Risk factors for secondary post-tonsillectomy haemorrhage following tonsillectomy with bipolar scissors: four-year retrospective cohort study.

OBJECTIVE: To analyse risk factors associated with secondary post-operative bleeding when only one technique, namely bipolar scissors, is used. METHODS: The medical records of all consecutive patients aged six years or older who underwent tonsillectomy or adenotonsillectomy between 1 December 2010 and 30 November 2014 were retrospectively analysed. RESULTS: A total of 1734 patients were included in the study. A secondary haemorrhage occurred in 208 patients (12 per cent). Patients aged 15 years or older were 4.5 times (95 per cent confidence interval = 2.6-7.9; p < 0.001) more likely to experience secondary haemorrhage. In cases of acute quinsy, patients aged 15 years or older had an 8.1-fold (95 per cent confidence interval = 1.1-59.6; p = 0.02) increased likelihood of experiencing secondary haemorrhage. CONCLUSION: Patients aged 15 years or older have a higher risk for bleeding regardless of the primary indication for the tonsillectomy. The risk for secondary haemorrhage does not seem to depend on the primary indication itself.

Acute Chlamydia pneumoniae infections in asthmatic and non-asthmatic military conscripts during a non-epidemic period.

Chlamydia pneumoniae respiratory tract infections were studied in 512 male military conscripts (123 asthmatic and 389 non-asthmatic) taking part in 180-day service between July 2004 and July 2005 in Kajaani, Finland. Respiratory tract infections requiring a medical consultation were analysed prospectively. At baseline, at end of service, and during each episode of respiratory infection, blood samples were obtained for measurement of C. pneumoniae antibodies. Data concerning the clinical features of each infection episode were collected. Serological evidence of acute C. pneumoniae infection was found in 34 of the 512 conscripts with antibody data available, including 9.8% of the asthmatic subjects and 5.7% of the non-asthmatic subjects (p 0.111). A serological diagnosis could be made for 25 clinical episodes in 24 conscripts. The spectrum of respiratory tract infections included 13 episodes of mild upper respiratory tract infection and seven episodes of sinusitis, with five episodes involving asthma exacerbation. Two of three pneumonias were primary infections. Primary infections were diagnosed in five subjects, and re-infection/reactivation in 19 subjects, with the latter comprising 12 non-asthmatic subjects and seven asthmatic subjects (p 0.180). Prolonged infections were present in six asthmatic subjects and one non-asthmatic subject (p 0.001). A wide variety of respiratory tract infections, ranging from common cold to pneumonia, were associated with serologically confirmed C. pneumoniae infections. Infections were often mild, with common cold and sinusitis being the most common manifestations. Acute, rapidly resolved C. pneumoniae infections were equally common among asthmatic subjects and non-asthmatic subjects, whereas prolonged infections were more common among subjects with asthma.

Pathogenic bacteria and viruses in induced sputum or pharyngeal secretions of adults with stable asthma.

BACKGROUND: Respiratory infections are well known triggers of asthma exacerbations, but their role in stable adult asthma remains unclear. METHODS: 103 asthmatics and 30 control subjects were enrolled in the study. Sputum was induced by inhalation of 3% NaCl solution. Oropharyngeal swab specimens were obtained from the posterior wall of the oropharynx. Respiratory specimens were analysed by RT-PCR for rhinovirus, enterovirus and respiratory syncytial virus and by PCR for adenovirus, Chlamydia pneumoniae, Mycoplasma pneumoniae and Bordetella pertussis. RESULTS: Sputum samples from two of the 30 healthy controls (6.7%), five of 53 patients with mild asthma (9.4%), and eight of 50 with moderate asthma (16.0%) were positive for rhinovirus. Rhinovirus positive asthmatic subjects had more asthma symptoms and lower forced expiratory volume in 1 second (FEV(1)) (79% predicted) than rhinovirus negative cases (93.5% predicted; p = 0.020). Chlamydia pneumoniae PCR was positive in 11 healthy controls (36.6%), 11 mild asthmatics (20.8%), and 11 moderate asthmatics (22%), and PCR positive asthmatics had lower FEV(1)/FVC than negative cases (78.2% v 80.8%, p = 0.023). Bordetella pertussis PCR was positive in 30 cases: five healthy controls (16.7%), 15 mild asthmatics (28.3%), and 10 moderate asthmatics (20%). Bordetella pertussis positive individuals had lower FEV(1)/FVC (77.1% v 80.7%, p = 0.012) and more asthma symptoms than B pertussis negative cases. CONCLUSIONS: Rhinovirus, C pneumoniae, and B pertussis are found in the sputum or pharyngeal swab specimens of asthmatic subjects without concurrent symptoms of infection or asthma exacerbation, as well as in some healthy controls. Positivity is associated with lower lung function and more frequent asthma symptoms.

