ANALYSIS OF THE BLOOD HYPERCOAGULATION RISK IN PATIENTS WITH ISCHEMIC ATHEROTHROMBOTIC STROKE DEPENDING OF THE VDR GENE POLYMORPHISMS.

OBJECTIVE: Aim: of our study was the analysis of the blood hypercoagulation risk in patients with ischemic atherotrombotic stroke depending of the VDR gene polymorphisms. PATIENTS AND METHODS: Materials and Methods: Blood of 170 patients with ischemic atherothrombotic stroke (IATS) and 124 healthy individuals (control group) was used for genotyping. Four polymorphisms (FokI, BsmI, ApaI, TaqI) of gene VDR were examined with PCR-RFLP methodology. Statistical analysis was performed by using SPSS-17.0 program. RESULTS: Results: Among patients with IATS who are carriers of the f/f genotype, FokI polymorphism of VDR gene by high thrombin time and a decrease in the rate of spontaneous fibrinolysis was registered. In individuals with the B/B genotype homozygous for the polymorphic variant, BsmI had significantly lower mean values of prothrombin and thrombin time and increased the rate of spontaneous fibrinolysis. The homozygotes for the A-allele ApaI polymorphism have 2.7 times higher risk of developing blood hypercoagulation than homozygotes for the a-allele was found. CONCLUSION: Conclusions: Biochemical signs of hypercoagulation syndrome among patients with IATS who are carriers of the f/f genotype of the FokI polymorphic variant and among B/B homozygotes of the BsmI polymorphic variant and homozygotes for the A-allele of the AрaI polymorphism of the VDR gene were registered.

FORMATION OF STUDENTS' HEALTH CULTURE IN THE PROCESS OF PHYSICAL EDUCATION AND HEALTH RECREATION ACTIVITIES.

OBJECTIVE: The aim: To check the e!ectiveness of the methodology for the formation of students' health culture in the process of their physical education and health recreation activities. PATIENTS AND METHODS: Materials and methods: The following methods were used to achieve the aim: analysis, synthesis and generalization of literary sources, pedagogical observation, questionnaires, testing, pedagogical experiment, methods of mathematical statistics. 368 students took part in the ascertaining experiment, 93 students were involved in the formative experiment (52 - experimental group, 41 - control group). RESULTS: Results: The existing level of health culture formedness in students was revealed to be insu"cient, which stipulated the development and substantiation of the methodology for the formation of students' health culture in the process of their physical education and health recreation activities. CONCLUSION: Conclusions: The implementation of the methodology for students' health culture formation into the educational process contributed to an increase in the number of students with a high level of health culture and the level of motivation for a healthy lifestyle. The level of physical #tness of the experimental group students signi#cantly improved during the experiment. All this con#rms the e!ectiveness of the developed methodology.

THE PECULIARITIES OF BIOCHEMICAL AND MORPHOLOGICAL CHANGES IN THE HEART OF THE CASTRATED RATS IN THE DEVELOPMENT OF ADRENALIN DAMAGE OF HEART.

