Some Selected Abstracts:

Aghayev E, Yen K, Sonnenschein M, Jackowski C, Thali M, Vock P, Dirnhofer  R.Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging? Forensic Sci Int. 2005 Oct 29;153(2-3):181-8.

Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland. emin.aghayev@irm.unibe.ch

Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (Valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70-90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum  and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.

Arora R, Gal TJ, Hagan LL. An unusual case of laryngomalacia presenting as asthma refractory to therapy. Ann Allergy Asthma Immunol. 2005 Dec;95(6):607-11.

Department of Allergy/Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236-5300, USA. rajiv.arora@us.army.mil

BACKGROUND: Laryngomalacia is the most common cause of stridor in infants, but few reports exist of clinically relevant laryngomalacia in adults. OBJECTIVE: To present and discuss an unusual late presentation of laryngomalacia and its significance in the evaluation and management of asthma. METHODS: An 18-year-old woman presented to an academic medical center with symptoms of "wheezing" on inspiration and exertion, with relatively normal spirometric findings. She was clinically diagnosed as having asthma at the age of 13 years, but her symptoms were poorly controlled by maximal medical therapy. Further evaluation with rhinolaryngoscopy demonstrated laryngomalacia characterized by redundant soft tissue overlying the right arytenoid cartilage and aryepiglottic fold. RESULTS: The patient demonstrated positive bronchoprovocation, with a 33% decrease in forced expiratory volume in 1 second after the administration of histamine, 1 mg/mL. However, with the otolaryngology evaluation, it was determined that her laryngeal findings were clinically significant. She subsequently underwent operative laryngoscopy with carbon dioxide laser excision of the laryngeal abnormality, resulting in improvement in her symptoms and a marked decrease in her need for asthma medication. CONCLUSIONS: We report an unusual case of laryngomalacia presenting as asthma that was successfully treated with laser surgical excision. This case emphasizes the necessity of differentiating classic wheezing from stridor and upper airway obstruction.

Chu KA, Wu YC, Lin MH, Wang HC. Acupuncture resulting in immediate bronchodilating response in asthma patients. J Chin Med Assoc. 2005 Dec;68(12):591-4.

Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan, ROC. kachu@vghks.gov.tw

There are some encouraging results in the English literature that show acupuncture resulting in an immediate improvement in pulmonary function, but there are also studies that have not demonstrated any benefit. We present 3 patients with persistent asthma who experienced immediate bronchodilatation after acupuncture without the use of any short-acting bronchodilator. After needle stimulation on selected acupoints, clinical symptoms such as dyspnea and wheezing improved. Pulmonary function test showed immediate improvement in forced expiratory volume in 1 second (FEV1), more than 20% as compared with baseline FEV1. Pulmonary function returned to baseline within 4 hours after acupuncture in 2 patients. From our observations of these 3 asthma patients, acupuncture may improve clinical dyspnea symptoms and performance on pulmonary function tests. Further large-scale controlled studies should be conducted to determine the effectiveness of acupuncture in the treatment of asthma.  

Goodnight WH, Soper DE. Pneumonia in pregnancy. Crit Care Med. 2005 Oct;33   (10 Suppl): S390-7.

Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, SC, USA.

OBJECTIVE: Historically, pneumonia during pregnancy has been associated with increased morbidity and mortality compared with nonpregnant women. The goal of this article is to review current literature describing pneumonia in pregnancy. This review will identify maternal risk factors, potential complications, and prenatal outcomes associated with pneumonia and describe the contemporary management of the varied causes of pneumonia in pregnancy. RESULTS: Coexisting maternal disease, including asthma and anemia, increase the risk of contracting pneumonia in pregnancy. Neonatal effects of pneumonia in pregnancy include low birth weight and increased risk of preterm birth, and serious maternal complications include respiratory failure. Community-acquired pneumonia is the most common form of pneumonia in pregnancy, with Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae accounting for most identified bacterial organisms. Beta-lactam and macrolide antibiotics are considered safe in pregnancy and are effective for most community-acquired pneumonia in pregnancy. Viral respiratory infections, including varicella, influenza, and severe acute respiratory syndrome, can be associated with maternal pneumonia. Current antiviral and respiratory therapies can reduce maternal morbidity and mortality from viral pneumonia. Influenza vaccination can reduce the prevalence of respiratory hospitalizations among pregnant women during influenza season. Pneumocystis pneumonia continues to carry significant maternal risk to an immunocompromised population. Prevention and treatment of Pneumocystis pneumonia with trimethoprim / sulfamethoxazole is effective in reducing this risk. CONCLUSIONS: Prompt diagnosis and treatment with contemporary antimicrobial therapy and intensive care unit management of respiratory compromise has reduced the maternal morbidity and mortality due to pneumonia in pregnancy. Prevention with vaccination in at-risk populations may reduce the prevalence and severity of pneumonia in pregnant women.

Levin ME, Motala C, Lopata AL. Anaphylaxis in a milk-allergic child after ingestion of soy formula cross-contaminated with cow's milk protein. Pediatrics. 2005 Nov;116(5):1223-5.

Allergy Clinic, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. mlevin@ich.uct.ac.za

In this report we describe a 9-month-old boy with severe persistent asthma and documented cow's milk allergy (presented with eczema and severe systemic reactions) who had an anaphylactic reaction to a soy formula contaminated with cow's milk protein. Quantitative  enzyme-linked immunosorbent assay analysis revealed trace quantities of beta-lactoglobulin in the offending soy formula as well as the dry powder. The patient did not demonstrate clinical reactivity to soy protein (negative challenge, tolerated pure soy formula well). Cross-contamination of the offending soy formula was presumed to have occurred during food manufacturing. This case demonstrates that trace quantities of cow's milk protein can elicit severe systemic reactions in highly milk-allergic individuals. This infant ingested the equivalent of 0.4 mL of cow's milk from the soy formula as documented by an immunoassay for beta-lactoglobulin. This highlights the ease with which cross-contamination can occur during food processing and reinforces the need for better quality control.  

