Pljučnica je najpogostejši vzrok za težji potek okužbe z virusom SARS-CoV-2 in s hospitalizacijo. Potek covidne pljučnice je lahko različen; infiltrati, vidni na rentgenski sliki, se lahko resorbirajo spontano, včasih pa je potrebno zdravljenje s sistemskimi glukokortikoidi. Ob odpustu iz bolnišnice zdravljenje običajno še ni končano, zato je Združenje pulmologov Slovenije v želji po enotnem obravnavanju bolnikov s covidno pljučnico izdelalo mnenje za obravnavo in sledenje bolnikov po odpustu iz bolnišnice. Zavedamo se, da ob novi bolezni ne gre za dokončno mnenje, saj bodo nova spoznanja o covidni pljučnici zanesljivo zahtevala obnavljanje mnenj.

Skin metastases of lung cancer are rare. In over a 3-year period we found only 14 cases of skin metastases among 1,614 patients with lung cancer admitted to the University Clinic of Respiratory and Allergic Diseases in Golnik. The metastases are usually manifested on the skin of the chest. Skin metastases are symptoms of progressive disease, and usually a sign of a poor prognosis. The median survival time of lung cancer patients with skin metastases was 85 days from the time of detection of the skin lesion. Because skin metastases can be the first sign of the disease, the entire skin should be carefully inspected whenever malignant disease is suspected.

Chronic pancreatitis (CP) is associated with osteopathy (osteoporosis or osteopenia). However, existing literature is mostly limited to retrospective or administrative studies that have not clearly defined the prevalence and risk factors. Our aim was to identify patient- and disease-related associations with osteopathy in a prospective cohort study of CP.We studied 282 subjects with definitive CP enrolled in the PROCEED study who had a baseline dual-energy X-ray absorptiometry (DXA) scan. Osteopenia and osteoporosis were defined using the lowest T-scores. Clinical data were collected using standardized case report forms. Comparisons were performed with a multivariate logistic regression model with forward selection to identify risk factors for osteopathy.The majority of subjects had osteopathy on DXA scan (56.0%; 17.0% osteoporosis; 39.0% osteopenia). Subjects with osteopathy had a higher prevalence of traumatic (40.0% vs 26.4%; P = .02) and spontaneous fractures (3.9% vs 0; P = .04). On multivariate analysis, older age (odds ratio [OR], 1.29 per 5 years; 95% confidence interval [CI], 1.15–1.45), female sex (OR, 3.08; 95% CI, 1.75–5.43), white race (OR, 2.68; 95% CI, 1.20–6.01), and underweight body mass index category (OR, 7.40; 95% CI, 1.56–34.99) were associated with higher probability of osteopathy. There were no significant associations between osteopathy and other patient and disease-related features of CP.In the largest study of patients with CP who underwent DXA screening, the majority had osteopathy. There are overlapping risk factors with osteopathy in the general population, but the high prevalence in men and younger women supports the need for future investigations into the mechanisms of bone loss in CP. ClinicalTrials.gov number, NCT03099850.

Background: Sudden onset and persistence of bronchial obstruction suggest asthma or COPD exacerbation. In differential diagnosis some other causes should be considered. We report a 49-year old male, non-smoker with dry cough and severe dyspnoea on exertion.

PURPOSE:Pleurodesis can relieve dyspnea in patients with malignant pleural effusions. We retrospectively compared the success rate of talc slurry instillation pleurodesis with thoracoscopic talc powder insufflation pleurodesis. PATIENTS AND METHODS:From 2000 to 2005, two methods of talc pleurodesis were performed in 71 patients with symptomatic massive malignant pleural effusions: a) through the pleural drain (24F), 50 ml of a slurry containing 4-5 g of Luzenac talc in saline with 20 ml 1% lidocaine were instilled. The drain was clamped for 1 h; b) insufflation of 3-5 g of talc powder was performed via videothoracoscope using local anaesthesia. The drain was left in the pleural space until the daily secretion of pleural fluid was under 100 ml. Pleurodesis was considered successful when the patient was without dyspnea and did not need pleural fluid evacuation and the pleural fluid did not re-accumulate in the 1st month after pleurodesis. RESULTS:The success rate of talc slurry pleurodesis was 78%(38/49). Excluding 8 patients who died in the first month, the success rate increased to 93% (38/41). Thoracoscopic pleurodesis was successful in 77% (17/22) of patients. Excluding one patient who died in the first month, the success rate increased to 81%(17/21) (intergroup difference non significant). Complications were observed in 41% (20/49). vs. 73% (16/22) of patients in the talc slurry group and thoracoscopic group, respectively (p=0.013). CONCLUSION:Pleurodesis with instillation of talc slurry and with insufflation of talc during thoracoscopy were equally successful in patients with massive malignant pleural effusions. However, thoracoscopic pleurodesis is accompanied with considerably more complications, rather as a result of the thoracoscopy itself and not as a consequence of pleurodesis.

