Respiratory allergy and the relationship between early childhood lower respiratory illness and subsequent lung function

In a study of 159 school-age children whose histories of outpatient visits for lower respiratory illness (LRI) had been documented from early infancy, we observed lower mean levels of small airway function in boys who had experienced two or more episodes of wheezing-associated LRI before 6 yr of age. To determine whether allergy was an important factor influencing this result, we examined relationships among the results of RAST tests for seven common inhalant allergens and concurrent lung function in 126 subjects who consented to venipuncture. Increasing values for the sum of scores for the seven RAST tests were associated with progressively lower mean levels of small airways function in boys with histories of recurrent wheezing LRI during the preschool years. The association of allergy with lower levels of lung function was largely accounted for by dust mite allergy. RAST results were not correlated with lung function in boys who had experienced zero or 1 wheezing LRI before 6 yr of age or in girls. A history of recurrent wheezing LRI during the preschool years was also associated with significantly lower mean levels of small airways function in boys who had negative RAST tests. A subset of 49 boys was reevaluated after an average interval of 4 yr with RAST tests, spirometry, and methacholine challenge. Dust mite allergy was associated with an increased prevalence of bronchial hyperreactivity independent of early childhood wheezing LRI history.(ABSTRACT TRUNCATED AT 250 WORDS)

Stridor in infants and children: ambulatory evaluation and operative diagnosis

The presence of stridor in the young child suggests a congenital or acquired abnormality of the large diameter airways. The diagnostic evaluation of the stridulous child is discussed. Emphasis is placed on those outpatient examination techniques and radiographic studies which can define the nature of the offending airway lesion(s).

Changes in chronic respiratory symptoms in two populations of adults studied longitudinally over 13 years

Data from two longitudinal studies conducted in Cracow, Poland, and Tucson, Arizona, USA, were used to evaluate the differences in period prevalence, incidence and remission rates of respiratory symptoms between two populations, as well as to assess the between-cities similarities in the relationships of the symptoms to age and smoking habit. The analysis was based on data from 3,082 adult Cracow residents, interviewed twice 13 yrs apart, and from 1,452 Tucson adults, with mean period between initial and final survey of 12.2 yrs. Log-linear models were used to consider possible interactions of the symptoms, age, smoking, gender and city. The relationship of the symptoms to smoking was similar in both cities, after adjustment for age and gender, with at least doubled incidence rates of most symptoms in continuous smokers compared to lifetime nonsmokers. The between-population differences in the symptoms were related to age, indicating onset of bronchitic symptoms occurring earlier in life in Cracow, and of asthmatic symptoms in Tucson. These differences were due to factors other than tobacco smoking e.g. various types of ambient air pollution.

Preliminary assessment of prevalence of toxoplasmosis in patients with chest diseases

Frequency of Toxoplasma antibodies in chest disease patients was assessed by IFAT. An overall positivity of 20.5% was recorded which is the range of prevalences reported in Egypt. The majority (90.3%) were positive at titre 1/16 and one case of atypical pneumonia showed titre of 1/256. The implications are discussed.

Higher lifetime prevalence of respiratory diseases in panic disorder?

Current and past frequencies of respiratory diseases were assessed in 30 patients with panic disorder, 30 patients with obsessive-compulsive disorder, and 30 patients with eating disorders. Lifetime prevalence of respiratory disorders was significantly higher in patients with panic disorder (47%) than in patients with either obsessive-compulsive disorder (13%) or eating disorder (13%). Point prevalences showed no differences.

Impact of influenza on morbidity in children with cystic fibrosis

Recommendations concerning annual influenza vaccination in children suffering from cystic fibrosis (CF) are not uniform. Previous studies have shown that influenza causes a small proportion of episodes of acute respiratory deterioration in CF patients. During the 1989 Australian winter, we studied the association between serologically proven influenza infection and acute respiratory morbidity in 20 children with CF. Six children were shown to have influenza infection, four with type A and two with type B. Four of five children requiring hospital admission were shown to have influenza, but only 2 of 15 did not need admission (P less than or equal to 0.025). As well, influenza was diagnosed in 6 of 12 children who suffered acute respiratory illness leading to school absenteeism (including hospitalization), but diagnosed in no children without this degree of illness (P less than or equal to 0.025). Influenza significantly increases the incidence of hospitalization and of less serious respiratory illness in children with CF, a finding which suggests that influenza vaccine efficacy studies are necessary in this group.

