tag:blogger.com,1999:blog-72753007961040682872024-03-18T20:49:39.755-07:00Internet ClinicAnonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.comBlogger63125tag:blogger.com,1999:blog-7275300796104068287.post-20055591450786641972013-04-02T16:26:00.001-07:002013-04-02T16:26:41.530-07:00EARLY CONGENITAL CARDITIS<span style="background-color: white;"><b><span lang="UK" style="font-size: 14pt;">Formed in the middle trimester of
pregnancy<span style="mso-spacerun: yes;"> </span>under influence<span style="mso-spacerun: yes;"> </span>of harmful factors<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b>
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-US" style="font-size: 14pt;">Cardiomegaly</span></b><b><span lang="UK" style="font-size: 14pt;"> at birth</span></b><b><span lang="EN-US" style="font-size: 14pt;">, its</span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>rapid </span></b><b><span lang="EN-US" style="font-size: 14pt;">progress</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-US" style="font-size: 14pt;">E</span></b><b><span lang="UK" style="font-size: 14pt;">arly form</span></b><b><span lang="EN-US" style="font-size: 14pt;">ation</span></b><b><span lang="UK" style="font-size: 14pt;"> of cardiac hump<span style="mso-spacerun: yes;">
</span></span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-US" style="font-size: 14pt;">Progressive
left-heart</span></b><b><span lang="UK" style="font-size: 14pt;">
cardiac insufficiency, </span></b><b><span lang="EN-US" style="font-size: 14pt;">refraction</span></b><b><span lang="UK" style="font-size: 14pt;"> to </span></b><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>the </span></b><b><span lang="UK" style="font-size: 14pt;">therapy<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><i><span lang="EN-US" style="font-size: 14pt;"></span></i></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;">P</span></b><b><span lang="UK" style="font-size: 14pt;">hysical and </span></b><b><span lang="EN-US" style="font-size: 14pt;">psychomotor
retardation</span></b><b><span lang="UK" style="font-size: 14pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="UK" style="font-size: 14pt;">E</span></b><b><span lang="EN-US" style="font-size: 14pt;">C</span></b><b><span lang="UK" style="font-size: 14pt;">G</span></b><b><span lang="EN-US" style="font-size: 14pt;">:</span></b><b><span lang="UK" style="font-size: 14pt;"> high R</span></b><b><span lang="EN-US" style="font-size: 14pt;"> waves</span></b><b><span lang="UK" style="font-size: 14pt;">, shortening of QRS </span></b><b><span lang="EN-US" style="font-size: 14pt;">complex</span></b><b><span lang="UK" style="font-size: 14pt;">, proof </span></b><b><span lang="EN-US" style="font-size: 14pt;">tachycardia</span></b><b><span lang="UK" style="font-size: 14pt;"> with a tendency<span style="mso-spacerun: yes;"> </span>to </span></b><b><span lang="EN-US" style="font-size: 14pt;">increase</span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="UK" style="font-size: 14pt;">E</span></b><b><span lang="EN-US" style="font-size: 14pt;">choC</span></b><b><span lang="UK" style="font-size: 14pt;">S</span></b><b><span lang="EN-US" style="font-size: 14pt;">: </span></b><b><span lang="UK" style="font-size: 14pt;">hypertrophy of the left ventricle with </span></b><b><span lang="EN-US" style="font-size: 14pt;">further</span></b><b><span lang="EN-US" style="font-size: 14pt;"> </span></b><b><span lang="EN-US" style="font-size: 14pt;">its</span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>expansion and<span style="mso-spacerun: yes;"> </span>increase of the
left auricle, areas of akinesia in the left ventricle, declines of FО of the
left ventricle<span style="mso-spacerun: yes;">
</span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="UK" style="font-size: 14pt;">Prognosis </span></b><b><span lang="EN-US" style="font-size: 14pt;">is </span></b><b><span lang="UK" style="font-size: 14pt;">unfavorable </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt;">
<br /></div>
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</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><img height="441" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image229.jpg" width="588" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Form of heart at early congenital carditis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><img height="347" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image231.jpg" width="444" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Form of heart at early congenital carditis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><img height="420" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image233.jpg" width="369" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Fibroelastosis as a result of
early congenital carditis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="UK" style="font-size: 18pt;">LATE<span style="mso-spacerun: yes;">
</span></span></b><b><span lang="EN-US" style="font-size: 18pt;">CONGENITAL</span></b><b><span lang="UK" style="font-size: 18pt;"> CARDITIS</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 18pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="UK" style="font-size: 14pt;">Formed in the </span></b><b><span lang="EN-US" style="font-size: 14pt;">3-rd</span></b><b><span lang="UK" style="font-size: 14pt;"> trimester of pregnancy under<span style="mso-spacerun: yes;"> </span>the action<span style="mso-spacerun: yes;">
</span>of harmful factors</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="UK" style="font-size: 14pt;">Often prematur</span></b><b><span lang="EN-US" style="font-size: 14pt;">ity</span></b><b><span lang="UK" style="font-size: 14pt;">, </span></b><b><span lang="EN-US" style="font-size: 14pt;">perinatal
progressive hypo</span></b><b><span lang="UK" style="font-size: 14pt;">trophy
</span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-US" style="font-size: 14pt;">P</span></b><b><span lang="UK" style="font-size: 14pt;">roof arrhythmias from birth</span></b><b><span lang="EN-GB" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-GB" style="font-size: 14pt;">Mild</span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span></span></b><b><span lang="EN-US" style="font-size: 14pt;">cardiomegaly</span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-GB" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-GB" style="font-size: 14pt;">P</span></b><b><span lang="UK" style="font-size: 14pt;">ossibl</span></b><b><span lang="EN-US" style="font-size: 14pt;">e right</span></b><b><span lang="UK" style="font-size: 14pt;"> and<span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-US" style="font-size: 14pt;">left heart</span></b><b><span lang="UK" style="font-size: 14pt;"> insufficiency</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="UK" style="font-size: 14pt;">E</span></b><b><span lang="EN-US" style="font-size: 14pt;">C</span></b><b><span lang="UK" style="font-size: 14pt;">G</span></b><b><span lang="EN-US" style="font-size: 14pt;">:</span></b><b><span lang="UK" style="font-size: 14pt;"> the voltage of </span></b><b><span lang="EN-US" style="font-size: 14pt;">waves</span></b><b><span lang="UK" style="font-size: 14pt;"> is </span></b><b><span lang="EN-US" style="font-size: 14pt;">dicreased</span></b><b><span lang="UK" style="font-size: 14pt;">, different arrhythmias and
conducti</span></b><b><span lang="EN-US" style="font-size: 14pt;">on impairments</span></b><b><span lang="EN-US" style="font-size: 14pt;"> </span></b><b><span lang="UK" style="font-size: 14pt;">which </span></b><b><span lang="EN-US" style="font-size: 14pt;">are
interrupted by medicines</span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="UK" style="font-size: 14pt;">E</span></b><b><span lang="EN-US" style="font-size: 14pt;">choC</span></b><b><span lang="UK" style="font-size: 14pt;">G – </span></b><b><span lang="EN-US" style="font-size: 14pt;">moderate dilatation</span></b><b><span lang="UK" style="font-size: 14pt;"> of the left ventricle, </span></b><b><span lang="EN-US" style="font-size: 14pt;">hypokinesia</span></b><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>of </span></b><b><span lang="EN-US" style="font-size: 14pt;">its</span></b><b><span lang="UK" style="font-size: 14pt;"> walls, without the morphological<span style="mso-spacerun: yes;">
</span>changes </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt;">
<br /></div>
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</span><div class="MsoNormal">
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<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><img height="333" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image235.jpg" width="444" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Form of heart at late congenital carditis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b><span lang="EN-US" style="font-size: 14pt;">ACUTE</span></b><b><span lang="UK" style="font-size: 14pt;"> CARDITIS</span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 16pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">beginning<span style="mso-spacerun: yes;"> </span>is
related<span style="mso-spacerun: yes;"> </span>directly to<span style="mso-spacerun: yes;"> </span>the action of etiologic factor, to the viral
infection,</span><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">after introduction<span style="mso-spacerun: yes;">
</span>of vaccine, medic</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ines</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">allergic</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> reaction</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">s</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
intensifying of chronic infection</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-US" style="font-size: 14pt;">Clinics:
</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Pale skin</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, weakness, decline
of appetite, shortness of breath</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">,</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>for </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">elder</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> children cardi</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">algia</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">heartbeating</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;">
</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Enlarged heart</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;">
</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">W</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">eak</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ness</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> of </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">apex beat </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">W</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">eak</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ness</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> of heart tones,
arrhythmias</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">,</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> soft systol</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ic
murmur</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">
on </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">the</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> apex<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">Dec</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">reased arterial pressure </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">S</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">igns
of </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>left heart</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> insufficiency</span><span lang="UK" style="font-size: 14.0pt;"> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">E</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">C</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">G</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">:</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> dec</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">rease</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> of </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">waves </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">voltage, conducti</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">on
impairments</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, arrhythmias<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">E</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">choC</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">S</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">:</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> myocardium </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is diffuse</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> or </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">local thick</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">dilatation</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> of pericardium, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">possible</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> presence of liquid in<span style="mso-spacerun: yes;">
</span>pericardium<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Acute phase</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> indexes, usually,
within the limits of norm<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">I</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">ncrease</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">d</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">
level</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">s</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> of LDG1</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">LDG2, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">creatininphosphokinase </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">Dependency<span style="mso-spacerun: yes;">
</span>upon<span style="mso-spacerun: yes;"> </span>predominance of cardi</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">algia</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, arrhythmia or </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">sings</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> of cardiac insufficiency,
clinical variants</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> are marked out</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, more frequent</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ly</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">
there are their combinations</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 16pt;"><span style="mso-spacerun: yes;">
</span></span></b><b><span lang="UK" style="font-size: 14pt;">SUB</span></b><b><span lang="EN-US" style="font-size: 14pt;">ACUTE</span></b><b><span lang="UK" style="font-size: 14pt;"> CARDITIS</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Occurs through</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 3 - 4 m</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ths after acute carditis</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> or </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is diagnosed<span style="mso-spacerun: yes;"> </span>occasionally.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><b>Clinics</b></span><b><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14pt;">unpleasant feelings, interruptions </span><span lang="EN-US" style="font-size: 14pt;">of</span><span lang="UK" style="font-size: 14pt;"> the </span><span lang="EN-US" style="font-size: 14pt;">heart </span><span lang="UK" style="font-size: 14pt;">, palpitation</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14pt;">periodic<span style="mso-spacerun: yes;">
</span>cardi</span><span lang="EN-US" style="font-size: 14pt;">algias</span><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">moderate<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14pt;">cardiomegaly</span><span lang="UK" style="font-size: 14pt;">, mainly
due to<span style="mso-spacerun: yes;"> </span>the left ventricle</span><span lang="EN-US" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">weakness </span><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>of heart tones </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14pt;">arrhythmias, functional systol</span><span lang="EN-US" style="font-size: 14pt;">ic</span><span lang="EN-US" style="font-size: 14pt;"> </span><span lang="EN-US" style="font-size: 14pt;">murmur</span><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">moderate
signs of cardiac insufficiency</span><span lang="EN-US" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14pt;">E</span><span lang="EN-US" style="font-size: 14pt;">C</span><span lang="UK" style="font-size: 14pt;">G</span><span lang="EN-US" style="font-size: 14pt;">:</span><span lang="UK" style="font-size: 14pt;"> arrhythmias, conducti</span><span lang="EN-US" style="font-size: 14pt;">on impairments</span><span lang="UK" style="font-size: 14pt;">, signs of hypoxia<span style="mso-spacerun: yes;"> </span>of myocardium </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 18pt;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">E</span><span lang="EN-US" style="font-size: 14pt;">choC</span><span lang="UK" style="font-size: 14pt;">S</span><span lang="EN-US" style="font-size: 14pt;">:</span><span lang="UK" style="font-size: 14pt;"> signs of </span><span lang="EN-US" style="font-size: 14pt;">CF</span><span lang="UK" style="font-size: 14pt;">, </span><span lang="EN-US" style="font-size: 14pt;">hypokinesia </span><span lang="UK" style="font-size: 14pt;">of the left ventricle</span><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 18pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="UK" style="font-size: 14pt;">CHRONIC<span style="mso-spacerun: yes;"> </span>CARDITIS</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">More
frequent</span><span lang="EN-US" style="font-size: 14pt;">ly is diagnosed</span><span lang="UK" style="font-size: 14pt;"> as
primary-chronic with </span><span lang="EN-US" style="font-size: 14pt;">the sings of
chronic left heart failure</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt;">P</span><span lang="UK" style="font-size: 14pt;">ossibly<span style="mso-spacerun: yes;">
</span></span><span lang="EN-US" style="font-size: 14pt;">occurs</span><span lang="UK" style="font-size: 14pt;"> after </span><span lang="EN-US" style="font-size: 14pt;">acute or subacute carditis lasting</span><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>more than 12 – 18 month</span><span lang="EN-US" style="font-size: 14pt;">s</span><span lang="EN-GB" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14pt;">Increasing</span><span lang="UK" style="font-size: 14pt;"> cardiac insufficiency on a
background </span><span lang="EN-US" style="font-size: 14pt;">of cardiomegaly</span><span lang="UK" style="font-size: 14pt;"> of
different degree</span><span lang="EN-GB" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14pt;">T</span><span lang="EN-US" style="font-size: 14pt;">achy</span><span lang="UK" style="font-size: 14pt;">-, </span><span lang="EN-US" style="font-size: 14pt;">bradycardia</span><span lang="UK" style="font-size: 14pt;">, weaken</span><span lang="EN-US" style="font-size: 14pt;">ess</span><span lang="UK" style="font-size: 14pt;"> of cardiac tones<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14pt;"></span></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt;">P</span><span lang="UK" style="font-size: 14pt;">hysical </span><span lang="EN-US" style="font-size: 14pt;">retardation</span><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt;">C</span><span lang="UK" style="font-size: 14pt;">ardiac hump</span><span lang="EN-US" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 18pt;"><span style="mso-list: Ignore;">u</span></span><span lang="EN-US" style="font-size: 14pt;">Encephalopathy</span><span lang="UK" style="font-size: 14pt;">, anaemia, immunological<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14pt;">deficite</span><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 18pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">E</span><span lang="EN-US" style="font-size: 14pt;">C</span><span lang="UK" style="font-size: 14pt;">G</span><span lang="EN-US" style="font-size: 14pt;">:</span><span lang="UK" style="font-size: 14pt;"> arrhythmias, violations of rhythm, </span><span lang="EN-US" style="font-size: 14pt;">dysmetabolic</span><span lang="UK" style="font-size: 14pt;"> and hypoxic changes<span style="mso-spacerun: yes;">
</span>in myocardium</span><span lang="EN-US" style="font-size: 14pt;">,</span><span lang="UK" style="font-size: 14pt;"> hypertrophy of
the left ventricle</span><span lang="UK" style="font-size: 14pt;"> </span><span lang="EN-US" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 18pt;"><span style="mso-list: Ignore;">u</span></span><span lang="EN-US" style="font-size: 14pt;">EchoC</span><span lang="UK" style="font-size: 14pt;">S</span><span lang="EN-US" style="font-size: 14pt;">: dilatation</span><span lang="UK" style="font-size: 14pt;"> of the left ventricle cavity, dec</span><span lang="EN-US" style="font-size: 14pt;">reased</span><span lang="UK" style="font-size: 14pt;"> retractive function<span style="mso-spacerun: yes;"> </span>of myocardium</span><span lang="EN-US" style="font-size: 14pt;"> (dilatation form)</span><span lang="UK" style="font-size: 14pt;">;<span style="mso-spacerun: yes;">
</span>rare</span><span lang="EN-US" style="font-size: 14pt;">ly</span><span lang="UK" style="font-size: 14pt;"> the hypertrophic
variant of carditis develops </span><span lang="EN-US" style="font-size: 14pt;">due to</span><span lang="UK" style="font-size: 14pt;"> the
hypertroph</span><span lang="EN-US" style="font-size: 14pt;">y </span><span lang="UK" style="font-size: 14pt;">of the left
ventricle</span><span lang="EN-US" style="font-size: 14pt;"> walls</span><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>and<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14pt;">decreasing of rejection</span><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>f</span><span lang="EN-US" style="font-size: 14pt;">r</span><span lang="UK" style="font-size: 14pt;">action</span><span lang="UK" style="font-size: 14pt;"> </span><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 18pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="UK" style="font-size: 14pt;">TREATMENT<span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-US" style="font-size: 14pt;">OF CARDITIS</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
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<span style="background-color: white;">
</span><div class="MsoNormal">
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">REGIME:</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>duration<span style="mso-spacerun: yes;">
</span>of the bed<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">regime</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>is determined<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">according to the
degree of cardiomegaly</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>and<span style="mso-spacerun: yes;"> </span>cardiac<span style="mso-spacerun: yes;">
</span>insufficiency, on the average<span style="mso-spacerun: yes;"> </span>2 –
6 weeks with gradual<span style="mso-spacerun: yes;"> </span>expansion<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">DIET:</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>Table </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">№</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 10, uses of
salt<span style="mso-spacerun: yes;"> </span>and<span style="mso-spacerun: yes;">
</span>liquid </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">according to the degree</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> of cardiac<span style="mso-spacerun: yes;"> </span>insufficiency</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">:excluding
of</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">
extractive<span style="mso-spacerun: yes;"> </span>and </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">piquant</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>products, replacing<span style="mso-spacerun: yes;"> </span>them on products</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">
with potassium and vitamines</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> </span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><img height="247" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image237.jpg" width="200" /><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><img height="201" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image239.jpg" width="214" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
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<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="UK" style="font-size: 14pt;">PATOGENETIC THERAPY</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><u><span lang="UK" style="font-size: 14pt;">At </span></u><u><span lang="EN-US" style="font-size: 14pt;">acute </span></u><u><span lang="UK" style="font-size: 14pt;">carditis</span></u><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">: </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">glucocorticoids</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>(</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">prednisolon</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 0,5 - 1,5 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">)
2 - 4 week</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">s </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">at a middle<span style="mso-spacerun: yes;">
</span>and<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">severe
forms</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>with </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">gradual
decreasing of dose</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">nonsteroid
anti</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">-</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">inflammatory drugs</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> (</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">A</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">spirin<span style="mso-spacerun: yes;"> </span>100 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Ibuprophen</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 10-15 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Voltaren</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>2 - 3 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Indometacin</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 2,5 - 3 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Misulid</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 5-10 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Mephenamin</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>acid<span style="mso-spacerun: yes;"> </span>of 50 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Amizon</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 50 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">)<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>4<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">weeks</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>with </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">gradual
decreasing of dose during</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 2-3<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">weeks</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
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<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><u><span lang="UK" style="font-size: 14pt;">At sub</span></u><u><span lang="EN-US" style="font-size: 14pt;">acute</span></u><u><span lang="UK" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>and<span style="mso-spacerun: yes;"> </span>chronic</span></u><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">: </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">chinoline</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>derivatives<span style="mso-spacerun: yes;">
</span>(</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Delagil</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 5 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg/kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Planquenil</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 8 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg/kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">)</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">4-6 m</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">th</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">s,<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">then decrease</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> to<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">1/2</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> dose and<span style="mso-spacerun: yes;"> </span>give<span style="mso-spacerun: yes;">
</span>by years</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Nonsteroid
anti</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">-</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">inflammatory drugs (scheme like for acute)</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">A</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">n</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">ti</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">biotic</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> therapy is </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">used</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> only at bacterial carditis </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">with</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> high activity</span><span lang="UK" style="font-size: 14.0pt;"> </span></span></div>
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<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-US" style="font-size: 14pt;">SYMPTOMATIC</span></b><b><span lang="UK" style="font-size: 14pt;"> THERAPY</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Cardiotropic medicines</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>which<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">improve the</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>function </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">of </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>myocardium: (ATP, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Phosphaden</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">P</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">otassium
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">orotatis</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Panangin</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Asparcam</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Riboxin</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Mildronat</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> Cardonat</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Carniton</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">) 1 -1,5 month </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">C</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">ardiac<span style="mso-spacerun: yes;"> </span>glycosides (</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">S</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">trophanthin of 0,012
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Digoxin</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> in the </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">supporting</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>dose of 0,01 - 0,02 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">)
at cardiac<span style="mso-spacerun: yes;"> </span>insufficiency</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">D</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">iuretic</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">s</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>( Lasix 1- 3 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Veroshpiron</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 1-3 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Hypothiazid</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 2-5 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">)</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">P</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">eripheral<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">vasodilatators</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> (Phentolaminum<span style="mso-spacerun: yes;"> </span>2 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Captopryl</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 0,5-1 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,<span style="mso-spacerun: yes;">
</span>anticoagulants (</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">H</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">eparin of 100 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">U</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">),<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">antiaggregants </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>( </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Curantil</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> 2,5 - 3 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">),
anti</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">a</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">rhythmical<span style="mso-spacerun: yes;"> </span>(</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Anaprillin</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Obzidan</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> - 1,0 - 2,0 </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">)</span><span lang="UK" style="font-size: 14.0pt;"> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 18.0pt; tab-stops: 36.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>P</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;">rophylaxis</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 18.0pt; tab-stops: 36.0pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="UK" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">A primary
prophylaxis</span><span lang="UK" style="font-size: 14.0pt;"> foresees </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">prevention</span><span lang="UK" style="font-size: 14.0pt;"> of infecting of f</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">eotus</span><span lang="UK" style="font-size: 14.0pt;"> during pregnancy, hard</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">iness</span><span lang="UK" style="font-size: 14.0pt;"> of child, treatment of </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">acute</span><span lang="UK" style="font-size: 14.0pt;"> and</span><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> </span><span lang="UK" style="font-size: 14.0pt;">chronic
infection</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">s</span><span lang="UK" style="font-size: 14.0pt;">, clinical </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">observation of the </span><span lang="UK" style="font-size: 14.0pt;">children </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">of</span><span lang="UK" style="font-size: 14.0pt;"> the group of risk on </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">cardio-vascular</span><span lang="UK" style="font-size: 14.0pt;"> diseases</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">.</span><span lang="UK" style="font-size: 14.0pt;"> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><span lang="UK" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">The second</span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">ary</span><span lang="UK" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">
prophylaxis</span><span lang="UK" style="font-size: 14.0pt;"> is directed on </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">prevention</span><span lang="UK" style="font-size: 14.0pt;"> of complications and relapse of process,
arrived at the clear observance of principles of clinical supervision of
patients</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="UK" style="font-size: 14pt;">The prognosis of </span></b><b><span lang="EN-US" style="font-size: 14pt;">no</span></b><b><span lang="UK" style="font-size: 14pt;">nrheumatic carditis depends on </span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span><span class="GramE">its</span></span></b><b><span lang="UK" style="font-size: 14pt;"> variant</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">Early </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">congenital</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> carditises </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">are</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, as a rule, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">severe</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> and quite often result in a fatal outcome in
the first years and even months of life</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">At a late </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">congenital</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> carditis at
adequate and in good time appointed therapy a process can </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">be</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">
chronic without progress of cardiac changes; possibly and convalescence</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span>Kawasaki disease</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Kawasaki disease
usually, but not always, affects children aged five years and under. It may
damage the heart muscle or coronary arteries. It is named after the Japanese
paediatrician who identified the disease. The cause is unknown but the disease
is probably caused by an abnormal reaction to a common germ. Kawasaki disease is not contagious, although
it can occur in clusters. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Symptoms
</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">The main symptom of Kawasaki disease is
persistent fever (over 38.5°C) for five days or longer. There is usually no
obvious explanation for the fever and it generally does not respond to
paracetamol. Other symptoms, usually caused by inflammation of small blood
vessels known as vasculitis, may include: </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">A rash, sometimes in the groin region </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Red, swollen and cracked lips </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Red eyes </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Bright red, swollen tongue </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Swollen hands and feet </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Red rash on palms of hands and soles of feet </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Swollen lymph nodes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="314" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image241.jpg" width="419" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="211" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image243.jpg" width="286" /><span style="mso-spacerun: yes;">
</span><img height="150" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image245.jpg" width="200" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="321" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image247.jpg" width="360" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="268" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image249.jpg" width="408" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="243" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image251.jpg" width="325" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">From an 8 year old child with Kawasaki
disease, this aneurysmally dilated epicardial coronary artery is occluded by
thrombus.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="400" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image253.jpg" width="206" /><span style="mso-spacerun: yes;"> </span><img height="400" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image255.jpg" width="267" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
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<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>Diagnosis</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>There is no test to diagnose Kawasaki disease.
Diagnosis is made by excluding other possible causes of symptoms. Diagnosis may
require blood tests and an echocardiogram to examine the heart for any changes
in the coronary arteries.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Most children who have Kawasaki disease and
receive proper treatment will make a full recovery. A few children will develop
heart problems, including damage to the coronary arteries. If no treatment is
given, about 25 per cent of patients experience inflammation of the coronary
arteries, which supply blood to the heart muscle. This can cause irregularities
with these blood vessels which may disturb the flow of blood. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The treatment for Kawasaki disease is
intravenous gammaglobulin (immunoglobulin), made from donated blood
transfusions. Large doses of intravenous gammaglobulin will usually stop the
fever and other symptoms of Kawasaki
disease. Treatment should be administered within 10 days of the onset of fever
to minimise heart problems. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Children may also be prescribed
aspirin for some weeks following the onset of Kawasaki disease, to prevent problems with
coronary arteries. However, aspirin should only be given to children on the
advice of a doctor, paediatrician or cardiologist. Aspirin is not usually
recommended for children because of the risk of Reye’s syndrome, a rare but
potentially fatal disease. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;">Cardiomyopathy</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 18pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Cardiomyopathy is a chronic and progressive disease in which the heart
muscle is abnormally enlarged, thickened and stiffened. The condition typically
begins in the walls of the heart's lower chambers and in more severe cases also
affects the walls of the upper chambers. The actual muscle cells as well as the
surrounding tissues of the heart become damaged. Eventually, the weakened heart
loses the ability to pump blood effectively and heart failure or irregular
heartbeats may occur.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cardiomyopathy is
nondiscriminatory in that it can affect any adult or child at any stage of
their life. It is not gender, geographic, race or age specific. It is a rare
disease when diagnosed in infants and young children. Cardiomyopathy continues
to be the leading reason for heart transplants in children.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">First term "</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">cardiomyopathy</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">" was offered </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">by </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">W.Bridgen in 1957<span lang="EN-US" style="mso-ansi-language: EN-US;">.</span> In obedience to his determination </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">cardiomyopathy</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> is a group of myocardium illnesses of<span style="mso-spacerun: yes;">
</span>unknown etiology </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">and<span style="mso-spacerun: yes;"> </span>uncoronarogenic</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> origin. During </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">prolonged time</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> this concept</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ion was </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">changed repeatedly, generating a mess in
terminology. In a consequence, due to introduction of modern methods of
diagnostics, both invasi</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ve</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> and uninvasi</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">ve</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">,
it was succeeded to derive many </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">cardiomyopathies</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">, and World
Organization of </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">H</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">ealth offer</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">s many </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">classifications</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">,</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">
last from which </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">was </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">presented in 1995</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b><span lang="EN-US" style="font-size: 14pt;">“Cardiomyopathy” is
a term that refers to the inability of the heart muscle to contract
appropriately to meet the demands of the body. There are several types of
cardiomyopathies defined by the World Health Organization on the basis of their
pathologic or pathophysiologic features: </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>“Dilated cardiomyopathy” or DCM,</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>“Hypertrophic cardiomyopathy” or HCM, </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>“Restrictive cardiomyopathy” or RCM, </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>“Ischemic cardiomyopathy” or ICM (cardiomyopathies
are due to or associated with specific systemic diseases).<span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">One particular type
of cardiomyopathy which primarily affects the right ventricle is called
Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy or ARVD / C.<span style="mso-spacerun: yes;"> </span></span></b><b><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt;"><img height="396" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image257.jpg" width="396" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The morphologic features of the cardiomyopathies are shows in this
illustration. For comparison the normal architecture of the left ventrilce is
shown in the top right illustration.<span style="mso-spacerun: yes;"> </span>In
DCM the left ventricle shows increase in size and volume.<span style="mso-spacerun: yes;"> </span>In HCM the ventricular walls are thick and
the ventricular chamber is consequently reduced in volume.<span style="mso-spacerun: yes;"> </span>In RCM the ventricular wall may or may not
be thicker. The restriction to the wall movement may be due to disease(s) that
affect the endocardium of the heart or that actually infiltrate the myocardium.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="mso-spacerun: yes;"> </span></b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="376" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image259.jpg" width="564" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Actuality</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">With
the pediatric population, cardiomyopathy occurs in approximately 12 children
out of every million with about 1,000-5,000 new cases diagnosed each year
worldwide. The majority of diagnosed children are infants under the age of 12
months with fewer cases between the ages of 1 to 12 years. When cardiomyopathy
is diagnosed in children before puberty, it is considered extremely unusual and
it may not have the same causes, manifestations or disease progression as
cardiomyopathy in adults.</span><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">CLINICS OF CMP</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Symptoms:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Many patients with cardiomyopathy may experience arrhythmia (abnormal
heart beats) which can be life threatening. Other symptoms may include
palpitations, fatigue, difficulty breathing (especially during exercise), poor
appetite, shaking, sweating, chest pain, syncope, upset stomach, failure to
grow and others.</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> </span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Cardiovascular Tests</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Electrocardiogram</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>Echocardiogram </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">24-hour Holter monitor</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Memory event recorders (for
certain symptoms)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Some patients may need
genetic testing, cardiac catheterization, MRI, heart biopsy and EP testing</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>Blood and urine testing is performed in all
patients</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Step-by-step
diagnostic approach</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Initial diagnosis of
cardiomyopathy rests on historical factors and physical exam findings.
Laboratory findings vary depending on specific aetiology. ECG, chest
radiography, echocardiogram, cardiac MRI, cardiac catheterisation and
endomyocardial biopsy are the diagnostic tests of choice. These tests are often
non-specific, pointing only to the pathophysiological consequences of
cardiomyopathy rather than its specific aetiology. Ultimately the aetiological
diagnosis of these conditions requires a combination of all these modalities,
as no one available test is specific enough to lead to an individual cause. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">History</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>History is a critical
component in diagnosis of cardiomyopathies. Emphasis should be placed on risk
factors for specific causes. Medical illnesses, family history, and alcohol and
drug exposure may predispose to the development of primary and secondary
cardiomyopathies.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">History
of present illness</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The most common symptoms
associated with cardiomyopathy are often non-specific, such as fatigue and
weight loss. Evaluation for symptoms of congestive heart failure (CHF) such as
orthopnoea, paroxysmal nocturnal dyspnoea and oedema is important.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Medical history</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>History of coronary artery
disease (CAD) and subsequent cardiac ischaemia should be excluded, since
specific therapy targeted at lesion revascularisation may improve symptoms.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>History of any of causes of
secondary cardiomyopathies including infiltrative, storage, toxicity,
endomyocardial, inflammatory, endocrine, cardiofacial and
neuromuscular/neurologic causes, nutritional deficiencies, autoimmune or
collagen diseases, electrolyte imbalance and cancer therapy as listed in
American Heart Association (AHA) scientific statement should be addressed. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Family history</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Family history</span> of
premature cardiac death or arrhythmia may indicate risk of primary
cardiomyopathy. Specific questions may elucidate hereditary causes of secondary
cardiomyopathy including infiltrative diseases (familial autosomal dominant
amyloidosis, Gaucher's, Hunter, Hurler's), storage diseases (Fabry, glycogen
storage, Niemann-Pick), diabetes mellitus, Noonan's syndrome, lentiginosis,
Friedreich ataxia, Duchenne/Becker muscular dystrophy, Emery-Dreifuss muscular
dystrophy, myotonic dystrophy, neurofibromatosis and tuberous sclerosis as
listed in AHA aetiological classification. <span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Physical examination</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">No specific physical examination findings are consistent</span>
with a particular cause but examination is directed towards looking for signs
of cardiac failure. A sustained prominent apical beat on palpation is
consistent with LVH. A diffusely palpable cardiac beat with apical displacement
may be seen with ventricular dilatation. Auscultation of the heart may reveal
murmurs, an S4 gallop (heard in types of cardiomyopathy that involve increased
left ventricular pressure) or an S3 gallop (heard when there is increased left
ventricular volume).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Auscultation</span> of the lungs typically demonstrates
crackles, indicating pulmonary congestion. Pedal and leg oedema and jugular
venous distension may also be present.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Initial tests</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>An ECG, although
commonly non-specific, may show specific abnormalities that point to an
individual aetiology. A normal ECG has approximately a 98% negative predictive
value when systolic dysfunction is suspected. Immediate laboratory tests should
include a FBC, a comprehensive metabolic profile and B-type natriuretic
peptide. Patients with chest pain require cardiac markers including troponins
and CK-MB. In addition a CXR (lateral and PA) is recommended. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span class="GramE"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echocardiogram and
further investigation.</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt;"><img height="266" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image261.jpg" width="481" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="155" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image263.jpg" width="359" /><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: bold;">24-hour Holter monitor</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="164" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image265.jpg" width="219" /><span style="mso-spacerun: yes;">
</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="97" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image267.jpg" width="299" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echo </span><span style="font-size: 14.0pt; mso-ansi-language: RU;">С</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">G</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Paroxismal
tachycardia</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echocardiography cannot
usually diagnose specific causes of cardiomyopathy alone. However, in
combination with history, physical examination and laboratory findings, it is
an extremely useful and noninvasive diagnostic tool. An echocardiogram helps to
distinguish the cardiomyopathies with respect to pathophysiology. It can
differentiate between hypertrophic, restrictive or dilated in most cases. It
may suggest a diagnosis of arrhythmogenic right ventricular dysplasia or
athlete's heart. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Newer available modalities
include cardiac MRI and cardiac CT. Cardiac MRI is a useful method for
uncovering the aetiology of cardiomyopathy because it provides excellent
contrast and spatial resolution of the heart. It is also noninvasive, readily
available and not operator dependent. It has the ability to assess ventricular
end-diastolic volumes, presence of intracardiac thrombi, stroke volume,
ejection fraction and valvular pathology.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Cardiac catheterisation may
be performed if echocardiography results are ambiguous. Ventricular and atrial
pressures are measured, which allow for the calculation of pressure gradients
across cardiac valves and the left ventricular outflow tract. Catheterisation
of the heart allows for ventriculography to be performed. Ejection fraction,
ventricular size and wall motion, and left ventricular outflow tract size can
be estimated, and the presence of valvular regurgitation can be evaluated.
Additionally, coronary angiography can be performed to evaluate for coronary
arterial disease as a cause of ischaemia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Endomyocardial
biopsy</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image269.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>When a small piece of heart muscle tissue is
needed for examination, a heart biopsy can be performed. A catheter is
carefully threaded into an artery or vein to gain access into the heart. A
bioptome (catheter with jaws in its tip) is then introduced. Once the bioptome
is in place, three to five small pieces of tissue from the heart muscle are
removed. The test is performed routinely after heart transplantation to detect
potential rejection. It may also be performed when cardiomyopathy, myocarditis,
cardiac amyloidosis, or other disorders are suspected.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="448" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image271.jpg" width="450" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span class="GramE"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Electron
micrographs of cardiac biopsy specimens.</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> A. Normal heart. B. Vacuole
formation. C. Myofibrillar dropout. D. Necrosis (magnification 5, ×100).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>In very rare circumstances, an endomyocardial
biopsy is needed to help differentiate disease processes and guide therapy. It
is useful in the diagnosis of the following causes of cardiomyopathy: <span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Inflammatory/immune cardiomyopathy: Lymphocytic
myocarditis, rheumatic carditis, sarcoidosis, giant cell myocarditis, cardiac
allograft rejection, Chagas cardiomyopathy, hypersensitivity myocarditis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Infectious cardiomyopathy: Toxoplasmosis, Lyme
carditis, cytomegalovirus (CMV).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Infiltrative cardiomyopathy: glycogen storage,
haemochromatosis, right ventricular lipomatosis, amyloidosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cardiac tumours: cardiac or non-cardiac origin.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Miscellaneous specific cardiomyopathies: Anthracycline
cardiotoxicity, endocardial fibrosis, endocardial fibroelastosis, Fabry
disease, carcinoid disease, irradiation injury, Kearns-Sayre syndrome,
Henoch-Schonlein purpura, chloroquine cardiomyopathy, carnitine deficiency,
hypereosinophilic syndrome</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Non-specific abnormalities.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="492" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image273.jpg" width="393" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="473" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image275.jpg" width="505" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;">Dilated
cardiomyopathy</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">The most common form is dilated
cardiomyopathy. In most cases the cause of dilated CM remains unknown. It may
be caused by viruses, metabolic <span class="GramE">diseases,</span> infectious
diseases, AIDS, obesity, nutritional deficiency, alcohol, radiation,
chemotherapy, adverse drug reactions, carnitine-deficiency, severe anemia or it
may be genetic (familial type).</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"> </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Unknown reason is idiopathic form.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="369" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image277.jpg" width="517" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>PEDIGREE of
family form of CMP</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="306" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image279.jpg" width="505" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">1 - <span class="GramE">death</span> is in </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">intrauterine</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> period, 2 -<span style="mso-spacerun: yes;">
</span>death to 1 year, 3 -<span style="mso-spacerun: yes;"> </span>death in 29
years, 4<span style="mso-spacerun: yes;"> </span>- </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">proband</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">, 6 years, presence
of clinical displays</span><span lang="EN-GB" style="font-size: 14.0pt;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><b><span style="font-size: 14pt;">Symptoms of dilatation
</span></b><b><span lang="EN-US" style="font-size: 14pt;">cardiomyopathy</span></b><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-GB" style="font-size: 14pt;">Catching
one's breath </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-GB" style="font-size: 14pt;">Apathy,
rapid fatigueability </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Edema of lower extremities </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Rapid set of weight </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Fainting fits, dizziness </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Strong palpitation, pulsation </span></b><b><span style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Stethalgia and
high pressure</span></b><b><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="553" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image281.jpg" width="553" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span class="GramE"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">a</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, Heart from an
individual with dilated cardiomyopathy. Note the dilated left ventricle and
thin ventricular walls. In life this ventricle pumped poorly. <span class="GramE">b</span>, Illustration of dilated cardiomyopathy (left), showing a
dilated left atrium and left ventricle, bulging interventricular septum from
left to right, and thin ventricular walls. For comparison, a normal heart is
shown on the right. IVC, inferior vena cava; IVS, interventricular septum; LA,
left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; SVC,
superior vena cava.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Prognosis</b></span><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image003.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt;">Mortality for DCM is highest in the first year after
diagnosis with a reported survival at 1 and 5 years after first presentation of
79% and 61% respectively. Early deaths are principally caused by severe heart
failure. Some late deaths are sudden, presumably due to arrhythmia, in children
who fail to recover to normal ventricular function. While it is accepted that
the risk of mortality is high there is less agreement as to predictors of poor
outcome. Failure of improvement or deterioration in shortening fraction,
ventricular arrhythmias, detection of mural thrombus, presentation at age
>2years, endocardial fibroelastosis and left ventricular and diastolic
pressure > 20mmHg have all been put forward as adverse prognostic factors.</span><span lang="UK" style="font-size: 14pt;"> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>HYPERTROPHIC CARDIOMYOPATHY</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"><img height="374" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image283.jpg" width="598" /></span></b></span></div>
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</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: bold;"></span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">It is the form of
cardiomyopathy characterized by progressive cardiac dilation and
contractile/systolic dysfunction, usually with concomitant hypertrophy.<span style="mso-spacerun: yes;"> </span>It is the second most common type of
cardiomyopathy. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">In this condition
the heart walls (mainly the middle wall) become excessively thickened. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Blood flow through
the heart is restricted. Most cases of this type of cardiomyopathy are genetic
in nature. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="322" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image285.jpg" width="396" /></span></span></div>
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</span><div class="MsoNormal">
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">RESTRICTIVE
CARDIOMYOPATHY</b></span><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image287.jpg" width="456" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
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<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><img height="306" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image289.jpg" width="408" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Restrictive
cardiomyopathy is a disease of the heart muscle that causes the walls of your
heart to get stiff. This restricts (holds back) some of the blood and oxygen that
is pumped out of your heart to your body.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">With restrictive cardiomyopathy, the muscle
wall of the left ventricle in your heart gets stiff and is not very flexible.