Background. Conventional transbronchial needle aspiration (TBNA) of enlarged mediastinal lymph nodes is a fairly blind technique. Endobronchial ultrasound (EBUS) guided TBNA resulted in higher success rate. The needle can be inserted safely into the lymph node. We examined the diagnostic yield of EBUS guided TBNA in clinical circumstan- ces. Patients and methods. Patients with enlarged mediastinal lymph nodes, detected on chest X-ray and/or CT scan, under- went bronchoscopy. The exact location of lymph nodes was established by EBUS. 20 MHz ultrasound probe with a balloon catheter was used. Results. Seventy-five patients aged between 20 and 79 years (median age 55 years), underwent EBUS examination followed by TBNA of the target lymph node. Lymph nodes pa- thology was correctly diagnosed in 65 (87%) of them. In 52 (70%) patients the lymph nodes were infiltrated with malignoma, 13 (17%) had benign diseases and in 10 (13%) patients with non definitive disease the final diagnosis was obtained by surgery or by follow up. No major complication was encountered after EBUS-guided TBNA. Conclusions. Diagnostic yield of EBUS-guided TBNA is high. There were no major complications and the procedure was tolerated well. Ključne besede: bronhoskopija; endobronhialni ultrazvok; bronhoskopska igelna aspiracija Izvleček - Izhodišča. Povečane mediastinalne bezgavke obi- čajno punktiramo »na slepo«. Z endobronhialnim ultrazvo- kom (EBUZ) mesto punkcije natančneje opredelimo in izbolj- šamo občutljivost bronhoskopske igelne aspiracije (BIA). Me- toda je varna in ima malo zapletov. Zanimala nas je občutlji- vost preiskave v vsakdanji klinični praksi. Bolniki in metode. Preiskavo smo opravili pri bolnikih, pri katerih smo na rentgenogramu pljuč in na posnetkih raču- nalniške tomografije (CT) opazili povečane bezgavke v medi- astinumu. Z EBUZ smo poiskali najugodnejše mesto za punk- cijo in opravili BIA. Uporabili smo 20 MHz ultrazvočno vrtlji- vo sondo z balonskim katetrom. Rezultati. Povečane mediastinalne bezgavke smo punktirali pri 75 bolnikih, starih med 20 in 79 let (mediana 55 let). Vzrok povečanih bezgavk smo ugotovili pri 65 (87%) bolnikih. Pri 52 (70%) bolnikih smo ugotovili malignom, pri 13 (17%) be- nigno bolezen, pri 10 (13%) bolnikih pa smo bolezen ugoto- vili kirurško ali s kliničnim sledenjem. Razen manjše krvavit- ve na mestu punkcije drugih zapletov nismo opazili.

Einleitung: LAM ist eine diffuse benigne Proliferation unreifer glatter Muskelzellen im alveolaren Interstitium bei Frauen im gebärfähigen Alter. An den proliferierten Zelloberflächen lässt sich HMB-45 nachweisen. LAM ist eine seltene Lungenerkrankung mit unterschiedlicher Prognose.