Meltzer DI. Complications of body piercing. Am Fam Physician. 2005 Nov 15;72(10):2029-34. Summary for patients in: Am Fam Physician. 2005 Nov 15;72(10):2035-6.

State University of New York at Stony Brook School of Medicine, Stony Brook, New York, USA. donna.meltzer@stonybrook.edu

The trend of body piercing at sites other than the earlobe has grown in popularity in the past decade. The tongue, lips, nose, eyebrows, nipples, navel, and genitals may be pierced. Complications of body piercing include local and systemic infections, poor cosmesis, and foreign body rejection. Swelling and tooth fracture are common problems after tongue piercing. Minor infections, allergic contact dermatitis, keloid formation, and traumatic tearing may occur after piercing of the earlobe. "High" ear piercing through the ear cartilage is associated with more serious infections and disfigurement. Fluoroquinolone antibiotics are advised for treatment of auricular perichondritis because of their antipseudomonal activity. Many complications from piercing are body-site-specific or related to the piercing technique used. Navel, nipple, and genital piercings often have prolonged healing times. Family physicians should be prepared to address complications of body piercing and provide accurate information to patients.  

Reid G, Kirjaivanen P. Taking probiotics during pregnancy. Are they useful therapy for mothers and  newborns?  Can Fam Physician. 2005 Nov;51:1477-9.

Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute.

QUESTION: Recently, several of my pregnant patients have asked me about using probiotics during pregnancy. Is there any evidence that these innocuous bacteria work effectively? ANSWER: An increasing body of evidence suggests that probiotics are effective for treating bacterial vaginosis and allergic reactions. Most probiotics available in Canada, however, are of dubious quality, and, for many claimed indications, there is no proof of effectiveness yet.  

Restrepo RD, Pettignano R, DeMeuse P. Halothane, an effective infrequently used drug, in the treatment of pediatric status asthmaticus: a case report. J Asthma. 2005 Oct;42(8):649-51.

Department of Cardiopulmonary Care Sciences, Georgia State University, and Division of Critical Care, Hughes Spalding Children's Hospital, Atlanta, Georgia, USA. restrepor@uthscsa.edu

Asthma is the most common chronic disease of childhood. Despite a better understanding of the disease process and its management, status asthmaticus continues to be a life-threatening event. The use of volatile inhaled anesthetics is infrequently reported as adjunctive therapy to conventional treatment of this condition. We report the use of halothane in a mechanically ventilated pediatric patient with life-threatening status asthmaticus who was admitted to the pediatric intensive care unit (PICU) after failing to respond to standard medical therapy and noninvasive positive pressure ventilation. A 12-year-old African American male was seen in the emergency department and treated with intravenous corticosteroids, beta-agonist therapy. He deteriorated rapidly and required endotracheal intubation and mechanical ventilation. Two hours later, the patient developed an acute, severe respiratory acidosis (pH=6.97, PaCO2=171, PaO2=162, BE=1.7). Halothane was started at 2% by using the Siemens Servo 900C anesthesia ventilator. Improvement in both arterial blood gases and exhaled tidal volume were noted 30 minutes after initiation of the anesthetic gas. The patient remained on halothane for a total of 36 hours. No adverse effects associated with the use of halothane were noted. The patient was extubated to BiPAP 16/6, FiO2=0.30 at 68 hours and was discharged home 5 days later.  

Vegunta RK, Raso M, Pollock J, Misra S, Wallace LJ, Torres A Jr, Pearl RH. Biliary dyskinesia: the most common indication for cholecystectomy in children. Surgery. 2005 Oct;138(4):  726-31; discussion 731-3.

University of Illinois College of Medicine at Peoria, USA. vegunta@uic.edu

BACKGROUND: The purpose of this study is to examine the current indications for cholecystectomy in children and to evaluate the results after such surgery. METHODS: Retrospective analysis of 107 consecutive cholecystectomies performed in children at the Children's Hospital of Illinois between October 1998 and September 2003. Hospital medical charts and outpatient clinic charts were reviewed. Patients' families were contacted by telephone to obtain longer-term follow-up. Results were analyzed with SPSS 12.0 for Windows (SPSS Inc, Chicago, Ill). RESULTS: Biliary dyskinesia (BD) was the indication for surgery for 62 (58%) of the 107 children who underwent cholecystectomy during the study period. Gallbladder calculus (GC) disease was the next most common indication with 29 (27%) children. The duration of symptoms was longer for BD. The most common presenting symptom in both groups was abdominal pain. Food intolerance was reported by 45% of patients with BD, significantly higher than patients with GC. Mean length of stay after cholecystectomy was 17 hours and 45 hours for BD and GC, respectively. Short-term follow-up showed relief or improvement of symptoms in 85% of children with BD and in 97% with GC. There were no deaths. Two (1.9%) children of the total of 107 developed complications; both had intra-abdominal abscesses. Most patients had complete or considerable long-term improvement in symptoms. CONCLUSIONS: Biliary dyskinesia was the most common indication for cholecystectomy in children in our study. More than half of the surgeries were performed on an outpatient basis. Morbidity was minimal and mortality was zero. We had satisfactory short- and long-term symptom resolution with long-term patient satisfaction reaching 95%.

13661.   Armstrong PA, Pazona JF, Schaeffer AJ. Anaphylactoid reaction after retrograde pyelography   despite        

             preoperative steroid preparation. Urology. 2005 Oct;66(4):880.

13662.     Bangash SA, Bahna SL. Pediatric food allergy update. Curr Allergy Asthma Rep. 2005 Nov;5(6):437-44.

13663.       Becklake MR. Wheeze, asthma diagnosis and medication use in developing countries. Thorax. 2005 Nov;60(11):885-7.

13664.       Bernstein JA. Chronic urticaria: an evolving story. Isr Med Assoc J. 2005 Dec;7(12):774-7.

13665.  Berstad A, Arslan G, Lind R, Florvaag E. Food hypersensitivity-immunologic (peripheral) or cognitive (central) sensitisation? Psychoneuroendocrinology. 2005 Nov;30(10):983-9.

