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Paediatric pulmonology and allergology
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Migle Klimantaviciene, Arunas Valiulis, Remigijus Lapinskas. Lung function measurements in young children by the interrupter technique Ingida Pumputiene, Regina Emuzyte, Regina Firantiene, Kristina Veriznikoviene, Vytas Tamosiunas. The activity of T cells during the remission of atopic and non-atopic asthma in children Petras Kaltenis, Jolanta Bernatoniene, Gina Bernatoniene, Einar Hjaltested, Helga Erlendsdottir, Karl Kristinsson, Asgeir Haraldsson. The prevalence of Haemophilus influenzae in nasopharynx of chirdren attending day care centers in 1999 and 2001 Odilija Rudzeviciene, Irena Narkeviciute. Diagnostic significance of skin patch test in children with atopic dermatitis Aleksandreas Balbierius. Quality fo life in patients with asthma and spirometry Pranas Gurskas, Benjaminas Siaurusaitis. Complications of surgical treatment of congenital esophageal atresia Stanislovas Maknavicius, Benjaminas Siaurusaitis. Thymic tumors in children Dane Slapkauskaite, Jura Vladas Vaitkevicius, Elena Suciliene, Vilma Rasiuliene, Violeta Klugiene. The sensitivity of children to tuberculin and prevalence of tuberculosis in Radviliskis region of Lithuania Virginija Zilinskaite. Definitions and diagnostics of sepsis Juozapas Butkus, Daiva Zukauskiene. Development of lung function testing in children Proceedings of IV International Asthma Conference-School Andre Pradalier, Marius Zolubas. Sublinqual-swallow immunotherapy - an alternative of subcutaneous immunotherapy? Jurate Staikuniene. Desloratadine in the treatment of allergic diseases: from pharmacology to clinical trials Andrew Bush. Different phenotypes of asthma in childhood Andrew Bush. Conditions which mimic asthma Andrew Bush. Very difficult asthma: bronchoscopic studies Jurgis Bojarskas, Ruta Dubakiene, Regina Emuzyte, Jolanta Kudzyte, Arunas Valiulis. Paediatric Asthma Guidelines. Lithuanian Consensus Report of paediatricians, family doctors, paediatric intensive care doctors, allergologists and pulmonologists Audra Blaziene, Ruta Dubakiene, Regina Emuzyte, Juozas Ivaskevicius, Palmira Leisyte, Rimantas Kevalas, Vidas Pilvinis, Eduardas Razgauskas, Arunas Valiulis, Virginija Zilinskaite. Anaphylaxis. Lithuanian Consensus Repors of allergologists, pulmonoloigsts, paediatricians, family doctors, anaesthesiologists and intensive care doctors. |
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Lung function measurements in young children by the interrupter techinque
Migle Klimantaviciene, Arunas Valiulis, Remigijus Lapinskas
Rint (the interrupter techinque fo the respiratory resistance measurement) is one of the several methods for lung function measurement suitable for young children who are unable to perform spirometry reliably. Rint decreases normaly when a child is growing up, and increases in case of airway obstruction. Objectives: To measure Rint for healthy 2-7 old children and to determinate the influence of rhinitis on interrupter airway resistance. Methods: 270 children (135 males and 135 females) underwnt measuremts with MicrRint (MicroMedical Ltd. UK) in kindergartens: 213 healthy with no history of atopy or respiratory infection, 57 with current rhinitis. Mean age was 4.6 yrs (2-7 yrs). Results: No difference were found between boys and girls, height predicted values more informative than age alone and as well as height and age together. No significant differences were found between mean Rint values of healthy and those with viral rhinitis. |
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T cells activity in children's atopic and nonatopic asthma remission
Ingrida Pumputiene, Regina Emuzyte, Regina Firantiene, Kristina Veriznikoviene, Vytas Tamosiunas
In recent years it is being stressed that asthma is a chronic inflammatory process present even in asymptomatic allergic subjects. T cells and their cytokines play a major role in regulation of allergic inflammation, so the aim of our study was to examine the activity of peripheral blood T cells in atopic and nonatopic asthmatic children during disease remission. We studies the proliferative activity of T cells after stimulation and sIL-2R, IL-2 and IL-4 concentration in serum. We examined 28 children with atopic asthma, 14 with nonatopic asthma and 13 healthy children. T cell proliferative activity after stimulation with PHA in vitro was higher in atopic asthmatics compared to nonatopic asthmatics (p<0.05) and healthy children (p<0.001). In case of nonatopic children asthma T cell proliferative activity was elevated compared to healthy children (p<0.01). The increase of sIL-2R concentration in serum of atopic asthmatic children compared to the control (p<0.05) revealed increased T cell activity in these patients during remission. Evaluating the data of IL-2 and IL-4 values in serum, it was found, that IL-2 concentration was increased in both atopic (p<0.05) and nonatopic (p<0.05) asthmatics compared to the control and it revealed the increased Th1 cell activation in these patients. IL-4 (Th2 cytokine) concentration was not changed in all asthmatic childen compared to healthy children. |