OBJECTIVE: The aim of the study was to evaluate the state of oxidation processes and morphological changes in the heart of castrated rats during the development of epinephrine heart damage (EHD). PATIENTS AND METHODS: Materials and methods. The study was performed on 120 white male Wistar rats. The animals were divided into four series: 1 - control, 2 - castration. For EHD, rats were injected once intraperitoneally with a 0.18% solution of adrenaline hydrotartrate at the rate of 0.5 mg/kg of weight. Castration was performed under anesthesia. The concentration of diene and triene conjugates (DC, TC), Schiff's bases (SB), TBA-active products (TBA-ap), oxidatively modi"ed proteins (OMP), activity of superoxide dismutase (SOD) and catalase (CAT) were determined in the heart. A morphological study of preparations stained with Azantrichrome was carried out. All studies were performed in control, 1, 3, 7, 14 and 28 days after adrenaline injection. RESULTS: Results: In the I series DC and TC increased after 1 day of EHD, fell to control values after 3 days, and then had wave-like character (highest - after 14 days). SB decreased (minimal after 7 days), TBA-ap increase (maximal after 14 days). OMP370 increased after 1 and 3 days, after 7 days they did not differ from the control, after 14 days they were higher than in control, and after 28 days they decreased to the control values. OMP430 and OMP530were greater than the control indicators in all terms, except the last; the maximum was noted after 14 days. The activity of antioxidant enzymes was lower than the control indicators at all times of the study. Castration caused an increase of lipid peroxidation. After 7 days, DC and TC, were lower and SB - higher, than in the I series. Castration caused a decrease in OMP. In EHD all values of OMP, compared to the castrated control rats, were higher at all studed times Castration leads to increase of SOD, and decrase of CAT. All indicators of SOD and CAT exceeded the indicators of animals of the I series at all times of the study. Biochemical changes are consistent with morphological changes. After injection of epinephrine, severe vascular disorders, adventitia edema, perivasal edema, endothelial cell damage, dilatation of hemicapillaries, full blood vessels, stasis, hemorrhages in the surrounding tissues, and sclerosing of the walls of arteries and venules were observed. Cardiomyocytes were swollen, shortening, necrosis was observed, myocytolysis was noted. Edema of the stroma was noted. In the stroma, around the vessels, located cells of connective tissue elements were observed. Indicate more damage to the myocardium in the process of development of EHD in animals of the I series. CONCLUSION: Conclusions: Castration of rats causes an increase of lipid peroxidation products and CAT activity in the heart, but a decrease in the content of OMP. Adrenaline injection causes activation of lipid peroxidation and an increase in the content of OMP. During the development of EHD, the activity of antioxidants is significantly higher in II group. Biochemical changes are consistent with morphological, and indicate more damage to the myocardium in the development of EHD in animals of the I series.

"The influence of olfactory enrichment on the behavior of two captive New World primates: Black-capped capuchin (Sapajus apella) and common marmoset (Callithrix jacchus)".

Environmental enrichment is an animal husbandry principle that seeks to provide the stimuli necessary for the optimal physiological and psychological well-being of animals. Due to primates having highly developed visual systems, there have been limited attempts to quantify the benefit of olfactory enrichment on captive primate populations. We aim to investigate how a range of odors may influence the behaviors of two captive New World primate species that have varying reliance on olfactory pathways, black-capped capuchin (Sapajus apella) and common marmoset (Callithrix jacchus), at the National Zoo and Aquarium, Canberra, Australia. We presented three odors (rosemary oil, Salvia rosmarinus, banana essence and white-tailed deer urine, Odocoileus virginianus) four different times to the two species following a 12-week randomized schedule. Using instantaneous scan sampling we collected behavioral and direct cloth interaction (DCI) data on 40 days. We then calculated activity budgets. Results show both species significantly respond to different olfactory conditions. S. apella responded to banana by decreasing inactivity (df = 4, F = 6.600, p = .007), and increasing DCI frequencies (df = 3, F = 116.196, p < .0001) whereas C. jacchus was influenced by rosemary and deer urine-also reducing inactivity levels (df= 4, F = 15.938, p < .0001), but not changing DCI frequencies. We also tested habituation however it is not significant for either species over the course of the study. This comparative investigation is one of the first of its kind and uncovers the possibility for olfactory stimulus to be successfully used as a type of beneficial environmental enrichment for captive primates, supporting the constructive and ongoing development of enrichment programs at captive facilities.

RELATIONSHIP OF DERMATOGLYPHICS WITH SPEED OF REACTION AND TYPE OF TEMPERAMENT OF ATHLETICS.

OBJECTIVE: The aim: To establish and practically substantiate the relationship between dermatoglyphic markers and the speed of reaction and type of temperament of track and field athletes. PATIENTS AND METHODS: Materials and methods: Analysis of scientific and methodological literature, survey, dermatoglyphics, methods of mathematical and statistical processing of the received data. RESULTS: Results: Track and field athletes among the population of the Sumy region of Ukraine have a tendency to decrease the number of whorls (p<0.05). Athletes of the sanguine type of temperament are most common (67,6%), and in the control group (among students of a medical university) the phlegmatic type of temperament is most common (68,4%). Also, among the subjects of the main group there is no such temperament as melancholic. We also determined the ATD angle for the palm. It was 37±4.88 in the main group, and 47±3.11 in the control group. This indicates a hereditary predisposition of this trait. The delta index in the control group has lower values (DI=9.5) than in the main group (DI=13.3). CONCLUSION: Conclusions: We established and practically substantiated the relationship between dermatoglyphic markers and reaction speed and temperament type of track and field athletes. Determined the relationship between the anatomical features of the fingers and the speed of mastering movements. For track and field athletes of the population of Ukraine, there were characteristic features of the dermatoglyphic structure: higher values of the deltoid index and genetic markers of the distance between the triradii a and d of the fingers.

