[Post-stroke somatic pathology in patients with a history of alcohol abuse]

AIM

to study concomitant somatic pathology in brain stroke patients abusing alcohol before cerebral catastrophe.

SUBJECTS AND METHODS

Two groups were identified according to the results of examining 255 poststroke patients. A study group included 57 (22.4%) pre-stroke alcohol abusers; a control group consisted of 198 (77.6%) alcohol non-abusers.

RESULTS

Among the study group patients, lacunar and hemodynamic pathogenetic subtypes of ischemic stroke were encountered 3 times more and 2 times less frequently, respectively, than in the control groups. After cerebral stroke, the study group patients had a clinical picture with a preponderance of diminished cognitive functions, as well as motor disorders mainly as hemiparetic syndrome. Assessment of the pattern of somatic pathology in both group patients revealed a predominance of myocardial infarction by almost 2-fold, hepatobiliary diseases by 4.7-fold, duodenal ulcer disease by 1.6-fold, and bronchopulmonary pathology by 2-fold among the study group patients. Arthrosis deformans and obesity were observed by 6.4 and 3.5 times more frequently, respectively. The incidence of cardiac disease and hypertension in the acute period did not differ greatly in the compared groups. No thyroid pathology was recorded in the study group. In this group, the poststroke period was generally severer or ran as a galloping type in one third of cases.

CONCLUSION

Somatic pathology aggravates the poststroke period, on the one hand, and it is decompensated in the presence of inadequate cerebral blood supply, on the other. Measures to compensate for neuropsychological disorders should be efficiently combined with rehabilitative actions on somatic pathology in poststroke patients with a history of burdened alcohol abuse.

Non-invasive ventilation: a nurse-led service

Respiratory diseases are the third most common presentations to emergency departments (EDs) in the Republic of Ireland. Evidence suggests that early non-invasive ventilation (NIV) is often the treatment of choice, particularly for patients with chronic obstructive pulmonary disease. Therefore, having access to NIV in EDs is likely to improve patient outcomes and reduce the likelihood of their mechanical ventilation.

Comorbidities of obesity

Obesity, especially visceral adiposity, is associated with morbidity and mortality through endocrine and mechanical processes. Clinical manifestations due to effects of obesity on the cardiovascular, respiratory, gastrointestinal, musculoskeletal, immune, and integumentary systems have been described. Further studies are needed to understand the pathologic processes underlying these clinical manifestations to improve disease prevention.

Severe respiratory symptoms to oxaliplatin infusion: a case report of delayed hypersensitivity reaction

A 46-year-old man with adenocarcinoma of the sigmoid colon developed a hypersensitivity reaction after the sixth cycle of combination chemotherapy with oxaliplatin infusion. Hypersensitivity to oxaliplatin occurring, after several courses of therapy, in about 10-15% of patients, especially during or immediately after the oxaliplatin infusion. In this case report we present a delayed hypersensitivity reaction, consisting in dysesthesia and laryngeal spasm developed 10 h after the sixth administration of oxaliplatin.

The many faces of scleroderma sine scleroderma: a literature review focusing on cardiopulmonary complications

Scleroderma sine scleroderma (ssSSc) is an occult form of systemic sclerosis that may cause diagnostic difficulties due to the absence of skin involvement. Delays in the diagnosis of ssSSc means lost opportunites to address and treat the often lethal involvement of internal organs such as the lungs and heart. In this systemic review we collected all published cases of ssSSc using EMBASE, MEDLINE, PubMed, and Web of Science from 1950 to present. Our purpose was to describe the range and frequency of the clinical manifestations of ssSSc. A total of 108 published cases of ssSSc were analyzed. Lung involvement was present in 66% of cases. Peripheral vascular system involvement was present in all patients whereas gastrointestinal manifestations were present in 82% of the cases. Overall the clinical presentation is subtle and heightened clinical awareness is required to facilitate prompt recognition and treatment.

Hemoptysis: diagnosis and treatment

Hemoptysis is the expectoration of blood or blood tinged sputum from the bronchi, larynx, trachea or lungs. The etiology of hemoptysis is best categorized from the various system or site of bleeding. The management of hemoptysis begins with an initial assessment of gas exchange and hemodynamic stability followed by an identification of the cause by means of fiberoptic bronchoscopy, and chest imaging studies to attain cessation of bleeding and to prevent future recurrence.

