Assuntos
Especificidade de Anticorpos , Venenos de Abelha/imunologia , Criação de Abelhas , Abelhas/imunologia , Tolerância Imunológica , Imunoglobulina E/deficiência , Imunoglobulina G/fisiologia , Adulto , Animais , Estudos de Casos e Controles , Disgamaglobulinemia/imunologia , Feminino , Humanos , Imunoglobulina G/biossíntese , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Exposição OcupacionalRESUMO
Pseudomonas aeruginosa is the major pathogen in the cystic fibrosis (CF) lung, the predominant source of its acquisition, however, is under discussion. In order to study the molecular epidemiology, we evaluated 86 P. aeruginosa isolates from 43 CF patients from southeast Austria. The DiversiLab system was used to identify genetic relationships among the isolates. Antibiotic susceptibilities were tested with a broth microdilution method (Micronaut Merlin). A total of 39 unrelated P. aeruginosa genotypes were found of which 34 were unique to a single patient and one was unique to a sibling pair. We found low rates of resistance for ß-lactams with resistance to piperacillin/tazobactam and ceftazidime ranging from 4 to 6%. Resistance rates for meropenem and ciprofloxacin were 11% and 15%, respectively. The prevalence of multidrug-resistant isolates was 2%. We conclude that the majority of P. aeruginosa isolates from CF patients originate from environmental sources and patient-to-patient spread is very uncommon in our centre.
Assuntos
Fibrose Cística/epidemiologia , Fibrose Cística/microbiologia , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , Áustria/epidemiologia , Comorbidade , Humanos , Prevalência , Pseudomonas aeruginosa/classificaçãoRESUMO
Common buckwheat (Fagopyrum esculentum) is known to cause severe anaphylactic reactions in adult individuals. However, type I allergy to buckwheat is rarely seen in children. We report on a 7-year-old boy who developed a grade III anaphylactic reaction after consumption of a cake containing buckwheat flour. Prior to this incident, the boy had developed severe allergic reactions to hazelnuts and suffered from an oral allergy syndrome to poppy seed. Analysis of the patient's IgE reactivity by immunoblotting experiments revealed that he was sensitized to members of the 2S albumin and 11S globulin protein families in buckwheat. Additionally, cross-reactivity was found between the 11S globulins in buckwheat, poppy and hazelnut. IgE inhibition experiments indicated that the 11S globulin in buckwheat was the initial sensitizing protein. We conclude that 11S globulins in buckwheat have the potential to induce IgE antibodies cross-reactive with 11S globulins in other, botanically unrelated foods and may induce anaphylactic reactions.
Assuntos
Anafilaxia/etiologia , Corylus/efeitos adversos , Fagopyrum/efeitos adversos , Hipersensibilidade Imediata/fisiopatologia , Papaver/efeitos adversos , Alérgenos/efeitos adversos , Alérgenos/imunologia , Anafilaxia/imunologia , Antígenos de Plantas/efeitos adversos , Antígenos de Plantas/imunologia , Criança , Corylus/imunologia , Reações Cruzadas/imunologia , Fagopyrum/química , Fagopyrum/imunologia , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/imunologia , Globulinas/imunologia , Humanos , Hipersensibilidade Imediata/etiologia , Hipersensibilidade Imediata/imunologia , Imunoglobulina E/sangue , Masculino , Papaver/imunologia , Fatores de Risco , Sementes/efeitos adversos , Sementes/imunologiaAssuntos
Fibrose Cística/complicações , Infecções Oportunistas/terapia , Infecções por Pseudomonas/terapia , Pseudomonas aeruginosa , Antibioticoprofilaxia , Criança , Humanos , Infecções Oportunistas/complicações , Infecções Oportunistas/prevenção & controle , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/prevenção & controle , Infecções Respiratórias/complicações , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/terapiaAssuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Adolescente , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/uso terapêutico , Asma/diagnóstico , Criança , Terapia Combinada , Quimioterapia Combinada , Medicina Baseada em Evidências , Seguimentos , Humanos , Antagonistas de Leucotrienos/uso terapêutico , Educação de Pacientes como Assunto , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
UNLABELLED: This case report describes a 13-year-old boy with diffuse microvascular pulmonary arteriovenous malformations, in whom total anomalous pulmonary venous drainage had been corrected surgically in the newborn period. Contrast transesophageal echocardiography, cardiac catheterization and a lung perfusion scan suggested, and lung biopsy confirmed the diagnosis in our patient. Treatment with nifedipin was commenced. CONCLUSION: This case illustrates the diagnostic difficulties with this rare malformation.