INFLUENCE OF POSITIVE AND NEGATIVE FACTORS ON THE UNIVERSITY STUDENTS' HEALTH.

OBJECTIVE: The aim is to analyze the factors that affect the students' health both positively and negatively and to evaluate the real health status of Ukrainian student youth. PATIENTS AND METHODS: Materials and methods: The research was conducted at Zhytomyr Ivan Franko State University and University of State Fiscal Service of Ukraine, 647 students of the 1st - 4th years of study were examined. To study both negative and positive factors, we conducted a survey of the students of different genders of several education departments, using original questionnaires. To analyze the results of the students' self-assessment of their health state, the methodology of V. P. Voitenko, which contains 27 questions that characterize the most important aspects of well-being, mood, activity, sleep quality, pain senses and lifestyle of students, was applied. RESULTS: Results: It was determined that the most important factors for the preservation of health included nutrition, physical activity, active leisure, sleep, love and sex. 56.3 % of male students and 49.9 % of female ones indicated that motor activity is of great importance for health care. The students stated that the most dangerous health factors included drug use, radioactive contamination of the environment, smoking, alcohol abuse, stress, etc. It was found that the highest percentage of students had satisfactory and poor health levels - 44.8-54.9 % and 17.8-29.5 % respectively. CONCLUSION: Conclusions: A wide range of specific components of the educational process and the healthy lifestyle of students can have different effects on life. Lifestyle is one of the many factors that affect students' health. The students' self-assessment of their health state lets to manage the educational process of physical education efficiently, allocate physical activity and apply individual tasks rationally.

Motor activity as the basis of a healthy lifestyle of student youth.

OBJECTIVE: The aim is to find out the role of motor activity in developing a healthy lifestyle of student youth in the process of physical education. PATIENTS AND METHODS: Materials and methods: The study involved 647 students, aged 18-22. The research methods are the analysis and synthesis of the literature, analysis of curricula, programs, methodological support and quality of training, questionnaires, and the methods of mathematical statistics. RESULTS: Results: It is determined that the majority of the students had no need for a healthy lifestyle, the lack of knowledge in this area, low activity while performing the requirements of a healthy lifestyle, irrational organization of educational activities, bad habits and other factors that negatively affect their health. CONCLUSION: Сonclusions: The current system of physical education in the higher education institutions of Ukraine cannot change the attitude of students to a healthy lifestyle. The purpose of physical education, in addition to the formation of physical skills and development of students' physical qualities, should be educational work aimed at forming a positive attitude towards a healthy lifestyle.

THE ASSOCIASON OF VITAMIN D RECEPTOR GENE (VDR) POLYMORPHISMS WITH HIGH BLOOD PRESSURE IN STROKE PATIENTS OF UKRAINIAN POPULATION.

OBJECTIVE: The aim: To study the association of the polymorphisms VDR gene with high blood pressure in stroke patients in the Ukrainian population. PATIENTS AND METHODS: Materials and methods: Venous blood of 170 patients with atherothrombotic ischemic stroke (AIS) and 124 healthy individuals (control group) was used for genotyping. Four polymorphisms (FokI, BsmI, ApaI, TaqI) of gene VDR were examined with PCR-RFLP methodology. Statistical analysis was performed by using SPSS-17.0 program. RESULTS: Results: The correlation of genotypes of polymorphic variants of FokI, BsmI, ApaI and TaqI of the VDR gene with the development of ischemic atherothrombotic stroke in individuals with normal and high blood pressure was detected. Statistical analysis of the obtained data revealed that among carriers of genotypes F/F, b/b, a/a, a/A, and T/T patients with AI have statistically significantly higher incidence of hypertension than patients in the control group. CONCLUSION: Conclusions: It was found that persons with genotypes F/F, b/b, a/a, a/A, and T/T showed a statistically significant relationship between hypertension and the development of IAS. The application of logistic regression has made it possible to establish that the risk of IAS in people with normal blood pressure and genotype F/f is 3.2 times higher than in normotensive homozygotes for the F-allele.

