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PubMedDate not supplied

Masticatory function in patients with juvenile rheumatoid arthritis.

PURPOSE: Children with Juvenile Rheumatoid Arthritis (JRA) rarely report temporomandibular joint (TMJ) pain, which may be due to pain avoidance mechanisms resulting in compromised masticatory function. This study examined the relationship between self-report measures of pain and dysfunction and measures of chewing performance in 44 JRA children and 34 normal controls. METHODS: The children were divided into three groups: Group 1, JRA children with temporomandibular joint disorder (TMD); Group 2, JRA children without TMD; Group 3, normal control children without TMD. Both visual and analog scales of jaw pain, ability to chew, and quality of life were administered before and after chewing tasks. Children chewed standardized portions of an artificial food for 20 cycles and expectorated the particles into a cup. This process was repeated five times. Median particle size and a broadness of particle distribution index were measured. Also, the number of chewing cycles prior to the child's first swallow for a cube of carrot was recorded. RESULTS: The broadness of particle distribution index was greater for Group 1 (P < 0.001) and Group 2 (P < 0.03) than for Group 3 with no difference in number of chews for carrot mastication among groups. Group 1 reported more pain and dysfunction before the chewing tasks than Groups 2 or 3 (P < 0.05). Interestingly, only Group 3 reported increased pain and decreased ability to chew after chewing tasks (P < 0.02). CONCLUSION: Children with JRA compromise their masticatory function as a pain avoidance mechanism. Such findings may have profound implications with regard to the nutritional status for these children.

Adolescent↗
PubMed2000

Chronic bronchitis in rural and industrial areas.

The purpose of the study was the determination of prevalence of chronic bronchitis in people older than 55 years in rural and industrial areas. 569 people over 55 years old living in central Greece were studied. A protocol was completed for each patient that included smoking habits, job, age, weight, drugs used for respiratory system and symptoms. A chest radiograph was taken for each patient. Each patient was submitted to three trials of dynamic spirometry. The best results were used for the study. The patients who complained of expectoration for three months for two continuous years and had obstructive pattern of lung function were diagnosed with chronic bronchitis. 9.6% of the subjects in rural area and 17.1% in industrial area were diagnosed with chronic bronchitis. Half the COPD patients never visited a doctor for this specific problem and were diagnosed for the first time. One out of three examined people had abnormal lung function. Consequently, more than one out of ten people older than 55 years have chronic bronchitis. Industrial exposure seems to double the risk for chronic bronchitis.

Aged↗
PubMed1976

Host factors in chronic obstructive pulmonary disease in an upper Midwest rural community. Design, case selection, and clinical characteristics in a matched-pair study.

A series of 111 index subjects with chronic obstructive pulmonary disease (COPD) who had forced expiratory volume in 1 second (FEV1) of 70% or less of that predicted were matched on the basis of age, sex, occupation, and smoking history with control subjects who had an FEV1 of 85% or more of that predicted. Index and control subjects with seasonal or reversible airway disease were excluded. Men outnumbered women by a ratio of 4.5 to 1. Thirty-five percent of the women and 2% of the men were nonsmokers (0 pack-years). There were three PiZ phenotypes in the index group (two nonsmokers) and none in the controls. PiMZ phenotypes in the index group outnumbered those in the controls by 8 to 5. Host factors that might be important in these closely matched pairs were sought by history, physical examination, and a large battery of laboratory tests. A standard respiratory questionnaire revealed the anticipated significantly higher frequency of cough, phlegm, noisy respiration, and all grades of dyspnea in index subjects. Previous lower respiratory tract infections also were more frequent in index subjects than in controls. There were no detectable differences between groups in the frequency of upper airway infections, nasal polyps, sinus surgery, or reported allergy to any substance. If the British Medical Research Council's definition of chronic bronchitis were applied to our study, about two-thirds of our index subjects and almost one-third of our controls would be considered to have chronic bronchitis. Pack-years of smoking were not significantly associated with the amount and duration of cough and expectoration in male or female index subjects or controls. Significant differences between index and control groups on physical examination included the audible forced expiratory flow time over the trachea, the estimated maximal midexpiratory flow, breath sounds, rales, and total excursion of the hemidiaphragms. An endocrine questionnaire and measurement of blood sex hormones did not give any clues as to the propensity of males to develop COPD. Women with airway obstruction similar to that of men had histories of significantly fewer pack-years than did the men, and there was a much larger proportion of women who never smoked. Further studies, specifically on genetic and immunologic characteristics, are under way to identify potential host factors.