It is difficult for blood to get inside the ventricle because the muscle is so
stiff. This means less blood gets pumped out to your body.</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
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<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: bold;">Signs and Symptoms:</span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Abnormal or distant heart sounds</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cough</span></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Crackles heard when caregivers listen to your chest</span></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Fatigue (tiredness)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Nausea, bloating, and poor appetite because fluid
collects around the stomach, liver, and intestines</span></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Shortness of breath, especially:</span></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">With activity</span></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">At night</span></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">When lying flat</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Swollen legs and feet caused by retaining fluid</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Veins in your neck are distended (stick out)</span></span></div>
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</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Weakness</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
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<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-US" style="font-size: 16pt;">Arrhythmogenic
Right Ventricular Dysplasia</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 16pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">This is a very rare cardiomyopathy that usually manifests later in
adults. It is a progressive condition where the heart muscle is replaced with
fatty tissue. Patients may present with palpitations, syncope and ventricular
tachycardia. Most cases are genetic in nature. </span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><b>Treatment of
cardiomyopathy</b></span></span></div>
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</span><div class="MsoNormal">
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<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span></span></b><span lang="EN-US" style="font-size: 14pt;">A physician may recommend
that the patient first make lifestyle changes, including:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l76 level1 lfo82; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Rest adequately </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l76 level1 lfo82; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Control weight<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l76 level1 lfo82; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Exercise moderately </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l76 level1 lfo82; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Limit sodium in the diet </span><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
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<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Many patients will require
treatment with multiple heart medications. Some patients may require
implantation of a pacemaker and/or defibrillator. Cardiomyopathy is one of the
two leading reasons for heart transplantation in children.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">The goal of treatment is to control or
prevent heart failure and complications such as blood clots, arrhythmias and
sudden death. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Growth failure is present in over one-third
of patients. A diet rich in fruits, vegetables, whole grains, and fish with
omega-3 fatty acids (tuna, salmon, <span class="GramE">trout</span>) is
beneficial in most patients. Nutritional supplements to consider include
co-enzyme Q10, L-carnitine, and taurine (an amino acid).<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Restrictions: Most of the patients are
restricted from any strenuous exercise and competitive sports. </span><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><b>Medications to control the
symptoms of heart failure that can accompany dilated cardiomyopathy:</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Angiotensin converting enzyme (ACE) inhibitors
</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Anticoagulants </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Beta-blockers </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Calcium channel blockers </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Digitalis </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Diuretics </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Nitrates </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Vasodilators</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">Patients with
severe congestive heart failure that is associated with dilated cardiomyopathy
may require a heart transplant.</span></b><span lang="UK" style="font-size: 14pt;"> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span></span><span class="GramE"><b><span lang="EN-GB" style="font-size: 14pt;">Treatment<span style="mso-spacerun: yes;"> </span>of</span></b></span><b><span lang="EN-GB" style="font-size: 14pt;"> </span></b><b><span lang="EN-US" style="font-size: 14pt;">HC</span></b><b><span lang="EN-GB" style="font-size: 14pt;">MP</span></b><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Treatment is indicated only at
presence of clinic or risk factors of the </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span><span class="GramE">sudden</span> death.</span><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">General measures </span><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>are</span><span lang="UK" style="font-size: 14pt;"> limitation of the </span><span lang="EN-US" style="font-size: 14pt;">high</span><span lang="UK" style="font-size: 14pt;"> physical loadings and sport. The everyday loadings </span><span lang="EN-US" style="font-size: 14pt;">are</span><span lang="UK" style="font-size: 14pt;"> not limit</span><span lang="EN-US" style="font-size: 14pt;">ed</span><span lang="UK" style="font-size: 14pt;">. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt;">Antibiotics
are used for</span><span lang="UK" style="font-size: 14pt;"> the
prophylaxis of infectio</span><span lang="EN-US" style="font-size: 14pt;">n</span><span lang="UK" style="font-size: 14pt;"> endocarditis. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">Basis of therapy of </span><span lang="EN-US" style="font-size: 14pt;">HC</span><span lang="UK" style="font-size: 14pt;">MP is </span><span lang="EN-US" style="font-size: 14pt;">the</span><span lang="UK" style="font-size: 14pt;"> preparations with a negative </span><span lang="EN-US" style="font-size: 14pt;">ionotropic</span><span lang="UK" style="font-size: 14pt;"> action. </span><span lang="EN-US" style="font-size: 14pt;">There are
β-adrenoblockers</span><span lang="UK" style="font-size: 14pt;">
or calcium antagonists of Verapamilum group.</span><span lang="EN-US" style="font-size: 14pt;"> P</span><span lang="UK" style="font-size: 14pt;">reparations </span><span lang="EN-US" style="font-size: 14pt;">are a</span><span lang="UK" style="font-size: 14pt;">ppoint</span><span lang="EN-US" style="font-size: 14pt;">ed </span><span lang="UK" style="font-size: 14pt;">in maximally doses for </span><span lang="EN-US" style="font-size: 14pt;">all the </span><span lang="UK" style="font-size: 14pt;">life</span><span lang="EN-US" style="font-size: 14pt;">.</span><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">Antiunrhythmical preparations </span><span lang="EN-US" style="font-size: 14pt;">are
indicated</span><span lang="UK" style="font-size: 14pt;"> at </span><span lang="EN-US" style="font-size: 14pt;">severe
disorders</span><span lang="UK" style="font-size: 14pt;"> of rhythm. </span><span lang="EN-US" style="font-size: 14pt;">The best
are C</span><span lang="UK" style="font-size: 14pt;">ordaron or </span><span lang="EN-US" style="font-size: 14pt;">Dizopiramid</span><span lang="UK" style="font-size: 14pt;">. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="font-size: 14pt;">At development </span><span lang="EN-US" style="font-size: 14pt;">in</span><span lang="UK" style="font-size: 14pt;"> patients </span><span lang="EN-US" style="font-size: 14pt;">the</span><span lang="UK" style="font-size: 14pt;"> dilatation of cavities and systole
disfunction treatment of cardiac insufficiency on general principles </span><span lang="EN-US" style="font-size: 14pt;">is </span><span lang="UK" style="font-size: 14pt;">conduct</span><span lang="EN-US" style="font-size: 14pt;">ed</span><span lang="UK" style="font-size: 14pt;">.</span><span lang="EN-US" style="font-size: 14pt;"> There are u</span><span lang="UK" style="font-size: 14pt;">se</span><span lang="EN-US" style="font-size: 14pt;">d</span><span lang="UK" style="font-size: 14pt;"> the inhibitors of A</span><span lang="EN-US" style="font-size: 14pt;">CE
(angiotensin converting enzyme)</span><span lang="UK" style="font-size: 14pt;">, antagonists of receptors of angiotensin, </span><span lang="EN-US" style="font-size: 14pt;">diuretics</span><span lang="UK" style="font-size: 14pt;">, cardiac glyco</span><span lang="EN-US" style="font-size: 14pt;">z</span><span lang="UK" style="font-size: 14pt;">ides, </span><span lang="EN-US" style="font-size: 14pt;">β-adrenoblockers</span><span lang="UK" style="font-size: 14pt;">, </span><span lang="EN-US" style="font-size: 14pt;">spirolacton.</span><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14pt;"><img height="306" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image291.jpg" width="459" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Implantation of
cardioverter</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">-</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">defibrillator</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">at HCMP</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="UK" style="font-size: 14pt;">Surgical treatment of </span></b><b><span lang="EN-US" style="font-size: 14pt;">HC</span></b><b><span lang="UK" style="font-size: 14pt;">MP</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
<b><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></b>
</span><div class="Section8">
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b><span lang="UK" style="font-size: 14pt;"><img height="279" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image293.jpg" width="270" /><span style="mso-spacerun: yes;"> </span></span></b><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"></span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">Surgical treatment of </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">HC</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">MP
is </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">indicated</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> at: </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">A</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">bsence of clinical effect
from active medicinal therapy</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">for the </span><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">patients </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">with CM</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">P hypertrophy</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">. </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">A
classic operation is </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">intraortal septal
myoectonomy by</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> A.</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">M</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">orrow. </span><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14pt;"></span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
</div>
<span style="background-color: white;">
<b><span lang="UK" style="font-family: "Times New Roman"; font-size: 14pt;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></b>
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">By an alternative </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">there is the</span><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">successive
double-chamber electro-cardio</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-stimulation</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> (E</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">C</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">S)
with the shortened </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">atrioventricular</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"> delay. This method of E</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">C</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">S
changes the order of excitation and reduction of ventricles: in the beginning
excitation </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">of </span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">an apex, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">then intraventricular
septum</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;">.
The gradient of obstruction goes down due to the decline of regional
contractility of </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">intraventricular septum.</span><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b><span lang="EN-GB" style="font-size: 14pt;">Cellular
</span></b><b><span lang="EN-US" style="font-size: 14pt;">cardioplastic </span></b><b><span lang="EN-GB" style="font-size: 14pt;">by the bone marrow cells</span></b><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><span lang="UK" style="font-size: 14.0pt;"><img alt="See full size image" height="170" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image295.jpg" width="227" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">A
method of directed </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">neoangiogenesis</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"> is
a cellular transplantation, most suitable for patients with </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">cardiomyopathy</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">.</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">An angiogenesis is a process at which new vessels are formed from the
elements of already existing and until now this way was considered the unique mechanism
of </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">vessels </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">formation in
postnatal period. </span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">Vesical genesis is the formation of primary vessels from
cells-predecessors during embryonic development. </span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;">Recommendations of American cardiologists</span></b><b style="mso-bidi-font-weight: normal;"><span lang="UK" style="font-size: 18pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><u>Ten easy steps in the treatment of
cardiomyopathy (heart failure)</u></b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><u><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 1:</span></u><u><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> </span></u><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">MSM and chromium, more energy
and improved oxygen transport MSM and chromium can be used to supply the body
with more energy. MSM improves the oxygen transport in the body, not an
unnecessary luxury for patients suffering from heart failure. Chromium improves
the metabolising of carbohydrates which increases the amount of bio-energy
(ATP)</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 2:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> Q-10, L-Carnitine
and Taurine, the basis of the cardiomyopathy protocol.After introducing MSM and
chromium (4 to 6 weeks) the basic protocol can begin: CoQ10, L-carnitine and
taurine Q-10 is one of the three basic supplements from the protocol.Q-10 plays
an important part in the mitochondria (power plants) of the heart cells. Q-10
improves the generation of energy in the heart so the heart can function better
and the EJF is elevated.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>L-Carnitine improves the burning of fatty
acids (fat) Heart cells depend for their energy supply mostly on the burning of
fat. Disruption of the process of fat burning can cause cardiomyopathy. The
underlying cause of this disruption could be hereditary (genetic) so the body
is not able to produce sufficient carnitine. Other Scientific Studies support
the use of L-carnitine in the treatment of cardiomyopathy. Q-10 and L-Carnitine
act synergicly (they augment each other). Thus it is sensible to use both
supplements simultaneously. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Taurine also belongs to the group of three
basic supplements for the treatment of cardiomyopathy (heart failure). Other
Scientific Studies support the use of Taurine in the treatment of
cardiomyopathy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 45pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 3:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> Alpha Lipoic Acid and Vitamins C and E, prevention of
arteriosclerosis. After another 4 to 6 weeks the third phase of the protocol
can be introduced: Alpha lipoic acid, vitamin E and vitamin C. This phase has
special significance for patients that suspect their cardiomyopathy was caused
by a heart infarct. Alpha lipoic acid and vitamins E and C supply the body with
sufficient water- and fat-soluble antioxydants. This provides an increased<u> </u>protection
against the progression of cardiovascular disease.</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 45pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 4:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> Magnesium and
Potassium, treatment cardiac arrhythmia and high blood pressure</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>If cardiac arrhythmia persists after
the introduction of the third <span class="GramE">phase <span style="mso-spacerun: yes;"> </span>magnesium</span> can be employed to try and
alleviate the arrhythmia. Magnesium also plays an important part in the
treatment of cardiomyopathy, lowering blood pressure and prevention of other
cardiovascular disease. Supplementation of Potassium can alleviate cardiac
arrhythmia. Bananas and fruit juice are sources of potassium. Try eating 4 to 5
bananas a day and see if this brings about an improvement. Potassium
supplementation is also a possibility. The smallest effective dose is the best
dose. Have your bloodserum values checked on a regular basis when using a
potassium supplement. Give this information to your doctor. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 45pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 5:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> More exercise</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>If you start feeling better after circa
six months consult your cardiologist whether he approves more exercise. It is
often sufficient to take a walk for half an hour every day (seven days a week).
Take care not to get out of breath during your walking.”Walk and talk”.</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 45pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 6:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> Nutrition</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Sunflower oil Alert In the late nineteen
fifties the promotion began: saturated fats are bad. Eat more essential fatty
acids. </span><span lang="UK" style="font-size: 14.0pt;">Eat less carbohydrates</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">. </span><span lang="UK" style="font-size: 14.0pt;">Eat more fiber</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">. Eat food with a low glycemic
index.</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 45pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 7:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> Selenium. A
deficiency of selenium can cause cardiomyopathy. Unfortunately the cardiologist
does not measure the level of selenium in the blood. That is why this cause is
overlooked</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 45pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 8:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> DHEA. Blood screening of cardiomyopathy patients
indicates that these patients generally have lower DHEA levels. The level of
DHEA in the blood is in direct proportion to the severity of the cardiomyopathy.
DHEA is probably able to protect the heart against changing shape. DHEA is a
hormone. </span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 45pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step 9:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> Growth hormone
releasers. Research indicates that patients diagnosed with cardiomyopathy
without a known cause often have blood levels of growth hormone that are too
low.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 45pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">u<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="UK" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Step
10:</span><span lang="UK" style="font-size: 14.0pt;"> Maintenance protocol</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">.</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
<span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"><br /></span></span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com2tag:blogger.com,1999:blog-7275300796104068287.post-35219266687612788242013-04-02T16:17:00.000-07:002013-04-02T16:17:46.259-07:00Differential Diagnosis Of Cardiomegaly In Children<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 20pt;">Congenital heart diseases</span></b></span>
<br />
<div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">A congenital heart
defect (CHD) is a defect in the structure of the heart and great vessels of a
newborn. Most heart defects either obstruct blood flow in the heart or vessels
near it or cause blood to flow through the heart in an abnormal pattern,
although other defects affecting heart rhythm (such as long QT syndrome) can
also occur. Heart defects are among the most common birth defects and are the
leading cause of birth defect-related deaths. Approximately </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">1 in</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span lang="EN-US" style="font-size: 14pt;"> 125 babies are born each year in the US with a
Congenital Heart Defect.</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Actuallity</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Congenital heart disease can
occur immediately after birth or leaking concealed. They occur with a frequency
of 6-8 cases per thousand births. They take first place in infant mortality and
children in the first year of life. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Today, thanks to the
development of medicine, diagnosis of heart diseases in children has become
possible even in the hospital, and under certain pathological conditions - for
prenatal (before birth) stage. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Statistics: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">10 children from 1000 birth have
heart defects </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">In 1-2 children in 1000 these
defects are severe, life-threatening condition (aortic coarctation, aortic
valve stenosis, total anomalous pulmonary venous drainage, interruption of the
aortic arch and others) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Not less than 25% of children
with valvular heart disease remain undetected at discharge from the hospital.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Children are
included to the risk of the availability of congenital heart disease with: </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">-Down syndrome and certain other genetic disorders
(chromosomal abnormalities). In this case, a geneticist directs the child to a
cardiologist for further examination </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">-Premature babies </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">-Children with multiple extracardiac (ie, other than
the heart defect) malformations. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">If a child has
pronounced developmental defects, violations in the structure or function of
major organs, a pediatrician should send him to the Pediatric Cardiology.</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Predisposing factors to heart defects in the child </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">genetic</span> predisposition </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">presence</span> of the mother or relatives with congenital </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span class="GramE">malformations</span> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">age</span> older than 35 years of pregnant women </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">infectious</span> diseases during pregnancy (especially in the
first trimester of pregnancy) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">smoking</span> and alcohol during pregnancy </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">endocrine</span> disorders in mother or father</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">serious</span> illness of pregnant women in the first trimester of pregnancy
(severe</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span class="GramE">toxaemia</span>) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">the</span> impact of environmental factors during pregnancy (eg,
bad ecology, radiation, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span class="GramE">etc</span>.) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">reception</span> during pregnancy of some drugs ( drugs to treat
cancer, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span class="GramE">a</span> certain
group of antibiotics, aspirin, etc.). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• <span class="GramE">miscarriage</span> and stillbirth in the history of women</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span class="GramE">Causes
of congenital heart disease.</span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>The cause may be due to a genetic
predisposition or an environmental exposure during pregnancy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Known genetic causes of heart
disease includes chromosomal abnormalities such as trisomies 21, 13, and 18, as
well as a range of newly recognised genetic point mutations, point deletions
and other genetic abnormalities as seen in syndromes such as Velo-Cardio-Facial
Syndrome, familial ASD with heart block, Alagille syndrome, Noonan syndrome,
and many more.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Known antenatal environmental
factors include maternal infections (Rubella), drugs (alcohol, hydantoin,
lithium and thalidomide) and maternal illness (diabetes mellitus,
phenylketonuria, and systemic lupus erythematosus).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="226" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image007.jpg" width="306" /><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">This is a normal fetal
ultrasound showing one pattern of the fetal heartbeat. Some ultrasound machines
have the ability to focus on different areas of the heart and evaluate the
heartbeat. This is useful in the early diagnosis of congenital heart
abnormalities.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">AHA classification
of congenital heart disease</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>There are three common
classifications of congenital heart disease (CHD) according to the American
Heart Association. These are:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Septal defects. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Obstructive defects. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cyanotic defects.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Ventricular
septal defect</span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image009.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Ventricular septal defect is
a congenital defect of the heart, with occurs as an abnormal opening in the
wall that separates the right and left ventricles. Ventricular septal defect
may also be associated with other heart defects. For those defects that do not
spontaneously close, the outcome is good with surgical repair.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Before a baby is
born, the right and left ventricles of its heart are not separate. During
intrauterine development of fetus ventricles are separated. If the wall does
not completely form, a hole remains. This hole is known as a ventricular septal
defect, or a VSD.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Ventricular septal defect
is one of the most common congenital heart defects. The baby may have no
symptoms, and the hole can eventually close as the wall continues to grow after
birth. If the hole is large, too much blood will be pumped to the lungs,
leading to heart failure.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Causes</b><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">The cause of VSD is not yet known. This
defect often occurs along with other congenital heart defects.</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Symptoms</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Patients with
ventricular septal defects may not have symptoms. However, if the hole is
large, symptoms, the baby often has symptoms related to heart failure.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The most common symptoms include:</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Shortness of breath</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Fast breathing</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Hard breathing</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Paleness</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Failure to gain weight</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Fast heart rate</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Sweating while feeding</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Frequent respiratory infections</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="199" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image011.jpg" width="297" /><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Paleness</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="256" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image013.jpg" width="339" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Cyanosis of rhino-lip
triangle</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Exams and Tests</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="310" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image015.jpg" width="400" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Prenatal diagnostic</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span class="GramE">Septal
defect.</span> 12 weeks pregnancy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Listening with a
stethoscope usually reveals a heart murmur (the sound of the blood crossing the
hole). The loudness of the murmur is related to the size of the defect and
amount of blood crossing the defect.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="432" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image017.jpg" width="288" /><span style="mso-spacerun: yes;"> </span><img height="418" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image019.jpg" width="279" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Tests may include:</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chest x-ray -- looks to see if there is a large heart
with fluid in the lungs</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ECG -- shows signs of an enlarged left ventricle</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echocardiogram -- used to make a definite diagnosis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cardiac catheterization (rarely needed, unless there
are concerns of high blood pressure in the lungs)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">MRI of the heart -- used to find out how much blood is
getting to the lungs</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="202" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image021.jpg" width="264" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ECG-diagnostic</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="365" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image023.jpg" width="433" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chest radiograph of a patient with ventricular septal defect (direct
view): the heart shadow is increased at the expense of both ventricles, marked
protrusion of the arc of pulmonary trunk (indicated by arrow), pulmonary
picture in the basal parts of the lungs is strengthened.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="348" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image025.jpg" width="432" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>EchoCS</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="283" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image027.jpg" width="400" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="283" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image029.jpg" width="400" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="232" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image031.jpg" width="232" /><span style="mso-spacerun: yes;"> </span>Angiogram at VSD</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>If the defect is small, no
treatment is usually needed. However, the baby should be closely monitored by a
health care provider to make sure that the hole eventually closes properly and
signs of heart failure do not occur.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Babies with a large VSD who have
symptoms related to heart failure may need medicine to control the symptoms and
surgery to close the hole. Medications may include digitalis (digoxin) and
diuretics.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>If symptoms continue despite
medication, surgery to close the defect with a Gore-tex patch is needed. Some
VSDs can be closed with a special device during a cardiac catheterization,
although this is infrequently done.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Surgery for a VSD with no symptoms
is controversial. This should be carefully discussed with your health care provider.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Outlook
(Prognosis)</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Many small defects will close without
therapy. For those defects that do not spontaneously close, the outcome is good
with surgical repair. Complications may result if a large defect is not
treated.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Possible
Complications</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart failure </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Infective endocarditis (bacterial infection of the
heart)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Aortic insufficiency (leaking of the valve that
separates the left ventricle from the aorta)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Damage to the electrical conduction system of the
heart during surgery (causing arrhythmias)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Delayed growth and development (failure to thrive in
infancy)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pulmonary hypertension (high blood pressure in the
lungs) leading to failure of the right side of the heart</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Prevention</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Except for the case of heart attack associated VSD, this condition is
always present at birth.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;">Atrial septal defect</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">Atrial septal defect (ASD) is a congenital
heart defect in which the wall that separates the upper heart chambers (atria)
does not close completely. Congenital means the defect is present at birth.</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image033.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In fetal circulation,
there is normally an opening between the two atria (the upper chambers of the
heart) to allow blood to bypass the lungs. This opening usually closes around
the time the baby is born.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>If the ASD is persistent,
blood continues to flow from the left to the right atria. This is called a
shunt. If too much blood moves to the right side of the heart, pressures in the
lungs build up. The shunt can be reversed so that blood flows from right to
left. Many problems can occur if the shunt is large, but small atrial septal
defects often cause very few problems and may be found much later in life.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>ASD is not very common. When
the person has no other congenital defect, symptoms may be absent, particularly
in children. Symptoms may begin any time after birth through childhood.
Individuals with ASD are at an increased risk for developing a number of
complications including:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Atrial fibrillation (in adults)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart failure</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pulmonary overcirculation</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pulmonary hypertension</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Stroke</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Symptoms</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Small to moderate sized defects may produce no symptoms, or not until
middle age or later. Symptoms that may occur can include:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Difficulty breathing (dyspnea)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Frequent respiratory infections in children</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Sensation of feeling the heart beat (palpitations)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Shortness of breath with activity</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Exams
and Tests</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The doctor may hear
abnormal heart sounds when listening to the chest with a stethoscope. A murmur
may be heard only in certain body positions, and sometimes a murmur may not be
heard at all. The physical exam may also reveal signs of heart failure in some
adults.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>If the shunt is large,
increased blood flow across the tricuspid valve may create an additional murmur
when the heart relaxes between beats.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Tests that may
done include:</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cardiac catheterization</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chest x-ray </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Doppler study of the heart </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ECG </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echocardiography </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart MRI</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Transesophageal echocardiography (TEE)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="410" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image035.jpg" width="480" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Chest radiograph
with atrial septal defect (direct view): increase of right ventricle, bulging
of the pulmonary trunk of the arc on the left contour of the shadow of the
heart (indicated by arrow); signs of hypertension of the pulmonary vessels.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="334" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image037.jpg" width="445" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Doppler
study of the heart </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="421" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image039.jpg" width="242" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Aortogram at ASD</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="553" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image041.jpg" width="480" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Figure A shows the
heart’s position in the body and the location and angle of the MRI images shown
in figure C. Figure B is a MRI angiogram, which is sometimes used instead of a
standard angiogram. Figure C shows MRI pictures of a normal left ventricle
(left image), a left ventricle damaged from a heart attack (middle image), and
a left ventricle that isn’t getting enough blood from the coronary arteries
(right image).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>Treatment</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>ASD may not
require treatment if there are few or no symptoms, or if the defect is small.
Surgical closure of the defect is recommended if the defect is large, the heart
is swollen, or symptoms occur.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A procedure has
been developed to close the defect without surgery. The procedure involves
placing an ASD closure device into the heart through tubes called catheters.
The health care provider makes a tiny surgical cut in the groin, then inserts
the catheters into a blood vessel and up into the heart. The closure device is
then placed across the ASD and the defect is closed.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Not all patients
with atrial septal defects can have this procedure.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Prophylactic
(preventive) antibiotics should be given prior to dental procedures to reduce
the risk of developing infective endocarditis immediately after surgery for the
ASD, but they are not required later on.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Outlook
(Prognosis)</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>With a
small to moderate atrial septal defect, a person may live a normal life span
without symptoms. Larger defects may cause disability by middle age because of
increased blood flow and shunting of blood back into the pulmonary circulation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Possible
Complications</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Arrhythmias, particularly atrial fibrillation</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart failure</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pulmonary hypertension </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Stroke</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">There is no known way to prevent the defect, but some of the
complications can be prevented with early detection.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;"><span style="mso-spacerun: yes;"> </span>Patent ductus
arteriosus</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image043.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Patent ductus arteriosus (PDA)
is a heart problem that occurs soon after birth in some babies. In PDA, there
is an abnormal circulation of blood between two of the major arteries near the
heart. Before birth, the two major arteries—the aorta and the pulmonary
artery—are normally connected by a blood vessel called the ductus arteriosus,
which is an essential part of the fetal circulation. After birth, the vessel is
supposed to close within a few days as part of the normal changes occurring in
the baby's circulation. In some babies, however, the ductus arteriosus remains
open (patent). This opening allows blood to flow directly from the aorta into
the pulmonary artery, which can put a strain on the heart and increase the
blood pressure in the lung arteries.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><img height="295" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image045.jpg" width="470" /></span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Signs
and symptoms </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">While some cases of PDA are asymptomatic, common symptoms include:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<i><span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">* <span class="GramE">tachycardia</span> or other arrhythmia</span></span></span></i></div>
<i><span style="background-color: white;">
</span></i><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<i><span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">* <span class="GramE">respiratory</span> problems</span></span></span></i></div>
<i><span style="background-color: white;">
</span></i><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<i><span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">* <span class="GramE">shortness</span> of breath</span></span></span></i></div>
<i><span style="background-color: white;">
</span></i><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<i><span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">* <span class="GramE">continuous</span> machine-like murmur</span></span></span></i></div>
<i><span style="background-color: white;">
</span></i><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<i><span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">* enlarged heart</span></span></span></i></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>Diagnosis </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>PDA is usually diagnosed using
non-invasive techniques. The primary methods of detecting PDA are echocardiography,
in which sound waves are used to capture the motion of the heart, and
associated Doppler studies. Electrocardiography (ECG), in which electrodes are
used to record the electrical activity of the heart, is not particularly
helpful as there are no specific rhythms or ECG patterns which can be used to
detect PDA.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A chest X-ray may be taken, which
reveals the overall size of infant's heart (as a reflection of the combined
mass of the cardiac chambers) and the appearance of the blood flow to the
lungs. A small PDA most often shows a normal sized heart and normal blood flow
to the lungs. A large PDA generally shows an enlarged cardiac silhouette and
increased blood flow to the lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The type and timing of surgical
repair depends on the child's condition and the type and severity of heart
defects. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>In general, symptoms that indicate that surgery is needed are: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">difficulty
breathing because the lungs are wet, congested, or fluid-filled (congestive
heart failure) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">problems with heart
rate or rhythm (arrhythmias) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">excessive work load
on heart that interferes with breathing, feeding, or sleeping</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image047.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>An
incision may be made through the breastbone (sternum) and between the lungs
(mediastinum) while the child is deep asleep and pain-free (under general
anesthesia). For some heart defect repairs, the incision is made on the side of
the chest, between the ribs (thoracotomy) instead of through the breastbone.
Heart-lung bypass may be needed. Tubes are used to re-route the blood through a
special pump that adds oxygen to the blood and keeps it warm and moving through
the rest of the body while the repair is being done.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image049.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Most children need to stay
in the Intensive Care Unit for 3 to 7 days and stay in the hospital for 5 to 14
days. By the time the child is transferred out of the intensive care unit, most
of the tubes and wires have been removed and he is encouraged to resume many of
his daily activities. At the time of discharge, the parents are instructed on
activity, how to care for the incision and how to give medications their child
may need to take such as Digoxin, Lasix, Aldactone and Coumadin. The child
needs at least several more weeks at home to recover.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Tetralogy of Fallot</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image051.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Tetralogy of Fallot is a birth
defect of the heart consisting of four abnormalities that results in
insufficiently oxygenated blood pumped to the body. It is classified as a
cyanotic heart defect because the condition leads to cyanosis, <span class="GramE">a bluish</span>-purple coloration to the skin, and shortness of
breath due to low oxygen levels in the blood. Surgery to repair the defects in
the heart is usually performed between 3 and 5 years old. In more severe forms,
surgery may be indicated earlier. In most cases the heart can be surgically
corrected and the outcome is good.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Tetralogy
of Fallot is rare, but it is the most common form of cyanotic congenital heart
disease. Patients with tetraology of Fallot have a higher incidence of major
non-heart congenital defects.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Tetralogy of Fallot
is classified as a <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">cyanotic
heart defect</span> because the condition causes low oxygen levels in the
blood. This leads to cyanosis (a bluish-purple color to the skin).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The
classic form of tetralogy includes four related defects of the heart and its
major blood vessels:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Ventricular septal defect (hole between the right and
left ventricles)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Narrowing of the pulmonary outflow tract (the valve
and artery that connect the heart with the lungs)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Overriding aorta (the artery that carries oxygen-rich
blood to the body) that is shifted over the right ventricle and ventricular
septal defect, instead of coming out only from the left ventricle</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">A thickened muscular wall of the right ventricle
(right ventricular hypertrophy)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The cause of most congenital
heart defects is unknown. Many factors seem to be involved.</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="315" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image053.jpg" width="348" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Newborn
with tetralogy of Fallot</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Factors that increase the risk for this
condition during pregnancy include:</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Alcoholism in the mother</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Diabetes</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Mother who is over 40 years old</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Poor nutrition during pregnancy</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Rubella or other viral illnesses during pregnancy</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>There is a high incidence of
chromosomal disorders in children with tetralogy of Fallot, such as Down
syndrome and Di George syndrome (a condition that causes heart defects, low
calcium levels, and immune deficiency).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Clinic</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>At birth, infants may not
show signs of cyanosis. However, later they may develop sudden episodes (called
"Tet spells") of bluish skin from crying or feeding.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Clubbing of fingers (skin or bone enlargement around
the fingernails)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cyanosis, which becomes more pronounced when the baby
is upset</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Difficult feeding (poor feeding habits)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Failure to gain weight</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Passing out</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Poor development</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Squatting during episodes of cyanosis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="243" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image055.jpg" width="324" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Clubbing of fingers (skin or bone enlargement around the fingernails)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image057.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b><span style="mso-bidi-font-weight: normal;">Tests
may include:</span></b></span></span></div>
<b><span style="background-color: white;">
</span></b><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<b><span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Chest
x-ray</span></span></span></b></div>
<b><span style="background-color: white;">
</span></b><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<b><span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Complete
blood count (CBC)</span></span></span></b></div>
<b><span style="background-color: white;">
</span></b><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<b><span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Echocardiogram</span></span></span></b></div>
<b><span style="background-color: white;">
</span></b><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<b><span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Electrocardiogram
(ECG)</span></span></span></b></div>
<b><span style="background-color: white;">
</span></b><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<b><span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">MRI of
the heart (generally after surgery)</span></span></span></b></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section2">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="266" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image059.jpg" width="256" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Specific form of heart</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart in the form of "boots"</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section3">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Surgery to repair tetralogy
of Fallot is done when the infant is very young. Sometimes more than one
surgery is needed. When more than one surgery is used, the first surgery is
done to help increase blood flow to the lungs.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Surgery to correct the
problem may be done at a later time. Often only one corrective surgery is
performed in the first few months of life. Corrective surgery is done to widen
part of the narrowed pulmonary tract and close the ventricular septal defect.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="277" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image061.jpg" width="337" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Outlook
(Prognosis)</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Most cases can be
corrected with surgery. Babies who have surgery usually do well. Ninety percent
survive to adulthood and live active, healthy, and productive lives. Without
surgery, death usually occurs by the time the person reaches age 20.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Patients who have continued,
severe leakiness of the pulmonary valve may need to have the valve replaced.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Complications</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Delayed growth and development</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Irregular heart rhythms (arrhythmias)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Seizures during periods when there is not enough
oxygen</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Death</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Prevention</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">There is no known prevention.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;">Transposition of the great vessels</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image063.jpg" width="400" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">Transposition of the great vessels is a
congenital heart defect in which the position of the two major vessels that
carry blood away from the heart - the aorta and the pulmonary artery - is
switched (transposed). This defect is classified as a cyanotic heart defect
because the condition results in insufficiently oxygenated blood pumped to the
body which leads to cyanosis (a bluish-purple coloration to the skin) and
shortness of breath. </span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>Causes</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The cause of most congenital
heart defects is unknown.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Factors in the mother that may increase the
risk of this condition include:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Age over 40</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Alcoholism</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Diabetes</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Poor nutrition during pregnancy (prenatal nutrition)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Rubella or other viral illness during pregnancy</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Transposition of the great
vessels is a cyanotic heart defect.</span> This means there is decreased oxygen
in the blood that is pumped from the heart to the rest of the body. Low blood
oxygen leads to cyanosis (a bluish-purple color to the skin) and shortness of
breath.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="263" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image065.jpg" width="250" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In normal hearts, blood that
returns from the body goes through the right side of the heart and pulmonary
artery to the lungs to get oxygen. The blood then comes back to the left side
of the heart and travels out the aorta to the body.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In transposition of the great
vessels, the blood goes to the lungs, picks up oxygen, and then goes right back
to the lungs without ever going to the body. Blood from the body returns to the
heart and goes back to the body without ever picking up oxygen in the lungs.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Clinic</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Symptoms appear at birth
or very soon afterward. How bad the symptoms are depends on the type and size
of heart defects (such as atrial septal defect or patent ductus arteriosus) and
how much oxygen moves through the body's general blood flow.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The
condition is the second most common cyanotic heart defect.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Symptoms</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Blueness of the skin</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Clubbing of the fingers or toes</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Poor feeding</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Shortness of breath</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Exams
and Tests</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The health care
provider may detect a heart murmur while listening to the chest with a stethoscope.
The baby's mouth and skin will be a blue color.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Tests often
include the following:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cardiac catheterization</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chest x-ray</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ECG</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echocardiogram (if done before birth, it is called a
fetal echocardiogram)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pulse oximetry (to check blood oxygen level)</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="269" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image067.jpg" width="384" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ECG</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="226" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image069.jpg" width="314" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>X-ray</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="425" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image071.jpg" width="233" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Angiogram</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="373" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image073.jpg" width="539" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Pulse oximetry</span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The baby will immediately receive a
medicine called prostaglandin through an IV (intravenous line). This medicine
helps keep the ductus arteriosus open, allowing some mixing of the two blood
circulations.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A procedure using cardiac
catheterization (balloon atrial septostomy) may be needed to create a large
hole in the atrial septum to allow blood to mix.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A surgery called an arterial
switch procedure is used to permanently correct the problem within the baby's
first week of life. This surgery switches the great arteries back to the normal
position and keeps the coronary arteries attached to the aorta.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Outlook
(Prognosis)</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The child's
symptoms will improve after surgery to correct the defect. Most infants who
undergo arterial switch do not have symptoms after surgery and live normal
lives. If corrective surgery is not performed, the life expectancy is months.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Possible Complications</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Arrhythmias</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Coronary artery problems</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart valve problems</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Prevention</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Women who plan to
become pregnant should be immunized against rubella if they are not already
immune. Eating well, avoiding alcohol, and controlling diabetes both before and
during pregnancy may be helpful.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;">Hypoplastic left heart</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image075.jpg" width="400" /></span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Hypoplastic left heart
syndrome is a congenital heart condition that occurs during the development of
the heart in the mother's womb. During the heart's development, parts of the
left side of the heart (mitral valve, left ventricle aortic valve, and aorta)
do not develop completely. In patients with this condition, the left side of
the heart is unable to send enough blood to the body.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Hypoplastic left heart syndrome
occurs when parts of the left side of the heart (mitral valve, left ventricle,
aortic valve, and aorta) do not develop completely. The condition is congenital
(present at birth).</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Causes</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Hypoplastic left heart is a rare type of
congenital heart disease. It is more common in males than in females. The
reason is unknown.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Pathogenesis</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The problem develops before
birth when there is not enough growth of the left ventricle and other
structures, including the:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Aorta -- the blood vessel that carries oxygen-rich
blood from the left ventricle to the entire body</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Entrance and exit of the ventricle</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Mitral and aortic valves</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>This causes the left ventricle and aorta
to be incompletely developed, or hypoplastic. In most cases, the left ventricle
and aorta are much smaller than normal.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In patients with this condition, the
left side of the heart is unable to send enough blood to the body. As a result,
the right side of the heart must maintain the circulation for both the lungs
and the body. The right ventricle can support the circulation to both the lungs
and the body for a while, but this extra workload eventually causes the right
side of the heart to fail.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The only possibility of survival is a
connection between the right and the left side of the heart, or between the
arteries and pulmonary arteries (the blood vesels that carry blood to the
lungs). Babies are normally born with two of these connections:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Foramen ovale (a hole between the right and left
atrium) </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Ductus arteriosus (a small blood vesel that connects
the aorta to the pulmonary artery)</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Both of these connections
normally close on their own a few days after birth.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In babies with hypoplastic
left heart syndrome, blood from the right side of the heart travels through the
ductus arteriosus. This is the only way for blood to get to the body. If the
ductus arteriosus is allowed to close in a baby with hypoplastic left heart syndrome,
the patient may quickly die because no blood will be pumped to the body. Babies
with known hypoplastic left heart syndrome are usually started on a medicine to
keep the ductus arteriosus open.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Because there is little or no flow
out of the left heart, blood returning to the heart from the lungs needs to
pass through the foramen ovale or an atrial septal defect (a hole connecting
the collecting chambers on the left and right sides of the heart) back to the
right side of the heart. If there is no foramen ovale, or if it is too small,
the baby could die. Patients with this problem have the hole between their
atria opened, either with surgery or using heart catheterization.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Clinic</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">At first, a newborn with hypoplastic
left heart may appear normal. Symptoms usually occur in the first few hours of
life, although it may take up to a few days to develop symptoms. </span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">These
symptoms may include:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bluish (cyanosis) or poor skin color</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cold hands and feet (extremities)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Lethargy</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Poor pulse</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Poor suckling and feeding </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pounding heart</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Rapid breathing</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Shortness of breath</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="240" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image077.jpg" width="319" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In healthy newborns, bluish
color in the hands and feet is a response to cold (this reaction is called
peripheral cyanosis).</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>However, a bluish color in the chest or abdomen, lips, and
tongue is abnormal (called central cyanosis). It is a sign that there is not
enough oxygen in the blood. Central cyanosis often increases with crying.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Exams
and Tests</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">A physical exam
may show signs of heart failure:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Faster-than-normal heart rate</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Lethargy</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Liver enlargement </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Rapid breathing</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Also, the pulse at various locations
(wrist, groin, and others) may be very weak. There are usually (but not always)
abnormal heart sounds when listening to the chest.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Tests
may include:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cardiac catheterization</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ECG</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echocardiogram</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">X-ray of the chest</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Once the diagnosis of
hypoplastic left heart is made, the baby will be admitted to the neonatal
intensive care unit. A breathing machine (ventilator) may be needed to help the
baby breathe. A medicine called prostaglandin E1 is used to keep blood
circulating to the body by keeping the ductus arteriosus open.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">These measures do not solve the
problem. The condition always requires surgery.</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="266" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image079.jpg" width="400" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The
first surgery, called the Norwood
operation, occurs within the baby's first few days of life. Stage I of the Norwood procedure
consists of building a new aorta by:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Using the pulmonary valve and artery</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Connecting the hypoplastic old aorta and
coronary arteries to the new aorta</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Removing the wall between the atria (atrial
septum)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Making an artificial connection from either
the right ventricle or a body-wide artery to the pulmonary artery to maintain
blood flow to the lungs (called a shunt)</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Afterwards, the baby usually goes
home. The child will need to take daily medicines and be closely followed by a
pediatric cardiologist, who will determine when the second stage of surgery
should be done.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;">
</span>Stage II of the operation is called the Glenn
shunt or Hemifontan procedure. This procedure connects the major vein carrying
blue blood from the top half of the body (the superior vena cava) directly to
blood vessels to the lungs (pulmonary arteries) to get oxygen. The surgery is
usually done when the child is 4 - 6 months of age.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">During stages I and II, the child
may still appear somewhat blue (cyanotic).</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Stage III,
the final step, is called the Fontan procedure. The rest of the veins that
carry blue blood from the body (the inferior vena cava) are connected directly
to the blood vessels to the lungs. The right ventricle now serves only as the
pumping chamber for the body (no longer the lungs and the body). This surgery
is usually performed when the baby is 18 months - 3 years old. After this final
step, the baby is no longer blue.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Some patients may need more
surgeries in their 20s or 30s if they develop hard-to-control arrhythmias or
other complications of the Fontan procedure.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">Today heart transplantation is considered a
better choice than the 3-step surgery process. However, there are few donated
hearts available for small infants.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-bidi-font-weight: normal;">Outlook
(Prognosis)</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">If left untreated, hypoplastic left heart
syndrome is fatal. Survival rates for the staged repair continue to rise as
surgical techniques and postoperative management improve. Survival after the
first stage is more than 75%.</span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">The size and function of the right ventricle are important in
determining the child's outcome after surgery.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Possible
Complications</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Complications
include:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Blockage of the artificial shunt</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chronic diarrhea (from a disease called protein losing
enteropathy)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Fluid in the abdomen (ascites) and in the lungs
(pleural effusion)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart failure</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Irregular, fast heart rhythms (arrhythmias)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Strokes and other neurological complications</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Sudden death</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;">Ebstein's anomaly</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 16pt;"></span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image081.jpg" width="400" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Ebstein's anomaly is a
congenital heart condition which results in an abnormality of the tricuspid
valve. In this condition the tricuspid valve is elongated and displaced
downward towards the right ventricle. The abnormality causes the tricuspid
valve to leak blood backwards into the right atrium.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The condition is congenital,
which means it is present from birth.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Causes</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The tricuspid valve is
normally made of three parts, called leaflets or flaps. The leaflets open to
allow blood to move from the right atrium (top chamber) to the right ventricle
(bottom chamber) while the heart relaxes. They close to prevent blood from
moving from the right ventricle to the right atrium while the heart pumps.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14pt;">In persons with
Ebstein's anomaly, the leaflets are unusually deep in the right ventricle. The
leaflets are often larger than normal. The defect usually causes the valve to
work poorly, and blood may go the wrong way back into the right atrium. The
backup of blood flow can lead to heart swelling and fluid buildup in the lungs
or liver. Sometimes, blood can't get out of the heart into the lungs and the
person may appear blue.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">In most cases, patients also
have a hole in the wall separating the heart's two upper chambers and blood
flow across this hole may cause oxygen-poor blood to go to the body. There may
be narrowing of the valve that leads to the lungs (pulmonary valve).</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Ebstein's anomaly occurs as a
baby develops in the womb. The exact cause is unknown, although the use of
certain drugs (such as lithium or benzodiazepines) during pregnancy may play a
role. The condition is rare. It is more common in white people.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Clinic</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Symptoms range from mild to very
severe. Often, symptoms develop soon after birth and include bluish-colored
lips and nails due to low blood oxygen levels. In severe cases, the baby
appears very sick and has trouble breathing.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Symptoms in older children may include:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cough</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Failure to grow</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Fatigue</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Rapid breathing</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Shortness of breath</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Very fast heartbeat</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Exams and Tests</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Newborns which have a severe
leakage across the tricuspid valve will have very low levels of oxygen in their
blood and significant heart swelling. The doctor may hear abnormal heart
sounds, such as murmur, when listening to the chest with a stethoscope.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Tests that can
help diagnose this condition include:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chest x-ray</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Magnetic resonance imaging (MRI) of the heart</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Measurement of the electrical activity of the heart (ECG)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Ultrasound of the heart (echocardiogram)</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="272" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image083.jpg" width="377" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Ultrasound of the heart (echocardiogram)</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="171" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image085.jpg" width="642" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>PhCG with <span class="GramE">Ebstein 's</span> anomaly in the V intercostal space on the left of
the sternum: beat the average amplitude, pathological IV tone.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Treatment</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Treatment
depends on the severity of the defect and the specific symptoms. </span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Medical care may include:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Medications to help with heart failure</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Oxygen and other breathing support</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Surgery to correct the valve may be needed for
children who continue to worsen or who have more serious complications</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Outlook
(Prognosis)</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>In general, the earlier symptoms develop, the
more severe the disease.</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Some patients may have either no
symptoms or very mild symptoms. Others may worsen over time, developing blue
coloring (cyanosis), heart failure, heart block, or dangerous heart rhythms.</span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>Possible Complications</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A severe
leakage can lead to swelling of the heart and liver, and congestive heart
failure.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Other complications may include:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Abnormal heart rhythms (arrhythmias), including
abormally fast rhythms (tachyarrhythmias) and abnormally slow rhythms
(bradyarrhythmias and heart block)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Blood clots from the heart to other parts of the body</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Brain abscess</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Prevention</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">There is no known
prevention.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;">Aortic stenosis</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image087.jpg" width="400" /></span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></b><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Aortic stenosis
is a heart valve disorder that narrows or obstructs the aortic valve opening.
Narrowing of the aortic valve prevents the valve from opening properly and
obstructs the flow of blood from the left ventricle to the aorta. This can
reduce the amount of blood that flows forward to the body.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The aorta is the main artery leaving
the heart. When blood leaves the heart, it flows from the lower chamber (the
left ventricle), through the aortic valve, into the aorta. In aortic stenosis,
the aortic valve does not open fully. This restricts blood flow.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Causes</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>As the aortic valve becomes <span class="GramE">more narrow</span>, the pressure increases inside the left heart
ventricle. This causes the left heart ventricle to become thicker, which
decreases blood flow and can lead to chest pain. As the pressure continues to
rise, blood may back up into the lungs, and you may feel short of breath.
Severe forms of aortic stenosis prevent enough blood from reaching the brain
and rest of the body. This can cause lightheadedness and fainting.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinic<span style="mso-spacerun: yes;"> </span></b></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>People with aortic stenosis
may have no symptoms at all until late in the course of the disease. The diagnosis
may have been made when the healthcare provider heard a heart murmur and then
performed additional tests.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Symptoms of aortic stenosis include:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Breathlessness with activity</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chest pain, angina-type </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Crushing, squeezing, pressure, tightness</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pain increases with exercise, relieved with rest</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Under the chest bone, may move to other areas</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Fainting, weakness, or dizziness with activity</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Sensation of feeling the heart beat (palpitations)</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>In infants and children,
symptoms include:</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Becoming tired or fatigued with exertion more easily
than others (in mild cases)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Serious breathing problems that develop within days or
weeks of birth (in severe cases)</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Children with mild
or moderate aortic stenosis may get worse as they get older. They also run the
risk of developing a heart infection (bacterial endocarditis).</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Exams
and Tests</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The health care provider will be
able to feel a vibration or movement when placing a hand over the person's
heart. A heart murmur, click, or other abnormal sound is almost always heard
through a stethoscope. There may be a faint pulse or changes in the quality of
the pulse in the neck (this is called pulsus parvus <span class="GramE">et</span>
tardus).</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Infants and children with aortic
stenosis may be extremely tired, sweaty, and have pale skin and fast breathing.
