Differential diagnosis of allergic diseases of the upper respiratory tract

The author studied various manifestations of the most widely spread clinical forms of allergic diseases of the upper respiratory tract, namely, the bacterial, atopic and combined ones. In addition to clinical investigations laborotory, immunologic and functional tests were conducted. The difference in pathogenesis affected the clinical course of the disease. Some symptoms depended on the kind of sensibilization, others on how strongly pronounced the pathologic process was.     

Therapy and prevention of chronic respiratory tract diseases

196 patients suffering from chronic infections of the respiratory tract (bronchial asthma, spastic bronchitis, sinobronchitis, increased liability to infections during childhood) were treated with non-specific hyposensitization by Paspat as no improvements had been obtained with other methods. The patients were observed for at least one year after the termination of the therapy: Recovery in 62,2%, clear improvements in 23% of the cases; only 14,8% did not respond. The author can now rely on a total of 466 cases, who have been treated by this method for 21 years. The results obtained after the childhood were significantly improved by modifying the treatment and the remedies and by increasing the numbers of injections. Consequently, repeated applications of Paspat for treating and preventing chronic infections of the respiratory tract are considered a real progress.     

X-ray diagnosis of liver and biliary tract diseases

The paper deals with combined diagnosis of hepatic and biliary diseases, involving a wide range of nosological entities. It shows the potentialities of currently available diagnostic techniques for the most common diseases. The authors examined 175 patients with acute and chronic hepatitis, 120 with hepatic cirrhosis, 486 with cystic changes, 324 with benign tumors, 292 with malignant tumors, 21 with hepatic abscess, 527 with cholecystitis, 566 with cholelithiasis. Cancer of the gall-bladder was in 10 patients, its polyps were in 18, cancers of the common bile duct and bile papilla were in 6 and 4 patients, respectively. A complex of the used diagnostic techniques involved ultrasonic scanning, X-ray computed tomography, hepatobiliary scintigraphy, angiography, retrograde cholangiopancreatography, transhepatic cholangiography, etc. The authors have demonstrated that each method used is highly diagnostically effective. At the same time they have shown the limits of each technique in the diagnosis of certain diseases. The authors' data suggest that the total efficiency of the applied complex of diagnostic means approaches 100%.     

Clinical significance of fungal and microbial associations and antibacterial therapy for treatment of chronic inflammatory respiratory tract diseases in children

Microbiological examination applied to 270 children with chronic inflammatory and relapsing respiratory tract diseases revealed that by the frequency of the etiologically significant organisms the main pathogens isolated from the bronchial secretion belonged to Haemophilus influenzae, then followed Streptococcus pneumoniae and the less frequent isolates belonged to Branhamella catarrhalis characterized by high susceptibility to the 2nd and 3rd generation cephalosporins, erythromycin and azithromycin. Mycological investigation of the oral mucus and sputum from the patients revealed high frequency of Candida, mainly C.albicans. The fungi were most frequent and abundant in the children with chronic pulmonary diseases and congenital immune deficiency and in the children with bronchial asthma and asthmatic bronchitis, as well as in the children with exacerbation of the chronic disease, especially with bronchial obstruction. The antibacterial therapy with semisynthetic penicillins, cephalosporins and macrolides led to an increase in the number of the Candida carriers and in the biological material contamination level. The fungal contamination of the host was mainly observed after the use of the penicillins and cephalosporins. Chronic Candida carriers were detected among the patients with chronic inflammatory diseases of the lungs. The diseases in such patients were particularly severe. There were also detected children with colonization resistance to Candida. In the latter cases the chronic process was more favourable. The data made it possible to recommend a more differential use of the antibacterial and antimycotic drugs in the treatment of children with chronic inflammatory diseases of the bronchopulmonary system.     

Videothoracoscopy versus thoracotomy in the diagnosis of diffuse interstitial disease

Histopathology plays an important role in the diagnosis of diffuse interstitial lung disease. New endoscopic techniques allow performance of sampling procedures that have the same diagnostic accuracy and fewer complications that open lung biopsy (OLB). We evaluated our experience with video thoracoscopic lung biopsy (VTLB) in comparison with OLB in terms of diagnostic accuracy, duration of pleural drainage and hospital stay, number and size of samples and complications. Thirty patients who underwent VTLB from March 1987 to January 1995, and 28 patients who underwent OLB from May 1987 to January 1995 were studied retrospectively. Diagnosis was achieved in the VLTB group in 96.66% of cases and in the OLB group in 92.85%. The number of specimens obtained was 1.5 (SD 0.5) in the VTLB group (p = 0.47). Overall specimen size expressed in cm3 was 13.3 (SD-15.4) in the VTLB group and 18.5 (SD 21) in the OLB group (p = 0.284). Length of pleural drainage in hours was 52 (SD 39.9) in the VTLB group and 89.1 (SD 47) in the OLB group (p = 0.002). Length of hospital stay in days was 3.5 (SD 2) in the VTLB group and 8.7 (3.5) in the OLB group (p = 0.001). Complications were fewer and less severe after VLTB. VLTB is as useful as OLD for obtaining lung biopsies in diffuse interstitial lung disease. VLTB also causes fewer complications and is less expensive because drainage times and hospital stays are shorter.     