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The prevalence of Haemophilus influenzae in children, attending day care centers, nasopharynx in 1999 and 2001
Petras Kaltenis, Jolanta Bernatoniene, Gina Bernatoniene, Einar Hjaltested, Helga Erlendsdottir, Karl Kristinsson, Asgeir Haraldsson
The most frequent respiratory tract pathogens in children are Streptococcus neumoniae, Haemophilus influenzae, Moraxella catarrhalis. These bacteria can be normal nasopharinx microflora. But there are many factors predisposing spread of these bacteria, that can cause local (sinusitis, otitis media, tonsillitis) or invazive disease (septicaemia, pneumonia, meningitis). The aim of this study was to evaluate carriage rate of the most frequent respiratory tract pathogens in children nasopharynx and to assess antimicrobial susceptibility in Lithuania and Island in 1999 and 2001. The study was carried out on February-March, 1999 and 2001. Nasopharyngeal swabes were taken from children (n=508 in 1999 and n=516 in 2001) attending day care centres in Vilnius. The average of age was similar in 1999 and 2001 (accordingly 4.2 and 4.7 years). The specimens were screened for the presence of pneumococci, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes according to conventional methods. Nasopharyngeal samples were collected from children nasopharynx, using Culturette transport swabs (Becton Dickinson). The swabs were incoulated within few hours of specimen collection. We present the results of the prevalence and antimicrobial resistance of H.influenzae bacteria in Lithuanian children. Of the 508 children in 1999 and 516 children in 2001, 68 perc. and 55 perc. carried respiratory tract pathogens. 7 perc. of the children in 1999 and 8.7 perc. in 2001 had type b capsulated H.influenzae in their nasopharynx. a-lactamase production was 3.5 perc. in 1999 and only 0.7 perc. in 2001. Antimicrobial susceptibilities of H.influenzae were performed. Our results show that antimicrobial susceptibility to ampicillin, azitromycin and cefuroxime is high in 1999 and 2001. Antimicrobial susceptibility of H.influenzae bacteria to many antimicrobials was similar (except to erythromycin and tetracycline) in 1999 and 2001.
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Diagnostic importance of skin patch test in children with atopic dermatitis
Odilija Rudzeviciene, Irena Narkviciute
Atopic dermatitis is associated with food allergy, especially in small children. The aim of this suty was to evaluatie the importance of patch test for early detection of food allergy in small children with atopic dermatitis, to compare the serum total IgE concentration in chidren with positive skin prick and patch tests. We examined 33 children aged 2-27 mo (mean age 9.9mo) suffering from atopic dermatitis 1-24 mo (mean duration 7.1 mo). The serum total IgE was measured in all children. Prick and patch tests with native cow's milk were performed in 33, with hen's egg and soy - in 28 children. Patch tests (46.1 perc.) were significantly more often positive than prick tests (16.9 perc.), p<0.001. In 4 patients only prick tests were positive (total IgE concentration 34.6-500IU/ml, mean - 308.9), in 16 - only patch tests (total IgE 4-125 IU/ml, mean - 30.8), in 8 - both prick and patch tests were positive (total IgE 41-249.6 IU/ml, mean 133.1), the differences of mean total IgE were statistically significant (p<0.0004). The atopy patch test is of great importance for the diagnosis of food allergy in small chidren with atopic dermatitis especially in cases of normal serum total IgE concentration and negative skin prick tests. |
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Quality Of Life in Patients With Asthma and Spirometry
Aleksandras Balbieris
Assessment of Quality of life by St. George hospital respiratory questionnaire (SGRQ) and standard spirometry has been performed of 601 patients with bronchial asthma. The aim of study correlation of questionnaire serusts and the investigated parameters of spirometry. Positive correlation was observed between SGRQ and following parameters of spirometry: TOTAL vs. FEV1/FVC and FEV 1 perc.; meand IMPACT and ACTIVITY vs. and both parameters of spirmetry. Correlation of SYMPTOMS with investigated parameters was not significant. According to the SYMPTOMS of disease for quality of life, patients evaluated their condition as more severe than the docteors would do evaluating the results of spirmetry. TOTAL index is the most reliable indicator for correlation of quality of life impairment with ogjective state of patient. Function lung volume (FVC) with SGRQ vs. was not related.