They may also be smaller than other children their age.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Blood pressure may be low.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">The following
tests may be performed:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Chest x-ray </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Doppler echocardiography</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">ECG </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Exercise stress testing</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Left cardiac catheterization</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">MRI of the heart</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Transesophageal echocardiogram (TEE)</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="361" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image089.jpg" width="480" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chest radiograph with aortic stenosis: the shadow of the heart has the
shape of shoe (aortic configuration) with an increase due to hypertrophy of the
left ventricle (indicated by arrow), the tip is rounded.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="340" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image091.jpg" width="643" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Phonogram of heart at aortic stenosis: systolic murmur diamond shape
(indicated by arrows).</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="272" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image093.jpg" width="377" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>EchoCG at
aortic stenosis</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="384" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image095.jpg" width="344" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>If there are no symptoms or
symptoms are mild, patients may only need to be monitored by a health care provider.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>They are usually told not to
play competitive sports, even if they don't have symptoms. If symptoms do
occur, strenuous activity must be limited.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Medications are used to treat
symptoms of heart failure or abnormal heart rhythms (most commonly atrial
fibrillation). These include diuretics (water pills), nitrates, and
beta-blockers. High blood pressure should also be treated.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Surgery to repair or replace the
valve is the preferred treatment for adults or children who develop symptoms.
Even if symptoms are not very bad, the doctor may recommend surgery. People
with no symptoms but worrisome results on diagnostic tests may also require
surgery.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Some high-risk patients may be
poor candidates for heart valve surgery. A less invasive procedure called
balloon valvuloplasty may be done in adults or children instead. This is a
procedure in which a balloon is placed into an artery in the groin, advanced to
the heart, placed across the valve, and inflated. This may relieve the
obstruction caused by the narrowed valve.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Children with mild aortic
stenosis may be able to participate in most activities and sports. As the
illness progresses, sports such as golf and baseball may be permitted, but not
more physically demanding activities.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Valvuloplasty is often the
first choice for surgery in children. Some children may require aortic valve
repair or replacement. If possible, the pulmonary valve may be used to replace
the aortic valve.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Outlook
(Prognosis)</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Without surgery, a person
with aortic stenosis who has angina or signs of heart failure may do poorly.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Aortic stenosis can be cured
with surgery. After surgery there is a risk for irregular heart rhythms, which
can cause sudden death, and blood clots, which can cause a stroke. There is
also a risk that the new valve will stop working and need to be replaced.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Possible Complications</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Arrhythmias</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Endocarditis </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Left-sided heart failure</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Left ventricular hypertrophy (enlargement) caused by
the extra work of pushing blood through the narrowed valve</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Prevention</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Treat strep infections promptly to prevent rheumatic fever, which can
cause aortic stenosis. This condition itself often cannot be prevented, but
some of the complications can be.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;">Coarctation of the aorta</span></b></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image097.jpg" width="400" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">Coarctation of the aorta is a birth defect in which the
aorta, the major artery from the heart, is narrowed. The narrowing results in
high blood pressure before the point of coarctation and low blood pressure
beyond the point of coarctation. Most commonly, coarctation is located so that
there is high blood pressure in the upper body and arms and low blood pressure
in the lower body and legs. Symptoms can include localized hypertension, cold
feet or legs, decreased exercise performance, and heart failure.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Aortic coarctation
is a narrowing of part of the aorta (the major artery leading out of the
heart). It is a type of birth defect. Coarctation means narrowing.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Causes</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">The aorta carries blood from the heart to the vessels that
supply the body with blood and nutrients. If part of the aorta is narrowed, it
is hard for blood to pass through the artery.</span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Aortic
coarctation is more common in persons with certain genetic disorders, such as
Turner syndrome. However, it can also be due to birth defects of the aortic
valves.</span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Aortic
coarctation is one of the more common heart conditions that are present at
birth (congenital heart conditions). It is usually diagnosed in children or
adults under age 40.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Clinic<span style="mso-spacerun: yes;"> </span></b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Symptoms depend on
how much blood can flow through the artery. Other heart defects may also play a
role.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Around half of
newborns with this problem will have symptoms in the first few days of life.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In milder cases, symptoms
may not develop until the child has reached adolescence. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Symptoms
include:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Dizziness or fainting </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Shortness of breath</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Pounding headache</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Chest pain</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Cold feet or legs</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Nosebleed </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Leg cramps with exercise</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">High blood pressure (hypertension) with
exercise</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Decreased ability to exercise</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Failure to thrive</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt;">Poor growth</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Note:
There may be no symptoms.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Exams and Tests</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The health care provider
will perform a physical exam and take blood pressure and pulse in arms and
legs.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The pulse in the femoral
(groin) area or feet will be weaker than the pulse in the arms or the carotid
(neck). Sometimes, the femoral pulse may not be felt at all.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The blood pressure in
legs is usually weaker than in the arms. Blood pressure is usually higher in
the arms after infancy.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The doctor will use a
stethoscope to listen to heart and check for murmurs. People with aortic
coarctation have a harsh-sounding murmur that can be heard from the back. Other
types of murmurs may also be present.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Coarctation is often
discovered during a newborn's first examination or well-baby exam. Taking the
pulses in an infant is an important part of the examination, because there may
not be any other symptoms or findings until the child is older.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Tests to diagnose this condition may include:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echocardiography is the most common test to diagnose
this condition, and it may also be used to monitor the patient after surgery</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chest x-ray </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> CT</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> may be needed in
older children</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">MRI or MR angiography of the chest may be needed in
older children</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cardiac catheterization and aortography</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Both Doppler ultrasound and cardiac catheterization
can be used to see if there are any differences in blood pressure in different
areas of the aorta.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="323" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image099.jpg" width="283" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="356" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image100.gif" width="239" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The absence of the aortic arch at <span style="mso-spacerun: yes;"> </span>Aortogramma with contrast</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Radiogramma</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="314" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image102.jpg" width="248" /></span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span lang="EN-US">Aortogramma patient with coarctation of the aorta (right oblique
projection): a complete interruption of the aorta shadow in its isthmus
(indicated by arrow).</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Most newborns with symptoms
will have surgery either right after birth or soon afterward. First they will
receive medications to stabilize them.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Children who are diagnosed when
they are older will also need surgery. Usually, the symptoms are not as severe,
and more time will be taken to plan for surgery.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>During surgery, the narrowed
part of the aorta will be removed or opened. If the problem area is small, the
two free ends of the aorta may be re-connected. This is called anastomosis. If
a large part of the aorta is removed, a Dacron graft (a man-made material) or one
of the patient's own arteries is used to fill the gap. A tube graft connecting
two parts of the aorta may also be used.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Sometimes, balloon angioplasty may
be done instead of surgery, but it has a higher rate of failure. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Older children usually need
medicines to treat high blood pressure after surgery. Some will need lifelong
treatment for this problem.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="257" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image104.jpg" width="384" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="336" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image106.jpg" width="505" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Macroscopic
remote part of the aorta in coarctation: the lumen of the aorta is narrowed
sharply, which shows drawn through a needle injection.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Outlook
(Prognosis)</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Coarctation of the aorta can be
cured with surgery. Symptoms quickly get better after surgery.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>However, there is an increased risk
for death due to heart problems among those who have had their aorta repaired.
Without treatment, most people die before age 40. For this reason, doctors
usually recommend that the patient has surgery before age 10. Most of the time,
surgery to fix the coarctation is done during infancy.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Narrowing or coarctation of the
artery can return after surgery. This is more likely in persons who had surgery
as a newborn.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Possible
Complications</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Complications that may occur
before, during, or soon after surgery include:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Aortic aneurysm </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Aortic dissection </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Aortic rupture</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bleeding in the
brain</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Endocarditis
(infection in the heart)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Heart failure </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Hoarseness caused
by injury to the nerve to the larynx</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Impaired kidney
function</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Paralysis of the
lower half of the body (rare complication of surgery to repair coarctation)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Premature
development of coronary artery disease (CAD)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Severe high blood pressure
</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Stroke </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Long-term
complications include:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Continued narrowing
of the aorta</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Endocarditis
(infection in the heart)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">High blood pressure</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Prevention</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>There is no known way
to prevent this disorder; however, being aware of your risk may make early
diagnosis and treatment possible.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;">Rheumatic fever</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Rheumatic
fever is a type of disease characterized by inflammation that affects the
heart, joints, skin, spinal cord and brain. It is caused by Group <span class="GramE">A</span> Streptococcal bacteria and typically aff</span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">e</span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">cts children between the
ages of 6 to 15.</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"> </span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Rheumatic fever is widespread
around the globe and is considered a serious ailment, particularly in
developing countries, with a mortality rate of 2 to 5%. However, the use of
antibiotics has made it almost rare in the United States, with fewer eruptions
of the disease in the 20th century. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Causes</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Rheumatic fever is caused by a
problem in the immune system. It happens in response to group A Streptococcus
pharyngitis (strep throat). In this case, the immune system not only fights the
bacteria but also attacks its own tissue. It often attacks heart tissue.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The connection
between strep throat and rheumatic fever was not realized until the late 19th
century. The development and availability of antibiotics in the 20th century is
credited for the diminishing frequency of rheumatic fever. Rheumatic fever is
not uncommon throughout the world, especially in developing countries, but is
less common in the United
States since the early 20th century.
According to the Merck Manual, the incidence of rheumatic fever in the United States
is approximately 1/100,000.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image108.jpg" width="400" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><img height="290" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image110.jpg" width="290" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Rheumatic fever develops about 20 days after
strep throat or scarlet fever. The streptococcus infection which leads to
rheumatic fever may be asymptomatic in a third of all cases.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The morphological changes
reflect a systemic disorganization of connective tissue, especially the
cardiovascular system with specific necrotic-proliferative reactions (Aschoff's
body) and nonspecific exudative manifestations. The latter are more expressive
in childhood, which determines a large (compared with adults), severity and
activity of the process, the severity of carditis and other manifestations of
rheumatic fever.<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="262" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image112.jpg" width="400" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Myocardial Aschoff
body – the cells are large with large nuclei; some are multinucleated.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="235" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image114.jpg" width="359" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Necrotic
proliferative reactions in connective tissue</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="522" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image116.jpg" width="320" /><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Risk</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;">Factors that may
increase your risk of rheumatic fever include: </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Age: 5 to 15 years old</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Previous case of rheumatic fever</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Malnutrition</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Overcrowded living conditions</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Symptoms</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Symptoms usually appear 2 to
4 weeks after a strep infection. They may include: </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Pain and swelling in large joints</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Fever</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Weakness</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Muscle aches</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Shortness of breath</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Chest pain</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Nausea and vomiting</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Hacking cough</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Circular rash</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Lumps under the skin</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Abnormal, sudden movements of arms and legs</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image118.jpg" width="400" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="400" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image120.jpg" width="400" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="368" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image122.jpg" width="396" /></span><span lang="EN-GB"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Diseased Heart Valve</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Clinical
Manifestations: </b></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="480" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image124.jpg" width="398" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">The clinical manifestations of rheumatic fever
include: </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Fever</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Polyarthralgia</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> (discomfort in the joints without objective evidence
of pain, redness or swelling) </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Migratory polyarthritis</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">: this asymmetrical and involves the large joints (knees,
ankles, elbow and the wrist). The affected joints are painful, red, hot, and
swollen for about 24 hours. After the recovery of one group of joints, the
attack moves on to other groups of joints. This movement of the attack from one
group of joints to the other explains the description of the arthritis as
migratory. The polyarthritis lasts 1-4 weeks and subsides without leaving any
residual damage in the affected joints. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Carditis:</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> the most serious manifestation of rheumatic fever, involves all the
layers of the heart wall simultaneously. The inflammation of the pericardium
(outer coating of the heart) is called pericarditis. The inflammation of the
myocardium (heart muscle) is called myocarditis. The inflammation of the
endocardium (internal lining of the heart wall) is called endocarditis. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The involvement of the heart is
revealed by the occurrence of new mitral and aortic murmurs and cardiomegaly.</span>
Very severe rheumatic heart disease may lead to heart failure. The heart
lesions may remain and worsen with every recurrence of the acute rheumatic
fever. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Subcutaneous nodules:</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> are several tender swellings 0.5-2cm in diameter.
These nodules are found on the extensor surfaces of the bone prominences of the
knees, elbows, shoulders, scapulae, the occiput and the spinal processes. The
subcutaneous nodules occur in less than 15% of the cases and are indicators of
a severe disease. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Sydenham chorea:</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> is characterized by jerky, involuntary and irregular
movements of the limbs and face, emotional instability, inattentiveness,
clumpsiness and crying out loudly. The movements are usually bilateral but may
also be unilateral. The chorea is worsened by stress and disappears when the
child is asleep. Sydenham chorea is rare and affects girls more commonly than
boys. After several weeks or months, spontaneous remission occurs. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Erythema marginatum:</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> consists of non-pruritic macules or patches with
central pallor and a well defined irregular margin on the trunk and the
proximal parts of the limbs. Erythema marginatum occurs in 10 % of the cases of
acute rheumatic fever. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">The laboratory findings</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> include acute phase reactants (leukocytosis, raised
erythrocyte sedimentation rate, and elevated C-reactive protein), evidence of a
preceding streptococcal infection (elevated or rising antistreptolysin titre,
isolation of streptococci from throat swab culture, and positive streptozyme
test) and prolonged PR interval in the Electrocardiogram (ECG). </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">In children aged < 2 years
the clinical course of the disease tends to be mild and the correct diagnosis
may often be missed in this age group. </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">In 1944, the "Jones criteria"
provided guidelines for the diagnosis of rheumatic fever. The guidelines, which
have been revised and modified, are still used today. In addition to previous
infection with streptococcus (i.e. positive throat culture, rising ASO titer),
the diagnosis of rheumatic fever requires the presence of 2 major Jones
criteria or 1 major plus 2 minor Jones criteria.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Major Jones
criteria:</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">carditis</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">migratory
polyarthritis (arthritis in two or more joints)</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">Sydenham
chorea </span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">erythema
marginatum (skin rash) <span style="mso-spacerun: yes;"> </span></span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">subcutaneous
nodules</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Minor
Jones criteria:</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">arthralgia</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">fever</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">previous
rheumatic fever or rheumatic heart disease</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">laboratory
findings including elevated erythrocyte sedimentation rate, elevated C-reactive
protein, elevated white blood cell count</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">prolonged
PR interval on an electrocardiogram (EKG) (a pause in the electrical activity)</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="491" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image126.jpg" width="426" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Schematic
representation of the aetiopathogenic events occurring during the <span style="mso-spacerun: yes;"> </span>development of carditis</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Symptoms of heart disease (carditis)</span> are
determined in 70-85% of cases at the beginning of the disease and more
frequently in subsequent attacks, depending on the preferential localization
process in the myocardium, endocardium, <span class="GramE">pericardium</span>.
Due to the complexity of feature extraction destruction of a shell in the heart
of practice use the term "rheumatic heart disease.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="350" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image128.jpg" width="528" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span class="GramE">Aortic
valve showing active valvulitis.</span> The valve is slightly thickened and
displays small vegetations – "verrucae"</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Two-dimensional color flow
Doppler image of the left ventricular inflow of a patient with mitral
regurgitation in the four-chamber view (top panel) and two-dimensional
parasternal long-axis view (lower panel), showing lack of apposition of the
leaflets of the mitral valve during systole (arrow)<span style="mso-tab-count: 1;"> </span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="269" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image130.jpg" width="359" /></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>X-ray except not always
pronounced increase in heart determined by an impairment of tonic and
myocardial contractility, mitral or aortic <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>configuration of the heart</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="384" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image131.jpg" width="235" /></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Doppler image of mitral valve regurgitation</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="114" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image133.jpg" width="114" /><span style="mso-spacerun: yes;"> </span><span class="GramE">prolonged</span> P-Q<span style="mso-spacerun: yes;"> </span>as
criteria of RF</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="276" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image135.jpg" width="276" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Arthritis</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">The Role of
Polyarthritis in Rheumatic Fever</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Symptoms of polyarthritis include
painful, tender, swollen, warm joints and usually occur early in the course of
rheumatic fever. The most commonly affected joints associated with
polyarthritis related to rheumatic fever are:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">ankles</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">knees</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">elbows</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">wrists</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Vertebral joints are not usually
affected but the following joints may be affected:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">shoulders</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">hips</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">small joints of the
hands and feet</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Joint pain and fever
associated with rheumatic fever usually <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">subside within 2 weeks.</span> The laboratory value of
the erythrocyte sedimentation rate usually returns to normal within 3 months if
carditis does not persist.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Arthralgia associated with
rheumatic fever differs from arthralgia associated with rheumatoid arthritis by
the absence of tenderness during passive movement of the affected joint (person
performing examination moves patient's joint through range of motion).</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Sydenham’s
chorea </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Sydenham’s chorea is
characterized by involuntary movements, <span class="GramE">specially</span> on
the face and limbs, muscle weakness, disturbances of speech and gait. Children
usually exhibit concomitant psycologic dysfunction, especially
obsessive-compulsive disorder, increased emotional lability, hyperactivity, irritablility
and age-regressed behavior. It is usually a delayed manifestation, and is often
the sole manifestation of ARF. However, chorea may occur in association with
other major manifestations of RF, particularly in the first attack. Evidence of
a recent GAS infection is often difficult to document. Most of the patients
experience resolution of the symptomatology after a few months. However, a
recurrence rate up to 32% has been described, despite the regular use of
secondary benzathine penicillin prophylaxis. Some believe that these episodes
represent exacerbations rather than distinct attacks of acute RF.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><img height="469" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image137.jpg" width="195" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Annular
and nodosum erythema</b></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">Annular erythema - pale pink rash in the form
of a thin ring-shaped rim, does not rise above the skin surface and then
disappears when pressing. Appears in 7-10% of children with rheumatism, mostly
at an altitude of disease and usually is fragile.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="300" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image139.jpg" width="249" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="295" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image141.jpg" width="360" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="304" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image143.jpg" width="433" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="279" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image145.jpg" width="389" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Annular
and nodosum erythema</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Subcutaneous
nodules</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="257" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image147.jpg" width="324" /><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="238" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image149.jpg" width="312" /></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Differential
diagnosis of rheumatic fever</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Juvenile rheumatoid arthritis</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Systemic lupus erythematosus</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Infective endocarditis</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Reactive arthritis</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Sickle cell disease</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Drug reactions</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Other connective tissue diseases</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Septicaemia</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Leukaemia</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Gonoccocal arthritis</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Tuberculosis</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Lyme disease</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Serum sickness</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Investigations:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>As Rheumatic fever is exhibited
in different forms, no exact diagnostic test has been developed to test for its
presence. A careful exam by a qualified medical practitioner will involve
checking the patient's skin for fever, a rash or nodules, arthritis or swelling
in the joints, and listening to the heart sounds for any atypical murmurs. An
electrocardiogram may also be required to do a thorough testing of the
patient's heart to test for irregular rhythms. The doctor may likewise order
blood tests to check for the presence of a strep infection. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Just as there is no particular
laboratory test to diagnose Rheumatic fever, there is no cure for it as well.
However, the disease can be prevented by immediate treatment of a strep throat
infection through antibiotic therapy, such as penicillin injections,
erythromycin, or sulfadiazine.<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The investigations done on suspecting
acute rheumatic fever are throat swab for culture, Antistreptolysin O titre
(ASOT), and blood for acute phase reactants. </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Arthritis </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Salicylates</span> remain the first-line drugs in the
treatment of arthritis. The response is usually excellent. Treatment should be
started at 80 to 100 mg/kg/day (maximum, 4g daily) for 3-4 weeks. Naproxen
(10-15mg/kg/day, bid) is an alternative drug, with very good response. Other
nonsteroidal antiinflammatory drugs also can be used. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Carditis </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Moderate to severe carditis is
usually an indication for <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">cortiscoteroids</span>
although efficacy in reducing sequelae has not been proven so far. It seems
clear that corticosteroids are superior to salicylates in rapidly resolving
acute manifestations, but the advantage of the former in preventing a
pathologic murmur at 1 year posttreatment was not statistically significant.
Prednisone, 2mg/kg/day (maximum, 60mg/day) is used for two weeks and after
that, the dose is gradually tapered, reducing 20 to 25% of the previous dose
every week. Some advocate the concomitant use of salicylates to avoid rebound.
In severe carditis, therapy may be initiated with intravenous
methylprednisolone. Intravenous immunoglobulin seems not to alter the extent
and severity of carditis or decrease chronic morbitidy. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Heart failure usually responds
to steroids. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Bed rest is
always recommended and should be planned on an individual basis.</span> <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Diuretics and vasodilators</span>
may be used in patients with more severe haemodynamic decompensation. Digoxin
should be used with caution because of the risk of toxicity in the presence of
active myocarditis. <span style="mso-spacerun: yes;"> </span>Surgical treatment
in the acute stage should be considered when clinical therapy is ineffective to
control cardic failure. Valve repair, although technically more difficult, is
the first choice for younger patients. <span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Chorea </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span class="GramE">Treatment
with haloperidol (initial dose of 0.5 to 1mg/kg/day, maximum, 5mg/day) or
valproic acid (15-20 mg/kg/day) are</span> helpful in decreasing the severity
of involuntary movements but may not improve the behavioral symptoms.
Carbamazepine has also been suggested as a first-line treatment for Sydenham’s
chorea. Alternatively, phenobarbital also may be used, 5-7mg/kg/day. Treatment
is usually maintained for 8-12 weeks. Intravenous immunoglobulin therapy has
been suggested. <span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Complications</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">The development of rheumatic valvular heart
disease is the major complication of acute rheumatic fever. </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The acute phase of rheumatic
fever lasts only 6 weeks in 75% of cases. Symptoms improve in 90% of rheumatic
fever cases within 12 weeks. Symptoms of rheumatic fever continue for 6 months
or more in less than 5% of patients.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">The damage to an infected
person's heart valves can cause long-term and serious complications. Rheumatic
fever can prevent blood from flowing normally through the heart and lead to
permanent scarring of the heart valves. This damage can result in an ailment
also known as rheumatic heart disease, which usually escapes diagnosis until
much later in a person's life. <span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Apart from damage to the heart valves,
also known as Mitral stenosis or Aortic stenosis, Rhematic fever can result in
complications like Endocarditis, an inflammation of both the heart valves
(endocardium) and the inner lining of the heart chambers. Irregular heart
rhythm or Arrhythmias may also develop, as well as Pericarditis, a condition
characterized by the inflammation of the heart's sac-like lining known as the
pericardium. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>In more severe cases of the
disease, the inflammation brought about by Rheumatic fever causes so much
damage to the heart that it results in heart failure. Surgery will be needed to
correct the damage to the heart valves when this happens. </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">People who have a family history of Rheumatic fever have a higher risk
for contracting the disease. Living in overcrowded communities where poverty
and poor nutrition is rampant is also a risk factor. So undergoing surgical
procedures such as dental operations can increase the chances for infection by
Streptococcal bacteria.</span> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><span class="GramE"><b style="mso-bidi-font-weight: normal;">Prevention of rheumatic fever.</b></span><b style="mso-bidi-font-weight: normal;"> </b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span class="GramE"><b style="mso-bidi-font-weight: normal;">Primary
prevention.</b></span><b style="mso-bidi-font-weight: normal;"> </b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">Primary prevention means treatment of the
streptococcal upper respiratory infection with antibiotics to prevent the first
attack of rheumatic fever. Antibiotic therapy started up to the 9th day of the
onset of symptoms of the upper respiratory infection can prevent rheumatic
fever. </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span class="GramE"><b style="mso-bidi-font-weight: normal;">Secondary
prevention.</b></span><b style="mso-bidi-font-weight: normal;"> </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">Secondary prevention means prevention of infection of
upper respiratory tract with group <span class="GramE">A</span> beta haemolytic
streptococci in persons who have had an attack of rheumatic fever. The
preferred method of secondary prevention is regular monthly intramuscular injections
of benzathine penicillin G, 1.200,000 units. Patients with rheumatic carditis
need a lifelong secondary prophylaxis. The individuals with no carditis
continue with secondary prophylaxis until early twenties provided that at least
5 years will have passed since the last attack of rheumatic fever. Before
dental or surgical procedures, patients with rheumatic carditis also need
additional antibiotics to prevent infective endocarditis. The secondary
prophylaxis of rheumatic fever is not enough for preventing infective
endocarditis. The additional antibiotics (gentamycin, amoxycillin, cephalexin,
azithromycin or erythromycin) are given within half an hour before the
procedure. Remember that it can be prevented by treating a sore throat early
with antibiotics. So advice parents not to ignore a child with a sore throat
but to bring them for treatment as early as possible.</span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>For patients who have had
previous bouts of Rheumatic fever, the American Heart Association is
recommending regular prophylaxis on a long-term basis to totally destroy any
traces of streptococcal infection.</span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Prevention is also achieved
through the school system, where children with symptoms of sore throats may be
screened for Group <span class="GramE">A</span> Streptococcal bacteria. As a
whole, prompt treatment of strep throat infections through a full course of
antibiotic therapy will prevent any occurrence of Rheumatic fever. Without
antibiotic treatment, the disease is likely to recur within 3 to 5 years after
the initial infection. </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="430" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image151.jpg" width="452" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;">Acquired heart anomalies</span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b><span style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">Acquired heart diseases, as well as
congenital, are violations of the heart. But, unlike the congenital, which
appear in person before his birth, the development of valvular clear from its
title. Acquired heart diseases - a defeat of the heart valves, most often
acquired defects manifest themselves as a consequence of rheumatic fever.
Often, the development of disease goes by without attacks of rheumatic fever
and heart disease is detected when there are complaints from the heart. </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The most common
acquired heart diseases in children are developing because of rheumatism. <span style="mso-spacerun: yes;"> </span>In the leaf valve develops an inflammatory
process that leads to their damage, destruction and scar deformation. There is
when impaired function of heart valves work with increased load. Developed hypertrophy
<span class="GramE">of <span style="mso-spacerun: yes;"> </span>heart</span> occur.
In the future, the heart cavity expands, decreases contractile force of cardiac
muscle, there are signs of cardiac insufficiency. </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>We can
distinguish the following types of heart defects: </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;">• Valvular
insufficiency </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;">• Stenosis </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;">• Combined heart
disease </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Insufficiency</b>- kind of heart disease, in which,
due to incomplete closure of the valve, due to its defeat, some blood flows
back to those portions of the heart, from which it came. This creates an
additional strain on the heart increasing its mass, and leads to exhaustion of
the heart. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Stenosis </b>- a defeat heart valve with fusion of its
wings. This leads to a narrowing of the openings between the chambers of the
heart, which also prevents normal blood flow, partially blocking it. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span class="GramE"><b style="mso-bidi-font-weight: normal;">Combined heart
defects.</b></span> If the two types of acquired heart disease - valvular
insufficiency and stenosis affect the cardiovascular system at the same time there
is a combined heart defects. </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;">Mitral
insufficiency </span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Hemodynamics</span> in valvular mitral
insufficiency is due to a constant retrograde flow of blood in the left atrium
during systole of the left ventricle, which causes it to overflow and to
hypertrophy. During systole the left atrium into the left ventricle sends more
blood than normal, which leads to an expansion and hypertrophy. After that
there is stagnation in the pulmonary veins, in the vessels of the pulmonary
circulation. This increases the load on the right heart and with decompensation
of right ventricular stagnation in the circulation occurs. Ascites and edema
appear on the lower extremities. Long-term decompensation leads to changes in
the lungs, liver, kidneys and other organs. </span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span class="GramE"><b style="mso-bidi-font-weight: normal;">Clinic and
diagnosis.</b></span><b style="mso-bidi-font-weight: normal;"> </b></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Symptoms of mitral insufficiency appear in
children with acute attack of rheumatism and an enlarged heart. This condition
develops after a sustained inflammatory process in cardiac muscle, which
remains a persistent failure valve. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b><span style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Initially,
patients complain of weakness, palpitations, pasty legs and feet. Later there <span class="GramE">are</span> shortness of breath, swelling, pain in the heart. Seen
in the heart can be seen bulging. On palpation of the chest is determined by
the displacement of cardiac beat to the left.</span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="234" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image153.jpg" width="261" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The amplified, shifted to the left and spilled apical beat with mitral
insufficiency</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>On auscultation
over the apex there is blowing systolic murmur, sometimes it is accompanied by
systolic tremor.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The ECG in
patients with mitral insufficiency shows</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span class="GramE"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">leftcardiogram</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">, the interval P - Q is
prolonged.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="330" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image155.jpg" width="472" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>At
phonocardiogram first tone merges with systolic murmur. </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>An extension of
the heart to the left in direct projection is showed on X-rays. Waist absent
because of the expansion of the left <span class="GramE">atrium,</span> enlarged
left ventricle. </span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Doppler echocardiography may clarify the
nature and extent of the damage. </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment of mitral insufficiency is surgical. </b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Currently there are used two
types of operations: the restriction annulus valve (annuloplastics), and the
replacement of the valve prosthesis. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Annuloplastics is indicated
for the expansion of fibrous ring and the good condition of the valves valves. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Treatment depends on the
type of valve lesion (you can narrow valve ring, leaf, if good, sew a special
prosthesis or replace the valve completely). The prosthesis may be of human
tissues (homologous) or animal tissue (heterotransplants). These transplants
are treated properly, are most suitable for the growing child's body. The use
of synthetic prostheses requires constant use of drugs that reduce blood
clotting, so that the valve is not formed clots. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The first successful
operation of the replacement of the mitral valve prosthesis was made in 1963 by
Amosov (Ukraine
surgery). Most surgeons use a ball-type prosthesis Starr - Edwards. The
operation was performed under extracorporeal circulation. Mortality after
mitral valve is 10-15%.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;">Mitral stenosis </span></b></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span><img height="154" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image157.jpg" width="230" /></span></b></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>It is the most common
rheumatic heart disease, in which there is a narrowing of the left
atrioventricular valve. It occurs in 75% of patients with mitral valve disease.
After the attacks of rheumatic patients mitral valve is narrowing at the poles
and causes can not passes the required amount of blood from the left atrium
into the left ventricle. The high occurrence of sclerotic changes in the
fibrous ring of the valve and papillary muscles are the reasons of stenosis.
Depending on the degree of narrowing of the left atrioventricular aperture
stenosis is distinguishing at:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">severe - at a diameter of up to 0.5cm</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">large - at a diameter of 0,5 to 1cm </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span class="GramE"><span lang="EN-GB" style="font-size: 14pt;">moderate</span></span><span lang="EN-GB" style="font-size: 14pt;"> - at a
diameter of more than 1cm.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="343" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image159.jpg" width="258" /></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="348" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image161.jpg" width="242" /></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Mitral stenosis<span style="mso-spacerun: yes;">
</span>Mitral stenosis</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span>Thickening of the cusps, commissures</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><span class="GramE">with</span> calcifications and thrombus,</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span class="GramE">thickening</span>, compaction and</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><span class="GramE">shortening</span> of the chord</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Physical
examination</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Upon auscultation of an individual with
mitral stenosis, the first heart sound is unusually loud and may be palpable
(tapping apex beat) because of increased force in closing the mitral valve. The
first heart sound is made by the mitral and tricuspid heart valves closing.
These are normally synchronous, and the sounds are termed M1 and T1
respectively. M1 becomes louder in mitral stenosis.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>If pulmonary hypertension
secondary to mitral stenosis is severe, the P<sub>2</sub> (pulmonic) component
of the second heart sound (S<sub>2</sub>) will become loud.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>An opening snap which is a high
pitched additional sound may be heard after the A<sub>2</sub> (aortic)
component of the second heart sound (S<sub>2</sub>), which correlates to the
forceful opening of the mitral valve. The mitral valve opens when the pressure
in the left atrium is greater than the pressure in the left ventricle. This
happens in ventricular diastole (after closure of the aortic valve), when the
pressure in the ventricle precipitously drops. In individuals with mitral
stenosis, the pressure in the left atrium correlates with the severity of the
mitral stenosis. As the severity of the mitral stenosis increases, the pressure
in the left atrium increases, and the mitral valve opens earlier in ventricular
diastole.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>A mid-diastolic rumbling murmur
will be heard after the opening snap. The murmur is best heard at the apical
region and is not radiated. Since it is low-pitched it should be picked up by
the bell of the stethoscope. Rolling the patient towards left, as well as
isometric exercise will accentuate the murmur. A thrill might be present when
palpating at the apical region of the praecordium.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Peripheral signs
include:</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Malar flush - pulmonary hypertension is prominent in
patients with mitral stenosis</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Ankle/sacral edema (oedema) when there is right heart
failure</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Atrial fibrillation - irregular pulse and loss of 'a'
wave in jugular venous pressure</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Left parasternal heave - presence of right ventricular
hypertrophy due to pulmonary hypertension</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Tapping apex beat which is not displaced</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="322" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image163.jpg" width="433" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><img height="130" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image165.jpg" width="175" /></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="150" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image167.jpg" width="137" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="172" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image169.jpg" width="108" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Periferal edema</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="295" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image171.jpg" width="525" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Normal ECG</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><img height="295" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image173.jpg" width="525" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Atrial
fibrillation</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="259" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image175.jpg" width="337" /><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">PhonoCG</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="220" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image177.jpg" width="238" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>EchoCG</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Patients with mitral stenosis are
operated on opened or closed techniques. The first mitral commissurotomia in
our country was made by Bakulev in 1952. In 1962 Amosov performed open heart
surgery of mitral commissurotomia. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Intraventricular mitral commissurotomy
with using of dubble poles dilator is currently the main method of treatment of
patients with mitral stenosis. This method is most simple, effective and safe.
Mortality is 2-5%. Excellent and good results are in 72-75% of cases. </span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-tab-count: 1;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;">Insufficiency
of aortic valve </span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Hemodynamic
abnormalities </b></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Hemodynamic disturbances in
aortic insufficiency by the absence of complete closure of the valve opening
during diastole the left ventricle, resulting in some blood from the aorta
returns to the ventricle. Ventricle imposes additional workload, so hypertrophy
and expansion occur. Tonogenic dilatation is replaced by myogenic and ventricle
can not cope with the load and decompensation develops, initially in a small
circle, then to the systemic circulation. Patients have signs of failure of the
coronary circulation.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Clinic</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Patients <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">complain of</span> weakness, retrosternal pain,
dizziness and heart beat, and then short of breath. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Objectively</span> there are pale skin and
pulsation of neck vessels. Pulse is fast and high. The minimum arterial
pressure is dramatically reduced with high maximum. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Auscultation:</span> on the basis of aortic diastolic
noise is auscultated (in the third intercostal space on the left at the edge of
the sternum), sometimes simultaneously listening to the aorta and the systolic
over the second intercostal space on the right at the edge of the sternum
(associated with aortic valve sclerosis). </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The ECG</span> - leftcardiogram and signs of deficiency
of the coronary circulation.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="288" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image179.jpg" width="288" /><img height="288" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image181.jpg" width="240" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">X-rays</span> revealed aortic configuration of the
heart due to expansion of left ventricle. Ascending aorta is extended.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span><img height="300" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image183.jpg" width="307" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span><img height="407" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image185.jpg" width="224" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Doppler image of
aortic valve with regurgitation</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Surgical treatment consists of
aortic valve replacement under extracorporeal circulation. The most frequently
ball aortic valves are used. Mortality after surgery is still up to 20%. .</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;">Tricuspid insufficiency</span></b></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>In its pure form is found
in 3%, in combination with other defects - 25% of cases. The cause of this evil
is rheumatic fever, which leads to valvulitis, sclerosis, and shortening of the
valves. <span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Circulatory
dynamics </b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>When tricuspid regurgitation during ventricular systole is
not tight closured valve leaflets the blood from the right ventricle back into
the right atrium. Stagnation of blood in the right atrium leads to increased
pressure in it, blood stagnation observed in the hollow veins and the liver.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Clinic </b></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The most characteristic features</span>
in tricuspid insufficiency are pulsations of the neck veins and the liver,
synchronously with the systole of the ventricles of the heart. Liver is enlarged,
painful. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">On auscultation</span>
systolic murmur is auscultated <span class="GramE">on<span style="mso-spacerun: yes;"> </span>right</span> part of the sternum. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">X-rays</span> indicates an
increasing of the right heart, and when combined with other defects expansion
of all parts of the heart. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Cardiac
catheterization</span> provides an opportunity to identify high pressure in the
right atrium and the portal veins.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section4">
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="419" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image187.jpg" width="257" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ECG in </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">tricuspid valve inssuficiency</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section5">
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;"><img height="343" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image189.jpg" width="457" /></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Increased
pressure and pulsation of blood flow in the portal vein in tricuspid
insufficiency.</span></span></div>
<div class="MsoNormal">
<br /></div>
</div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section6">
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="504" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image191.jpg" width="263" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echo symptoms of </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">tricuspid insufficiency</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
</div>
<span style="background-color: white;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 18pt;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></b>
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;"><img height="198" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image193.jpg" width="552" /></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Radiography of the heart
with varying degrees of tricuspid insufficiency</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The operation on the
tricuspid insufficiency is performed on the open heart surgery. It is
annuloplasty or prosthetic valve ball prosthesis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;">Tricuspid stenosis</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="401" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image195.jpg" width="296" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>This isolated defect is
extremely rare disease. Most often occurs in conjunction with mitral stenosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Etiology is
rheumatic endocarditis.</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="292" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image197.jpg" width="388" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Circulatory dynamics </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In systole of the right atrium the
blood dose not pass completely through the narrowed venous right atrium to
ventricle. The right atrium is stretching, while the right ventricle and the
left half of the heart remain the same normal load.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="333" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image199.jpg" width="360" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>View looking
down on the right atrium (no tricuspid valve is present)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinic </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Clinic in
stenosis of the </span><span lang="EN-US" style="font-size: 14pt;">tricuspid valve</span><span lang="EN-GB" style="font-size: 14pt;">s is shortness of
breath, marked cyanosis, enlargement and pulsation of neck veins and a
significant increase in the liver. <b style="mso-bidi-font-weight: normal;">On
auscultation</b> over the right half of the heart at the right edge of the
sternum presystolic murmur and amplified first tone may be heard. <b style="mso-bidi-font-weight: normal;">Percussion</b> and <b style="mso-bidi-font-weight: normal;">radiological examination </b>determine a significant expansion of the
right atrium. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">At
cardiac catheterization</b> high pressure in the right atrium and decrease in
the right ventricle there are determined. The pressure gradient between the
right atrium and right ventricle is higher than 5mm Hg. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image201.jpg" width="300" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Echo- and Doppler <span class="GramE">sings</span>
of tricuspid stenosis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="241" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image203.jpg" width="390" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="280" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image205.jpg" width="329" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>PhonoCG</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="285" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image207.jpg" width="324" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Hypertrophy of the right ventricle with stenosis of the right
atrioventricular</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span class="GramE"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">valve</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Operation on the
narrowing of the tricuspid valve is commissurotomy. When mitral stenosis is combined
with stenosis of the tricuspid valve operations are performed simultaneously.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="216" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image209.jpg" width="289" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;">Aortic stenosis</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="388" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image211.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Circulatory dynamics</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A narrow valve makes the heart work
harder just to pump the blood through the valve to the body. A leaky valve lets
blood back into the heart after it has been pumped out. The heart must
therefore pump more blood forward to make up for the blood that is leaking
backwards.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Either way the extra work may cause
symptoms of heart failure, such as shortness of breath. Early on the shortness
of breath may be noticeable only with exercise. Later, with the progression of
valve disease, a patient could experience shortness of breath with even light
activity or at rest. Some patients will be unable to sleep flat in bed or may
awaken from sleep short of breath. Another sign of heart failure that may
occasionally occur is swelling of feet, particularly prominent later in the
afternoon or evening although other conditions, such as varicose veins, can
also cause this to occur.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The extra work the heart has to perform
<span class="GramE">may</span> also cause chest pain or angina pectoris similar
to the symptoms of a heart attack. It may be difficult to tell the difference
between heart valve disease and narrowing of the blood vessels to the heart
itself.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="201" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image213.jpg" width="300" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image215.jpg" width="303" /></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Aortic valve stenosis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">A failing aortic valve may cause a variety of symptoms including:</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;">• </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">Shortness of
breath, </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">• Chest pain (angina pectoris) </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">• Dizziness or loss of consciousness (passing out)</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Often patients <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">complain</span> of attacks of
rheumatic fever, shortness of breath, general weakness, fatigue and pain in the
heart, dizziness and fainting. Pulse is small. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Systolic pressure</span> is lowered in normal or high
diastolic. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Heart borders</span>
are shifted left by larger left ventricle. In the second intercostal space on
the right there is systolic murmur. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">X-rays</span> determined by enlargement of the heart to the left
through the left ventricle of the heart Waist well defined. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The ECG</span> reveales left ventricular overload, S - T
intervals are shifted down, there is a negative T wave.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="270" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image217.jpg" width="337" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="396" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image219.jpg" width="247" /></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">PhonoCG</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="423" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image221.jpg" width="438" /></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>X-ray sings of
aortic stenosis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="281" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image223.jpg" width="444" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Doppler sings of aortic
stenosis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The operation is indicated in
the early stages of the defect. In the presence of Right heart decompensation
surgery is contraindicated. The operation is performed on open and closed
methods. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Closed aortic commissurotomy is
often performed by intraventricular access. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Open aortic commissurotomy is performed
under extracorporeal circulation with general hypothermia to 30°C and
additional cooling of the heart with ice (cardioplegia).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="264" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%204%20Differential%20diagnosis%20of%20cardiomegaly%20in%20children..files/image225.jpg" width="314" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 18pt;"><span style="mso-spacerun: yes;"> </span><span class="GramE"></span></span></b></span><span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><br /></span></span></div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com2tag:blogger.com,1999:blog-7275300796104068287.post-16231859461781415542013-04-02T15:59:00.002-07:002013-04-02T15:59:55.173-07:00Chronic Bronchopulmonary Disease In Children. <span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Chronic
bronchopulmonary pathology - is an inflammatory process of infectious origin
(caused by the microflora), which is the recurring, usually bronchogenic spread
and is based on functional and organic lesions of bronchi, vessels, parenchyma
and interstitial tissue of the lungs, pleura and the subsequent development of
sclerosis.</span></span>
<br />
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span>Actuallity of the problem of chronic bronchopulmonary pathology. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
a considerable incidence - 0.2-1% among children (according to the
pathologists, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>in adults it occurs in 1.5-12% dead) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">• severe
<span style="mso-tab-count: 1;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
irreversible complications (sclerosis, bronchiectasis, cardiovascular </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>failure, brain abscess, abscess lung
formation, amyloidosis) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
disability of children and later adults, possible adverse health effects </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The problem of chronic
bronchopulmonary pathology always aroused the attention of pulmonologists.
Perhaps no disease of bronchopulmonary system has<span style="mso-spacerun: yes;"> </span>caused so much discussion and debate among scientists
as chronic bronchopulmonary pathology. The term "chronic bronchopulmonary
disease" has been repeatedly revised, but attempts to replace it by bronchiectasis,
pneumosclerosis or chronic bronchitis have been in vain. After all, none of
them could not reflect the depth of pathomorphologic changes, but was only
evidence of adverse trends (bronchiectasis, pneumosclerosis) or a component of
the pathological process (chronic bronchitis). The term "chronic
bronchopulmonary disease" encompasses a range of morphological changes in all
anatomical structures of the lung. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Now scientists abroad again reject the term
"chronic bronchopulmonary disease", finding him an alternative -
chronic bronchitis. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Statistics say that over the past years
there was no increase in chronic bronchopulmonary diseases among children. But
this is not indicative of its absence. Timely diagnosis and treatment of acute
pneumonia, the effectiveness of antibacterial new generation medicines significantly
reduced risk of chronic inflammatory process.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>At
the same time, the effects of environmental catastrophes, increasing the number
of sick children was continued, and especially during the first 3-5 years of
life. Reduced immunological resistance of the organism, the low sensitivity of
the respiratory tract flora to antibiotics and the increasing allergy to them
create the complete objective prerequisites for the emergence of chronic
bronchopulmonary pathology. Clinical experience proves that, the more so that
the low social and cultural level of the population today leads to an increase
in incompletely treated patients with acute pneumonia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Etiology,
pathogenesis and pathomorphology </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>The etiology, pathogenesis and morbid anatomy
are complex and many aspects were studied. The factors that cause
predisposition to the development of chronic respiratory pathology, are: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">prematurity </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">anomalies of the
constitution, especially exudative-catarrhal </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">malnutrition<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">rickets </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">artificial feeding </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">pollution of the
atmosphere </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">bad living conditions. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Promotion factors: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">• acute pneumonia (80%) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">• whooping cough, measles </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">• frequent ARI </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">• foreign body of airway </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">• congenital and acquired malformations of the bronchopulmonary system </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">• hereditary diseases (cystic fibrosis). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>This factors
contribute: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">reducing overall
reactivity (resistance) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">violation of local
immunity </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">disorders of drainage
(evacuation) and the barrier function of bronchi.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The reason
supporting a chronic inflammatory process is the microflora (inflyuenza coli,
streptococci, staphylococci, pneumococci, Gram-negative bacteria) or its α-forms
which are in bronchopulmonary lymph nodes, in foci of chronic infection
(tonsillitis, adenoids, sinusitis, carious teeth, cholecystitis). In children,
the main way of spreading of infection is bronchogenic.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span></span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The inflammatory process is consistent and progressive in nature:
single-layered ciliated epithelium is replaced by a cubic (violation of
bronchial drainage function) → damage nerve endings bronchi (disturbed
peristalsis), connective tissue is developing, changing the size, form and
elasticity of the bronchi → development of panbronchitis facilitates the
induction of inflammation in the lung interstitium in intraalveolar septums,
directly into the alveoli. Thus, in chronic respiratory pathology all
structures of the bronchopulmonary system are affected (bronchi, interstitial
tissue, parenchyma, vessels, nerves, pleura), but according to the clinic we
may only speak about the prevalence of changes in the bronchi, interstitium or
parenchyma of the lung.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">This is
confirmed by pathological data, when according to the severity of the
pathological process such consecutive changes are observed: 1) chronic
bronchitis with bronchiectasis and emphysema, 2) chronic bronchitis with bronchiectasis
and atelectasis, and 3) chronic deforming bronchitis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>P</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">athoanatomic</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">
examination provides a diverse macroscopic picture in conjunction with the
histological heterogeneity of lesions in chronic bronchopulmonary disease. In
the same case different changes are revealed: chronic inflammation of the
interstitium, carnification, sclerosis, deforming bronchitis, bronchiectasis,
emphysema, atelectasis, worsening the inflammatory process. There are
lymphangitis, abscesses, etc. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The main among the histological changes are:
organization of exudate in the alveoli, chronic inflammation of the
intermediate tissue, chronic bronchitis with bronchiectasis (or deforming
bronchitis), foci of acute inflammation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section10">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="225" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image177.jpg" width="250" /></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Chronic bronchitis. Bronchoectasis.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Lung emphysema.
