[Clinical application of tidal breathing lung function test in 1-4 years old children with wheezing diseases].

OBJECTIVE: To study the clinical significance of tidal breathing lung function test in 1-4 years old children with wheezing diseases. METHODS: A total of 141 1-4 years old children with wheezing diseases were enrolled as the observed groups (41 cases of asthma, 54 cases of asthmatic bronchitis, and 46 cases of bronchopneumonia). Thirty children without respiratory diseases were enrolled as the control group. All the recruits underwent tidal breathing lung function test. The observed groups underwent bronchial dilation test, and tidal breathing flow volume (TBFV) parameters were evaluated before and after bronchial dilation test. RESULTS: The observed groups showed obstructive ventilatory disorder (65%) according to the TBFV loop, and their ratio of time to peak tidal expiratory flow (TPTEF) to total expiratory time (TE) and ratio of volume to peak expiratory flow (VPEF) to total expiratory volume (VE) were significantly lower than in the control group (P<0.05). The asthma subgroup had significantly improved TPTEF/TE and VPEF/VE after bronchial dilation test (P<0.05). Taking an improvement rate of ≥ 15% either for TPTEF/TE or for VPEF/VE as an indicator of positive bronchial dilation test, the bronchial dilation test had a sensitivity of 47% and a specificity of 84% in diagnosing asthma in 1-4 years old children. The positive rate was 28% among the children in the asthma subgroup with an TPTEF/TE ratio of ≥ 23% before bronchial dilation test, versus 65% in those with an TPTEF/TE ratio of <23%. CONCLUSIONS: Obstructive ventilatory disorder is the main impairment of tidal breathing lung function in 1-4 years old children with wheezing diseases. Tidal breathing bronchial dilation test can reflect a reversal of airway obstruction to a certain extent. The sensitivity of bronchial dilation test for the diagnosis of asthma is not satisfactory in 1-4 years old children with wheezing diseases, but this test has a relatively high diagnostic value in children with severe airway obstruction.

Extracellular matrix remodeling genes polymorphisms and risk of chronic bronchitis and recurrent pneumonia in children.

We investigated the association of matrix metalloproteinases, the disintegrin and metalloprotease 33 and the tissue and serum inhibitors of proteinase gene polymorphisms with severe chronic respiratory diseases in Tatar children. We analyzed the case-control data sample from a total of 592 Tatar individuals, consisting of 119 children with chronic bronchitis, 138 with recurrent pneumonia and 335 control children residing in Ufa (Russia). The percentage of heterozygous genotype for the MMP9 (2660A>G) was higher among healthy children (52.54% vs 36.13% in chronic bronchitis patients, P(adj)=0.0033, P(cor)=0.033, odds ratio (OR)=0.51; and 36.96% in recurrent pneumonia group, P(adj)=0.0034, P(cor)=0.034, OR=0.53). The MMP12 (-82A>G) locus was associated with chronic bronchitis in the additive model (P(adj)=0.0091, P(cor)=0.09, OR=0.45, ß=-0.798). The relationship between the 6A6A genotype of MMP3 (-1171 5A>6A) (P(adj)=0.0013, P(cor)=0.013, OR=3.91) and the 6A-A haplotype of MMP3 (-1171 5A>6A) and MMP12 (-82A>G) and recurrent pneumonia were unraveled (Padj=0.001, P(cor)=0.01, OR=2.07). This haplotype was also associated with a higher risk of chronic bronchitis (P(adj)=0.0012, P(cor)=0.012, OR=2.15). The TIMP3 (-1296T>C) was associated with recurrent pneumonia in the dominant model (P(adj)=0.0031, P(cor)=0.031, OR=1.91). The MMP9, MMP3 and TIMP3 (tissue inhibitors of matrix metalloproteinases) polymorphisms and MMP3 and MMP12 haplotypes may play a substantial role in susceptibility to severe airway and lung injury in children with chronic bronchitis and recurrent pneumonia.

Natural history of inhalation melioidosis in rhesus macaques (Macaca mulatta) and African green monkeys (Chlorocebus aethiops).