Is a chest radiograph necessary in the evaluation of every febrile infant less than 8 weeks of age?

This study was designed to examine the relationship between respiratory signs and the likelihood of having an abnormal chest radiograph in a sample of febrile infants less than 8 weeks of age. The sample consisted of 242 infants who were admitted during a 3-year period with temperatures greater than or equal to 38 degrees C (100.4 degrees F) and had a chest radiograph. The house officer recorded the presence of respiratory signs and symptoms including rhinorrhea, tachypnea, cough, rales, wheezes, retractions, and rhonchi. Each chest radiograph was reviewed independently according to predetermined criteria by a senior radiology resident and an attending pediatric radiologist. Interobserver agreement was 91%. Both observers were blind to the infants' respiratory signs. The chest radiograph interpretations were compared with the presence of respiratory signs. Of the 242 cases, 228 had chest radiographs available for interpretation. Of these, 27 chest radiographs (12%) were identified as abnormal, including 6 where there was initial disagreement as to the presence of an abnormality. Twenty-five (31%) of 80 infants with any respiratory signs had an abnormal chest radiograph, whereas only 2 (1%) of 148 asymptomatic infants did. The sensitivity of respiratory signs was 93% (confidence interval = 76% to 99%). These findings suggest that in the absence of respiratory signs, febrile infants are unlikely to have an abnormal chest radiograph.

[HLA-B27 in the families of probands with arthritis after acute respiratory tract disease]

HLA B27 antigen was found in 10/25 patients with arthritis after acute respiratory disease (ARD) and in 21/75 direct relatives of 23 of these probands, where a genealogical investigation could be made. With regard to the 9.5% incidence of HLA B27 in the Czech population this implies a positive association in patients (RR = 6.35) and direct relatives (R = 3.70). In the sub-group of HLA B27 positive probands HLA B27 positivity was found in 19/27 (70.4%) of direct relatives (RR = 22.6). In one female relative a recurrent monoarthritis of the talo-crural joint was found, the remainder did not suffer from inflammatory changes of the joints. The revealed positive associations indicate the probability of arthritis after ARD in HLA B27 positive subjects and their families. They indicate also that in arthritis after ARD reactive arthritis is involved with a less common organ manifestation of the initial infection.

Otitis media: the pathogenesis approach. Assessment and treatment of associated upper respiratory tract pathology

The communication of the middle ear with the nasopharynx via the Eustachian tube makes it susceptible to disease processes of the upper airway. It is therefore necessary for patients with otitis media to have a thorough evaluation of the upper airway for detection and management of any concurrent pathologic condition. This article reviews the various upper respiratory tract pathologic entities associated with otitis media.

[Clinical evaluation of ciprofloxacin in pulmonary infections in the patients with chronic respiratory diseases]

The clinical efficacy of ciprofloxacin (CPFX) was investigated in pulmonary infections in patients with chronic respiratory diseases. Out of 58 cases collected, 54 were evaluable for utility of CPFX including 20 with pneumonia, 34 with chronic bronchial infection. CPFX was given orally at 200 mg 3 times per day. In 20 cases of pneumonia, the mean age was 62.0 years underlying diseases were chronic bronchitis 9, bronchiectasis 6, inactive pulmonary tuberculosis 4, and diffuse panbronchiolitis 1. The efficacy rate of CPFX in this group was 90.0%. In 34 cases of chronic bronchial infection, the mean age was 59.8 years, underlying diseases included bronchiectasis 10, chronic bronchitis 8, inactive pulmonary tuberculosis 7, diffuse panbronchiolitis 5, and pulmonary emphysema 4. The efficacy rate of CPFX in this group was 70.6%. The overall efficacy rate in the entire cases was 77.8%, and we consider CPFX to be effective in the treatment of patients with chronic respiratory diseases.

[Etiological, clinical and roentgenological aspects of mediastinal emphysema in children and adolescents]

The authors publish 8 cases of emphysema of the mediastinum in childhood and adolescence. The aetiologic variety and the radiologic symptoms are presented. Chronic diseases of the lungs and the respiratory tract, injuries of the thorax or iatrogenic genesis are the cause of emphysema. The spontaneous emphysema of the mediastinum is rare in childhood and adolescence.

