Lege Artis Medicinae

[NEW METHODS FOR NON-INVASIVE ASSESSMENT OF AIRWAY DISEASES]

HORVÁTH Ildikó

JUNE 22, 2004

Lege Artis Medicinae - 2004;14(06)

[In chronic obstructive airway diseases there are several unsolved questions regarding the early diagnosis, monitoring treatment, simple detection of exacerbations and the questions of differential diagnosis. These problems indicate the need for the development of new diagnostic methods and their application in clinical practice. This need is further emphasized by the fact that in most chronic airway diseases, including asthma and chronic obstructive pulmonary disease inflammation has a central role in the pathomechanism and its suppression is the main aim of treatment, but so far, we do not have adequate method for the assessment of inflammation intensity in clinical practice. In recent decades non-invasive sampling techniques directly from the airways have made a progress in respiratory research and at present some of them are available for clinical use. Among these techniques sputum induction, measurement of exhaled biomarkers including exhaled nitric oxide and mediators in exhaled breath condensate samples are used increasingly. The present review summarises our current knowledge on these methods and the most important findings obtained by their applications.]

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Lege Artis Medicinae

[MEDICAL ANTHROPOLOGICAL APPROACH TO CHILDREN'S SURMISES ON SMOKING]

BAK Judit, PIKÓ Bettina

[INTRODUCTION - The aim of our study was to explore school children'’s surmises on smoking. The following questions were in the focus of our analysis: what concepts children have about smoking and smoking-related diseases before adolescence? Have they already tried smoking? METHODS - The study was conducted among 3rd, 4th and 5th year school children (N=128) in two towns of Békés County, namely in Békés and Köröstarcsa. The sample consisted of 57% males and 43% females. Regarding sampling we followed international studies with similar aims where samples of 9-11-year-old average children were thought to be ideal for such study purpose using the draw-and-write technique. RESULTS - Most respondents from the study have not tried smoking yet. On the other hand, there are great number of adults who smoke in children’s environments, in many times, both parents do. Despite these facts, children’s attitudes toward smoking is rather negative. Children'’ s opinions reflect many negative aspects of smoking: the health-damaging effect, the financial aspects, the negative effects for social and physical environment. CONCLUSIONS - Similar to previous international studies, children of our sample possess correct and comprehensive knowledge of the smoking-related health problems. Findings of our study provides a support to the need of a smoking prevention program for children in the age of their negative opinions of smoking and well before the peer group effect is getting significant.]

Lege Artis Medicinae

[ONCOHEMATOLOGIC MALIGNANCIES WITH SKIN SYMPTOMS]

BENE Ibolya, ERŐS Nóra, KÁROLYI Zsuzsánna, TAKÁCS István, RADVÁNYI Gáspár

[INTRODUCTION - Haematologic malignancies can originate from the skin (cutaneous lymphomas, rarely acute myelomonocytic leukemia) or can infiltrate the skin secondarily during the progression of the disease (nodal and systemic non-Hodgkin’s lymphomas, Hodgkin'’s disease, chronic lymphocytic leukemia). PATIENTS AND METHODS - The clinical history of seven patients treated by the authors between 1997-2003, is reviewed. CONCLUSIONS - The clinical and histopathologic features of each entity are discussed, emphasizing differences in the clinical course between cutaneous and nodal lymphomas, considering diagnostic difficulties, conventional and recent therapeutic approaches.]

Lege Artis Medicinae

[Postgraduate conference on hepatology]

TELEGDY László

Lege Artis Medicinae

[INCIDENCE RATES OF CHILDHOOD TYPE 1 DIABETES WITHIN EUROPE AND HUNGARY BASED ON EURODIAB DATA]

