As optimal therapy is unknown, attempts have been made with immunosuppressive therapy according to the Fauci scheme as well as with combined chemotherapy according to the CHOP scheme and radiation. In a recent trial, promising results have been reported for interferon alpha 2b.
Zusammenfassung: Prävalenz und klinische Relevanz einer Latex‐Sensibilisierung wurden mittels Fragebogen‐Interview und IgE‐Bestimmung bei 136 Mitarbeitern einer universitären Kinderklinik untersucht. Ein erhöhtes Gesamt‐IgE zeigten 34 Mitarbeiter, acht wiesen Latex‐spezifische IgE‐Antikörper auf. Hiervon berichteten drei Personen über eine Unverträglichkeit exotischer Früchte, zwei über eine Zunahme atopischer Beschwerden im vollklimatisierten Großklinikum. Bei allen war eine Allergie vordiagnostiziert worden. 17 Mitarbeiter klagten über Hautreaktionen auf Einmal‐Handschuhe, bei zweien fanden sich Latex‐spezifische IgE‐Antikörper. Nur ein geringer Teil der subjektiven Beschwerden am Arbeitsplatz ließ sich somit auf eine Typ‐I‐Allergie gegen Latex zurückführen.
In this controlled, prospective study 30 ventilated premature infants with a birth weight < 1250 g were randomized to receive treatment with dexamethasone (DEX) either on day 7 of life or on day 14 of life. DEX was given over 16 days tapering from 0.5 mg/kg/day to 0.1 mg/kg/day. The infants treated with DEX on day 7 of life could be weaned earlier from the ventilator -in median after 14 days (range 10 -34) versus 24 days (range 8 -44) in the late treatment group (p = 0.01). The need for supplemental oxygen was shorter in the early treatment group -in median 24 days (range 10 -50) versus 40 days (range 10 -70) (p = 0.2, ns). The incidence of chronic lung disease was lower in the early treatment group -6 of 14 infants (42.9%) versus 10 of 16 patients (62.5%) (ns).To evaluate the long-term efficacy of early DEX treatment we performed a respiratory function test in the age of 3 -6 months using an infant whole body-plethysmograph. The intrathoracic gas volume (ITGV), the airway resistance (R aw ) and the airway conductance (Gaw) were measured and no significant differences could be detected between the groups. The frequency of adverse effects due to DEX therapy was found to be without significant differences between the early and the late treatment group. We conclude that early DEX treatment had short-term improvements in pulmonary outcome in our study population, long-term efficacy however, remained unproven.
In addition to metastasis, the differential diagnosis of multiple pulmonary nodules also includes tuberculosis, sarcoidosis, and silicosis. Rarer diseases such as amyloid tumors, rheumatic nodules and plasma-cell granulomas can be the cause of this finding. This depends on the clinical manifestation. Based on clinical findings of lymphomatoid granulomatosis, the problems in diagnostics using bronchoscopy, mediastinoscopy and thoracoscopy are outlined. Etiology, morphology and differential diagnosis of lymphomatoid granulomatosis versus necrotizing inflammatory or neoplastic lesions are discussed. Treatment and prognosis are described.
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