Are morning headaches part of obstructive sleep apnea syndrome?

To determine whether morning headaches are a consistent symptom in sleep apnea, we reviewed clinical and polysomnographic data of 304 patients with sleep apnea and compared the findings with normal control subjects and with three other groups of patients seen at a sleep disorders center. Eighteen percent of patients with sleep apnea had frequent morning headaches compared with 21% to 38% in the other groups of patients and 6% of control subjects. In patients with sleep apnea, morning headaches were most common in those with mild predominantly nonobstructive apnea. Polysomnographic characteristics of patients with moderate to severe sleep apnea did not significantly differ between patients with frequent headaches and those without such headaches. Frequent morning headaches are a nonspecific symptom in patients with sleep disorders and are not a consistent or reliable symptom of sleep apnea syndrome.

Respiratory cryptosporidiosis in a patient with malignant lymphoma. Report of a case and review of the literature

Respiratory cryptosporidiosis is a rare complication of intestinal infection by cryptosporidia, with only six cases reported (to our knowledge) since its first description in 1983. We report the first case of respiratory cryptosporidiosis recognized at the National Institutes of Health, Bethesda, Md. An antemortem diagnosis was made based on recognition of acid-fast cryptosporidia in an induced sputum specimen obtained from a 64-year-old woman with malignant lymphoma and an associated profound immunodeficiency. Autopsy confirmed the presence of cryptosporidia along the apical aspect of the respiratory epithelium lining the trachea, bronchi, and bronchioles. Cryptosporidia were also identified in the duodenum and gallbladder. Immunohistochemical staining of the paraffin-embedded autopsy lung sections using a monoclonal antibody verified the diagnosis of cryptosporidiosis. Review of our case and the literature suggests that respiratory cryptosporidiosis is characterized by a chronic tracheitis, bronchitis, and bronchiolitis but generally does not cause severe pulmonary dysfunction.

Peripheral vs central squamous cell carcinoma of the lung. A comparison of clinical features, histopathology, and survival

We reviewed the clinical features and histopathologic findings of 21 peripheral pulmonary squamous cell carcinomas (SCC) resected at our institution between 1961 and 1981 and compared them with 19 central SCCs. Histologic features were scored semiquantitatively from 0 to 3+. Peripheral SCC represented 16% of all resected SCCs. The proportion of patients with multiple symptoms was lower and survival during the 5 years after surgery was better in the peripheral group. Tumor size, mitoses per high-power field (2.4 +/- 0.3 vs 4.1 +/- 0.6 [SEM]), prevalence of lymphatic invasion (19% vs 58%), and lymph node metastases (5% vs 37%) were lower, while chest wall invasion was more frequent (25% vs 0) for peripheral SCCs. Peripheral tumors also had more intense (2 or 3+) lymphoplasmacytic (86% vs 47%) and desmoplastic (95% vs 68%) reactions. Cox regression analysis did not support a significant relationship between tumor location and survival. We conclude that, compared with the central SCC, peripheral SCC is associated with fewer symptoms at presentation and better survival. Morphologically, peripheral SCCs are smaller, have fewer mitoses, less prevalent lymphatic invasion, and a more intense stromal reaction. Improved survival in patients with peripheral SCC may be due to a more favorable stage at the time of initial treatment.

[Feeding problems in infants with bronchopulmonary dysplasia and other chronic respiratory disorders]

Long lasting feeding problems can occur in children who, in the neonatal period, needed intensive treatment for severe respiratory disease. In some of these children long-term (months) gavage feeding is needed. Retrospectively a group consisting of 16 children with extended feeding problems after neonatal respiratory disease was examined. The results are being described in this article.