Burkholderia pseudomallei, the causative agent of melioidosis, is recognized as a serious health threat due to its involvement in septic and pulmonary infections in areas of endemicity and is recognized by the Centers for Disease Control and Prevention as a category B biothreat agent. An animal model is desirable to evaluate the pathogenesis of melioidosis and medical countermeasures. A model system that represents human melioidosis infections is essential in this process. A group of 10 rhesus macaques (RMs) and 10 African green monkeys (AGMs) was exposed to aerosolized B. pseudomallei 1026b. The first clinical signs were fever developing 24 to 40 h postexposure followed by leukocytosis resulting from a high percentage of neutrophils. Dyspnea manifested 2 to 4 days postexposure. In the AGMs, an increase in interleukin 1ß (IL-1ß), IL-6, IL-8, gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α) was observed. In the RMs, IL-1ß, IL-6, and TNF-α increased. All the RMs and AGMs had various degrees of bronchopneumonia, with inflammation consisting of numerous neutrophils and a moderate number of macrophages. Both the RMs and the AGMs appear to develop a melioidosis infection that closely resembles that seen in acute human melioidosis. However, for an evaluation of medical countermeasures, AGMs appear to be a more appropriate model.

Severe course of community-acquired pneumonia in an adult patient who is heterozygous for Q481P in the perforin gene: are carriers of the mutation free of risk?

Most cases of autosomal recessive hemophagocytic lymphohistiocytosis (HLH) are associated with over 50 mutations in the perforin gene. Some of these mutations have no clear functional association. Only homozygous patients display a full-blown syndrome, whereas no severe disease has been described in heterozygous carriers of these mutations despite the presence of functional and phenotypic alterations in cytotoxic cells. We study the family of a child who died from HLH at 6 months of age due to a Q481P mutation in the perforin gene. The study is particularly interesting because the patient's heterozygous father experienced severe community-acquired pneumonia that could be attributed to deficient in vitro NK cell activity despite normal perforin expression. This case report suggests that impaired NK cell activity in a heterozygote can result in poorer initial control of infections with severe clinical expression.

Comparison of nifedipine and captopril in children with pulmonary hypertension due to bronchopneumonia.

This study included 40 children, who were diagnosed with pneumonia and pulmonary hypertension (from the radiographic and clinical features), was performed at Yuzuncu Yil University Faculty of Medicine, Department of Pediatrics, from September 2003 to July 2005. Patients who had pneumonia and congenital heart disease or systemic hypertension or renal and liver disease together were excluded from the study. Blood gas analysis and oxygen concentration, measured with pulse oximetry, were performed in all patients. Besides chest X-ray, electrocardiography and echocardiographic search was also carried out. Echocardiographic examination was performed by using M mode, two-dimensional echocardiography and colored Doppler sonotron Vingmed CFM 725. At echocardiographic examination, pulmonary hypertension is defined as above 35 mmHg of pulmonary artery pressure. For echocardiographic examination, patients with pulmonary hypertension were divided into two groups. Captopril (2 mg/kg/day, three doses a day) and nifedipine (0.5 mg/kg/day, three doses a day) were given to the first and the second group, respectively. Echocardiography was performed daily until normal pulmonary artery pressure was achieved. At the beginning of the treatment, the patients were treated with double antibiotics and antibiotic change was carried out in needed cases at the follow up. Digoxin was administered to the cases of respiratory infection with heart failure.

Laryngeal lesion in leprosy and the risk of aspiration.

Leprosy affects the larynx, damaging its mucosa and sensory nerves and loss of sensation may result in aspiration of food and secretions. The laryngeal lesion may be insidious. Post-mortem studies showed bronchopneumonia that could have originated from aspiration. In patients with laryngeal symptoms, dysphagia or aspiration pneumonia loss of laryngeal sensation should be looked for.

Clinical manifestations, diagnosis, treatment, and prevention of Rhodococcus equi infections in foals.