[Experience with the use of surgical lasers for the treatment of patients with upper respiratory tract and ear diseases]

The objective of this study was to analyse the efficiency and safety of the use of a holmium- YAG laser (wave length 2.09 mcm) and an erbium-activated glass-based fiber laser scalpel (wave length 1.56 mcm) in ENT-surgery. Priority methods for the surgical intervention in the nasal cavity, paranasal sinuses, and middle ear were developed to treat patients with distorted nasal septa, vasomotor rhinitis, polypous rhinosinusitis, Eustachian tube dysfunction, and various forms of chronic suppurative otitis media. Long-term observations demonstrated fairly good stability of beneficial outcomes of the treatment with the above methods in the majority of the patients. It is concluded that surgical technologies with the use of modern medical lasers provide extensive possibilities for a great variety of interventions in patients with upper respiratory tract and ear diseases.

[Respiratory diseases as a cause of death in schizophrenia]

Eight hundred and thirty autopsy protocols of died patients with schizophrenia from 1952 to 2007 were studied. Respiratory pathology as a cause of death was noted in 29.8% of cases. There are great changes in the study parameters, which have been particularly evident in the past 2 decades: a reduction in the rate of lobar (croupous) and bronchial pneumonia, an increase in the number of cases of active pulmonary tuberculosis and chronic obstructive pulmonary disease, and lung cancer. The higher incidence of the two latter diseases is associated by the author with the side effects of phenothiazine neuroleptics in the long-term treatment of schizophrenia.

[Relations between symptoms, durations and triggers of attacks and concurrent diseases in paradoxical vocal fold movement disorder]

OBJECTIVES

To discover the relation between initial symptoms, triggers and durations of attacks of paradoxical vocal fold movement disorder (PVFMD) and concurrent laryngeal and respiratory diseases.

PATIENTS AND METHODS

Twenty one PVFMD patients (17 females, 4 males; mean age 50 year; range 31 to 72 years) were included in the study. Diagnosis of PVFMD was established when inspiratory and/or expiratory vocal cord adduction was seen during laryngostroboscopy.

RESULTS

Laryngeal and respiratory diseases accompanying PVFMD were laryngopharyngeal reflux (n=15; 71%), asthma (n=11; 52%), allergic rhinitis (n=6; 28%), chronic sinusitis (n=1; 4%), right vocal cord paresis (n=1; 4%) and chronic obstructive pulmonary disease (n=2; 9%), (p=0.346). The most common symptoms were inspiratory stridor (n=16; 76%), dyspnea (n=13; 60%) and cough (n=9; 42%), (p=0.346). There was no significant relation between concurrent diseases and the frequencies of symptoms (0.091). Triggers for attacks were found to be air pollutants including dust, smoke and temperature variations (n=8; 38%), exercise (n=7; 33%), perfumes and detergents (n=6; 28%), animal fur and pollen (n=4; 19%), phonation and loud speaking (n=3; 14%) and emotional stress-anxiety (n=1; 4%), (p=0.308). Durations of attacks were several minutes in 14 patients (66%), several seconds in five patients (23%) and more than one hour in two patients (9%), (p=0.338).

CONCLUSION

Durations and triggers of attacks and initial symptoms in paradoxical vocal fold movement disorder seems not to be related with concurrent laryngeal and respiratory diseases.

Body mass index and airway hyper-responsiveness in individuals without respiratory disease

BACKGROUND

Overweight and obesity are major health issues in Western societies. They are related with a higher risk of different co-morbidities but their relationship with airway hyperresponsiveness (AHR) is still under discussion. Nevertheless, they are related to higher severity in asthma and other respiratory diseases. The aim of the study was to analyze the AHR in individuals with normal lung function without respiratory disorders, according to body mass index (BMI) calculation.

METHODS

We performed clinical observation and basal lung function tests (LFT) in 595 consecutive individuals in order to exclude respiratory disease. 377 individuals fulfilled the criteria of normal values according international guidelines. They were submitted to standardized treadmill exercise test followed by bronchodilator test. FVC, FEV1, FEF 25/75, RV and Raw were obtained at different conditions according to BMI groups (I: lean; II: normal; III: overweight; IV obese).