Pneumosclerosis.</span></span></div>
</div>
<span style="background-color: white;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt; line-height: 150%;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></b>
</span><div class="Section11">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="331" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image178.jpg" width="396" /></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Micropreparation of <span style="mso-spacerun: yes;"> </span>lung in
diffuse interstitial pneumosclerosis: intraalveolar septums are greatly
thickened and sclerotic; coloured by Van Gieson; × 24.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="256" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image180.jpg" width="325" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Micropreparation of lung at local pneumosclerosis: substitution of the
alveoli, bronchioles, alveolar ducts by proliferation of connective tissue; coloured
by Van Gieson; × 24.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Morphological studies</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> indicate that at the presence of purulent bronchitis
lymph capillaries and efferent lymphatic </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">vessels</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">are constantly
involved in the inflammation process. This is explained by the fact that the
resorption of purulent exudate and the output is mainly done by lymphatic
pathways. Later purulent lymphangitis is changed by lymphangiosclerosis,
obliteration of the lumen, causing resorption and mechanical failure. At the
same time, disruption of lymphatic drainage of the bronchial wall is of
particular importance, since sharply reduced ability to clean itself, and
therefore, there is stagnation of secretions, especially in the bronchioles,
activation of the microflora and the development of peribronchial inflammation.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Arround the lymphatic
capillaries there is observed infiltration by lymphocytes and plasmocytes with
the formation of lymphomas. In addition to induction of cellular elements,
lymphostasis sharply violates vascular tissue ratio, tissue metabolism, which
lead to degeneration of the structural components of the bronchi with
subsequent development of cylindrical bronchiectasis and reticular
pneumosclerosis. Thus, there is convincing evidence: bronchitis is only the
initial phase, followed by involvement in the process lung parenchyma, which is
more appropriate to designate as a chronic inflammation of the structural
components of the lungs (chronic bronchopulmonary disease). In contrast to
acute pneumonia, respiratory failure (<span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">ventilation, diffusion, distribution</span>) develops
gradually, slowly.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Circulatory hypoxia also
slowly joins respiratory one with the development of hypertension in the
pulmonary circulation and pulmonary heart. Hypoxia is defined already in the
preterminal stage of disease. Prolonged hypoxemia leads to disruption of all
metabolic functions of organs and systems, and in severe cases - to
morphological changes. This manifests itself in reducing the child's memory,
his irritability, aggression (CNS), liver enlargement and functional disability
decrease enzymatic function of the stomach and intestines (digestion tract),
dryness of the skin, mucous membranes, papillae atrophy of tongue
(hypovitaminosis), etc. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Thus, the basis of chronic
bronchopulmonary pathology is organic and functional changes in the
bronchopulmonary system and the subsequent development of hypoxemia and
hypoxia. Now there is reason to talk about the distortion of the immunological
status and surfactant deficiency in chronic bronchopulmonary disease. However,
their role in the deep pathological, progressive changes has not been fully established.
We can only assume their genetically determined deficiency, which causes
chronization and progression of the process.</span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Clinic
</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The clinic is
manifested as symptoms of a general nature and directly related with the
bronchopulmonary system. It must be remembered that chronic bronchopulmonary
pathology in 80% of cases occurs in the first 3 years of life and approximately
50% - in the first year of life, when its diagnosis at the initial stage is
difficult<span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">. It is necessary
to clarify the frequency of respiratory episodes in a child, and their
duration.</span> With increasing frequency of these episodes, their duration
and the probability of chronization of the process increase.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;">Coughing</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> is a reflex act aimed at
self-purification of the respiratory tract of mucus, pus, blood, foreign body,
and other particles, which are normally not present in the bronchial tree. In
chronic respiratory pathology there is occurrence of <span style="mso-spacerun: yes;"> </span>the proliferation of the bronchial mucosa in
relation to the inflammatory reaction, hypersecretion of glands, a violation of
peristalsis, the accumulation of mucus and pus, compression of the bronchi and
trachea by enlarged lymph nodes. Cough, mostly wet, accompanied by sputum, in
the presence of emphysema is severe, unproductive, in remission - dry.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;">Sputum</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> is puromucous or purulent, more in
the morning. It is not a three-layer, as in adults, in small quantities (30-50
ml), it is difficult to obtain it, because in most cases children can not
expectorate. For bacteriological examination sputum is taken during
bronchoscopic lavage or after digital pressure with a spatula on the tongue
root, which causes reflex cough with expectoration. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Cyanosis</span> appears at exacerbation of chronic
respiratory pathology or with the development of chronic pulmonary vascular
disease, when it is constant and, depending on the activity of the pathological
process, only its intensity changes. Often there is observed increase in body
temperature, the phenomenon of hyperhidrosis.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>We must always pay attention at
the <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">form of a chest</span>.
Its deformation is evident in moderate and severe cases. It indicates a
significant area of the pathological process in the lungs and long-term
hypoxemia. "Chicken", "pigeon" chest, depressed sternum are
signs of chronic bronchopulmonary diseases in preschool age; barrel - in
schoolchildren. The asymmetry of the chest, deformation, a marked decrease in
the size of a half part in measuring by centimeter tape - all this makes it
possible to analyze during the inspection the severity, duration and
localization of process.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="277" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image182.jpg" width="172" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="227" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image184.jpg" width="218" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="360" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image186.jpg" width="339" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="388" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image188.jpg" width="222" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="394" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image190.jpg" width="233" /></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;">Shortness of breath</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> at chronic
bronchopulmonary disease is mixed, sometimes expiration. Deformation of the
fingers in the form of drum sticks and nails in the form of watch glass
reflects the duration of hypoxemia.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><img height="281" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image192.jpg" width="375" /><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;">Percussion</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> reveals </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">band</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">box
sound (emphysema), at marked sclerotic changes shortening is detected. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Auscultation</span> (at
exacerbation) reveals diversity of dry and moist rales. Constant local fine
bubbling moist rales is the criteria of chronic bronchopulmonary disease. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Cardiovascular system</span>: expansion of the right
heart, accent of the second tone in the pulmonary artery, weak tones and
functional systolic murmur, the ECG changes shows myocardial hypoxia.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;">Digestive system</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">. Appetite is
reduced, the liver </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">is </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">increased in size, its function is
disrupted, there are disorders in hydrolysis and absorption of food, in severe
cases, a child retards in the mass and growth. The skin is dry, visible pallor,
reduced flexibility, opacity and the fragility of the hair. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Sometimes there is</span> short-term allergic rash, once rising
of high temperature (due to a violation of drainage of purulent sputum).
Headache, fatigue, irritability, aggression, memory decline indicate CNS
violation. Pulmonary hemorrhage is very rare in children.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">X-rays changes</span> are different: increased lung
pattern, its deformation, cyst enlightenments, volume reduction of segment,
lobe, mediastinal shift toward pathology, disatele</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;">с</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">tasis
(airless areas alternate with emphysema). Characteristic for this disease is
that they are sustainable. They can only increase at exacerbation, but remain
in remission.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="344" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image194.jpg" width="515" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="219" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image196.jpg" width="324" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="238" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image198.jpg" width="297" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Left side chronic
bronchopulmonary<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Direct radiogram of chest.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">disease.<span style="mso-spacerun: yes;">
</span>Decreasing of left lung field,</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>shadowing in the middle areas.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section12">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="400" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image200.jpg" width="243" /></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Detail of chest radiograph at peribronchial pneumosclerosis in patient
with chronic obstructive bronchitis: lung pattern is reinforced and deformed, there
are clearly distinguished bronchial lumen, bordered by thickened walls.</span></span></div>
</div>
<span style="background-color: white;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt; line-height: 150%;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></b>
</span><div class="Section13">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="395" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image202.jpg" width="308" /></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Detail of chest radiographs in a direct projection at chronic
bronchopulmonary disease: at low part of the right lung field lung pattern is
reinforced and deformed, its radial direction can not be seen.</span></span></div>
</div>
<span style="background-color: white;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt; line-height: 150%;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></b>
</span><div class="Section14">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">At bronchographic observation</span> (which is obligate)
there are the deformation of the bronchi, cylindrical and saccular
bronchiectasis, reducing the angle of the bronchi branching.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image204.jpg" width="400" /></span></b></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</div>
<span style="background-color: white;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt; line-height: 150%;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></b>
</span><div class="Section15">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><img height="431" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image206.jpg" width="293" /></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Bronchiectasis. Coloured bronchogram (X-ray) of a human lung showing
bronchiectasis.Bronchiectasis is a lung disorder in which the bronchi and
bronchioles (airways of the lungs, red) are permanently dilated and distorted.
In this case, some of the bronchi have terminal bulbous enlargements, a
condition known as fusiform (saccular) bronchiectasis.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image208.jpg" width="247" /><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="337" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image210.jpg" width="245" /><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Normal bronchogram.<span style="mso-spacerun: yes;"> </span>Varicose bronchoectasis.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><img height="312" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image212.jpg" width="312" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Representative</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> CT</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> scan image from a
person with advanced CBPD shows emphysematous changes and subpleural blebs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Identification of chronic
bronchopulmonary diseases at the level of deforming bronchitis without
bronchiectasis may be conventionally considered<span style="mso-spacerun: yes;">
</span>because the stabilization of the pathological process in these
conditions is more likely. Clinical experience shows that bronchiectasis is
less evident than deforming bronchitis. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="291" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image214.jpg" width="291" /></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span lang="EN-US"></span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Deforming
bronchitis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Deformations of the bronchi may
be different: the broadening or narrowing of the lumen, presence of granulation
and follicular polyps, false cysts, bronchiectasis (cylindrical, saccular,
mixed), which lead to varying degrees of obstruction of small bronchi. Chronic
process in the lung tissue in combination with deforming bronchitis or
bronchiectasis becomes stable, leads to irreversible changes in the affected
area of lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>It is believed that chronic
bronchopulmonary diseases are characterized by the local endobronchitis.
However, at the severe forms with involvement in the pathological process of
many segments of the left and right lungs endobronchitis becomes diffuse.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Modern classification of chronic
pulmonary disease involves the next indicators: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">1. Localization and extent of
pathological process (segment or segments, lobe). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">2. The nature of bronchial
lesions: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Deformation </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Bronchiectasis: cylindrical,
saccular, varicose, mixed </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Bronchostenosis </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">3. Nature of endobronchitis: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Catarrhal </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Purulent </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Local </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Diffuse </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">4. Current: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- With occasional
exacerbations </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- With frequent exacerbations </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Continuously recurring </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">5. Severity: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Mild </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Moderate </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Severe </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">6. Period of illness: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Exacerbation </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Recovery </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Remission </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">7. The degree of respiratory
failure. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">8. Complications: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Pulmonary (emphysema,
obstructive syndrome, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>abscess, pulmonary hemorrhage, pleurisy,
pyopneumothorax etc.) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Extrapulmonary (pulmonary
heart, amyloidosis, brain abscess)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Diagnostic criteria
of chronic bronchopulmonary disease: </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">1. Anamnesis: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">a) direct link with a previous
acute pneumonia; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">b) recurrent inflammation in
the same area of the lungs. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">2. Clinical: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">a) cough (mostly wet); </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">b) sputum (mucous-purulent); </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">c) hyperhydrosis, intermittent
fever; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">d) deformation of the thorax
(in particular, flattening on the side of lesion; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">d) the presence of stable
local fine bubbling moist rales. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">3. Radiographic: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">a) strengthening and
deformation of the pulmonary pattern; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">b) thickening of the bronchial
walls; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">a) reducing of fibrosic lung
segments; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">d) infiltration of lung tissue
in the focus of the lesion in the acute phase. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">4. Bronchologic: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">a) Bronchoscopy - a localized
endobronchitis; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">b) Bronchography: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Cylindrical or saccular
bronchiectasis; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Curvature, the convergence
of bronchial trunks (deforming bronchitis) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- Bronchostenosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="300" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image216.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pneumothorax</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">WHO Strategy for prevention
and control of Chronic Respiratory Diseases:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Introduction</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">The Global Strategy for the
prevention and control of noncommunicable diseases, developed in direct
response to the global threat posed by noncommunicable diseases and endorsed by
the Fifty-Third World Health Assembly, cites chronic respiratory disease as one
of the four priority disease groups to be addressed.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Factors
contributing to the burden of CRDs</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="404" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image218.jpg" width="539" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="406" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image220.jpg" width="541" /></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Goal
of the strategy</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="387" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image222.jpg" width="516" /></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Objectives
of the strategy</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="387" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image224.jpg" width="516" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">General
principles</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="414" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image226.jpg" width="552" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Strategic
directions</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="414" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image228.jpg" width="552" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt;">Referens:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt;">A - Basic: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt;">1.<span style="mso-spacerun: yes;"> </span>Pediatrics. Textbook. /
O. V. Tiazhka, T. V. Pochinok, A. N. Antoshkina et al. /
edited by O. Tiazhka – Vinnytsia : Nova Knyha Publishers, 2011 – 584 pp. : il.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt;">2.<span style="mso-spacerun: yes;"> </span>ISBN
978-966-382-355-3Nelson Textbook of Pediatrics, 19th Edition Kliegman, Behrman.
Published by Jenson & Stanton, 2011, 2608.<span style="mso-spacerun: yes;">
</span>ISBN: 978-080-892-420-3.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt;">3.<span style="mso-spacerun: yes;"> </span>Illustrated Textbook of
Paediatrics, 4th Edition.<span style="mso-spacerun: yes;"> </span>Published
by<span style="mso-spacerun: yes;"> </span>Lissauer & Clayden, 2012, 552 p.
ISBN: 978-072-343-566-2.</span></span></div>
<span style="background-color: white;">
<span lang="UK" style="font-size: 14.0pt;">4.<span style="mso-spacerun: yes;"> </span>Denial Bernstein.
Pediatrics for medical Students. – Second edition, 2012. – 650 p.</span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com1tag:blogger.com,1999:blog-7275300796104068287.post-76108869812734942142013-04-02T15:57:00.002-07:002013-04-02T15:57:57.912-07:00Hereditary Polyorganic Diseases Mainly Affecting The Respiratory System<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><b style="mso-bidi-font-weight: normal;">Cystic fibrosis <span style="mso-spacerun: yes;"> </span></b></span></span>
<br />
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Cystic fibrosis is a hereditary systemic disease caused by
mutation of cystic fibrosis transmembrane regulator and characterized by exocrine
glands disorders, severe impaired function of the respiratory and gastro-intestinal
tract.</span> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="258" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image135.jpg" width="322" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 51.05pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Cystic fibrosis is the most
common cause of chronic lung disease in children and young adults, and the most
common fatal hereditary disorder affecting Caucasians in the US.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Etiology and Pathogenesis </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The disease is the result of gene
mutation. Pathological gene is localized in the middle of the long arm of
chromosome 7. Cystic fibrosis is inherited in an autosomal-recessive type and
is registered in most European countries with a frequency of 1:2000 - 1:2500
newborns. If both parents are heterozygous carriers of the mutated gene, the
risk of birth of the child with cystic fibrosis is 25%. According to studies
the frequency of heterozygous carriers of the pathological gene is 2-5%.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="264" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image137.jpg" width="120" /><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="375" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image139.jpg" width="395" /><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">This chart can help you determine the genetic
probability of having a</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>child with cystic fibrosis</span></b></span></div>
<span style="background-color: white;">
</span><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 123.15pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">Parents</span></b></span></div>
</td>
<td style="-moz-border-bottom-colors: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; border-color: windowtext windowtext windowtext -moz-use-text-color; border-image: none; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">Chance of Unaffected Child</span></b></span></div>
</td>
<td style="-moz-border-bottom-colors: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; border-color: windowtext windowtext windowtext -moz-use-text-color; border-image: none; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">Chance of Child Carrier</span></b></span></div>
</td>
<td style="-moz-border-bottom-colors: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; border-color: windowtext windowtext windowtext -moz-use-text-color; border-image: none; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">Chance of Child with CF</span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.15pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Unaffected + Carrier<span style="mso-tab-count: 1;"> </span></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">50%</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">50%</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">No Chance</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.15pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Two Carriers</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">25%</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">50%</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">25%</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.15pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Unaffected + CF Patient</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>No Chance</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">100%</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>No Chance</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.15pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Carrier + CF Patient</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>No Chance</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">50%</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 123.2pt;" valign="top" width="164">
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">50%</span></span></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Currently, there are about
1000 identifiable gene mutations in cystic fibrosis. The consequence of gene
mutation is a disturbance of the structure and function of the protein, known
as the cystic fibrosis transmembrane regulator (CFTR). The result is a
thickening of the secrets of exocrine glands, difficulty in evacuation
secretion and changes in its physical and chemical properties, which, in turn,
causes the clinical picture. Changes in the pancreas, respiratory and
gastro-intestinal tract are recorded in the prenatal period and with the
patient's age are steadily increasing. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Isolation of a viscous exocrine
glands secretion leads to difficult output and stagnation with subsequent
expansion of the excretory ducts of glands, atrophy of glandular tissue and the
development of progressive fibrosis. Enzyme activity of the intestine and
pancreas is significantly decreased. Along with the formation of sclerosis in
the organs there is a violation of the functions of fibroblasts. It is
established that fibroblasts of patients with cystic fibrosis produce ciliary
factor, or M-factor, which has anticiliar activity - it disrupts the function
of ciliar epithelium.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="379" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image141.jpg" width="379" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="tab-stops: 51.0pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Schematic
representation of proposed CFTR structure. CFTR is made up of five domains: two
membrane-spanning domains that form the chloride ion channel, two
nucleotide-binding domains that bind and hydrolyze ATP and a regulatory domain.
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="260" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image143.jpg" width="400" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Pathological
anatomy. </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Pathological changes in the lungs are
characterized by symptoms of chronic bronchitis with the development of
bronchiectasis and diffuse pneumosclerosis. In the bronchial lumen there is the
viscous mucous-purulent content. Often findings are <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>atelectasis and areas of emphysema. In many
patients during the pathological process in the lungs there are complications
by joining the bacterial infection (pathogenic Staphylococcus aureus,
Haemophilus influenzae and Pseudomonas aeruginosa) and the formation of destruction.
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>In the pancreas there are revealed
diffuse fibrosis, thickening of the interlobular connective tissue, cystic
changes of small and medium-sized ducts. In the liver there are indicated focal
or diffuse fatty and protein dystrophy of liver cells, bile stasis in the
interlobular bile ducts, interlobular lymphohistiocytic infiltrates in
intralobular layers, fibrous transformation and development of cirrhosis. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>At meconium ileus there is expressed
atrophy of the mucous layer, mucous glands of the intestinal lumen are enlarged,
filled with eosinophylic secretion masses, sometimes there is edema of
submucosal layer, the expansion of lymphatic slits. Often cystic fibrosis is combined
with various anomalies of gastrointestinal tract.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">There are the following clinical forms of
cystic fibrosis: </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>mostly pulmonary (respiratory,
bronchopulmonary) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>mostly enteric form </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>mixed form with simultaneous involvement of
the gastrointestinal tract and</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>respiratory system </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>meconium ileus </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>atypical and abortive forms (edematous-anemic,
cirrhotic, and others).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Clinical
features in 70% of cases of cystic fibrosis is detected during the first
2 years of life.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;">The signs and symptoms of CF in children and young
adults may include:</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Salty taste of the skin. People with CF
tend to have two to five times the normal amount of salt (sodium chloride) in
their sweat. This may be one of the first signs parents notice because they
taste the salt when they kiss their child. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Blockage in the bowel.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Foul-smelling, greasy stools.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Delayed growth.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Thick sputum. It's easy for parents to
overlook this symptom because infants and young children tend to swallow their
sputum rather than cough it up.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Coughing or wheezing.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Frequent chest and sinus infections with
recurring pneumonia or bronchitis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Growths (polyps) in the nasal passages.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Cirrhosis of the liver due to inflammation
or obstruction of the bile ducts.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Displacement of one part of the intestine
into another part of the intestine (intussusception) in children older than age
4.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Protrusion of part of the rectum through
the anus (rectal prolapse). This is often caused by stools that are difficult
to pass or by frequent coughing.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14pt;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14pt;">Enlargement or rounding (clubbing) of the
fingertips and toes. Although clubbing eventually occurs in most people with
CF, it also occurs in some people born with heart disease and other types of
lung problems.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="342" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image145.jpg" width="480" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Meconium ileus </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>At 30-40% patients cystic
fibrosis is diagnosed in the early days of life in the form of meconium ileus.
This form of the disease is due to a lack of trypsin, which leads to
accumulation in the loops of the small intestine (usually in the ileocecal
region) of dense, viscous meconium. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>A healthy newborn first feces
departs at first, less often - the second day after birth. In a sick child
meconium is absent. By the second day of life the child becomes restless,
abdomen is distended, regurgitation and vomiting are marked with an admixture
of bile. After 1-2 days the state of newborn becomes worse: skin is dry and pale,
expressed vascular pattern appears on the abdomen, tissue turgor is reduced,
anxiety is replaced by lethargy and adynamia, signs of intoxication and dehydration
occur.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">An objective examination</span> of patients reveals
dyspnea and tachycardia, at the percussion of the abdomen – tympanic sound.
Auscultation: peristalsis is not listening. Review radiograph of the abdominal
cavity reveals swollen loops of the small intestine and sleeping units in the
lower abdomen. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Complication meconium ileus
may be perforation of the intestine with the development of meconium
peritonitis. Frequently, the intestinal obstruction in cystic fibrosis patients
on the 3-4-th day of life is associated with pneumonia, which has a protracted
nature. Intestinal obstruction may also develop later.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="278" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image147.jpg" width="438" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">A. Illustration of intestine blocked by meconium. B. Abdominal xray of a
newborn infant with meconium ileus showing dilated loops of bowel.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">Pulmonary (respiratory) form </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="287" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image149.jpg" width="413" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The first symptoms of
broncho-pulmonary forms of cystic fibrosis are fatigue, paleness of the skin,
lack of weight gain with satisfactory appetite. In some cases (severe course)
from the first days of life the patients have hacking cough, which gradually
increases and becomes like pertussis. The cough is accompanied by excretion of
the thick phlegm, which with presence of the bacterial flora is subsequently mucopurulent.
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The increased viscosity of bronchial
secretion leads to the development mucostasis and occlusions of small bronchi
and bronchioles, which contribute to the development of emphysema, while the
total occlusion of the bronchi - the formation of atelectases. In very young
children lung parenchyma becomes quickly involved in the pathological process,
which leads to the development of severe, prolonged pneumonia with a tendency
to abscess formation. Lung affection is always bilateral. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="261" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image151.jpg" width="287" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><img height="553" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image153.jpg" width="265" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>An <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">objective examination</span>
indicated moist small-and medium bubbling rale, bandbox percussion sound.
Patients may have toxemia, and even clinical shock on the background of
diseases that occur with a high body temperature, or in the hot season in a
significant loss of sodium and chloride through sweat. Later chronic pneumonia
occurs with pneumosclerosis and bronchiectasis, symptoms of "cor
pulmonale", respiratory and cardiac failure.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>At long course of disease there is
involving in the pathological process nasopharynx: sinusitis, adenoidal
vegetation, nasal polyps, chronic tonsillitis. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Radiological examination</span> of the lungs at cystic
fibrosis reveals widespread peribronchial, infiltrative, sclerotic changes and
atelectasis on the background of marked emphysema. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">At bronchography</span> there is the presence of
drop-shaped bronchiectasis, bronchial abnormalities and a decrease in the
number of small branches, the bronchi 3-6-th calibre are in the form of beads. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">At bronchoscopy</span> there is
often found a small amount of thick viscous sputum, which resides in the form
of threads in the lumens of the major bronchi. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Microbiological examination of sputum</span> in cystic
fibrosis patients can identify Staphylococcus aureus, Haemophilus influenzae
and Pseudomonas aeruginosa. The presence of Pseudomonas aeruginosa in sputum is
a poor prognostic sign for the patient.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>There is specific appearance
of the patient: pale-gray skin, acrocyanosis, general cyanosis, shortness of
breath at rest, barrel chest, sternum deformation of type "wedge" and
deformation of terminal phalanges of the type "drumsticks ",limitation
of motor activity, decreased appetite and weight loss.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="289" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image155.jpg" width="505" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Symptom of </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">"drumsticks
" and "watch glasses" at cystic fibrosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><img height="257" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image157.jpg" width="456" /></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">CT gram</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="363" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image159.jpg" width="380" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Ultrasound of the chest.
Bronchiectasis in a vacuum section of lung at cystic fibrosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="293" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image161.jpg" width="257" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Frontal chest X ray in CF shows diffuse interstitial disease with
bronchiectasis and nodular densities of mucoid impaction.CF = cystic fibrosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="312" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image163.jpg" width="266" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">At bronchography of
the left lung in left lateral projections shows the decrease of the lower lobe
of the left lung, convergence and expressed deformation of the bronchial tree,
cylindrical bronchiectasis, lack of filling in small bronchial branches.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The rare complications of cystic fibrosis</span> are
pneumo- and pyopneumothorax, pulmonary hemorrhage. In a more favorable course
of cystic fibrosis, at which onset of the disease is observed at older age,
bronchopulmonary pathology manifests slowly with progressive deforming
bronchitis with moderate pneumosclerosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Intestinal form</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span><img height="348" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image165.jpg" width="300" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Clinical symptoms of the intestinal form</span> are
caused by secretory insufficiency of the gastrointestinal tract. Violation of
the enzymatic activity of the gastrointestinal tract is particularly pronounced
after the transfer of the child to bottle-feeding or complementary feeding and
manifest lack of splitting and absorption of proteins, fats and carbohydrates. Putrefactive
processes is dominated in intestine, accompanied by the accumulation of gases,
which leads to bloating. Frequent bowel movements, polifecalia (daily amount of
feces 2-8 times exceed the age limit). In elder patiens with cystic fibrosis there
is often marked prolapse of the rectum (in 10-20% of patients). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Patients complain of</span> dry mouth, due to the high
viscosity of saliva. Patients with difficulty chew dry food, and during meals drink
a significant amount of fluid. Appetite in the first months is normal or even
increased, but due to the violation of the digestive processes in patients hypotrophy
and polyhypovitaminosis <span style="mso-spacerun: yes;"> </span>rapidly occur.
Muscle tone and tissue turgor are reduced. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Patients complain of</span> abdominal pain of various
kinds: cramping - with meteorism, muscle - after coughing, pain in right
hypochondrium - the presence of right heart failure, pain in epigastric region
due to the lack of neutralization of gastric juice into the duodenum at a
reduced secretion of pancreatic bicarbonates. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Violation of neutralization of gastric juice</span> may cause the
development of duodenal ulcer or ulcerative process in the small intestine.
Intestinal complications of the cystic fibrosis may be secondary disaccharidase
failure, intestinal obstruction, secondary pyelonephritis and urolithiasis on
the background of metabolic disorders, latent diabetes in lesions of insular
apparatus of the pancreas. Violation of protein metabolism leads to
hypoproteinemia, which becomes the cause of development in some cases, infants
edema. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Hepatomegaly</span> (liver enlargement) occurs due
to cholestasis. When clinical picture of biliary cirrhosis is present there may
be observed jaundice, itching, signs of portal hypertension, ascites. Cirrhosis
of the liver in some patients may develop without cholestasis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Mixed
form</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;">
</span>Mixed form of cystic fibrosis is the most severe and includes clinical
symptoms of pulmonary and intestinal forms. Usually the first week of life the
patient has severe recurrent bronchitis and pneumonia with protracted,
persistent cough, bowel syndrome, eating disorders and expressed dyspeptic
syndrome. Clinical features of cystic fibrosis differ by considerable
polymorphism, which determines the clinical variants of the disease. Severity of
cystic fibrosis depends on the onset of the first symptoms. For the younger
child the disease manifestation are severer and <span style="mso-spacerun: yes;"> </span>prognosis is more unfavorable. Taking into
account the polymorphism of clinical manifestations of cystic fibrosis severity
is determined in most cases by the nature and extent of lesions of the broncho-pulmonary
system.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">There are 4 stages of pathological changes in the
bronchopulmonary system in cystic fibrosis: </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• 1-stage - the
stage of non-permanent functional changes, which is characterized by a dry
cough without sputum, low or moderate dyspnea during physical exertion.
Duration of this stage may be up to 10 years. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• 2-stage - stage
of development of chronic bronchitis, which is characterized by the presence of
cough with phlegm excreation, moderate dyspnea (increases with tense), the formation
of the deformation of the terminal phalanges. Auscultation reveals moist,
"booming" rales on the hard breathing. The duration of this stage may
range from 2 to 15 years. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• 3-stage - stage
of the progression of bronchopulmonary process with the development of
complications. There are forming a zone of diffuse pulmonary fibrosis and focal
pneumosclerosis, bronchiectasis, cysts and severe respiratory failure in
combination with RV heart failure (cor pulmonale). The duration of the stage is
from 3 to 5 years. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">• 4-stage is
characterized by severe cardio-respiratory insufficiency, which in the months is
leading to the death of the patient.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Diagnosis
</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The diagnosis
of cystic fibrosis is determined by the data of clinical and laboratory
examination of a patient. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>For the diagnosis of
the disease four basic criteria are necessary: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">chronic bronchopulmonary process </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">bowel syndrome </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">cases of cystic fibrosis in sibs </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;"><img alt="*" height="16" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image001.gif" width="16" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">positive results of sweat test. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Sweat</span> for the study is collected after
electrophoresis with pilocarpine. The minimum amount of sweat required to
obtain reliable results, is 100 mg. The difference between the sodium and
chlorine in the sample should not exceed 20 mmol / l, otherwise the study is
repeated. At an acceptable methodology the determination of one of the ions is
possible. In healthy children the concentration of sodium and chloride in the
sweat can not exceed 40 mg / dl. Diagnostic criteria for cystic fibrosis is a
reliable content of chloride ions more than 60 mmol / l<span style="mso-spacerun: yes;"> </span>and sodium – more than 70 mmol / liter. To
confirm the diagnosis there is required three positive sweat test s with
chloride more than 60 mmol / liter. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Important in the diagnosis of cystic
fsbrosis has <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">coprological
study</span>.</span><span lang="EN-US"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">In patients with cystic
fibrosis in coprogram the most characteristic feature is the high content of
neutral fat, but perhaps the presence of muscle fibers, cellulose and starch
grains, which allows determine the degree of impairment of the enzymatic
activity of the gastrointestinal glands. Under the supervision of data coprological
research the dose of pancreatic enzymes is correcting. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Approximate methods</span> for the diagnosis of cystic fibrosis
are the identification of the proteolytic activity of feces by X-ray test,
enzyme activity of the pancreas in the duodenal contents, the concentration of
sodium in nails and salivary gland secretion. As a screening test in the
neonatal period the method of determining the high content of albumin in
meconium - meconium test is used (normal albumin content does not exceed 20 mg
per 1g of dry weight). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A special place in the
diagnosis is <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">molecular
genetic testing</span>. Today, the presence of known mutations is available
identifying in 65-75% of patients with cystic fibrosis, which makes it
impossible to use for verification of the diagnosis of the disease only by molecular-genetic
examination.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;">
</span>Differential diagnosis </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The differential diagnosis of
cystic fibrosis is conducted with whooping cough, obstructive bronchitis,
bronchial asthma, congenital and acquired bronchiectasis, pulmonary fibrosis nonpancreatic
origin. In the presence of a high rate of electrolytes in sweat cystic fibrosis
is differentiated with such diseases as diabetes insipidus, adrenal
insufficiency, hereditary ectodermal dysplasia, glycogenic disease, lack of
glucose-1-phosphatase, hypoparathyreoidism, malnutrition, gargoilism, fucozidosis,
dehydration, edema.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Treatment of cystic fibrosis is symptomatic.
<span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Feeding</span> is very
important to the patient. Daily calories must be 10-30% higher than the age
limit due to an increase in dietary protein component. Protein requirements are
satisfied by the consumption of meat, fish, eggs, cottage cheese. Fat intake is
significantly reduced. It is possible to use the fat, composed of fatty acids
with an average size of the chain, because their digestion does not dependent
on the activity of pancreatic lipase. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>At deficiency of
disaccharidases in the small intestine the corresponding sugar (usually
lactose) must be excluded from the diet. It is necessary to add salt to food,
especially in the hot season and at high temperature, because of the large
losses of salt through sweat. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A sufficient intake of
fluids is provided to the patient. In the food should be included products
containing vitamins, fruit and vegetable juices, butter.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>It is obligatory to carry out <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">correction of pancreatic
function</span> through the use of pancreatin or combined preparations
containing pancreatin, along with other intestinal enzymes and lipotropics (Creon,
Polizim, panzinorm, meksaza, etc.). The dose of enzyme preparations is picked
individually, focusing on data of coprological study. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Indicators of the optimal
selection of a dose are normalization of stool and the disappearance of neutral
fat in feces. The initial dose is 2-3grams a day. Dose is gradually raised
until a positive effect. To liquefy the secrets of the gastrointestinal tract
and improve their excreation the acetylcysteine is used in tablets and
granules, which is indicated at cholestasis, viscous duodenal contents, impossibility
of probe.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><img height="255" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image167.jpg" width="138" /><span style="mso-spacerun: yes;"> </span><img height="277" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image169.jpg" width="156" /></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Treatment of pulmonary syndrome</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> includes a complex
of measures aimed at thinning of the sputum and removing it from the bronchi.
For this purpose physical, chemical and instrumental methods are applied. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Mucus-thinning therapy</span> is carried out daily
throughout the patient's life. The effectiveness of treatment increases with
the simultaneous use of aerosol inhalation, exercise therapy, vibratory massage
and postural drainage. The number and duration of inhaled medicines depend on
the severity of the patient. As a mucus-thinning drugs may be used saline-alkaline
mixture (1-2% solution– saline chloride and sodium carbonate), bronchodilators
drugs acetylcysteine (one inhalation of 2-3 ml of 7-10% solution), pulmozim
(dornaza alpha). Postural drainage is carried out every morning, vibrating
massage - at least 3 times a day.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Therapeutic bronchoscopy</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> with bronchial lavage with acetylcysteine
and isotonic sodium chloride solution is indicated as emergency procedure in
the absence of the effect of the previous therapy. During periods of
exacerbation, in the presence of acute pneumonia or acute respiratory viral
infection there are indications for <span style="mso-spacerun: yes;"> </span>the
using of antibacterial therapy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Antibacterial drugs</span> are injected parenterally
(semi-synthetic penicillins, cephalosporins of second and third generation,
aminoglycosides, Chinolones) and in the form of aerosols (aminoglycosides:
gentamicin, tobramicin). As the pneumonia at cystic fibrosis has a prolonged
duration, a course of antibiotics is not less than one month and sometimes
more. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In severe pneumonia, <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">corticosteroids</span> are used
for 1,5-2 months. Prednisolone is prescribed in dose of 1,0-1,5 mg / kg / day
for 10 - 15 days. Then the dose is gradually reduced. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Antibiotics are used during the
course of corticosteroid therapy. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">In addition to antibacterial and mucus-thinning therapy there are
carried out a full range of therapeutic measures aimed to liquidate hypoxia,
cardiovascular disorders, acid-base changes.</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="250" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image171.jpg" width="289" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="281" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image173.jpg" width="289" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The organization of <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">dispensary observation</span> of
patients with cystic fibrosis in an outpatient setting it is necessary to
monitor a feces and a patient's body weight, regular (1 every 3 months) to
conduct coprological study for correction of <span style="mso-spacerun: yes;"> </span>doses of the pancreatic enzymes, in the spring
and during exacerbation of the process to assign courses of vitamins (it is justified
the appointment of double dose of fat-soluble vitamins A, E, D in water
solutions). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Relatives of the patient should
be taught techniques of postural drainage, vibration massage and care for the
patient. Along with exercise therapy, physical therapy recommends dosing
exercise and sports. At sustained remission for 6 months there is allowed
preventive vaccinations.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image175.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>The prognosis</span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> for cystic fibrosis
remains serious. Mortality is 50-60% among young children. Late diagnosis of
disease and inadequate therapy significantly worsen the prognosis. Currently
there is available the diagnostic of the disease in early pregnancy, and
therefore becomes important medico-genetic counseling of families in which
there are patients with cystic fibrosis.</span></span></div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-81027687818677840752013-04-02T15:55:00.002-07:002013-04-02T15:55:32.011-07:00 Idiopathic Pulmonary Hemosiderosis (IPH) <span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"></span><b style="mso-bidi-font-weight: normal;">Idiopathic pulmonary hemosiderosis - </b><span style="mso-bidi-font-weight: normal;">(syn.: idiopathic
pulmonary progressive induration, purpura immune pulmonary disease, Delen-
Gellerstedt disease, etc.) - a disease in which the main symptom is recurrent
hemorrhage in lung tissue and the subsequent development of fibrosis and
hemosiderin deposition. </span></span></span>
<br />
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>At first the disease was
described by Virhow in 1864 under the name "brown lung induration".
The basis of the disease is bleeding in lung alveoli, which has usually a
diffuse character. Free iron as a result of the collapse of erythrocyte is
absorbed by macrophages, which may be found in the sputum of patients (siderophages).
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>It is </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">consider</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">ed
that the anomaly of arteriolar-venular anastomoses and pathological structure
of the connective tissue of the lungs is hereditary.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Pathogenesis.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>As a result of an inherited
defect forced hemocirculation of lung tissue occurs with a significant exit in it
red blood cells (per diapedesis) and the progressive sensitization of the
organism to them. Iron from haemolysed red cells becomes stable connected with
pathologic sulfated mucopolysaccharides and dose not return to the blood, dose
not include in the metabolism and synthesis of hemoglobin. Therefore, anemia
accompanying IPH is related with iron deficiency. Iron deposition, hemorrhage,
inflammation leads to pneumosclerosis, pulmonary hypertension and chronic
pulmonary failure. Allergic lesions of the joints, skin, heart, kidneys may
develop.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Morphologically</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> (based on open lung biopsy)
there are revealed red blood cells in the cavity of the alveoli,
hemosiderin-containing macrophages (siderophages), diffuse interstitial
fibrosis, sclerosis of small vessels of the lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinic </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The clinical
picture of IPH is composed of the respiratory and hematological
symptoms. At exacerbation cough appears, in older children accompanied by
hemoptysis - the appearance of blood in the sputum. Small children do not
expectorate sputum, they swallow it. With abundant pulmonary hemorrhage, they
may have vomiting with ingested blood. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Severity of the clinical picture in
the lungs depends on the amount of haemorrhage into the alveoli. Together with
cough and fever dyspnea and cyanosis occur. Wheezing in the lungs is listened.
Radiographic changes appear in the form of large focus shadows in both lungs.
The disease is often diagnosed as pneumonia, which leads to the appointment of
inadequate treatment and the worsening of patient's condition.</span></span></div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section5">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section6">
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Laboratory data </span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">1. Complete blood count: signs of anemia, aniso</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">-</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> and poicylocytosis,
reticulocytosis, during exacerbation - leukocytosis, leukocyte shift to the
left, increasing ESR. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">2. Biochemical blood analysis: an increase of the level
of indirect bilirubin and decrease of serum iron. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">3. General sputum analysis: siderophages are found. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">4. Investigation of lung biopsy: at a period of
remission hemorrhage is weakly expressed, mainly in the cortical areas of the
lung, pleura in these areas is thickened, in the alveoli, intralobulary, around
vessels, peribronhially and in connective tissue there are many hemosiderophages,
reactive fibrosis. At exacerbation alveolars are filled with fresh red cells,
alveolar macrophages containing hemosiderin. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">5. Peculiarity of radiological changes in the IPH is the
rapid regression of foci shadows. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="307" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image099.jpg" width="391" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Review chest X-ray of patients with idiopathic
pulmonary hemosiderosis: small meshy diffuse lung pattern deformation caused by
compaction of interstitial lung tissue, multiple foci of diffused small
monomorphic shadows.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="210" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image101.jpg" width="300" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>Idiopathic pulmonary
hemosiderosis.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="297" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image103.jpg" width="493" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Hemosiderophages in
hemoptysis of a patient with IPH. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Materials obtained through
bronchoalveolar lavage.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In some cases, the X-ray of
the chest indicates diffuse small shadows in both lungs, which are the reason
of mistake diagnosis of miliary tuberculosis of the lungs. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Changes in the lungs that maybe
detected with X-rays can vary widely: from small to massive infiltration shadows
accompanied by atelectasis, emphysema, and reaction from the lymph nodes of the
roots of the lungs. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Immediately after the exacerbation,
which lasts 3-5 days, there is marked anemia - microcytic and hypochromic. The
level of serum iron falls. In the biochemical analysis of blood there may be
elevated levels of bilirubin. Since the regenerative bone marrow function does
not suffer, in the peripheral blood reticulocytes appear. In young children in
the fecal analysis blood test may be positive (swallowed by coughing phlegm
with blood). Often there is hepatosplenomegaly.</span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The course
of idiopathic pulmonary hemosiderosis </span><span lang="EN-US" style="font-size: 14pt;">is </span><span lang="EN-GB" style="font-size: 14pt;">undulating.
Periods of crises alternate with periods of remission varying duration. Acute
and subacute forms<span style="mso-spacerun: yes;"> </span>are relatively distinguishing.
