摘要:

AbstractThe aims of treating patients with asthma are to relieve symptoms, to prevent symptoms and exacerbations, and to prevent long‐term deterioration in lung function. It is the role of medical practitioners to inform the patient what asthma is, and to develop a plan to achieve the aims for the individual, recognizing that asthma is frequently a chronic, lifelong disease. Most patients can be diagnosed, assessed for severity and causes, and treated in primary care practices, however sometimes help from an asthma clinic or a specialist is required. The most important management decision is to determine whether the patient needs inhaled corticosteroids; subsequently, decisions about dose, duration and method of delivery of treatment can be tailored to the individual depending on the preferences and social conditions of the patient. The aim of this article is to present the latest strategies for the management of asthma and the simplest methods for their implementation. Important new strategies include careful assessment of the severity; the immediate introduction of a plan that is tailored for the individual and aimed at the possible reversing of the disease; detailed instructions for management of exacerbations and the combined use of inhaled corticosteroids with a long‐acting bronchodilator. It is becoming clear that these strategies obviate dependence on oral corticosteroids in newly diagnosed asthmatic patients. Furthermore, relatively low doses of inhaled corticosteroids can be used to maintain good control if used in conjunction with other therapies. The role of newly developed antagonists to leukotrienes is not yet known but it may well be useful in mild asthma and in special forms of the disease, such as those sensitive to aspirin. In the future, the most important strategy will be to prevent the dise

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00015.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractIndonesia as a developing country has air pollution which is mainly caused by motor vehicle emissions and industrial smoke. The most important indoor air pollution is cigarette smoke. The prevalence of smoking among Indonesian men is 45.7%. Of the population, 10.8% are ex‐smokers and 43.5% are non‐smokers. Among the female population, only 1.8% smoke. There are some important factors that influence the air pollution in Indonesia; this paper identifies the real problems and their impact. The paper reviews various studies that have been carried out in Indonesia which were related to ambient air quality, industrial air pollutants and the respiratory problems resultant. From all available data, it is concluded that the air pollutants levels (SO2, NOx, Ox, Pb, CO, HC) in large cities in Indonesia have exceeded the acceptable level, especially in industrial trade and heavy traffic areas. The more cigarettes inhaled and the deeper the inhalation, especially the kretek cigarettes, the risk of lung function abnormality becomes greater. Smoking high dose kretek cigarettes, that is ≥ 116 cigarettes/day x years, the risk of abnormal lung function is 13‐fold that of a non‐smoker; if added with the deep inhalation of smoke, the risk becomes 20‐fold. Smoking increases the risk of occupational lung diseases. The level of dust in some industrial areas exceeded the standard level and correlated with respiratory problems. The existence of industry‐caused air pollution in the environment increased the incidence of obstructive airway diseases. We conclude that the main cause of air pollution in Indonesia is motor vehicle emissions, followed by industrial smoke. Cigarette smoke is also related to abnormal

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00016.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractEndobronchial tuberculosis (EBTB) is a highly infectious disease that remains a diagnostic challenge in the developed countries. It also presents as a troublesome therapeutic problem due to its sequelae of cicatrical stenosis. Due to the worldwide decrease of tuberculosis, diagnosis of EBTB is frequently delayed until the onset of serious bronchial stenosis with resultant atelectasis and bronchiectasis. The exact pathogenesis of EBTB is not yet completely understood and the course of EBTB differs according to the type. The prognosis of actively caseating type and edematous‐hyperemic type EBTB is grave, resulting fibrostenosis in two thirds of patients. Fibrostenotic type EBTB shows no change or worsening of stenosis. The prognosis is good for granular and non‐specific bronchitic type EBTB; however, the prognosis of tumorous type is poor, frequently resulting in bronchial stenosis despite adequate treatment. Antituberculous chemotherapy is effective in controlling the infection, but does not prevent residual bronchostenosis. Early treatment with steroid therapy is effective in certain groups of EBTB. Balloon dilatation and stent insertion is an effective treatment of bronchial stenosis if obstruction of the stent by granulation tissue overgrowth can be prevented. Future research should focus on the pathogenesis of bronchial inflammatory reaction and resulting fibrosis to prevent bronchial stenosis at the early st