Risk factors in relation to postoperative complications and mortality after total gastrectomy in aged patients

To clarify the risk factors contributing to postoperative complications in elderly patients undergoing total gastrectomy, 84 patients with primary gastric cancer were evaluated. Twenty-seven patients were older than 65 years of age; they had much more preoperative cardiac (P = 0.00003), respiratory (P = 0.0008), and multiorgan impairment (P = 0.009) than did the control group (age less than 65 yrs). Although overall morbidities (44.4% vs. 19.2%; P = 0.01) and overall septic complication rates (33.3% vs. 12.2%; P = 0.02) were higher in aged patients, no significant differences between the two groups were found in the incidence of major surgical complications (18.5% in aged patients vs. 10.5% in control groups; P = NS), serious septic (sepsis score greater than 10) complications (18.5% vs. 7.0%; P = NS) and hospital mortalities (11.1% vs. 3.5%; P = NS). In older patients the occurrence of multiorgan impairment and malnutrition was significantly related to postoperative complication rates. These results suggest that the degree of organ impairment rather than age is predictive of postoperative difficulty and should be used in assessing preoperative risk.

[Evaluation of an anamnesis questionnaire for the diagnosis of sleep apnea in patients with chronic diseases of the respiratory organs]

In a Rehabilitation Clinic for Diseases of the Respiratory Organs we examined 497 male patients aged 45.9 +/- 11.1 years with a relative weight of 109 +/- 16.7% who were suffering from chronic diseases of the respiratory tract (66.2% chronic bronchitis, 33.8% asthma bronchiale, 49.6% obstruction of the respiratory tract). They were subjected to a detailed physical examination and were given an anamnestic questionnaire for the purpose of diagnosing sleep-related respiratory disturbances (Siegrist et al., 1987). In addition, whole body plethysmography was performed in all patients as well as a pulse-oximetric examination during night sleep. Using factor analysis, it was possible to extract 5 factors from the 23 items of the anamnesis questionnaire. With these 5 factors, 60.5% of the total variance could be explained. These factors describe: 1. Dyspnoea (35.3%); 2. Vigilance (8.5%); 3. Sleep disturbances (6.3%); 4. Headache (5.8%) and 5. Snoring (4.7%). Different factor patterns are seen for different groups of patients. In patients suspected of an obstructive sleep apnoea syndrome, however, it will always be necessary to perform further stage-wise diagnosis to safeguard the diagnosis.

Pertussis in French adolescents: risk factors and respiratory sequels

An analysis of the risk factors for pertussis and the possible respiratory sequels was carried out in a sample of 499 children and adolescents aged 10-16 years from the general population in north-eastern France. 44 subjects (8.8%) had pertussis during childhood; and the sex ratio was 1 in these cases. Pertussis was significantly associated with a maternal history of respiratory disease, residence in a rural area and coal heating. In a multiple logistic regression model, a maternal history of respiratory disease was the only significant factor (p = 0.01), the number of siblings being of borderline significance (p = 0.06). No increase in respiratory symptoms or asthma prevalence was found in our subjects who had pertussis during childhood.

Symptoms of respiratory allergies are worse in subjects with coexisting food sensitization

Food sensitization was evaluated in 78 subjects with respiratory allergies, both by skin tests with commercial and fresh allergens, and by specific IgE determination. On the basis of the presence or absence of the latter the population was divided into two groups. The group with food-specific IgE showed more severe features of respiratory allergy, including a greater number of positive skin tests and specific IgE determinations, more class 3 and 4 reactions, and more symptoms. The hypothesis that early food sensitization can predispose to severe inhalant allergy is discussed.

Clinical prediction rule for pulmonary infiltrates

OBJECTIVE

To derive and validate a clinical rule for predicting pneumonic infiltrates in adult patients with acute respiratory illness.

DESIGN

Prevalence studies in three settings.

SETTING

Emergency departments of the University of Illinois Hospital at Chicago, the University of Nebraska Medical Center at Omaha, and the Medical College of Virginia at Richmond.

PATIENTS

Symptoms, signs, comorbidity data, and chest roentgenogram results were recorded for 1134 patients from Illinois (the derivation set), 150 patients from Nebraska, and 152 patients from Virginia (the validation sets). All patients presented to the emergency department and had a chest roentgenogram to evaluate fever or respiratory complaints.