Chronic productive cough in young adults is very often due to chronic rhino-sinusitis.

BACKGROUND: Chronic productive cough is a common clinical problem; often potential causes outside the lower respiratory tract are forgotten or ignored. The aim of this study was to make a precise etiopathogenetic diagnosis of chronic productive cough in young adults. METHODS: In a clinical setting, 212 subjects (mean age 41+/-5 years) who had reported chronic productive cough in a previous postal survey of a young adult population underwent within two years clinical and functional investigations following a rational diagnostic approach. Two pulmonologists independently established the diagnosis using a clinically structured interview on nasal and respiratory symptoms, spirometry and other tests when appropriate (bronchodilator test or methacholine bronchial challenge, chest radiography); if rhino-sinusitis was suspected, subjects underwent an ENT examination with nasal endoscopy and/or sinus computed tomography. RESULTS: At the end of the diagnostic procedure, 87 subjects (41%) no longer had chronic productive cough and had normal function. Fifty-eight subjects (27%) had chronic rhino-sinusitis; seventeen subjects (8%) had asthma, and of these fourteen also had chronic rhino-sinusitis; 50 subjects (24%) had COPD stage 0+, of these seven also had chronic rhino-sinusitis. Chronic rhino-sinusitis was more frequent in females than in males (p<0.05). CONCLUSIONS: Both in clinical practice and in epidemiological studies, it is important to consider that the origin of chronic productive cough could be frequently outside the lower respiratory tract; a consistent percentage of young adults with persistent productive cough has indeed chronic rhino-sinusitis.

Identification of sixty-two novel and twelve known FBN1 mutations in eighty-one unrelated probands with Marfan syndrome and other fibrillinopathies.

Marfan Syndrome (MFS) is an autosomal dominant disorder of the connective tissue due to mutations of Fibrillin-1 gene (FBN1) in more than 90% of cases and Transforming Growth Factor-Beta-Receptor2 gene (TGFB2R) in a minority of cases. Genotyping is relevant for diagnosis and genotype-phenotype correlations. We describe the FBN1 genotypes and related phenotypes of 81 patients who were referred to our attention for MFS or Marfan-like phenotypes. Patients underwent multidisciplinary pertinent evaluation in the adult or paediatric setting, according to their age. The diagnosis relied on Ghent criteria. To optimise DHPLC analysis of the FBN1 gene, all coding regions of the gene were directly sequenced in 19 cases and 10 controls: heterozygous amplicons were used as true positives. DHPLC sensitivity was 100%. Then, DHPLC was used to screen 62 other cases. We identified 74 FBN1 mutations in 81 patients: 64 were novel and 17 known. Of the 81 mutations, 41 were missense (50.6%), 27, either nonsense or frameshift mutations and predicted a premature termination codon (PTC) (33%), 11 affected splice sites (13.6%), and two predicted in-frame deletions (2.5%). Most mutations (67.9%) occurred in cbEGF-like modules. Genotype was clinically relevant for early diagnosis and conclusion of the diagnostic work-up in patients with incomplete or atypical phenotypes.

Long-term durable benefit after whole lung lavage in pulmonary alveolar proteinosis.

Whole lung lavage (WLL) is still the gold-standard therapy for pulmonary alveolar proteinosis (PAP). The few studies on the duration of the effect of WLL, belonging to a rather remote period, show significant but transient benefits. In 21 patients with idiopathic PAP, the duration of any benefit and, in 16 of them, the time course of lung function improvement (at baseline, 1 week, 6 months, 1 yr and then every 2 yrs after WLL) were evaluated. The present WLL technique takes longer, is invasively monitored and partially modified with respect to past techniques. More than 70% of patients remained free from recurrent PAP at 7 yrs. The bulk of the improvement in spirometric results was almost completely gained in the immediate post-WLL period due to the efficient clearance of the alveoli. At a median of 5 yrs, recovery of diffusing capacity of the lung for carbon monoxide was incomplete (75 +/- 19% of the predicted value) and there were residual gas exchange abnormalities (alveolar to arterial oxygen tension difference 3.6 +/- 1.5 kPa (27 +/- 11 mmHg)) and exercise limitation, probably explained by engorgement of lymphatic vessels. In conclusion, whole lung lavage for idiopathic pulmonary alveolar proteinosis is currently a safe procedure in an experienced setting, and provides long-lasting benefits in the majority of patients.

