Status of the bronchi in adolescents and young patients with tuberculosis of the respiratory organs

A comparative analysis is presented of the results of bronchoscopy carried out in 1976-1980 in 406 adolescents and young subjects with different forms of pulmonary tuberculosis and in 115 patients of the same age groups who were examined in 1987-1989. The last decade was marked by the incidence decrease of tuberculosis of bronchi in patients with tuberculosis of respiratory organs from 27.8 to 17.4% and by more benign course. At the same time, the incidence of nonspecific endobronchitis significantly increased (by 3 times). Among the causes of development and growth of the incidence of nonspecific endobronchitis in pulmonary tuberculosis patients the main role is assigned to the deterioration of ecological situation, occupational factors and bad habits. It is considered that nonspecific endobronchitis is not the consequence of pulmonary tuberculosis but are independent diseases having a negative influence on the course of pulmonary tuberculosis.     

Tuberculosis morbidity among the population of a large industrial center]

Tuberculosis morbidity in children, adolescents, young people and adults for the period of 1986-1990 has been analysed. Parameters of morbidity were compared with general morbidity of the population of Chelyabinsk. It was found that at the present stage of tuberculosis control parameters of general morbidity remained unchanged. Morbidity in adolescents and young people aged 18-19 years markedly decreased, while a tendency to its slow growth was revealed in children and in subjects aged 24-29 years. In contrast to other groups, parameters of morbidity in adults are the highest (32.7-37.4 per 1,000,000) and steady owing to which measures aimed at tuberculosis control should be improved.     

Lesions of the bronchial system in patients of different age groups with tuberculosis of the respiratory organs]

The results of bronchological examinations were analysed in 650 patients (between the ages of 1 and 89 years) with tuberculosis of respiratory organs. Three age groups were specified: group I included children and adolescents to 17 years (152 subjects); group II-adults aged 18 to 59 years (408 subjects), and group III--those aged 60 to 89 years (90 subjects). In group I active bronchial tuberculosis was diagnosed in 14.3% of the cases, residual changes after past tuberculosis in 11.1%, nonspecific endobronchitis in 33.3%; the respective figures for group II were 7.1%, 11% and 43.3% and those for group III 20%, 31.1% and 24.4% of the cases. Isolated froms of bronchial tuberculosis account for 0.9% among all clinical froms of tuberculosis of respiratory organs. Nonspecific endobronchitis in cases with tuberculosis of respiratory organs occur in the form of bilateral catarrhal processes. With age catarrhal changes decline from 92.2% to 54.7% and atrophic and hypertrophic bronchial changes increase and amount to 9.2% and 22.3%, respectively. The character of bronchial pathology is determined by the initial forms of tuberculosis.     

The dynamics of the bronchial system lesions in patients with pulmonary tuberculosis

The state of the bronchial system was examined in 1066 patients within the period of 1964 to 1984. Infiltrative tuberculosis of the lungs predominated in the patients. There was a high incidence (30.1 per cent) of specific affections of the bronchial system complicating infiltrative tuberculosis. Within the last decade the incidence of tuberculosis of the bronchi complicating disseminated tuberculosis has markedly lowered. The incidence of newly detected inactive posttuberculous lesions on the bronchial mucosa and nonspecific endobronchitis increased.     

The changed spectrum of purulent pericarditis : An 86 year autopsy experience in 200 patients

Purulent pericarditis continues to be a problem of diagnosis and therapy. To determine its current spectrum we studied the 55 patients with purulent pericarditis examined at autopsy at The Johns Hopkins Hospital since 1943 (group 2) and compared the findings with those in the 145 patients with purulent pericarditis so examined from 1889 to 1943 (group 1). Since 1943, the patients' median age was 49 years; two-thirds were over 40 years of age, and 30 (55 per cent) were men. Gram-negative bacilli were isolated in over a third of the patients; Staphylococcus aureus in 22 per cent, Streptococcus in 13 per cent and Pneumococcus in 9 per cent. Infection spread from intrathoracic foci in 24 (44 per cent) patients, including 13 (24 per cent) in whom this occurred after thoracic surgery. Pericardial effusions were greater than 300 cc in six patients. Myocardial abscess or endocarditis was present in 16 patients (29 per cent) and the presence of aseptic pericarditis, as with uremia or thoracic surgery, predisposed the 26 (47 per cent) affected patients to purulent pericarditis. Diagnosis was made antemortem in only 10 patients (18 per cent) and infection alone caused 22 per cent of the deaths.     

