Local streptokinase administration in massive pulmonary embolism

Five patients with acute massive pulmonary embolism were treated with streptokinase administered via the pulmonary artery as close as possible to the embolus. Streptokinase (Awelysin) was infused at a loading dose of 250,000 IU followed by a maintenance dose of 100,000 IU/hour under haemodynamic and angiographic control. In four of five patients (two patients with cardiogenic shock) the clinical signs, pulmonary artery pressure and the angiographic findings improved or they normalised within 5-12 hours. In one patient with recurrent embolisation over three weeks the clinical condition improved gradually, although the angiographic findings improved only slightly. The results demonstrate that local thrombolysis of acute massive pulmonary embolism is a highly effective form of treatment.     

Thrombolytic Therapy in Haemolytic-Uraemic Syndrome

The treatment of five children with the haemolytic-uraemic syndrome using streptokinase is described to illustrate the difficulties and limitations of thrombolytic therapy in this disease. This experience is germane to the design of multicentre clinical trials.A multivariate analysis relating clinical outcome to the data obtained at the time of admission was also carried out for 31 children with the disease treated in four centres. The results suggest that this technique may help to identify those patients likely to have a fatal outcome. An expanded form of this type of analysis should be incorporated in future clinical trials.     

Primary hyperparathyroidism: a rare endocrinopathy in children. Two case reports

Primary hyperparathyroidism (PHPT) is thought to be a common disease in adults. However, it is a rare endocrine disorder in children and adolescents. We report two cases of primary hyperparathyroidism in children diagnosed at the Department of Endocrinology and Diabetes (EU and D) in the Children's Hospital (ChH), Kielce. The clinical course of the disease in these cases was fundamentally dissimilar, which confirms the observation that this rare endocrinopathy in children presents various clinical profiles, leading to diagnostic difficulties. In the first case, the severe course of PHPT was observed with signs suggesting a hypercalcemic crisis. In the second case, the patient was in a good condition with a mild hypercalcemia and symptoms limited to the skeleton, due to early identification of the disease. We believe these cases indicate the significant role of calcemia determination as a screening test in the diagnosis of PHPT, including in children.     

Facial animation in children with Möbius syndrome after segmental gracilis muscle transplant

M?bius syndrome is a complex congenital anomaly involving multiple cranial nerves, including the abducens (VI) and facial (II) nerves, and often associated with limb anomalies. Muscle transplantation has been used to address the lack of facial animation, lack of lower lip support, and speech difficulties these patients experience. The purpose of this study was to investigate the results of bilateral, segmental gracilis muscle transplantation to the face using the facial vessels for revascularization and the motor nerve to the masseter for reinnervation. The outcome of the two-stage procedure was assessed in 10 consecutive children with M?bius syndrome by direct interview, speech assessment, and oral commissure movement. Preoperative data were collected from direct questioning, viewing of preoperative videotapes, notes from prior medical evaluations, and rehabilitation medicine and speech pathology assessments. All of the patients developed reinnervation and muscle movement. The children who described self-esteem to be an issue preoperatively reported a significant posttransplant improvement. The muscle transplants produced a smile with an average commissure excursion of 1.37 cm. The frequency and severity of drooling and drinking difficulties decreased postoperatively in the seven symptomatic children. Speech difficulties improved in all children. Specifically, of the six children with bilabial incompetence, three received complete correction and three had significant improvement. Despite the length and complexity of these procedures, complications were minimal. Muscle transplantation had positive effects in all problematic areas, with a high degree of patient satisfaction and improvement in drooling, drinking, speech, and facial animation. The surgical technique is described in detail and the advantages over regional muscle transfers are outlined. Segmental gracilis muscle transplantation innervated by the motor nerve to the masseter is an effective method of treating patients with M?bius syndrome.     

Trichomonal vaginitis; the problem of chronic or recurring infection

In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician. The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results. In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy-one or two suppositories weekly-especially if the emotional difficulties appear to be insurmountable.     

TRICHOMONAL VAGINITIS—The Problem of Chronic or Recurring Infection

In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician.The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results.In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy—one or two suppositories weekly—especially if the emotional difficulties appear to be insurmountable.     