Bronchitis↗
PubMedDate not supplied

[Introduction to a study of the hydrosoluble proteins of the sputum (author's transl)].

Synthesis of a study of the proteins outline of the bronchial secretion with the qualitative and quantitative determination of six protein fractions (albumin, Alfa-antitrypsin, acid Alfa-glycoprotein, haptoglobin, transferrin); comparation of the concentration of these fractions of the expectoration with those of the serum of the patient himself.

Albumins↗
PubMed1975

Selective sputum cultures. A bronchial culture technique using a modified nasotracheal suction catheter with a sterile, inner telescoping cannula.

The contamination of expectorated or catheter-aspirated sputum specimens by pathogenic microorganisms which have colonized the nose and oropharynx remains a formidable obstacle to the accurate interpretation of sputum cultures. This problem is encountered in all forms of acute and chronic bronchopulmonary infection. A standard suctioning technique via a nasotracheal catheter has been modified with a telescoping sterile inner cannula to obtain uncontaminated bronchopulmonary secretions for culture. Bacteriologic results of selective bronchial cultures obtained in 18 patients following major chest surgery have provided important considerations concerning the prophylactic use of antibiotics. The telescoping cannula method is a simple, safe, and practical means of selectively monitoring the bacteriologic flora of the lower respiratory tract.

Adult↗
PubMed2000

[Infection and antibiotic use in COPD in primary care].

OBJECTIVES: The aim of this study was to know the opinion of Spanish primary care physicians regarding various aspects of diagnosis and treatment of chronic obstructive pulmonary disease (COPD), particularly with regard to bacterial infection in COPD. METHODS: A 20-item questionnaire about diagnostic and therapeutic aspects of COPD was distributed to 15,000 primary care physicians. The sample was stratified to be representative of Spanish geographic areas. Participation was voluntary and no incentive was provided; assurance of confidentiality of information given. A specially designed program was used for data analysis. RESULTS: Valid responses were obtained from 1,852 physicians (12.3%), 86% of whom were practicing in public clinics. Increased coughing with mucopurulent expectoration was considered the most important sign leading to suspicion of respiratory infection according to 70% of the respondents. The germs that primary care physicians thought responsible for infection in most cases were H. influenzae (83%), S. pneumoniae (79%), Pseudomonas (65%) and M. catarrhalis (61%). Antimicrobial spectrum was considered the main criterion for choosing an antibiotic (by 91%). The most frequently prescribed antibiotics were by order of preference: amoxicillin-clavulanic (50%), macrolides (24%), second and third generation cephalosporins (15%) and others. Mean duration of treatment was seen to be 10 days in nearly all cases. CONCLUSIONS: The primary care physicians surveyed were shown to have a good level of understanding of bacterial infection and its treatment in COPD.

Bacterial Infections↗
PubMed2000

[Chronic necrotizing pulmonary aspergillosis and ankylosing spondylarthritis].

Fibro-bullous disease is a late complication of ankylosing spondylarthritis. Its radiologic features frequently mimics tuberculosis or excavated neoplasm. About 50 to 65% of patients with ankylosing spondylarthritis have chronic aspergillus colonization of their airways. Pulmonary aspergillosis infection occurs in 10 to 30% during evolution. We report two cases of patients with spondylarthritis who developed chronic necrotizing pulmonary aspergillosis. Diagnosis was based on serology, mycologic examination of expectoration and in one case on histology obtain by transbronchial biopsies. Pulmonary complications due to aspergillus species frequently reveal an associated fibro-bullous disease in patients with ankylosing spondylarthritis. This can be reported to diminished chest wall movements in such patients. Treatment is based on administration of anti-fungal drugs. In case of medical treatment failure, thoracic surgery may be indicated.

Adult↗
PubMed2000

Help-seeking behavior and self-medication of a population in an urban area in Turkey: cross sectional study.