Etiology and therapy of obstructive respiratory tract diseases in infancy and early childhood

Wheezing disorders in early childhood are frequent, nevertheless little is known about their heterogeneous aetiology. In the last few years there has been increasing evidence of antenatal as well as postnatal influences which can make infants more prone to wheezing episodes. This review tries to classify various groups of wheezing disorders based on risk factors such as allergy, developmental differences in airway mechanics or association with viral infections. On this basis the different therapeutic regimens and particularly the effect of anti-inflammatory treatment with inhaled corticosteroids in this age group are discussed. New concepts of anti-inflammatory treatment for croup syndromes are summarised.     

Chemotherapeutics for treatment of influenza and other viral respiratory tract infections in children

Regardless of the primary care model used in the long-term care facility, each of the three approaches offers quality care improvement and greater consistency for residents at reduced costs. Of the three, an all licensed nursing staff model could best meet the higher acuity levels of residents and the disintegrating availability of qualified nursing assistants. If nurses are unable to "sell" this model to administration, it may be helpful to pilot the concept one one unit for a period of time and compare resident, family, and staff satisfaction with that of a similar unit. Also, it is critical to compare the financial implications, including cost per resident per day and rate of staff turnover, to weigh the model's effectiveness. This small sampling of five facilities indicates the average cost per resident per day is $10 less when using either the primary team or all licensed staff models than in facilities of comparable size. Hospitals have already passed the time when they have had to work smarter, leaner, and more efficiently. Can long-term care facilities afford not to do the same?     

Patient compliance in the treatment of respiratory tract infections

The survey on outpatients compliance in the treatment of respiratory tract infections was performed in Croatia during April 1996. A total of 213 physicians, 201 adult patients, and 178 parents of sick children were polled by the appropriate questionnaires. The results have shown that in the treatment of respiratory tract infections physicians commonly prescribe thrice-daily antibiotic regimens for 8-10 days. Concerning patients' knowledge, 85% of patients deem that regularity, and 64% that duration of antibiotic administration influences treatment outcome. Over 80% of patients are compliant with once-or twice-daily regimens, but only 50% take regularly and timely drugs that are dosed every 6 or 8 hours. Common reasons for irregular taking of antibiotics are forgetfulness and dosing during sleeping. In terms of appropriate duration of antibiotic therapy, about 20% of patients usually take antibiotic for 8-10 days, 60% for 5-7 days, and 20% for < or = 4 days. It may be concluded that the patients are poorly compliant with oral antibiotics treatment.     

Therapeutic problems of allergy specific immunotherapy for treatment of upper respiratory tract allergies

BACKGROUND: The outcome of management in patients with osteosarcoma and pulmonary metastases at a Sydney teaching hospital was reviewed. METHODS: A retrospective review was undertaken of all patients diagnosed with osteosarcoma and treated by the Bone and Soft Tissue Unit and the Medical Oncology Department, Royal Prince Alfred Hospital between 1979 and January 1995. Information was collected on demographics, tumour site, tumour histology, primary management including surgery and adjuvant therapy, and the subsequent development and management of pulmonary metastases. RESULTS: A total of 56 patients with localized osteosarcoma was seen. Overall survival and survival following pulmonary metastases was assessed. There were 33 (59%) males and 23 (41%) females, with a median age of 27 years. Survival at 5 years, for patients with non-axial osteosarcoma was 60% (95% CI, 44-77%). Pulmonary metastases without other metastatic disease being apparent, developed in 22 patients, of whom 12 underwent surgical resection. The median disease-free interval of these latter patients was 20 months (95% CI, 8-32 months). Median survival among patients not undergoing surgical resection was 5 months from detection of metastases. Patients undergoing resection of pulmonary metastases had a median survival of 17 months following detection of pulmonary metastases (95% CI, 7-27 months). Actuarial 5-year survival was 16% (95% CI, 0-42%). CONCLUSIONS: A small proportion of patients with resectable pulmonary metastases from osteosarcoma achieve long-term disease-free survival following surgical resection. It is not possible to accurately identify these patients prospectively.