Chronic cough and phlegm in young adults.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines underline that the presence of chronic cough and sputum production before airflow obstruction offers a unique opportunity to identify subjects at risk of chronic obstructive pulmonary disease for an early intervention. Current epidemiological data on these subjects are scant. Between 1998-2000, the authors evaluated the prevalence and characteristics of these symptoms by a multicentre cross-sectional survey of Italian people aged between 20-44 yrs from the general population (Italian Study on Asthma in Young Adults (ISAYA)). Besides the questions on asthma, more than 18,000 subjects answered the question: "Have you had cough and phlegm on most days for as much as 3 months per year and for at least two successive years?" The adjusted prevalence of subjects with chronic cough and phlegm was 11.9%, being 11.8% in males and 12.0% in females. From these subjects approximately 20% reported coexisting asthma and approximately 30%, predominately females, were nonsmokers. The survey showed that sex (female), smoking and low socioeconomic status were significantly and independently associated with chronic cough and phlegm, current smoking playing the major role. The prevalence of subjects with chronic cough and phlegm is startlingly high among young adults. Further follow-up studies are needed to establish how many of them will go on to develop chronic obstructive pulmonary disease.

Mid term effects of pulmonary thromboendarterectomy on clinical and cardiopulmonary function status.

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) can be successfully treated surgically by pulmonary thromboendarterectomy (PTE) but there are few data on mid-term cardiopulmonary function, particularly on exertion, and clinical benefits following pulmonary PTE. METHODS: A 2 year follow up study was undertaken of clinical status, haemodynamic and lung function indices, gas exchange, and exercise tolerance in 38 patients of mean (SD) age 50 (15) years who had undergone PTE. RESULTS: In-hospital mortality was about 10%. Before PTE all the patients were severely impaired (NYHA classes III-IV). There was no time difference in the improvement in the parameters: nearly all the improvement in cardiac output, gas exchange, and clinical status was achieved in the first 3 months as a result of the relief of pulmonary obstruction. At 3 months the percentage of patients with normal cardiac output and PaO(2) and of those with reduced clinical impairment increased to 97%, 59%, and 87%, respectively, without any further change. Only mean pulmonary artery pressure (mPAP), carbon monoxide transfer factor (TLCO), and exercise tolerance improved gradually during the second year, probably due to the recovery of the damaged small vessels. TLCO was overestimated before PTE but afterwards the trend was similar to that of mPAP. CONCLUSIONS: At mid term only a few patients did not have a satisfactory recovery because of lack of operative success, hypertension relapse, or the effect of preoperative hypertension on vessels in non-obstructed segments. Most of the patients, even the more compromised ones, had excellent long lasting results.

Lung function abnormalities after bone marrow transplantation in children: has the trend recently changed?

STUDY OBJECTIVES: To evaluate early and late lung function abnormalities and their predictors in a large sample of children who underwent bone marrow transplantation (BMT) for leukemias in the 1990s, highlighting changes with respect to the 1980s. DESIGNS: Prospective cohort. SETTING: A university department of pediatrics. PARTICIPANTS: Seventy-five consecutive children who underwent BMT were enrolled in the study (median age, 11 years; range, 6 to 19 years; 45 male and 30 female children). Twenty-three children received autologous BMT, and 52 children received allogeneic BMT; 50 children completed the study. MEASUREMENTS: Clinical examinations and lung function tests were performed before BMT, and 3 to 6 months, 12 months, and 24 months after BMT. RESULTS: Before BMT, at 3 to 6 months after BMT, and at 24 months after BMT, 44%, 85%, and 62% of children, respectively, had altered lung function in the absence of persistent respiratory symptoms. Between 3 months and 6 months after BMT, a restrictive pattern was the most frequent abnormality. The only predictive factors for late abnormalities were transplantation performed in the advanced disease phase (odds ratio [OR], 6.75; p = 0.005) and bronchopulmonary infections (OR, 3.9; p < 0.05). CONCLUSIONS: These data suggest that a significant proportion of children who undergo BMT, especially if for leukemia in advanced phase, have early and late pulmonary abnormalities. These abnormalities, especially the late ones, seem to be more severe than patients reported in studies analyzing children undergoing BMT in the 1980s. This could be due to the more intensive front-line treatment protocols employed for treatment of children with acute leukemia in the 1990s.