13666.     Buchvald F, Hermansen MN, Nielsen KG, Bisgaard H. Exhaled nitric oxide predicts exercise-induced bronchoconstriction in    asthmatic school children. Chest. 2005 Oct;128(4):1964-7.

13667.      Dauer EH, Freese DK, El-Youssef M, Thompson DM. Clinical characteristics of eosinophilic esophagitis in children. Ann Otol Rhinol   Laryngol. 2005 Nov;114(11):827-33.

13668.     David GL, Koh WP, Lee HP, Yu MC, London SJ. Childhood exposure to environmental tobacco smoke and chronic respiratory symptoms in non-smoking adults: the Singapore Chinese Health Study. Thorax. 2005 Dec;60(12):1052-8. 

13669.      Ferrario F, Rastaldi MP. Henoch-Schonlein nephritis. J Nephrol. 2005 Nov-Dec;18(6):637-41.

13670.     Fruhauf J, Weinke R, Pilger U, Kerl H, Mullegger RR. Soft tissue cervicofacial emphysema after dental treatment: report of 2 cases with emphasis on the differential diagnosis of angioedema. Arch Dermatol. 2005 Nov;141(11):1437-40.

13671.     Garcia-Careaga M Jr, Kerner JA Jr. Gastrointestinal manifestations of food allergies in pediatric patients. Nutr Clin Pract. 2005 Oct;20(5):526-35. Review.

13672.     Gomez Real F, Svanes C, Bjornsson EH, Franklin K, Gislason D, Gislason T, Gulsvik A, Janson C, Jogi R, Kiserud T, Norback D, Nystrom L, Toren K, Wentzel-Larsen T, Omenaas E. Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey. Thorax. 2006 Jan;61(1):34-40. 

13673.     Hendeles L, Marshik PL, Ahrens R, Kifle Y, Shuster J. Response to nonprescription epinephrine inhaler during nocturnal asthma. Ann Allergy Asthma Immunol. 2005 Dec;95(6):530-4.

13674.     Jani M, Ogston S, Mukhopadhyay S. Annual increase in body mass index in children with asthma on higher doses of inhaled steroids. J Pediatr. 2005 Oct;147(4):549-51.

13675.      Jindal SK, Gupta D, Aggarwal AN, Agarwal R; World Health Organization; Government of India. Guidelines for management of  asthma at primary and secondary levels of health care in India (2005). Indian J Chest Dis Allied Sci. 2005 Oct-Dec;47(4):309-43. Review.

13676.     Karatzios C, Bratu I, Flageole H, McDonald J. Chest pain and pulmonary lesion in a child with asthma. Pediatr Infect Dis J. 2005 Nov;24(11):1026, 1031.

13677.     Kawai M, Nakashima M, Takaori S, Nakamura Y, Akamatsu K, Nakashima M, Miyamoto T. Pharmacodynamic equivalence study of CFC-free and CFC-containing procaterol hydrochloride metered-dose inhalers. Methods Find Exp Clin Pharmacol. 2005 Oct;27(8):555-8. 

13678.      Khan J. Eye know it's red. Lancet. 2005 Oct 29-Nov 4;366(9496):1583.

13679.     Kim CJ, Chung HY, Kim SY, Kim YO, Ryu SY, Kim JC, Chung JH. Acute appendicitis in Henoch-Schonlein purpura: a case report. J Korean Med Sci. 2005 Oct;20(5):899-900.

13680.     Kim IK, Phrampus E, Venkataraman S, Pitetti R, Saville A, Corcoran T, Gracely E, Funt N, Thompson A. Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: a randomized, controlled trial. Pediatrics. 2005 Nov;116(5):1127-33.

13681.     Kristjansson S, Bjarnarson SP, Wennergren G, Palsdottir AH, Arnadottir T, Haraldsson A, Jonsdottir I. Respirtory syncytial virus and other respiratory viruses during the first 3 months of life promote a local TH2-like response. J Allergy Clin Immunol. 2005 Oct;116(4):805-11.

13682.     Kroigaard M, Garvey LH, Menne T, Husum B. Allergic reactions in anaesthesia: are suspected causes confirmed on subsequent testing? Br J Anaesth. 2005 Oct;95(4):468-71. 

13683.     Lang DM.  Blocking aspirin-induced bronchospasm. Ann Allergy Asthma Immunol. 2005 Oct;95(4):307-8. Review.

13684.     Mandell D, Curtis R, Gold M, Hardie S.  Anaphylaxis: how do you live with it? Health Soc Work. 2005 Nov;30(4):325-35.

13685.     McClelland VM, Brookfield DS.  Palpation reveals the diagnosis. Arch Dis Child. 2005 Dec;90(12):1278.

13686.     McIntyre CL, Sheetz AH, Carroll CR, Young MC. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics. 2005 Nov;116(5):1134-40.

13687.     Moss JR, Zanation AM, Shores CG. ACE inhibitor associated recurrent intermittent parotid gland swelling. Otolaryngol Head Neck Surg. 2005 Dec;133(6):992-4.

13688.     Nadarajah K, Green GR, Naglak M.   Clinical outcomes of penicillin skin testing.Ann Allergy Asthma Immunol. 2005 Dec;95(6):541-5. 

13689.     Neri I, Savoia F, Guareschi E, Medri M, Patrizi A.  Purpura after application of EMLA cream in two children. Pediatr Dermatol. 2005 Nov-Dec;22(6):566-8. 

13690.     Newcomb AE, Clarke CP. Spontaneous pneumomediastinum: a benign curiosity or a significant problem? Chest. 2005 Nov;128(5):3298-302.

13691.     Nicol AA. Understanding peanut allergy: an overview of medical and lifestyle concerns. Adv Nurse Pract. 2005 Oct;13(10):63-8. Review.

13692.     Opstelten W, van Essen GA, Moons KG, van Wijck AJ, Schellevis FG, Kalkman CJ, Verheij TJ.   Do herpes zoster patients receive antivirals? A Dutch National Survey in General Practice. Fam Pract. 2005 Oct;22(5):523-8. 