[Evaluation of the effects of pneumogenic hypoxemia on the nervous tissue by the determination of the critical flicker fusion frequency of the central retina]

Considering the eye an extroflection of the brain it is possible to detect a decrease of nervous tissues efficiency during hypoxia through a deficit of eye function. The authors studied a highly specialized retinal function that is extremely sensitive to low values of PaO2: the so called "critical flicker fusion frequency". The authors tested 14 patients with respiratory disorders and PaO2 levels between 36.5 and 67.1 mmHg. All patients showed impairment of this function.

Epidemiology of obstruction, exacerbations and hyperreactivity. Effects of glucocorticosteroids and other anti-inflammatory treatment

Validated and standardized questions are available for self-reporting of exacerbations of symptoms due to bronchopulmonary infections but not for non-infective exacerbations. The presence of non-specific bronchial hyperresponsiveness may help to identify smokers with a high risk of rapid decline in lung function, but change in bronchial responsiveness with treatment probably cannot be used to predict subsequent long-term progression in FEV1. In non-asthmatic individuals three months' treatment with glucocorticosteroids has not improved FEV1 nor reduced bronchial responsiveness; the effects of glucocorticosteroids on bronchial secretions and infections and long-term decline in FEV1 are largely unknown.

Respiratory complications in children with spondyloepiphyseal dysplasia congenita

Mild respiratory distress at birth is a common occurrence in infants with spondyloepiphyseal dysplasia congenita (SEDC) while severe respiratory insufficiency and death have been reported only rarely. We describe three infants with SEDC who experienced severe respiratory complications and required tracheostomies. Two of these infants have also needed long-term continuous positive airway pressure to maintain adequate ventilation. The features and clinical course of these children are described, previous reports of respiratory complications in SEDC are summarized, mechanisms resulting in respiratory problems in SEDC are postulated, and comparison is made with mechanisms giving rise to respiratory risks in other skeletal dysplasias.

Restoring functional independence in the older hip fracture patient

The older patient requiring major orthopedic surgery for a hip fracture is at risk of poor outcome if special precautions are not taken during the perioperative period. Close attention must be paid to associated medical problems and the use of medications, especially during the postoperative period. Surgical success and rehabilitation with a return to a high level of function can be best assured through good cooperation between primary care physicians, internists, and orthopedic surgeons.

Back pain, ventilatory function, chest symptoms, and smoking

Tests of ventilatory function were made and a history of previous back pain was obtained from 909 volunteers (592 men and 317 women). One year later, using postal questionnaires, they were asked about their experience of back pain in the ensuing 12 months and about smoking habits, breathlessness, coughing, and the bringing up of phlegm. From the frequency of their experience of back pain, the population was divided into "nonbacks," "mild backs," and "chronic backs." From their answers to the MRC Questionnaire on respiratory symptoms they were divided first into good, mild, and bad with regard to chest symptoms; and also into smokers, exsmokers, and nonsmokers. Ventilatory function tests were reduced in both smokers and "bad chests" and chest symptoms were significantly worse in smokers. Women with back pain were more likely to be smokers, but men with back pain were not. Chest symptoms were significantly worse in "chronic backs," whether men or women. The results suggest that previous reports of a relation between smoking and back pain arose incidentally from the associations between (a) chest and back symptoms and (b) chest symptoms and smoking.

Amyloidosis in pigtailed macaques (Macaca nemestrina): epidemiologic aspects

A retrospective study of amyloidosis in pigtailed macaques (Macaca nemestrina) at the Washington Regional Primate Research Center (WRPRC) was conducted. Between 1971 and 1985, 248 of 1,952 (13%) necropsies revealed amyloidosis in pigtailed macaques. The influence of demographic factors, diseases and experimental interventions on amyloidosis was examined. Univariate analyses, using two controls for each case, indicated that age, sex, birthplace and residence were related to amyloidosis. After adjusting for age, females were not at greater risk. However, monkeys born at the WRPRC were at greater risk and monkeys 0 to 5 years old residing at the breeding colony were at greater risk than monkeys at the research center. After adjustment for age, monkeys were at greater risk of developing amyloidosis if they had a history of episodes of diarrhea, respiratory disease or trauma. As the number of episodes increased, the risk increased. Monkeys with retroperitoneal fibromatosis, a manifestation of simian D retrovirus infection, were also at greater risk. Using logistic regression and controlling for age, sex, birthplace and residence, monkeys with diarrhea remained at an elevated risk for amyloidosis. Compared with a model combining diarrhea, respiratory disease, septicemia, surgery, trauma and retroperitoneal fibromatosis, a model with diarrhea alone accounted for most of the increased risk.