Comparison of optimization parametrizations for regional lung compliance estimation using personalized pulmonary poromechanical modeling

Interstitial lung diseases, such as idiopathic pulmonary fibrosis (IPF) or post-COVID-19 pulmonary fibrosis, are progressive and severe diseases characterized by an irreversible scarring of interstitial tissues that affects lung function. Despite many efforts, these diseases remain poorly understood and poorly treated. In this paper, we propose an automated method for the estimation of personalized regional lung compliances based on a poromechanical model of the lung. The model is personalized by integrating routine clinical imaging data – namely computed tomography images taken at two breathing levels in order to reproduce the breathing kinematic—notably through an inverse problem with fully personalized boundary conditions that is solved to estimate patient-specific regional lung compliances. A new parametrization of the inverse problem is introduced in this paper, based on the combined estimation of a personalized breathing pressure in addition to material parameters, improving the robustness and consistency of estimation results. The method is applied to three IPF patients and one post-COVID-19 patient. This personalized model could help better understand the role of mechanics in pulmonary remodeling due to fibrosis; moreover, patient-specific regional lung compliances could be used as an objective and quantitative biomarker for improved diagnosis and treatment follow up for various interstitial lung diseases.

     

Pulmonary Mycobacterium tuberculosis in acquired immune deficiency syndrome.

A case of pulmonary infection with Mycobacterium tuberculosis in a patient with the acquired immune deficiency syndrome (AIDS) was studied. Diagnosis of AIDS was confirmed by the finding of pulmonary M tuberculosis with oral and oesophageal candidiasis accompanied by characteristic immunological changes with evidence of infection with human T cell lymphotropic virus III. Treatment of this patient was complicated by an unusual drug interaction between rifampicin and ketoconazole, leading to subtherapeutic serum concentrations and poor clinical response to treatment. Intravenous treatment was more effective than oral treatment. This drug interaction should be studied in greater detail as ketoconazole and rifampicin may be used together to treat patients with candidiasis and infection with M tuberculosis.     

孟鲁司特钠联合布地奈德混悬液对哮喘急性发作患儿血清EOS、ECP水平和肺功能的影响

目的:探索孟鲁司特钠联合布地奈德混悬液对哮喘急性发作患儿血清嗜酸性粒细胞(EOS)、嗜酸性粒细胞阳离子蛋白(ECP)水平和肺功能的影响。方法:选择自2015年10月至2016年10月我院收治的200例支气管哮喘急性发作患儿,按照随机数表法分成观察组和对照组各100例。对照组患儿口服孟鲁司特钠,观察组患儿在对照组基础上给予布地奈德气雾剂进行雾化治疗,两组均治疗1周。统计分析两组患儿的临床有效率,肺功能指标,包括第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及FEV1/FVC,对比治疗前后两组患儿血清中EOS、ECP水平的变化。结果:治疗后,观察组的总有效率为97.00%,显著高于对照组的81.00%(P0.05);经治疗后两组患儿肺功能指标均较治疗前明显改善,且观察组患儿优于对照组(P0.05);两组患儿治疗后EOS、ECP水平均低于治疗前,而观察组患儿低于对照组,差异均有统计学意义(P0.05)。结论:孟鲁司特钠联合布地奈德对于小儿哮喘的急性发作具有良好的临床疗效,能显著改善患儿肺功能和血清中炎症因子的水平,减轻患儿体内的炎症反应,值得在临床上推广应用。     

Minor differences in ADHD-related difficulties between boys and girls treated with atomoxetine for attention-deficit/hyperactivity disorder

Atomoxetine may improve ADHD-related difficulties and hence the quality of life (QoL) in children and adolescents. Perception of these difficulties may differ with the rater perspective (patient, parent, physician) or patients' sex. The objective of this study was to investigate QoL as reflected by perceived ADHD-related difficulties perceived from these three perspectives and compare boys and girls. Patients aged 6-17 with ADHD were treated with atomoxetine (target dose 0.5-1.2 mg/kg/day) in two studies. In both studies, ADHD-related difficulties were assessed after 8 and 24 weeks using the Global Impression of Perceived Difficulties (GIPD) instrument, which can be taken to reflect the patient's QoL from the three perspectives. Data from the two studies were combined and analyzed together in order to compare boys and girls. Four hundred and twenty-one patients were treated with atomoxetine, 338 boys and 83 girls. Three hundred and fifty-five patients completed the 8-week study period. QoL, as reflected by perceived ADHD-related difficulties (measured with GIPD), improved over time. Mean GIPD total scores showed a similar course over time for all rater groups, although the patients rated the degree of difficulties significantly lower than parents and physicians. The sexes did not differ significantly in mean GIPD total scores. The GIPD scores over time suggest that patients' QoL, as reflected by perceived ADHD-related difficulties, improved with time on atomoxetine. However, improvement did not differ significantly between boys and girls. Trial Registration: ClinicalTrials.gov Identifiers NCT00191516 and NCT00191737.     