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Causes of complications of surgical treatment of congenital esophageal atresia
Pranas Gurskas, Benjaminas Siaurusaitis
The aim of study - analysis of complications of surgical treatment of patients were operated for congenital esophageal atreasi in Vilnius University Children's Hospital. 112 patients were treated by primary esophageal anastomosis, 14 received delayed primary anasotmosis of the esophagus after mechinical elongation of proximal esophageal pach. Most frequent cause of early complication was high traction of the anastomosis, that determine leakage of the anastomosis. Extubation and manipulations during repetitive intubation could cause leakage, especially in those patients with high traction of the sutures. The lae complication - stricture of the anastomosis was successfully trated by bougienage of esophagus.
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Thymic tumors in children
Stanislovas Maknavicius, Benjaminas Siaurusaitis
We have analyzes case histories of 25 children who were treated in our clinic because of thymic and anterior mediastinal tumors. Aim of the sudy - to determine the accuracy of diagnostic methods and tactic of surgical treatment. Clinical symptoms, diagnostic methods, methods of surgical treatment and results of histological examination were reviewed. Besides of ultrasound examination, CT and MRI, tumor's biopsy using punction or mediastinotomy methods and histological examination should be performed. The main indications for surgical tratment are suspition of malignancy of the tumor, symptoms of respiratory tract compression and Myasthenia gravis.
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The sensitivity of children to tuberculin and prevalence of tuberculosis in Radviliskis region of Lithuania
Dane Slapkauskaite, Jura Vladas Vaikevicius, Elena Suciliene, Vilma Rasiuliene, Violeta Klugiene
Comparative test on schoolchildren's sensitivy to tuberculin, which was conducted in Radviliskis region in different epidemiological background in 1977 and 2000, revealed no reliable quantitative differences. Rate of infection of M.tuberculosis among 7-year-old children and teenagers is respectively 6,5±5,25 and 14,3±4,7 perc.. Spread of tuberculosis infection and sensitivity to tuberculin is nore dependent on the decreasing number of chidren in families with members with bacillary tuberculosis than on the general increase of tuberculosis incidence in the region.
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Definitions and diagnosis of sepsis
Virginija Zilinskaite
Sepsis is the systemic inflammatory response to infection. Sepsis and its sequelae represent progressive stages of the same illness in which a systemic response to an ifection mediated by endogenous mediators may lead to a generalized inflammatory reaction in organs remote from the initial insult and to end-organ dysfunction and failure. Sepsis is the most common cause of death in the intesive care unit. The Consesus Conference of the American College of Chest Physicitans and the Society of Critical Care Medicine proposed a new set of definitions in 1991. These definitions included patients in various stages of infection: bacteraemia, sepsis, severe sepsis septic shock, and multiple organ dystunction syndrome. The Conference proposed a new term, systemic inflammatory response syndrome (SIRS), to describe widespread inflammation that occurs following a wide variety of insults including infection, pancreatits, trauma, burns, etc. no single physiological or laboratory parameter can universally identify sepsis. The continuumo of sepsis, severe sepsis and septic shock is correlated with increasing organ dysfunction and mortality. The source of infection and diagnosis of sepsis must be identified as early as possible to permit early intervention with antimicrobial therapy and surgical drainage to prevent disease progression, organ dysfunction and mortality.
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Development of childrens lung function testing Juozapas Butkus, Daiva Zukauskiene We present authentic spirograms of healthy childrens registered with spirograph SG-Im in this work. The measurements of spirograms computations and importance are described. We compare lung function testing in 7 decade of XX c. with more perfect, simple and easy accessible present PFT and its interpretation. We think, that presented spirograms will allow us better understand the meaninf of different characteristics of cumputerised assessment of lung function testing.