[Stridor in children]

Stridor is the presenting symptom of abnormalities of larynx and trachea in children. The anatomical differences in size and consistency of the larynx play a crucial role in stridor in children as compared with adults. From 1983 to 1988, 81 children (65 males, 16 females) with severe or prolonged stridor were admitted to our hospital. Thorough examination, including endoscopy of larynx and trachea and radiology revealed various congenital abnormalities and acquired conditions as the cause of stridor. Congenital laryngeal anomalies accounted for stridor in 26 children, there were 12 children with congenital tracheal or vascular anomalies, 28 with infectious diseases and 15 with other diseases. Intubation and (or) tracheotomy were performed in one-third of the patients: 5 of them died of severe complications. For proper treatment of children with stridor it is essential to investigate its aetiology carefully.

[Evaluation of the treatment with levodropropizine of respiratory diseases in children]

Sometimes, antitussives can be a valid adjuvant to respiratory tract infections treatment. Although not always needed, this therapeutic support can be extremely useful in selected cases, and when patient is resident and monitored. In this line, the efficacy of a new peripheral antitussive, levodropropizine (Dompé farmaceutici, Milan), has been evaluated in 70 children inpatients of the Pediatric Department at san Paolo Hospital - Milan University - from September 1987 to May 1988. Thirty one male and 29 female children, aged 4 years and 6 months +/- 3 years and 5 months, suffering from various respiratory tract diseases were included in the study. Underlying diseases were represented by 21 acute bronchitis, 20 asthmatic attacks, 18 bronchopneumonia, 11 tracheitis, 6 acute episodes of chronic bronchitis, 2 hypoglottis laryngitis, 1 pertussis, 1 spontaneous pneumothorax. All parents gave their oral informed consent. The basic treatments were antibiotics in 44 patients associated or not with beta 2 agonists (31), theophylline (15), corticosteroids via aerosol (9) or parenterally (3), immunomodulators (2). Treatment with levodropropizine in the oral drops formulation at 2 mg pro kg a day was continued for 5 days and withdrawn according to the clinical evolution. Cough was registered by means of appropriate record forms given to the parents as well as with 120' tape recording whenever possible, i.e. 60 minutes before and 60 minutes after drug administration, on day one and 2. At treatment end, parents and investigator gave an antitussive efficacy judgement. Tolerability was evaluated as per clinical evolution and laboratory parameters.

[Prognosis in joint inflammation after acute respiratory diseases]

A group of 25 patients with arthritis after acute respiratory disease (ARD) was followed up, on average for 4.7 years, with regard to the short-term and long-term prognosis. The patients developed arthritis 1-4 weeks after ARD and it affected mainly or exclusively the joints of the lower extremities, in particular the talocrural ones. After a mean period of five weeks the arthritis receded completely. 60% of the patients were HLA B27+, the number of affected joints in these patients was greater than in HLA B27- patients. HLA B27+ subjects are more likely to develop arthritis after ARD than HLA B27- subjects (relative risk = 6.35). In the long-term prognosis articular changes were found in 6/22 patients (5 were HLA B27+): three times sacroileitis was found, twice a relapse of arthritis after repeated ARD and once systemic lupus erythematosus. As to laboratory tests, arthritis after ARD was associated with a transient response of reactants of the acute phase and serum IgG. High values of IgA and immunocomplexes, on the other hand, persisted throughout the investigation in 41% and 28% of the patients resp.