AIM: To define help-seeking behavior and self-medication among people with different symptoms and complaints in an industrialized urban area of Turkey. METHODS: This cross-sectional study was carried out in the city center of Kocaeli province, Western Turkey, in October-November 1998. To research help-seeking behavior in respect of secondary prevention and curative practices, we randomly selected households (N=812), interviewed the household members at their home, and recorded the reasons for visiting a pharmacy in 6 pharmacies (N=1,331 visits to pharmacy) in the Kocaeli region. RESULTS: The majority of interviewed people knew the meaning and importance of regular medical checkups, and only 7% had never underwent periodic checkups, mainly because of the lack of interest or time. Self-medication was found to be the dominant mode of help-seeking behavior, especially in the case of pain. The proportion of unprescribed to prescribed drugs was 1:1.75, with analgetics, antipyretics, expectorants, and antitussives as the most commonly requested unprescribed drugs. CONCLUSION: A considerable amount of health care occured within the popular sector, with self-medication and pharmacist's advice as dominant modes of behavior. The health care system should take this into account when planning activities aimed at detection of disease.

Adult↗
PubMed2000

[Infective endocarditis in intravenous drug users. Study of 34 cases].

OBJECTIVE: Infective endocarditis (IE) in injection drug users (IDU) have a special etiologic, epidemiological and clinical characteristics different to IE in the general population. The clinical and evolutive features of a group of IE in IVD are reported. METHODS: A retrospective analysis was made of 34 episodes (24 patients) of IE in IDU in the Catagena Area (Murcia, Sapin). RESULTS: A total 34 episodes, 18 was males (75%) and 6 (25%) females with a age media of 26.1 years (DE, 4.3). Eighty-four percents were infected with human immunodeficiency virus. The location of IE was right-side in 26 (73%), left-side in 7 cases (18%) and right-left in one (2%). Staphylocococcus aureus was isolated in 31 cases (91%), it was meticillin-resistant in 4 cases (13%); Pseudomonas aeruginosa, and Streptococcus equisimilis was isolated in one case each. Fever was present in 33 patients (97%) and more than half were cough, pleuritic chest pain and expectoration. Twenty-five patients with right IE has chest X-ray abnormal, specially nodules-infiltrates pulmonary. Vegetations were not observe in 7 (21%) occasions by transthoracic echocardiography. In six of 8 patients with left-side IE present a cerebri embolisms. Two patients with left IE death (21%). The rate of successful therapy in the right-side IE treated during 2 or 4 weeks were 100%. CONCLUSIONS: The IE in IDU is a entity produced mainly by S. aureus, affect preferentially a right-side cavities and the prognosis is generally good.

Adult↗
PubMed2000

[Detection of bronchopleural fistula by ventilation scintigraphy. Based on one case].

Bronchopleural fistula (BPF) is a rare but extremely serious complication of lung resection surgery. Its diagnosis is often overlooked in the clinical evolution of the patients undergoing surgery due to the subacute presentation of the picture. The procedures used to detect it are either invasive or have low accuracy. We report the case of a patient with lung carcinoma treated by left pneumonectomy in whom BPF was suspected after an episode of coughing and expectoration. The conventional chest x-ray did not show any significant findings while the (99m)Tc-DTPA ventilation lung scintigraphy demonstrated bronchopleural communication in a very early phase.

Adenocarcinoma↗
PubMedDate not supplied

[Evaluation of the efficiency of selected thoracic physiotherapy methods used in the treatment of patients with cystic fibrosis].

In Poland the standard treatment of pulmonary manifestation of cystic fibrosis consists of physiotherapy techniques of postural drainage with clapping. However many studies demonstrated that various alternative airway clearance techniques performed in Europe the last few years have been more effective than postural drainage. The aim of the study was a comparative analysis of the efficiency of selected chest physiotherapy methods used in the treatment of children with cystic fibrosis. We studied 21 patients, aged 5-18 (x 10.57), who were hospitalised in the Paediatric Clinic of National Research Institute of Mother and Child in Warsaw, Poland. We compared five chest physiotherapy techniques: 1 - postural drainage with clapping, 2 - postural drainage with clapping and vibration, 3 - active cycle of breathing technique, 4 - Flutter(R), 5 - Flutter(R) with relaxation. Every investigated drainage method was tested by each patient according to a determined procedure. The following indices were measured: weight of coughed up sputum, oxygen saturation (SaO2) before, during and after drainage, peak expiratory flaw (PEF) before and after drainage. The biggest quantity of sputum determined by its coughed up weight was with active cycle of breathing technique (x 2.126 g). In comparison, in patients using postural drainage with clapping and clapping with vibration average sputum expectoration was 0.895 and 1.012 g. Flutter device is recommended for individual usage. Our findings demonstrate that the Flutter with relaxation effectively facilitates removal of mucus from airways (Flutter - x 1.48 g, Flutter with relaxation - x 2.012 g). We observed PEF decrease (p > 0.05) during postural drainage with clapping and vibration. There were no significant differences in SaO2 between the values before and after drainage in every investigated technique.