Background. The aim of the study was to identify perioperative morbidity and mortality, the category and mode of adjuvant treatment, local recurrence and survival in patients treated by extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM). Methods. From 2000 to 2003, 18 patients with MPM were referred to the Department of Thoracic Surgery in Ljubljana, and 17 of them were operated on. Two patients underwent explorative thoracotomy, and 15 patients were evaluated. Five female and nine male patients (aged 52-68 years) were treated by EPP and one male patient by pleurectomy. Eight patients received both adjuvant chemotherapy (ChT) and radiotherapy (RT), with cisplatin 100 mg/m2 + mitomycin C 6-10 mg/m2 or gemcitabine 1000 mg/m2 and external beam radiation with 24 Gy - 58 Gy respectively, three patients received no adjuvant therapy, three patients were treated by adjuvant ChT, two of them were given cisplatin 100 mg/m2 + mitomycin C 6-10 mg/m2, and one patient cisplatin 100 mg/m2 on the first day and gemcitabine 250 mg/m2 in prolonged 6 hours infusion on the first and on the eighth day. One patient was treated only by adjuvant RT. Results. There were no perioperative deaths and the postoperative morbidity was 42%. Of the 15 evaluable patients, and in the median follow up of 40 months (28-64), we noticed nine (60.0%) recurrences, seven local and two abdominal. Eight (53.3%) patients died, all because of the local progress of disease. Of the 3/15 patients without adjuvant treatment, one patient (T1bN0M0) is well 46 months after the operation, one patient (T2N0M0) got recurrence in abdomen, was treated with ChT and reoperation, and is still alive 31 month after the first surgical treatment. One patient (T2N0M0) died two months after the surgery due to local recurrence. In ChT+RT group, 6/8 patients died: the patient at stage T1aN0M0 died after nine months, the patient at stage T1bN0M0 died after nine months, two patients at the stage T2N0M0 died after four and 23 months respectively, the patient at stage T3N0M0 after 11 months, and the patients at stage T3N2M0 died seven months after the operation. Two out of eight patients are alive: the patient at stage T1bN0M0 is alive 43 months, and the patient at stage T2N0M0 is alive 28 months after the operation. In the ChT group, 1/3 patient (T2N0M0) died 6 months after the operation, 2/3 patients (T2N0M0 and T3N0M0) are well after 43 and 20 months respectively. The patient treated with adjuvant RT only is well 50 months after the surgical treatment. The median survival time was 20 months for the whole group of patients operated on, the 1-year survival rate was 53.3% and 2-year survival rate was 46.7%. Conclusions. In selected patients with MPM, complete surgical resection is indicated, followed by chemotherapy and radiotherapy. The operation could be performed safely with acceptable mortality and morbidity. Our group of patients is too small, the adjuvant therapies were too different to favour any of the treatment mode applied. Further randomised studies and standardised protocols are needed to evaluate the best mode of treatment for each patient.

Background: IPF is lung disease of unfavorable prognosis. Earliest stages are responsive to treatment. Late diagnosis causes bad outcome.

Two different methods of topical anesthesia with lidocaine and possible benefits of premedication with atropine were studied in a randomized manner. Patients were randomized into 4 groups: lidocaine for topical anesthesia was administered either through the working channel of the bronchoscope (BC) or by transcricoid (TC) injection with or without premedication with atropine. The duration of bronchoscopic session, amount of lidocaine used, cough, heart rate, and oxygen saturation were documented. Patients, nursing staff, and bronchoscopists graded the cough and salivation during the procedure using a severity scale. The patients who were anesthetized through BC required significant more additional lidocaine than patients in the TC group. The amount of lidocaine required by those who received atropine or placebo was the same. The cough, scored by medical staff as severe, was equally frequent in BC and TC group and was significantly more frequent in patients without atropine premedication and in those whom the bronchoscope was inserted through the mouth. Patients did not recognize any difference between procedure performed with either atropine or placebo premedication. Patients tolerated both variants of topical anesthesia equally well. Bronchoscopy without atropine caused some difficulties to the bronchoscopists because of coughing and salivation, but we did not need to curtail any procedures. In the group of patients who received atropine, more tachycardias were recorded.

Background: Atypical pneumonia mimics diffuse interstitial lung disease (DILD) on chest x-ray and can progress to the lung fibrosis.

Background. By the bronchoscopic lavaging we obtain cytological specimen of the peripheral airways and lung parenchyma. Bronchoalveolar lavage fluid (BALF) examination gives us information about inflammation in the interstitial lung diseases. BALF sampling and its laboratory processing are standardized in our hospital. Quality assurance practice requires that each institution establish disease characteristic BALF profiles. The aim of this study was to find common cytological characteristics of BALF specimens in sarcoidosis, extrinsic allergic bronchoalveolitis (EABA), asbestosis and idiopathic interstitial pneumonias (IIP).Material and methods. We included 135 BALF specimens of good quality from patients with one of the mentioned entities that were diagnosed clinically, radiographically and pathologically. Based on diferential cell counts and lymphocytic phenotypisation done by immunofluorescence, BALF specimens were categorized as normal type, lymphocytic, neutrophilic, eosinophilic, macrophagic and mixed cell alveolitis. Statistical comparison was performed by the analysis of variance which was done by SAS software.Results. BALF in sarcoidosis shown in 71% lymphocytic or mixed cell (lymphocytic and neutrophilic or eosinophilic) type alveolitis with increased CD4/CD8 ratio (> 3.5) in 61.4% specimens. EABA patients had lymphocytic or mixed cell (lymphocytic and neutrophilic or eosinophilic) type alveolitis in 53.3% of BALF specimens with decreased CD4/CD8 ratio (< 1) in 38.5% of specimens. Macrophagic alveolitis was the most common type found in asbestosis (52.9%). CD4/CD8 ratio was usually decreased or normal. Patients with IIP had all types of alveolitis and none of them prevailed, but neutrophils were increased often (53.3%). CD4/CD8 ratio was decreased in 65.5% of BALF specimens in IIP.Conclusions. Sarcoidosis has the most characteristic BALF profile (CD4 lymphocytic alveolitis). We often see macrophagic alveolitis in asbestosis. BALF specimens in EABA and IIP have less characteristic profiles.