RESULTS

55.2% of the sample was overweight or obese, and a signficant relationship was found with female gender and older ages (p=0.0046 and p<0.0001 respectively). The positive response to exercise test or bronchodilator beta2 agonists was not significantly frequent compared with the other groups. In obese individuals the exercise markedly reduced basal Raw and increased FEF 25/75. Lean individuals showed higher basal values of RV that was reduced upon exercise. Response to 12 agonists showed no differences according to weight biotypes.

CONCLUSION

BMI hampers lung function in normal individuals, and seems not to be related to AHR. Regular exercise should be encouraged in overweight and obese individuals, since it increases their bronchial permeability as shown in lower frequency of positive exercise tests. The same is advisable for lean individuals for different reasons. Their increased basal RV and Raw improve upon exercise. Despite overweight and obesity are being related to a low-grade of basal systemic inflammation, there was no association with a higher basal bronchial hyperresponsiveness in these individuals.

Severe respiratory distress caused by central airway obstruction treated with self-expandable metallic stents

We investigate retrospectively the efficacy of self-expandable metallic stents (SEMS) for severe respiratory distress (SRD) in patients with central airway obstruction (CAO). Thirty three patients with CAO were treated with SEMS using fiberoptic bronchoscopy method. We found an intraluminal obstruction present in 7, extraluminal compression in 10, and combined stenosis in 16 cases. Tumor infiltration occupied more than 90% of the endoluminal diameter in 21, 70% in 9, and 50% in 3 cases. Obstruction was caused by primary cancer of lung in 23, thyroid in 5, and esophagus in 5 patients. Up to 3 stents per patient were placed. Double stenting (esophagus and trachea) was required in five patients. All patients exhibited symptomatic and arterial blood gas improvement. The mean follow-up was 65 (5 to 752) days. SEMS are useful for the treatment of SRD caused by CAO. The overall effect is related to the degree of tumor progression itself.

[Pulmonary hypertension in chronic respiratory and cardiac diseases]

Pulmonary hypertension (PH) is frequent in the course of chronic respiratory diseases with hypoxia which leads to vascular remodeling, especially chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis. PH is usually moderate but may be disproportionate in some patients. In the chronic diseases of the left heart, increased atrial pressure results in pulmonary venous distension and passive PH (post-capillary) which may further lead to precapillary hypertension. A precise diagnosis of PH in chronic respiratory and cardiac diseases requires right heart catheterization. The possible role of specific treatments of PH in these disorders is not established.

[Clinical features of chronic necrotizing pulmonary aspergillosis treated with voriconazole in patients with chronic respiratory disease]

We analyzed clinical features of chronic necrotizing pulmonary aspergillosis (CNPA) in patients with underlying chronic respiratory disease, and evaluated the efficacy and tolerability of voriconazole against CNPA in those patients. Voriconazole therapy was indicated in 45 CNPA patients between October 2005 and September 2007, in 23 patients as first-line treatment and in 22 after lack of response to or intolerance of prior antifungal agent. The most common underlying respiratory disease was sequelae of tuberculosis (n = 23) followed by COPD (n = 13). Cavitary lesions were found in 32 patients. Galactomannan antigen test was positive in 29 patients while 28 patients out of 36 were positive for anti-Aspergillus serum antibody. The antibody-negative group had significantly higher levels of galactomannan antigen than the antibody-positive group. Mycological culture or hyphae were positive in 15 patients. Beta-D glucan level was within the normal limit in 27 patients. Clinical, radiological improvement, or both was obtained in 30 patients after an average voriconazole treatment of 4.8 months, with the main adverse effects being visual disturbance and hepatotoxicity. During the observation period 14 patients died due to CNPA or other causes. Although voriconazole demonstrated good efficacy against CNPA, the outcome is still unsatisfactory.

Nonabdominal causes of abdominal pain--finding your heart in your stomach!

BACKGROUND

The diagnosis of abdominal pain is difficult and often inaccurate. Nonabdominal disease, in particular cardiac and pulmonary disease, may present with abdominal symptoms.

OBJECTIVE

This article provides a brief review of the neuro-anatomical basis of abdominal pain in the adult patient population. Differential diagnoses are outlined with a specific focus on time critical conditions, and clinical 'red flags' for the physician in the 'frontline' are highlighted.

DISCUSSION

Physicians need a high clinical index of suspicion when the diagnosis is elusive. They must acknowledge atypical presentations are common, avoid over reliance on 'classic' presentations or the outcome of preliminary investigations, and specifically seek time critical diagnoses. A detailed history and examination remains the key to avoiding diagnostic error. The priority is not 'correct diagnosis' but 'correct patient disposition'. Options include prolonged observation, further sophisticated investigations, and early specialist referral. Physician's gestalt in elusive cases remains important.

Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention

Sleep-disordered breathing (SDB) has been associated with insulin resistance and glucose intolerance, and is frequently found in people with type 2 diabetes. SDB not only causes poor sleep quality and daytime sleepiness, but has clinical consequences, including hypertension and increased risk of cardiovascular disease. In addition to supporting the need for further research into the links between SDB and diabetes, the International Diabetes Federation Taskforce on Epidemiology and Prevention strongly recommends that health professionals working in both type 2 diabetes and SDB adopt clinical practices to ensure that a patient presenting with one condition is considered for the other.

Periodontal-systemic disease education in United States dental hygiene programs

The relationship between periodontal disease and systemic disease has gained much attention in recent years in the dental profession and from national health care agencies. Two third-party providers are now modifying their dental reimbursements for patients who have periodontal disease and are pregnant or have cardiovascular disease. However, there are few reports in the dental or dental hygiene literature about how students are taught this information and how it is incorporated into the didactic and clinical aspects of the curriculum. A thirty-item survey and cover letter on these subjects were emailed to the directors of the 286 accredited dental hygiene programs in the United States in 2007. The response rate was 63 percent. According to these responses, the three most emphasized topics regarding oral-systemic disease are diabetes, tobacco use, and cardiovascular disease. Most programs (90 percent) use journal articles for instructional content, and 87 percent use the American Academy of Periodontology website for reference. Only 4 percent have content taught jointly with nursing, medical, or allied health students. The majority of directors (87 percent) indicated they could use more evidence-based educational materials to help teach the concepts to students. Only 9 percent of survey respondents thought that nurses and physicians are knowledgeable about the relationship of oral health to systemic disease. The findings indicate that dental hygiene program directors are confident about the education on oral-systemic content provided to their dental hygiene students, but would like additional evidence-based materials to help their students learn this topic.

Toll-like receptors and airway inflammation

The respiratory tract opens to the external environment at the oral side edge, and the other edge of the respiratory tract connects to the closed space (alveoli), and so to preserve the sterility in the terminal respiratory tract is critical for protection against pathogens. The recognition machinery for the invasion of microbes is indispensable for the preservation of the sterility in the lungs. Our general understanding of how microbes are recognized by the innate immune system has increased considerably over the past several years, and the contribution of Toll-Like Receptors (TLRs) to innate immunity is now well documented. In the meantime, it has come to understand that many inflammatory processes may depend on TLR signaling, it has been considered to be involved in the pathogenesis of airway inflammatory diseases such as airway infections, bronchial asthma, and occupational airway diseases. In this review, we focus on physiological roles of TLRs in defense mechanisms of the airways, and pathophysiological roles on airway diseases.

Epidemiological investigation in outpatients with symptomatic gastroesophageal reflux from the Department of Medicine in Zhejiang Province, east China

BACKGROUND AND AIM

To elucidate the epidemiology of gastroesophageal reflux disease (GERD) symptoms in outpatients from the Department of Medicine in 10 hospitals in Zhejiang Province, east China.

METHODS

A cross-sectional survey in the cluster random sample was conducted from November 2004 to June 2005 using a validated Chinese version of the reflux disease questionnaire and other items recording the demographic characteristics for GERD symptoms. The statistical analysis was performed with SPSS 13.0 programs.

RESULTS

A total of 15,283 outpatients from the Department of Medicine were investigated. The prevalence of GERD symptoms was 7.28% (95% confidence interval [CI], 6.87%, and 7.69%) with the prevalence rate increasing with age (P < 0.001), which was higher in men (7.79%, 95% CI: 7.20%, 8.38%) than in women (6.73%, 95% CI: 6.18%, 7.28%; chi2 = 5.81, P < 0.05). The prevalence rate of the gastrointestinal symptoms in GERD symptoms, including epigastric discomfort, nausea, retrosternal pain, belching, globus sensation, loss of appetite, excessive salivation, vomiting, wheezing cough, weight loss, and dysphagia were all higher than the non-GERD patients (P < 0.0001). In the GERD patients, the prevalence of diseases, such as pharyngolaryngitis, snoring, bronchitis, liver disease, and gallbladder disease were all higher than the non-GERD patients (P < 0.01). The multiple logistic regression analysis showed that old age, night-shift work, heavy work burdens, single or divorced people, increase intake of greasy or sweet foods, excessive eating, and constipation were independent risk factors associated with GERD symptoms.