13693.     Paajanen L, Korpela R, Tuure T, Honkanen J, Jarvela I, Ilonen J, Knip M,Vaarala O, Kokkonen J.   Cow milk is not responsible for most gastrointestinal immune-like syndromes--evidence from a population-based study. Am J Clin Nutr. 2005 Dec;82(6):1327-35.

13694.     Saarinen KM, Pelkonen AS, Makela MJ, Savilahti E. Clinical course and prognosis of cow's milk allergy are dependent on milk-specific IgE status. J Allergy Clin Immunol. 2005 Oct;116(4):869-75. 

13695.     Schreck DM, Babin S.  Comparison of racemic albuterol and levalbuterol in the treatment of acute asthma in the ED. Am J Emerg Med. 2005 Nov;23(7):842-7.

13696.     Sevar R. Audit of outcome in 455 consecutive patients treated with homeopathic medicines. Homeopathy. 2005 Oct;94(4):215-21. 

13697.     Soylu A, Kavukcu S, Erdur B, Demir K, Turkmen MA. Multisystemic leukocytoclastic vasculitis affecting the central nervous system. Pediatr Neurol. 2005 Oct;33(4):289-91.

13698.     Stover DE, Mangino D. Macrolides: a treatment alternative for bronchiolitis obliterans organizing pneumonia? Chest. 2005 Nov;128(5):3611-7.

13699.     Wickens K, Barry D, Friezema A, Rhodius R, Bone N, Purdie G, Crane J.  Fast foods - are they a risk factor for asthma? Allergy. 2005 Dec;60(12):1537-41.

13700.     Zacharisen M, Schoenwetter W. Fatal hypersensitivity pneumonitis. Ann Allergy Asthma Immunol. 2005 Nov;95(5):484-7.

13701.     Zanconato S, Meneghelli G, Braga R, Zacchello F, Baraldi E. Office spirometry in primary care pediatrics: a pilot study. Pediatrics. 2005 Dec;116(6):e792-7.

Pathogenesis:

13702.     Allmers H. Frequent acetaminophen use and allergic diseases: is the association clear? J Allergy Clin Immunol. 2005 Oct;116(4):859-62. Review. 

13703.     Bjorksten B. Evidence of probiotics in prevention of allergy and asthma. Curr Drug Targets Inflamm Allergy. 2005 Oct;4(5):599-604. Review.

13704.     Britton J. Passive smoking and asthma exacerbation. Thorax. 2005 Oct;60(10):794-5. 

13705.     Corkins MR. Are diet and constipation related in children? Nutr Clin Pract. 2005 Oct;20(5):536-9. Review.

13706.     Davoren M, Peake J. Cashew nut allergy is associated with a high risk of anaphylaxis.Arch Dis Child. 2005 Oct;90(10):1084-5.

13707.     Demiraran Y, Kocaman B, Akman RY. A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children. Br J Anaesth. 2005 Oct;95(4):510-3. 

13708.     Eskinazi D.  Vaccinations: for or against. Homeopathy. 2005 Oct;94(4):252-3. 

13709.     Haroon M. Should children with Henoch-Schonlein purpura and abdominal pain be treated with steroids? Arch Dis Child. 2005 Nov;90(11):1196-8. Review. 

13710.     Holgate ST. Exacerbations: the asthma paradox. Am J Respir Crit Care Med. 2005 Oct 15;172(8):941-3. Review. 

13711.     Jolles S, Sewell WA, Misbah SA.  Clinical uses of intravenous immunoglobulin. Clin Exp Immunol. 2005 Oct;142(1):1-11. Review. Jun ZJ, Lei Y, Shimizu Y, Dobashi K, Mori M. Helicobacter pylori seroprevalence in patients with mild asthma. Tohoku J Exp Med. 2005 Dec;207(4):287-91.

13712.     King N, Helm R, Stanley JS, Vieths S, Luttkopf D, Hatahet L, Sampson H, Pons L, Burks W, Bannon GA. Allergenic characteristics of a modified peanut allergen. Mol Nutr Food Res. 2005 Oct;49(10):963-71.

13713.     Latha GS, Lakshmi VV, Rani HS, Anuradha B, Murthy KJR. Specific IgG and its subclass antibodies after immunotherapy with gynandropsis gynandra . Lung India. 2005 Jul-Sept; 22(3): 77-80

13714.     Miller MM, Miller MM.  Beta-blockers and anaphylaxis: are the risks overstated? J Allergy Clin Immunol. 2005 Oct;116(4):931-3; author reply 933-6.

13715.     Richardson L. Re: "please read the following paper and write this way!". Am J Epidemiol. 2005 Oct 1;162(7):706-7. 

13716.     Romero-Frais E, Vazquez MI, Sandez E, Blanco-Aparicio M, Otero I, Verea H.  Prescription of oral corticosteroids in near-fatal asthma patients: relationship with panic-fear, anxiety and depression. Scand J Psychol. 2005 Oct;46(5):459-65.

13717.     Su SS, Yu KH, Woung PS. Comment: esomeprazole-induced central fever with severe myalgia. Ann Pharmacother. 2005 Oct;39(10):1764; author reply 1765. 

13718.     van Rijt LS, van Kessel CH, Boogaard I, Lambrecht BN. Respiratory viral infections and asthma pathogenesis: a critical role for dendritic cells? J Clin Virol. 2005 Nov;34(3):161-9.  Review.

13719.     Ward MD, Selgrade MK. Benefits and risks in malaria control. Science. 2005 Oct 7;310(5745):49-51; author reply 49-51. 

13720.     Zanoni LZ, Palhares DB, Consolo LC. Myocardial ischemia induced by nebulized fenoterol for severe childhood asthma. Indian Pediatr. 2005 Oct;42(10):1013-8.

13721.     Zinderman CE, Wise R, Landow L. Fluid solutions in dengue shock syndrome. N Engl J Med. 2005 Dec 8;353(23):2510-1; author reply 2510-1.

