Early detection of COPD by high risk population spirometric screening

COPD is the most frequent chronic lung disease in Poland. The disease is however under-diagnosed, especially at the early stages. The aim of the study was to assess the efficacy of spirometric screening for COPD in middle aged smokers. Informations on causes and symptoms of COPD were disseminated in mass media in 14 large cities. Subject aged over 39 and with smoking history of > 10 packyears were invited for a free spirometry in local chest clinic. However, everyone attending had the spirometry performed. Spirometry was performed according to ATS recommendations. Airway obstruction (AO) was diagnosed when FEV1/FVC < 85% of N and categorised as mild (FEV1 > 70% of N), moderate (FEV1 50-69% of N) or severe (FEV1 < 50% of N). Spirometry was accompanied by an antismoking advice. RESULTS: 12.781 subjects were screened (mean age 52 +/- 12 years, 57% males). In 8.269 subjects who complied with inclusion criteria AO was diagnosed in 29.8% (mild in 10.9%, moderate in 12% and severe in 6.9%). In smokers < 40 years of age and a history of < 10 packyears AO was found in 8.8% (mild in 6.0%, moderate in 1.8% and severe in 1.0%). CONCLUSION: Mass spirometry is an effective and easy method for early detection of COPD.     

不同时间应用静脉丙种球蛋白治疗川崎病疗效分析

目的探讨不同时间应用大剂量静脉丙种球蛋白（IVGG）治疗川崎病（KD）疗效,分析其热程及冠状动脉损害（CAL）情况。方法将79例在初次发病10d内接受大剂量IVGG治疗的住院KD患儿按IVGG应用时间不同分成两组,≤6d为A组（32例）,7～10d为B组（47例）;将两组CAL情况及其他临床资料进行对比分析。结果两组病例性别、年龄、ESR、CRP、WBC、HGB、PLT、ALB均衡可比。两组热程比较A组（7.00±0.87）d短于B组（9.00±1.00）d,差异有显著性（P〈0.001）;A组无CAA发生,B组2例发生CAA;发病21d内CAL发生率A组37.5%（12例）低于B组46.8%（22例）,差异无统计学意义（P=0.412）。结论KD发病早期应用IVGG治疗,可缩短热程,减少CAA发生。建议KD确诊病例尽早应用大剂量IVGG治疗。     

川崎病早期诊断探讨

目的为早期正确诊断KD提供临床依据。方法对2005年1月-12月住院KD患儿107例进行研究，分析各种不典型病例的特点和临床表现的发生率。结果①107例KD不典型病例占19．6％。≤3岁的病例占62．6％；②不典型病例确诊较晚，冠脉损害发生率与典型病例相仿；③典型临床表现中淋巴结肿大（直径≥1．5cm）的发生率最低。仅占24．3％，肢端硬肿的发生率次之（48．6％）；④烦躁易激惹、卡瘢再现红斑、肛周脱皮在发病早期出现率分别为94．4％，35．5％，51．4％；ESR快（≥40mm／h）67．3％,CRP高（≥30mg／L）50．5％。结论将常见临床特点、实验室检查纳入诊断标准可能有利于临床医生早期诊断KD。     

Early detection of COPD in smokers from Warsaw using spirometric screening

COPD is the fourth leading cause of death in Poland. The disease is diagnosed not early enough. The aim of the study was to establish prevalence of COPD in smokers, inhabitants of Warsaw. Therefore, using local mass media, smokers with at least 10 pack-years history of smoking, over 40 years of age, were invited for a free spirometry. The spirometries were performed during 33 weekends. 3340 subjects (51.8% M and 48.2% F) mean age 57 +/- 13.2 years were examined. Most of them were current smokers (57.8%) or ex-smokers (27%) with a history of 31.9 +/- 18.8 packyears, the remaining subjects (15.2%) declared themselves as a life non-smokers. From all screened 1520 (45.6%) presented airflow limitation (AL). Following ERS recommendations, AL was classified as mild in 27.7%, moderate in 11.1% and severe in 6.8% subjects. One third of examined declared morning cough (36.9%) or sputum production (34.8%), or both symptoms (26.7%). Morning cough (p < 0.05) or cough together with sputum production (p < 0.01) were related to result of spirometry. Subjects aged > or = 40 years with a history of > or = 10 packyears had AL diagnosed in 50.1%, in contrast to younger than 40 years and smoking < 10 packyears in whom AL was detected in 14.3%. In life non-smokers AL was diagnosed in 35.9%. The majority of non-smokers were females (70%), 7.5% declared history of bronchial asthma. The great efficacy of AL detection in targeted population (50%) should be an incentive to perform routine spirometric examination in smokers aged 40+ with a history of 10+ packyears of smoking.     

早发型先天性骨梅毒的X线诊断

目的探讨先天性早发型骨梅毒X线表现及其特点。提高对早发型先天性骨梅毒的认识。方法回顾性分析近4年临床资料较完整,均有四肢长骨x线检查资料,并经血清学证实为先天性早发型骨梅毒27例。结果按照病变累及的部位分为干骺端炎：骨干炎、骨膜炎。27例均有干骺端炎,主要表现为先期钙化带不规则增厚及其下方的透亮横带;6例有骨干炎。显示轻度的斑片状和虫蚀状骨质破坏,以及皮质增厚为主的骨质增生;18例有骨膜炎,显示层状、葱皮状骨膜增厚。骨骺及颅骨、椎骨、肋骨一般不累及。结论四肢长骨摄片应作为评估新生儿先天性骨梅毒的一种重要手段,可以早期发现新生儿先天性梅毒骨损害及其受累程度,有助于临床进行及时治疗。