Effectiveness of intratracheal administration of contrykal in combined treatment of children with intrathoracic tuberculosis complicated by endobronchial pathology

Local balance in the system of proteinases-inhibitors in bronchial secretion was studied in 97 children with intrathoracic tuberculosis involving the bronchial tree by activity of trypsin-like proteinases (TLP), free antitryptic activity (ATA) and total content of locally synthesized low molecular acid resisting proteinase inhibitors (ARI). In the children with endobronchial pathology there was observed imbalance in the system evident from increasing activity of TLP and simultaneous decreasing of ATA and the content of ARI. The maximum inhibition of ARI local secretion and increasing of the TLP activity were stated in the patients with purulent and specific endobronchitis. In the children with catarrhal endobronchitis the shifts were moderate. Local use of contrykal in the form of ultrasonic inhalations in complex therapy of tuberculosis promoted in short periods reduction of the inhibitory potential, a 2-fold decrease in the terms of clinical recovery from endobronchitis and a decrease in the frequency of marked fibrous lesions in the bronchi and lungs as compared to analogous patients in the control group treated without the use of the proteinase inhibitor.     

Changes in the incidence of tuberculosis among residents of the Semipalatinsk region

The incidence of tuberculosis among the Semipalatinsk Region's residents over 29 years (1971-1990) is analyzed. It increased in all age groups (children, adolescents, and adults) and in urban populations. In the last 10 years, the incidence of tuberculosis also rose and reached the rate among males under 40 years.     

Aggressive chemotherapy for diffuse histiocytic lymphoma in the elderly: increased complications with advancing age

Twenty patients greater than or equal to 70 years of age were included in a study of the treatment of diffuse histiocytic lymphoma utilizing cyclophosphamide, adriamycin, vincristine, and prednisone. These patients ranged in age from 70 to 94 years (median 75 years). There were also 55 younger patients (age range 33 to 69 years) in the treatment trial. There were no dose adjustments for age. The complete remission rate in the elderly patients (45 per cent) was not different from that in the younger patients (53 per cent). The overall survival in the elderly patients (median 13 months) was somewhat shorter than that in the younger patients (medians 22 months for patients 56-69 years of age and 41 months for patients 33-55 years of age), but not significantly different. Death during the first two treatment cycles from causes other than lymphoma occurred in 25 per cent of the patients greater than or equal to 70 years of age versus 2 per cent of younger patients (P less than 0.01). In addition, three other patients aged 79, 65, and 59 years died in the fourth or fifth cycles of treatment from causes other than lymphoma. Thus, 30 per cent of patients greater than or equal to 70 years of age died during therapy from causes other than lymphoma, versus 5 per cent of younger patients (P less than 0.01). Whether this altered ability to tolerate therapy in the older patients reflected decreased marrow function, altered drug metabolism, other effects of aging, or a combination of these factors is not clear. It might be appropriate to alter drug doses when treating elderly patients, and particular attention to supportive measures seems appropriate.     

Enterocutaneous fistulas in Enugu,Nigeria

Forty-four patients with enterocutaneous fistulas treated at the University of Nigeria Teaching Hospital (UNTH) Enugu in five years (1977–81) are reviewed. Most fistulas resulted from complications of surgery (29 per cent) and appendicitis (55 per cent). The commonest locations were in the cecum (48 per cent), ileum (30 per cent), and colon (20 per cent). The outstanding complication was sepsis. Spontaneous closure occurred in 15 patients (34 per cent). Twenty-two patients were treated surgically. There was a high mortality of 18 per cent from septic complications and malnutrition.     