At acute form of disease there are a significant worsening, weakness, dyspnea. Older
children complain of chest pain, cough with small amount of sputum, relaxed
breathing and wet wheezing are listened in lungs. Perhaps may be raising the
temperature to febrile scores. There is rapidly increasing cell anemia. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>In the subacute form of IPH pallor of
the skin, the symptoms of intoxication gradually develop. Exacerbations of the
disease are more severe.</span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Diagnose. </b></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Diagnostic significance has
the discovery in sputum or endotracheal aspirate, and in some cases, in gastric
lavage sidergophages. Puncture biopsy of the lung is accompanied with serious
complications. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Investigation of respiratory function
detects or normal rates of ventilation, if the duration of the disease is little,
or restrictive severe violations, reduced lung diffusion capacity, if the
disease is prolonged with severe exacerbations. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>If repeated respiratory diseases
occur every time with anemia, an unusual radiological pattern in the lungs and ineffectiveness
of antiinflammatory therapy are present such a patient should be examined for
the presence of IPH.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="300" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image105.jpg" width="300" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Spirometer </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">SPIROVIT
SP-1</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section7">
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Lung Volumes and capacities</span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="207" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image107.jpg" width="285" /></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section8">
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
</div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section9">
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="290" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image109.jpg" width="360" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Lung
Volumes and Capacities</span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="356" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image111.jpg" width="642" /></span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Differential diagnosis</b> should be conducted with
tuberculosis and fungal infections of the lungs. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment.</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Treatment of
patients with IPH involves the appointment of corticosteroid drugs and
symptomatic treatment. During periods of exacerbation oxygen therapy,
glucocorticoids, antibiotics, disintoxication, vitamin and treatment of anemia are
indicated. If you find high levels of precipients to cow's milk this product is
excluded from the diet. Prednisolone is appointed by the dose of 1 -1.5 mg / kg
to achieve clinical and laboratory remission. There are reports that after
splenectomy resistant prolonged remission may occur. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Prognosis</b> is serious. Half of the children die in
the first five years after onset. Subsequent exacerbations are more difficulty
to treat, the average life span of a sick is 2-3 years, rarely – more. Immediate
causes of death often are acute massive pulmonary hemorrhage or progressive
pulmonary heart failure. Perhaps there is a combination of both reasons. And to
predict the probability of acute pulmonary hemorrhage is not possible.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Primary pulmonary hypertension (PPH)</span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: normal;">Primary pulmonary hypertension is a rise in pressure in the
pulmonary artery and right ventricular hypertrophy which are not associated
with congenital or acquired pathology of the heart and lungs. </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In 1901 Auerza described patient with
marked cyanosis, right ventricular hypertrophy and chronic bronchitis. Family
form of primary PH was first described in the report Clarke et al. in 1927. The
authors have noted a similar clinic and morphological changes in autopsy
material from two sisters, 5 - and 8-years of age and confirmed the presence of
primary PH. There are more than 20 titles of the disease. Among them:
Idiopathic right ventricular hypertrophy, primary pulmonary artery sclerosis,
isolated pulmonary hypertension, a disease Aersa etc. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Currently there is established the
gene BMPR2, localized in the locus of the second chromosome 2q33, which
regulates growth and proliferation of endothelial cells. This gene is
responsible for the development of a family primary pulmonary hypertension. The
disease is inherited in an autosomal-dominant type with incomplete penetrance,
which manifests itself in a population with a frequency of 1-2 cases per 1
million people. Family nature of PPH is approximately in 6% of patients, the
remaining cases are sporadic. Family form of PPH is not clinically different
from sporadic, but after the first symptoms is usually diagnosed earlier. In
sporadic cases diagnose of PPH is usually established in the advanced stages of
disease. <span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Pathomorphology.</span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Pathomorphologic changes in primary
pulmonary hypertension are clear. There is right ventricular hypertrophy,
expansion of large branches of pulmonary artery with layer fibroelastosis of
the intima, the presence of atriovenose anastomoses, thrombosis and fibrinous
necrotizing arteritis of small branches of the pulmonary artery. </span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinic. </span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>In the initial stages the
objective symptoms are mild, cardialgia in children is atypical. There is a
poor tolerance to physical activity through the development of shortness of
breath, sometimes accompanied by attacks of breathlessness. The appearance of syncope
point at severe phase of the disease, they often appear at an exercise, RV
heart failure increases. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>There
are three stages of development of pulmonary hypertension in children. At I stage
increased pulmonary pressure is the only hemodynamic abnormality, patients do
not have distinct symptoms, there may be shortness of breath during physical
activity, which often does not wary the doctors and patients for the presence
of the disease and is usually associated with poor training of the body. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>When
a decrease in cardiac output (II stage) occurs, there are detailed clinical
symptoms in the form of hypoxemia, dyspnea and syncope. Pressure in the
pulmonary artery remains stable at a high level. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>With
the advent of right heart failure III stage of disease occurs: in this case,
despite the consistently high values of pulmonary pressure, cardiac output
falls sharply, there are venous congestion and peripheral edema. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>There
is variability in the duration of different stages of the disease, an average from
6 months to 6 years or more from the stage of minimal hemodynamic changes to
the lethal disease. The reason of death is the developing prolonged functional
overload the right heart, destructive and sclerotic changes in lung tissue and
myocardium.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>PPH
affects mainly young patients, and the disease is usually fatal, although in
the literature there are described isolated cases of spontaneous remission. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>It is
assumed that the therapeutic activities of the patients of childhood will be
more effective, as the remodeling of the pulmonary vessels in children can be
prevented and even reversed. The development of new directions in treatment can
increase survival and improve quality of life of patients.<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="195" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image113.jpg" width="256" /></span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The child 13 yrs
old with PPH.</span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Weight - 33,5 kg (norm -
44,1 ± 8,68 kg), height - 144 cm (average 155,7 ± 6,57 cm). There are mixed
apnea, tachypnea to 38 per minute. Skin is pale, cyanosis of the lips,
acrocyanosis. </span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 51.0pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="218" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image115.jpg" width="290" /></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="218" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image117.jpg" width="290" /></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Deformation of the terminal phalanges as
"drumsticks" and "watch glasses", enlargement of the
abdomen (ascites) in patient with PPH. </span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="225" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image119.jpg" width="527" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ECG of patient with PPH. Sinus tachycardia
(cardiac rate 140 per minute).</span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Rightgram. Atrioventricular blockade Іst.
(PQ–0,20"). Expressed hypertrophy of right</span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">ventricular. Dilatation of the both auricles. </span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image121.jpg" width="385" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><img height="208" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image123.jpg" width="150" /></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A<span style="mso-spacerun: yes;">
</span>B</span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="290" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image125.jpg" width="165" /><span style="mso-spacerun: yes;"> </span><img height="244" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image127.jpg" width="339" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>C<span style="mso-spacerun: yes;">
</span>D</span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">A. Hypertrophy of media and adventitia of small
pulmonary arteries. </span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">B. Concentric intimal fibrosis of pulmonary
arteries with a diameter of 180 microns, there is also hypertrophy of the
middle and the outer shell of the vessel. </span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">C. Obliteration of the lumen of the pulmonary
artery. </span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">D. Plexiform defect. Note the absence of
elastic membrane in the wall plexiform structure. </span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Increasing x 100. Coloured by Verhoeff's - Van
Gieson.</span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="196" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image129.jpg" width="600" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Muscularization of arterioles: a - hematoxylin
and eosin. ґ400 b - immunohistochemical coloration on actin of smooth muscle
(SMA). ґ200.</span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="208" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image131.jpg" width="600" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Necrotizing arteritis. Coloured <span style="mso-spacerun: yes;"> </span>Rechanaled thrombus of branch
of</span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">by hematoxylin and<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>pulmonary
artery. Coloured<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">eosin <span style="mso-spacerun: yes;"> </span>ґ100..<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>by hematoxylin and
eosin<span style="mso-spacerun: yes;"> </span>ґ40.<span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="272" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image133.jpg" width="377" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="tab-stops: 51.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">EchoCG. A-wave is escaped.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Treatment</span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> is symptomatic:
antihypertensives, anticoagulants, antiplatelet agents. Effects are minor.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Prognosis</b> is poor. Life expectancy is
from several months to 10 years from </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">onset of the </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">first symptoms.</span></span></div>
</div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-44362409076945116272013-04-02T15:53:00.003-07:002013-04-02T15:53:46.762-07:00Idiopathic Fibrosing Alveolitis (Hamman-Rich Syndrome)<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">LV
Hamman, Amer. Physician, 1877-1946; AR Rich, Amer. Physician, was born in 1893;
synonym</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">s</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">: idiopathic
pulmonary fibrosis) - a progressive inflammatory lung lesion of unknown nature,
which leads to the development of diffuse fibrosis, chronic respiratory and
cardiopulmonary failure. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;">Hamman-Rich syndrome is a rare disease characterized by rapidly
progressive diffuse pulmonary fibrosis with the development of respiratory
failure, pulmonary hypertension and cor pulmonale.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="262" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image079.jpg" width="403" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Etiology.</b></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Hereditary disease with
autosomal dominant type of inheritance. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Pathogenesis.</span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> Previously in the development of syndrome there was attached
importance of auto-sensitization in connection with which diseases was entered
to a group of connective tissue disease. Now there is considered that the
syndrome occurs as the result of repeated inflammatory bronchopulmonary diseases.
Morphological substrate is perialveolar fibrosis, which reduces the elasticity
and pliability of lung tissue and thus worsens the excursion of the lungs. Due
to the thickening of the interalveolar septa diffusion of gases in the blood is
damaged, which leads to hypoxemia and hypoxia, hypercapnia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinic </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The disease manifests
itself mainly in school age children and adolescents, but the first signs of it
(on history) almost half of the patients are detected in pre-school age. The
disease begins gradually after an attack of influenza, repeated pneumonia,
bronchitis and often measles. There are a spastic, dry cough, shortness of
breath and cyanosis during physical exertion, sometimes chest pain, feeling of
tightness in the chest. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Percussion defines an
insignificant shortening of sound in the basal zones or no change, decrease of
excursion of lungs, reducing difference of lung volume during inspiration and
expiration. Auscultation reveals inconstant fine bubbling or crepitation moist
rales, sometimes may be weakening of breathing in the lower areas. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Further there are increasing
of cyanosis around the mouth, acrocyanosis, fingers take the form
"drumsticks". The child retards in weight and growth. Thorax is flattened,
circumference of the neck disproportionately increases (due to increased
contractility of the neck muscles that perform the role of auxiliary
respiratory muscles during difficult breathing). Pulmonary heart syndrome is developing
with the expansion of the cardiac dullness, signs of cardiovascular failure.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">In the blood</span> – polycythemia, may be polyglobulinemia,
ESR is increased, especially in acute periods, concentrations of gamma-globulin
is elevated. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The study of respiratory function</span> reveal the
decline of lung volumes, reduced lung compliance and difficulty in passing the
oxygen through the alveolar-capillary membrane, and therefore change in the gas
composition of the blood (hypoxemia, then hypercapnia) and indicators of
acid-base status.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="320" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image081.jpg" width="400" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">After treatment with corticosteroids LVC, total lung
capacity, the inspiratory volume is practically unchanged. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Radiological investigation</span>
in the initial period reveals that the interstitial pattern is enhanced, later nodular
formation appear on its background. In periods of exacerbations there is determined
multiple shadowing, alternating with areas of particularly clear lung fields. Shadowing
is usually localized in the roots and lower parts. Pneumothorax may be possible
complication.</span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="253" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image083.jpg" width="253" /></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section2">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Representative
CT scan image from a person with</span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>idiopathic pulmonary fibrosis.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="359" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image085.jpg" width="220" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="236" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image087.jpg" width="334" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span>Idiopathic fibrosing alveolitis</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Detail of chest radiograph with<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>interstitial pneumosclerosis
with a primary</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">lesion
of the alveolar connective tissue (fibrosing alveolitis):<span style="mso-spacerun: yes;"> </span>small meshy pattern of lung.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="322" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image089.jpg" width="386" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Micropreparations of lung at diffuse interstitial pneumosclerosis: interseptums
are extremely thickened and sclerotic; coloured by Van Gieson; × 24.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="577" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image091.jpg" width="530" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">A. Lung showing extensive interstitial and alveolar fibrosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Note the increased
interstitial cellularity with numerous fibroblasts.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">B. Patchy areas of alveolar septal thickening and prominent hyaline
membranes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">C. Higher magnification showing typical dense laminated hyaline
membranes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">D. Alveolar septum showing prominent type II pneumocyte proliferation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">E. Abundant polymorphonuclear leukocytes fill alveolar spaces with focal
destruction of alveolar septa.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">F. Higher power magnification showing the antraalveolar exudate</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">composed mainly of polymorphonuclear leukocytes, red blood cells, and
fibrin.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Original magnifications: A & B, x 50; C, x 100; D, x 158; E, x 50;
F, x 158.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="321" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image093.jpg" width="553" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Electron-microscopic picture of fibrosed alveoli.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="209" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image095.jpg" width="300" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>CT-image of
meshy lung</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="236" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image097.jpg" width="421" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Vacuolization of macrophages in amiodarone alveolitis. Materials
obtained through bronchoalveolar lavage.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The disease is </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">undulating</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">with periods of
exacerbation and remission. However, remission time zone fibrotic changes do
not disappear, and rates of respiratory still significantly reduced. Depending
on the frequency and duration of periods of exacerbation, some authors
distinguish subacute and chronic forms of course. In subacute form periods of
exacerbation are more frequent, accompanied by fever reaction, while at chronic
progression of pulmonary fibrosis occurs gradually and manifests the growth of
respiratory failure. At present, long-term treatment of patients with
corticosteroid differences within these two forms have become less pronounced. There
are two clinical forms of idiopathic diffuse pulmonary fibrosis depending on diffusion
of gases in the lungs. In most cases diffusion capacity is decreased, but in 10-15%
of patients it is within normal limits. In such patients the process is easier,
retarded growth and weight are insignificant or absent. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Diagnosis</b> is mainly based on typical
clinical signs of disease.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Diagnostic criteria of IFA </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Clinical </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">progressive dyspnea </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">cyanosis </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">dry cough </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">progressive loss of weight </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">tender crepitation wheezing </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">thickening of hand phalanges nails </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Radiographic </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">diffuse fibrosis </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">deformation of the pulmonary pattern </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">presence of focal shadows </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Indicators of
external respiration </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">decrease of lung volumes </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">hypoxemia </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Indicators of
regional lung function </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">diffuse irregular distribution of radionucleids </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">regional lung volume reduction </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">smoothing apex-basal ingredients</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Differential diagnose. </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Differential diagnosis should be carried out with
exogenous allergic alveolitis caused by the inhalation of various organic
antigens. Such condition is observed in children with close and prolonged
contact with animals and birds.</span> Clinically, the disease is very similar
to idiopathic diffuse pulmonary fibrosis. Exogenous allergic alveolitis is
diagnosed based on the detection of precipital antibodies against animal serum
and excrements. Excluding the effects of antigen in combination with
corticosteroid therapy in such patients may lead to recovery. In idiopathic
pulmonary fibrosis diffused all lung volumes, lung elasticity during therapy
with corticosteroids did not decreased even at satisfactory state of health of
patients and the absence of exacerbations process.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment. </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Corticosteroid therapy is used.
Originally prednisolone is prescribed at a dose of 1 mg / kg per day. The dose
is gradually reducing, but maintenance therapy (5-10 mg prednisolone per day),
continue for many months. In severe progressive course corticosteroids are combined
with cytostatic drugs (azathioprine, etc.). During exacerbations, the accession
of pneumonia, bronchitis, corticosteroids are combined with antibiotics. In
addition, antihistamines, vitamins, symptomatic treatment is used. </span></span></div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Prognosis</b>
is unfavorable.</span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-82284674742950325712013-04-02T15:52:00.002-07:002013-04-02T15:52:31.876-07:00Hereditary lung diseases- Kartagener syndrome <span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Kartagener syndrome has
autosomal dominant type of inheritance with 50% penentrance (frequency of 1:50
000) of the pathological gene. It occurs more frequently in kinship marriages. </span></span>
<br />
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Kartagener's
syndrome - the combined congenital defect characterized by a triad of symptoms:
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">sinus viscerus inversus </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">chronic bronchopulmonary process </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">pathology of paranasal sinuses (hypoplasia or chronic sinusitis).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Syndrome reverse arrangement of lungs
is always combined with dextrocardia, and sometimes the opposite arrangement of
the abdominal cavity. Reverse position of internal organs is often combined
with a violation of mucociliary clearance due to congenital disorders of motor
function of the ciliated epithelium of the respiratory tract.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="260" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image071.jpg" width="336" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>Clinic </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Frequent respiratory infections,
recurrent bronchitis, pneumonia in the first months of life are characteristic.
There is early occurrence of chronic bronchitis and pneumonia with the
development of bronchiectasis and bronchiectasis symptoms (</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">retard</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> physical
development, intoxication symptoms, cough with purulent sputum, deformation of
terminal phalanges of the type of drum sticks and nails in the form of watch glasses).
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Percussion and auscultation
determine dextrocardia. In the lungs, predominantly in the lower parts, mostly
on the right there is variety of moist and dry rales. Periods of exacerbation
are accompanied by fever, deterioration of general condition and the growth of
the symptoms of intoxication. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Nasal breathing is hard with
purulent nasal discharge. Often, there are recurrent or chronic sinusitis,
otitis, polyposis of the mucous membrane of the nose and sinus.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Diagnostic criteria
</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The
diagnosis of Kartagener syndrome is set on the basis of the following </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>syndromes. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">1. Respiratory Syndrome -
cough with sputum (purulent). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">2. Bronchopulmonary syndrome -
a shortening of the sound </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">on</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> percussion over</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>separate
areas of the lungs; persistent wet fine bubbling rales on both sides. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">3. Respiratory distress
syndrome - shortness of breath at rest and at low physical </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>activity. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">4. Symptoms of chronic hypoxia:
change of the terminal phalanges in the form of</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>drumsticks, dystrophy. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">5. The reverse arrangement of
internal organs - dextrocardia, left-sided localization of</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>the lungs,
difficulty in nasal breathing, sinusitis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Often patients with Kartagener
syndrome have other defects and anomalies: polydactyly, heart, kidney anomalies,
hypofunction of endocrine system etc. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>At the X-ray of lungs there are
reverse position of internal organs, diffuse deformation of lung pattern, may
be cysts in the lungs. The X-ray of paranasal sinuses reveales decrease lucency
of sinuses.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="283" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image073.jpg" width="208" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">X-ray of the paranasal sinuses of girl 14 years old with chronic lung
disease and polypous-purulent antritoetmoiditis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="338" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image075.jpg" width="325" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>X-ray of lungs of the same
child.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Bronchoscopical
picture in patients with Kartagener syndrome is</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">characterised
by diffuse purulent endobronchitis. Bronchography reveales deformation of the
bronchi, bronchiectasis and cysts.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="284" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image077.jpg" width="301" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Bronchogram of the same patient.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>The differential
diagnosis</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> is carried out with chronic pneumonia, congenital abnormalities of
bronchopulmonary system (agenesia, aplasia or hypoplasia of the right lung), in
which heart is shifted into the right half of the thorax. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The main method of treatment of Kartagener syndrome is
a conservative therapy aimed at eliminating or reducing the activity of the
inflammatory process in the bronchi and lungs, improving drainage and ventilation
functions. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Prognosis depends on the nature, incidence of
bronchopulmonary process, the frequency of exacerbations, severity of the
disease. With proper systematic treatment and regular rehabilitation prognosis
is relatively favorable.</span></span></div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com1tag:blogger.com,1999:blog-7275300796104068287.post-9138284665930648682013-04-02T15:50:00.003-07:002013-04-02T15:50:50.148-07:00Tracheoesophageal And Bronhoesophageal Fistulas<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"></span>Tracheoesophageal and bronchoesophageal
fistulas<b style="mso-bidi-font-weight: normal;"> </b>manifest
themselves at the first feeding of the child by severe attack of asphyxia, cough
and cyanosis. Quickly severe aspiration pneumonia occurs and is usually fatal
in saved hernia. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">This
defect is often combined with atresia of the esophagus.</span> It is diagnosed
with the introduction of X-ray contrast into the trachea and bronchi, or
bronchoscopically with the introduction of contrast into the esophagus.</span></span>
<br />
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinic</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Clinical manifestations of
this defect depend on the width of the message of the esophagus with the
trachea. The wider the anastomosis, the more rapidly and early clinical
symptoms arise. Any form of congenital isolated tracheoesophageal fistula mainly
manifests is respiratory failure (cyanosis, shortness of breath, coughing,
choking) that occur during breastfeeding. This relationship of breathing
disorders in feeding is the cardinal symptom, distinguishing
esophageal-endotracheal anastomosis from other types of diseases in neonates,
occurring respiratory disorders. With a wide fistula respiratory failure is so
severe that requires removal of the child on mechanical ventilation. Suction of
gastric contents in this case from the intubation tube (tracheal) makes the
diagnosis tracheoesophageal fistula uncertain.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="354" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image069.jpg" width="275" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Radiograph of the
chest. Radiocontrast substance is flowing through the tracheoesophageal fistula
from the esophagus to tracheobronchial tree.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Surgical
treatment must be performed as soon as possible. In this case the prognosis for life is good.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Although
congenital lung malformations are rare, they are important disorders because
they may lead to considerable morbidity and mortality (eg, infection,
hemorrhage, respiratory failure). Prognosis depends on the size of the lesion,
and the degree of functional impairment. Small lesions may remain asymptomatic.
Failure to recognize a malformation may lead to inappropriate
intervention.<span style="mso-spacerun: yes;"> </span></span></span></div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-18269874327730434122013-04-02T15:49:00.002-07:002013-04-02T15:49:39.641-07:00Williams– Campbell Syndrome (Generalized Congenital Bronchiectasis) <span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">In
1960, Williams and Campbell have described the clinic and radiological picture
of peculiar generalized bronchiectasis due to congenital hypoplasia of the
bronchial branches. Due to the structural deficiency in patients with bronchial
tree during inspiration there is arising pathological balloon expansion of
subsegmental bronchi, falling on the exhale.</span></span><span lang="UK" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;"></span></span>
<br />
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Bronchiectasis
are the pathologically enlarged sections of the bronchi, in the mucous membrane
of which chronic inflammation develops, usually with purulent exudation and
sclerotic changes in the peribronchial tissues. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Syndrome is based on genetically
inferiority of bronchial wall due to the bronchial cartilage defect. It arises
under the influence of various pathological processes on formation of lungs in
the embryonic period.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The morphological defect is
associated with segmental and subsegmental bronchi, most of the lower lobes. As
with lobar emphysema, lung tissue is air. Therefore it is believed that these
two diseases occur as a result of one and the same process. It occurs with a
frequency of 1:100 000.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;">The
clinical picture is the bronchial obstruction and bronchopulmonary infection.
Usually in the first year of life an acute pneumonia occurs, and then
eventually a chronic bronchopulmonary process is formed. Objectively chest </span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">is like hump</span><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;">.The cough is resistant with shortness
of breath. At percussion of the lungs there is bandbox sound, at auscultation–
dry and moist rales of various sizes. Phalanges and nails </span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">become</span><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"> "drumsticks", "hour-glass",
a violation of external respiration is present. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Radiological
findings in the lungs are increased pulmonary pattern, the phenomenon of
emphysema. At bronchography there are determined generalize bronchiectasis with
balloon expansion during inspiration and collapse (by closing the walls) during
expiration.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="338" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image055.jpg" width="396" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The scheme of the diameter changes of the bronchi at Williams - Campbell syndrome on
inhalation (a) and expiration (b).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="289" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image057.jpg" width="262" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bronchogram of the left lung of the child with the Williams-Campbell
syndrome.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Prognosis
is poor. Progression of syndrome leads to cardiopulmonary failure, which is the
cause of death. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Treatment
is conservative.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Congenital lobar emphysema </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Congenital lobar emphysema (congenital
localized emphysema, gigantic emphysema, tense emphysema) is characterized by stretching
of the parenchyma of the lung lobe or a segment with manifestation mainly in
early childhood. This anomaly is rare, but late diagnosis quickly leads to
death of newborns. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>This disease is characterized by
narrowing of the bronchus, it aplasia, dysplasia, and hypertrophy of the mucosa
with the formation of folds, which act as valves. Amount of air, which gets
into the lungs is more than that which gets out (valve mechanism). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Massive
overinflation of one or more lung lobes occurs postnatally in congenital lobar
emphysema. Causes include intrinsic absence or abnormality (bronchomalacia) of
cartilaginous rings or external compression by a large pulmonary artery.
(Compression of the cartilage usually leads to malacia.) Hyperexpansion of a
pulmonary lobe is present after birth when, with negative inspiratory pressure,
air can enter the lung. However, the air cannot exit easily because positive
pressure causes the softened airway to collapse. The remaining normal lung is
then compressed.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Causes of congenital lobar
emphysema include bronchial cartilage deficiency, extrinsic compression by a
bronchogenic cyst, a large pulmonary artery, or mucus plugs. Lobar
overdistention and airtrapping lead to compressive changes in the rest of the
lung.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Congenital lobar emphysema
primarily involves the upper lobes. The left upper lobe is involved in 41% of
patients; the right middle lobe, in 34%; and the right upper lobe, in 21%.
Involvement of the lower lobes is rare, occurring in fewer than 5% of patients.
Congenital cardiac anomalies may be present in as many as 10% of patients.
Lesions most commonly occur in whites, in male individuals (male-to-female
ratio, 3:1), and in young infants.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinic </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Most
patients with congenital lobar emphysema present before 6 months of life.
Neonates may present with mild-to-moderate respiratory distress. Mediastinal
shift may be present, with hyperresonance and decreased breath sounds on the
involved side. Infants present with cough, wheezing, respiratory distress, and
cyanosis. Older children may present with recurrent chest infections. On images
obtained in neonates, the affected lobe may be slightly opacified, rather than
lucent, because it is still filled with fluid. Associated cardiac anomalies
occur in as many as 10% of patients.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>The most severe
condition is in children in the first days of life. In newborns there are
increasing dyspnea, cyanosis, convulsions, loss of consciousness. One half of
the thorax is protuberant. Here there is bandbox percussion sound. Breathing is
weakened or absent on auscultation. Radiologically hyper aeration of one lung,
mediastinum and heart are displaced in the opposite side. Lung pattern is
scanty or absent. The diaphragm is flat, excursion of it is limited, possible
mediastinal hernia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="379" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image059.jpg" width="421" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="279" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image061.jpg" width="372" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Congenital lobar emphysema on the right side of the chest in a neonate. There
is<span style="mso-spacerun: yes;"> </span>marked lucent hyperexpansion in the
middle lobe of the right lung; this finding is consistent with lobar emphysema.
The possibility of tension pneumothorax is unlikely because lung markings are
seen in this region, with splaying of the pulmonary vessels. Compressive
atelectasis is present in the left upper and right lower areas of the lungs.
The mediastinum and heart are shifted to the left. The osseous structures are
intact.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="324" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image062.jpg" width="432" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Congenital lobar emphysema. Lateral view
in the same patient.</span><span lang="EN-US" style="font-size: 14.0pt;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><img height="363" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image064.jpg" width="396" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Congenital left
side lobar emphysema.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="mso-ansi-language: RU;"><img height="367" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image066.jpg" width="480" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Review chest
X-ray of the child with congenital emphysema of the upper lobe of left lung:
pulmonary tissue of upper lobe of left lung is increased lucent, in the lower areas
- reduced by compression of the lower lobe, the mediastinum is shifted to the
right.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="402" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image067.jpg" width="346" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>T</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">he mediastinum is flat and shifted
to the right.</span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The
differential diagnosis is carried out with pneumothorax, cysts,
diaphragmatic hernia, hypoplasia and aspiration syndrome.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Prognosis is
poor. Children are dying too early. In milder forms the flow can be subacute
and chronic. Children are </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">retard</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> in physical development, constantly cough and
shortness of breath are observed. There are described cases of the disease with
little emphysema diagnosed by chance.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Treatment.
Surgical treatment is needed in the "stress syndrome", which develops
due to compression of the mediastinum. Milder forms are treated conservatively.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Progressive airtrapping leads to
respiratory and circulatory compromise in infancy. Emergency lobectomy may be
required. A patient with respiratory distress whose chest radiograph reveals a
hyperlucency on one side and mediastinal shift usually has a tension
pneumothorax. However, one must consider congenital lobar emphysema, especially
in the newborn. The diagnosis can usually be determined by looking at the edges
of the hyperlucent area. In pneumothorax, the edges are convex and outline the
chest wall, whereas in congenital lobar emphysema, they are concave and outline
the cystic structure of an overexpanded lobe.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Placing a chest tube in the
hyperlucent airspace of congenital lobar emphysema decreases ventilation as air
takes the path of least resistance out the chest tube from the bronchus rather
than expanding the stiff infant lung in the remaining lobes. Prompt thoracotomy
relieves the pressure inside a hyperexpanded lobe and allows the other
compressed areas to ventilate. This overexpansion often stretches and dissects
the bronchi and vessels, facilitating lobectomy. In cases that are detected
early or surgically treated because of radiographic findings and not because of
symptoms, the abnormal lobe may be difficult to identify during surgery.
Therefore, in these cases, radiographs and CT scans must be carefully reviewed
preoperatively.</span></span></div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com1tag:blogger.com,1999:blog-7275300796104068287.post-61600715563283363452013-04-02T15:47:00.002-07:002013-04-02T15:47:39.009-07:00Differential Diagnosis Of Hereditary, Congenital And Chronic Diseases Of Bronchopulmonary System In Children<div class="MsoNormal" style="line-height: 150%; margin-left: 9.0pt; text-align: justify; text-indent: -9.0pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Study of hereditary and congenital chronic broncho- pulmonary
diseases in children is significant due to: </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 9.0pt; text-align: justify; text-indent: -9.0pt;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">1. The overall
incidence of recurrent and chronic diseases of this system in <span style="mso-spacerun: yes;"> </span>children ranges from 0,85 to 1,45%<span style="mso-spacerun: yes;"> </span>and the proportion of malformations and <span style="mso-spacerun: yes;"> </span>hereditary diseases in the structure of
this pathology is quite high (from 4.6 to 20% according to different authors). </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 9.0pt; text-align: justify; text-indent: -9.0pt;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">2. <span style="mso-spacerun: yes;"> </span>In 1-3% of deceased infants and 1/5-1/3 with
chronic bronchopulmonary <span style="mso-spacerun: yes;"> </span>pathology congenital<span style="mso-spacerun: yes;"> </span>anomalies of the lungs is diagnosed.
Moreover,</span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"> </span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">with improved methods of diagnostics frequency of congenital and</span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"> </span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">hereditary
pathology has a tendency to increase. </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 9.0pt; text-align: justify; text-indent: -9.0pt;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>3. This group of diseases has usually
unfavorable forecast, because that leads to<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>disability, reduced life expectancy, and often
to death in early age. </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="margin-left: 9.0pt; text-align: justify; text-indent: -9.0pt;">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>4.<span style="mso-spacerun: yes;"> </span>A
large number of pathological forms, lack of their study, low separate<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>experience
for each pediatrician, rarity of a disease make it difficult to establish
diagnosis at time and prescribe treatment. </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>5. There are no effective preventive
measures. </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span></span></b><b><i><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Physicians
of different professions should be aware clinic of these diseases in order to
suspect congenital or hereditary pathology, to diagnose them in children and to
send a child to a specialist, as well as prevent these diseases.</span></span></i></b></span></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="line-height: 150%;">
<b><i><span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Common
clinical symptoms of congenital lung diseases: </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">debut of the disease at an early age </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">prolonged, recurrent, chronic inflammation
in the lungs </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">obstructive syndrome </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">persistent prolonged wheezing in the lungs,
weakened breathing </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">"drumsticks", pallor, cyanosis </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">physical retardation</span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">"cor pulmonale" </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">breathlessness </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">bulging chest </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">asphyxia </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">loss of consciousness, convulsions </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">prolonged cough </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">pleural friction rub </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">combination with other symptoms</span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="line-height: 150%;">
<b><i><span style="background-color: white;"><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Classification of hereditary and congenital bronchopulmonary
diseases <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l12 level1 lfo9; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Defects of the respiratory system: </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l12 level1 lfo9; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">abnormalities of the trachea and bronchi </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l12 level1 lfo9; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">anomalies of the lungs </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l12 level1 lfo9; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Hereditary lung diseases. </span></span></span></i></b></div>
<b><i><span style="background-color: white;">
</span></i></b><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l12 level1 lfo9; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<b><i><span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Polyorganic hereditary disease with primary
lesion of the lungs.</span></span></span></i></b></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 3.75pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">General diagnostic criteria</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Early emergence of diseases of the respiratory system
(the neonatal period, I year of life)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Physical retardation</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Persistent obstructive syndrome</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Recurrent nature of the respiratory system diseases </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Increasing of sings of respiratory failure despite
treatment </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Inefficiency therapy</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">ABNORMALITIES OF TRACHEA AND BRONCHI</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Anomalies of branching
tracheobronchial tree. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Congenital
lobar emphysema (lobar, obstructive, hypertrophic, gigant) is a malformation
characterized by a sharp increase in the proportion of one lung due emphyzematous
change and blowing </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Traheobronhomegalia / Mounier-Kuhn syndrome –
1932, France/
– congenital anomaly of the system of the trachea and bronchi, with their
expansion due to underdevelopment of elastic cartilage and muscle structures of
the tracheobronchial tree. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Syndrome
Williams-Campbell (I960) – congenital defect of the system due to generalized
hypoplasia of cartilage and segmental subsegmental bronchi from 3rd to 8 th caliber,
followed by the formation of secondary bronchiectasis, predominantly symmetric
in the lower lobes. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Tracheo(bronchi)
- esophageal fistula – a severe malformation, which might result in a fatal
outcome already in the early periods after birth </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>ANOMALIES
OF LUNG </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Lung agenesia – absence of lung together with the main
bronchus. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Lung aplasia <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>– absence of lung with the presence of
rudimentary main bronchus. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pulmonary Hypoplasia – underdevelopment simultaneous
bronchi and lung parenchyma.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cystic hypoplasia of the lungs /polycystitis/ –
congenital malformation, which except reduction is accompanied by respiratory areas
of cystic like formation of cavities and bronchiectasis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pulmonary sequestration – a section of lung placed
inside or outside the pulmonary lobe and does not participate in gas exchange.
Blood supply to the site is provided by the anomalous vessel from the thoracic
or abdominal aorta or intercostal arteries.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt;">Malformations of
lung </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Malformations
of lung frequently underlie the second place amount inflammatory processes in
the bronchopulmonary system and are evident more frequently in childhood and
adolescence. They include, first of all, various options of cystic hypoplasia
of the lung, congenital solitary cyst, pulmonary sequestration and rare
abnormalities of the trachea and bronchi.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Agenesia, aplasia
and hypoplasia of lungs</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Agenesia</span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> is the absence of
lung together with the main bronchus.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In lung agenesis, the entire lung
and bronchial tree may be absent on one side. The bronchial tree may form
without development of the alveoli. Pulmonary hypertension complicates lung
agenesis because of a combination of factors: normal blood volume passing
through reduced lung tissue, hypoxemia leading to pulmonary vasoconstriction,
and any associated left-to-right shunting cardiac lesion.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Aplasia</b> is the absence of lung tissue in the presence of
rudimentary bronchus.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="277" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image005.jpg" width="216" /></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Hypoplasia i</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">s
a state when the main and lobar bronchi terminate functionally insolvent
rudiment, lung tissue is underdeveloped.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Intrathoracic
or extrathoracic lesions can cause pulmonary hypoplasia. Therefore, prolonged
rupture of membranes, renal dysplasia, neuromuscular diseases, and congenital
diaphragmatic hernia can lead to lung hypoplasia. Reduced urine volume during
fetal life may retard lung growth. Pulmonary aplasia leads to respiratory
distress, which may vary according to the degree of alveolar involvement.
Pulmonary hypoplasia may be primary when the entire lung or when one lobe is
reduced in size.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="269" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image007.jpg" width="279" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Both pulmonary agenesis and
hypoplasia may be accompanied by renal anomalies, which are usually apparent
soon after birth and associated with respiratory distress. Cardiac defects
occur in 50% of patients.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pulmonary agenesis is
differentiated from lung aplasia by the absence of the carina in the latter.
Lung agenesis is less common than aplasia, about 75% of cases affect the left
side, and it is lethal in half of all patients. It may be associated with other
manifestations of the syndrome of abnormalities of the vertebrae, anus,
cardiovascular system, trachea, esophagus, renal system, and limb buds (VACTERL
syndrome). The survival rate is better with left-sided lung agenesis than with
right-sided agenesis because the right lung is the larger of the two.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Clinic</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Asymptomatic clinic is rare.
Children have physical retardation. <span style="mso-spacerun: yes;"> </span>Respiratory
failure is observed: dyspnea, cyanosis of varying severity. Cough and the
allocation of purulent phlegm are associated with the accession of the
inflammatory process. Sometimes there is a pain in the chest. On the lesion
side thorax is flattened, and the healthy half is convex. At the site of the
lesion there are observed shortening of percussion sounds, absent or weakened
respiratory noises. The heart is shifted toward the lesion, which may
erroneously be interpreted as dextracardia. When expressed hypoxia is observed for
a long time the nail phalanx become thickened as "drumsticks." </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Clinic of hypoplasia is less
pronounced. The process proceeds by the type of chronic lung disease, vital lung
capacity, GLC are decreased. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">X-rays
reveal the decrease of lung volume on the side of lesion, intense darkness,
highstanding of diaphragm. The heart and mediastinum organs are removed so that
the spine looks bare. However, there may be a "pneumocele" when
healthy lung is prolaboring through the anterior mediastinum in the other
direction. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The final diagnosis is based on
bronchography.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">In pulmonary hypoplasia,
development of the distal lung tissue is incomplete. At earlier the delivery of
a child the incidence of lung hypoplasia is higher. In babies delivered before
28 weeks' gestation, the incidence approaches 20%. Pulmonary hypoplasia occur
as a result of conditions that restrict lung growth, such as oligohydramnios,
Potter syndrome (with bilateral renal agenesis or dysplasia), abnormalities of
the thoracic cage, Scimitar syndrome (right-sided pulmonary hypoplasia), and
diaphragmatic hernia (usually left-sided hypoplasia). More than 50% of patients
have associated cardiac, gut, or skeletal malformations. They may have a small
thoracic cage, decreased breath sounds on the affected side, and a mediastinal
shift to the side of the lesion. Therefore, aplasia of the right lung can be
confused with dextrocardia. Patients may present with lung infections, dyspnea
upon exertion, and/or scoliosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="259" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image009.jpg" width="264" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Radiography
of the newborn the first day of life with suspected hypoplasia of the left lung
(right lung volume more)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="271" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image011.jpg" width="362" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Hypovascularity of the entire left lung in a 16-year-old patient with
mild exercise intolerance. This patient had hypoplasia of the left lung</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="332" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image013.jpg" width="433" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bronchogram in simple
hypoplastic left lung: the left lung is reduced</span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>in volume.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="328" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image015.jpg" width="283" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Displacement of mediastinum and heart to the left. Loculated
translucencies in right middle and lower lung fields with flattened right
diaphragm. (reprinted by permission from W. B. Saunders Company Ltd. Manual of
Neonatal Emergency X-Ray Interpretation, 1994.)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Patients with pulmonary
agenesis and pulmonary hypoplasia seem to have one of 3 presentations. The
first group consists of patients with insufficient lung tissue who may have
received mechanical ventilation for some time. However, ventilator-induced lung
injury results in slow decompensation and death. The second group of patients
is identified serendipitously when chest radiography is obtained to assess a
minor complaint. These patients require no intervention. The third group does
not have respiratory distress requiring mechanical ventilation, but they have
respiratory limitations to activity or kinking of the airway with shift of the
lung to the contralateral side of the chest. In addition to the aplasia or
hypoplasia, congenital narrowing of the upper airway also affects many
patients.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Cystic adenomatoid malformation</span></b><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Cystic
adenomatoid malformation is a defect in the development of the terminal
bronchioles. A hamartomatous proliferation of cysts occurs and resembles
bronchioles (airways without cartilage).</span><span lang="EN-US" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Congenital Cystic Adenomatoid
Malformation was first identified in 1949 by Ch'in and Tang. Cystic adenomatoid
malformation accounts for 25% of all congenital lung malformations. Respiratory
distress occurs in the neonatal period, when collateral pores of Kohn ventilate
the alveolar tissue present. This process is responsible for the cystic
appearance on radiographs. Patients may have mediastinal shift and a
pneumothorax. The affected area is dull on percussion, and air entry is
decreased. The radiographic depiction of a solid or cystic mass on one side of
the thorax suggests the diagnosis.</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> Cystic changes underdeveloped lungs or </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">it lobe</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> are a good ground
for the development of chronic suppuration, as the drainage function of bronchi
is severely disturbed.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Three
histologic categories of cystic adenomatoid malformation are described: (1)
macrocystic (13%), which has the best prognosis and in which one or more large
(>5 mm
on prenatal ultrasound) cysts are lined with normal pseudostratified ciliated
epithelium; (2) microcystic (73%), which has small cysts lined with ciliated
columnar or cuboidal epithelium; and (3) solid cystic adenomatoid malformation
(13%), which has the worst prognosis and is an airless tissue mass composed of
cuboidal epithelium-lined bronchioles. The difference in prognosis may be
because the solid and microcystic lesions involve a relatively large amount of
lung tissue. Macrocystic lesions are comprised of large, air filled,
nonfunctioning spaces involving smaller areas of lungs.</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>One lobe, multiple lobes, or
multiple segments on both sides may be affected. The upper lobes are usually
involved. The bronchiolar proliferation is terminal without much alveolar
development. The abnormal hamartomatous proliferation usually retains its
communication with the normal bronchiolar tree. However, no cartilage or
bronchiolar tubular glands are present in the malformation itself. Columnar
mucinous epithelium is present.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="248" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image017.jpg" width="408" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Polyhydramnios may be present if
the cystic adenomatoid malformation presses on the esophagus. Pressure on the
heart and large vessels may lead to hydrops fetalis. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Cystic adenomatoid malformation
results when the terminal bronchiolar component of the advancing endodermal
lung bud proliferates haphazardly because of disruption of humoral factors from
the surrounding mesenchyme. Apoptosis in the advancing lung bud is decreased.
Glial cell–derived neurotrophic factor is a growth factor that is abnormally expressed
in the epithelial cells of the cystic adenomatoid malformation. Cystic
adenomatoid malformations usually appear before 7 weeks' gestation but can
occur in the mid stage of lung development. The growth is thought to plateau at
28 weeks' gestation. Communication with the normal airways can lead to
overinflation and compression of the surrounding lung tissue. At the larger the
sonographic volume of cystic adenomatoid malformation in relation to head
circumference the chance for developing hydrops because of more severe central
venous compression is the greater.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinic</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In approximately 60% of
patients, cystic adenomatoid malformation manifests soon after the neonatal
period. It results in recurrent infections because the mucociliary clearance is
poor. Malignancy can occur in the cystic adenomatoid malformation (pulmonary
blastoma, rhabdomyosarcoma, and bronchoalveolar carcinoma).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The disease
may occur immediately after birth or later, sometimes even in<span style="mso-spacerun: yes;"> </span>teens agers, depending on the join of
infection. Patients complain of a cough with purulent sputum, frequent colds, dyspnea
during physical exertion, fatigue. Early the developing phalanges and nail
changes in the form of drum sticks and watch glasses</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">occur.
As result of the decline in lung maturation asymmetry of the chest is observed.
Children suffer from malnutrition and have physical retardation. On
auscultation over the affected areas of lung there are constantly listened dry
and moist rales of various sizes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">X-ray
picture depends on the level and extent of damage of bronchial tree. In
hypoplasia of the lung there is marked shift of the mediastinum in the affected
side, the high standing of the diaphragm. Affected lung is reduced in volume,
sealed, sometimes with annular illumination. In hypoplastic lobe pattern
develops equity fibroatelectasia with a decrease and compaction percentage,
usually pressed against the mediastinum and therefore not always immediately
visible. Adjacent healthy areas of the lung appear to be more transparent in
comparison with the opposite lung due to hyperinflation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="203" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image019.jpg" width="218" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Cystic adenomatoid
malformation</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">of
</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">right
lung</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="313" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image021.jpg" width="333" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Polycysti</span><span style="font-size: 14.0pt; mso-ansi-language: RU;">с </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">malformation of left lung </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="279" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image023.jpg" width="372" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Polycysti</span><span style="font-size: 14.0pt; mso-ansi-language: RU;">с</span><span style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">malformation of the upper lobe of right lung </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Most
demonstrably picture is given at bronchography, and computed tomography (CT). They
reveal multiple cystic cavities, which are the ends of lobe, segmental or
smaller bronchi. At angiopulmonography may be found signs of malformation of
the pulmonary blood vessels - their thinness, lack of contrasting small
branches, the expansion of branching angles.</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="183" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image025.jpg" width="196" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Cystic
hypoplasia of right lung (bronchography in lateral projection)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="278" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image027.jpg" width="371" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Air cysts of right
lung</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Changes in cystic
hypoplasia that develops in the later stages of embryogenesis are very similar
to those of acquired atelectasis bronchiectasia. In the absence of typical
radiological signs to determine the innate pathology is possible only by the
morphological study of resected preparates and even then not always.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In cystic adenomatoid
malformation, resection of even asymptomatic masses is recommended because of
the risk for infection, hemorrhage, acute respiratory compromise (which may
occur anytime), and neoplastic transformation. This disease is usually
segmental; however, as noted for sequestration, lobectomy may reduce morbidity.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;">
</span>During surgery, lung cysts are often found to be cystic adenomatoid
malformations, though simple cysts do occur. Some lesions can be shelled out or
unroofed. If they are not congenital but related to barotrauma, they may
communicate directly with small bronchi. In this case, unroofing leads to major
air leaks. These lesions can sometimes be controlled with figure-8 sutures, but
wedge resection, segmentectomy, or even lobectomy may be required to avoid a
bronchopleural fistula.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Congenital (real) solitary
cysts</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Bronchogenic cysts are also
known as foregut duplication. They arise from an abnormal budding of the
ventral foregut. Approximately 85% are mediastinal, and 15% are intrapulmonary.