The relation between snoring and smoking, body mass index, age, alcohol consumption and respiratory symptoms

Potential risk factors for snoring were studied in a population of 457 middle-aged men. Eversnoring was reported by 60% of the men and snoring with an age of onset before or equal to 20 years by 13%. Eversnoring was significantly related to older age, higher body mass index and smoking habits. Alcohol consumption, estimated by questionnaire and gamma-glutamyl transpeptidase was unrelated to a history of snoring. Logistic regression showed that snoring was independently associated with age, body mass index and smoking habits. An exposure-effect relationship clearly appeared between tobacco consumption and snoring. After adjustment for smoking habits, none of the upper or lower respiratory symptoms was significantly related to snoring.

[Study of the esophageal function by prolonged intraluminal pH-metry in patients with gastroesophageal reflux and respiratory manifestations]

Gastroesophageal reflux (GER) can be found in a high number of patients with respiratory tract disease (RTD). In the present study a 24 hours esophageal pH monitoring was performed in 55 children. 15 of them were normal controls, 16 patients with GER but normal score, 14 patients with GER and RTD and 9 patients with GER and only digestive symptoms. The number of reflux episodes of more than 5 minutes, the duration of the longest single reflux episode, the percentage of time the esophageal pH was less than 4, the reflux/hour index and the clearance index were measured. Comparing the results of the different groups we found that normal controls and normal vomiting patients were significatively different. Refluxers and refluxers with RTD also were different of asymptomatic controls. The main significative differences founded comparing refluxers and refluxers with RTD were the duration of the longest single reflux, the percentage of time the esophageal pH was less than 4 and the clearance index. All these parameters were longer in the refluxers with RTD. Our conclusion is that esophageal clearance is slower in the group of refluxers with RTD and that this index is helpful to distinguish them from the single refluxers.

Cytomegalovirus infection in low-birth-weight infants with acute respiratory tract disease

To determine a participation of cytomegalovirus (CMV) infection in acute respiratory tract disease (ARTD) of low-birth-weight (LBW) infants, specific antibodies against CMV antigens, IgG antibodies against early antigens of CMV (IgG EA) and IgM antibodies against membrane antigens of CMV (IgG MA) were analyzed. The frequency of IgG EA in patients with ARTD was higher than that in controls (46% vs. 32%), and the geometrical mean titer (GMT) of IgG EA in the patients was also higher than that in controls (50.2 vs. 20.1). Five of 15 ARTD patients had IgM MA, and the frequency was significantly higher than that of controls (33% vs. 1.3%, p less than 0.01). Eleven of 15 LBW patients with ARTD had a history of blood transfusions during the neonatal period, and 5 of them had significant IgM MA indicating active CMV infection. All 4 LBW patients without blood transfusion were negative for IgM MA. These results suggest a close relationship of CMV infection to ARTD of LBW infants, but it remains for further studies whether blood transfusion is a primary source of CMV infection in LBW infants.

The Tucson Children's Respiratory Study. I. Design and implementation of a prospective study of acute and chronic respiratory illness in children

The Tucson Children's Respiratory Study, Tucson, Arizona, has been established as a long-term, longitudinal, prospective study of the risk factors for acute lower respiratory tract illnesses in early childhood and for chronic obstructive airways disease in later life. A total of 1,246 newborns were enrolled into the study between May 1980 and January 1984, representing 78% of eligible infants. Cord blood for immunologic studies, neonatal blood specimens for blood counts and differentials, and blood specimens at nine to 15 months of age for immunologic studies, blood counts, and differentials have been obtained on the majority of enrolled children. Pre-illness physiologic and more detailed immunologic studies have also been done on large subgroups of subjects. The majority of lower respiratory tract illnesses suffered by these children in the first three years of life have been assessed in detail for etiologic agents by means of culture and serologic techniques; 1,052 illnesses have been evaluated thus far. The type of illness and nature of etiologic agents are very similar to those reported in other epidemiologic studies. Thus, this group of enrolled infants and their family members constitute an appropriate population for the long-term study of risk factors for acute and chronic respiratory disorders.