Declining testicular function with age. Hormonal and clinical correlates

Testicular endocrine function and androgen-dependent secondary sexual characteristics were assessed in 283 men 18 to 96 years of age. Mean serum total testosterone levels remained unchanged up to age 70 and declined thereafter. In 29 per cent of the men over 70 years of age total testosterone levels were below the lower limit of normal for young adults, In contrast, mean free or unbound testosterone levels declined after age 50 and were below the lower limit of normal for young adults in 40 per cent of the men over 70 years of age. Serum-luteinizing hormone and follicle-stimulating hormone levels showed a slight but steady rise after age 40 which became more abrupt after age 70. Serum gonadotropin levels were elevated in approximately 60 per cent of the men over 70 years of age.Mean testis length and volume were decreased in 78 per cent and 37 per cent, respectively, of the men over 60 years of age. Facial, pubic and axillary hair were also reduced in amount whereas the prostate was enlarged in 73 per cent of the elderly men. There appeared to be an inverse relationship in older men between testicular size and gonadotropin levels, and a direct relationship between testicular and prostatic sizes.It would appear that some degree of Leydig cell hypofunction commonly begins at around 45 to 50 years of age, becoming more pronounced after age 70. The concomitant elevation in serum gonadotropin levels at this time indicates that this is due to a primary decline in testicular function and is not secondary to pituitary hypofunction.     

Treatment and outcomes of complicated tuberculosis of the respiratory organs in young children

The main course of tuberculosis chemotherapy was applied to 85 children at the age of 3 months to 3 years. 62.4, 30.6 and 7.0 per cent of the children suffered from tuberculosis of the intrathoracic lymph nodes, primary tuberculosis and miliary tuberculosis, respectively. The children of younger ages were subjected early during the treatment to intensive chemotherapy consisting of intravenous administration of isoniazid in parallel with 2-3 antituberculous drugs applied to 41.2 per cent of the children and of infusion desintoxication therapy applied to 74.1 per cent of the children. The chemotherapy regimen including isoniazid + streptomycin + ethionamide resulted in clinical recovery 10.1 +/- 0.32 months later, in 48.1 per cent of the patients, the tuberculous inflammation completely resolving, in 40.7 per cent it consolidated and in 11.1 per cent it petrificated. 31 patients with the most severe processes were treated, in addition to the above drugs, with rifampicin as rectal suppositories within 87.0 +/- 3.3 days. The clinical recovery was observed in 10.9 +/- 0.22 months (p greater than 0.05); specific inflammation resolution, consolidation and petrification being observed in 41.9, 45.2 and 12.9 per cent of the children, respectively. The morphofunctional indices of T- and B-immunity markedly lowered at the beginning of the treatment returned to normal 3 months earlier in the patients treated with rifampicin.     

Natural resistance to atherosclerosis exhibited by the first centimeter of left and right coronary arteries

A combined gross and histologic study carried out on 270 selected male subjects with the common type of distribution of the coronary arteries revealed a natural resistance to intimal thickening and plaque development exhibited by the left main coronary artery and by the first centimeter of the right coronary artery. The importance of this natural resistance in children, adolescents, young and mature adults up to 55 years old was demonstrated by means of a comparative investigation, involving the degree of intimal thickness, the media thickness versus intima thickness ratio and the per cent of subjects with atherosclerotic plaques. These parameters were examined in 6 selected samples: (a) at 5 mm distal to the aortic origin of the left main coronary artery, compared with those detected at 10 mm and 20 mm distal to the point of origin of the anterior descending artery; (b) at 5 mm from the aortic origin of the right coronary artery, compared with those recorded at 20 mm and 30 mm from the same point of origin. The differences between the above-mentioned samples appeared statistically significant in all age groups investigated. The first atherosclerotic lesions developed about three decades later in the left main coronary artery than in the proximal segment of the anterior descending artery. In the age group 51-55 years old, only 13.3% of subjects showed atherosclerotic plaques in the left main coronary artery, compared to 77.6% in the proximal segment of the anterior descending artery. Also only 6.6% of subjects 51-55 years old showed atherosclerotic plaques at 5 mm distal to the aortic origin of the right coronary artery, compared to 50.0% at 30 mm.     