Assuntos
Malformações Arteriovenosas/diagnóstico , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Telangiectasia Hemorrágica Hereditária/complicações , Adolescente , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/cirurgia , Biópsia , Cateterismo Cardíaco , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Humanos , Masculino , Telangiectasia Hemorrágica Hereditária/diagnósticoAssuntos
Asma/diagnóstico , Asma/terapia , Bronquite Crônica/diagnóstico , Bronquite Crônica/terapia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Asma/complicações , Áustria , Bronquite Crônica/complicações , Pré-Escolar , Humanos , Doença Pulmonar Obstrutiva Crônica/etiologia , Prevenção SecundáriaRESUMO
Recent publications suggest that long-acting beta-2 agonists (LABAs) increase the risk for death in asthma. The American Food and Drug Administration (FDA) published a relevant alert in 2005. In the currently valid Austrian consensus guidelines for drug therapy of bronchial asthma in children and adolescents, LABAs are only recommended as add-on therapy in those patients whose asthma is not sufficiently controlled by inhaled corticosteroids (ICS) alone. LABAs have no established role in earlier steps of the therapeutic algorithm; consequently, the prescription of ICS-LABA combinations for initial treatment of paediatric asthma is not supported by these consensus treatment guidelines.
Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Agonistas Adrenérgicos beta/uso terapêutico , Antiasmáticos/efeitos adversos , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/mortalidade , Guias de Prática Clínica como Assunto , Áustria , Preparações de Ação Retardada , Medição de Risco/métodos , Fatores de RiscoRESUMO
Gorham-Stout syndrome is a rare disease characterized by vascular proliferation in the bones, effecting osteolysis. When it is complicated by chylothorax, the prognosis is poor. The present case illustrates successful management of chylothorax by a combination of surgery (thoracic duct ligation and excision of lymphangiomatous tissue combined with pleurodesis) and treatment with alpha-2b interferon. Treatment in 38 published cases is reviewed.
Assuntos
Osteólise Essencial/diagnóstico por imagem , Osteólise Essencial/cirurgia , Adolescente , Humanos , Masculino , RadiografiaRESUMO
OBJECTIVE: To assess the relation between age and bronchodilator responsiveness in infants with bronchiolitis. STUDY DESIGN: In 41 infants (age, 2 to 18 months) with bronchiolitis, lung function was measured with the raised volume rapid thoracoabdominal compression technique before and after salbutamol inhalation. Lung function was quantified in terms of timed volumes (FEV(0.5), FEV(0.75), and FEV(1.0)). A significant change was defined as a postbronchodilator value that differed from baseline by more than twice the within-subject coefficient of variation. RESULTS: For the group, postbronchodilator values did not differ significantly from baseline (DeltaFEV(0.5), 3.8% +/- 9.3%; DeltaFEV(0.75), 3.5% +/- 9.5%; and DeltaFEV(1.0), 4.0 +/- 9.8%). Eleven subjects showed significantly increased timed volumes; 3 presented with a decreased lung function; the remaining patients failed to show a significant change. The mean age of subjects with improved lung function did not differ significantly from the mean age of those with no or paradoxical responses (9.7 +/- 4.7 vs 8.1 +/- 4.1 months); there was no correlation of age with the size of the bronchodilator response. CONCLUSIONS: The results of the current study indicate that bronchodilator responsiveness in infants with bronchiolitis is not age-dependent.