Manganese superoxide dismutase is increased in the airways of smokers' lungs.

Oxidant stress is a key mechanism for smoking-induced chronic obstructive pulmonary disease (COPD). Smoking has been shown to upregulate several antioxidant enzymes, with potential effects on the prevention of the disease and/or its progression. Superoxide dismutases (SOD)s are the only enzymes capable of consuming superoxide radicals. The purpose of the present study was to investigate SODs in the lungs of nonsmokers, smokers and COPD patients. Manganese superoxide dismutase (MnSOD), copper zinc SOD (CuZnSOD), and extracellular SOD (ECSOD), were investigated by immunohistochemistry in the airways of 13 nonsmokers, 20 smokers and 22 COPD patients with mild-to-moderate disease. Lung tissue homogenates of three nonsmokers and four smokers were used for Western blot and enzyme activity analysis. The expression of MnSOD was higher in the central bronchial epithelium of smokers with COPD and in the alveolar epithelium of smokers without or with COPD than innonsmokers. Lung MnSOD immunoreactivity, evaluated by Western blotting and specific activity, were 33% and 51% higher, respectively, in smokers than in nonsmokers. No major changes could be observed in lung CuZnSOD or ECSOD immunoreactivities. Manganese superoxide dismutase is elevated in the alveolar epithelium of cigarette smokers, probably due to the increased oxidant burden in smokers' lungs.

Chlamydia pneumoniae infection and inflammation in adults with asthma.

BACKGROUND: Chlamydia pneumoniae infection and immune response to the C. pneumoniae heat shock protein 60 (CpHsp60) have been suggested to be associated with asthma. OBJECTIVES: To study whether a slightly elevated C-reactive protein (CRP) level as a marker of low-grade systemic inflammation has a role in this association, we collected serum and sputum samples from 103 asthma patients with disease severity ranging from mild to moderate and from 30 healthy volunteers. METHODS: IgA and IgG antibodies to C. pneumoniae elementary bodies (CpEB) and CpHsp60 were measured by enzyme immunoassay. Serum CRP levels were measured with a rapid two-site ultra-sensitive assay based on time-resolved immunofluorometry. RESULTS: The asthma patients, especially those with moderate asthma, had higher serum IgA antibody levels to CpHsp60 than the healthy controls (test for trend, p = 0.05), whereas antibody levels to CpEB antigen did not differ between the study groups. CRP levels were higher in both asthma groups compared to the control group and moreover, the patients with moderate asthma had higher CRP levels than those with mild asthma (test for trend, p < 0.01). The subjects with a slightly elevated CRP level, defined as > or =1.8 mg/l, had higher CpEB IgA (p = 0.001), CpEB IgG (p = 0.008) and CpHsp60 IgA (p = 0.023) antibody levels in serum compared to the subjects with lower CRP levels. CONCLUSIONS: Slightly elevated CRP levels as a marker of low-grade systemic inflammation may be associated with C. pneumoniae infection in asthma patients.

Up-regulation of heme oxygenase-I in alveolar macrophages of newly diagnosed asthmatics.

Exhaled carbon monoxide (CO), which has been found to be elevated in asthma, is generated primarily by heme oxygenase I (HO-I), an enzyme induced by oxidant stress and cytokines. The aim of this study was to assess the distribution and expression of HO-I in various human lung cells in acute and stable asthma. Normal lung tissue biopsies (from 6 non-smoking subjects operated on for a lung tumour) and macrophages from induced sputum (from 5 healthy controls, 5 untreated asthmatics, 7 stable treated asthmatics and 5 asthmatics recovering from exacerbation and being on systemic steroids) were investigated for HO-I by immunohistochemistry. The time response of HO-I induction was examined in cultured monocytes, which are known to maturate into monocyte-derived macrophages in culture. Lung biopsies showed prominent HO-I immunoreactivity only in alveolar macrophages. Macrophages in the induced sputum of healthy controls showed no HO-I immunoreactivity, with the exception of one case. Moderate or intense HO-I immunoreactivity could be observed in alveolar macrophages in 4/5 cases with recent asthma, and 2/7 with stable asthma, but in none ofthe patients treated with systemic corticosteroids for acute exacerbation. Experiments with cultured cells revealed that HO-I was induced by oxidants within the first 24 h, but the induction was reversed during the next 48 h. HO-I is mainly expressed in alveolar macrophages of human lung. Macrophages of induced sputum show prominent but transient HO-I immunoreactivity, in untreated asthmatics, but not in asthmatics treated with corticosteroids.