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Sublinqual-swallow immunotherapy - an alternative to subcutaneous immunotherapy? Andre Pradalier, Marius Zolubas
Available trials on new and emerging method of ummunotherapy in allergic diseases - sublinqual-swallow immunotherapy are described and analysed in terms of efficacy and safety. It seems that sublinqual-swallow immunotherapy could be a viable and safe alternative of conventional treatment in selected patients with allergic rhinitis and/or asthma. |
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Desloratadine in the treatment of allergic diseases: from pharmocology to clinical trials (review article) Jurate Staikuniene
Allergic rhinitis, asthma and chronic idiopathic urticaria are disease with underlying allergic inflammation. Histamine is its important mediator, and H1-antihistamines are widely used pharmacological agents in the treatment of these diseases. Increased knowledge of the complexity of the allergic cascade opened may potential avenues for clinical interventions, which are directed toward immune effector cells, their mediators, receptors and adhesion molecules. Desloratadine has recently been developed as a potent and selective antihistamine with additional anti-allergic and anti-inflammatory properties, inhibitory effects on tha allergic cascade. This novel nonsedating histamine H1-receptor antagonist, desloratadine, significantly decreased seasonal allergic rhinitis symptoms, including nasal congestion, improved other "non-nasal" and asthma symptoms, diminished daily beta 2-agonist use, improved quality of life of these patients. Clinical trials proved the efficacy of desloratadine in chronic idiopathic urticaria. Desloradatine has a rapid and long lasting effect with the safety profile comparable to placebo. |
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Different phenotypes of asthma in childhood Andrew Bush
The term "asthma syndrome" encompasses a range of disorders, all characterised clinically by combinaton of cough, wheeze and breathlessness. in older children, evidence of variable airway obstruction is manifest by change in peak flow over time or with treatment, reduction in peak flow on exercise, and a positie methacholine challenge. The underlying pathology includes combinations of bronchial hyperreactiveiy (BHR0, airway inflamation and alterations in underlying baseline airway calibre of compliance. THis in not merely of academic importance, but is fundamental to organizing appropirte treatment. In children with symptoms with viral colds and also between colds, and in particluar if they are atopic, the underling abnormality is likely to be T-cell driven, eosinophil mediated airway inflammation. There is compelling evidence that early treatiment with inhaled corticosteroids is essential if airway remodielling is to be avoided and optimum long term lung function is to be achieved. The pathophysiology of wheezing with viral colds in the non-atopic infant is completely different; such infants have evidence of abnormal lung function soon after birth and before their first episode of viral wheeze, and no evidence of either bronchial hyperreactivity orairflow inflammation. Response to inhaled steroids is very poor. For most infants with wheeze, it is currently not possible to predict whether they will go on to the pictore of established asthma. Post-bronchiolitic asthma ayndrome also does not respond to inhaled steroids, because prolonged symptoms are likely due to abnormal pre-morbid airway function, albeit worsened by atopy. Phenotybe specific treatment is also important in older children and is covered in another paper. Asthma is not one disease but many, and attention to delineating clinical phenotypes, rather than being obsessed with guidelines based on large heterogenous groups, may allow rational treatment of individual treatment. |
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Conditions which mimic asthma: paediatric disease Andrew Bush
Although most children who cough and/or wheeze have either a variant of asthma or are normal, a few have an underlying serious illness. These include causes of chronic pulmonary sepsis such a cystic fibrosis; congenital lung diseases, including upper airway disease, large airway obstruction by abnormal blood vessels, oesophageal disease, and a number of other rare conditions. Children should be selected for further investigation on the basis of a carefully focused history and physical examination. The pattern of symptoms, the timing of onset and the response to treatment are all important. Specific physical signs to be sought include digital clubbing, severe chst deformity, unusual auscultatory singns, and signs of cardiac or systemic disease. This may be supplemented by a chest radiograph and, in children old eouugh to cooperate, simple lung function tests. Further invesitagions will only be needed in a small minority of children with cough and wheeze, and should be targeted at the specific possibilities raised by history and examination. |
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Very difficult asthma: bronchoscopic studies Andrew Bush
Endobronchial biopsy is a safe procedure in children. It can be performed ethically for research as an add-on procedure during frbreoptic bronchoscopy, or while the child is intubated for another procedure. It offers the otential to reveal fundamental insights into the events initiating asthma and other childhood respiratory diseases. |
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April, 2002, Vol. V, No.1-2 (p. 1641-1800)