Since the 1986 Rhodococcus equi workshop, there have been major breakthroughs in understanding the epidemiology of, the virulence of, and the immune response to, this intriguing pathogen. However, with the exception of the use of hyperimmune plasma for the prevention of the disease (Martens et al., 1989; Madigan et al., 1991) the clinical aspects of R. equi infections have essentially remained unchanged. This article reviews the various clinical manifestations and summarizes recent advances in diagnosis, treatment and prevention of R. equi infections in foals.

Sudden death of an infant with 'an early epileptic encephalopathy'.

This article reports an autopsy case of sudden death of an infant with an infrequent encephalopathy involving epileptic episodes. The infant was a 1-year and 10-month-old boy, who had a history of the first convulsive seizures in the third month after birth. The clinical diagnosis was described as 'an early infantile epileptic encephalopathy with suppression-bursts' (Ohtahara syndrome). On a winter day, he was collapsed following a high fever and was already dead on the arrival at a hospital. The body was small for the age and poorly nourished. The autopsy and postmortem magnetic resonance imaging scan (MRI) of formalin-fixed brain revealed advanced unsymmetric brain atrophy with cortical dysplasia, which were prominent in the left temporal and right occipital lobes, and sclerotic atrophy of the parahippocampal gyri, additionally showing a feature of the olivo-ponto-cerebellar atrophy. However, the cause of death was pathologically and microbiologically determined as bacterial bronchopneumonia following pulmonary infection of the influenza A virus. In sudden death cases of physically handicapped infants, the investigation of viral infection in consideration of an epidemiological survey is important even when the death can be pathomorphologically explained.

Diagnosis by ultrasonography of congestion of the caudal vena cava secondary to thrombosis in 12 cows.

This paper describes the clinical, ultrasonographic, radiographic and postmortem findings in 12 cows with thrombosis of the caudal vena cava. The principal clinical signs were chronic bronchopneumonia and fever in 11 cows; one cow had epistaxis and one cow bled from the mouth; eight cows had anaemia and leucocytosis, and the clotting time for the glutaraldehyde test was markedly decreased in all the cows; in nine of the cows the activity of gamma-glutamyltransferase was high, suggesting chronic hepatic congestion. The most important ultrasonographic finding was congestion of the caudal vena cava attributable to thrombosis of the vein. In all the cows the caudal vena cava was round to oval on cross-section, rather than the normal triangular shape. The hepatic, splenic and portal veins were dilated in five, three and one cow, respectively. The results of radiography and endoscopy supported a diagnosis of bronchopneumonia, but there were radiographic changes in the diaphragmatic lung lobes that supported a diagnosis of vena caval disease in only four cows. Postmortem there was a thrombosis of the caudal vena cava in all the cows, and the thrombi were located in the thoracic, subphrenic and abdominal part of the caudal vena cava at the level of the liver in four, one and seven cows, respectively. In three cows, the thrombus was situated where a hepatic abscess had broken into the caudal vena cava, and in one cow it was at the site of a diaphragmatic abscess. In another cow, there was a fistula between the major bronchus of the right diaphragmatic lung lobe and the caudal vena cava where the thrombus was situated. Three cows had liver abscesses that had not broken into the caudal vena cava. There was severe bronchopneumonia in 11 of the cows, some of which also had multiple pulmonary abscesses.

The effects of clenbuterol hydrochloride on the pulmonary function of calves with subacute and chronic bronchopneumonia.

The influence of clenbuterol on some pulmonary function tests in 11 calves with subacute and chronic bronchopneumonia has been investigated. Treatment with clenbuterol caused changes only in calves with subacute bronchopneumonia; in these animals it decreased the total pulmonary resistance, the viscous work per litre and the peak to peak changes in transpulmonary pressure.

Managing smoke inhalation injuries.

Inhalation injuries most often occur with cutaneous burns, and the likelihood of an inhalation injury increases incrementally with age of the patient and size of the burn. Damage to the pulmonary parenchymal tissue manifests as increased capillary permeability leading to excessive lung fluid formation and increasing hypoxia. An inhalation injury may be diagnosed using observation of indirect criteria in conjunction with fiberoptic bronchoscopy, xenon 133 radiospirometry, and/or measurement of extravascular lung water. Initially, carbon monoxide poisoning threatens the patient's oxygenation capacity. High-flow oxygen therapy reduces the half-life of carbon monoxide to an acceptable period. The patient proceeds through three stages: pulmonary insufficiency, pulmonary edema, and bronchopneumonia. Treatment is directed toward supporting oxygenation using endotracheal intubation with mechanical ventilation, humidification of inspired air, early mobilization, chest physiotherapy, antibiotics for documented infection, and adequate systemic hydration.

