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Paediatric pulmonology and allergology
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Jurgis Bojarskas, Vilija Bubnaitiene. Community acquired atypical pneumonia: aetiological data, epidemiology, diagnostics and treatment Irena Narkeviciute, Indre Tamuliene, Justina Cipkuviene. Antibacterial therapy of upper respiratory tract infections: current point of view and real situation Edvardas Danila. Evaluation of inflammation in the respiratory tract in chronic bronchitis Albinas Naudziunas, Silvija Kontautiene. Pulmonary thromboembolism: peculiarities of invasive and noninvasive methods of diagnosis Alfredo Visca, Domenico Castello. Preparation for flexible bronchoscopy in pediatric patients Aldona Rainyte, Ramune Mykolaitiene, Petras Stakenas. Mycoplasma pneumonia characteristic confirmed by PCR method Dalia Steponaviciene, Edita Tamulaitiene, Aleksandra Stoskuviene, Nijole Simkiene. Aspects of the TB pneumonia in children Iveta Skurvydiene, Arunas Valiulis. Prognosis of survival of CF patients Regina Emuzyte, Ingrida Kazlauskiene, Regina Firantiene, Vytas Tamosiunas. Immunological mechanisms of allergic diseases Andrew Bush. The growing lung - normal development and effects of disease Matti Korppi. Childhood whearing: modes of treatment and prognoses Anne H Thomson. Community acquired pneumonia Matti Korppi. Mixed viral-bacterial lower respiratory infections in children Andrew Bush. Diagnostic methods of pneumonia in children Colin Wallis. Causes of atypical pneumoia in children Andrew Bush. Non-pneumonic causes of pulmonary shadowing Anne Thomson. compliactions of childhood pneumonia Jane Davis. New approaches to the management severe penumonia Jane Davis. Pneumonia in the immunocompromised host Colin Wallis. Pneumonia in children with neuromuscular disease. |
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Community acquired atypical pneumonia: aetiological data, epidemiology, diagnostics and treatment
Jurgis Bojarskas, Vilija Bubnaitiene
The incidence of community acquired atypical pneumonia is growing in Lithuania. To avoid any possible mistakes in the diagnosis and treatment of community acquired atypical pneumonia we present this article, which deals with the main pathogenic agents, diagnostic methods and treatment's strategy of community acquired atypical pneumonia.
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Antibacterial therapy of upper respiratory tract infections: current point of view and real situation
Irena Narkeviciute, Indre Tamuliene, Justina Cipkuviene
172 patients (43 percent) from 400 with upper respiratory tract infection and otitis media acuta were treated with antibiotics. 25 percent of those with otitis media acuta received amoxycillin and 20 percent - II-nd generation cefalosporins before hospitalizations. 30 percent of patients received amoxycillin during hospitalization. 22 percent of patients with upper respiratory tract infection were treated with amoxycillin and 22 percent - with macrolides before hospitalization. 31 percent of patients received penicillin during hospitalization.
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Evaluation of inflammation in the respiratory tract in chronic bronchitis
Edvardas Danila
Aim of the Study: to evaluate changes of peripheral blood cells percentage count, blood gases and spirometrical indices in various stages of endobronchitis activity in chronic bronchitis. Results: there was no statistical significant difference in peripheral blood cells percentage count, blood gases and spirometrical indices in patients with active or nonactive endobronchitis. Patients with active endobronchitis had significant (p<0.05) increased in erythrocyte sedimentation rate (ESR) compared with patients with nonactive endobronchitis. However ESR of most these patients were in normal range. Patients with active endobronchitis compared with patients with non-active endobronchitis had an increased number of neutrophils (p<0.05) in bronchial samples of BAL fluid. Smokers patients with active endobronchitis had an increased number of lymphocytes (p<0.05) both in bronchial and alveolar samples of BAL fluid also compared with healthy smokers and neutrophils (p<0.01) and of ICAM-1 (CD54+) (p<0.05) in alveolar sample of BAL fluid. Neutrophils, eosinophils, CD3 and CD8 lymphocytes were statistically significant increase both in the epithelium and lamina propria in active endobronchitis group compared with non-active endobronchitis group. There were neutrophils (p<0.001), eosinophils (p<0.0001), CD3 lymphocytes (p<0.05) and CD8 lymphocytes (p<0.05) in the epithelium; neutrophils (p<0.0001), eosinophils (p<0.0001), CD3 lymphocytes (p<0.01) and CD8 lymphocytes (p<0.01) in the lamina propria. There were no complications of bronchoscopy, bronchoalveolar lavage and bronchial biopsies. Conclusions: Peripheral blood cells percentage count, blood gases and spirometrical indices are insufficient to discriminate between chronic bronchitis with active and nonactive endobronchitis. Bronchoalveolar lavage and bronchial biopsies are suitable methods to evaluation of endobronchitis activity in chronic bronchitis.
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Pulmonary thromboembolism: peculiarities of invasive and noninvasive methods of diagnosis
Albinas Naudziunas, Silvija Kontautiene
Data of 336 patients with confirmed pulmonary thromboembolism for the period 1990-1998 from Kaunas Medical University Clinic have been analysed. Pulmonary thromboembolism in 48.2% cases was confirmed by invasive methods of diagnosis - right heart catetherisation and pumoangiography, in 9.2% cases - by invasive methods and perfusion lung scan. In 19.6% cases diagnosis was confirmed by typical clinical signs and instrumental tests. Peak of morbidity: 60-70 years. Or results suggest that men are more frequently affected by pulmonary thromboembolism in the 6th decade of age (men/woman ration - 1.45). The most common clinical signs were: dyspnea - 79.5%, angina type chest pain - 40.5%, cyanosis - 19.5%. The most common underlying pathologic conditions were heart diseases - 33.9%, 7% patients underwent surgery of suffered from trauma. Pulmoangiography the was most common method of diagnosis of thromboemoli in main branches of pulmonary artery. In case of microthromboembolism more information is obtained by using perfusion lung scan.