Therapy:

Back

October 2006

Some selected abstracts:

1

Arcola T, Ruuska T, Keranen J, Hyoty H, Salminen S, Isolauri E.  Rectal bleeding in infancy: clinical,     allergological, and microbiological examination.Pediatrics. 2006 Apr;117(4):e760-8.
Department of Paediatrics, Tampere University Hospital, Tampere, Finland. taina.arvola@uta.fi
OBJECTIVE: Rectal bleeding is an alarming symptom and requires additional investigation. In infants it has been explained mainly by hypersensitivity. In addition to dietary antigens, intraluminal microbial agents challenge the immature gut mucosa. Although controlled in the mature gut, these antigens may induce inflammation in the developing gastrointestinal tract. The objectives of this study were to evaluate prospectively the clinical course of rectal bleeding and evaluate the impact of cow's milk allergy and aberrant gut microbiota on the condition. Because withdrawal of cow's milk antigens from the infants' diet is used as a first treatment without evidence of its efficacy, we also aimed to asses the effect of a cow's milk-elimination diet on the duration of rectal bleeding. METHODS: The study involved 40 consecutive infants (mean age: 2.7 months) with visible rectal bleeding during a 2-year period at the Tampere University Hospital Department of Pediatrics. Most of the infants (68%) were fully breastfed. At enrollment the infants were randomly allocated to receive a cow's milk-elimination diet (n = 19) or continue their previous diet (n = 21) for 1 month. Findings of colonoscopy, fecal bacterial culture, fluorescence in situ hybridization of selected gut genera, specific detection of fecal enteroviruses, rotaviruses, and adenoviruses, fecal electron microscopy for viruses, and mucosal electron microscopy for viruses were assessed. During each visit the severity of atopic eczema, if any, was assessed according to the SCORAD method. In evaluating the extent of sensitization, serum total immunoglobulin E (IgE) and specific IgE and skin-prick tests for cow's milk, egg, and wheat were studied. Cow's milk allergy was diagnosed by elimination and provocation testing. Five patients were hospitalized; all others were treated on an outpatient basis. The follow-up visits were scheduled 1 month later and at the age of 1 year. Sixty-four healthy reference infants were selected as controls according to the following criteria: age and timing of fecal sampling being identical to within 1 month. RESULTS: Altogether, 32 (80%) infants manifested bloody stools during follow-up (mean [range]: 2.1 [1-15] per day). The mean number of days with rectal bleeding on follow-up was 6. Typically, bloody stools occurred irregularly, for which reason the mean time to the last occurrence of rectal bleeding was 24 (range: 1-85) days from admission. Atopic eczema at presentation or during follow-up was diagnosed in 38% of the infants. Increased specific IgE concentrations or a positive skin-prick test were uncommon. The growth of the infants was normal on admission and during follow-up. Colonoscopy revealed typically focal mucosal erythema and aphthous ulcerations. The mucosa appeared normal in less than half of the patients. No anorectal fissures or colonic polyps were found. Light microscopy revealed that the overall architecture of the mucosa was well maintained. Acute inflammation or postinflammatory state and focal infiltration of eosinophils in the lamina propria were the most common abnormalities. A cow's milk-elimination diet did not affect the duration of rectal bleeding. Cow's milk allergy was diagnosed in 7 (18%) patients. Virus-particle aggregates were found in the microvillus layer of the colon epithelium in 8 cases. The surface epithelium of the virus-positive colon biopsy specimens regularly showed degenerative changes in the microvillus layer and epithelial cells. Electron microscopy study of the colon biopsies disclosed virus particles (30 nm in diameter) on the surface of epithelial cells. Virus particles or RNA were present in feces in only a minority of the patients. All fecal cultures were negative for Salmonella, Shigella, and Yersinia. Campylobacter jejuni was found in the feces of 1 patient, and fecal cultures were positive for Clostridium difficile in 4 patients, Staphylococcus aureus in 8 patients, and yeast in 2 patients. Fluorescence in situ hybridization revealed that at the time of admission the total numbers of bacteria and the numbers of bifidobacteria and lactobacilli in feces were lower in the patients compared with controls. The fecal concentrations of microbes characterized in this study (Bacteroides, bifidobacteria, Clostridium, lactobacilli, and enterococci) did not differ significantly between the time of admission and the second visit in the patients or controls. At the age of 1 year, 7 patients still suffered from cow's milk allergy, 5 of whom also suffered from multiple food allergies. Atopic eczema and histopathologically confirmed inflammation of the colonic mucosa at presentation were associated with persistence of cow's milk allergy at the age of 1 year. No patients exhibited gastrointestinal complaints or visible blood in stools. CONCLUSIONS: Rectal bleeding in infants is generally a benign and self-limiting disorder. Bloody stools occurred irregularly for only a few days during the following months. As in a previous report, most infants were exclusively breastfed. In the majority of the patients the cause of the condition remains unknown. An association with viruses can be seen in some patients. The microbes that commonly lead to bloody diarrhea in older children and adults, Salmonella, Shigella, and Yersinia, were absent in the present material. The low bifidobacterial numbers in fecal samples may indicate a significant aberrance that may provide a target for probiotic intervention to normalize gut microbiota. The gut microbiota overall seemed stable, because the numbers of major groups of microbiota tested did not change significantly between the time of admission and after 1 month. Cow's milk allergy among these patients is more uncommon than previously believed. Cow's milk challenge is thus essential in infants who become symptom-free during a cow's milk-free diet to reduce the number of false-positive cow's milk-allergy diagnoses.

Devadason SG.  Recent advances in aerosol therapy for children with asthma. J Aerosol Med. 2006 Spring;19(1):61-6. Review.