Adolescent↗
PubMed2000

[Prevalence of respiratory systems and evaluation of sensitization levels in traditional grain market workers in Casablanca].

Our study proposes to evaluate the prevalence of clinical respiratory symptoms, spirometric abnormalities and allergy skin test sensitivities in two groups: on exposed to grain dust in a big traditional grain market in Casablanca and the other unexposed. The inquiry which concerned 277 exposed workers and 230 non exposed consisted of a questionnaire, spirometric examinations and skin prick testings. Exposed and no exposed groups are statically similar as far as physical data (sex, age, weight, heignt) and smoking habits. The atopy was found among 18% of the exposed. The prevalence of clinical respiratory symptomatology among exposed is 64.3% against 24.8% among non exposed. Respiratory symptoms (cough, expectoration), rhinitis, asthma, conjonctivitis, dermatitis, chronic bronchitis were significantly more frequent in those exposed than in the non exposed. Smoking is at the origin of additional morbidity. Atopy seems to be a potentiating factor as all the atopic people exposed are symptomatic. Respiratory function was altered in 37.1% of those exposed versus 12.8% of those no exposed. Among exposed workers with decline of lung function parameters 68.9% have only light anomalies. Tabacco interferes significantly in the alteration of respiratory function parameters. Work exposure to grain associated with smoking resulted in a reduction in respiratory function values. In grain workers, the prevalence of allergy skin test sensitivities of occupational allergens is 30.3% versus 6.9% among those no exposed. The enquiry in the workplace shows complete absence of means of protection for the work force and elevated levels of dust. It is imperative to implement an occupational health service and to develop means for collective and individual prevention to maximally reduce the risk.

Adult↗
PubMedDate not supplied

Neurogenic pulmonary oedema in a 13-year-old boy in the course of symptomatic epilepsy--case report.

Pulmonary oedema with severe, dramatic course following CNS injury was termed neurogenic pulmonary oedema (NPO). NPO was mainly described as a consequence of grand mal seizures, subarachnoid bleeding, intracranial bleeding or head injury. However, the pathogenesis of NPO is not entirely clear yet. In the majority of cases, early or classic symptoms of pulmonary oedema are evident from several minutes up to several hours after CNS damage. Dyspnoea, chest pain, bloody expectoration are observed shortly after consciousness disorders, although NPO may occasionally be diagnosed on the basis of chest x-ray in patients with no clinical symptoms. Tachypnoea, tachycardia, rales without any changes in cardiac system are usually observed during physical examination. The ailments withdraw quickly in the majority of patients, who may require oxygen therapy at most. NPO has been well-known in adults, but our knowledge of its occurrence in children is still rather sparse. The current work presents a case of a 13-year-old boy with pulmonary oedema as a post-seizure complication.

Adolescent↗
PubMed2001

Acute community-acquired pneumonia: current diagnosis and treatment.

1. Diagnosis of acute community acquired pneumonia is based on the history, physical examination, and chest x-ray. With respect to diagnosis, the clinician should ask, (1) Is the problem pneumonia or something else? (2) Is the pneumonia often treated empirically with a macrolide (erythromycin, clarithromycin, or azithromycin), a "respiratory quinolone" (levofloxacin, moxifloxacin, gatifloxacin, or gemifloxacin) or doxycycline. 4. Concern has expressed that use of quinolones as monotherapy for pneumonia may promote the emergence of resistant strains. However, the quinolones are more reliable than the macrolides and doxycycline against pneumococcal strains that exhibit reduced susceptibility to penicillin G. 5. Appropriate diagnostic studies for patients with moderately-severe to severe pneumonis include sputum Gram's stain and culture (for those patients who expectorate purulent sputum), blood cultures, and acute serum sample, and --in some circumstnaces--urinary antigen test for Legionella pneumophila. 6. Appropriate initial therapy for patients requiring hospitalization includes a third-generation cephalosporin (such as ceftriaxone or cefotaxime) plus a macrolide or a quinolone.

Acute Disease↗
PubMed2000

[Improvement of a case of broncholithiasis after spontaneous lithoptysis].

A 53-year-old woman was admitted for recurrent hemoptysis and cough. The chest radiograph showed an infiltrative shadow in the left upper region. Chest tomogram and CT scan showed a small calcification and consolidation in the left upper lobe. Fiberoptic bronchoscopy revealed fresh hemorrhage from the left upper bronchus but no broncholith or bleeding point were detected. Since the symptoms had disappeared by 10 days after admission, the patient was discharged and followed up as an outpatient. Three weeks later, she spontaneously expectorated a stone 3 mm in maximum diameter, with an irregular surface. Analysis revealed that the stone's composition was 56% of calcium phosphate and 44% of calcium carbonate. Hemoptysis seemed to have been caused by the broncholith, which had originated as a calcification of a peribronchial lymph node that subsequently eroded its way into the airway. After lithoptysis, no recurrence has been observed.

Bronchi↗
PubMed1998

[Pneumocystis carinii pneumopathy in patients with AIDS. The first 3 cases reported in Algeria and review of the literature].

Pneumocystis carinii pneumonia (PCP) is a severe and dangerous infection which afflicts patients with immune deficiency, particularly those with AIDS. This pathology isn't well known in Algeria. The aim of the present study is a contribution to make this disease more known in the algerian AIDS patients. It has focused on the research and the identification of P. carinii in the expectorations and in the bronchalveolar lavage (BAL) fluids of 14 patients with respiratory troubles: 13 were AIDS cases and one with an iatrogenic immune deficiency. 3 of these patients were women and the rest were men. Their average age was 35.

AIDS-Related Opportunistic Infections↗
PubMed2000

Pulmonary manifestations in malaria.

Malaria, a major killer of mankind, apart from classical ague presentation, may present with respiratory manifestations. This may be misdiagnosed and important time may be lost in instituting antimalarials leading to higher morbidity and mortality. Present work was undertaken to study the clinical presentations of malaria with special reference to respiratory system and to evaluate the effect of antimalarials to such atypical presentation. One hundred slide positive cases of malaria were taken and detailed for respiratory involvement. Response to antimalarials was seen in these cases and associated complications (if any) were looked for. Mean age of the cases was 29.3 years with a male predominance. Positivity of peripheral smear read as: P vivax(53%), P falciparum (36%) and mixed infection (11%). Twenty-six patients had presented with respiratory manifestations-bronchitis (15), pneumonia (4), asthmatic bronchitis (1), adult respiratory distress syndrome (ARDS) (4) and pulmonary tuberculosis (2). Of these 26 cases, presenting symptoms noticed were cough (77%), dyspnoea (32%), expectoration (29%) and chest pain (15%). Twenty-five (96%) of these 26 patients were positive for P falciparum. Response to antimalarials was not significantly different in these 26 patients as compared to the rest (74 cases). All patients developing ARDS expired. The present study concludes that malarial atypical respiratory presentations are far higher in incidence than reported in literature. Peripheral smear examination in all patients of high grade fever with chills and rigors and having respiratory manifestations may unmask malarial infection and warrant early antimalarial treatment resulting in decreased morbidity and mortality.

Adult↗
PubMed1998

[Clinical significance of cytokine and eosinophil cationic protein concentrations in sputum of asthmatic patients].

OBJECTIVE: To examine whether levels of inflammatory cytokines and eosinophil cationic protein (ECP) in the sputum reflect the severity of bronchial asthma. METHOD: We collected sputum expectorated spontaneously from 15 asthmatics with acute attacks of moderate to severe degree (MS group) and 10 subjects with acute attacks of mild asthma (M group). The interleukin (IL)-5(35 ng/L) tumor necrosis factor (TNF)-alpha(M 149 +/- 59 ng/L, MS 267 +/- 147 ng/L), soluble IL-2 receptor (sIL-2R) (M 348 +/- 107 kU/L, MS 488 +/- 127 kU/L) levels in the sputum were measured with enzyme-linked immunosorbent assay, and sputum ECP (M 127 +/- 95 micrograms/L, MS 278 +/- 150 micrograms/L) concentration were measured by Immuno-CAP System. RESULT: Sputum IL-5, TNF-alpha, sIL-2R, ECP concentrations in moderate to severe patients were significantly higher than in mild subjects. CONCLUSION: These findings suggest that inflammatory cytokines and mediator levels are detectable in the sputum from asthmatics and they might participate in the exacerbation of asthma.

Adult↗