-related elevation of pleural pressure is unknown, but it seems to be an interesting subject for further research.
ABSTRACT A spontaneous rupture of the oesophagus (Boerhaave syndrome) is a rare but lifethreateni... more ABSTRACT A spontaneous rupture of the oesophagus (Boerhaave syndrome) is a rare but lifethreatening condition. Vomiting, chest pain, dyspnoea and subcutaneous emphysema are the most commonly reported symptoms. Since severe respiratory distress, sepsis and shock may develop rapidly in the course of the disease, a prompt diagnosis plays a crucial prognostic role in patients with Boerhaave syndrome. We report a case of 79-year-old man presenting with severe chest pain and respiratory distress who was successfully diagnosed and treated with primary surgical repair.
Measurement of intrapleural pressure is useful during various pleural procedures. However, a pleu... more Measurement of intrapleural pressure is useful during various pleural procedures. However, a pleural manometer is rarely available. The aim of this study was to (1) construct an electronic pleural manometer, (2) assess the accuracy of the measurements done with the new device, (3) calculate the costs of the manometer construction and (4) perform an initial evaluation of the device in a clinical setting. Only widely accessible elements were used to construct the device. A vascular pressure transducer was used to transform pressure into an electronic signal. Reliability of the measurements was evaluated in a laboratory setting in a prospective, single-blind manner by comparing the results with those measured by a water manometer. Functionality of the device was assessed during therapeutic thoracentesis. The cost of the new pleural manometer was calculated. We built a small, portable device which can precisely measure intrapleural pressure. The measurement results showed very high agreement with those registered with a water manometer (r = 0.999; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The initial evaluation of the electronic manometer during therapeutic thoracentesis showed it was easy to use. The total time needed for 6 measurements after withdrawal of different volumes of pleural fluid in 1 patient did not exceed 6 min. The total cost of the device was calculated to be &amp;amp;amp;amp;amp;amp;amp;amp;lt;2,000 EUR. In the face of very limited offer of commercially available pleural manometers, it is possible to successfully construct a self-made, reliable, electronic pleural manometer at modest costs. The device is easy to use and enables data display and storage in the personal computer.
The high diagnostic yield and favorable safety profile of endobronchial ultrasound-guided transbr... more The high diagnostic yield and favorable safety profile of endobronchial ultrasound-guided transbronchial forceps biopsy of the mediastinal lymph nodes have been recently demonstrated. We report an unusual technical problem during endobronchial ultrasound-guided transbronchial forceps biopsy that could be a prerequisite for severe complications. A rupture of the steering band precluded closure of the forceps jaws opened in the subcarinal lymph node. A solution to the problem is presented, together with other procedure-related complications reported in the literature. The report emphasizes that a dysfunction of the forceps steering band can result in severe complications when it occurs during transbronchial sampling of mediastinal lesions.
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Papers by Rafal Krenke