The peripheral cysts are multiple and appear late in gestation. They may be filled
with air or fluid, or they may have air-fluid levels. The cysts can be central
or peripheral. Many are asymptomatic, but incidental findings may be observed
on chest radiography. Infection, hemorrhage, and, in rare cases, malignancy can
occur. Respiratory distress may result in a stridor or wheeze. Airtrapping may
lead to emphysema, atelectasis, or both. Dysphagia, chest pain, and epigastric
discomfort can occur.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Lung cysts are rare lesions
that may arise from any of the parenchymal tissues of the lung. They can cause
symptoms if they enlarge and occupy substantial space. Resection is performed
to diagnose lung cyst and to stop the progression of symptoms.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Bronchogenic cysts represent
outpouchings of the ventral foregut in the early part of gestation. These
outpouchings generally arise close to the bronchial tree. A cyst may become
infected, or it may compress adjacent structures to produce signs and symptoms.
Chronic infection and inflammation may predispose the patient to malignancy.
Peripheral cysts appear late in gestation and are multiple.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Bronchogenic
cysts are most commonly mediastinal in a pericarinal, paratracheal, or
retrocardiac location. The cysts are thin walled and lined with columnar
epithelium. The common central cysts represent outpouchings of the ventral
foregut in the early part of gestation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinics</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Many
cysts are asymptomatic, but incidental findings may be observed on chest
radiography. Infection, hemorrhage, and, in rare cases, malignancy can occur.
Respiratory distress may result in a stridor or wheeze. Airtrapping may lead to
emphysema, atelectasis, or both. Dysphagia, chest pain, and epigastric
discomfort can occur.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Unlike cystic hypoplasia solitary cysts
usually do not have widespread reports of bronchi and therefore become infected
less often and later than cystic. True cysts of the lung at birth are filled
with mucus, often having a dark brown color (so-called chocolate cysts). Communicating
with the small bronchi of the cyst may be complicated by valve mechanism (tense
cysts), a breakthrough in the pleural cavity or infection. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>At infected
cysts on the first place there are the symptoms of purulent intoxication: high
fever, sweating, increasing weakness, lethargy, loss of appetite. For large
scale cysts symptoms of respiratory failure may appear: shortness of breath,
cyanosis of lips and limbs, which are more common in young children.
Characteristic is<span style="mso-spacerun: yes;"> </span>the appearance of dry
or wet cough. At percussion over the cavity of the cyst when it is of
sufficient size may be noted dullness of sound and auscultation with the
weakening of breath and wheezing of various sizes. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>On plain radiograms and tomograms lung
festering cysts are seen as round or oval hollows formations with, as a rule,
the level of liquid and air over it. Unlike lung abscesses inner and outer
contours of the cyst are clear and smooth, perifocal reaction is expressed
slightly. Often cysts are a multi, and the upper edge of the liquid in
individual cells may be at different levels. <span style="mso-spacerun: yes;"> </span>Bronchi and vessels, clearly visible in
contrasting and tomograms uniformly bend around the contours of the cyst, which
is not at the case with lung abscess.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="255" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image029.jpg" width="504" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bronchogenic cyst. Conventional radiographs demonstrate a subcarinal
mass.</span><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="347" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image031.jpg" width="346" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bronchogenic cyst. Media file shows a right paratracheal mass.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="149" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image033.jpg" width="200" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bronchogenic cyst. CT scan demonstrates a thin-walled cyst in the right
upper lobe.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="288" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image035.jpg" width="358" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Review chest X-ray of the
child with a congenital air cyst of the right lung in</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>direct projection: annular shadow of the cyst is
indicated by arrows.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="334" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image037.jpg" width="325" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Review chest X-ray of the
child with a congenital air cyst of the right lung in</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>lateral projection: annular shadow of the cyst
is indicated by arrows.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In the differential diagnosis of
purulant cysts it is needed to remember about tuberculous cavity, the more so
that their localization (mainly in the upper lobes) usually coincides. For tuberculous
cavern characteristic features are rugged, "moth" inner contour and
fibrose focal shadows on the periphery of the cavity. In addition, the cavity is
characterized by the presence of shadows and enlarged lymph gland in the root
of the lungs and shadow of draining bronchus, well visible on the tomograms.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Pulmonary sequestration</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Pulmonary
sequestration accounts for 6% of all congenital lung malformations and mostly
occurs in the lower lobes. A sequestration is a bronchopulmonary tissue without
a normal bronchial communication and with normal or anomalous vascular supply.
Sequestered lung may be intralobar or extralobar. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">A pulmonary
sequestration there is a benign mass of non-functioning lung tissue that
appears during early lung development. This lesion has no connection with the
airway and receives its blood supply from the systemic circulation usually off
the abdominal or thoracic aorta. The most common type of BPS is formed within
the normal lung itself and is referred to as intralobar. The other type of BPS
is known as extralobar, and is formed outside the normal lung. This type of
lesion is usually found in the chest cavity although rarely it may be found in
the abdomen. There is a higher incidence of associated anomalies in babies with
extralobar BPS.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="244" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image039.jpg" width="365" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The involved lung
segments can be classified on the basis of their pleural coverage into
intrapulmonary or extrapulmonary types. Variants of pulmonary sequestration are
described as disconnected or abnormally communicative bronchopulmonary masses
with normal or anomalous vascular supply. The lesions may have some sort of
communication with the gut</span><span lang="EN-US" style="mso-ansi-language: EN-US;">.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinic</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>About 50% of pulmonary
sequestration cases are intrapulmonic, and 60% of intrapulmonic cases occur in
the left lower lobe with equal sex distributions. Patients with intrapulmonary
sequestration usually present late. They may have a chronic cough, recurrent
pneumonias, or poor exercise performance. Systemic arterial flow may produce a
murmur, and shunts may lead to congestive cardiac failure. Squamous cell
carcinoma, adenocarcinoma, and rhabdomyosarcoma may arise in the sequestration.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Approximately 95% of
extrapulmonary cases are left sided. Most extrapulmonary cases are detected in
infancy, with boys affected 4 times more than girls. Infants usually present with
a chronic cough and recurrent chest infections. Radiographs may reveal signs of
consolidation. If communication with the gut is present, children may present
with vomiting, failure to thrive due to poor oral intake, and abdominal pain.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Clinical manifestations are due to
inflammatory changes: cough, fever, shortness of breath, over the lesions
listened small bubbling moist rales.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>There are three forms of the
pathological process:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>bronchiectasis,
in which repeated inflammation leads to</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>fusion of lung tissue and
secondary connection with</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;">bronchial </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">tree</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>pseudotumoral
that is characterized by small clinical symptoms</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>local abscess
formation or empyema</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">The main
distinguishing feature of sequestration of the lung is an additional large
vessel which deviates from the aorta and branching in the sequestered lung
tissue. This vessel can be identified at aortography, tomography and CT.
Sometimes <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>it is finding during the operation as an
accident. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Diagnose of pulmonary sequestration
is based on angiography. Much less importance has bronchography. At radiograph
may be darkening of the affected segment inflammation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span style="mso-ansi-language: RU;"><img height="218" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image041.jpg" width="229" /></span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span lang="EN-US"></span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Sequestration of the lung. There
is cystic changed area</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>of S10 of the lower lobe of
the left lung.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt; line-height: 150%;"><img height="347" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image043.jpg" width="314" /></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Aortogramme at sequestration
of the lower lobe of right lung: the additional vessel (2) is going from the
aorta (1) to the sequestered part of lung.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="315" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image045.jpg" width="395" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Review X-ray of the child with
intrapulmonary sequestration in low medium sections of the right lung: in the
zone sequestration there is shading lung tissue (indicated by arrow).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Surgical
treatment</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">: resection of the sequestered area.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Resection is recommended, even
in asymptomatic patients, to prevent infection, hemorrhage, shunting from
arteriovenous anastomoses, or compression of normal lung mass leading to
respiratory distress. Lobectomy can usually be performed. For patients with
intralobar sequestration, segmentectomy may suffice. Segmentectomy is
relatively difficult, but preserves additional functioning lung tissue.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Prognosis</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> is <span style="mso-spacerun: yes;"> </span>favorable.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt;">Malformations of trachea and bronchi</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Among the rare malformation of the trachea
and bronchi, facilitating the development of intrapulmonary suppuration, should
first be called traheobronhomegalia usually combined with tracheomalacia (so
called </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Moanier-Kuhn</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> syndrome), and
congenital stenosis of the bronchi, as described in the form of casuistic
observations.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Traheobronchomegalia</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt;">
(Moanier-Kuhn</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">
syndrome)</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-indent: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Tracheobronchomegalia (</span><span lang="EN-GB" style="font-size: 14pt;">Moanier</span><span lang="EN-GB" style="font-size: 14pt;"> </span><span lang="EN-US" style="font-size: 14pt;">-Kuhn
syndrome (P. Moanier-Kuhn, modern French otolaryngologist), 1932) - congenital
enlargement of the trachea and bronchi.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>At tracheobronchomegalia and malacia
softened and lost their resilience cartilages of the trachea and major bronchi
make in the airways the flaccid, extended tube, decreasing with exhalation and
cough. Bronchial drainage function is disrupted, and delayed sputum, rapidly
infecting, promotes suppuration in the distal lung. A similar mechanism of
development of septic complications arise at bronchial stenosis, which disturb
the self-cleaning of bronchi.</span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Pathomorphologic changes are due to
the diffuse extension of the trachea, sometimes the main bronchi. At this
anomaly atrophy of the longitudinal elastic fibres and thinning of the muscle
bundles occur. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Ther</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">e</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">are</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">the following types of a
defect: an isolated tracheomegalia (pathological enlargement of the trachea
with a normal value of the lumen of the bronchi), isolated bronhomegalia
(enlargement of one or both main bronchi with normal width of the trachea) and
traheobronhomegalia (enlargement of the trachea and one or both main bronchi). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>There is a rare involving in
pathological process the segmental and smaller bronchi, although in the distal
bronchial tree in some cases may be secondary changes. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="244" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image047.jpg" width="289" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Clinic</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Clinically there is the recurrent
tracheobronchitis, in the course of which predominates bitonal irritating cough
with prolonged sputum discharge.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Abnormalities of the trachea and
bronchi may be suspected by the presence of the characteristic cough with
metal, vibration shade, hard forced exhalation and the presence of hard
discharged purulent sputum in children. On auscultation over the lungs there
are listened many variegated wheezing, which do not disappear after cough.
Radiographic examination often reveals signs of bronchiectasis, and in patients
with acute inflammation the massive bilateral pneumonia, often with abscess
formation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;">
</span>Frequent symptoms are chronic intoxication and hypoxemia, pallor,
retarded physical development, the deformation of the fingers on the type of
drum sticks. In the lungs, there are different changes in percussion sounds, a
variety of wheezing.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Studies of lung function and blood
gas composition reveal pronounced degree of combined ventilatory insufficiency
and hypoxemia. <span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>B</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">ronchofibroscopy helps to establish
the correct diagnosis. At tracheobronhomegalia there are determined a
significant expansion of the lumen of the trachea and main bronchi, deformation
of their walls with the curvature of the cartilaginous rings and deep, sac
interchondral intervals, a thickening of the mucous membrane in the form of
circular folds and the almost total collapse of the lumen by coughing and
forced expiration, expiratory stenosis and </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">the presence of inflammatory
changes in the trachea and bronchi</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">. Congenital stenosis of the major bronchi is
defined as smooth wall sunken or membranous narrowing with a small round hole
at the center.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="492" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image049.jpg" width="389" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">Bronchoscopy </span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">- the examination of the
bronchi (the main airways of the lungs) using a flexible tube (bronchoscope).
Bronchoscopy helps to evaluate and diagnose lung problems, assess blockages,
obtain samples of tissue and/or fluid, and/or to help remove a foreign body. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt;">В</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">ronchoalveolar lavage - to remove cells from
lower respiratory tract to help identify inflammation and exclude certain
causes. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">lung biopsy - to
remove tissue from the lung for examination in the pathology laboratory. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.45pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="266" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image051.jpg" width="276" /></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span style="mso-ansi-language: RU;"><img height="263" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%203%20Congenit%20and%20chron%D1%96%D1%81%20lung%20disease.files/image053.jpg" width="277" /></span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Bronchoscopical sings at t</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">racheobronchomegalia</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> (Moanier-Kuhn</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> syndrome)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Treatment
is provided as at endobronchitis.</span></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Prognosis
for life is favourable.</span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-48130957566839822442013-04-02T15:42:00.000-07:002013-04-02T15:42:14.929-07:00FOREIGN BODIES IN LUNGS, TRACHEA AND BRONCHIAL TUBES<div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.45pt;">
<span style="background-color: white;">It is the acute
obstruction of respiratory tracts as a result of aspiration of foreign
bodies<span style="mso-spacerun: yes;"> </span>of different nature(organic,
inorganic, metallic)<span style="mso-spacerun: yes;"> </span>in the respiratory
tracts (larynx, trachea, bronchial tubes).<span style="mso-spacerun: yes;">
</span>Depending on the location<span style="mso-spacerun: yes;"> </span>foreign
bodies are divided into balloting, valvular (valve) and obturacting. Mechanical
obstructions<span style="mso-spacerun: yes;"> </span>and laryngospasm<span style="mso-spacerun: yes;"> </span>have the main role I pathogenesis. </span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.45pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 35.45pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinic.</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> Polymorphic, depends on the level of localization of </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">foreign
</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">body, its size and form, time of stay in
respiratory tracts. At the hit of </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">foreign</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> body in a larynx on a complete health attack of
strong cough arises up, dyspnea, asphyxia, hoarse of voice. The clinical sings
change as a result of motion of body. A diagnosis is due to laryngoscopy. The </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">foreign</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> body of trachea predetermines an exhausting cough,
characteristic noise of slamming as a result of its blow on trachea, dyspnea
attack .In the case of invasive penetration of foreigh body pain in chest,
blood phlegma occur. If there is aspiration of </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">foreign </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">body in main bronchus, symptoms are the same, as
well as at the hit in a trachea. When it penetrates deeper, in the distal
regions of respiratory tracts, a cough becomes weaker. Obturation atelectasis
in the proper lobe with compensating emphysema of neighbouring lobe develops at
the complete corking of bronchus. The incomplete corking valve stenosis and
obturation emphysema occur. Collection of anamnesis is purposeful important in
establishment of diagnosis. Roentgencontrastive </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">foreign</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> bodies, or indirect signs of aspiration of
nonroentgencontrastive bodies (atelectasis, acute emphysema of segment, lobe
or<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>lung),
appear at roentgenologic research, the Holtskneht – Jacobson symptom is
exposed: displacement of mediastenum at deep inhalation in a sick side and at
deep exhalation – in healthy. F</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">oreign</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> body of trachea and bronchial tubes is diagnosed also by bronchoscopy. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 35.45pt;">
<br /></div>
<span style="background-color: white;">
</span><h1 style="text-indent: 35.45pt;">
<span style="background-color: white;"><b>Help </b><b>on prehospital </b><b>stage</b></span></h1>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To try to delete the
foreign body. To take a child for feet, to drop downward by a head (for a short
time) and inflict a few blows on the back. The children of the first year of
life are laid on abdomen and face on the forearm of doctor, here by forel and
middle fingers a head and neck are fixed. A forearm together with a child is
lowered downward on 60<sup> O</sup>. By the rib of palm of right hand short
blows are dealed between shoulder-blades. For<span style="mso-spacerun: yes;">
</span>elders<span style="mso-spacerun: yes;"> </span>children<span style="mso-spacerun: yes;"> </span>the Heymlih method is used : on the
epigastrial area of child, which lies on a side, a doctor lays<span style="mso-spacerun: yes;"> </span>the palm of the left hand, by the fist of
right hand deals 5-8 short blows under the corner of 45<sup> O</sup> in
direction of diaphragm, or child which suffered, is clasped from behind of back
by<span style="mso-spacerun: yes;"> </span>hands so that the right palm
compresses in a fist was at level between umbilicus and sternum, and left palm
– over it, four sharp blows are done in this position, sending them insite and
upwards, causing an artificial cough.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">With an attempt to delete
the review of mouth cavity foreign body by hands or pincers, at possibility
with direct laryngoscopy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Immediate hospitalization
to otolaryngology unit. During transporting there must be the promoted
position, to quiet a child, oxygen therapy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">At ineffective of previous
measures and impossibility of rapid hospitalization, there is the risk of death
from an asphyxia. So conicotomia or tracheostomy is executed. Method of conicotomia: head of patient is
maximally<span style="mso-spacerun: yes;"> </span>backwards, feel an interval
between thyroid that cricoid cartilages and with scalpel or another cutting
object cut a skin, and then conical ligamentum<span style="mso-spacerun: yes;">
</span>in transversal position. In the opening hole tracheostomic, intubation or
another tube, which is in hands, are placed in order to provide access of air
in a trachea.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Method of </span><span lang="EN-US" style="font-size: 14pt;">tracheostomy</span><span lang="EN-US" style="font-size: 14pt;">:</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> bolster under the
shoulders (not under a neck!) of patient. A head is maximally background. The
little turn of head causes the displacement of trachea and cut her over not on
a middle line and the wound of esophagus. Local anaesthesia. Vertical cut of
skin from a </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">cricoid</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"> cartilage by length of 4-5 cm. If a neck is short
transversal cut is used by length of 5-6 cm at level of 2-3 rings of trachea. After
dissection skins and fascia execute the subsequent baring of trachea only by a
dull way. Move away the isthmus of thyroid downward and do overhead </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">tracheostomy</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">. Before section a trachea is sewed by silk which serves as a holder.
Interval between cartilages is cutting by scalpel<span style="mso-spacerun: yes;"> </span>higher than a holder, canulla is entered in</span><span lang="EN-US" style="font-size: 14.0pt;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">trachea.</span><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="478" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image166.jpg" width="642" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Chronic foreign body producing
bronchiectasis in a 2-year-old boy. He had a history of choking on
"something" while playing outdoors. A productive cough, recurrent
pneumonia, and finger clubbing developed over the next 9 months. Chest film
(<IT+>A<IT->) shows right lower lobe infiltrate. Bronchogram
(<IT+>B<IT->) shows nonfilling of anterior basilar segment
(<IT+>arrow<IT->) of right lung. The resected segment (<IT+>C<IT->)
contained a bronchiectatic cavity (<IT+>arrow<IT->) with an
aspirated grasshead (<IT+>D<IT->). Recovery was complete after
operation and included resolution of severe clubbing. (From Hilman BC
(ed): Pediatric Respiratory Disease. Philadelphia,
WB Saunders, 1993, p 519.)</span></span></div>
<span style="background-color: white;">
</span><h1 style="text-indent: 35.45pt;">
<span style="background-color: white;"><b> </b></span></h1>
<span style="background-color: white;">
</span><h1 style="text-indent: 35.45pt;">
<span style="background-color: white;"><b>Help on<span style="mso-spacerun: yes;"> </span>hospital
stage</b></span></h1>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US;">If
foreign body is in a larynx - laryngoscopy must be done to its delete.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">At finding of </span><span lang="EN-US" style="mso-ansi-language: EN-US;">foreign</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"> body in a trachea or
bronchial tubes – quickly</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>tracheobronchoscopy with
anesthesia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Antibiotics
of wide spectrum of action.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt; line-height: 150%;">ANOTHER PATHOLOGY THAT
CAUSES BOS </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A large group of diseases that
occur with the manifestations of BOS, are hereditary metabolic. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Hereditary deficiency α<sub>1</sub>-antitrypsin</span>
(α<sub>1</sub>-protease inhibitor) is a relatively rare disorder,
inherited by autosomal recessive type. The earliest complaint is shortness of
breath that occurs without cough and sputum, which, however, may join later.
Percussion, auscultation and radiological findings are typical of pulmonary
emphysema: swelling of the chest, bandbox sound over the lungs, weak breathing,
increased pneumatization of pulmonary pattern. At α<sub>1</sub>-antitrypsin
deficiency obstruction occurs due to loss of elasticity, and not as a result of
bronchospasm. The diagnosis of α<sub>1</sub>-antitrypsin deficiency is
confirmed by decrease of its content in the blood (normal 20-30 IU / ml),
phenotype, genetic examination of relatives of the patient. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Clinical manifestations of BOS at
<span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">congenital malformations
of the heart and blood vessels</span> have certain similarity with acute
obstructive bronchitis. The main mechanism for the development of BOS is a
compression or occlusion of bronchial obstruction. The main in diagnosis is
clinical and instrumental examination of the cardiovascular system with obligatory
echocardiography. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Recently, problem of relevant
spread of tuberculosis among children becomes actual, which may be masked as
obstructive bronchitis. In such case will be a long-term symptoms of
intoxication, a history of frequent respiratory infections.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">At X-ray of the chest thqre
will be marked narrowing of the lumen of the bronchi, areas of atelectasis,
emphysema, the presence of fistula with separation of caseous mass. For the
correct diagnosis the utmost importance has tuberculin diagnostics, as well as
identification of the causative agent in the washing waters. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Often, BOS may be detected in <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">diseases of the central and
peripheral nervous system.</span> In children with birth trauma, CNS
impairment, hypertension-hydrocephalic syndrome, with severe malformations of
the brain may be disrupted coordination of swallowing and sucking, which may
result in aspiration of food (mostly liquid) with the development of BOS. At
myopathy (amyotrophy Verdniga-Hoffmann disease, Oppenheim's) dysphagia
associated with paresis of the swallowing muscles occurs with subsequent
development of aspiration bronchitis. Swallowing disorders in these diseases
are wavelike nature: the periods of improvement are replaced by increasing
aspiration, mainly in the background of ARVI. Increased respiration and a
direct effect of viral infection on the neuro-muscular system may contribute to
violations of swallowing, dyskinesia of bronchial tree with the development of
pronounced bronhoconstriction. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Thus, the
differential diagnosis of bronchial obstruction syndrome in children is an
extremely important issue. The tactics to the patient, differential treatment
measures, which in turn determines the outcome of the disease depends on the
timely establishment of the causes of bronchial obstruction.</span><span lang="UK" style="font-size: 14pt;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;">Referens:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;">A - Basic: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;">1.<span style="mso-spacerun: yes;"> </span>Pediatrics.
Textbook. / O. V. Tiazhka, T. V. Pochinok, A. N. Antoshkina
et al. / edited by O. Tiazhka – Vinnytsia : Nova Knyha Publishers, 2011 – 584
pp. : il.ISBN 978-966-382-355-3</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;">2.<span style="mso-spacerun: yes;"> </span>Nelson
Textbook of Pediatrics, 19th Edition Kliegman, Behrman. Published by Jenson
& Stanton, 2011, 2608.<span style="mso-spacerun: yes;"> </span>ISBN: 978-080-892-420-3.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;">3.<span style="mso-spacerun: yes;"> </span>Illustrated
Textbook of Paediatrics, 4th Edition.<span style="mso-spacerun: yes;">
</span>Published by<span style="mso-spacerun: yes;"> </span>Lissauer &
Clayden, 2012, 552 p. ISBN: 978-072-343-566-2.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;">4.<span style="mso-spacerun: yes;"> </span>Denial
Bernstein. Pediatrics for medical Students. – Second edition, 2012. – 650 p.</span></span></div>
<span style="background-color: white;"><br /><span lang="UK" style="font-size: 14pt;"></span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-70327784110034127972013-04-02T15:40:00.001-07:002013-04-02T15:40:13.670-07:00ATTACK OF BRONCHIAL ASTHMA IN CHILDREN OF EARLY AGE<div class="MsoBodyTextIndent2" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt; line-height: 150%;">As a result of
anatomo-physiologic features of breathing organs<span style="mso-spacerun: yes;"> </span>in the children of early age<span style="mso-spacerun: yes;"> </span>the pathophysiologic mechanisms of
bronchoobstruction and<span style="mso-spacerun: yes;"> </span>edema of mucus
membrane of bronchial tubes and hypersecretion of bronchial glands come forward
on the first plan. It is the reasone of<span style="mso-spacerun: yes;">
</span>more gradual beginning and slow<span style="mso-spacerun: yes;">
</span>development of disease, “moist” character of asthma, less efficiency of
sympatomimetics.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinic.</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> Trouble, crabbiness of child at the moderate phenomena of general
intoxication and normal temperature of body. Cyanosis<span style="mso-spacerun: yes;"> </span>of lips, nasolibs triangle, acrocyanosis.
Dyspnoe, noisy, with the prolonged inspiration and<span style="mso-spacerun: yes;"> </span>distance wheezes. Downing in of interribs
intervals, supraclavicular areas, jugular pit. Attacks of underproductive,
sometimes attack cough. A thorax is emphizematous, at percussion above lungs bandbox
sound, at auscultation breathing is hard, with the prolonged inspiration and
dissipated dry and different moist wheezes. </span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">Та</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">chycardia. A liver is often enlarged. There can be
eozinophylia in the general analysis of<span style="mso-spacerun: yes;">
</span>blood, sometimes there is moderate neutrophyl leucytosis. On the X-ray
examination of thorax organs pulmonary<span style="mso-spacerun: yes;">
</span>picture is strengthening , areas of promoted pneumatisation without of
infiltrative changes in lungs.</span></span></div>
<span style="background-color: white;">
</span><h1 style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"> </span></span></h1>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Further Inpatient Care</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Admit patients for treatment of acute severe episodes
if they are unresponsive to outpatient care (eg, they have worsening
bronchospasm, hypoxia, evidence of respiratory failure). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Once the patient is admitted, further investigations
(eg, PFTs, allergy testing, and investigations to rule out other associated
conditions and complications) can be performed. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Further Outpatient
Care</b> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Regular follow-up visits (1-6-mo intervals) are
essential to ensure control and appropriate therapeutic adjustments. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Outpatient visits should include the
following: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Interval history of asthmatic
complaints, including history of acute episodes</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">(eg, severity, measures and treatment
taken, response to therapy) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">History of nocturnal symptoms </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">History of symptoms with exercise and
exercise tolerance </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Review of medications, including use
of rescue medications </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Review of home-monitoring data (eg,
symptom diary, peak flow meter</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">readings, daily treatments) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Patient evaluation should include the
following: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Assessment for signs of bronchospasm
and complications </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Evaluation of associated conditions
(eg, allergic rhinitis) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Pulmonary function testing (in appropriate
age group) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Address issues of treatment adherence
and avoidance of environmental</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">triggers and irritants. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Long-term asthma care pathways
that incorporate the aforementioned factors can serve as roadmaps for
ambulatory asthma care and help streamline outpatient care by different
providers. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">In the author's asthma clinic,
a member of the asthma care team sits with each patient to review the written
asthma care plan and to write and discuss in detail a rescue plan for acute
episode, which includes instructions about identifying signs of acute episode,
using rescue medications, monitoring, and contacting the asthma care team.
These items are reviewed at each visit. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;">Inpatient
& Outpatient Medications</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bronchodilators (short- and long-acting) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Controlling medications (nonsteroidal, steroidal,
newer agents such </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>as leukotriene modifiers) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Medications for the treatment of associated conditions
(antiallergy </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>medications, nasal steroids for
allergic rhinitis) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Rescue medications for use in acute episodes (short
burst of steroids) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Transfer</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Any patient with a high risk of asthma should be referred to
a specialist. The following may suggest a high risk: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">History of sudden severe
exacerbations </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">History of prior intubation for
asthma </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Admission to an ICU because of asthma
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Two or more hospitalizations for
asthma in the past year </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Three or more emergency department
visits for asthma in the past year </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Hospitalization or an emergency
department visit for asthma within the </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">past month </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Use of 2 or more canisters of inhaled
short-acting beta<sub>2</sub>-agonists per month </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 0cm;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Current use of systemic
corticosteroids or recent withdrawal from </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>systemic corticosteroids </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The choice between a pediatric
pulmonologist and an allergist may depend on local availability and practices.
A patient with frequent ICU admissions, previous intubation, and a history of
complicating factors or comorbidity (eg, cystic fibrosis) should be referred to
a pediatric pulmonologist. When allergies are thought to significantly
contribute to the morbidity, an allergist may be helpful. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Prevention</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The goal of long-term therapy
is to prevent acute exacerbations. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The patient should avoid
exposure to environmental allergens and irritants that are identified during
the evaluation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Complications</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Pneumothorax, status asthmaticus with
respiratory failure </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Fixed (nonreversible) airway
obstruction </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Death </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Prognosis</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Of infants who wheeze with
URTIs, 60% are asymptomatic by age 6 years; however, children who have asthma
(recurrent symptoms continuing at age 6 y) have airway reactivity later in
childhood. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Some findings suggest a poor
prognosis if asthma develops in children younger than 3 years, unless it occurs
solely in association with viral infections. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Individuals who have asthma
during childhood have significantly lower FEV1 and airway reactivity and more
persistent bronchospastic symptoms than those with infection-associated
wheezing. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Children with mild asthma who
are asymptomatic between attacks are likely to improve and be symptom-free
later in life. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Children with asthma appear to
have less severe symptoms as they enter adolescence, but half of these children
continue to have asthma. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Asthma has a tendency to remit
during puberty, with a somewhat earlier remission in girls. However, compared
with men, women have more BHR. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Patient Education</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Patient and parent education
should include instructions on how to use medications and devices (eg, spacers,
nebulizers, MDIs). The patient's MDI technique should be assessed on every
visit. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Discuss the management plan,
which includes instructions about the use of medications, precautions with drug
and/or device usage, monitoring symptoms and their severity (peak flow meter
reading), and identifying potential adverse effects and necessary actions. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Write and discuss in detail a
rescue plan for an acute episode. This plan should include instructions for
identifying signs of an acute attack, using rescue medications, monitoring, and
contacting the asthma care team. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Parents should understand that
asthma is a chronic disorder with acute exacerbations; hence, continuity of
management with active participation by the patient and/or parents and
interaction with asthma care medical personnel is important. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Emphasize the importance of
compliance with and adherence to treatment. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Incorporate the concept of
expecting full control of symptoms, including nocturnal and exercise-induced
symptoms, in the management plans and goals (for all but the most severely
affected patients). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Avoid unnecessary restrictions
in the lifestyle of the child or family. Expect the child to participate in
recreational activities and sports and to attend school as usual.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt; line-height: 150%;">ASPIRATION
SYNDROME</span></b></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>One of the most common causes of BOS in
infants - a syndrome of habitual microaspiration of liquid food associated with
dysphagia, often in combination with gastro-oesophageal reflux. Up to 30% of
all cases of recurrent cough in infants are associated with aspiration syndrome.
Determination of the cause may be difficult. Anamnestic data helps in the
diagnosis of aspiration. Usually in these children there are the history and
neurological symptoms such as attack coughing that develops in the child during
feeding, the appearance of dry or moist rales in the lungs after a meal. The
diagnosis is confirmed after examining a patient in the hospital.</span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-46023970085007776652013-04-02T15:38:00.004-07:002013-04-02T15:38:40.822-07:00Asthmatic State In Children<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">The asthmatic state is the attack of asthma,
which lasts more than 6–10 hours and resistant to sympatomimetics and
methylxantins. It is characterized by total bronchoobstruction on a background
of refraction of </span><span lang="UK" style="font-family: Symbol; font-size: 14pt;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">b</span></span><sub><span lang="EN-US" style="font-size: 14pt;">2</span></sub><span lang="EN-US" style="font-size: 14pt;">-adrenoreceptors
with progress of hypoxia, hypercapnia, decompensative acidosis, dehydration and
development of acute cardiac insufficiency of a right-heart type. In the
process of development of the asthmatic state three stages are selected:
relative indemnification, decompensation and hypoxemic comma.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoHeading8" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Diagnostic criteria of asthmatic status</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1.
</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Protracted attack of bronchial asthma, which
is not cured during 6 hears </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>and
anymore. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2.
Resistens</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> to sympatomimetics.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Violation of drainage
function of bronchial tubes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4. Development hypoxemia - </span><b><i><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></i></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">РаО<sub>2</sub> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>-</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> 60
ml Hg, hypercarpnia - РаСО<sub>2</sub> </span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-char-type: symbol; mso-symbol-font-family: "Times New Roman";"><span style="mso-char-type: symbol; mso-symbol-font-family: "Times New Roman";"></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> 60 ml Hg.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Clinic</span></b><b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><b>I </b></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">stage of the asthmatic status (relative compensation).</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Forced sitting<span style="mso-spacerun: yes;"> </span>position, leaning against
hands, tachypnoe with the considerably prolonged inspiration, attack cough with
much amount of viscid phlegm which is badly deleted. Skinis pale, cyanosys of
lips, nasolips triangle, acro</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;">-</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> or general cyanosys. A thorax is emphysematous,
the excursion<span style="mso-spacerun: yes;"> </span>is limited, above lungs
percussion box sound. Plenty of the<span style="mso-spacerun: yes;">
</span>distance wheezes in comparisone with little amount of<span style="mso-spacerun: yes;"> </span>dry wheezes, the loosened breathing in lungs.
The border of heart is not determined, are low, systolic murmur on an apex,
tachycardia. A liver is enlarged, sickly. Arterial pressure is decreased.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Help </span></b><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">on prehospital </span></b><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">stage</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Do not use of
symdatomimetics!</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">To provide access of fresh air.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">To release from squeezing clothes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy:<span style="mso-spacerun: yes;"> </span>moistened air through a mask.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2,4
% solution of Euphyllini in dose of a 5 mg/kg of<span style="mso-spacerun: yes;"> </span>mass of</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">intravenously
streamly on a 15 –20 ml of isotonic<span style="mso-spacerun: yes;">
</span>solution of sodium</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">chloride.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2 % solution of No-spani a 1 mg/кг
mass on dose intramuscular.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3 % solution of Prednisoloni 2-3 mg/kg
of the masses (Hydrocortison</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;">і </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">10-15 mg/kg) intramuscular or intravenously
streamly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Urgent hospitalization.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 1.4pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Help on a hospital stage</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Do not use sympatomimetics!</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">To provide access of fresh air.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
optimum 40 % by the moistened oxygen constantly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3
% solution of Prednisoloni in dose 2-3 mg/kg of<span style="mso-spacerun: yes;">
</span>the mass intravenously streamly on a 5-10 ml of<span style="mso-spacerun: yes;"> </span>isotonic<span style="mso-spacerun: yes;">
</span>solution of sodium chloride.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2
% solution of No-spani<span style="mso-spacerun: yes;"> </span>1 mg/kg of<span style="mso-spacerun: yes;"> </span>mass on dose intramuscular or intravenously
streamly slowly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Solution
of Corgliconi 0,06 % or Strophantini 0,05 % 0,1 ml per the year</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>of life, but not more than 0,3-0,4 ml on a
5-10 ml isotonic<span style="mso-spacerun: yes;"> </span>solution of sodium<span style="mso-spacerun: yes;"> </span>chloride<span style="mso-spacerun: yes;">
</span>intravenously streamly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Cocarboxylazae
50-100 mg, 5 % solution of sodium ascorbinati 2,0-5,0 ml, Panangini 0,5 ml per
year of life of intravenously streamly in separate syringe .</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2,4
% solution of Euphyllini 7-10 mg/kg of<span style="mso-spacerun: yes;">
</span>mass on a 200 ml of isotonic<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>solution of sodium<span style="mso-spacerun: yes;"> </span>chloride</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">intravenously
with a next continuous tranfusion on </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Euphyllinization</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
by intravenously infusion of 2,4 % solution of Euphyllini at a speed of 0,7
mg/kg/hour on isotonic<span style="mso-spacerun: yes;"> </span>solution</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">of
sodium<span style="mso-spacerun: yes;"> </span>chloride, but not more than 24
mg/kg/day for the children upto 9 years and 20 mg/kg/day for children<span style="mso-spacerun: yes;"> </span>senior than<span style="mso-spacerun: yes;">
</span>9 years.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Heparini
200-300 U/day on 4 intravenous stream injection every 6 hours.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Reopoliglucini 150-200 ml
intravenously in drops.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">11.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">In default of effect in 2 hours o
repeate intravenous stream injection of<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Prednisolone 2-3 mg/kg of<span style="mso-spacerun: yes;"> </span>the masses or Hydrocortisoni 10-15 mg/kg
of<span style="mso-spacerun: yes;"> </span>mass.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Alkaline drink: mineral water, 1 %
solution of soda, milk with a soda.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Intravenous<span style="mso-spacerun: yes;">
</span>injection of 4 % solution of sodium bicarbonatis only under</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">the control
of<span style="mso-spacerun: yes;"> </span>acid – alkaline equilibrium indexes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">13.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Absence of effect after the repeated
injection<span style="mso-spacerun: yes;"> </span>of glucocorticoids testifies</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">to transition
of the asthmatic state in the ІІ stage.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinic of the ІІ stage of
the asthmatic status (decompensations).</span></b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Child
in consciousness, excited or apathetical. General cyanosis of skin and mucus, a
person is puffy, the veins of neck are swelling. Breathing is encreased, noisy
with the prolonged inspiration and acute downing in of interribs intervals,
supraclavicular and epigastrial areas, jugular pit with a limited excursion of
thorax. Percussion: bandbox sound. Breathing is sharply loosened with single
unsounding dry wheezes, in the lower areas of lungs breathing is not listened,
syndrome of “mute lungs”. </span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;">Та</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">hycardia, pulse of the weak filling,
unrhythmical. The tones of heart are not determined, tones are deaf. Arterial
pressure is reduced. A liver is enlarged, sickly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Help </span></b><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">on prehospital </span></b><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">stage</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">To provide access of fresh air.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy:<span style="mso-spacerun: yes;"> </span>moistened air through a mask</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2,4 % solution of Euphyllini in dose
of a 5 mg/kg of<span style="mso-spacerun: yes;"> </span>mass intravenously</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>streamly on a 15-20 ml of<span style="mso-spacerun: yes;"> </span>isotonic<span style="mso-spacerun: yes;">
</span>solution of sodium<span style="mso-spacerun: yes;"> </span>chloride.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3 % solution of Prednisoloni in dose
of a 3-5 mg/kg of<span style="mso-spacerun: yes;"> </span>mass or </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Hydrocortisoni 15-25 mg/kg
of<span style="mso-spacerun: yes;"> </span>mass intramuscular or intravenously</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>streamly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Urgent hospitalization.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Help on<span style="mso-spacerun: yes;"> </span>hospital stage</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">To provide access of fresh air.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy:
</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">optimum 40 % of the moistened oxygen constantly</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>through a mask.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3 % solution of Prednisoloni in dose
of<span style="mso-spacerun: yes;"> </span>3-5 mg/kg of<span style="mso-spacerun: yes;"> </span>mass or </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Hydrocortisoni<span style="mso-spacerun: yes;"> </span>15-25 mg/kg
of<span style="mso-spacerun: yes;"> </span>mass of intravenously streamly with
the </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>repeated introduction after 1,5-2 hours in default of effect.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2 % solution of No-spani 1 mg/kg of
mass in dose intramuscular or </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>intravenously streamly
slowly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Solution of Corgliconi 0,06 % or
Strophantini 0,05 % in dose 0,1 ml per</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>the year of life, but not more than 0,3-0,4 ml
intravenously streamly on a</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>5-10 ml of<span style="mso-spacerun: yes;">
</span>isotonic solution of sodium<span style="mso-spacerun: yes;">
</span>chloride.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Cocarboxylazae 50-100 mg, panangini
0,5 ml per year of life, 5 % </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>solution of<span style="mso-spacerun: yes;"> </span>sodium<span style="mso-spacerun: yes;">
</span>ascorbinati 2,0-5,0 ml intravenously streamly in</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>separate syringes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2,4 % solution of Euphyllini 7-10
mg/kg of mass on a 200 ml of isotonic</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>solution of sodium<span style="mso-spacerun: yes;"> </span>chloride of intravenously in drops. If
Euphyllini was</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>already entered at treatment of I stage of the
asthmatic status, continue</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Euphyllini</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;">zation</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> at a speed
of 0,7 mg/kg/hour on isotonic solution of </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>sodium chloride 50 ml/ hour.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Heparini 200-300 Units/kg/days,
divided in 4 injections, every 6 hours</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>intravenously streamly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">In default of effect after the
repeated introduction of glucocorticoids</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>urgent intubation with
bronchoscopy sanation and after that- artificial</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>ventilation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">On artificial ventilation Euphyllini</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;">zation</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
must be continued, repeat </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>introductions of
Prednisoloni every 1,5-2 hours in<span style="mso-spacerun: yes;"> </span>dose
of<span style="mso-spacerun: yes;"> </span>6-10 mg/kg</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>of<span style="mso-spacerun: yes;"> </span>mass.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">11.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Mucolitic drugs endotrachially with
the following lavagge of bronchial</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>tubes with bronchoscopy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Intravenously 4 % solution of sodium
bycarbonatis only under the</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>control of indexes acid – alkaline
equilibrium.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">13.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Haemosorbtion, plazmopheresis.</span></span></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">It is not recommended to enter:</span></b><b><span lang="UK" style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">1.</span><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-fareast-language: EN-US;">Antihistaminic drugs – Suprastini,Tavegili,
Claritini.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">2.Sedative</span><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-fareast-language: EN-US;"> drugs – Seduxeni, Sodium oxytirati , Aminasini.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3.Drugs with ephedrini</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> –
Solutani, Broncholitini.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4.Unselective</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> </span><span lang="UK" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">b</span></span><sub><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">2-</span></sub><sub><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> </span></sub><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">-adrenomimetics -
Astmopent, Alupent, Izadrin. </span></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">5.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Prolonged </span><span lang="UK" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">b</span></span><sub><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">2-</span></sub><sub><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> </span></sub><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">-adrenomimetics –
Salmeterol, Seretid.</span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-69851660897411168962013-04-02T15:37:00.002-07:002013-04-02T15:37:35.794-07:00Bronchial Asthma In Children<span style="background-color: white;"><span style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></span>
<br />
<div class="Section26">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-fareast-language: RU;"><img height="277" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image072.jpg" width="277" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: RU;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Bronchial asthma is a disease manifested reversible (fully or partially),
bronchial obstruction, which is based on pathogenetic allergic inflammation of
airways and, in most cases, bronchial hyperreactivity.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section27">
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">It is characterized
by recurring attacks of breathlessness, resulting from smooth muscle spasm,
edema of mucous membrane of the bronchi and their blockage by viscid secret
that leads to the BOS.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Etiology
and pathogenesis.</b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Asthma may be allergic origin, ie, occurs in
individuals with increased sensitivity to certain chemicals or physical factors
- allergens. Increased sensitivity may be a manifestation of
hereditary-constitutional features of the organism, or develops as a result of
prolonged contact with the allergen, while the impact on the body of a number
of adverse factors (cooling, fatigue, chronic inflammatory diseases, etc.). </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Asthma may also be infectious
origin. At the outbreak of infectious bronchial asthma important role have bacteria,
viruses and other microbes, which in interaction with the organism cause its
allergic restruction. Most often it develops on a background of chronic
respiratory diseases or paranasal sinusitis, at which in the body there is
infection focus of a long time, as well as products of the microbes and substances
produced during inflammation, have the properties of allergens.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Noninfectious asthma is caused by
allergens of animal and vegetable origin. Allergens of animal origin include
wool, horse hair, fish scales, etc. Sensitivity is sometimes also observed in
some insect - bugs, cockroaches, butterflies, etc. Among the allergens of plant
pollens play a special role. Bronchial asthma caused by plant allergens occur
in a certain season of the year (April - July) - the period of flowering
plants. In addition, the cause of asthma may be house dust and dry food for
aquarium fish, etc., certain foods (eggs, crabs, chocolate, mushrooms,
strawberries, oranges, etc.), some medicines.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In the event of attack of asthma there
are importance of <span style="mso-spacerun: yes;"> </span>individual
characteristics of nervous and endocrine systems. There are known occasions that
in <span style="mso-spacerun: yes;"> </span>the patient with sensitiveness to the
smell of roses, attack started at the sight of artificial roses. Negative
emotions may provoke attacks also. In some patients attacks of asthma do not
appear in periods of intense work, or during deep sleep. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The development and course of
bronchial asthma depend on climatic factors. Exacerbations of the disease are
often observed in spring and fall moon, patients often feel worse in windy
weather, with sudden changes in temperature and atmospheric pressure at high
humidity. In addition, high humidity contribute to the exacerbation of chronic
bronchial and lung infections, which aggravates the course of bronchial asthma.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The modern theory of the
pathogenesis of asthma is the concept of allergic inflammation, which has
become an integrating, connecting the mediator (histamine), lipid membranes -
receptor (β<sub>2</sub> - adrenergic receptors), neurovegetative
(vagotonia), reagine (Ig E) and other concepts. Development of suffocation is
conditioned directly by three major pathophysiological mechanisms:
bronchospasm, edema of bronchial mucosa and hypersecretion of bronchial glands.
