Of the two most common obstructive lung diseases - bronchial asthma and chronic obstructive pulmonary disease (COPD) - asthma is clearly associated with a possible allergic background, therefore an allergological examination should be included in the work-up of this disease. COPD on the other hand is usually not expected to be linked with an atopic diathesis. Medical history, clinical manifestations, the presence of other atopic diseases, prick tests and measurement of specific IgE antibodies in the serum provide an indication of an allergic genesis of the obstructive pulmonary disease. Bronchial asthma can be roughly divided into an allergic phenotype (TH2-weighted) and a non-allergic phenotype (non-TH2-weighted). The TH2- weighted form leads to an infiltration of eosinophils into the bronchial wall allowing the possibility of a higher concentration of nitrogen oxide in the exhaled air (FeNO measurement) to be detected. In addition to the differentiation between allergic and non-allergic bronchial obstruction, an evaluation of symptoms associated with the workplace (work related asthma) must take place. Furthermore, questions about an intolerance to aspirin (aspirin - exacerbated respiratory disease) or exercise induced symptoms (exercise-induced asthma) should be asked. After a careful interpretation of clinical symptoms and findings in allergy tests, an allergologist can analyze the usefulness of a specific immunotherapy (SIT). For children who suffer from allergic rhinoconjunctivitis, an early SIT can prevent the shift to inflammation of the lower respiratory tract (asthma). Due to the overlapping pathophysiology and symptomatology between bronchial asthma and chronic obstructive pulmonary disease an allergological examination should be considered also in COPD patients.
discharge, our results indicate that the optimum time to measure serum lipid concentrations in such patients is immediately on admission. In addition, these findings have implications for research-for example, they attest to the validity of measuring total serum cholesterol concentrations soon after myocardial infarction in case-control studies of coronary heart disease. Case reportAn 1i year old girl presented with a two hour history of bleeding from the rectum. This followed a two week illness similar to flu, four days of constipation, and then diarrhoea. There was no relevant medical or drug history. On admission she was shocked and feverish (396'C) with pulse 120 beats/min and blood pressure 100/60 mm Hg. There were no abnormal signs, but rectal examination showed fresh clots of blood.Despite active resuscitation her condition remained critical. Her haemoglobin concentration was 40 g/l, but all other tests including coagulation studies yielded normal results. Findings on gastroscopy were normal. Superior and inferior mesenteric arteriograms showed'no evidence of bleeding. Colonoscopy was unsuccessful because of the profuse haemorrhage. A scan using red cells tagged with technetium-99m showed pooling of blood only in the colon, and at laparotomy only the left colon was affected. Colotomy showed bleeding from innumerable shallow ulcers. Extended left hemicolectomy and end colostomy were performed. Continued bleeding from the ulcerated mucosa in the rectal stump required an underrunning suture and packing of the rectum. She received a total of 26 litres of blood and plasma.Culture of a stool specimen showed Salmonella paratyphi B (phage type Dundee). There were innumerable superficial ulcers 1-12 mm in diameter in the colon, their severity increasing distally (figure). Histologically the ulcers were characterised by a paucity of neutrophils in the granulation tissue and exudate. The colonic lymphoid aggregates contained many plump histiocytes, some containing debris ("typhoid cells"); similar cells were present in the dilated sinuses of the draining lymph nodes. No vasculitis was seen.Postoperatively no further complications occurred. The rectal pack was removed after 72 hours and chloramphenicol 50 mg/kg given for 10 days. The colostomy was closed uneventfully two months later. CommentParatyphoid B is the commonest enteric fever in western Europe and is more commonly acquired by ingestion of infected food than contaminated water. Postoperatively this patient said that she had eaten a hamburger in a seaside resort two weeks before her admission; this incubation time is consistent with paratyphoid fever.
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