Variations in the prevalence across countries of chronic bronchitis and smoking habits in young adults.

The present work aims to assess the international variation in the prevalence of chronic bronchitis and its main risk factor, smoking habits, in young adults of 35 centres from 16 countries. Respiratory symptoms and pulmonary function were assessed in 17,966 subjects (20-44 yrs), randomly selected from the general population, in the frame of the European Community Respiratory Health Survey. The median prevalence of chronic bronchitis was 2.6%, with wide variations across countries (p<0.001; 0.7-9.7%). The prevalence of current smokers ranged 20.1-56.9%, (p<0.001) with a median value of 40%. Current smoking was the major risk factor for chronic bronchitis, especially in males. Its effect increased according to number of pack-yrs: in males, the odds ratio of chronic bronchitis was 3.51 (95% confidence interval (CI) 2.31-5.32) in 1-14 pack-yrs smokers and increased to 17.32 (9.97-30.11) in > or = 45 pack-yrs smokers with respect to nonsmokers. Only 30% of the geographical variability in prevalence could be explained by differences in smoking habits, suggesting that other environmental and/or genetic factors may play an important role. In conclusion, chronic bronchitis is a substantial health problem even in young adults. The impressive prevalence in current smokers in most countries highlights the need to improve the quality of prevention.

Lung cancer resection: the prediction of postsurgical outcomes should include long-term functional results.

STUDY OBJECTIVES: To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (O(2)max) as a criterion for operability and as a predictor of long-term disability. DESIGN: Prospective study. SETTING: Outpatients and inpatients of a university hospital. PARTICIPANTS: Sixty-two consecutive patients (mean +/- SD age, 62 +/- 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). MEASUREMENTS: Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV(1) (ppoFEV(1)) was < 40%, patients underwent exercise testing; if O(2)max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. RESULTS: All the patients with ppoFEV(1) > or = 40%-even those patients (26%) with FEV(1) < 80%-underwent thoracotomy without further tests. Seven patients with ppoFEV(1) < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV(1) > or = 40%. ppoFEV(1) significantly underestimated the actual postoperative FEV(1) (poFEV(1); p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV(1) after lobectomy. Two patients with predicted postoperative O(2)max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. CONCLUSIONS: ppoFEV(1) > or = 40% reliably identifies patients not requiring further tests and not at long-term risk of respiratory disability. O(2)max, effective for defining the immediate surgical risk, is not useful in predicting long-term disability.

Effects of inhaled steroids on methacholine-induced bronchoconstriction and gas trapping in mild asthma.

According to a recent hypothesis, airway smooth muscle regulates airway calibre mostly at high lung volume, whereas the mucosa and adventitia dimensions dominate at low lung volumes. It was thought that if inhaled steroids decrease the thickness of airway wall in asthma, then forced vital capacity (FVC), which reflects the functional changes at low lung volume, should decrease less during induced bronchoconstriction than flow at high volume. The study was conducted in 31 mild asthmatics under control conditions and during a methacholine challenge before and after 4-weeks treatment with inhaled fluticasone dipropionate (1.5 mg daily, 16 patients) or placebo (15 patients). After fluticasone dipropionate treatment, control forced expiratory volume in one second (FEV1), and maximal flow at 50% of control FVC during forced expiration after a maximal (V'max,50) and a partial inspiration (V'p,50) significantly increased. During methacholine challenge, FVC decreased less than did FEV1 or V'max,50, and so did inspiratory vital capacity compared to V'p,50. Both the provocative dose of methacholine causing a 20% fall in FEV1 and the bronchodilator effect of deep inhalation significantly increased. The latter was assessed by means of the regression coefficient of all V'max,50 plotted against V'p,50. No significant changes in these parameters occurred after placebo. These data show that inhaled steroids remarkably blunt the occurrence of gas trapping during induced bronchoconstriction in mild bronchial asthma, possibly due to their effect on airway wall remodelling.

Lung function in survivors of childhood acute lymphoblastic leukemia.