</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"><img height="303" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image074.jpg" width="354" /></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-fareast-language: EN-US;">The inflammatory response in asthma is
illustrated in this airway section from a patient with mild asthma who died in
an accident. There is a submucosal infiltration of eosinophils and a marked
deposition of collagen below the basement membrane. (From Hilman BC (ed):
Pediatric Respiratory Disease. Philadelphia, WB Saunders, 1993, </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">p.</span><span lang="UK" style="font-size: 14.0pt; mso-fareast-language: EN-US;">625.)</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span>Classification of bronchial asthma</span></b></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The severity of asthma is
classified on the basis of complex clinical and functional signs of bronchial
obstruction. The physician evaluates the frequency, severity and duration of
attacks of expiratory dyspnea, patient's condition during the period between
attacks, severity, variabillity, and repayment of functional bronchial
obstruction, response to treatment. Evaluation of functional indicators for
determining the severity of the disease is carried out in the absence of
episodes expiratory dyspnea. According to this classification, the patient's
condition is determined by the degrees of seriousness of bronchial asthma. So
there are <span style="mso-spacerun: yes;"> </span>intermittent (episodic)
course; persistent (constant) course: mild, moderate and severe.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The
National Asthma Education and Prevention Program Expert Panel Report II
(EPR-2), "Guidelines for the Diagnosis and Management of Asthma,"
highlight the importance of correctly diagnosing asthma. To establish the
diagnosis of asthma, the clinician must establish the following: (a) episodic
symptoms of airflow obstruction are present, (b) airflow obstruction or
symptoms are at least partially reversible, and (c) alternative diagnoses are
excluded.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The
severity of asthma is classified as mild intermittent, mild persistent,
moderate persistent, or severe persistent, according to the frequency and
severity of symptoms, including nocturnal symptoms, characteristics of acute
episodes, and pulmonary function. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>These categories do not always work well in
children. First, lung function is difficult to assess in younger children.
Second, asthma that is triggered solely by viral infections does not fit into
any category. While the symptoms may be intermittent, they may be severe enough
to warrant hospitalization. Therefore, a category of severe intermittent asthma
has been suggested. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Features of the categories include the
following: </b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Patients with mild intermittent disease</span> have
symptoms fewer than 2 times a week, and pulmonary function is normal between
exacerbations. Exacerbations are brief, lasting from a few hours to a few days.
Nighttime symptoms occur less than twice a month. The variation in peak
expiratory flow (PEF) is less than 20%. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Patients with mild persistent asthma</span> have symptoms
more than 2 times a week but less than once a day. Exacerbations may affect
activity. Nighttime symptoms occur more than twice a month. Pulmonary function
test results (in age-appropriate patients) demonstrate that the forced
expiratory volume in 1 second (FEV1) or PEF is less than 80% of the predicted
value, and the variation in PEF is 20-30%. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Patients with moderate persistent asthma</span> have
daily symptoms and use inhaled short-acting beta2-agonists every day. Acute
exacerbations in patients with moderate persistent asthma may occur more than 2
times a week and last for days. The exacerbations affect activity. Nocturnal
symptoms occur more than once a week. FEV1 and PEF values are 60-80% of the
predicted values, and PEF varies by more than 30%. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Patients with severe persistent asthma</span> have
continuous or frequent symptoms, limited physical activity, and frequent
nocturnal symptoms. FEV1 and PEF values are less than 60% of the predicted
values, and PEF varies by more than 30%. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Disease with any of their features
is assigned to the most severe grade. The presence of one severe feature is
sufficient to diagnose severe persistent asthma. The characteristics in this
classification system are general and may overlap because asthma is highly
variable. The classification may change over time. Patients with asthma of any
level of severity may have mild, moderate, or severe exacerbations. Some patients
with intermittent asthma have severe and life-threatening exacerbations
separated by episodes with almost normal lung function and minimal symptoms;
however, they are likely to have other evidence of increased BHR (exercise or
challenge testing) due to ongoing inflammation. </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Physical examination during an acute
episode may reveal different findings in mild, moderately severe, and severe
episodes and in status asthmaticus with imminent respiratory arrest. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Mild episode:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
The respiratory rate is increased. Accessory muscles of respiration are not
used. The heart rate is less than 100 beats per minute. Pulsus paradoxus is not
present. Auscultation of chest reveals moderate wheezing, which is often end
expiratory. Oxyhemoglobin saturation with room air is greater than 95%. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Moderately severe
episode:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> The respiratory rate is increased. Typically,
accessory muscles of respiration are used, and suprasternal retractions are
present. The heart rate is 100-120 beats per minute. Loud expiratory wheezing can
be heard. Pulsus paradoxus may be present (10-20 mm Hg). Oxyhemoglobin
saturation with room air is 91-95%. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Severe episode:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
The respiratory rate is often greater than 30 breaths per minute. Accessory
muscles of respiration are usually used, and suprasternal retractions are
commonly present. The heart rate is more than 120 beats per minute. Loud
biphasic (expiratory and inspiratory) wheezing can be heard. Pulsus paradoxus
is often present (20-40 mm
Hg). Oxyhemoglobin saturation with room air is less than 91%. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Status
asthmaticus with imminent respiratory arrest: Paradoxical thoracoabdominal
movement occurs. Wheezing may be absent (associated with most severe airway
obstruction). Severe hypoxemia may manifest as bradycardia. Pulsus paradoxus
noted earlier may be absent; this finding suggests respiratory muscle fatigue.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">Clinic</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Asthma may be manifested in
the form of whistles, wheezing when breathing, shortness of breath (dyspnea) with
exertion or at rest, in the form of coughing, which may be paroxysmal. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The classic manifestation of
bronchial asthma is the attack of asphyxia. Typically, it begins suddenly,
usually at night. The patient feels a pain and lack of air. Breathing is
difficult, exhaling long and is accompanied by a loud whistling wheezing
(so-called, expiratory dyspnea). Cough may join soon. In order to facilitate
breathing patient takes the forced position - rising or setting, leaning on the
edge of the bed, chair, straining his pectoral muscle.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-fareast-language: RU;"><img height="192" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image076.jpg" width="160" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: RU;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>After some time, breathing
becomes calmer, sputum is separating; attack stops. Attacks last from several
minutes to several hours or even days. Such prolonged or frequent (occurring at
short intervals during the day) the attacks are called an asthmatic state.
Occasional attacks do not leave behind any changes in the lungs, but with the
development of the disease and the increasing frequency of attacks may occur
emphysema, impairment of the heart. It should be in mind that asphyxia may be
caused not only by asthma but other diseases. In most cases, the doctor during
the examination of <span style="mso-spacerun: yes;"> </span>the patient may
determine the nature and origin of suffocation, with the need to use
instrumental and laboratory methods.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Objectively:</span> skinis pale, cyanosis of the lips,
nasolabial triangle, acrocyanosis. Thorax is blown, shoulders are raised, lung
percussion sound is bandbox, auscultation reveals relaxed breathing, prolonged exhaling,
a large number of dry whistling </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">wheezing</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">and
changing moist rales. Borders of the heart are not defined, the tones are
weakened, tachycardia.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Diagnostic criteria</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 13pt; line-height: 150%;">Anamnesis</span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;">. Symptoms:
wheezing, shortness of breath, cough, fever, the formation of phlegm, and other
allergic disorders. There is possible presence of contributing factors
(allergens, infection, etc.), occurrence of asthma attacks at night. Attacks
are curable. The outcome of previous attacks (the need for hospitalization,
treatment with steroids).</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 13pt; line-height: 150%;">Physical examination.</span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Total: tachypnea, tachycardia, part of the auxiliary respiratory muscles,
cyanosis, paradoxical pulse (the inclusion of support muscles and paradoxical
pulse are correlated with the severity of obstruction). Lungs: adequate
aeration, with auscultation the symmetry of breath, wheezing, long exhalation,
increased volume of lungs are determined. Heart: signs of CVF. Allergic
rhinitis and (or) sinusitis or dermatitis.<span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The clinical picture varies. Symptoms may be
associated with URTIs, nocturnal or exercise-induced asthmatic symptoms, and
status asthmaticus. Status asthmaticus, or an acute severe asthmatic episode
that is resistant to appropriate outpatient therapy, is a medical emergency
that requires aggressive hospital management. This may include admission to an
ICU for the treatment of hypoxia, hypercarbia, and dehydration and possibly for
assisted ventilation because of respiratory failure. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Physical findings vary with
the absence or presence of an acute episode and its severity, as follows: </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–Physical examination in
the absence of an acute episode (eg, during an outpatient visit between acute
episodes) </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–The physical findings vary
with the severity of the asthma. During an outpatient visit, it is not uncommon
for a patient with mild asthma to have normal findings at physical examination.
Patients with more severe asthma are likely to have signs of chronic respiratory
distress and chronic hyperinflation. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Signs
of atopy or allergic rhinitis, such as conjunctival congestion and
inflammation, ocular shiners, a transverse crease on the nose due to constant
rubbing associated with allergic rhinitis, and pale violaceous nasal mucosa due
to allergic rhinitis, may be present. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The anteroposterior diameter
of the chest may be increased because of hyperinflation. Hyperinflation may
also cause an abdominal breathing pattern. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Lung examination may reveal
prolongation of the expiratory phase, expiratory wheezing, coarse crackles, or
unequal breath sounds. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Clubbing of the fingers is not a feature of
straightforward asthma and indicates a need for more extensive evaluation and
work-up to exclude other conditions, such as cystic fibrosis.</span><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14pt; line-height: 150%;"><img height="280" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image078.jpg" width="409" /></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></span></div>
<div class="MsoBodyText3">
<span style="background-color: white;"><span lang="UK">Allergic shiners. (From Marks M: Physical
Signs of Allergy of the Respiratory Tract in Children. New
York, American College
of Allergy, Asthma and
Immunology, 1990.)</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt; line-height: 150%;"><img height="318" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image080.jpg" width="325" /></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Nose wrinkling of an allergic child. (From
Marks M: Physical Signs of Allergy of the Respiratory Tract in Children. New York, American College of Allergy,
Asthma and Immunology, 1990.)</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt; line-height: 150%;"><img height="314" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image082.jpg" width="352" /></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></span></div>
<div class="MsoBodyText3">
<span style="background-color: white;"><span lang="UK">Allergic salute. (From Marks M: Physical
Signs of Allergy of the Respiratory Tract in Children. New
York, American College
of Allergy, Asthma and
Immunology, 1990.)</span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><img align="left" height="336" hspace="12" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image084.jpg" width="348" /><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Transverse nasal crease in an allergic child.
(From Marks M: Physical Signs of Allergy of the Respiratory Tract in Children. New York, American College of Allergy,
Asthma and Immunology, 1990.)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;"><img height="327" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image086.jpg" width="335" /></span><span lang="EN-US" style="font-size: 14pt;"></span></span></div>
<div class="MsoBodyText3">
<span style="background-color: white;"><span lang="UK">"Rabbit nose" of allergic
rhinitis. (From Marks M: Physical Signs of Allergy of the Respiratory Tract in
Children. New York, American College of Allergy,
Asthma and Immunology, 1990.)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14pt;"><img height="244" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image088.jpg" width="493" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoBodyText3">
<span style="background-color: white;"><span lang="UK" style="mso-fareast-language: UK;">Dark
circles beneath the eyes of a child with allergic rhinitis. (From Marks M:
Physical Signs of Allergy of the Respiratory Tract in Children. New York, American College of Allergy,
Asthma and Immunology, 1990.)</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><img height="252" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image090.jpg" width="361" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Ocular allergy. (From Marks M: Physical Signs of Allergy of the
Respiratory Tract in Children. New York,
American College
of Allergy, Asthma and
Immunology, 1990.)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="372" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image092.jpg" width="241" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><img height="423" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image094.jpg" width="277" /></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Polymorphis erythema (Courtesy of Robert A.
Silverman, M.D.)</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"><img height="309" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image096.jpg" width="461" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Urticaria.
(Courtesy of LM Pachter, M.D.)</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Symptoms
of asthma may include wheezing, coughing, and chest tightness, among others. </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Wheezing:<span style="mso-spacerun: yes;"> </span></span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A musical, high-pitched,
whistling sound produced by airflow turbulence is one of the most common
symptoms. In the mildest form, wheezing is only end expiratory. As severity
increases, the wheeze lasts throughout expiration. In a more severe asthmatic
episode, wheezing is also present during inspiration. During a most severe
episode, wheezing may be absent because of the severe limitation of airflow
associated with airway narrowing and respiratory muscle fatigue. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Asthma can occur without
wheezing when obstruction involves predominantly the small airways. Thus,
wheezing is not necessary for the diagnosis of asthma. Furthermore, wheezing
can be associated with other causes of airway obstruction, such as cystic
fibrosis and heart failure. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Patients with vocal cord
dysfunction have a predominantly inspiratory monophonic wheeze (different from
the polyphonic wheeze in asthma), which is heard best over the laryngeal area
in the neck. Patients with bronchomalacia and tracheomalacia also have a
monophonic wheeze. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In exercise-induced or
nocturnal asthma, wheezing may be present after exercise or during the night,
respectively. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Coughing:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Cough may be the only symptom of asthma, especially in cases of
exercise-induced or nocturnal asthma. Usually, the cough is nonproductive and
nonparoxysmal. Also, coughing may be present with wheezing. Children with
nocturnal asthma tend to cough after midnight, during the early hours of
morning. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Chest tightness:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> A
history of tightness or pain in the chest may be present with or without other
symptoms of asthma, especially in exercise-induced or nocturnal asthma. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Other nonspecific
symptoms:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Infants or young children may have history of
recurrent bronchitis, bronchiolitis, or pneumonia; a persistent cough with
colds; and/or recurrent croup or chest rattling. Most children with chronic or
recurrent bronchitis have asthma. Asthma is the most common underlying
diagnosis in children with recurrent pneumonia. Older children may have a
history of chest tightness and/or recurrent chest congestion. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>During an acute episode,
symptoms vary according to the severity. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Symptoms during a mild
episode:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Patients may be breathless after physical activity
such as walking. They can talk in sentences and lie down, and they may be
agitated. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Symptoms during a
moderate severe episode:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Patients are breathless while
talking. Infants have feeding difficulties and a softer, shorter cry. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Symptoms during a severe
episode:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Patients are breathless during rest, are not
interested in feeding, sit upright, talk in words (not sentences), and are
usually agitated. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Symptoms with imminent
respiratory arrest (in addition to the aforementioned symptoms): </span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The
child is drowsy and confused. However, adolescents may not have these symptoms
until they are in frank respiratory failure. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-GB" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;">Additional
data.</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> Despite the fact that lung function tests are not
decisive in the diagnosis, they help assess the severity of airway obstruction
and subsequent response to therapy in chronic and acute situations. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">V</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">C,
FVC,, FEV, the maximum air velocity in the middle of expiration, the maximum
expiratory flow rate (test Tiffno), FEV / VC decrease, residual volume (RV) and
total lung capacity (TLC) increase <span style="mso-spacerun: yes;"> </span>during
episodes of obstruction. Reduced FVC <25% of the proper or <0,75 after
the appointment of bronchodilator indicates the severity of the disease.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Pulmonary function test (PFT)</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> results are
not reliable in patients younger than 5 years. In young children (3-6 y) and
older children who can't perform the conventional spirometry maneuver, newer
techniques, such as measurement of airway resistance using impulse oscillometry
system, are being tried. Measurement of airway resistance before and after a
dose of inhaled bronchodilator may help to diagnose bronchodilator responsive
airway obstruction. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 35.45pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Spirometry:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
In a typical case, an obstructive defect is present in the form of normal
forced vital capacity (FVC), reduced FEV1, and reduced forced expiratory flow
over 25-75% of the FVC (FEF 25-75). The flow-volume loop can be concave.
Documentation of reversibility of airway obstruction after bronchodilator
therapy is central to the definition of asthma. FEF 25-75 is a sensitive
indicator of obstruction and may be the only abnormality in a child with mild
disease. In an outpatient or office setting, measurement of the peak flow rate
by using a peak flow meter can provide useful information about obstruction in
the large airways. Take care to ensure maximum patient effort. However, a
normal peak flow rate does not necessarily mean a lack of airway obstruction.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="277" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image098.jpg" width="348" /></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="164" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image100.jpg" width="250" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Spirograph</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Plethysmography:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Patients
with chronic persistent asthma may have hyperinflation, as evidenced by an
increased total lung capacity (TLC) at plethysmography. Increased residual
volume (RV) and functional residual capacity (FRC) with normal TLC suggests air
trapping. Airway resistance is increased when significant obstruction is
present.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="298" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image102.jpg" width="372" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Air Displacement Plethysmography (ADP)</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Bronchial provocation tests:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Bronchial provocation tests may be performed to diagnose BHR. These tests are
performed in specialized laboratories by specially trained personnel to
document airway hyperresponsiveness to substances (eg, methacholine,
histamine). Increasing doses of provocation agents are given, and FEV1 is
measured. The endpoint is a 20% decrease in FEV1 (PD20). </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Exercise challenge:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> In a patient
with a history of exercise-induced symptoms (eg, cough, wheeze, chest tightness
or pain), the diagnosis of asthma can be confirmed with the exercise challenge.
In a patient of appropriate age (usually >6 y), the procedure involves
baseline spirometry followed by exercise on a treadmill or bicycle to a heart
rate greater than 60% of the predicted maximum, with monitoring of the
electrocardiogram and oxyhemoglobin saturation. The patient should be breathing
cold, dry air during the exercise to increase the yield of the study.
Spirographic findings and the PEF rate (PEFR) are determined immediately after
the exercise period and at 3, 5, 10, 15, and 20 minutes after the first
measurement. The maximal decrease in lung function is calculated by using the
lowest postexercise and highest preexercise values. The reversibility of airway
obstruction can be assessed by administering aerosolized bronchodilators. </span></span></div>
</div>
<span style="background-color: white;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt; line-height: 150%;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span></b>
</span><div class="Section28">
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Blood testing:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Eosinophil
counts and IgE levels may help when allergic factors are suspected. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Recent evidence suggests the
usefulness of <b style="mso-bidi-font-weight: normal;">measuring
the fraction of exhaled nitric oxide (FeNO) </b>as a noninvasive marker
of airway inflammation, in order to adjust the dose of inhaled corticosteroids
treatment. Currently FeNO measurement, due to high cost of equipment, is used
primarily as a research tool. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Histologic Findings.</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Asthma is an inflammatory
disease characterized by the recruitment of inflammatory cells, vascular
congestion, increased vascular permeability, increased tissue volume, and the
presence of an exudate. Eosinophilic infiltration, a universal finding, is
considered a major marker of the inflammatory activity of the disease.
Histologic evaluations of the airways in a typical patient reveal infiltration
with inflammatory cells, narrowing of airway lumina, bronchial and bronchiolar
epithelial denudation, and mucus plugs. Additionally, a patient with severe
asthma may have a markedly thickened basement membrane and airway remodeling in
the form of subepithelial fibrosis and smooth muscle hypertrophy or
hyperplasia.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: RU;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Peakflowmetria</span> allows,
though tentatively, to control state of the respiratory system and helps to
some extent monitor of the effectiveness of treatment.</span></span></div>
<h3 style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="300" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image104.jpg" width="239" /></span><span lang="UK" style="font-size: 14pt; line-height: 150%;"><img height="250" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image106.jpg" width="126" /></span><span style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; font-weight: normal; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-language: RU;">Peakflowmeter</span><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt; line-height: 150%;"></span></span></h3>
<h3>
<span style="background-color: white;"><span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; font-weight: normal; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">Portable
spirometer MicroLoop </span></span></h3>
<h3>
<span style="background-color: white;"><span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; font-weight: normal; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">(Micro
Medical Ltd., UK)
</span></span></h3>
<h3>
<span style="background-color: white;"><span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; font-weight: normal; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">with
color sensor screen.<span style="mso-spacerun: yes;">
</span></span></span></h3>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section29">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Imaging Studies</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Chest radiography:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Include chest radiography in the initial workup if the asthma does not respond
to therapy as expected. In addition to typical findings of hyperinflation and
increased bronchial markings, a chest radiograph may reveal evidence of
parenchymal disease, atelectasis, pneumonia, congenital anomaly, or a foreign
body. In a patient with an acute asthmatic episode that responds poorly to
therapy, a chest radiograph helps in the diagnosis of complications such as
pneumothorax or pneumomediastinum.<span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;"> Chest x-ray</span> is not always necessary. It can document the
increase of pulmonary volume, infiltrates areas due to atelectasis of distal obturated
airway, this feature is important in suspecting of their infection.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><img height="408" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image108.jpg" width="405" /></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Asthma. A. The typical X-ray data 9-year-old child.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The inflation and increased lung
pattern. B. 7-year-old child with a more pronounced changes. C. Side projection
showing swelling with flattening of the diaphragm and increased anteroposterior
diameter at the top.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">(From Edwards D III: The child who wheezes. <IT+>In:<IT->
von Waldenburg Hilton S, Edwards DIII (eds): Practical Pediatric Radiology, 2nd
ed. Philadelphia, WB Saunders, 1994, p 106.)</span></span></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section30">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Paranasal sinus
radiography or CT scanning</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">: Consider using these to rule out
sinusitis. </span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section31">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="mso-ansi-language: RU; mso-fareast-language: RU;"><img height="286" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image110.jpg" width="456" /></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: RU;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: RU;"><span style="mso-spacerun: yes;"> </span>Computor
tomography. Emphysema.</span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="132" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image112.jpg" width="132" /><span style="mso-spacerun: yes;"> </span><img height="132" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image114.jpg" width="132" /><span style="mso-spacerun: yes;"> </span><img height="133" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image116.jpg" width="133" /><span style="mso-spacerun: yes;"> </span></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Chronic
Sinusitis</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section32">
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<br /></div>
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<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Other Tests</span></b></span></div>
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<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 13pt; line-height: 150%;">Allergy testing:</span></b><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Allergy
testing can be used to identify allergic factors that may significantly
contribute to the asthma. Once identified, environmental factors (eg, dust
mites, cockroaches, molds, animal dander) and outdoor factors (eg, pollen,
grass, trees, molds) may be controlled or avoided to reduce asthmatic symptoms.
Allergens for skin testing are selected on the basis of suspected or known
allergens identified from a detailed environmental history. Antihistamines can
suppress the skin test results and should be discontinued for an appropriate
period (according to the duration of action) before allergy testing. Topical or
systemic corticosteroids do not affect the skin reaction. </span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In the period of remission <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">allergic skin tests</span> are
conducted, positive analysis of which gives the possibility to exclude contact
with the causative allergen, that is the key of the recovery.</span></span></div>
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<span style="background-color: white;"><span style="font-size: 13pt; line-height: 150%;"><img height="288" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image118.jpg" width="437" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; mso-fareast-language: EN-US;">Allergic prick
text. (Courtesy of MR Sly, M.D.)</span></span></div>
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<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">The analysis of sputum:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
eosinophilia, Kurshman spiral (cylinders of the bronchioles), crystals Charcot
- Leiden; neutrophilia proves the existence of bronchial infection.</span></span></div>
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<br /></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="477" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image120.jpg" width="334" /></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">A–eosinophyles</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">B– Charcot - Leiden crystals </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">C– Kurshman spiral</span></span></div>
<span style="background-color: white;">
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Arterial blood gases:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> typical
symptoms of hypoxemia during attacks and is usually expressed in hypocapnia and
respiratory alkalosis, a normal or increased partial pressure pCO<sub>2</sub>
showes a significant fatigue of respiratory muscles and airway obstruction. </span></span></div>
<span style="background-color: white;">
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<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Differential diagnosis </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">"Any wheezing" - is
not bronchial asthma. Differentiated with CNS diseases, chronic bronchitis and
(or) emphysema, obstruction URT caused by foreign body, tumor, edema of the
larynx, carcinoid tumors (usually followed by a crowing, but not wheezing), repeated
emphysema, eosinophilic pneumonia, dysfunction of the vocal folds, systemic
vasculitis with lesions of the lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Clinically the most important
is differential diagnosis with bronchiolitis and </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;">laryngotracheal stenosis</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
due to similar clinical picture.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><img height="230" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image122.jpg" width="388" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">Differential diagnostics</span></b><b><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>attack of bronchial asthma that
laryngotracheal stenosis</span></b><b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></b></span></div>
<span style="background-color: white;">
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<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
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<h6>
<span style="background-color: white;">Criteria</span></h6>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
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<div align="center" class="MsoNormal" style="text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">Bronchial
asthma</span></b><b><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">Laryngotracheal stenosis</span></b><b><span lang="UK" style="font-size: 14pt;"></span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
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<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Background of process</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Period of precursors</span></span></div>
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<br /></div>
</td>
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<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">ARVI (parainfluenza)</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.0pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Cough</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Dry, with transition in moist one</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<h5>
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Dry, barking</span></span></h5>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.0pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Temperature</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Normal</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Subfebrile </span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.0pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Change of voice</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Absent</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Hoarse of voice</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.0pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Shortness of breath</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Expiration</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Inciter</span></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.0pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Forsed position</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Characteristically</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Non characteristically</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.0pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Auscultation</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoBodyText3">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;">The
loosened breathing, the prolonged inspiration, dry whistling and moist
wheezes</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Strict breathing</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Dry<span style="mso-spacerun: yes;">
</span>wheezes</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.0pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Percussion</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Box sound</span><span lang="UK" style="font-size: 14.0pt;"></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Pulmonary sound</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.0pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">“</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Mute” lights</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Characteristically</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 142.05pt;" valign="top" width="189">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Not characteristically</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Treatment of the
patients</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Medical Care</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The goals of asthma therapy
are to prevent chronic and troublesome symptoms, maintain normal or near-normal
pulmonary function, maintain normal physical activity levels (including
exercise), prevent recurrent exacerbations of asthma, and minimize the need for
emergency department visits or hospitalizations, provide optimal
pharmacotherapy with minimal or no adverse effects, and meet the family's
expectations for asthma care. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Medical care includes
treatment of acute asthmatic episodes and control of chronic symptoms,
including nocturnal and exercise-induced asthmatic symptoms. <b style="mso-bidi-font-weight: normal;">Pharmacologic
management</b> includes the use of control agents such as inhaled
corticosteroids, inhaled cromolyn or nedocromil, long-acting bronchodilators,
theophylline, leukotriene modifiers, and recently introduced strategies such as
the use of anti-IgE antibodies. Relief medications include short-acting
bronchodilators, systemic corticosteroids, and ipratropium. Nonpharmacologic
management includes measures to improve patient compliance and adherence. For
all but the most severely affected patients, the ultimate goal is to prevent
symptoms, minimize morbidity from acute episodes, and prevent functional and
psychological morbidity to provide a healthy (or near healthy) lifestyle
appropriate to the age of child.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">A step-down
approach based on the asthma severity classification system emphasizes the initiation
of high-level therapy to establish prompt control and then decreasing therapy
(National Asthma Education and Prevention Program Expert Panel Report II,
1997). Treatment should be reviewed every 1-6 months; a gradual stepwise
reduction in treatment may be possible. If control is not maintained despite
adequate medication and adherence and the exclusion of contributing
environmental factors, increased therapy should be considered. Long- and
short-term therapy is based on the severity of asthma, as follows: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Mild intermittent
asthma<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Long-term control:
Usually, no daily medication is needed. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Quick relief: Short-acting
bronchodilators in the form of inhaled beta2-agonists should be used as needed
for symptom control. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The use of short-acting
inhaled beta<sub>2</sub>-agonists more than 2 times a week may indicate the
need to initiate long-term control therapy. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Mild persistent asthma<span style="mso-spacerun: yes;">
</span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Long-term control:</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Anti-inflammatory treatment in the form of low-dose inhaled corticosteroids or
nonsteroidal agents (eg, cromolyn, nedocromil) is preferred. Some evidence
suggests that leukotriene antagonists may be useful as first-line therapy in
children. Recently, the use of montelukast was approved for children aged 2
years and older. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Quick relief:</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Short-acting bronchodilators in the form of inhaled beta2-agonists should be
used as needed for symptom control. Use of short-acting inhaled beta2-agonists
on a daily basis or increasing use indicates the need for additional long-term
therapy. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Moderate persistent asthma </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Long-term control:</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Daily anti-inflammatory treatment in the form of inhaled corticosteroids
(medium dose) is preferred. Otherwise, low- or medium-dose inhaled
corticosteroids combined with a long-acting bronchodilator or leukotriene
antagonist can be used, especially for the control of nocturnal or
exercise-induced asthmatic symptoms. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Quick relief:</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Short-acting bronchodilators in the form of inhaled beta2-agonists should be
used as needed for symptom control. The use of short-acting inhaled
beta2-agonists on a daily basis or increasing use indicates the need for
additional long-term therapy. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Severe persistent asthma<span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Long-term
control<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Daily anti-inflammatory
treatment in the form of inhaled corticosteroids (high dose) is preferred.
Other medications, such as a long-acting bronchodilator leukotriene antagonist
or theophylline, can be added. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Patients with
moderate-to-severe asthma who react to perennial allergens despite inhaled
corticosteroids may benefit from omalizumab treatment. Two 52-week pivotal
Phase III clinical trials were designed to study asthma exacerbation reduction
in 1071 patients with asthma (aged 12-76 y). The coprimary endpoint of each
study was the number of asthma exacerbations per patient during the
stable-steroid phase and the steroid-reduction phase. Patients were randomized
to receive subcutaneous omalizumab or placebo every 2-4 weeks. Inhaled
corticosteroid doses were kept stable over the initial 16 weeks of treatment
(stable-steroid phase) and tapered during a further 12-week treatment period
(steroid-reduction phase). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">In both pivotal clinical
trials, when used as an add-on therapy to inhaled corticosteroids, omalizumab
reduced mean asthma exacerbations (ie, asthma attacks) per patient by 33%-75%
during the stable-steroid phase and 33%-50% during the steroid-reduction phase.
Reduction in asthma exacerbations was confirmed by improvements in other
measurements of asthma control, including symptom scores (eg, nocturnal
awakenings, daytime asthma symptoms). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Quick relief:</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Short-acting bronchodilators in the form of inhaled beta2-agonists should be
used as needed for symptom control. The use of short-acting inhaled
beta2-agonists on a daily basis or increasing use indicates the need for
additional long-term therapy. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Acute severe asthmatic episode (status asthmaticus)<span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Treatment goals are the
following:<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Correction of significant
hypoxemia with supplemental oxygen: In severe cases, alveolar hypoventilation
requires mechanically assisted ventilation. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Rapid reversal of airflow
obstruction by using repeated or continuous administration of an inhaled beta<sub>2</sub>-agonist:
Early administration of systemic corticosteroids (eg, oral prednisone or
intravenous methylprednisolone) is suggested in children with asthma that fails
to respond promptly and completely to inhaled beta2-agonists. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Reduction in the likelihood of
recurrence of severe airflow obstruction by intensifying therapy: Often, a
short course of systemic corticosteroids is helpful. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Achieving these goals requires
close monitoring by means of serial clinical assessment and measurement of lung
function (in patients of appropriate ages) to quantify the severity of airflow
obstruction and its response to treatment. Improvement in FEV1 after 30 minutes
of treatment is significantly correlated with a broad range of indices of the
severity of asthmatic exacerbations, and repeated measurement of airflow in the
emergency department can help reduce unnecessary admissions. Use of the peak
flow rate or FEV1 values, along with the patient's history, current symptoms,
physical findings, to guide treatment decisions is helpful in achieving the
aforementioned goals. In using the PEF expressed as a percentage of the
patient's best value, the effect of irreversible airflow obstruction should be
considered. For example, in a patient whose best peak flow rate is 160 L/min, a
decrease of 40% represents severe and potentially life-threatening obstruction.
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Consultations</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Consider consultation with an
allergist; ear, nose, and throat (ENT) specialist; or gastroenterologist. An
allergist may help with further evaluation and management when the history and
physical examination findings suggest significant allergies (especially
systemic involvement and allergies to dietary products). An ENT specialist may
help in managing chronic sinusitis. A gastroenterologist may help in excluding
gastroesophageal reflux. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Diet</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">When a patient has major
allergies to dietary products, avoidance of particular foods may help. In the
absence of specific food allergies, dietary changes are not necessary. Unless
compelling evidence for a specific allergy exists, milk products do not have to
be avoided. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Activity</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">One of the goals of therapy is
to adequately control exercise-induced asthmatic symptoms so that physical
activity is not restricted.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Medication</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Current treatment of asthma
includes the use of relievers, such as beta-adrenergic agonists, systemic
corticosteroids, and ipratropium, and controllers, such as cromolyn,
nedocromil, inhaled corticosteroids, long-acting beta-agonists, theophylline,
and leukotriene modifiers.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Bronchodilator, beta<sub>2</sub>-agonists</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>These agents act as bronchodilators, used to
treat bronchospasm in acute asthmatic episodes, and used to prevent
bronchospasm associated with exercise-induced asthma or nocturnal asthma.
Several studies have suggested that short-acting beta<sub>2</sub>-agonists such
as albuterol may produce adverse outcomes (eg, decreased peak flow or increased
risk of exacerbations) in patients homozygous for arginine (Arg/Arg) at the
16th amino acid position of beta-adrenergic receptor gene compared with
patients homozygous for glycine (Gly-Gly). Recently, similar findings are
reported for long-acting beta<sub>2</sub>-agonists (eg, salmeterol).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Albuterol sulfate
(Proventil, Ventolin)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>This
beta<sub>2</sub>-agonist is the most commonly used bronchodilator that is
available in multiple forms (eg, solution for nebulization, metered-dose
inhaler (MDI), oral solution). This is most commonly used in rescue therapy for
acute asthmatic symptoms. Albuterol is used as needed, and prolonged use may be
associated with tachyphylaxis due to beta2-receptor downregulation and receptor
hyposensitivity. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Pediatric:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Oral inhaler: 90 mcg per
inhalation, 2 inhalations q4-6h; more inhalations may be used in severe, acute
episodes; more frequent dosing can be used to treat acute symptoms</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Nebulizer: 2.5 mg via nebulization of 0.5%
solution in 2-3 mL of sodium chloride solution q4-6h </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="277" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image124.jpg" width="291" /><span style="mso-spacerun: yes;"> </span><img height="272" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image126.jpg" width="293" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Pirbuterol acetate (Maxair)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Available as a breath-actuated or ordinary
inhaler. The ease of administration with the breath-actuated device makes it an
attractive choice in the treatment of acute symptoms in younger children who
otherwise cannot use an MDI. Strength is 200 mcg per inhalation. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Oral inhalation: 1-2
inhalations q4-6h; not to exceed 12 inhalations q24h</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="183" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image128.jpg" width="263" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Nonracemic form of the beta<sub>2</sub>-agonist albuterol</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">This nonracemic form of albuterol was recently
introduced. One advantage is better efficacy; hence, lower doses have a
therapeutic effect, and a significant reduction in the adverse effects
associated with racemic albuterol (eg, muscle tremors, tachycardia,
hyperglycemia, hypokalemia) is reported. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Levalbuterol (Xopenex) </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Nonracemic
form of albuterol, levalbuterol (R isomer) is effective in smaller doses and is
reported to have fewer adverse effects (eg, tachycardia, hyperglycemia,
hypokalemia). The dose may be doubled in acute severe episodes when even a
slight increase in the bronchodilator response may make a big difference in the
management strategy (eg, in avoiding patient ventilation). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>0.63 mg by
nebulizer q8h</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="247" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image130.jpg" width="267" /><span style="mso-spacerun: yes;"> </span><img height="234" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image132.jpg" width="351" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Long-acting beta<sub>2</sub>-agonist</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Long-acting bronchodilators are not used for the
treatment of acute bronchospasm. They are used for the preventive treatment of
nocturnal asthma or exercise-induced asthmatic symptoms, for example.
Currently, 2 long-acting beta2-agonists are available in the United States:
salmeterol (Serevent) and formoterol (Foradil). Salmeterol is discussed below.
Salmeterol is available as a combination of salmeterol and fluticasone (Advair)
in the United States.
Advair has an expiration date of 30 days once the protective wrapper is
removed. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Salmeterol
(Serevent Diskus)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> This long-acting preparation of a beta2-agonist
is used primarily to treat nocturnal or exercise-induced symptoms. It has no
anti-inflammatory action and is not indicated in the treatment of acute
bronchospastic episodes. It may be used as an adjunct to inhaled
corticosteroids to reduce the potential adverse effects of the steroids. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><12 years: Not established</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">>12 years: 1 inhalation of
inhalation powder (50 mcg) q12h; data </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>in children are limited </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="289" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image134.jpg" width="279" /><span style="mso-spacerun: yes;"> </span><img height="339" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image136.jpg" width="328" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Methylxanthines</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">These agents are used for
long-term control and prevention of symptoms, especially nocturnal symptoms.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Theophylline
(Theo-24, Theolair, Theo-Dur, Slo-bid)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> is available in short- and
long-acting formulations. Because of the need to monitor the drug levels (see
Precautions below), this agent is used infrequently. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Initial dose: 10 mg/kg PO sustained-release tablets and capsules; not to exceed
300 mg/d</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>First dose adjustment: 13 mg/kg PO; not to exceed 450 mg/d</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Second dose adjustment: 16 mg/kg PO; not to exceed 600 mg/d</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="298" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image138.jpg" width="436" /><span style="mso-spacerun: yes;"> </span><img height="160" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image140.jpg" width="160" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Mast cell stabilizers</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>These agents block early and late asthmatic
responses, interfere with chloride channels, stabilize the mast cell membrane,
and inhibit the activation and release of mediators from eosinophils and
epithelial cells. They inhibit acute responses to cold air, exercise, and
sulfur dioxide.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Cromolyn sodium
(Intal), nedocromil sodium (Tilade). </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">These nonsteroidal
anti-inflammatory agents are used primarily in preventive therapy. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Cromolyn: 20 mg in 2 mL
nebulizer solution q6-8h</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Nedocromil: 2-4 inhalations bid/tid; 1.75
mg/actuation</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="230" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image142.jpg" width="222" /></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Intal<span style="mso-spacerun: yes;"> </span>- cromolyn sodium</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="237" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image144.jpg" width="225" /><span style="mso-spacerun: yes;"> </span>Tilade<span style="mso-spacerun: yes;"> </span>- nedocromil</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Corticosteroids</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Steroids are the most potent
anti-inflammatory agents. Inhaled forms are topically active, poorly absorbed,
and least likely to cause adverse effects. No study has shown significant
toxicity with inhaled steroid use in children at doses less than the equivalent
of 400 mcg of beclomethasone per day. They are used for long-term control of symptoms
and for the suppression, control, and reversal of inflammation. Inhaled forms
reduce the need for systemic corticosteroids. They block late asthmatic
response to allergens; reduce airway hyperresponsiveness; inhibit cytokine
production, adhesion protein activation, and inflammatory cell migration and
activation; and reverse beta2-receptor downregulation and subsensitivity (in
acute asthmatic episodes with long-term beta2-agonist use).<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Inhaled steroids include
beclomethasone, triamcinolone, flunisolide, fluticasone, and budesonide.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Beclomethasone
(Beclovent, Vanceril, QVAR)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Inhibits bronchoconstriction mechanisms; causes direct smooth muscle
relaxation; and may decrease the number and activity of inflammatory cells,
which, in turn, decreases airway hyperresponsiveness. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Low dose: 84-336 mcg/d (42
mcg/oral inhalation, 2-8 inhalations q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Medium dose: 336-672 mcg/d (42 mcg/oral
inhalations, 8-16 </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>inhalations q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>High dose: >672 mcg/d (42 mcg/oral
inhalation, >16 inhalations q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="150" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image146.jpg" width="150" /><span style="mso-spacerun: yes;"> </span><img height="193" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image148.jpg" width="204" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Fluticasone (Flovent)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> has
extremely potent vasoconstrictive and anti-inflammatory activity. Has a weak
hypothalamic-pituitary adrenocortical axis inhibitory potency when applied
topically. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Low dose: 88-176 mcg/d (44
mcg/oral inhalation, 2-4 inhalations q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Medium dose: 176-440 mcg/d (110 mcg/oral
inhalation, 2-4 inhalations</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>High dose: >440 mcg/d (110 mcg/oral
inhalation, >4 inhalations q24h or 220</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>mcg/oral inhalation, 2 inhalations q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="307" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image150.jpg" width="230" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Budesonide (Pulmicort Turbuhaler or
Respules)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Has extremely
potent vasoconstrictive and anti-inflammatory activity. Has a weak
hypothalamic-pituitary adrenocortical axis inhibitory potency when applied
topically. Pulmicort is available in a powder inhaler (200 mcg per oral inhalation)
or as a nebulized susp (ie, Respules). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">MDI: Low dose: 100-200 mcg/d
(1 inhalation q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Medium dose: 200-400 mcg/d (1-2 inhalation
q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>High dose: >400 mcg/d (>2 inhalations
q24h)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Nebulizer (inhalation susp): 0.25-0.5 mg bid;
not to exceed 1 mg/d</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="307" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image152.jpg" width="230" /><span style="mso-spacerun: yes;">
</span><img height="295" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image154.jpg" width="171" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Systemic corticosteroids</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>These agents are used for short courses (3-10
d) to gain prompt control of inadequately controlled acute asthmatic episodes.
They are also used for long-term prevention of symptoms in severe persistent
asthma as well as for suppression, control, and reversal of inflammation.
