550 research outputs found
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
Heparin as a risk factor for perigraft seroma complicating the modified Blalock-Taussig shunt
OBJECTIVE: The purpose of this study was to determine the risk factors associated with the occurrence of perigraft seromas complicating systemic-to-pulmonary polytetrafluoroethylene grafts. METHODS: Clinical and perioperative variables were reexamined, blinded for the outcome variable perigraft seroma, in 60 patients undergoing 67 consecutive graft procedures in a 3.5-year period. RESULTS: Eight cases of perigraft seroma were diagnosed in six patients. Univariate analysis revealed age (p = 0.02), a diagnosis of pulmonary atresia with ventricular septal defect and systemic-pulmonary collaterals (p = 0.001), reimplantation of collaterals during the procedure (p < 0.001), and intravenous heparin administered after operation (p < 0.0001) as risk factors for symptomatic perigraft seroma. Multivariable analysis defined heparin as the only significant factor associated with symptomatic perigraft seroma. Consolidation of the upper lobe on chest radiograph, ipsilateral to the shunt, directly after operation (p = 0.01), but especially 8 to 10 days after operation (p < 0.0001), or the need for prolonged drainage of pleural fluid (p < 0.0001) were correlated with the occurrence of perigraft seroma. Perigraft seroma led to four early rethoracotomies in three patients and to accelerated corrective surgery in three cases. Consolidation and absent perfusion of lung segments persisted in two patients. CONCLUSIONS: Our data suggest that the use of heparin leads to an increased risk of perigraft seroma, complicating systemic-pulmonary polytetrafluoroethylene grafts. Prolonged pleural drainage and/or postoperative consolidation of the upper lobe indicate the development of symptomatic perigraft seroma. Treatment is controversial and results are unpredictable. Expectative management seems to be justified so long as permitted by the clinical condition
Functional outcome and quality of life 5 and 12.5 years after aneurysmal subarachnoid haemorrhage
Patients who recover from aneurysmal subarachnoid haemorrhage (SAH) often remain disabled or have persisting symptoms with a reduced quality of life (QoL). We assessed functional outcome and QoL 5 and 12.5 years after SAH. In a consecutive series of 64 patients with mean age at SAH of 51 years, initial outcome assessments had been performed at 4 and 18 months after SAH. At the initial and current outcome assessments, functional outcome was measured with the modified Rankin Scale (mRS) and QoL with the SF-36 and a visual analogue scale (VAS). We studied the change in outcome measurements over time. We used the non-parametric Wilcoxon test to compare differences in mRS grades and calculated differences with corresponding 95% confidence intervals in the domain scores of the SF-36 and the VAS. After 5 years, seven patients had died and five patients had missing data. Compared with the 4-month follow-up, the mRS had improved in 29 of the 52 patients, remained similar in 19 patients. The overall QoL (SF-36 domains and VAS score) was better. At 12.5 years an additional six patients had died. Compared to the 4-month study, 25 of the 46 remaining patients had improved mRS, 12 had remained the same and in nine patients the mRS had worsened. Between the 5 and the 12.5 years follow-up, the improvement in mRS had decreased but patients reported overall a better QoL. Among long-time survivors, QoL may improve more than a decade after SAH
Urinary Eosinophil Protein X in Children with Atopic Asthma
The aim of this study was to investigate the relationship between urinary eosinophil protein X (uEPX) and asthma symptoms, lung function, and other markers of eosinophilic airway inflammation in asthmatic school children. Methods. A cross-sectional study was performed in 180 steroid dependent atopic children with stable moderately severe asthma, who were stable on 200 or 500μg of fluticasone per day. uEPX was measured in a single sample of urine and was normalized for creatinine concentration (uEPX/c). Symptom scores were kept on a diary card. FEV1 and PD20 methacholine were measured. Sputum induction was performed in 49 and FENO levels measured in 24 children. Results. We found an inverse correlation between uEPX/c and FEV1 (r = −.20, P = .01) and a borderline significant correlation between uEPX/c and PD20 methacholine (r = −.15, P = .06). Symptom score, %eosinophils and ECP in induced sputum and FENO levels did not correlate with uEPX/c. Conclusion. uEPX/c levels did not correlate with established markers of asthma severity and eosinophilic airway inflammation in atopic asthmatic children
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
Self reported stressful life events and exacerbations in multiple sclerosis: prospective study
OBJECTIVE: To study the relation between self reported stressful life
events not related to multiple sclerosis and the occurrence of
exacerbations in relapsing-remitting multiple sclerosis. DESIGN:
Longitudinal, prospective cohort study. SETTING: Outpatient clinic of
department of neurology in the Netherlands. PARTICIPANTS: Patients aged
18-55 with relapsing-remitting multiple sclerosis, who could walk with a
cane or better (score of 0-6.0 on the expanded disability status scale),
and had had at least two exacerbations in 24 months before inclusion in
the study. Patients with other serious conditions were excluded. MAIN
OUTCOME MEASURE: The risk of increased disease activity as measured by the
occurrence of exacerbations after weeks with stressful events. RESULTS:
Seventy out of 73 included patients (96%) reported at least one stressful
event. In total, 457 stressful life events were reported that were not
related to multiple sclerosis. Average follow up time was 1.4 years.
Throughout the study, 134 exacerbations occurred in 56 patients and 136
infections occurred in 57 patients. Cox regression analysis with time
dependent variables showed that stress was associated with a doubling of
the exacerbation rate (relative risk 2.2, 95% confidence interval 1.2 to
4.0, P = 0.014) during the subsequent four weeks. Infections were
associated with a threefold increase in the risk of exacerbation, but this
effect was found to be independent of experienced stress. CONCLUSION:
Stressful events were associated with increased exacerbations in
relapsing-remitting multiple sclerosis. This association was independent
of the triggering effect of infections on exacerbations of multiple
sclerosis
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