STUDY OBJECTIVES: To evaluate lung function in patients cured from childhood acute lymphoblastic leukemia (ALL) with chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary toxicity is a well-recognized side effect of many ALL treatments. DESIGN: Cross-sectional study conducted at least 3 years after cessation of therapy. SETTING: Outpatient pneumology department of the University Hospital. PATIENTS: Forty-four subjects (age range at observation, 6 to 23 years): 21 treated only with intensive Berlin-Frankfurt-Munster (BFM)-type chemotherapy for newly diagnosed ALL (group A), and 23 treated with chemotherapy plus BMT (group B). MEASUREMENTS: A detailed history of smoking habit, respiratory symptoms, and diseases was recorded directly from the patients with the aid of their parents. A complete physical examination and lung function testing (lung volumes and diffusion capacity for carbon monoxide [DLCO]) were performed in all subjects. RESULTS: No patient reported acute or chronic respiratory symptoms or diseases. In group A patients, lung function was in the normal range, except for three subjects in whom there was an isolated impairment of DLCO. In group B patients, lung function was markedly impaired, with more than half the patients having an abnormal DLCO. A statistically significant difference was found between the two groups for FVC (p = 0.022) and DLCO (p = 0.004). CONCLUSIONS: Intensive, BFM-type frontline chemotherapy is not associated with late pulmonary dysfunction; however, retreatment including BMT can frequently injure the lung. Thus, in patients who undergo BMT and whose life expectancy is long, careful monitoring of lung function and counseling about avoiding additional lung risk factors is recommended.

International variations in asthma treatment compliance: the results of the European Community Respiratory Health Survey (ECRHS).

Noncompliance to medication is a major barrier to effective asthma management. Its real extent and geographical variation throughout the world are not yet known. The data on compliance, collected in the framework of the European Community Respiratory Health Survey (ECRHS) on 1771 subjects (aged 20-44 yrs) with current asthma identified in 14 countries, offer a unique opportunity to assess the extent of noncompliance and its variation across countries. The median percentage of current asthmatics who had received a medical prescription at least once was 95%. The compliance of those patients who had received a medical prescription was found to be low in all countries (median 67%) but with wide variations, the rate ranging from 40% (USA) to 78% (Iceland). During exacerbations patients' rate of compliance increased to 72%. Age was the only variable which influenced compliance to treatment. A significant, although weak, negative correlation was found between patients' compliance and rate of hospital casualty department or emergency room admissions. This study documents that compliance to the treatment of asthma is poor worldwide and that there are large variations between countries. These results emphasize the necessity for further efforts to improve patients' education and to promulgate the international guidelines.

Late pulmonary sequelae after childhood bone marrow transplantation.

BACKGROUND: Respiratory function in transplanted children is important because of the long life expectancy of bone marrow transplant recipients, particularly children. Attention is now being focused on the late sequelae of treatment on organ system function. A few papers have been published but available data are somewhat conflicting. METHODS: A cross sectional study aimed at evaluating the late effects of transplantation on lung function was performed in a group of 52 young patients who were given autologous or allogeneic bone marrow transplants during childhood for haematological malignancies. RESULTS: No patients reported chronic respiratory symptoms. The distribution of respiratory function patterns showed that only 62% of patients had respiratory function within the normal limits; 23% had a restrictive pattern and 15% had isolated transfer factor impairment. The percentage of patients with lung function abnormalities was higher in those who (1) received a bone marrow transplant after two or three complete remissions compared with those who were transplanted immediately after the first remission (54% vs 21%; p < 0.02), (2) underwent allogeneic bone marrow transplantation rather than an autologous transplantation (45% vs 26%; p = 0.06), and (3) had a pulmonary infection compared with those without (56% vs 26%; p = 0.07). CONCLUSIONS: In spite of the absence of chronic respiratory symptoms there is a high prevalence of children with late pulmonary sequelae after bone marrow transplantation. Regular testing is recommended after transplantation, in particular in subjects at higher risk of lung injuries, such as those receiving transplants after more than one remission, those receiving allogeneic transplants, and those having suffered from pulmonary infections. When lung function abnormalities become apparent, long term follow up is necessary to see whether they become clinically relevant. All patients should remain non-smokers after transplantation and should have active early and aggressive treatment for respiratory illnesses.