The clinical aspects of tuberculosis of the respiratory organs in adolescents

Investigation of the tuberculous process of the respiratory organs in 120 adolescents showed that the disease was more frequent in female persons (61.7 per cent). Schoolchildren amounted to 52.6 per cent. Prophylactic examinations revealed 50 per cent of the patients. 38.3 per cent of the patients were detected on their taking medical advice. With the Mantoux test with 2 TU of PPD-L only 5 per cent of the patients were detected. Infiltrative tuberculosis in 53.3 per cent of the patients was recorded. In the majority of the patients, the signs of tuberculosis were insignificant. However, in 44.2 per cent of the adolescents, the process was accompanied by destructions. In 86.7 per cent of the patients the process was primary by its genesis. Pronounced clinical signs of tuberculosis in 36.7 per cent of the adolescents were due to extended processes in 68 per cent of the cases. The phase of destruction in them reached 86.6 per cent. 39.7 per cent of the patients were from tuberculosis foci with insufficient prophylactic and antiepidemic measures. To lower the incidence of tuberculosis in adolescents it is necessary to increase the measures for tuberculosis detection in them and to improve the quality of prophylaxis in tuberculosis foci.     

Effectiveness of Bacillus Calamette Guerin (BCG) vaccination against genital tuberculosis: a case-control study

A hospital-based pair-matched case-control study was performed at Government Medical College Hospital, Nagpur, to estimate the effectiveness of Bacillus Calmette Guerin (BCG) vaccination against genital tuberculosis. The study included 48 cases of genital tuberculosis in the age group of 21-34 years and an equal number of controls, matched for age and socioeconomic status. The estimates of vaccine effectiveness and prevented fraction were higher for the subjects in the age group of 21-30 years and subjects from middle strata of socioeconomic class. The overall vaccine effectiveness and prevented fraction was estimated to be 75 (38.85-89.79) and 49.99 (17.46-74.55) per cent respectively. Results of this study thus indicate that BCG vaccination is effective against genital tuberculosis.     

Characteristics of the incidence of tuberculosis in Orenburg oblast

The trend in tuberculosis morbidity and characteristics of its clinical picture in the Orenburg Region within 1980-1987 were studied. During the 7-year period, there was a decrease in the disease morbidity by 21 per cent in the Region at large and by 10 per cent in the rural areas. A decrease in the proportion of destructive and extended tuberculosis was revealed. The incidence of tuberculosis in the rural population remained high. In the cattle breeders it was 3 times higher than the average figure for the Region. The real level of cattle affection with tuberculosis by the slaughter data amounted to 26 per cent and was by 64 per cent higher than the tuberculin diagnosis data of the veterinary departments. Direct average correlation between the levels of tuberculosis incidence in the cattle and cattle breeders was shown. A high incidence of tuberculosis was stated in urban industrial workers and especially in gas industry workers. In the latter, productive forms of tuberculosis coupled with increased tuberculin sensitivity were mainly diagnosed. Despite the downward trend in the morbidity of tuberculosis in children and adolescents, their contamination remained high. Single cases of tuberculous meningitis and generalized affections were recorded.     

Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult

In order to define the roentgenographic manifestations of pulmonary tuberculosis in the adult, we reviewed a 12 month experience with newly diagnosed patients with active pulmonary tuberculosis in two Boston hospitals. Of 88 patients, 30 (34 per cent) presented with roentgenographic manifestations other than those associated with “usual” postprimary disease. At least 12 patients (13.5 per cent) had primary tuberculosis, including two subjects over 60 years of age. Six patients (6.8 per cent) had disease confined to the lower lung fields, eight patients (9 per cent) had tuberculomas and four (4.5 per cent) had miliary tuberculosis. Twenty per cent of the patients were totally asymptomatic. With the shift of tuberculosis care to community hospitals, knowledge of the varied roentgenographic manifestations is of increasing importance for the practicing internist.     