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Preparation for flexible bronchoscopy in pediatric patients
Alfredo Visca, Domenico Castello
To evaluate both safety and efficiency of two procedures of preparation, 40 pediatric patients (3-16 yrs) undergoing flexible bronchoscopy were randomly assigned to two groups. Patients in Group 1 were premedicated with IM atropine sulfate, 0.01 mg/kg, followed by a combination of IV pethidine, 0.5 mg/kg, and midazolam, 0.1 mg/kg. Patients in Group 2 were premedicated with IV midazolam, 0.02 mg/kg. We used 1-2% lidocaine as a topical anesthetic agent in both groups. In Group 1, two patients (10%) had respiratory depression, two patients (10%) had bradycardia, and three patients (15%) vomited after the procedure. In Group 2, two patients (10%) had insufficient sedation and one patient (5%) had bradycardia. We suggest that premedication with atropine is often unnecessary in pediatrics, and that sedation with midazolam alone is as effective as its combination with pethidine, and it is probably safer.
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Mycoplasma pneumonia characteristic confirmed by PCR method
Aldona Rainyte, Ramune Mykolaitiene, Petras Stakenas
In order to determine the clinical characteristics of mycoplasma's pneumonia we have analysed the symptoms of the mycoplasma's pneumonia in 38 children. The pneumonia was confirmed by x-ray and mycoplasma's infections was established by PCR method. The majority of children suffering from mycoplasma's pneumonia were from 7 till 12 years of age and nursery-school children. The symptoms of the disease developed gradually. Regardless of the febrile fever the state of patients was not severe. Most important symptom of the sickness was persistent tiresome cough. In spite of the infiltration of one or more pulmonary segments documented by chest x-rays, blood leukocyte differential counts did not show bacterial process.
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Aspects of the TB pneumonia in children
Dalia Steponaviciene, Edita Tamulaitiene, Aleksandra Stoskuviene, Nijole Simkiene
Children morbidity of tuberculosis (TB) increased in twice during last ten years in Lithuania. The study included 54 cases of pulmonary TB hospitalized during the period from 1990-1998 in Pediatric Clinic of Kaunas Infectious diseases hospital. All patients were treated as pneumonia from 2 weeks to 3 months before pulmonary TB was diagnosed. Tuberculin test was positive in all cases. The contact with TB ill persons was found in 37 (67.5%) cases. Chest radiography showed pulmonary infiltration in upper lobe in 30 (60%) cases.
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Prognosis of survival of CF patients
Iveta Skurvydiene, Arunas Valiulis
The survival of patients with cystic fibrosis is permanently increasing in highly developed countries mostly due to improved respiratory care. But the majority of patients, however, still die from the respiratory failure. The treatment of choice for the terminal phase patients is double-lung, heart-lung or heart-lung-liver transplantation. Current recommendations to transplant organs in cystic fibrosis patients in USA and Great Britain include severely impaired lung function and life expectancy less than two years. The opened possibility for organ transplanting induced the attempts to create a proper cystic fibrosis prognostic model that might predict longer survival. Several criteria's including low weight centille, low Schwachman score, pancreatic insufficiency and presence of Burkholderia cepacia in sputum were associated with worse prognosis for survival of patients with cystic fibrosis in different cystic fibrosis centers. In 1998 in London was completed 18 year study and was created a new statistically derived prognostic model which allows more accurate prediction of survival of patients with cystic fibrosis for the short period of time. Several variables including percentage of predicted FEV1 and FVC, short statue, high white cell count and chronic liver disease were negatively correlated with survival. These variables were combined into a prognostic index that accurately predicted one year survival in the study population. This prognostic index might be valuable in predicting prognosis in other cystic fibrosis centers and may improve the timing of organ transplantation.
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Immunological mechanisms of allergic diseases
Regina Emuzyte, Ingrida Kazlauskiene, Regina Firantiene, Vytas Tamosiunas
All allergic reactions according to their immunological mechanism are classified into four basic types. Type I allergic reactions (atopic diseases) are a major health problem. The pathophysiology of allergic disease is multifactorial involving an intricate network of interactions among cells, mediators and especially cytokines. In atopic subjects allergen induces activation and/or proliferation of cells having the Th2 cytokine profile. Expression of Th2 cytokines is critical in the induciton of IgE synthesis. IL-4 plays the most crucial role as a switching factor of B cells from IgM/IgG to the IgE antibody isotype. Acute phase of type I reaction is directly associated with mast cell activation, preformed active mediators (as histamine) and lipid mediators. Late (inflammatory) phase of type I reaction is mainly induced by cytokines and directly associated with eosinophil activation. Late phase is clearly important to the pathophysiology in chronic allergic disease. Some of the novel approaches to the treatment of allergy are in research state, as antagonists and inhibitors of lipid mediators, cytokines, adhesion molecules and regulation immune processes by new immunotherapeutic strategies. Investigations of immunological mechanisms in allergic diseases are important for more effective diagnostics, prevention and therapy of allergy.
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March, 1999, Vol. II, No. 1 (p. 1-160)