CONCLUSION

GERD has a high prevalence in China and its main associated factors include respiratory, laryngopharyngeal and dental disorders, sex, anthropometrical variables, and social-psychological characteristics.

[Peculiarities of gastroesophageal reflux disease course in children with diseases of the upper respiratory ways]

Data about patogenesis, clinical characteristics, diagnostics, treatment and the forecast of diseases of the upper departments of respiratory ways at children in a combination with gastroesophageal reflux disease (GRD) are presented proceed on the literature and own experience data. The purpose of ours research consisted in revealing of correlation dependence between GRD and chronic diseases of a throat at children. 77 children at the age of 5-16 years with the nonheritable cicatricial stenosis of a throat and cervical department of a trachea (n = 12), with small knots of vocal folds (n = 17), with dysphonia (n = 20) and with anticipate respiratory papillomatosis (n = 28) are surveyed. Reflux disease is diagnosed by means of the developed technique of pH-monitoring at which electrodes were established in hypopharynx, average and bottom departments of a gullet.

RESULTS

at definitive rare frequency of clinical GRD signs at children with various variants of reflux disease in 74 cases (96,1%): GRD in a combination with pharyngolaryngeal a reflux (FR)---at 48 children (62,3 %), isolated FR---at 18 children (23,4 %), isolated GRD--in 8 cases (10,4 %).

CONCLUSIONS

1) correlation between chronic diseases of a throat at children and GRD is established; 2) in case of isolated FR often works protective alkalize gullet mechanism; 3) with chronic diseases of a throat it is expedient to include carrying out of daily pH-monitoring in the plan of inspection of children; 4) prospective FR participation in pathogenesis of chronic throat diseases demands carrying out of the further researches.

Clinical and immunologic features of pediatric patients with common variable immunodeficiency and respiratory complications

BACKGROUND

Common variable immunodeficiency (CVID) is the term used to describe a heterogeneous group of B-cell deficiency syndromes characterized by hypogammaglobulinemia, impaired antibody production, and recurrent bacterial infections.

OBJECTIVES

To determine the clinical manifestations and perform an immunological analysis of pediatric CVID patients suffering from respiratory complications.

METHODS

The records of 10 patients with CVID who were followed up from 1992 to 2005 (6 males and 4 females) with a median (interquartile range) age of 13.9 (10.4-19.4) years were reviewed. All patients met the standard criteria set for CVID.

RESULTS

Median total serum levels of immunoglobulin (Ig) G, IgM, and IgA in mg/dL were 383.5 (239.2-574.5), 32.5 (17.0-117.0), and 12.5 (5.0-30.7), respectively. Median age at the onset of symptoms, at CVID diagnosis, and on starting intravenous Ig therapy was 4.0 (0.8-6.2), 9.4 (6.7-11.3), and 9.1 (7.0-11.6) years, respectively. Associated disorders were recurrent infections (100%), bronchiectasis (90%), and growth failure (80%), whereas malabsorption, malignant neoplasm, inflammatory bowel disease, and autoimmune disorders were less common. All bronchiectatic patients had a low percentage of B cells, with an average of 4% (range, 1%-7%). The characteristic computed tomography finding in patients with CVID was a multilobar pattern. Malignant neoplasm developed an average of 11.5 (range, 6.5-20.2) years after the diagnosis of CVID was made.

CONCLUSION

Recurrent respiratory infection should be evaluated to rule out CVID. Early diagnosis and intravenous Ig replacement therapy may reduce the frequency of respiratory infection. Low levels of serum Ig and percentage of B lymphocytes at diagnosis are important parameters for identifying patients at risk of structural lung damage.

Non-malignant thoracic pathologies of the women of reproductive age. Can we suggest to collect them under the same heading?

The reproductive age covers approximately 1/3 of a woman's life and have many hormone-related problems causing many admissions to gynecology clinics. Beside these pathologies, there are also some respiratory system related diseases making women to admit pulmonology clinics. In this article, we want to focus attention of gynecologists, chest physicians, thoracic surgeons and primary care physicians to these pathologies which could be collected under the same heading "Non-malignant thoracic pathologies of the women of reproductive age".