Assuntos
Albuterol/farmacologia , Bronquiolite Viral/tratamento farmacológico , Broncodilatadores/farmacologia , Ventilação Pulmonar/efeitos dos fármacos , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Fatores Etários , Feminino , Volume Expiratório Forçado , Humanos , Lactente , Masculino , Análise de RegressãoRESUMO
Accidental ingestion and aspiration of hydrocarbons in children are common. Among the various clinical and pathological manifestations of hydrocarbon (HC) poisoning, pneumonitis is the most significant and occurs in up to 40% of children, whereas formation of pneumatoceles is believed to be a rare event. We report two children with HC pneumonitis and pneumatoceles as a reversible complication after ingestion and aspiration of lamp oil with very low viscosity. Patient 1, a 21-month-old boy, started to cough and developed tachypnea, sternal retractions and mild cyanosis immediately after aspiration. Patient 2, a 24-month-old girl, was asymptomatic during the first days after the accident; subsequently, she started to cough and developed fever, dyspnea and chest pain. Chest x-ray and computed tomography revealed multiple patchy infiltrates in both cases; after several days, these confluent infiltrates developed into pneumatoceles. Both children were treated with antibiotics and steroids. They recovered within three and four weeks, respectively, with complete remission of the radiologic abnormalities and had an uneventful follow-up after discharge.
Assuntos
Hidrocarbonetos/intoxicação , Óleos Industriais/intoxicação , Pneumonia/induzido quimicamente , Pneumonia/diagnóstico por imagem , Acidentes Domésticos , Antibacterianos/administração & dosagem , Pré-Escolar , Humanos , Lactente , Masculino , Pneumonia/tratamento farmacológico , Radiografia , Esteroides/administração & dosagem , Resultado do TratamentoAssuntos
Serviços de Assistência Domiciliar/normas , Respiração Artificial/normas , Adolescente , Adulto , Fatores Etários , Áustria , Criança , Consenso , Eletrodos Implantados , Serviços de Assistência Domiciliar/economia , Humanos , Consentimento Livre e Esclarecido , Pneumopatias Obstrutivas/terapia , Máscaras , Monitorização Fisiológica , Pneumologia , Qualidade de Vida , Respiração Artificial/economia , Sociedades Médicas , Fatores de Tempo , Traqueotomia , Ventiladores Mecânicos , Recursos HumanosAssuntos
Infecções por Vírus Epstein-Barr/diagnóstico , Soronegatividade para HIV , Doenças Pulmonares Intersticiais/virologia , Antivirais/uso terapêutico , Biópsia por Agulha , Líquido da Lavagem Broncoalveolar/virologia , Criança , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Seguimentos , Humanos , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/tratamento farmacológico , Contagem de Linfócitos , Masculino , Medição de Risco , Índice de Gravidade de DoençaAssuntos
Medicina do Adolescente , Asma/tratamento farmacológico , Pediatria , Pneumologia , Sociedades Médicas , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/uso terapêutico , Adulto , Fatores Etários , Antiasmáticos/administração & dosagem , Antiasmáticos/uso terapêutico , Áustria , Broncodilatadores/administração & dosagem , Broncodilatadores/uso terapêutico , Criança , Quimioterapia Combinada , Humanos , Antagonistas de Leucotrienos/administração & dosagem , Antagonistas de Leucotrienos/uso terapêutico , Guias de Prática Clínica como Assunto , Teofilina/administração & dosagem , Teofilina/uso terapêutico , Fatores de TempoRESUMO
Inhaled antibiotics are an established treatment for chronic Pseudomonas aeruginosa (PA) infection in patients with cystic fibrosis (CF). However, inhaled antibiotics might also have prophylactic potential to delay acquisition of PA in early stages of the disease. From 1986-1999, all CF patients at this center who experienced defined risk situations for acquisition of PA (28 patients) received inhaled gentamicin (80 mg BID for those < 12 months; 120 mg BID for those > 12 months) for a minimum of 3 years. Twelve patients had repeated risk situations and continued this prophylaxis without interruption during the entire study period (group 1). In the remaining 16 patients, inhaled antibiotics were discontinued at various times for a variety of reasons (group 2). None of the patients in group 1, but 7 in group 2, became chronically infected with PA (P = 0.01). Lung function and chest X-ray scores were significantly worse in those 7 infected patients, when compared to the noninfected ones in both groups. This suggests that long-term-prophylaxis with inhaled gentamicin can effectively delay acquisition of PA and decrease disease progression in children with CF.