Pulmonary Embolectomy

Embolectomy was carried out in eight patients with pulmonary emboli. Angiographic diagnosis was obtained in six, and in two cases pulmonary angiography could not be done because of the very critical condition of the patients. In the latter two, diagnosis was made based only on clinical findings. Two patients died in the operating room (25 percent). Six patients were discharged in good condition.It is emphasized that pulmonary embolectomy should be done in cases of pulmonary emboli when a clinical status of shock is present (systolic blood pressure less than 80 mm of mercury and the patient in low cardiac output syndrome) and when there is no response to medical treatment regardless of the degree of obstruction in the pulmonary arterial tree.     

Streptokinase Therapy in Acute Major Pulmonary Embolism: Effectiveness and Problems

Eighteen patients with major pulmonary embolism were treated with streptokinase infused by a catheter or given intravenously. Fourteen showed clinical improvement and 12 out of 16 patients investigated showed definite angiographic improvement after 24 to 48 hours of treatment with streptokinase. The angiographic improvement following streptokinase contrasted with the lack of this in three patients after 24 hours of heparin treatment.Resolution following streptokinase therapy was most noticeable in patients treated shortly after a single embolic episode, and was least marked in those with recurrent embolism complicated by associated cardiac or pulmonary disease. Of the four patients who failed to improve, two died and two had pulmonary embolectomy and survived.The results suggest that streptokinase therapy is practicable provided that adequate laboratory control is available, and that it hastens early resolution in acute major pulmonary embolism.     

老年脑卒中患者合并肺部感染的原因分析及早期康复治疗

目的：对老年脑卒中患者合并肺部感染的原因进行分析,探讨早期康复治疗的方法与效果。方法：选择我院2012年1月．2013年1月70例合并肺部感染的脑卒中患者与70例未合并肺部感染的脑卒中患者进行对照研究,分析发生肺部感染高危因素。35例合并肺部感染的脑卒中患者给予常规抗感染治疗,另外35例患者在此基础上给予早期康复治疗,对两组治疗的效果进行比较。结果：NIHSS评分与神经功能缺损评分评分高,有气管切开史、有吞咽功能障碍、合并意识障碍、高龄、合并糖尿病及营养状况差等是老年脑卒中患者发生肺部感染的主要因素,以上因素具有代表性（P〈0．05）。观察组痊愈27例,显效6例,总有效率为94．29％;对照组痊愈21例,显效8例,总有效率为82．86％;观察组治疗效果明显好于对照组,两组比较差异具有显著性（P〈0．05）。结论：老年人脑卒中后由于多种因素的影响,肺部感染的发生率较高。为了提高治疗效果,在常规治疗的基础上结合康复治疗,具有科学}生与有效性,可更有效促进患者的痊愈。     

Lung function in diaphragm pacing.

Electric stimulation of the diaphragm via the phrenic nerve to induce ventilation has recently been used for the long-term management of chronic ventilatory insufficiency. Since 1973 three patients with inadequate alveolar ventilation have been treated with diaphragm pacing at the Toronto Western Hospital. Two, who had quadriplegia due to lesions of the spinal cord in the upper cervical region and a severe restrictive ventilatory defect, were treated with continuous diaphragm pacing. The third patient required assisted nocturnal ventilation because of primary alveolar hypoventilation. All three patients tolerated the diaphragm pacing well, and pulmonary function tests showed satisfactory gas exchange with the patients breathing room air. This form of therapy seems to be a practical clinical method of managing chronic ventilatory failure in patients with lesions of the upper cervical cord or primary alveolar hypoventilation.     

Gunshot wound to the heart and lung in a massively obese patient

The clinical course of a 354-pound patient who sustained a gunshot wound to the heart and lung is described. In the acutely injured morbidly obese patient, the physician must anticipate and prevent the following difficulties: pre-, peri- and postoperative pulmonary problems, venous thrombosis and pulmonary embolism, metabolic changes, and inadequate manpower for effective patient mobilization.     