GYÜRÜS Éva, SOLTÉSZ Gyula

[Type 1 diabetes is generally believed to be be the result of an immune destruction of pancreatic ßcells in genetically susceptible individuals exposed to environmental risk factors. To study the epidemiology of childhood-onset type 1 diabetes mellitus in Europe, the EURODIAB collaborative group established in 1988 prospective geographicallydefined registers of new cases diagnosed under 15 years of age. The 10-year-old study shows a greater than 10-fold range in incidence rate of childhood diabetes in Europe. The standardised average annual incidence rate during the period 1989-1998 ranged from 3,6 cases per 100 000 per year in Macedonia to 43,9 cases per 100 000 per year in Finland. Combined data from all centres indicates that the annual rate of increase in incidence was 3,2% but in some central and eastern European countries it was higher. The age-group-specific rates of increase were 5% for children aged 0-4 years, 3,7% for 5-9 years, and 2,1% for 10-14 years, which shows that the highest rates of increase occurred in the youngest age group. The Hungarian Childhood Diabetes Registry has collected the data of all newly diagnosed children with type 1 diabetes aged 0-14 years since 1st January 1978. The standardised incidence rate during the period 1978-2002 was 8,6 cases per 100000 per year, the lowest in the youngest (0-4 yr), highest in the10-14-year-old-children. There was a linear increasing trend in incidence with the average rate of annual increase of 5,1%. Comparing our incidence rate with other European countries Hungary belongs to the medium-risk countries with similar age- and sex-specific incidence rates. The results of the EURODIAB study confirm a very wide range of incidence rates of childhood type 1 diabetes within Europe and show that the increase in incidence varies from country to country. Such variation seems to be unlikely to be explained by genetic differences, since Europeans (except some small populations) are more homogeneous compared with other populations of other continents. The rapid increase in incidence may be explained by changes in environmental factors.]

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Lege Artis Medicinae

[THE INFLUENCE OF GASTROESOPHAGEAL REFLUX DISEASE AND ITS TREATMENT ON ASTHMATIC COUGH]

BÖCSKEI Csaba, VICZIÁN Magdolna, BÖCSKEI Renáta, HORVÁTH Ildikó

[INTRODUCTION - Gastroesophageal reflux is known to cause chronic cough and it is also implicated in worsening of asthma. We conducted a prospective study to examine the clinical significance of gastroesophageal reflux disease in asthmatic patients with chronic cough, to analyse the temporal relationship between reflux events and coughing and to assess the effect of esomeprazole treatment on respiratory symptoms and lung function in these patients. PATIENTS AND METHODS - 126 asthmatic patients with chronic dry cough were studied. Diagnosis of gastroesophageal reflux disease was based on typical symptoms and the effectiveness of therapeutic test or on pH monitoring, while control group consisted of the patients without gastroesophageal reflux (negative pH results). The study group patients received the proton pump inhibitor esomeprazole (40 mg/day for three months) and standard treatment for asthma was continued. During the study pulmonary function tests (forced expiratory volume in one second and peak expiratory flow) were evaluated four times and the reflux symptom scores as well, using a questionnaire. RESULTS - The results of pH monitoring showed that 64% of cough episodes were related to acid reflux and in 91% of reflux events preceded coughing. Esomeprazole treatment (40 mg/day for three months) not only diminished gastroesophageal reflux symptoms but also improved asthma outcome measures. Baseline pulmonary function values increased significantly together with a decrease in symptom scores and the use of rescue medication. In most patients included in the extended part of the study for another three months, the dose of inhaled steroids could be reduced with sustained therapy against gastroesophageal reflux. CONCLUSION - Our data shows that reflux events preceded coughing in most cases and that treatment of gastroesophageal reflux disease caused an improvement in different outcome measures of asthma suggest that gastroesophageal reflux disease worsens asthma and its treatment is of clinical importance in the effective management of these patients.]

Lege Artis Medicinae

[NONINVASIVE MECHANICAL VENTILATION IN CHRONIC OBSTRUCTIVE LUNG DISEASES WITH ACUTE OR CHRONIC RESPIRATORY FAILURE]

BALIKÓ Zoltán

[Over the past decade, the use of noninvasive ventilation in the setting of acute exacerbations of chronic obstructive pulmonary disease (COPD) has gained popularity, and is recommended by evidence-based guidelines. The evidence that it should be effective in chronic COPD is much weaker, and large, prospective, randomised, controlled studies that would also provide a guide for the selection of the best candidates, are still lacking. It has bee established, however, that home mechanical ventilation is certainly beneficial for a well-defined subgroup of patients. This includes the so called “blue bloater” patients (with hypercapnia and polyglobulia), other cases with increased hypercapnia, and patients with "overlapping" syndrome (COPD accompanied by sleep apnoe). Also, for patients with acute respiratory failure who refuse intratracheal intubation noninvasive mechanical ventilation remains the only choice. The past years have unequivocally proved the superiority of the positive pressure ventilation mode for either short term or long term use.]