School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Perth, Australia. sunalene@ichr.uwa.edu.au

Inhalational drug delivery is the primary mode of asthma therapy in children and is the main focus of this article. Pressurized metered dose inhalers (pMDIs) are now the method of choice in infants and children under 5 years old, when used in combination with an appropriate valved holding chamber or spacer. Spacers are particularly important for steroid inhalation to maximize lung deposition and minimize unwanted oropharyngeal deposition. Optimal inhalation technique with a pMDI-spacer in infants is to inhale the drug by breathing tidally through the spacer. Drug delivery to the lungs using pMDIs can vary greatly, depending on the formulation used and the age of the child. Dry powder inhalers (DPIs) are driven by the peak inspiratory flow of the patient and are usually not appropriate for children under 5 or 6 years of age. Nebulizers continue to play a role in the treatment of acute asthma where high doses of bronchodilator are required, though multiple doses via pMDI spacer may suffice. Important drug delivery issues specific to children include compliance, use of mask versus mouthpiece, lower tidal volumes and inspiratory flows, determination of appropriate dosages, and minimization of adverse local and systemic effects.
 

Heine RG. Gastroesophageal reflux disease, colic and constipation in infants with food allergy. Curr Opin Allergy Clin Immunol. 2006 Jun;6(3):220-5. Review.
Department of Allergy, Royal Children's Hospital, Parkville, Victoria, Australia. ralf.heine@rch.org.au
PURPOSE OF REVIEW: This review assesses the role of food allergy in the pathophysiology of gastroesophageal reflux disease, colic and constipation in infancy. RECENT FINDINGS: Frequent regurgitation, persistent crying and constipation are common clinical problems in infancy. A subgroup of infants with these conditions may respond to hypoallergenic diets, but only few randomized clinical trials have been conducted. Skin prick testing and food-specific antibody levels are usually not elevated in these infants, whereas atopy patch testing may diagnostic. The mechanisms by which cow's milk and other food allergens induce gastrointestinal motility disorders are not understood. Apart from cell-mediated reactions, non-immunological effects of food constituents on gastrointestinal motility and gut microbiota may be involved in the pathogenesis. In the absence of reliable diagnostic tests, dietary elimination and re-challenge are usually required to confirm food allergy. A trial of amino acid-based formula or an oligoantigenic maternal elimination diet may be indicated in infants who have failed conventional medical treatment. SUMMARY: Food allergy may contribute to gastroesophageal reflux disease, colic or constipation in infancy. Infants with these conditions often respond to hypoallergenic formula or a maternal elimination diet. Further research is needed to define the mechanisms and clinical markers of gastrointestinal food allergy in infancy.
 

Hickey AJ, Lu D, Ashley ED, Stout J.  Inhaled azithromycin therapy. J Aerosol Med. 2006 Spring;19(1):54-60.

Division of Drug Delivery and Disposition, School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina 27599-7360, USA. ahickey@unc.edu 

The treatment of pulmonary infectious diseases with pharmaceutical aerosols is an attractive option considering the accessibility of the lungs for topical drug delivery. Aerosols have been targeted to the lungs for the treatment of asthma with great success. Current therapies for other diseases, including Pseudomonas aeruginosa, Pneumocystis jirovecii (formerly Pneumocystis carinii), and mycobacterial infections, remain suboptimal due to the efficacy/safety profile. This may be improved by aerosol targeted pulmonary drug delivery. Azithromycin is a broad spectrum antibiotic that acts by inhibiting protein synthesis. It is associated with side effects that might be avoided by aerosol delivery to the lungs. In the present study three concentrations of azithromycin (10, 50, and 100 mg/mL) were delivered from three nebulizers (Acorn II, Updraft, and LC Plus) operated at 8 L/min. Particles size analyses were conducted by inertial impaction and laser diffraction. In addition, emitted doses were determined. A linear proportionality existed across the concentration range between nominal dose and both fine particle dose/fraction and emitted dose, with R2 > 0.999 in all cases. The mass median aerodynamic diameter increased from 1.4 to 1.9 microm between 10 and 100 mg/mL of azithromycin solution concentration for the Acorn II. The particle size distributions were not all log-normally distributed. The median particle size delivered from the devices was largest for the Updraft (2.8 microm) and smallest for the Acorn II (1.9 microm) for 100 mg/mL azithromycin solution concentrations. The efficiencies of small particle delivery (%<4.7 microm) were as follows, LC Plus = Acorn II (85%) > UpDraft (75%). However, the emitted dose from the LC Plus (55 mg/min) was higher than the Acorn II (31 mg/min) to maximize lung exposure to the aerosol, small median diameters and broad particle size distributions would be most effective. This study demonstrates that the dose delivered to the lungs will be maximized, under the current operating conditions by adopting the LC Plus, and high (100 mg/mL) azithromycin concentrations.
 

Shiber JR, Santana J. Dyspnea. Med Clin North Am. 2006 May;90(3):453-79. Review.
Department of Medicine, East Carolina University, Greenville, NC 27834, USA. shiberj@mail.ecu.edu
When evaluating a dyspneic patient in the office, a quick initial assessment of the airway, breathing, and circulation, while gathering a brief history and focused physical examination are necessary. Most often, an acute cardiopulmonary disorder, such as CHF, cardiac ischemia, pneumonia, asthma, or COPD exacerbation, can be identified and treated. Stable patients who improve can be sent home, but those in acute distress with unstable or impending unstable conditions need to be transferred emergently to definitive care. Because of the difficult logistics involved in attempting to work up an outpatient for new onset of SOB, some patients will need to be transferred to the nearest ED for a definitive diagnosis.
 

