Clinical applications of infant lung function testing

The studies in this thesis show that research in the field of lung function testing in infants has moved from methodological issues towards clinical applications. This development is mainly the result of publications of guidelines for infant lung function testing and standardization of the equipment used, by the European Respiratory Society en de American Thoracic Society (ERS/ATS) (7-10). As a result, normative data have become available for different lung function methods, allowing comparison of data from different centers. In addition, several biomedical engineering companies have marketed equipment with specifications according to the guidelines given by the ERS/ATS. These developments are a necessity for wide applications of infant lung function testing in a clinical setting, such as collaborative studies and multicenter drug trials in infants with airway disease (II). On the other hand, there are high costs for buying complete recording systems and training the staff. In addition, most methods require sedation of the infant. Therefore, infant lung function measurements will probably be established primarily in larger, mostly academic, centers. The forthcoming challenges for those involved in this field will be to develop methods that are cheap to buy and simple to use, still providing essential information. These methods should be applicable in infants without sedation. When this has been achieved, infant lung function testing may even move out of the clinic (II)

Blue rubber-bleb naevus syndrome: report of a case with consumption coagulopathy complicated by manifest thrombosis

Abstract Blue rubber-bleb naevus (BRBN) syndrome is a rare disorder characterized by subcutaneous and gastrointestinal haemangiomas. The latter may lead to bleeding complications. A case is reported in which a process of chronic intravascular coagulation resulted in serious thrombotic complications. In the presence of a chronic consumption coagulopathy, it remains uncertain whether antiplatelet drugs are of prophylactic antithrombotic value

Exhaled nitric oxide predicts asthma relapse in children with clinical asthma remission

BACKGROUND: Nitric oxide in exhaled air (FE(NO)) is a marker of eosinophilic airway inflammation. A study was undertaken to determine whether FE(NO) predicts asthma relapse in asymptomatic asthmatic children in whom inhaled corticosteroids are discontinued. METHODS: Forty children (21 boys) of mean age 12.2 years on a median dose of 400 mug budesonide or equivalent (range 100-400) were included. FE(NO) was measured before and 2, 4, 12, and 24 weeks after withdrawal of steroids. A relapse was defined as more than one exacerbation per month, or need for beta agonist treatment on 4 days per week for at least 2 weeks, or diurnal peak flow variability of >20%. FE(NO) measurements were performed online with an expiratory flow of 50 ml/s. RESULTS: Nine patients relapsed. Two and 4 weeks after withdrawal of steroids geometric mean FE(NO) in children who were about to relapse was higher than in those who did not relapse: 35.3 ppb v 15.7 ppb at 2 weeks (ratio 2.3; 95% CI 1.2 to 4.1; p = 0.01) and 40.8 ppb v 15.9 ppb at 4 weeks (ratio 2.6; 95% CI 1.3 to 5.1). An FE(NO) value of 49 ppb at 4 weeks after discontinuation of steroids had the best combination of sensitivity (71%) and specificity (93%) for asthma relapse. CONCLUSION: FE(NO) 2 and 4 weeks after discontinuation of steroids in asymptomatic asthmatic children may be an objective predictor of asthma relapse

Exhaled nitric oxide measurements with dynamic flow restriction in children aged 4-8 yrs

Fractional exhaled nitric oxide concentration (FENO) depends on exhalation flow; however, children often are unable to perform controlled flow procedures. Therefore, a device was developed for off-line FENO sampling, with dynamic flow restriction (DFR). The authors compared off-line w

Compliance, hysteresis, and collapsibility of human small airways

We tested the hypothesis that airway wall dimensions are important determinants for the mechanical properties of airways. Lung tissue was obtained from 31 smokers with different degrees of chronic obstructive pulmonary disease (COPD) who were operated on for a solitary lung lesion. Segments of small airways (n = 35) were mounted on cannulas in an organ bath and inflated and deflated cyclically between +15 and -15 cm H(2)O. For each airway this was done at baseline, after methacholine, and after isoprenaline. Specific compliance (sCdyn), specific hysteresis (seta), and pressure at which the airways collapsed (Pcol) were calculated from each recording. Airway wall dimensions were measured morphometrically. Lung function parameters of airflow obstruction were correlated to sCdyn, seta, and Pcol. At baseline, after methacholine, and after isoprenaline sCdyn was 0.059, 0.052, and 0. 085 cm H(2)O(-)(1), seta was 13.5, 12.9, and 7.1%, and Pcol was -3.4, -3.5, and -1.9 cm H(2)O, respectively. Differences between sCdyn, seta, and Pcol after methacholine and after isoprenaline were highly significant (p < 0.001). Of all dimensions studied, smooth muscle area, but not total wall ar

Severe bronchopulmonary dysplasia improved by noninvasive positive pressure ventilation: a case report

<p>Abstract</p> <p>Introduction</p> <p>This is the first report to describe the feasibility and effectiveness of noninvasive positive pressure ventilation in the secondary treatment of bronchopulmonary dysplasia.</p> <p>Case presentation</p> <p>A former male preterm of Caucasian ethnicity delivered at 29 weeks gestation developed severe bronchopulmonary dysplasia. At the age of six months he was in permanent tachypnea and dyspnea and in need of 100% oxygen with a flow of 2.0 L/minute via a nasal cannula. Intermittent nocturnal noninvasive positive pressure ventilation was then administered for seven hours daily. The ventilator was set at a positive end-expiratory pressure of 6 cmH₂O, with pressure support of 4 cmH₂O, trigger at 1.4 mL/second, and a maximum inspiratory time of 0.7 seconds. Over the course of seven weeks, the patient's maximum daytime fraction of inspired oxygen via nasal cannula decreased from 1.0 to 0.75, his respiratory rate from 64 breaths/minute to 50 breaths/minute and carbon dioxide from 58 mmHg to 44 mmHg.</p> <p>Conclusion</p> <p>Noninvasive positive pressure ventilation may be a novel therapeutic option for established severe bronchopulmonary dysplasia. In the case presented, noninvasive positive pressure ventilation achieved sustained improvement in ventilation and thus prepared our patient for safe home oxygen therapy.</p

Tekenradar.nl, een webplatform over tekenbeten en de ziekte van Lyme

Tekenradar.nl is een webplatform voor onderzoek naar teken en tekenoverdraagbare aandoeningen zoals de ziekte van Lyme. Het RIVM en Wageningen University hebben de website in 2012 gezamenlijk opgericht. Tekenradar.nl geeft informatie over tekenbeten en de ziekte van Lyme en een actuele voorspelling van de tekenactiviteit. Mensen kunnen hun tekenbeet of erythema migrans en de vermoedelijke geografische locatie waar de beet is opgelopen melden op de site. Tot voorjaar 2013 konden deze melders van een tekenbeet worden uitgenodigd de teek op te sturen voor onderzoek, om gedurende anderhalf jaar periodiek vragenlijsten in te vullen waarin wordt gevraagd naar hun gezondheid. In één van de nog lopende onderzoeken wordt onderzocht in hoeverre een eenmalige preventieve dosis antibioticum na een tekenbeet helpt om het ontstaan van de ziekte van Lyme te voorkomen. In dit artikel geven wij een overzicht van het bereik van Tekenradar.nl onder het Nederlands publiek, en een samenvatting van lopende onderzoeken en eerste resultaten