Seasonal variations in hospital treatment periods and deaths among adult asthmatics.

The purpose of this study was to examine possible seasonal variations in relations between hospital treatment periods and in deaths (asthma-related and other) among adult asthmatics. Out of a total of 364,871 asthma-induced hospitalization periods (diagnosis No. 493, International Classification of Diseases) recorded in the hospital discharge register maintained by the National Research and Development Centre for Welfare and Health during 1972-1992, all of those applying to persons aged >24 yrs during 1987-1992 were analysed here. The discharge file was linked to the register of deaths on the basis of the patients' social security numbers in order to analyse all deaths among the same patients during 1987-1993. A total of 81,243 asthma-related treatment periods were analysed. The monthly variation in the number of such periods showed a peak in January (18.2% above the mean number of monthly deaths in the study period) and a trough in July (26.1% below the mean). Of the 7,622 hospitalized asthmatics who died during the period examined here, 1,274 died of obstructive pulmonary diseases, with asthma as the primary cause in 489 cases. The majority of the deaths were caused by cardiovascular diseases. Mortality was highest in January (+14.7%) and lowest in August (-12.3%). The similarity in the seasonal variation observed between the treatment periods and deaths recorded for adult asthmatics may be taken to indicate a genuine need for treatment.

Asthma-induced hospitalizations among conscripts in Finland in 1982-1992.

The purpose was to examine changes in the numbers of asthma-related hospitalizations among conscripts and possible seasonal fluctuations. Data on treatment periods for asthma among men aged 18-22 years at military hospitals in 1982-1992 were collected from the national hospital discharge register. Monthly numbers of hospitalizations were calculated for each year separately, together with the frequency of such periods per 1000 conscripts. Results. A total of 4894 asthma-related hospitalizations were recorded in 1982-1992, the frequency per 1000 conscripts increasing from 8.5 in 1982 to 27.7 in 1992. Evident seasonal fluctuations were observed in 1982-1989, the peaks being recorded for February (14% above the annual average), July (26%) and November (51%). A change in these seasonal fluctuations was observed in 1990-1992, however. The frequency of asthma-induced hospitalizations among conscripts tripled between 1982 and 1992, evidently indicating a real increase in the number of occurrences. The hospitalization peaks are located at the beginning of military service, a point at which factors tending to aggravate asthma exercise a major impact.

Seasonal variation in childhood asthma hospitalisations in Finland, 1972-1992.

UNLABELLED: All hospital treatment periods caused by asthma in children under 15 years in Finland during 1972-1992 were examined. The data were obtained from the Hospital Discharge Register, covering all hospitalisations in Finland. A total of 59,624 asthma related treatment periods were recorded. The monthly variation in hospitalisations peaked in May (35.6% above the trend) and in autumn and early winter (41.3% above the trend in October), whereas the monthly variations were low in late winter and in summer. The overall profile of seasonal variation was similar in both sexes, although admissions were lower for boys than for girls in winter and higher in autumn. The average monthly deviation was highest in the age group 0-4 years in May, 42.8% above the trend, and highest in the age group 5-9 years in October, 53.9% above the trend. Closer examination of the seasonal variation gives indirect information on possible trigger factors for acute asthma. CONCLUSION: A clear seasonal variation could be observed in childhood asthma hospital admissions, together with age and sex-related differences in this seasonality. Preventive treatment for asthma should be used effectively in order to avoid acute attacks leading to hospitalisation in children who are allergic to birch pollen and also at times of viral respiratory infections.

Hospital admissions of asthmatics by age and sex.

Asthma-related hospital admissions and the occurrence of new admissions were studied by age and sex in order to find the groups of asthmatics with high hospital admission rates. Data from the Finnish discharge register for 1972-92 were used to analyze the number of hospital admissions caused by asthma (defined in the International Classification of Diseases, 8th and 9th revisions, code 493) and occurrence of new asthma admissions between 1983 and 1992. A total of 192195 asthma-induced treatment periods were identified, 91223 for males and 100972 for females. Boys were admitted twice as often as girls at the age of 1 year (11.2 in comparison with 5.9 admissions per 1000 per year), whereas the admission rate was consistently higher among women 25-55 years of age. The highest asthma admission rate among the elderly was at age 73 for men (10.3 per 1000) and 75 for women (9.5 per 1000). Occurrences of new asthma admissions were most frequent at the age of 1 year (5.3 per 1000 for boys and 2.9 per 1000 for girls) and remained constant among those aged 50-80 years. Asthma is not only a disease of childhood and adolescence. The number of middle-aged and elderly asthmatics requiring hospitalization is markedly high.