The effect of clenbuterol on lung function parameters in calves suffering from bronchopneumonia.

Pulmonary function testing was performed in calves affected with bronchopneumonia. In these calves respiratory rate, viscous work per litre air and per minute, intrapleural pressure difference, mean inspiratory and expiratory flow rate and ventilation per minute were significantly increased. Total resistance of the lung was just not significantly increased. Dynamic compliance and tidal volume were significantly reduced. The main effect of clenbuterol was a significant increase in dynamic compliance. The reduction in the total resistance of the lung was just not significant. These results indicate that clenbuterol can antagonise, at least partly, the alterations caused by bronchopneumonia.

[Incidence of ciliary beats in nasal cells obtained from smears. Study of 40 patients of whom 28 were children with respiratory pathology]. / Fréquence du battement des cils des cellules nasales obtenues par frottis. Etude chez 40 patients dont 28 enfants atteints de pathologie respiratoire.

Disturbance of ciliary function are considered as a significant factor in the outcome of chronic respiratory afflictions. Thanks to a simple method of stroboscopic lighting, the ciliary beat frequency was studied on 40 nasal mucus smears obtained by swabbing in 28 children and 12 adults with chronic respiratory failure or recurrent disease. The 28 children were divided into three groups: group A (n = 10), pulmonary disease (broncho-pneumonia); group B (n = 3), Kartagener syndrome; group C (n = 15) pure otorhinolaryngological (ORL) disease (rhino-opharyngitis, sinusitis, otitis). Twelve adults with chronic ORL pathology (vaso-motor rhinitis) made up group D. A cytological control was carried out on each smear and showed the presence of ciliated cells in 92.5% of samples. In three group B cases (Kartagener's syndrome) no ciliary movement was observed. The results in groups A (9.3 +/- 1.46 Hz) and C (8.98 +/- 2.23 Hz) show that the level of respiratory infection (pulmonary or ORL) did not influence the ciliary beat frequency (p greater than 0.05). On the other hand, there was a significant difference (p less than 0.001) between the beat frequency in the group of children in group A (9.3 +/- 1.46 Hz) and C (8.98 +/- 2.23 Hz) and those of adults in group D (11.32 +/- 1.89 Hz). Two hypotheses might explain these facts: The existence of a differing physiological response in children and adults. Different mechanisms during chronic ORL infections in adults (vasomotor phenomena) and in the child (bacterial infection). The average frequencies measured were comparable to those previously published in human respiratory cilia using other methods.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of cefoxitin against intractable bronchopulmonary infections. Patients not responding to other conventional antibiotics (author's transl)].

Cefoxitin was administered to a total of 17 patients with intractable bronchopulmonary infections who had failed to respond to other conventional antibiotics, and the following results were obtained. (1) The clinical response, except 1 patient classified as evaluation impossible, was excellent in 3 patients, good in 10 and fair in 3 with an efficacy rate of 81.3%. (2) An improvement rate of more than 70% was observed in the findings of body temperature, dyspnea, colour of sputum, WBC and CRP. (3) There was no subjective nor objective side effects attributable to cefoxitin. In view of the results stated above, we have concluded that cefoxitin is a useful antibiotic for the treatment of intractable bronchopulmonary infections.

[Laboratory and clinical investigation on lower respiratory tract infection by Haemophilus influenzae].

