End-expiratory lung volume remains stable during N2 MBW in healthy sleeping infants.

We have previously shown that functional residual capacity (FRC) and lung clearance index were significantly greater in sleeping healthy infants when measured by N2 (nitrogen) washout using 100% O2 (oxygen) versus 4% SF6 (sulfur hexafluoride) washout using air. Following 100% O2 exposure, tidal volumes decreased by over 30%, while end-expiratory lung volume (EELV, i.e., FRC) rose markedly based on ultrasonic flow meter assessments. In the present study to investigate the mechanism behind the observed changes, N2 MBW was performed in 10 separate healthy full-term spontaneously sleeping infants, mean (range) 26 (18-31) weeks, with simultaneous EELV monitoring (respiratory inductance plethysmography, RIP) and oxygen uptake (V´O2 ) assessment during prephase air breathing, during N2 washout by exposure to 100% O2 , and subsequently during air breathing. While flow meter signals suggested a rise in ELLV by mean (SD) 26 (9) ml over the washout period, RIP signals demonstrated no EELV change. V'O2 /FRC ratio during air breathing was mean (SD) 0.43 (0.08)/min, approximately seven times higher than that calculated from adult data. We propose that our previously reported flow meter-based overestimation of EELV was in fact a physiological artifact caused by rapid and marked movement of O2 across the alveolar capillary membrane into the blood and tissue during 100% O2 exposure, without concomitant transfer of N2 to the same degree in the opposite direction. This may be driven by the high observed O2 consumption and resulting cardiac output encountered in infancy. Furthermore, the low resting lung volume in infancy may make this error in lung volume determination by N2 washout relatively large.

Decreased VEGF Level Is Associated with Elevated Ferritin Concentration in Bronchoalveolar Lavage Fluid of Children with Interstitial Lung Diseases.

BACKGROUND: A decreased level of vascular endothelial growth factor (VEGF) was previously described in bronchoalveolar lavage fluid (BALF) of adults with interstitial lung diseases (ILD) due to bronchial epithelial cell apoptosis and its proteolytic degradation. Elevated intrapulmonary ferritin was produced by alveolar cells that promoted oxidative injury in such patients. OBJECTIVES: In this study, we analyzed the concentrations of VEGF and ferritin in BALF samples of ILD children and studied the relationship between their levels and the degree of inflammation. METHODS: BALF and serum concentration of VEGF as well as ferritin and albumin in BALF samples were measured using enzyme-linked immunosorbent assay in children with idiopathic interstitial pneumonia (n = 16), hypersensitivity pneumonitis (n = 11) and idiopathic pulmonary hemosiderosis (n = 3). Twenty-four age- and gender-matched subjects with suspicious foreign body aspiration served as a control group. RESULTS: VEGF per albumin levels in BALF were significantly decreased in ILD children compared to controls (1,075 [784-1,415] pg/mg albumin vs. 2,741 [1,131-4,660] pg/mg albumin, p = 0.0008). These values showed a significant negative correlation with inflammatory markers of total immune cell count in BALF (r = -0.411, p = 0.002) and serum C-reactive protein (r = -0.367, p = 0.006). Although serum VEGF was augmented in ILD children versus controls, no difference was observed among the ILD groups. In addition, BALF ferritin/albumin level (688 [188-1,571] ng/mg albumin vs. 256 [178-350] ng/mg albumin, p = 0.022) was significantly higher than normal in ILD individuals, especially in idiopathic pulmonary hemosiderosis. CONCLUSION: Depressed VEGF and increased ferritin in BALF may reflect the severity of chronic pulmonary inflammation in altered respiratory epithelium of childhood ILD.

Health Related Quality of Life of Children with Chronic Respiratory Conditions.

BACKGROUND: In the management of chronic diseases, treatment approaches have changed in recent decades. Not only are clinical outcomes assessed but also the patients' perception of their quality of life has become an important aspect. OBJECTIVES: The aim of our study was to compare the health-related quality of life (HRQoL) of children with cystic fibrosis (CF) to the HRQoL of asthmatic patients, to assess the level of agreement between parent proxy-report and child self-report and to measure the relationship between spirometry and HRQoL. MATERIAL AND METHODS: 172 children (mean age: 11.61±2.56 years) and their parents completed the questionnaire. The Hungarian version of the Pediatric Quality of Life InventoryTM 4.0 (PedsQLTM 4.0) Generic Core Scale was used to assess HRQoL. Lung function was assessed via spirometry. RESULTS: Significantly lower PedsQLTM scores were measured for CF patients on the psychosocial health (p<0.05), emotional functioning (p<0.005) and school functioning (p<0.01) subscales and the total scale (p<0.05) from the children's self-report. The level of child-parent agreement was fair and moderate in both patient populations [intra-class correlation coefficient range (ICC) asthma=0.29-0.37; ICCCF=0.39-0.59, p<0.001]. The relationship between forced expiratory volume in 1 second (FEV1) and the physical health subscale (r=0.49, p<0.01) was moderate in young (8-12 years) children and also teenagers (13-18 years), with CF (r=0.58, p<0.05) from self-report. We found weak, non-significant correlations between FEV1 and PedsQLTM subscales in children with asthma (8-12 years) (r=-0.01-0.18, ns.). CONCLUSIONS: Children suffering from CF perceive their HRQoL as poorer than children with asthma. In asthmatic patients, it is not sufficient to evaluate clinical outcomes (FEV1); subjective HRQoL should be also estimated in the course of patient care.

Factors influencing quality of life and disease severity in Hungarian children and young adults with cystic fibrosis.

