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Paediatric pulmonology and allergology
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Ieva Laimute Indrejaityte, Iveta Skurvydiene, Arunas Valiulis. Long-term follow up in patients with cystic fibrosis Edvardas Danila, Laimute Jurgauskiene, Radvile Malickaite, Remigijus Nargela, Marija Avizieniene, Regina Aleksoniene, Bronislovas Satkauskas. Bronchoalveolar lavage for the diagnostics of sarcoidosis Laimute Vaideliene, Jurgis Bojarskas. The importance of bronchial hyperresponsiveness diagnosing bronchial asthma in chlidhood Ausra Kaminskaite. CD4 T lymphocyte count and the clinical-radiographic presentation of pulmonary tyberculosis Migle Klimantaviciene, Arunas Valiulis. Bronchial response to salbutamol in preschool children with infection related and non-infection wheezing Aleksandras Balbieris, Remigijus Valdemaras Nargela, Arturas Andziulis, Genius Alfonsas Norvaisas. Quality of life measurement for patients with asthma St.George's respiratory questionnaire Danute Astrauskiene. On Kingella kingae as an emerging cause of invasive infections in children Stanislovas Maknavicius. Mediastinal neurogenic tumours in children Albinas Naudziunas, Skaidrius Miliauskas. Impact of activatied proein C resistance on the clinical presentation of venous thromboembolism Petras Kaltenis. New aspects of the action of macrolide antibiotcs (Review article) Algimantas Vingras, Danute Skuodyte. Diagnosis of atypical infection Global Initiative for Asthma 2002. Pocket Guide for Asthma Management and Prevention |
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Long-term follow up in patients with cystic fibrosis
Ieva Laimute Indrejaityte, Iveta Skurvydiene, Arunas Valiulis
Cystic fibrosis was recognized over 60 years ago. This disease was considered to be "fatal" for a long time. During recent 30 years the length and quality of life patients with CF has significantly improved. These improvements have resulted not only from the cellular and molecular biologic discoveries, but form the modern early diagnostic and more active, effective complex treatment. Mean age of patients with cystic fibrosis in only approximately 15 years (excluding adults findings) in Lithuania. Recently, more effective antibiotics, pancreas enzymes, mucolitics become accessible. The approach to nourishment of CF patients has also changes. In order to prolong CF patients lifetime and improve the quality of life it is necessary to better organize the long-term follow up of patients with CF. The authors present particular and long lasting recommendations containing the experience of the most famous world of CF centers. |
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Bronchoalveolar lavage for the diagnostics of sarcoidosis
Edvardas Danila, Laimute Jurgauskiene, Radvile Malickaite, Remigijus Nargela, Marija Avizieniene, Regina Aleksoniene, Bronislovas Satkauskas
Sarcoidosis is a multisystem disorder with a heightened cellular immune response at sited of disease activity in patients with a predisposition for sarcoidosis and a presumed exposure to as yet unknown transmissible agents. Aim of the study was to evaluate significance of bronchoalveolar lavage fluid (BALF) examination in sarcoid patients. Clinical symptoms, cell differentials and distribution of lymphocyte subgroups in BALF, chest X-ray, spirometric indices, blood gases in 80 sarcoid patients and 38 healthy volunteers were examined. We founded that lymphocyte percentages in BAL fluid from sarcoidosis patients were threefold as high as normals (about 38 perc. compared to 14 perc.). Spontaneous macrophage-lymphocyte rosettes were found in 63 perc. of these patients. BALF CD4/CD8 ration in sarcoid patients was 7.2±4.6 as compared to 1.3±0.7 in healthy volunteers. We concluded that BALF examination may confirm the diagnosis of sarcoidosis. |
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The importance of bronchial hyperresponsiveness diagnosing bronchial asthma in childhood
Laimute Vaideliene, Jurgis Bojarskas
Not much is still known about bronchial hyperreactivity in asthmatic and allergic children. The task of our study was to evaluate the relationship of bronchial hyperresponsiveness, asthma and other allergic diseases in childhood. According our results, bronchial hyperresponsiveness was not found only in 29.0 perc. of children, allergic to some aeroallergens and having some symptoms of allergy. Even 27.3 perc. of children had positive bronchial hyperresponsiveness tests, not having clinical symptoms of obstruction. Positive bronchial hyperresponsiveness test was found in all 30 children, having asthma symptoms, but asthma was diagnosed only in 70 perc. of these patients. 70 perc. of children, having allergic rhinitis symptoms without wheezing, had bronchial hyperresponsiveness, as well. Bronchial hyperresponsiveness was not existing in children with atopic dermetitis symptoms only. Our data showed, that dry cough in children, allergic to some aeroallergens was related with bronchial hyperresponsiveness more often (80 perc.) in comparison with non allergic children (50 perc.) and data were statistically significant.
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CD4 T lymphocyte count and the clinical-radiographic presentation of pulmonary tuberculosis
Ausra Kaminskaite
The analysis between radiographic presentation and CD4 T lymphocyte count was performed after evaluation of blood CD4 T lymphocyte count and CD4/CD8. The first group included 12 patients (11 males, 1 female, aged 28-45) with spread cavitary pulmonary tuberculosis: radiographs were evaluated for the presence of dissemination or infiltration in more than two lobes and cavities. Tuberculosis for all 12 patients was confirmed by bacteriology. The second group included 6 patients (males, aged 21-74) with acute hematogenic generalised tuberculosis: 5 - miliary tuberculosis with signs of hematogenic pulmonary dissemination, 1 - generalised tuberculous lymphadenitis without pulmonary changes. Diagnosis of tuberculosis for them was confirmed by histology. In the first group CD4 T lymphocyte count in many cases was normal: 580-870/mkl (50 perc. ± 10 perc.); CD4/CD8 - 2.5±0.8. In the second group CD4 T lymphocyte count was significantly decreased: 103-375/mkl (16.5 perc. ± 9.5 perc.); CD4/CD8 - 0.69±0.5. The results shows the evidence of the relationship between clinical-radiographic presentation of pulmonary tuberculosis and CD4 T lymphocyte count. |
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Bronchial response to salbutamol in preschool children with infection related and non-infection wheezing
Migle Klimantaviciene, Arunas Valiulis
The purpose of this study was to compare airway resistance (Rint) and bronchodilator response of infection related and non-infection wheezing. Rint was measured before (baseline) and after salbutamol treatment (postbronchodilator) in 15 children with atopic asthma and 19 with infection related wheezing bronchitis. Control group for measure of baseline Rint was recruited of 213 healthy children. The mean age was 4 (2-6) years. It was found no differences of mean baseline Rint in all three groups. At the same time bronchodilator response was significantly higher in asthmatic children compare with infection related wheezing bronchitis: the mean ratios of baseline to postsalbutamol measurements was 1.38 (28 perc. change) and 1.17 (15 perc.) respectively. It was confirmed different airway responsiveness in preschool children with atopic asthma and infection related wheezing bronchitis.
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Quality of life measurement for patients with asthma St. George's respiratory questionnaire
Aleksandras Balbieris, Remigijus Valdemaras Nargela, Arturas Andziulis, Genius Alfonsas Norvaisas
Quality of life of 601 patients with bronchial asthma was assessed by St.George respiratory questionnaire (SGRQ). SGRQ measures showed QL impairment, which was independent of severity of disease (95 perc. confidence intervals for TOTAL index 53-55, for SYMPTOMS 64-68, for IMPACT 43-46, for ACTIVITY 60-64). Addressing the character of impairment, patients indicated that the SYMPTOMS disturbed their quality of life most of all, the decrease of ACTIVITY negatively influenced quality of life to a lesser extent, and the limitations of IMPACT had the least influence. Correlation of all measures with the main integrated TOTAL index was confirmed as valid, sufficiently determined and having satisfactory internal consistency. SGRQ measures were independent of the following demographic data: age, gender and the duration of disease.
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On Kingella kingae as an emerging cause of invasive infections in children
Danute Astrauskiene
Kingella kingae, the â-hemolytic gram-negative bacillus was described four decades ago. As a part of commensal flora of upper respiratory tract it could be isolated in 1 perc. of children. K.kingae has been given extensive studies in the recent decade as has been found to cause invasive infections in children more often than it was thought earlier. It was ascertained that the best way for isolation of K.kingae is to take material from the tonsilar surface and to grow on the blood agar medium with the addition of vancomycin. BACTEC blood culture bottles of BacT/Alert system (Organon Teknika, USA) media are advised for the isolation of this bacterium from the synovial fluid. The organism is usually susceptible to ß-lactam drugs, macrolides, tetracycline, gentamicin, chloramphenicol, ciprofloxacin, cotrimoxazole and resistant to vancomycin. The damaged upper respiratory tract mucosa, most often by viral disease, favours dissemination of K.kingae and the onset of invasive disease. Most of K.kingae invasive infections are observed in children up to 5 years, with the highest frequency at the age of 6-24 months. Septic arthiritis and osteomyelitis are the most common clinical presentations and constitute about three quarters of invasive infections caused by K.kingae. Other invasive diseases are endocarditis (observed also in school-age children and adults), meningitis, diseases of lower respiratory tract, ocular diseases, soft tissue diseases, symptomatic bacteremias. Except for some cases of endocarditis, invasive K.kingae infections generally follow a benign clinical course after administration of antibiotic therapy.
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Mediastinal neurogenic tumours in children
Stanislovas Maknavicius
In the majority of cases neurological mediastinal tumours were diagnosed because of increased lymph nodes in the neck region, decreased activity of the child, pain in the bones and joints, anemia, bronchitis. Posterior-anterior and lateral X-ray examination, CT, MRI, sonoscopy, bronchoscopy and histological examination were used to make the correct diagnosis. In the period of 1979-2001 we have treated 29 children due to neurological mediastinal tumours. We had 20 cases of malignant tubours, 9 cases - benign. Surgery was the main method of diagnosis and treatment. Radical treatment is impossible in the stages 3 and 4 of the tumour. Treatment consists of extirpation of the tumour, biopsy of mediastinal or neck region lymph nodes of histological examination and chemotherapy following the operation. Patients with benign neurogenic tumours recovered after the operation.
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Impact of activated protein C resistance on the clinical presentation of venous thormboembolism
Albinas Naudziunas, Skaidrius Miliauskas
The aim of the study - to establish incidence of activated protein C resistance (APC-R) in cases of venous thromboembolism (VT) and healthy people, to determine influence of APC-R on patients' age, relapse of VT. Inherited APC-R, as a VT risk factor for those who were ill with VT was found in 22.1±4.07% cases and 7.1±3.07% for healthy people (difference of probabilities 0.15). APC-R is a VT risk factor for the various age people, and not for young patients only: the patients, who had APC-R, age during the first VT episode was 44.6±17.85 years old, and those, who didn't have APC-R - 50.4±15.34 years old (t=1.536, p=0.128). A positive family VT history is not a reliable criterion for selection of persons who should be examined for inherited APC-R: APC-R was found for 21.0% of patients, which family thrombosis history was positive and for 22.4% of patients, which this history was negative (p>0.05). Inherited APC-R is not significant factor for VT recurrence. APC-R was found of 28.6% patients with VT recurrence, and 20.5% patients not having the recurrence (p>0.05). APC-R is a VT risk factor in patients being ill with the various underlying diseases. No dependence of APC-R and the PE underlying diseases was found (p of exact X2 criterion for probability comparison was >0.05).
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New aspects of the action of macrolide antibiotics (Review article) Petras Kaltenis The aim of this article is to present a short historical review and the newest data on the influence of macrolide antibiotics on inflammatory reaction and immune response. It is shown that some macrolides used with glucocorticoids to treat bronchial asthma lower the need for steroids (steroid-sparing effect). Most of macrolides act in some way the metabolism of cytokines, reactive oxygen radicals and other mediators of inflammatory reaction and immune response. Some data on positive influence of macorlides in treatment of bronchial asthma, chronic sinusitis and cystic fibrosis are presented.
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Diagnostics of atypical infection Algimantas Vingras, Danute Skuodyte
Atypical infectious agents - M.pneumoniae and C.pneumoniae become more frequent among the other infectious agents of upper and lower respiratory tract diseases. Epidemiological data, clinical symptoms, blood and radiological changes do not allow reliable differentiation of the causative infectious agent - virus, bacteria, including atypical. Thus, children with upper and lower respiratory tract diseases should be investigated for atypical infectious agents more frequently, especially if disease is of prolonged character. In the papter clinical symptoms of upper and lower respiratory diseases caused by M.pneumonia and C.pneumoniae are discussed, as well as laboratory diagnosis and its interpretation. Enzyme immunoassay method is preferred for the laboratory diagnosis. Recommendations for specific IgG and IgM assays are presented. |
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October, 2002, Vol. V, No.3 (p. 1801-1902)