OBJECTIVE: To improve the positive rate of Hi isolation and to study the epidemiology, antibiotic sensitivity and clinical characteristics of the lower respiratory tract infection by Hi. METHODS: Modified Columbia chocolate agar(ICCA) was compared with blood agar staphy stick (BASS) for the primary isolation of Hi from sputa. The sensitivities of 20 antibiotics to Hi were determined in vitro by KB method and MICs of 12 antibiotics were determined by broth microdilution method. The clinical characteristics of 92 cases with lower respiratory tract infection by Hi were analyzed. RESULTS: The isolation rate of Hi by ICCA was 20%, which was higher than 13% of BASS(P < 0.01). The third generation cephalosporins and the quinolones were most active against Hi. The resistant rate against Hi of ampicillin was 21%, however, that of the third generation cephalosporins was 45%-49%. 67(73%) of 92 cases were bronchopneumonia. CONCLUSIONS: The isolation rate of Hi could be improved by ICCA. The clinical characteristic of lower respiratory tract infection by Hi was not specific. There has been a steady increase of antibiotic resistance during these years.

[Local and general changes in inflammatory lung diseases]. / Mestnye i obshchie izmeneniia pri vospalitel'nykh zabolevaniiakh legkikh.

Composite histo-cytoenzymochemical characteristics of local (pulmonary tissue) and general (polymorphonuclear leukocytes, PMNL, blood lymphocytes) changes in inflammatory lung diseases were obtained. Local and general changes were found to be interrelated and to reflect morphological and clinical features of inflammatory lung diseases. Differential diagnosis between acute and protracted bronchopneumonia, chronic pneumonia, bronchoectases is possible on the basis of the condition of PMNL and blood lymphocytes.

[Microcirculation, blood coagulation and blood phospholipids in acute pneumonia]. / Mikrotsirkuliatsiia, gemokoaguliatsiia i fosfolipidy krovi pri ostroi pnevmonii.

The state of conjunctival microcirculation, thromboelastographic hemocoagulation by 10 indices and 8 fractions of citrated blood plasma phospholipids was studied in 145 patients with acute pneumonia. Microcirculatory disorders with an increase in all conjunctival indices, marked hypercoagulation with raised concentration of phosphatidylethanolamine, lysophosphatidylcholines in parallel with a decrease in the level of phosphatidylcholines of the blood plasma, particularly at the peak of an inflammatory pulmonary process, were found. The relationship of phospholipids with plasma coagulation and microcirculation as a result of the development of a pathological pulmonary process was revealed.

[Clinical forms of enzootic pneumonia in calves and their effects on respiration]. / Klinische Formen der enzootischen Pneumonie bei Kälbern und ihre Auswirkungen auf die Atmung.

Enzootic pneumonia was diagnosed in 160 of 225 bullocks in a livestock fattening unit. Within the first 10 weeks, 51 of those affected contracted the disease a second time after the symptoms had vanished. Acute catarrhal bronchopneumonia were most common (49.3%) during the first outbreak, whereas acute catarrhal purulent bronchopneumonia (39.2%) and chronic pneumonia (29.4%) were most common during the second. Arterial blood gas analysis was undertaken for 33 clinically healthy bullocks and 100 bullocks with clinically diagnosed acute bronchitis, acute catarrhal bronchopneumonia, acute catarrhal purulent bronchopneumonia and chronic pneumonia. The pO2, SATO2 and A-aDO2 levels found in blood from the abdominal aorta of all diseased animals differed significantly from those of healthy animals. The values for animals with distinct catarrhal bronchopneumonia and catarrhal purulent bronchopneumonia showed the greatest differences.

[Theoretical basis and clinical assessment of fluid evacuation from the lungs during bronchoalveolar lavage in children]. / Teoreticheskoe obosnovanie i klinicheskaia otsenka évakuatsii zhidkosti iz legkikh pri bronkhoal'veoliarnom lavazhe u detei.

The authors discuss the theoretical aspects of the process of lavage fluid absorption from bronchial and alveolar spaces during broncho-alveolar lavage. It is shown that pressure in the vessels of pulmonary circulation, the blood colloid osmotic pressure, and permeability of the alveolar-capillary barrier play an important role in the dynamics of changes of the absorption process. Methods for correcting the intensity of absorption (use of solutions of different osmotic force for lavage) are suggested. Data gained in observation over the use of therapeutic lavage in children confirm the theoretical conclusions and demonstrate the favourable results of lavage in children with atelectases.