Sun HL, Kao YH, Chou MC, Lu TH, Lue KH. Differences in the prescription patterns of anti-asthmatic medications for children by pediatricians, family physicians and physicians of other specialties. J Formos Med Assoc. 2006 Apr;105(4):277-83.
Department of Pediatrics, Chung Shan Medical University Hospital, and Institute of Medicine, Taichung, Taiwan.
BACKGROUND: Prescription patterns of anti-asthma medications in children vary among doctors in different disciplines and settings, and may reflect differences in treatment outcome. The purpose of this study was to analyze the prescribing patterns of anti-asthma drugs by pediatricians, family physicians and other practitioners. METHODS: Data for a total of 225,537 anti-asthma prescriptions were collected from the National Health Insurance Research Database for the period from January 1, 2024 to March 31, 2002. These medications included inhaled and oral adrenergics, inhaled and oral corticosteroids, xanthine derivatives, and leukotriene receptor antagonists prescribed by general pediatricians, family physicians and physicians in other disciplines. RESULTS: Oral beta2-agonist was the most commonly prescribed drug used as monotherapy, with prescription rates of 70.4%, 46.9% and 58.0% by pediatricians, family physicians and other physicians, respectively. A xanthine derivative was the next most commonly prescribed monotherapy. Oral corticosteroid combined with oral beta2-agonist, followed by oral beta2-agonist combined with a xanthine derivative were the two most commonly prescribed dual-agent combined therapies by all three physician categories. The prescription rate for inhaled corticosteroid monotherapy was 7.8% by pediatricians, 5.6% by family physicians, and 8.0% by other physicians. The prescription rate for inhaled adrenergic was the highest in family physicians (14.9%), followed by the other physicians (7.2%), and was lowest in pediatricians (3.1%). CONCLUSION: Pediatricians and family physicians appeared to share similar opinions on the medical management of children with asthma in that both most commonly prescribed oral beta2-agonists and xanthine derivatives, either alone or in combination. Family physicians were least likely to prescribe an inhaled corticosteroid and most likely to prescribe an inhaled adrenergic agent.
 

Watanasomsiri A, Phipatanakul W. Comparison of nebulized ipratropium bromide with salbutamol vs salbutamol alone in acute asthma exacerbation in children. Ann Allergy Asthma Immunol. 2006 May;96(5):701-6.
Department of Pediatrics, Thammasat Chalerm Prakiat Hospital, Thammasat University Medical School, Pathumthani, Thailand. apassornw@yahoo.com
BACKGROUND: Despite multiple doses of beta2-agonists in the treatment of acute asthma exacerbation, significant residual airways obstruction often remains. OBJECTIVE: To determine whether the addition of inhaled ipratropium bromide to salbutamol provides improvement in lung function and clinical asthma symptoms in young children with acute asthma exacerbation. METHODS: This study was a prospective, double-blind randomized control trial of children aged 3 to 15 years who presented with an acute asthma exacerbation at the emergency department or outpatient clinic of Thammasat University Hospital, Pathumthani, Thailand, between September 2001 and February 2003. Subjects were randomized to receive 3 doses of nebulized salbutamol mixed with isotonic sodium chloride solution (control) or ipratropium bromide (treatment) every 20 minutes. Additional doses of salbutamol were given every 30 minutes as needed. Asthma outcome measures were evaluated 40, 70, 100, and 120 minutes after baseline. Primary outcomes were the differences in percent change in asthma clinical score and percent change in peak expiratory flow rate (PEFR) from baseline. Secondary outcomes included change in percent predicted PEFR. RESULTS: Of 74 children randomized and enrolled in the trial, 71 had complete data for analysis. Thirty-three children were in the control group and 38 were in the treatment group. Both the percent change in PEFR and the change in percent predicted PEFR at any time were higher in the treatment group, but these findings were not statistically significantly different. The number of subjects with at least a 100% percent predicted PEFR at any time point was greater in the treatment group. CONCLUSION: Although this study did not demonstrate a significant advantage in clinical score and PEFR, the trend toward additional effect of ipratropium bromide was consistent with previous studies.
 

Zwerneman K.  End-tidal carbon dioxide monitoring: a VITAL sign worth watching. Crit Care Nurs Clin North Am. 2006 Jun;18(2):217-25, xi. Review.
Neurology Service, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75228, USA. karenz@baylorhealth.edu
Capnography is the monitoring of end-tidal carbon dioxide in waveform and numeric display. For this technology to be useful, the critical care nurse must have a clear understanding of the normal capnography waveform and what the alterations in this waveform represent. The critical care nurse can use this information to plan patient care interventions with other critical care team members and to adjust care based on the patient's response. End-tidal carbon dioxide physiology, normal waveforms, abnormal waveforms, and clinical aspects of capnography monitoring are included.
 

Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostics:

14651.  Al-Shawwa B, Al-Huniti N, Titus G, Abu-Hasan M. Hypercholesterolemia is a potential risk factor for asthma. J Asthma. 2006 Apr;43(3):231-3.

14652.  Canani RB, Cirillo P, Roggero P, Romano C, Malamisura B, Terrin G, Passariello A, Manguso F, Morelli L, Guarino A; Working Group on Intestinal Infections of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children. Pediatrics. 2006 May;117(5):e817-20.

14653.  Christopher KL. Understanding vocal cord dysfunction: a step in the right direction with a long road ahead.Chest. 2006 Apr;129(4):842-3.

14654.  Cockcroft DW, Davis BE. Deep inhalation bronchoprotection in asthma: correlation with airway responsiveness. J Allergy Clin Immunol. 2006 Apr;117(4):951-2.

14655.  Cunha BA. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect. 2006 May;12 Suppl 3:12-24. Review.

14656.  Delfino RJ. Who are the children with asthma most susceptible to air pollution? Am J Respir Crit Care Med. 2006 May 15;173(10):1054-5.

14657.  Dinakar C, Simon S. The link between the Hippocratic Oath and evidence-based medicine. Ann Allergy Asthma Immunol. 2006 Apr;96(4):511-3.

14658.  Eschenauer GA, Regal RE, DePestel DD. Antibiotic allergy.N Engl J Med. 2006 May 25;354(21):2293-4.

14659.  Flaherman V, Rutherford GW. A meta-analysis of the effect of high weight on asthma.Arch Dis Child. 2006 Apr;91(4):334-9.     Review.

14660.  Heraghty JL, Henderson AJ. Highlights in asthma 2005. Arch Dis Child.2006 May;91(5):422-5. Review. 

14661.  Kanter RK, Moran JR. Recent trends in pediatric hospitalization in New York state. J Pediatr. 2006 May;148(5):637-641.

14662.  Kraft M, Hamid Q.  Mycoplasma in severe asthma. J Allergy Clin Immunol. 2006 May;117(5):1197-8.

14663.  Kugelman A, Shaoul R, Goldsher M, Srugo I. Persistent cough and failure to thrive: a presentation of foreign body aspiration in a child with asthma. Pediatrics. 2006 May;117(5):e1057-60. 