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00017.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBronchiectasis is defined in current medical parlance as the abnormal and permanent dilatation of one or more bronchi, and in clinical practice, the condition is often characterized by features of chronic bronchial infection. Apart from occurring as a primary lung disease, bronchiectasis is a major component of two other disease entities, cystic fibrosis and diffuse panbronchiolitis. Although the three conditions have distinctly different underlying causes, they share the similarity of a predominantly neutrophilic airways inflammation, and the persistent bronchial infection by bacteria, in particularPseudotnonas aeruginosa. Hence, new knowledge in one disease may be explored and applied in the others.

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00018.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractEven with advancements in knowledge the problem of pneumonia will not be eliminated. It should be understood who is at risk, why such people develop pneumonia, what causes the pneumonia, and respiratory infection should be managed and prevented. The relative frequency of the isolation of various etiologic agents that cause bacterial pneumonia differ according to age group, geography, socio‐economic status, underlying disease, time of year, and possible concomitant viral illnesses. Prompt identification of the causative agent is vital in the management of pneumonia. The present status of elucidating the etiologic agent is far from complete and recently, newer techniques using DNA probes and polymerase chain reactions were used for the identification of microbial pathogens. The timely use of appropriate systemic antibacterial therapy eradicates the pathogens. Considering the alterations of the etiologic agents of bacterial pneumonia and antibiotic susceptibilities, attention should be directed to the usage of antimicrobial agents in order to maximize the efficacy and the therapeutic implication

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00019.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractThe dramatic influx of immigrants from South‐East Asian countries into Australia over the past 20 years was associated with an increase in asthma and allergic disease amongst these immigrants. Epidemiological data showed that the prevalence rates of asthma and allergic disease increased with the duration of residence in Australia so that after 10 years in Australia, up to 60% of South‐East Asian immigrants developed hayfever while 15% had symptoms of asthma. Many immigrants developed these conditions for the first time after arrival in Australia suggesting that the environment plays an important role in the pathogenesis of asthma and allergy. While sensitization to inhalant allergens such as house dust mite and grass pollen are apparently important in some, other yet undefined local factors are likely to contribute significantly to the overall increase in prevalence. A prospective study designed to follow a group of migrants in areas where asthma and allergic disease are common such as Australia, may reveal the pathogenic role of the environment and provide valuable information that may explain the global distribution and increasing trend of asthma and allerg

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00020.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractAlveolar macrophages (AM) have many Fc receptors for IgG, but are less reactive to lymphokines. They have a well‐developed oxidative metabolism and contain large amounts of lysosomal enzyme. This suggests that the antibacterial antibody plays an important role in early resistance by AM to intracellular bacterial infection and that a bactericidal agent, dependent on oxygen and lysosomal enzyme, participates in the intracellular killing of bacteria in AM. We studied the effects of the antibacterial antibody on bactericidal activities of superoxide (O2−) and lysosomal enzyme from rabbit AM. The number ofListeria monocytogenesin AM increased after pretreatment with saline or normal IgG but decreased by 60% after pretreatment with anti‐Listeria and 120 min incubation. Alveolar macrophage‐phagocytizedListeriamonocytogenes and Bacille Calmette Guérin (BCG) bound with antibacterial antibody enhanced release of O2−, and nitroblue tetrazolium (NBT) formazan reduced by O2−was observed around the bacteria in the phagosomes of AM. We also confirmed that Listeria and BCG were killed extracellularly by O2−released by a superoxide‐generating system in vitro and/or by lysosomal enzyme obtained from AM at a low pH. We concluded that the antibacterial antibody of the IgG class enhances the antibacterial activity of AM thereby increasing the production of O2−and lysosomal enzyme in the phagosome. This finding may be important in the early resistance to intracellular bacteria infection by AM in t

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00021.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractThe objective of this study was to define the relationship between respiratory insufficiency (RI) and various putative risk factors for patients undergoing abdominal surgery. A review of 1332 adults undergoing abdominal surgery was undertaken. Information was collected in a unbiased, prospective and uniform manner with regard to baseline characteristics, perioperative events and adverse outcomes after surgery. Respiratory insufficiency was defined as either: a PO22 (P<0.001) and the presence of chronic bronchitis (P=2), as well as patients with chronic bronchitis, should be the recipients of intense efforts to prevent pulmonary complications after abdominal surgery.