LAM Extra for General Practicioners

[CHRONIC COUGH - THE OTOLARYNGOLOGISTS’ POINT OF VIEW]

GERLINGER Imre

[Chronic cough can have a profound impact on the psychosocial function of patients. Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastro-esophageal reflux disease (GERD), and laryngo-pharyngeal reflux (LPR) are the most common causes of chronic cough in immunocompetent, non-smoking patients who are not taking angiotensin-converting enzyme (ACE) inhibitors and present with a negative chest x-ray. No diagnostic test has yet been found to define those who have PNDS other than the response to a first-generation antihistamine. Examination of the available evidence suggests that the theory of mechanical stimulation of the pharynx by mucus does not explain the occurrence of cough. Inflammatory mediators’ levels in the lower airways are higher in PNDS, cough variant asthma, and GERD, and the theory that an inflammatory process is affecting “one airway” is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through a yet undefined pathway. Mediation by eosinophil and mast cells appears to be a likely mechanism. In this paper, the author summarizes all potential pulmonological, otolaryngological and other reasons of chronic cough, suggesting a systematic therapeutic algorithm.]

Lege Artis Medicinae

[The asthma-COPD overlap syndrome]

NAGY László Béla

[The asthma bronchiale and chronic obstructive pulmonary disease (COPD) are not simple diseases, but heterogenous syndromes. In their most typical forms, asthma and COPD are clearly distinguishable, but many patients demonstrate features of both conditions. This is the asthma - COPD overlap syndrome (ACOS). We present the latest findings in the pathogenesis, clinical characterisation, diagnosis, and management of ACOS. Because the limitations of the studies need future research, mainly to develop targeted therapy. ]

Lege Artis Medicinae

[Treatment of chronic Pseudomonas aeruginosa lung infections in cystic fibrosis with inhaled tobramycin]

NAGY Béla, HOLICS Klára

[BACKGROUND - Intermittent or chronic pulmonary infections caused by Pseudo­monas aeruginosa (Pa) deteriorate clinical status and worsen lung function in patients with cystic fibrosis (CF). The prognosis of the disease and life expectancy of patients are substantially dependent on lung infections and inflammation; therefore the primary goal of the treatment is the early termination of the infection. PATIENTS AND METHODS - Efficacy of tobramycin (TOBI® 300 mg/5 mL solution for inhalation, henceforth TOBI®) inhalation in Pa pulmonary infections was studied in a non-interventional, observational, open-label, single-arm trial in subjects with CF. Fifty-three patients aged six to 31 years (averaged 15.8 years) were enrolled into the study. Three treatment cycles of TOBI® inhalation (28 days on drug, 28 days off drug) plus 6 months observational period were evaluated. Primary endpoint was changing in the predictive values of forced expiratory volume in 1 sec (FEV1) compared to the initial values after three cycles of the treatment. Secondary endpoints were changing in the FEV1 predictive values at the end of the complete study compared to the initial values; ratios of patients with decreased density of originally Pa-positive result of sputum culture; as well as safety and tolerability of the TOBI® treatment. RESULTS - FEV1 and FEV1% results were unchanged comparing to the initial values at the end of the treatment and after the observational period in the whole study population. However, sputum cultures became negative in 47.2% of all subjects as a result of the treatment, and the FEV1 values were gradually increased in these patients: after the third treatment cycle plus 160 mL, and at the end of the study plus 110 mL comparing to the initial values. Similar considerable increase was detected in the predictive FEV1% in this sub-group: after the first cycle plus 5.2%, at the end of third cycle plus 7%, after the observational period above 3.8% considering the starting results. CONCLUSIONS - TOBI® inhalation proved to be effective in improvement of lung function results and eradication of infection in our patients with Pa positive CF. The treatment was well tolerated and safe.]