The influence of psychological status on respiratory symptom reporting

The American Thoracic Society respiratory symptom questionnaire (ATS-Q) is widely used and has provided valuable information in epidemiologic studies. To determine the influence of psychological status on respiratory symptoms, we compared subjects' ATS-Q responses to their Ilfeld Psychiatric Symptom Index (PSI) scores. To minimize the potential confounding effect of respiratory disease on the association between respiratory and psychological status, from a population-based survey of 3,628 subjects, we studied only the 600 "healthy" subjects, defined by the following characteristics: between 14 and 55 yr of age; never-smokers; no diagnoses of respiratory, heart, kidney, thyroid disease, or anemia; and normal spirometry (defined as an FEV1 and FVC greater than 80% of predicted). Associations were found between respiratory symptoms (cough, phlegm, wheeze, dyspnea) and PSI subscales (anxiety, anger, depression, and cognitive disturbance). Adjusted odds ratios for respiratory symptoms ranged from 1.13 to 2.15 for every 10% increase in PSI score. Psychological status is an important determinant of respiratory symptoms and therefore must be taken into consideration when interpreting results of epidemiologic studies using questionnaire information.

[Hemosorption in the correction of disorders of the transport function of erythrocytes in diseases of the respiratory organs]

A considerable improvement of the transport function of erythrocytes due to desorption of endotoxins from their membranes was found by results of fluorescent probes of the blood erythrocyte membranes in 92 patients with different diseases who were under 275 hemosorptions in the complex treatment.

[Clinico-morphologic changes of the respiratory passages in cases of burns of them]

The authors examined the functional state of the respiratory apparatus in 343 patients with burns of the respiratory ways (BRW). The defensive, respiratory, conditioning and olfactory functions were investigated. It was established that lesions of the respiratory tract mucosa in BRW causes primarily severe disorders of the transport and secretory functions that further the development of bronchial obstruction and deteriorate pulmonary ventilation. Lesions of the respiratory tract mucosa in BRW are deep and should be equated with III AB grade burns. The course of he burn process in the respiratory ways plays a significant part in the pathogenesis of burn disease pneumonia. This should be considered in planning treatment of patients with BRW.

Feline immunodeficiency virus infection in cats of Japan

A seroepidemiologic survey for feline immunodeficiency virus (FIV) infection was conducted in Japan. Between June and December 1987, individual sera (n = 3,323) were submitted by veterinary practitioners from many parts of the country. Specimens were from 1,739 cats with clinical signs suggestive of FIV infection and from 1,584 healthy-appearing cats seen by the same practitioners. The overall FIV infection rate among cats in Japan was 960/3,323 cats (28.9%). The infection rate was more than 3 times higher in the clinically ill cats, compared with that in the healthy cats of the same cohort (43.9 vs 12.4%). Male cats were 1.5 times as likely to be infected as were females. Almost all FIV-infected cats were domestic cats (as opposed to purebred cats). Complete clinical history was available for 700 of 960 FIV-infected cats. Of these 700 FIV-infected cats, 626 (89.4%) were clinically ill, and the remainder did not have clinical signs of disease. The mean age at the time of FIV diagnosis for the 700 cats was 5.2 years, with younger mean age for males (4.9 years) than for females (5.8 years). Most of the infected cats (94.7%) were either allowed to run outdoors or had lived outdoors before being brought into homes. The mortality for FIV-infected cats during the 6 months after diagnosis was 14.7%, and the mean age at the time of death was 5.7 years. Concurrent FeLV infection was seen in 12.4% of the FIV-infected cats, but this was not much different from the historical incidence of FeLV infection in similar groups of cats not infected with FIV.(ABSTRACT TRUNCATED AT 250 WORDS)