Background. This article presents our three year experience with bronchoscopic management of central bronchial tumours stenosis. Methods. In the years 2000, 2001, and 2002, 52 patients (43 men, 9 women), aged 62.3 ± 10.8 years with central airway obstruction because of primary or secondary malignant tumours in 47 cases (90%) and benign diseases in 5 (10%) were treated. Topical anaesthesia with Lidocaine in all 52 patients where flexible bronchoscopes Olympus were applied was used. Additionally, Fentanyl or Diprivane were used in 25 patients where rigid bronchoscopy (Storz) was performed. Mechanical removal and electrocautery resection (Olympus) were used for tumour resection. In 2 patients Polyflex stent (Rusch) was introduced into the trachea. Results. We treated 17 (33%) tumours in the trachea, 14 (27%) in the right, 15 (29%) in the left main bronchi and 6 (11%) in more peripheral bronchi. The combination of mechanical removal and electrocautery was applied in 32 (61%), mechanical removal alone in 4 (8%) and electrocautery alone in 16 (31%) of patients. Symptomatic relief was achieved in 41 (79%) patients. In 47 patients with malignant tumours bronchoscopic intervention was applied during the first diagnostic procedure 28 times (60%), after additional surgery, radiotherapy or chemotherapy 14 times (30%) and between additional therapeutic interventions 5 times (10%). The procedure had to be terminated in one patient due to hypoxemia. There was no immediate mortality. Conclusions. Mechanical desobstruction in combination with electrocautery through the flexible and/or rigid bronchoscopes and stent introduction in patients with central airways tumours are efficient and rather safe palliative procedures.

OBJECTIVE To determine the frequency, morphology and possible diagnostic significance of multinucleated giant cells (MGC) in bronchoalveolar lavage (BAL). STUDY DESIGN Retrospectively we examined 671 BAL specimens. Enlarged cells having > or = 10 nuclei were defined as MGC. Cytomorphologic features were described. BAL specimens containing MGC were grouped according to clinicohistologic diagnosis into sarcoidosis, asbestosis, other interstitial lung diseases and different chronic, noninterstitial lung diseases. RESULTS MGC were present in 10.7% of BAL specimens and occurred in low numbers. MGC were classified into Langhans' or foreign-body-type MGC (LF-MGC), alveolar macrophage-like MGC (AM-MGC) and nonspecific MGC (NS-MGC). LF-MGC were found most often in patients with sarcoidosis. AM-MGC were found in all groups of patients. NS-MGC were found most often in patients with asbestosis and other interstital lung diseases. CONCLUSION MGC in BAL are not encountered frequently and are not numerous. Based on cytomorphologic features, three types of MGC can be distinguished.

OBJECTIVE: To determine whether cells from histologically normal appearing epithelium of the lactiferous duct from women with a remote ductal lesion in the breast provide any clues indicating the existence of such a lesion. STUDY DESIGN: Tissue sections cut to 4 μm and stained with hematoxylin and eosin were prepared from duct tissue of 20 women with breast lesions and of 20 women free of any such lesion who had undergone mammoplastic procedures or resection for benign reasons. One hundred nuclei were measured from each case. Measures of nuclear deviation from normal were computed, discriminant functions were derived, and multivariate significance tests were conducted. RESULTS: Nuclei from histologically normal appearing regions of lactiferous duct epithelium from women harboring distant lesions exhibited changes in the distribution pattern of their nuclear chromatin, indicating the presence of these lesions. The statistical significance of these changes was documented. The changes were clearly evident in all 20 subjects with lesions and were not observed in 19 of the 20 subjects without lesions. CONCLUSION: The results suggest that studies aimed at detecting malignancy-associated changes in cells collected by ductal lavage might lead to a minimally invasive screening procedure for breast lesions.