14664.  Kuzucu A.  Parasitic diseases of the respiratory tract. Curr Opin Pulm Med. 2006 May;12(3):212-21. Review.

14665.  Kwon NH, Oh MJ, Min TH, Lee BJ, Choi DC. Causes and clinical features of subacute cough. Chest. 2006 May;129(5):1142-7.

14666.  Linday LA. Nutritional supplements and pediatric upper respiratory tract illnesses. J Allergy Clin Immunol. 2006 Apr;117(4):953-4; author reply 954.

14667.  Niggemann B, Heine RG.  Who should manage infants and young children with food induced symptoms? Arch Dis Child. 2006 May;91(5):379-82.

14668.  Putland M, Kerr D, Kelly AM. Adverse events associated with the use of intravenous epinephrine in emergency department patients presenting with severe asthma. Ann Emerg Med. 2006 Jun;47(6):559-63.

14669.  Raherison C, Abouelfath A, Le Gros V, Taytard A, Molimard M. Underdiagnosis of nocturnal symptoms in asthma in general practice. J Asthma. 2006 Apr;43(3):199-202.

14670.     Rowe BH, Camargo CA Jr. Emergency department treatment of severe acute asthma. Ann Emerg Med. 2006 Jun;47(6):564-6. 

14671.     Siddiqui AM, Bardapurkar JS, Patil VP. Oxidant and antioxidants in bronchial asthma. Indian Med Gazette 2005, 139(5), 174-7.

14672.  Weinberger M.  Exercise induced dyspnoea: if not asthma, then what? Arch Dis Child. 2006 Jun;91(6):543-4.

14673.  Yasmeen S, Romano PS, Schembri ME, Keyzer JM, Gilbert WM.  Accuracy of obstetric diagnoses and procedures in hospital discharge data. Am J Obstet Gynecol. 2006 Apr;194(4):992-1001.

Therapy:

14651.  Bisgaard H, Hermansen MN, Loland L, Halkjaer LB, Buchvald F. Intermittent inhaled corticosteroids in infants with episodic wheezing. N Engl J Med. 2006 May 11;354(19):1998-2005.

14652.  Brightling CE.  Clinical applications of induced sputum. Chest. 2006 May;129(5):1344-8. Review.

14653.  Burns SM. Ventilating patients with acute severe asthma: what do we really know? AACN Adv Crit Care. 2006 Apr-Jun;17(2):186-93. Review.

14654.  Cox G, Miller JD, McWilliams A, Fitzgerald JM, Lam S. Bronchial thermoplasty for asthma. Am J Respir Crit Care Med. 2006 May 1;173(9):965-9.

14655.  Cox LS, Linnemann DL, Nolte H, Weldon D, Finegold I, Nelson HS. Sublingual immunotherapy: a comprehensive review. J Allergy Clin Immunol. 2006 May;117(5):1021-35. 

14656.  Donohue JF, Fromer L.  Long-acting beta-agonists role in asthma management. J Fam Pract. 2006 Apr;Suppl:1-6. Review.

14657.  Glassroth J. The role of long-acting beta-agonists in the management of asthma: analysis, meta-analysis, and more analysis. Ann Intern Med. 2006 Jun 20;144(12):936-7. 

14658.  Harmanci K, Bakirtas A, Turktas I, Degim T. Oral montelukast treatment of preschool-aged children with acute asthma. Ann Allergy Asthma Immunol. 2006 May;96(5):731-5. 

14659.  Hermansen MN, Nielsen KG, Buchvald F, Jespersen JJ, Bengtsson T, Bisgaard H.  Acute relief of exercise-induced bronchoconstriction by inhaled formoterol inchildren with persistent asthma. Chest. 2006 May;129(5):1203-9. 

14660.  Heymann WR.  Intramuscular triamcinolone. J Am Acad Dermatol. 2006 May;54(5):866-7. 

14661.  Johnston SL, Blasi F, Black PN, Martin RJ, Farrell DJ, Nieman RB; TELICAST Investigators.  The effect of telithromycin in acute exacerbations of asthma. N Engl J Med. 2006 Apr 13;354(15):1589-600. 

14662.  Karagiannidis C, Hense G, Rueckert B, Mantel PY, Ichters B, Blaser K, Menz G, Schmidt-Weber CB. High-altitude climate therapy reduces local airway inflammation and modulates lymphocyte activation. Scand J Immunol. 2006 Apr;63(4):304-10. 

14663.  Koopmans JG, Lutter R, Jansen HM, van der Zee JS.  Adding salmeterol to an inhaled corticosteroid: long term effects on bronchial inflammation in asthma. Thorax. 2006 Apr;61(4):306-12.

14664.  Lipworth B. Phosphodiesterase type 4 inhibitors for asthma: a real breakthrough or just expensive theophylline? Ann Allergy Asthma Immunol. 2006 May;96(5):640-2.

14665.  Little FF. Treating acute asthma with antibiotics--not quite yet. N Engl J Med. 2006 Apr 13;354(15):1632-4.

14666.  Palmer K, Burks W.  Current developments in peanut allergy. Curr Opin Allergy Clin Immunol. 2006 Jun;6(3):202-6. Review. 

14667.  Stumpf JL, Shehab N, Patel AC. Safety of Angiotensin-converting enzyme inhibitors in patients with insect venom allergies. Ann Pharmacother. 2006 Apr;40(4):699-703

14668.  Xue CC, Li CG, Hugel HM, Story DF. Does acupuncture or Chinese herbal medicine have a role in the treatment of allergic rhinitis? Curr Opin Allergy Clin Immunol. 2006 Jun;6(3):175-9. Review. 

14669.  Yu JW, Pekeles G, Legault L, McCusker CT. Milk allergy and vitamin D deficiency rickets: a common disorder associated with an uncommon disease. Ann Allergy Asthma Immunol. 2006 Apr;96(4):615-9.

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