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00022.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractIn Japan a number of reported cases of diffuse panbronchiolitis (DPB) have been associated with human T lymphotropic virus type I (HTLV‐I) infection. In this study the hypothesis that HTLV‐I proviral DNA may be prevalent in DPB was examined using polymerase chain reaction (PCR) for the region of env or the two‐step PCR for the pX region of this virus. The presence of HTLV‐I proviral DNA was studied in the peripheral blood mononuclear cells (PBMC) obtained from 10 patients with DPB. The presence of proviral DNA in PBMC in 12 patients with chronic obstructive pulmonary disease (COPD), eight patients with idiopathic interstitial pneumonia (IIP), four patients with bronchiectasis, 12 patients with bronchogenic carcinoma and 47 subjects without pulmonary diseases were also studied as relevant controls. The lung tissue obtained from 11 patients with DPB, 12 patients with diffuse aspiration bronchiolitis (DAB) at autopsy, and the surgical lung samples obtained from 12 patients with bronchogenic cancer were also studied. Peripheral blood mononuclear cells obtained from one DPB patient and one bronchogenic carcinoma patient were positive for the HTLV‐I pX region. The presence of the pX region was also found in the lung tissue of three DPB patients (27.3%) and one DAB patient (8.3%). None of other subjects were positive for HTLV‐I proviral DNA. In conclusion, HTLV‐I is not the causative virus in the pathogenesis of COPD, IIP bronchiectasis and bronchogenic carcinoma. There is a likelihood that HTLV‐I infection is associated with some cases of DPB; however, this association needs furth

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00023.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractAn ELISA diagnostic test for tuberculosis antigen A60 (TBA60) IgG/IgM was used in a tertiary referral hospital in Taiwan. From June 1992 to December 1993, serum samples obtained from 907 patients were analyzed for TBA60 IgG and IgM titres. The final diagnosis of these patients was confirmed by microbiological study and clinical follow up for 18–24 months. Among 147 patients with active pulmonary tuberculosis, IgG was positive in 112 (76.2%), IgM was positive in 14 (9.52%). Among 90 patients with active extrapulmonary tuberculosis, IgG was positive in 53 (58.9%), IgM was positive in 9 (10%). Among 153 patients with inactive tuberculosis, IgG was positive in 28 (18.3%), IgM was positive in 1 (0.6%). Among 517 patients with nontuberculous disease, IgG was positive in 50 (9.7%), IgM was positive in 3 (0.6%). In this study population with 26% (237/907) active tuberculous infection rate, the TBA60 ELISA IgG had a diagnostic sensitivity of 69.6% and a specificity of 92.1%. These results indicate a positive predictive value of 67.9% and a negative predictive value of 89.2%. The sensitivity of IgM was 10.5% and specificity, 99.4%. The serum IgG titre had good correlation with the extent of pulmonary disease. Patients with smear‐positive pulmonary TB had a higher percentage of IgG seropositivity (83.9%) than those with smear‐negative pulmonary TB (70.6%) and extrapulmonary TB (58.9%). In 50 cases with active tuberculosis, follow‐ up examinations were carried out one month after treatment. In 18 cases with initially negative IgG and IgM titres, 13 showed elevation of serum IgG titres into positive level, one had positive seroconversion of IgM which was the only serological marker indicating active infection. Therefore, 77.8% (14/18) gained diagnostic benefit from follow‐up serological examination. It was concluded that TBA60 IgG and IgM ELISA is a useful test when diagnosing tuberculosis. This test also assists in the clinical judgement of tuberculosis when used as an adjunct to symptoms and sputum smear, and for monitoring therapeutic response at the commencement of

ISSN:1323-7799    

DOI:10.1111/j.1440-1843.1996.tb00024.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY