Rising trends in the prevalence of asthma and allergic diseases among school children in the north-west coastal part of Croatia.

OBJECTIVE: To estimate time trends in prevalence of symptoms and reported diagnosis related to asthma, allergic rhinitis/conjunctivitis and eczema among school children in the north-west coastal part of Croatia. METHODS: Results of two identical cross-sectional surveys conducted on the same area 8 years apart (school years 2001/02 versus 2009/10) in complete adherence to the protocol of the International Study of Asthma and Allergies in Childhood were compared. Surveyed population comprised two age groups: 6-7 years (n = 1634 versus n = 1052) and 13-14 years (n = 2194 versus 1181). RESULTS: Significant (p < 0.001) increases in prevalence (%) of symptoms related to asthma (8.4 versus 14.0), allergic rhinitis (17.5 versus 25.6), allergic rhinoconjunctivitis (6.7 versus 15.3) and eczema (3.4 versus 5.9) were observed in the 13-14-year-olds. In the 6-7-year-olds there were observed significant (p < 0.001) increases in prevalence of symptoms of eczema (5.4 versus 8.7) and allergic rhinitis (16.9 versus 22.1) whereas prevalence of symptoms related to asthma (9.7 versus 9.4; p = 0.398) and allergic rhinoconjunctivitis (5.6 versus 6.8; p = 0.102) showed to be stable. Significant increases in prevalence of reported diagnosis were observed for asthma (5.2 versus 6.9; p = 0.02) and hay fever (10.5 versus 14.6; p < 0.001) in the older, and for eczema (10.6 versus 14.1; p < 0.001) in the younger age group. CONCLUSION: Prevalence of asthma and allergic diseases among the school children living on the surveyed area showed a rising trend.

Postlaryngectomy olfactory rehabilitation and swimming.

The aim of the study was to determine the influence of swimming on postlaryngectomy olfactory rehabilitation. This prospective open interventional trial at a tertiary academic hospital included 100 laryngectomised patients; 17 were swimmers and 83 were nonswimmers. Participants practiced the polite yawning technique (PYT) for postlaryngectomy olfactory rehabilitation. Rhinomanometry was used to measure air quantity in the right and left nostrils, respectively; to test sense of smell, we applied the smell diskettes olfaction test (SDOT). Swimmers used swimming aids and swam only in a pool accompanied by another person trained in the rescue and resuscitation of a laryngectomee. Measures were made at three time points. Following PYT initiation, the number of accurately guessed odours was higher among swimmers (SDOT1 = 5.29, SDOT2 = 6.40, SDOT3 = 6.76) than nonswimmers (SDOT1 = 3.73, SDOT2 = 5.48, SDOT3 = 5.60) as were airflows through the left (swimmers: FL1 = 40.82, FL2 = 137.71, FL3 = 172.80; nonswimmers: FL1 = 13.05, FL2 = 104.63, FL3 = 113.00) and right nostrils (swimmers: FR1 = 46.82, FR2 = 115.41, FR3 = 145.40; nonswimmers: FR1 = 13.70, FR2 = 92.77, FR3 = 106.43). The number of odours identified by laryngectomised patients increased with the volume of nasal airflow, but this number and the efficiency of olfactory rehabilitation were higher in swimmers compared to nonswimmers. Swimming with a swimming aid improved the quality of life after surgery and may facilitate resocialisation of laryngectomised patients.

Henoch-Schönlein purpura complicated by appendicitis, intussusception and ureteritis.

Henoch-Schönlein purpura (HSP) is the most common childhood systemic small-vessel vasculitis with skin, joint, gastrointestinal (GI) and renal involvement. Uncommon GI complications are intussusception, bowel perforation and rarely reported appendicitis. HSP-associated stenosing ureteritis represents a rare and potentially serious complication. We present a 5-year-old boy with severe and prolonged course of HSP and three very rare complications that occurred sequentially: appendicitis, intussusception and ureteritis. Only three days after admission, he developed clinical signs of acute appendicitis indicating surgical intervention. Histological analysis of excised appendix showed inflammation but without signs typical for vasculitis. Two weeks later, with the reccurence of HSP he again developed clinical picture of acute abdomen. Ultrasound and radiologic evaluation demonstrated ileo-ileal intussusception and the second laparotomy was undertaken. Histological analysis of the resected bowel tissue showed typical signs of leucocytoclastic vasculitis. In the fourth week of his illness, serial urinalysis showed nephritic urinary sediment indicative of renal involvement. Unexpectedly, control abdominal ultrasound demonstrated mild hydronephrosis of the left kidney, not seen on previous ultrasound evaluations. Undertaken excretory urography and computed tomography (CT) scan showed stenosis of upper/ midureter with mild dilation of upper part of the left ureter suggesting unilateral HSP-associated stenosing ureteritis. Eventually, the patient was discharged and closely followed-up for the next two years. He had no further reccurence of HSP, the urinalysis normalized after six months, while mild unilateral hydronephrosis remained unchanged. Our search of the literature did not show reports of HSP complicated by appendicitis, intussusception and ureteritis, and to our knowledge this is the first case with three different illness events that occured sequentially. We emphasize the necessity of repeated ultrasound evaluations in the course of HSR especially in cases with severe GI and renal invovement.

Role of magnetic resonance imaging and scintigraphy in the diagnosis and follow-up of osteomyelitis in cat-scratch disease.

Cat-scratch disease (CSD) is a self-limiting infectious disease characterised with lymphadenopathy in a patient with a history of cat contact. Cases of bone involvement in patients with CSD are rare. We reported a case of 11-year-old boy with prolonged intermittent fever, inguinal lymphadenopathy and osteomyelitis. He had a history of exposure to kittens. The physical examination revealed a febrile boy without an apparent site of infection except an enlarged inguinal lymph node. Its histopathology demonstrated granulomatous lesion with no presence of acid-fast bacilli. Serum titers for Bartonella henselae were positive. Multiple bone lesions were detected by skeletal scintigraphy. Magnetic resonance imaging (MRI) confirmed and characterised osteolytic masses. The oral combination of azithromycin and rifampicin were given for 6 weeks with a good clinical response. At follow-up, the boy was without symptoms or signs of the disease. Successive MRI controls showed gradual regression of the bone lesions together with significant decrease of acute-phase reactants. In conclusion, CSD should be considered in the differential diagnosis of osteomyelitis. MRI is more reliable for the characterisation, evaluation of soft-tissue extension and follow-up of the bone lesions than scintigraphy. However, the later method permits an overview of the multiple osseous lesions. Therefore, standard MRI equipment may not exclude bone scintigraphy. Both methods are required until whole-body MRI units become routine.