BACKGROUND: The aim of our study was to evaluate factors affecting cystic fibrosis (CF) patients' health-related quality of life (HRQoL) and to assess the level of agreement on HRQol between children and their parents. METHODS: Fifty-nine patients (mean age: 14.03 ± 4.81 years) from 5 Hungarian CF centres completed the survey. HRQoL was measured using The Cystic Fibrosis Questionnaire-Revised (CFQ-R). Parents were asked to fill out a questionnaire about their smoking habits, educational level and history of chronic illness. Disease severity was assessed using the physician-reported Shwachman-Kulczycki (SK) score system. Spirometry, Body Mass Index (BMI) percentile (pc), hospitalisation and Pseudomonas aeruginosa (PA) infection were examined as physiologic parameters of CF, and the impact of these factors on HRQoL was assessed. A multivariate regression analysis was performed to identify the most important factors affecting HRQoL. The level of significance was set to 0.05. RESULTS: Passive smoking and parental educational level and chronic diseases status did not have a significant impact on the patients' HRQoL (p > 0.05). Significantly lower SK scores and spirometry values were found in low BMI pc patients (p < 0.001), in hospitalised (p < 0.01) and in PA-infected patients (p < 0.01), than in the adequate-weight, non-hospitalised and PA culture-negative subgroup. Lower CFQ-R scores were detected in hospitalised patients than in non-hospitalised patients in their Physical functioning domain. PA-infected patients had HRQoL scores that were significantly worse in the Body image (p < 0.01) and Respiratory symptoms (p < 0.05) domains than the PA culture-negative patients. Patients with a low BMI pc (<25th BMI pc) had significantly lower scores in the Eating, Body image and Treatment burden domains, than the adequate-weight patients (>25th BMI pc) (p < 0.01). A strong child-parent agreement was found in the Physical functioning domain (r = 0.77, p < 0.01). CONCLUSIONS: Passive smoking, parental educational level and chronic diseases of parents do not affect the HRQoL of CF patients. In contrast, hospitalisation, PA infection and malnutrition have a significant and negative impact on patients' HRQoL and the clinical severity of the disease. Parents and children were consistent in their scoring of symptoms and behaviours that were observable.

[Removable dentures with implants for edentulous lower jaw]. / Implantaciós fogpótlások protetikai aspektusai kiveheto teljes alsó fogpótlások esetén.

Fabrication of a complete mandibular denture that offers patient comfort, function, and aesthetics along with stability and acceptable retention remains one of the most challenging procedures in dental practice. Based on a thorough treatment planning and a successful surgical procedure implants have been shown to be reliable abutment for both retention and support of overdentures. During planning important relevant factors must be considered such as old age, systemic diseases, increased financial capability, etc. Implants retained overdentures can be divided into three groups according to the type of support: mucosal, muco-implantal and implantal. Key factors concerning the planning of prosthetic rehabilitation are the number and length of the implants, together with the quality and quantity of the anchoring bone tissue.

[Quality of life in Hungarian patients with cystic fibrosis]. / Cystás fibrosisban szenvedo betegek életminoségének felmérése Magyarországon.

INTRODUCTION: Cystic fibrosis is a progressive multisystemic disease which affects the quality of life of patients. AIM: The aim of the study was to evaluate quality of life in Hungarian patients with cystic fibrosis. METHODS: Validated Hungarian translation of The Cystic Fibrosis Questionnaire - Revised was used to measure quality of life. Clinical severity was determined on the basis of Shwachman-Kulczycki score. Lung function was measured using spirometry. RESULTS: 59 patients were included from five centres in Hungary. The relationships between 8-13 year-old children self-report and parent proxy report was 0.77 (p<0.001) in physical functioning, 0.07 (p<0.001) in emotional functioning, 0.51 (p<0.001) in eating, 0.21 (p<0.001) in treatment burden, 0.54 (p<0.001) in body image, 0.49 (p<0.001) in respiratory symptoms and 0.40 (p<0.001) in digestive symptoms domains. CONCLUSIONS: In contrast to physical domains weak correlations were observed between answers obtained from children and their parents in psychosocial domains. The perception of both patients and their parents should be assessed when measuring quality of life in paediatric patients with cystic fibrosis.

[Analysis of direct costs during the treatment of tuberculosis in childhood]. / Tuberkulózis kezelése során felmerülo direkt költségek elemzése gyermekkorban.

Incidence and prevalence of tuberculosis (TB) shows a decreasing tendency in Hungary. The medical care of these patients represents a substantial cost to the health services. We assessed the direct costs of paediatric patients with TB in a Hungarian hospital. Patients participating in the study were 9 children, with an average age of 11.17 +/- 6.34 years. In the study group there were two immigrant patients (22, 23%), two (22, 23%) had multidrug-resistant TB (MDR-TB), five patients (62.5%) were contacts, six (66, 67%) had extrapulmonary tuberculosis and three (33, 34% suffered from other co-morbidities. The average direct cost of pulmonary TB was 2920 Euros, direct cost of MDR-TB was between 7300-9120 Euros. MDR-TB increases one and half times the period spent in hospital, two and half times the cost of inpatient care. Extrapulmonary TB with concomitant disease causes 3-7 times higher expenditures to the health service. According to our results we found significant differences between the cost of actual therapy and resources available; thus the compensation needs to be solved.

[Construction of the new dental arch in the prosthetic rehabilitation of cleft lip and palate. Case report]. / Uj fogív megteremtése szájpadhasadékos páciens protetikai rehabilitáclója során Esetismertetés.

The authors describe the prosthodontic rehabilitation of an adult patient with unilateral cleft lip and palate. After the surgical and orthodontic treatment of cleft lip and palate patients the prosthodontic treatment was started to correct the palatal defect, the malocclusion and the missing teeth. The authors emphasize on preliminary steps by using diagnostic casts and try-in dentures and they also suggest other directives in the dental management of cleft lip and palate patients.