MEASUREMENTS AND MAIN RESULTS

Within the training set, temperature greater than 37.8 degrees C, pulse greater than 100 beats/min, rales, decreased breath sounds, and the absence of asthma were identified as significant predictors of radiographically proved pneumonia in a stepwise logistic regression model (P = 0.001). The logistic rule discriminated patients with and without pneumonia in the training set with a receiver operating characteristic (ROC) area of 0.82. In the validation sets, the rule discriminated pneumonia and nonpneumonia with ROC areas of 0.82 and 0.76 after adjusting for differences in disease prevalence (P greater than 0.2 compared with the training set). The predicted probability of having pneumonia for patients with different clinical findings corresponded closely with the incidence of pneumonia among patients with such findings in the three settings.

CONCLUSIONS

Among adults presenting with acute respiratory illness, a prediction rule based on clinical findings accurately discriminated patients with and without radiographic pneumonia, and was used in two other samples of patients without significant decrement in discriminatory ability. This rule can be used by physicians to develop more effective strategies for detecting pneumonia and for helping to determine the need for radiologic study among patients with acute respiratory disease.

Chest pain in teenagers. When is it significant?

Chest pain in teenagers often has no obvious organic cause. Onset of symptoms with an emotionally stressful situation may indicate psychogenic chest pain. The differential diagnosis also includes cardiac, musculoskeletal, gastrointestinal, and respiratory disorders. Routine testing generally does not help to establish a diagnosis and may even do harm by reinforcing a patient's unspoken fear of serious illness. Most teenagers with chest pain have no such illness, and symptoms usually resolve without therapy. An important role for primary care physicians is to provide support during evaluation and follow-up.

Serum copper, zinc, calcium and phosphorus concentrations of calves stressed by bovine respiratory disease and infectious bovine rhinotracheitis

The relationship between serum minerals and stress and(or) disease has not been fully evaluated in beef cattle. Two trials were conducted to determine the changes in serum Cu and Zn during market-transit stress and(or) disease. Two additional trials were conducted to determine the changes in serum Cu and Zn after inoculation with infectious bovine rhinotracheitis virus (IBRV), with one of the trials determining the changes in serum Ca and P. Trials 1 (n = 80) and 2 (n = 100) utilized calves that were handled through a normal market-transit system and transported 1,967 km to the feedlot. Trials 3 (n = 37) and 4 (n = 8) used calves that were sero-negative to IBRV and then challenged with 2.7 x 10(5) plaque-forming units of the virus. Serum samples were collected at specified intervals and serum minerals were measured for each trial. Serum Zn for morbid or IBRV-challenged calves was decreased by 34, 57, 29 and 15% (P less than .05) for the four trials, respectively, at peak morbidity. Serum Cu of morbid or IBRV-challenged calves increased 5, 15, 40 and 33% for the four trials, respectively, at peak morbidity. Feed intakes were lower during morbidity for market-transit trials and after IBRV inoculation. Lower feed intake could partially explain the decrease in serum Zn; however, when feed intake was held constant, serum Zn concentration still decreased. Serum Zn decreased and serum Cu increased during market-transit morbidity or after IBRV.

Natural history of peptic ulcer disease in Poland. Part. IX. Peptic ulcer disease and cardiovascular and respiratory system diseases

Another analysis of the Ulcer databank was concerned with the incidence of cardiovascular diseases, respiratory diseases and pulmonary emphysema in patients with peptic ulcer. In the studied population of 5813 patients with peptic ulcer 744 (12.79%) had cardiovascular diseases, 437 (7.51%) had respiratory diseases, and 17 (0.29%) had pulmonary emphysema.

Pneumothorax in the newborn with respiratory difficulties

Pneumothorax develops when extraalveolar air ruptures into the pleural space with partial or complete collapse of the affected lung. Pneumothorax can occur at any time during the newborn period, but it usually appears as a complication of some other respiratory problem. The purpose of this study is to known the incidence of pneumothorax due to the respiratory difficulties. The materials were taken from 2368 neonates suffering from respiratory difficulties, out of 7445 neonates born in Cipto Mangunkusumo General Hospital in 1987 and 1988. All these babies were put on radiological examination. Among those 10 babies were diagnosed as pneumothorax. It occurred as a complication of severe asphyxia (due to over vigorous initial resuscitation), and its incidence was 0.09%, that of respiratory distress syndrome (2.13%), bronchopneumonia (6.25%) and aspiration pneumonia (2.8%). The overall incidence of pneumothorax in the newborn with respiratory difficulties was 0.42% and the mortality 20%.