肺泡灌洗技术对重症支原体肺炎患儿血清炎症因子及肺功能的影响

目的:探讨支气管肺泡灌洗液(Bronchoalveolar Lavage Fluid,BALF)技术应用于儿科重症支原体肺炎(Severe Mycoplasma Pneumoniae Pneumonia,SMPP)对患儿的血清炎症因子表达影响及肺功能的变化,旨在为临床上SMPP的诊治提供科学参考。方法:回顾性选取我院收治的SMPP患儿83例,按照治疗方式不同,分为两组,对照组41例,静滴阿奇霉素,研究组42例,采用静滴阿奇霉素3-5天行BALF灌洗生理盐水+布地奈德治疗。于治疗7 d后对比两组治疗前后及组间肺功能和炎症指标的变化。结果:研究组IL-2、IL-6、IL-10表达水平均较对照组显著降低,差异有统计学差异(P0.05);研究组mPAP、PAWP、PVR均比对照组下降明显,差异有显著性意义(P0.05)。结论:BALF技术可明显改善患儿炎症因子表达,对促进患儿肺功能恢复正常有良好作用,适用于儿童SMPP的治疗。     

圣乔治教堂诺卡菌引起的肺部感染1例

诺卡菌肺部感染可引起肺诺卡菌病,因其无特异性的临床表现,容易误诊、漏诊。因此,临床实验室的培养鉴定能力非常重要,若不能及时诊治,则会导致病死率较高。诺卡菌病临床较为少见,为引起临床实验室对诺卡菌的鉴定和药敏试验的重视,本文报道了上海市嘉定区中心医院2019年2月收治的1例由圣乔治教堂诺卡菌(Nocardia cyriacigeorgica)感染引起的肺诺卡菌病病例,针对其临床特征、实验室检测及治疗等进行分析,期望对临床诊治诺卡菌病有所帮助。     

Cryptococcosis as an opportunistic infection in immunodeficiency secondary to paracoccidioidomycosis

We describe the case reports of two patients with immunodeficiency secondary to paracoccidioidomycosis (PCM) and opportunistic Cryptococcus neoformans infections. Secondary immunodeficiency likely occurred as a consequence of the intestinal loss of proteins and lymphocytes associated with malabsorption syndrome due to obstructed lymphatic drainage. Both patients had had severe abdominal involvement during the acute PCM disease. Immunological evaluation showed cellular and humoral immunity impairment. Cryptococcosis manifested as relatively well circumscribed lesions: osteolytic lesions of the skull in one patient, and pulmonary nodules in the other. The latter was treated surgically and with amphotericin B, whereas the other was treated with the combination amphotericin-B and flucytosine. Both patients had a good response to treatment with complete regression of the lesions. They have now 2 and 4 years of follow-up with maintenance therapy and no indication of reactivation of the infection. PCM also did not reactivate. The clinical and immunological characteristics of these patients are discussed and compared to the opportunistic C. neoformans infections of AIDS and transplant patients.     

Results of polychemotherapy and immunotherapy in acute leukemias]

For the purpose of evaluating the efficiency of an unspecific immunostimulation in acute leukaemias the results of treatment obtained from two groups of patients (a total of 55 children) were compiled. In the first group an unspecific immunostimulation with vaccination (BCG, diphtheria-tetanus-pertussis, measles) could be observed after the induction of remission during a cytostatic maintenance therapy. In the second group a polychemical therapy and the CNS-irradiation was applied according to the treatment scheme developed by the working team of Donald Pinkel. The group of patients treated with unspecific immunostimulation involved a high percentage of surviving children. In total there was no essential difference between the treatment results of both schemes of therapy during our period of observation. As before, the treatment of hyperleukocytic forms of leukaemias will cause particular difficulties.     

The relationship between mucosal immunoresponse and clinical outcome in patients with recurrent upper respiratory tract infections treated with a mechanical bacterial lysate

This open prospective study aims to evaluate whether a therapy with a polyvalent mechanical bacterial lysate (PMBL) could be associated to the enhancement of the locoregional immunoresponse in patients with recurrent upper respiratory tract infections. Forty patients (23 females and 17 males) were enrolled, 33 of whom concluded the study. The duration of the study was six months and each patient was visited five times. Twenty-six patients had an objective improvement in clinical and medical locoregional conditions, while in seven patients the treatment did not result in an objective amelioration. Twenty-five out of 27 patients with clinical response were characterized by an increase of specific antibodies against PMBL antigens in salivary fluids. Only two patients, with a non-significant clinical result, had a slight increase in the concentration of salivary specific IgA. The association between PMBLspecific immunoglobulin titers and clinical results was significant for IgG and IgA, but not significant for IgM. Th1 switch was detected only in patients with clinical amelioration, while the Th0 phenotype was observed in three responder and four non-responder patients. Weak Th2 polarization was also observed in one clinical responsive patient. The capacity of effectively opsonizing living bacteria was detected in samples derived from responder patients. These results suggest that PMBL treatment was able to trigger an efficient and well-targeted immune-response resulting in positive clinical outcome of the patients treated.