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Biomedical subjects

H Puolijoki

Publications and source records attributed to H Puolijoki.

35 records · Page 2Linked to original sources

Wegener's granulomatosis--treatment under revision?

A 44-year-old man with nasal and respiratory symptoms combined with positive serum antibodies to neutrophil cytoplasmic antigens (ANCA) suggestive of Wegener's granulomatosis was treated with antibacterial agents. Complete clinical response was achieved with co-trimoxazole, and the titer of ANCA declined. After a 12-month treatment period, the patient contracted fever and respiratory symptoms and fatigue again, and he had proteinuria and hematuria. After the institution of conventional treatment with oral prednisolone and cyclophosphamide, a favorable response was achieved. Wegener's-like granulomatosis is difficult to diagnose at its early stage, but the presence of ANCA may be helpful. We suggest that co-trimoxazole should be considered as a first-line treatment, under careful supervision, for young patients whose disease is limited to the respiratory organ.

Antibodies, Antineutrophil Cytoplasmic↗

Periodic breathing imitating hyperventilation syndrome.

We report a male patient who developed an unusual periodic breathing. At presentation, the differential diagnosis at bedside between Cheyne-Stokes and primary hyperventilation syndrome was laborious, and the final verification was based on the result of capnography.

Cheyne-Stokes Respiration↗

Proteinuria and haematuria are frequently present in patients with lung cancer.

The aim of the study was to ascertain whether there is an increased occurrence of proteinuria and/or haematuria among lung cancer patients. As a control group we selected patients with bronchial asthma treated at the same hospital and during the same period as the lung cancer patients. The study comprised a retrospective part, where observations were made at two hospitals on 166 and 284 lung cancer patients. Proteinuria was observed in 9% and 13% and haematuria in 5% and 9% of these patients. The prevalences were significantly greater than among the asthmatic patients. This result prompted a prospective case-control study involving 150 consecutive patients with lung cancer and asthma, respectively. Twelve patients in the cancer group and one asthmatic patient had a daily urine protein excretion exceeding 100 mg (P less than 0.004); haematuria was noted in 14 and one, respectively (P less than 0.002). We conclude that the occurrence of proteinuria and haematuria is unexpectedly increased among patients with lung cancer.

Aged↗

Causes of prolonged cough in patients referred to a chest clinic.

The aim of this study was to evaluate the causes of prolonged cough in a patient population referred to a chest clinic during a single year. One hundred and ninety-eight patients (11%) of the total yearly 1745 adult admissions fulfilled our criteria of prolonged cough. Asthma, suspicion of asthma and postnasal drip were the commonest causes of prolonged cough in 147 patients with normal chest roentgenograms (26%, 9% and 16%, respectively), and in 45% the cough was of unexplained origin. Nonspecific bronchial hyperreactivity was common in this latter group of patients probably due to a previous respiratory infection. Lung cancer (37%), tuberculosis (16%), sarcoidosis (16%), and allergic alveolitis (9%) were the most important findings in patients with abnormal chest roentgenograms.

Adolescent↗

Cough induced by enalapril but not by captopril.

We report a 68 yr old woman with hypertension who developed a dry cough on enalapril but not on captopril therapy. Pulmonary function tests, methacholine inhalation challenges, total blood eosinophil counts, and changes in plasma concentrations of prostaglandin E2 and thromboxane B2 did not explain the difference in the adverse reaction between these two angiotensin converting enzyme inhibitors.

Aged↗

Chronic cough as a risk indicator of broncho-pulmonary disease.

The aim of this study was to discover the subsequent histories and ultimate diagnoses in 182 patients studied in a chest clinic because of unexplained cough. Twenty-nine patients (16%) developed asthma during the mean follow-up time of 4.4 years. Chronic bronchitis was diagnosed in 18 patients (10%) and sporadic instances of some other diseases were also seen. The development of asthma was studied both by calculating simple relative risks and using a multiple logistic model. Circadian changes in peak expiratory flow (PEF)-values and total blood eosinophil count were found to be the best variables for predicting the risk of developing asthma in a patient with unexplained cough, whereas mild bronchial hyperreactivity had only a low predictive value. If the risk of developing asthma in a patient presenting with unexplained cough is to be estimated, attention should be paid simultaneously to a number of variables. Even mild abnormalities in several variables can be significant when they occur together.

Adolescent↗

Bone mineral density in asthmatic women on high-dose inhaled beclomethasone dipropionate.

Inhaled corticosteroids are the cornerstone of the modern therapy for asthma. In recent years, inhaled corticosteroids have been used in higher doses than previously. This has caused concern about possible osteoporotic side-effects. We studied bone mineral densities (BMDs) in 19 non-smoking women (mean age 53 years, range 40-63) with newly diagnosed bronchial asthma and 19 voluntary healthy non-smoking women (mean age 53 years, range 43-67). In both groups, 13 subjects were postmenopausal. Patients started beclomethasone dipropionate from the spacer 500 micrograms twice daily as the sole corticosteroid therapy. BMDs were measured with dual-energy x-ray absorptiometry (DEXA) at the lumbar spine (L2-4) and at the left proximal femur (the neck, Ward's triangle and the trochanteric region). The measurements were made at baseline and 6 and 12 months thereafter. No significant changes were observed in the measured BMDs in either study group. The results show that inhaled beclomethasone dipropionate therapy 1000 micrograms/day for one year does not affect BMD. Further studies are needed to assess the effects of inhaled corticosteroid on BMD during a longer treatment period.

Absorptiometry, Photon↗