Level of care and complications among geriatric patients discharged from the medical service of a teaching hospital

To assess the effects of hospitalization on the subsequent placement and supportive care of elderly patients, the medical records of 233 consecutive patients aged 75 years or older, admitted to the medical service of a university hospital, were reviewed. The level of care on admission and at discharge, hospital-associated complications, and demographic data were abstracted for each patient. At discharge, 1 per cent returned to a nursing home, 6 per cent were newly placed in a nursing home, 65 per cent returned to the same level of care as on admission, 10 per cent returned home with an increased level of care, and 18 per cent died or were discharged to another acute care facility. Complications occurred in 30 per cent of patients but did not correlate with age, increased level of care at discharge, or increased rate of nursing home placement. Few elderly patients were discharged to nursing homes, and most returned home without arrangements for increased care.     

Yield of endoscopy in children with hematemesis.

Upper gastrointestinal (UGI) endoscopy is an important tool in the evaluation of patients presenting with haematemesis. The objective of this study was to report the yield of this procedure in a Saudi Arabian population. We analysed the result UGI endoscopy in children and adolescents of 0-18 years of age who presented with haematemesis over a period of 10 years. From 1993 to 2003, endoscopy was performed on 60 consecutive children presenting with haematemesis. This group represented 12% of the indications during the same period. The majority (98%) were Saudi nationals, with an age range from 4 days to 18 years, and a male to female ratio of 1:1.5. The overall yield of endoscopy was 75%; however, the yield was higher (91%) in children below 12 years of age. Gastritis was the commonest cause of haematemesis (44%), followed by oesophagitis (36%). However, age-related analysis shows that oesophagitis was a more common cause of haematemesis in the younger age group (45%) than gastritis in adolescents (30%). In contrast, gastritis was more common in older children (56%) than oesophagitis (28%). Peptic ulcer disease and oesophageal varices were seen in only 3 (7%) and 2 children (4.3%), respectively. The overall yield of endoscopy in our patients is similar to that in most reports. However, oesophagitis and gastritis were the commonest causes of haematemesis, whereas oesophageal varices and peptic ulcer disease were much less common.     

Persistent social disparities in the risk of hospital admission of paediatric diabetic patients in Germany-prospective data from 1277 diabetic children and adolescents.

BACKGROUND: Reduction of social inequality in health care is a major target in many countries. The risk of hospital admission is thought to be higher in diabetic children from socially deprived families but actual data are lacking. METHODS: Based on a nationwide prospective computer-based documentation program (DPV), we determined the association between three social parameters (parental professional education, one-parent family vs. complete family, migration background) and the risk for post-onset hospital admission, as well as the number of hospital admission days in children and adolescents < 20 years of age with diabetes onset in 2002-2005 [n = 1277, 56% male, mean age at onset 8.5 (4.1) years]. We estimated relative risks with 95% confidence intervals, adjusting for age, sex, and diabetes centre (cluster), using random effect models. RESULTS: Forty-two per cent of the study subjects were admitted to hospital at least once during follow-up. The incidence of hospital admissions was 0.46 (0.43-0.49) per person year, and there were 2.72 (2.65-2.80) hospital days per person year. Hospital admissions and hospital days were higher in girls than in boys (significant for hospital days, P < 0.05), and significantly lower in adolescents aged 15-19 compared with children aged 0-4 years (P < 0.05 in all models). Hospital admission rates were significantly higher in children from lower-educated parents, single-parent families, and families with a migration background (all P < 0.05). DISCUSSION: We found post-onset hospital admission rates to be higher in diabetic children and adolescents from socially deprived families. In comparison with an analysis in the 1990s, no decrease in social disparity in hospital admission risk was found.