Frequent and repetitive use of beta2-agonists has been associated with
beta2-receptor subsensitivity and downregulation; these processes are reversed
with corticosteroids.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Higher-dose corticosteroids
have no advantage in severe asthma exacerbations, and intravenous
administration has no advantage over oral therapy, provided that
gastrointestinal transit time or absorption is not impaired. The usual regimen
is to continue frequent multiple daily dosing until the FEV1 or PEF is 50% of
the predicted or personal best values; then, the dose is changed to twice
daily. This usually occurs within 48 hours. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Prednisone
(Deltasone, Orasone)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> and prednisolone (Pediapred, Prelone, Orapred) --
Immunosuppressants for the treatment of autoimmune disorders; may decrease
inflammation by reversing increased capillary permeability and suppressing PMN
activity. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1-2 mg/kg/d PO
for 3-10 d; not to exceed 60-80 mg/d</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Methylprednisolone (Solu-Medrol)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>May decrease inflammation by reversing
increased capillary permeability and suppressing PMN activity. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1 mg/kg IV q6h</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="340" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image156.jpg" width="304" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Leukotriene modifier</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Knowledge that leukotrienes cause
bronchospasm, increased vascular permeability, mucosal edema, and inflammatory
cell infiltration leads to the concept of modifying their action by using
pharmacologic agents. These are either 5-lipoxygenase inhibitors or
leukotriene-receptor antagonists. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Zafirlukast (Accolate).</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> <span style="mso-spacerun: yes;"> </span>It is a selective competitive inhibitor of
LTD4, LTE4 receptors.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">5-11 years: 10 mg PO bid</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>>12 years: Administer as in adults</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="240" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image158.jpg" width="240" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Montelukast (Singulair)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>It is
a last agent introduced in its class. The advantages are that it is chewable,
it has a once-a-day dosing, and it has no significant adverse effects. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">12-23 months: 1 packet of 4 mg
oral granules PO hs</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>2-6 years: 4 mg PO
hs</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>6-14 years: 5 mg PO
hs</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>>14 years: Administer as in adults</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="261" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image160.jpg" width="398" /><img height="267" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image162.jpg" width="351" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Drug Category: Monoclonal antibody</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>These
agents bind selectively to human IgE on the surface of mast cells </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">and basophils.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Omalizumab (Xolair)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> <span style="mso-spacerun: yes;"> </span>Recombinant, DNA-derived, humanized IgG
monoclonal antibody that binds selectively to human IgE on surface of mast
cells and basophils. Reduces mediator release, which promotes allergic
response. Indicated for moderate-to-severe persistent asthma in patients who
react to perennial allergens in whom symptoms are not controlled by inhaled
corticosteroids. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><12 years: Not established</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">>12 years: 150-375 mg SC
q2-4wk; inject slowly over 5-10 s because of viscosity; not to exceed 150 mg
per injection site</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Precise dose and frequency established by
serum total IgE level (IU/mL)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="242" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image164.jpg" width="272" /></span></span></div>
<span style="background-color: white;">
</span><h2>
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><br /><b><span lang="EN-US" style="font-size: 18pt;"></span></b></span></h2>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-67634464498550548102013-04-02T15:35:00.000-07:002013-04-02T15:35:01.960-07:00BRONCHOPULMONARY DYSPLASIA (BPD) IN CHILDREN<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>In recent years increasingly
relevant bronchopulmonary dysplasia (BPD). </span></span>
<br />
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>BPD is
acquired chronic obstructive pulmonary disease that develops as a result of
respiratory distress syndrome of neonates and / or artificial ventilation (AVL)
with high concentrations of oxygen, accompanied by hypoxemia, altered
reactivity of the bronchi with hypersensitivity of airways, and typical
radiological changes. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>In the etiology
of BPD there are many factors: the impact of oxygen in high concentrations,
mechanical ventilation, pulmonary edema, left to right shunt at patent ductus
arteriosus, recurrent bacterial pneumonia, hereditary predisposition,
hypovitaminosis A and E.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Pathological
Anatomy and Physiology</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>According to the results of
postmortem studies, there are 4 stages of BPD, which are similar to roengenologic
findings. In the first three days of life (I stage), there is a typical
respiratory distress syndrome. In the following days the first week of life (II
stage) there are destruction of cells of the alveolar epithelium and capillary
endothelium, interstitial edema and perivascular space, necrosis of the
bronchioles, squamous metaplasia, hypertrophy of smooth muscle cells of the
disappearance of ciliated epithelium. In the II-III week (III stage) there is increasing
of the number of macrophages and plasma cells and fibroblasts. Process damage
the bronchial tubes of different orders, which in severe cases leads to obliterative
<span style="mso-spacerun: yes;"> </span>bronchiolitis. In the following week
atelectasis zones with interstitial and peribronchial fibrosis in conjunction
with areas of emphysema (IV stage) are revealed. In the walls of the alveoli there
is increasing of the number of reticular, collagen, elastic fibers, which
structure is disrupted. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Naturally pulmonary emphysema
develops caused by three mechanisms: 1) scars that appear due to hyperextension
of nonfibroid lung; 2) violation of the multiplication of alveoli in some areas
(atrophic form of emphysema); 3) destruction as a result of the inflammation
and destruction of the walls of the alveoli and capillaries. Structural changes
of the pulmonary arteries include intimal proliferation, smooth muscle
hypertrophy, the proliferation of smooth muscle on the distal parts of vessels,
thickening and fibrosis of the adventitia, the decreasing of diameter of the
arteries.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">In diagnosing BPD
anamnestic data are important:</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">prematurity</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">birth weight less than 1500g</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">RDS in the first hours of life</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">ALV with rigid parameters for more
than 6 days</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 36pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">oxygen dependance at least 1 month.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinic: </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Specific clinical manifestations of
BPD are absent. The clinical picture of BPD symptoms is presented with chronic
respiratory failure (tachypnea to 80-100 per minute, cyanosis, emphysema, rib
retraction, persistent physical examination changes in the form of an elongated
exhalation, dry wheezing, moist small bubbling rales, stridor is possible) in
preterm infants who are dependent on high concentrations of oxygen in inhaled
air and mechanical ventilation for a longer or shorter time. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Resistant respiratory failure
develops after the initial improvement under AVl. This dependence on oxygen and
mechanical ventilation may be manifested in different ways.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The diagnosis of BPD brings together
a wide range of clinical manifestations and changes on the radiograph. In mild
cases may be observed only the impossibility of reducing the oxygen concentration
and the parameters of artificial ventilation for 1-2 weeks, lengthening the
period of recovery from respiratory failure. In severe cases in the background
of AVL hypoxemia, hypercapnia remain, "remove" a child from a
ventilator is impossible within a few months, reintubations are characteriatic.
Typically, the suspicion of BPD occur when the child needed mechanical ventilation,
especially with positive end-expiratory pressure, for more than 1 week. Cough,
persistent symptoms of bronchial obstruction syndrome in patients are preserved
<span style="mso-spacerun: yes;"> </span>on already spontaneous respiration.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Further, after the neonatal period, course
of BPD is wavy, depending on the degree of morphological and functional
disorders. The majority of patients showed a slow but clear improvement and
normalization of the state in 6-12 months, but in some patients violations
persist for a long time. According to observations GM Dementieva et al. (1997)
at 16-20% of children discharged from office for prematurity, pathological changes
in the lungs retained and in older age - for 1-4 years of life, and 4% of
patients BPD in the future lead to disability. Recovery in children with BPD
may be due to the fact that along with the fibro-proliferative processes in the
lungs of preterm there is occurring regenerative process and continuing growth
and development of the lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Examination reveals the cough and
persistent physical examination changes, the increasing of obstructive
disorders at virus infection, the symptoms of latent respiratory insufficiency
detected by the load - sucking, moving, crying, while often develop pulmonary
heart at an early age, neurological disorders, retarded physical development.
The final diagnosis is established after the radiographic examination with
signs of fibrosis in the form of deformation and strengthening of local lung
pattern or a light disguise lung fields in middle medium sections, alternating
with areas of swelling of lung tissue, primarily in low lateral areas in
children older than 1 month. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="mso-ansi-language: RU; mso-fareast-language: RU;"><img height="319" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image054.jpg" width="372" /></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: RU;">Roentgenography
of child 5 mths with </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">BPD </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: RU;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 13pt; line-height: 150%;">Activities for the prevention of BPD include: </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">1</span></b><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">.
Pharmacological acceleration of lung maturation: prenatal prevention of RDS
accelerates the maturation of surfactant synthesis and is one of effective
methods of reducing the frequency and severity of BPD. Birth of a baby without
the RDS <span style="mso-spacerun: yes;"> </span>gives possible to avoid
mechanical ventilation, and consequently, the mechanical (positive pressure)
and chemical (oxygen) injury of the lungs. One of the most common methods of
prenatal prevention of RDS is the GCS therapy, which stimulates the synthesis
of surfactant in the lungs of the fetus. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">2</span></b><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">. Rational
etiopathogenic therapy of RDS: in preterm infants it involves the use of
exogenous surfactant preparations that can achieve the reduction of severity
and reducing the duration of the disease and, consequently, the duration of
mechanical ventilation and oxygen therapy in general. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">3</span></b><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">. Selection
of the optimal level of respiratory support of <span style="mso-spacerun: yes;"> </span>child: currently there is no doubt that the
early onset of respiratory care can reduce its duration and limit the softer
options like the pressure and the oxygen content. Early spontaneous respiration
under constant positive pressure of (SRCPP) makes it possible to limit the scope
of respiratory care, stop the progression of RDS and avoid the need for
mechanical ventilation. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>At mechanical ventilation it should
be strive to limit the minimal sufficient level of peak pressure and minimal
sufficient concentration of oxygen. A special problem is a return the child from
mechanical ventilation to spontaneous respiration. This is a long process,
involving a slow decrease in ventilatory parameters, transfer the child to SRCPP
through endotracheal tube, and then - through a nasal cannula.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">4</span></b><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">. Proper
maintenance of water balance and energy supplementation: control of water
balance is reduced to restrict fluids to 90% of fluid consumption. Excessive
hydration leads to the pulmonary edema and disorders of gas exchange. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Already in the early stages of BPD
children need increased energy supply. Parenteral nutrition in the first days
of life is intended to prevent catabolic processes. The full parenteral
providing of proteins, carbohydrates, fats, vitamins and micro elements is
important to limit further damage to the lungs and create conditions for their
repair. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>In children with already
established BPD in terms of water balance, their treatment has a number of perculiarities.
Children with BPD have little resistant to the normal amount of fluid and tend
to accumulate it in their lungs. They have<span style="mso-spacerun: yes;">
</span>problems with nutrition, manifested in an imbalance between the demand of
food and limitation of fluid. Often grows retardation occurs, so callories<span style="mso-spacerun: yes;"> </span>should be increased, due to immaturity, growth
need, increased work of breathing, high levels of metabolism (the additional
cost of the energy supply of the inflammatory reaction). In order to achieve
normal growth and development there must be at least 120-150 kcal / kg per day.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">5</span></b><span lang="EN-GB" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-GB;">. Supply of
antioxidant protection. There is the immaturity of enzyme mechanisms in preterm
infants. Animal studies and human biological material confirm the effectiveness
of superoxide dismutase and catalase, the result of which is manifested
decreasing of cell damage, increasing survival, and possibly the prevention or
reduction in the severity of barotrauma. Today GCS are used n the postnatal
period, not only for prevention of BPD, but for treatment of already formed
disease.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Therapeutic activities: </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">1</span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">. System GCS
stabilize cellular and lysosomal membranes, increases surfactant synthesis,
increases the concentration of vitamin A in serum, inhibit prostaglandins and
leukotrienes, reduce swelling of lung tissue and improve microcirculation in
it. Currently, there is intensive studing of the role of inhaled GCS
(beclomethasone, budesonide, flyuticazon) as an alternative to systemic GCS, or
as a component of systemic steroid therapy. The available data are contradictory:
some researchers prefer inhalation dexamethasone, others do not confirm the
benefits of its application.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><img height="161" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image056.jpg" width="204" /><span style="mso-spacerun: yes;"> </span><img height="160" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image058.jpg" width="221" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Flixotide</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><img height="349" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image060.jpg" width="324" /><span style="mso-spacerun: yes;"> </span><img height="225" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image062.jpg" width="300" /><span style="mso-spacerun: yes;"> </span><img height="267" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image064.jpg" width="408" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Steroid therapy involves
two options: early administration of steroids prevents the formation of BPD
(late first - early second week of life when on the background of persistent
pulmonary edema appears interstitial emphysema) and<span style="mso-spacerun: yes;"> </span>treats already established BPD (from the
second month of life). Routine use of dexamethasone in the treatment of BPD is
not currently recommended because of the many negative side effects. Its
appointment is justified only when there is extreme severity of pulmonary
symptoms. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">2</span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">. Inhaled β<sub>2</sub>-adrenomimetics also found
their application in the treatment of BPD. Salbutamol is a specific agonist of
β<sub>2</sub>-receptors and currently enjoys high popularity in the
treatment of BPD. Thanks bronchodilatory effect it reduces bronchial resistance
and increases the permeability of the bronchi. However, since the first weeks
of life expressed relaxation of smooth muscles of the bronchi is absent, early
salbutamol inhalation therapy is not considered justified.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><img height="308" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image066.jpg" width="238" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">3</span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">. Systemic
bronchodilators, which are the most commonly used in the treatment of children
with BPD, include methylxanthines - aminophylline, theophylline, caffeine (more
rarely). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><img height="319" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image068.jpg" width="315" /><span style="mso-spacerun: yes;"> </span><img height="315" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image070.jpg" width="311" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">4</span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">. Pulmonary vasodilators: nifedipine (calcium channel
blockers). A single oral dose of nifedipine (0.5 mg / kg) reduces vascular
resistance in the lungs and increases cardiac output in older children with
severe vascular hypertension due to BPD. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">5</span></b><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB;">. Antibiotic: A number of studies in recent years
distinguished Ureoplasma urealyticum as a factor contributing to the
development of BPD. The results of clinical trials demonstrate reduction in the
severity of the disease during therapy with macrolides.</span></span></div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-8439635012481009062013-04-02T15:32:00.003-07:002013-04-02T15:32:46.159-07:00ACUTE BRONCHIOLITIS <div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;">Development of total obstruction of respiratory tracts
lies in basis of syndrome, which is<span style="mso-spacerun: yes;">
</span>conditioned with the expressed hypersecretion of phlegma, with the edema
and swelling of mucus of<span style="mso-spacerun: yes;"> </span>bronchial tubes
and bronchiols and, in a less measure, bronchospasm in<span style="mso-spacerun: yes;"> </span>the children of the first year of life on a
background of viral, more frequent respiratory-syncitial infections.</span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Criteria of diagnosis of bronchiolitis:</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1.
</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Presence of the catarrhal phenomena
(rhynopharyngitis, cough).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2.
</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Temperature of body – subfebrile, rarely 38<sup>o</sup>С.
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Expressed signs of
respiratory insufficiency:<span style="mso-spacerun: yes;"> </span>shortness of
breathing, blowing nostrils, cyanosis of nasolabial triangle, participation of
auxiliary musculature.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4. Violation of the bronchial passage: thorax is emphysematosis;
horizontal position of ribs, flat position of diaphragm.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">5.Bandbox sound at percussion</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">6. Auscultation: hard<span style="mso-spacerun: yes;"> </span>breathing</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">with</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">prolonged inspiration, moist wheezes, on out</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">breathing</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> -</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> dry, whistling.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">7. Cardiovascular syndrome</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> –
tachycardia, weakening of tones.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">8. X-ray</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">-</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> sharp swelling of lungs tissue, increased
broncho-vascular pattern, without infiltrative shades; sometimes atelectasis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinic</span></b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> Syndrome
of airway obstruction lies at the basis of acute bronchiolitis, which is more
typical for children of the first six months of life. In acute bronchiolitis
body temperature is subfebrile or normal, respiratory failure progresses gradually.
Signs of intoxication are insignificant. Characteristic features are perioral
or acrocyanosis, dry cough, a large number of small moist rales on both sides -
"wet" lung and a small number of dry wheezes. <span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">In severe cases dyspnea has predominantly
expiratory character, groaning breath, tension and swelling of nostrils,
participation in the act of breathing supporting muscles, general cyanosis of
the skin. Nonproductive cough, frequently emphysematous swelling of the chest
are present. Above the lungs percussion sounds are bandbox, throughout the
lungs a large number of small bubbling and wet crepitative wheezing. There are
tachycardia, increased liver, <span style="mso-spacerun: yes;"> </span>may be
attacks of apnea, hypoxic seizures, dehydration.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">X-ray examination</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> shows the symmetric strengthening of pulmonary pattern of<span style="mso-spacerun: yes;"> </span>both sides, increase of transparency of
pulmonary tissue, absence of infiltratative shades. In the blood test the appropriate changes are absent.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Help on
prehospital stage</span></b><u><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">.</span></u></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US;">To
release from clothes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To give the promoted
position of body to the child.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">By a rubber bulb or gauze
clean the<span style="mso-spacerun: yes;"> </span>nasal cavity, mouth and
pharynx </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>from mucus
and phlegma.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To provide access of fresh
air.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygenation with clean
moistened oxygen through a mask.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Euphyllini in dose of 3-5
mg/kg of mass -24 % solution intramuscular.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">3 % solution of
Prednisoloni 1-2 mg/kg of<span style="mso-spacerun: yes;"> </span>the
masses<span style="mso-spacerun: yes;"> </span>for<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>dose
intramuscular</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Salt-alkaline inhalation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Urgent hospitalization.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Help on<span style="mso-spacerun: yes;"> </span>hospital stage.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US;">To
release respiratory tracts from mucus and </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">phlegma</span><span lang="EN-US" style="mso-ansi-language: EN-US;"> with the help </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>of electrosuccer.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="157" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image050.jpg" width="199" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy with<span style="mso-spacerun: yes;"> </span>moistened warm 40 %<span style="mso-spacerun: yes;"> </span>oxygen through a nasal</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>catheter or
mask 3-5 litres
per 1 minute.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Inhalation of broncholytic
mixture: Euphillini – 0,3, ephedrine – 0,2,</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>novocaine – 0,25, water –
50,0 ml. On inhalation 3-5 ml, before </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>inhalation to add 1,0 ml of<span style="mso-spacerun: yes;"> </span>5 % solution of sodium ascorbinati.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Inhalations of mucolytic
drugs – 2 % solution of sodium hydrocarbonatis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>3-5 ml,
Acetylcysteini, Bisolvoni, Lasolvani<span style="mso-spacerun: yes;"> </span>2-3
ml on inhalation with </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>next aspiration of phlegma. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">2,4 % solution of Euphyllin
3-5 mg/kg of mass on 10 % glucose solution</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>10 ml/kg of
mass of intravenously slowly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">3 % solution of
Prednisoloni 1-2 mg/kg of the masses, one dose </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>intravenously streamly on 10 %<span style="mso-spacerun: yes;"> </span>glucose solution 10 ml.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">5 % solution of sodium
ascorbinati 0,2 ml/kg of the masses</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>of intravenously streamly on 5 ml of<span style="mso-spacerun: yes;"> </span>10 % glucose solution .</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Cocarboxylazae 5-8 mg/kg
of<span style="mso-spacerun: yes;"> </span>mass of intravenously streamly </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>on 5 ml
of<span style="mso-spacerun: yes;"> </span>10 % glucose solution .</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Alkaline drink: 1 %
solution of sodium hydrocarbonatis<span style="mso-spacerun: yes;"> </span>10-15
ml/kg </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>of mass per
day.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Vibration massage of thorax
in drainage position.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">11.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">In default of effect and
enlargement of respiratory insufficiency –<span style="mso-spacerun: yes;">
</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>clearing of bronchial tree
by bronchoscope,<span style="mso-spacerun: yes;"> </span>artificial ventilation.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: RU;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-fareast-language: RU;"><img height="294" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image052.jpg" width="300" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: RU;"></span></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: RU;"><span style="mso-spacerun: yes;"> </span>Sonotherapy at
bronchiolitis</span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-81776880674667644962013-04-02T15:31:00.002-07:002013-04-02T15:31:35.978-07:00ACUTE OBSTRUCTIVE BRONCHITIS<div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;">In the basis of syndrome is violation of the
bronchial passage, conditioned by the diffuse inflammatory edema of mucus,
hypersecretion and accumulation of mucous and purulent phegma in bronchial
tubes, transitory reflex spasm of smooth musculature.</span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Until the 70's, the last
century, the term "obstructive bronchitis and its analogs (asthmatic
bronchitis, spastic bronchitis, etc.) were widely used by pediatricians. However,
in the early 70's a series of epidemiological studies were performed, which
showed that distinguish obstructive bronchitis and asthma in the general
pediatric practice is almost impossible. Thus, equal sign between these states
was put. This approach in older children has largely justified itself, as would
save many patients from antibiotic therapy. But in younger children the problem
is more complicated. It was established that cromoglycate in these patients is
not effective enough or not effective at all. Inhaled bronchodilators such as
salbutamol, are ineffective enough or not effective at all at wheezing in
children of the first three years of life. Information regarding the
effectiveness of inhaled steroids for acute or chronic bronchiolitis was
contradictory.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>In addition, numerous studies in
our country and abroad have shown that the outcomes of obstructive bronchitis
in general are favourable. 54% of children with repeated episodes of
obstructive bronchitis stopped hurting after four years, and another 37% of -
at a later age, thus recovering is more than 90% of patients. In addition, the
presence of obstructive syndrome in the first three years of life can not be
considered as a factor predisposing to the appearance of asthma in the future.
That is, it became clear that the mechanism of development of wheezing in
infants, other than for the older children, and the main role is played not hyper
reactivity in bronchial mucosa and muscle spasm and tone of the bronchial wall
and edema of bronchial mucosa. This reflects the fact that "wheezing"
in young children is a consequence of various causes, including abnormalities
of the respiratory system and inflammatory processes of other etiologies.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><b>Clinics:</b><b><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> s</span></b><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">ubfebril
temperature, trouble, crabbiness of child, cyanosis of lips, nasolips triangle,
acrocyanosis. Dyspnea, noisy, with the prolonged inspiration and<span style="mso-spacerun: yes;"> </span>distance wheezes. Downing in of interrib intervals,
supraclavia areas, jugular pit.<span style="mso-spacerun: yes;">
</span>Unproductive coughing. A thorax is emphysematous, at percussion above
lungs -box sound, </span><span lang="UK" style="mso-fareast-language: EN-US;">а</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">t
auscultation- breathing is hard, with the prolonged inspiration and dry and
different moist wheezes, character of which is changed after a cough. </span><span lang="UK" style="mso-fareast-language: EN-US;">Та</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">chycardia. A liver
is often enlarged. In the general blood analysis there is not substantial
changes or insignificant neutrophyls leucocytosis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="mso-ansi-language: RU;"><img height="267" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image042.jpg" width="434" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Barrel
thorax</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;">Diagnostic criteria of
acute obstructive bronchitis in children </b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>- Long whistling breath, which is
audible at a distance<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">- Inflated thorax when viewed from (horizontal placement </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>ribs) participated in the act of
breathing support muscles, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>retraction of the intercostal
spaces, signs of respiratory </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>failure </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">- Dry cough, paroxysmal, prolonged and at the end of the first </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>week passes in the moist</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">- Percussion determined bandbox pulmonary sound </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">- Auscultation: hard breathing, exhaling is prolonged, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>large amount of dry whistling
rales. There may be coarse </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>bubbling low sound rales </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">- On the chest radiograph is observed decreased lung </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>pattern in the lateral regions of
the lungs, and increased in the medial </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>(hidden emphysema).</span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;">On the X-ray
of thorax organs<span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"> - the strengthening of pulmonary pattern, areas of
promoted pneumatization without of infiltration changes in lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="276" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image044.jpg" width="234" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><img height="276" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image046.jpg" width="328" /></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Radiographs of the chest in front projection with AOB: total marked
bilateral increase the transparency of lung fields, depletion of vascular
pattern on the periphery with its increasing in the central parts, the expansion
of the roots of the lungs and flattening of the diaphragm.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Differential diagnosis of obstructive
bronchitis and pneumonia</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Symptoms</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Obstructive bronchitis</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Pneumonia</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Temperature</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Subfebril</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Hyperthermia</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Intoxication</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Absent or slight</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Expressed</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Dyspnea</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">+</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>+</span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Dry whistling rales</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>+</span></b></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–</span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Local moist rales</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–</span></b></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>+</span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Percussion sound</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bandbox</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Dull</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">X-ray</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The strengthening of pulmonary pattern</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Local (segmental, lobe, focal) infiltrates</span></span></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Differential diagnosis of bronchial asthma
and obstructive bronchitis <span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Symptoms</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Bronchial asthma</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Obstructive bronchitis</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Allergologic anamnesis</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Positive</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Sometimes positive</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Start of illness</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Catarrhal sings of ARVI </span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Attack of dyspnea with or </span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">without ARVI</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Gradual increasing of symptoms</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Temperature</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Normal</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">, sometimes
increased</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Everytimes increased</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Course of disease</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: RU;"> </span><span style="font-size: 14.0pt; mso-ansi-language: RU;"></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Repeating attack of dyspnea</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Frequency of obstructive episodes decreases, recovery is possible</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Ig E</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Increased</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Normal</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Eosynophylia in blood</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Present</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="219">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Absent</span></span></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: center; text-indent: 40.55pt;">
<span style="background-color: white;"><b>Help on prehospital stage.</b></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To provide access of fresh air.</span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To release from squeezing clothes.</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"></span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">Succing with electrosuccer mucus and phlegma from
upper </span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>respiratory tracts.</span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy with<span style="mso-spacerun: yes;">
</span>clean moistened oxygen through a mask.</span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">Broncholytin for </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">children upto 3 years– harf of<span style="mso-spacerun: yes;"> </span>tea-spoon, 3-10 years </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>a 1 tea-spoon, more senior
than 10 years<span style="mso-spacerun: yes;"> </span>a 1 dessert-spoon 3 times
per</span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>day </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">or Solutani 5-10
drops 3 times per<span style="mso-spacerun: yes;"> </span>day.<span style="mso-spacerun: yes;">
</span></span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Euphyllini in<span style="mso-spacerun: yes;">
</span>dose of a 3-5 mg per kg of<span style="mso-spacerun: yes;"> </span>mass
orally or 24 % Euphyllini</span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>solution intramuscular.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Salt-alkaline inhalation.</span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">In default of effect - hospitalization.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: center; text-indent: 40.55pt;">
<span style="background-color: white;"><b>Help on<span style="mso-spacerun: yes;">
</span>hospital stage.</b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>1. Succing with electrosuccer mucus
and phlegma from upper respiratory</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>tracts.</span><b><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">2. Oxygentherapy</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"> through the
nasal catheter with 40 % moistened oxygen</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>constantly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoBodyText">
<br /></div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section24">
<div class="MsoBodyText">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="265" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image048.jpg" width="265" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoBodyText">
<br /></div>
<div class="MsoBodyText">
<br /></div>
<div class="MsoBodyText">
<br /></div>
<div class="MsoBodyText">
<br /></div>
<div class="MsoBodyText">
<br /></div>
<div class="MsoBodyText">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Nasal
catheters for oxygenotherapy</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="MsoBodyText">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoBodyText">
<br /></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>3. </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">Inhalations of
broncholitic mixture: </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Euphyllini</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"> - 0,3, ephedrine<span style="mso-spacerun: yes;"> </span>– 0,2,</span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>novocaine – 0,25, water – 50,0 </span><span lang="UK" style="mso-fareast-language: UK;">мл</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">. On inhalation 3–5 ml,
before inhalation </span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>to add 1,0 ml of<span style="mso-spacerun: yes;"> </span>5 % sodium ascorbinati solution .</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>4. Mucolytic drugs</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">:
salt-alkaline inhalations; Acetylcysteini or Lasolvani in </span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>inhalations, syrup, tablets;
Mucaltini in tablets, extract of altey.</span><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>5. Vibromassage of </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>thorax in drainage position with next active
aspiration </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>of phlegma.</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>6.<span style="mso-spacerun: yes;">
</span>2,4 % solution of </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Euphyllini</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"> 3-5 mg/kg of<span style="mso-spacerun: yes;">
</span>mass of intravenously </span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;">in drops on isotonic
solution of chloride sodium<span style="mso-spacerun: yes;"> </span>10-15 ml/kg
of mass.</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>7. 5 % solution of sodium ascorbinati
0,2 mg/kg of the masses intravenously</span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>streamly on 5 ml of<span style="mso-spacerun: yes;"> </span>10 % glucose solution . </span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>8. Cocarboxylazae 5-8 mg/kg of mass
of intravenously streamly on 5 ml of<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>10 % glucose solution.</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>9. In default of effect from previous therapy
Prednisoloni 1–2 mg/kg of the </span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>masses (or Hydrocortisoni 5 mg/kg
of<span style="mso-spacerun: yes;"> </span>mass) intravenously streamly on </span></span></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: left;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>5 ml of<span style="mso-spacerun: yes;"> </span>10 % glucose solution.</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: UK;"><span style="mso-spacerun: yes;"> </span>10. Alkaline drink: 1 % solution of
sodium bicarbonates 10-15 ml/kg of<span style="mso-spacerun: yes;"> </span></span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com1tag:blogger.com,1999:blog-7275300796104068287.post-47980158701689972952013-04-02T15:30:00.000-07:002013-04-02T15:30:17.972-07:00Viral Croup Manifestation In Children With Respiratory Insufficiency<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Acute narrowing of larynx, conditioned by the
inflammatory edema of vocal cords and membranous space, hypersecretion of
glands, viral etiology, that is accompanied by the hard breathing (croup).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">Etiology: paraenfluenza I, ІІ type, flu I, rarely
RS</span><span lang="UK" style="font-size: 14pt;">-</span><span lang="EN-US" style="font-size: 14pt;">, adenovirus infection. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText3" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 35.45pt;">
<span style="background-color: white;">Children are ill from 6
months till 3 years old.</span></div>
<span style="background-color: white;">
</span><div class="MsoBodyText3" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">It is acute widespread infection-inflammatory
disease with the phenomena of stenosis. In most cases it arises up under action
of different respiratory viruses, mainly paraenfluenza, more frequent in age
from 6 months to 3 years. </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-fareast-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">The most common pathogens are influenza viruses
(56.8%), second in frequency space occupied by parainfluenza viruses (20,1%),
third - adenovirus (16,7%)</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">, </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>at 6.4% of
patients with acute laryngotracheitis there is a manifestation of a mixed viral
infection.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Mostly in the development of acute
laryngotracheitis a bacterial process is joined and may change the clinical
picture.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">Laryngoscopic picture with stenosing
laryngotracheitis is characterized by the formation of rollers under the vocal </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">ligaments</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">
and the presence of mucous-purulent discharge in the tracheobronchial tree.
Some authors, except edematous form of stenotic laryngotracheitis, allocate
purulent, fibrinous, necrotic, and other forms. After the obstruction at the
level of the larynx there is a violation of drainage function of
tracheobronchial tree, resulting in the appearance of inflammation in the lower
respiratory tract, including lung tissue.</span></span></div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section6">
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="295" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image016.jpg" width="300" /></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">Optical laryngoscope </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">Airtraq</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section7">
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Stenosis is a result of mucus and submucous tissue edema
of larynx below vocal ligaments, accumulation of mucus, reflex spasm of
muscles. </span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="184" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image018.jpg" width="368" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Schematic stages of the introduction of a
laryngoscope with the direct laryngoscopy and the corresponding laryngoscopic
picture – the end of a laryngoscope blade presses the epiglottis to the root of
the tongue: 1 - aryepiglottic cartilage, 2 - interaryepiglottic hollow, 3 -
vocal cords, 4 - folds of the laryngeal vestibule.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
</div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section8">
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="215" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image020.jpg" width="199" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<div class="MsoNormal" style="text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Endoscopy
image of larynx</span></span></div>
<div class="MsoNormal" style="text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Aquied
undercord stenosis</span></span></div>
<div class="MsoNormal" style="text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">(narrowing
of respiratory tract)</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section9">
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">The thickness of respiratory tracts is decreased,
resistance of air grows. Inflammation, edema, spasm, presence of inflammatory
exudation of respiratory tracts are the basic links of pathogenesis, which
result in violation of breathing, hypoxia, hypercapnia. An inflammatory process
can spread on a trachea, bronchial tubes.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinical classification of acute
laryngotracheitis:</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;">I. Type of respiratory viral
infection: 1) influenza, parainfluenza, adenovirus infection, etc., and 2) ARVI
(is specified in the impossibility of clinical interpretation and the absence
of express-diagnostics).</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;">II. Degrees of laryngeal
stenosis: 1) compensation, 2) incomplete compensation, 3) decompensation, 4)
terminal.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinic</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The
characteristic is triad of symptoms: the change of voice, rough, “barking”
cough, stenotic breathing.</span> More frequent stenosis laryngitis develops
suddenly among night. There are 4 degrees of larynx stenosis.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13pt; line-height: 150%;">I degree </span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">(compensated stenosis): hoarse of voice, rough
“barking” cough, compensated hyperventilation of lungs, рО<sub>2</sub> – within
the limits of norm.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13pt; line-height: 150%;">The ІІ degree</span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;">
(subcompensated stenosis): the child is excited, voice getting hoarse, rough,
cough increases, the inciter shortness of breath appears. A skin is<span style="mso-spacerun: yes;"> </span>moist, pallor, cyanosis of perioral triangle.
Breathing is with participation of auxiliary muscles. Hyperventilation of lungs
gradually changes on hypoventilation. Considerable tachycardia, рО<sub>2</sub> </span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">is not reduced. Metabolic acidosis develops.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13pt; line-height: 150%;">The ІІІ degree</span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;">
(decompensated form of stenosis) is the severe state. A child is excited. There
are loosened voice, expressed inciter shortness of breath (inspiration is
prolonged with stenotic noise). Breathing with participation of all auxiliary
muscles. Frequent “barking” unproductive cough. A skin is pale, covered by a
cold sweat, considerable cyanosis of nasooral triangle, lips, tongue, nail
phalanges. Tones of heart are deaf, tachycardia, decreased arterial preassure,
a pulse is frequent, weak. In lungs there is decreased breathing, superficial,
is badly listened, sternum is down in. рО<sub>2</sub> of </span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">arterial blood is reduced, рСО<sub>2</sub> is
promoted, mixed acidosis develops (metabolic and respiratory).</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 13pt; line-height: 150%;">The </span><span lang="EN-US" style="font-size: 13pt; line-height: 150%;">ІV </span><span lang="EN-US" style="font-size: 13pt; line-height: 150%;">degree</span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> (asphyxia): a child is in the extraordinarily severe
condition, without consciousness. Cyanosis of skin, a pallor develops later.
Breathing is superficial, frequent, with the quick stops with next deep
inspiration. At auscultation the breathing is not<span style="mso-spacerun: yes;"> </span>listened. Tones of heart are deaf, </span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;">decreased
arterial preassure</span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">, a pulse is
threadlike, later brad</span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US;">ycardia</span><span lang="EN-US" style="font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">, arrhythmia develop, which<span style="mso-spacerun: yes;">
</span>precede to the stop of heart. In a blood рСО<sub>2</sub>considerably grows
(to 100 ml Hg and higher) and рО<sub>2</sub> considerably goes down (to 40 ml
Hg.). The child dies from the asphyxia. </span><span lang="UK" style="font-size: 13.0pt; line-height: 150%; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Differential diagnosis of real and false croup</b></span></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Real croup</span></b></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">False
croup</span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Acute start</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Permanent start</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Febril high t°</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Subfebril t° </span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Catarrhal sings are expressed</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Catarrhal sings are absent</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Skin is moist, cyanotic</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Skin is “toxic”, pale</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal" style="mso-outline-level: 5;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Hyperemia,
edema of pharynx</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Grey-dirty tapes on tonsils after their
scopes</span></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Voice is hoarse </span></span></div>
<div class="MsoNormal" style="mso-outline-level: 5;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Aphonia</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Edema of<span style="mso-spacerun: yes;">
</span>subcutaneous tissue is absent</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Edema of<span style="mso-spacerun: yes;">
</span>subcutaneous tissue of neck</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="328">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Absence of signs of palate paresis<span style="mso-spacerun: yes;"> </span></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="329">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Effluence of liquid through a nose </span></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="text-autospace: none; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt;">Primary aim of treatment is
to pick up thread passage of respiratory tracts and remove hypoxia.</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoHeading9" style="text-align: justify;">
<span style="background-color: white;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt;">Help on prehospital stage</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">The volume of medical manipulations depends on the
degree of stenosis severity.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">I degree:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Distracting procedures:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–warm
tender baths, it is possible with mustard</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>–</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">mustard plasters on a thorax, on an area of laryngs</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>–</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">at allergy to mustard semialcoholic hot compress on
a thorax, </span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">on the area of neck</span><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>–</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">warm alkaline drink: mineral water, tea with 2
%<span style="mso-spacerun: yes;"> </span>solution of soda, </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>warm milk</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy: </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–warm,
moistened air</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 65.2pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–soda
inhalations.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">In children with the
allergic reactions – Suprastin orally, in a dose 2 mg</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>per the kg
of mass; from 2 years 1 tea-spoon of Claritini in syrup.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Hospitalization in the
diagnostic or infectious unit.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">ІІ degree.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Intramuscular 2 % solution
of Suprastini 2 mg per the kg of mass.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">In excitation – 0,5 %
solution of Seduxeni (Sibasoni, Relanium) in a</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>dose 0,3-0,5
mg per the kg of mass intramuscular, or 20 % solution </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>of<span style="mso-spacerun: yes;"> </span>Oxybutirati sodium in a dose 50 mg per the kg
of mass</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>intramuscular.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Distracting procedures:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–
warm tender baths, it is possible with mustard;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–
mustard plasters on a thorax, on an area of laryngs;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>– at allergy to mustard semialcoholic hot compress on a thorax, on the </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>area of neck.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Warm alkaline drink:
mineral water, tea with 2 % soda solution, warm </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>milk.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-align: justify; text-indent: 17.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy: </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>– warm,
moistened air;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 65.2pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>– soda
inhalations.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Hospitalization in the
intensive unit or chamber of intensive therapy for diagnostic or infectious
separation.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">ІІІ degree.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Sucking of mucus from a
mouth cavity, respiratory tracts;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy: warm,
moistened air through a mask;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">0,5 % solution of Seduxeni
(Sibasoni, Relanium) in a dose 0,3-0,5 mg</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>per the kg of mass intramuscular, or 20 %
solution of Oxybutirati</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>sodium in a dose 50 mg per the kg of mass
intramuscular;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Hydrocortisoni intramuscular
in a dose 5 mg per the kg of mass or 3 % </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>solution of
Prednisoloni intravenously in a dose 1 mg/kg of mass.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Distracting procedures:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–
mustard plasters on a thorax, on an area of laryngs;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>– at
allergy to mustard semialcoholic hot compress on a thorax, </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>on the area of neck.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy through a
mask.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Hospitalization in the
intensive unit of child's hospital.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">ІV degree.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Sucking of mucus from the
cavity of mouth, respiratory tracts.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy through a
mask, aerotherapy with the warm moistened</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>air.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Intravenously streamly 3 %
solution of Prednisoloni in a dose 1-2 mg </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>per the kg of
mass of body.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Intravenously streamly 10 %
solution of Calcium gluconatis in a dose 1</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>ml per the year of life.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">At departure on the call of
the specialized brigade and equipped </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>ambulance
the intubation of patient.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Hospitalization in the
intensive unit of child's hospital.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoHeading9" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14pt; line-height: 150%;">Help on a hospital stage</span></b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 42.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Permanent observation of a patient who is hospitalized, the unit must be
equipped by the inhalators of the «fog» type, </span><span lang="UK" style="font-size: 14.0pt; mso-fareast-language: EN-US;">І</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">P</span><span lang="UK" style="font-size: 14.0pt; mso-fareast-language: EN-US;">-2</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> and others, by oxygen tents, in which the proper microclimate is
created (temperature 30 <sup>0</sup>C,
moisture 100 %, 40-50 % oxygen).</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">I degree.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Inhalations by the
moistened 40 % oxygen, oxygen is possible to skip </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>through Bobrov apparatus,
through the water extract of camomile, clary,</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>infusion of<span style="mso-spacerun: yes;">
</span>eucalyptus, 2 % alkaline solution. Treatment in a oxygen tent</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>2-3 times per day.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section10">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"><img height="285" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image022.jpg" width="222" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="221" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image024.jpg" width="288" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Apparatus Bobrov 1l (plastic cover with
thread, needle, syringe)</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Depending on the modification Bobrov
apparatus may be used for puncture of the pleural cavity or for moistening of
oxygen.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="background-color: white;"><span style="font-size: 14.0pt; mso-ansi-language: RU;"><img height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image026.jpg" width="298" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygen tent for babies and young children (up
to 3 years) is used in maternity hospitals and children's hospitals for oxygen
therapy procedures.</span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygen therapy in the oxygent tent.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section11">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Salt-alkaline inhalations or inhalations of
such composition:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–
5 % solution of ascorbic acid – 5,0;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–
5 % solution of Ephedrine<span style="mso-spacerun: yes;"> </span>– 1,0;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–0,1 % solution
of Adrenalin<span style="mso-spacerun: yes;"> </span>– 1,0;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>–Hydrocortisoni
25 mg;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>–3% solution of sodium
hydrocarbonatis 6,0. </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">On inhalation - 4 ml of solution. In the first 2 days inhalations are
done 4 </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">times per day, on 3th day – 3 times, on 4-6th days – 1-2 times per day.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Distracting therapy:
mustard plasters on a thorax, tender baths, ozocerite</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>or paraphine “knee-boots”, warm drink.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Sucking of mucus.</span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">ІІ degree.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">At the protracted stenosis
there is direct laryngoscopy for diagnostics of</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>inflammatory process, sucking of mucus
(clearning of tracheobronchial</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>tree and larynx);</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Protracted inhalations of
warm, moistened air, stream through mask or</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>under framework which covers a bed, in which a
patient is (moisture to</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>90-100 %, temperature to 26-30 0С) <sup><span style="mso-spacerun: yes;"> </span></sup>for 3-4 hours; oxygen tent.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section12">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"><img height="235" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image028.jpg" width="274" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygen therapy through a mask.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section13">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Inhalations with the
medicine mixture:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">5 % solution of Ephedrine –
0,5 (1) ml,<span style="mso-spacerun: yes;"> </span>Hydrocortisone 12,5 (25)
mg, </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 11.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>1 % Dimedroli
solution – 0,5 (1) ml, 0,5 % solution of sodium<span style="mso-spacerun: yes;">
</span>chloride</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 11.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>– 3-4 ml (in handles there are<span style="mso-spacerun: yes;"> </span>the indicated doses for children more </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 11.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>senior than 1
year old),</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>antiedema mixture: 5 % solution of
Ephedrine<span style="mso-spacerun: yes;"> </span>1,0; 0,1 % solution of</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 11.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Adrenalini 1,0; 0,1 % solution of sulfate
Atropine<span style="mso-spacerun: yes;"> </span>– 0,5; 1 % solution</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 11.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>of Dimedroli - 1,0; 2,5 % solution of
Pipolpheni 1,0; Hydrocortisoni </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 11.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>25 mg;
Hymotripsini 2 mg in 1 ml of liquids; 5 % solution of ascorbic</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 11.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>acid – 5,0. On one inhalation 4 ml of mixtures
are used.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section14">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="mso-ansi-language: RU;"><img height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image030.jpg" width="200" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Stream
inhalator</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section15">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">At the excitation 20 %
solution of<span style="mso-spacerun: yes;"> </span>Oxybutiratis sodium<span style="mso-spacerun: yes;"> </span>intravenously</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>streamly slowly in a dose 50 mg per the kg of
mass.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">2,4 % solution of
Euphyllini intravenously streamly slowly in a dose </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>1 ml per the year of life on
10 % glucose solution.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Intravenously in drops 10 %
Glucose solution , 0,9 % solution of sodium</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>chloride (in the ratio 3:1) + 5 % solution of
ascorbic acid – 1-2 ml,</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Cocarboxilazae 5 mg per the kg of mass; 15-20
drops in 1 minute.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Distracting therapy:
mustard plasters on a thorax, tender baths, ozocerite</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>or paraphine “knee-boots”.</span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">ІІІ degree.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>1.<span style="mso-spacerun: yes;"> </span>Hospitalization in intensive unit.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>2.<span style="mso-spacerun: yes;"> </span>Inhalation therapy in oxygen tent, 4-6
inhalations per day.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>3. 20 % solution of Oxybutiratis
sodium <span style="mso-spacerun: yes;"> </span>intravenously streamly slowly in
a</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>dose 50 mg per<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>the kg of mass; in 3-4 hours –
0,25 % solution of </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Droperidoli 0,3-0,5 ml/kg of mass.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>4. Direct laryngoscopy
for diagnostics of inflammatory process, clearning</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>of larynx, respiratory tract.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>5. 3 % solution of
Prednisoloni intravenously streamly in a dose 2-3 mg per</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>the kg of mass.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>6. Inhalations to the
aerosol: 0,1 % solution of Adrenalini 0,5-1 ml per </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>3 ml of isotonic solution of sodium chloride
together with oxygen</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>during 5-10 minutes; with a antiedema mixture.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.15pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section16">
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.15pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="mso-ansi-language: RU;"><img height="321" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image032.jpg" width="194" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="margin-left: 39.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 39.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 39.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 39.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 39.15pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Dummy-
inhalator that is compatible with standard sockets inhalator supply gas or
mixed medication to the nose of the child. Dummy is reusable, capable of being
sterilized by standard autoclaving or disinfectants.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section17">
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.15pt; text-align: justify;">
<br /></div>
</div>
<span style="background-color: white;">
<span lang="UK" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: UK; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section18">
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.15pt; text-align: justify;">
<span style="background-color: white;"><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"><img height="263" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image034.jpg" width="247" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.15pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Inhaler ultrasound MUSSON-1 <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>for spray
inhalations</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section19">
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>8. 2,4 % solution of
Euphyllini intravenously streamly slowly in a dose 1</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>ml per the year of life on 5-10 ml of<span style="mso-spacerun: yes;"> </span>0,9 % isotonic solution.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>9. Intravenously
in<span style="mso-spacerun: yes;"> </span>drops (20-25 drops for a minute) 10 %
solution of</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Glucose, 10-20 % solution of Albumini or
similar group Plasma in a</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>dose 5-10 ml on the kg of mass of body;
Reopoliglucini in a dose 10 ml</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>on the kg of mass of body, correlation of
glucose to the salt and colloid</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>solutions 2:1. Common amount of liquid is a
30-50 ml/kg of mass</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>daily.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>10. 4 % solution of
Hydrocortisoni 4-8 ml per the kg of mass intravenously</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>in<span style="mso-spacerun: yes;">
</span>drops, in 2 injections under the control of acid- alkaloid balance.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>11. 10 % solution of
Calcium gluconatis</span><span lang="EN-US" style="font-size: 14.0pt; mso-fareast-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">intravenously streamly slowly in a</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>dose 1 ml per the year of life.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>12. Antibiotics:</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Cephalosporins: Duracef
(Cefadroxil), suspensia 50 mg per the kg of mass per<span style="mso-spacerun: yes;"> </span>day for 2 receptions in interval 12 hours;
Kefsoli 75-100 mg/kg of<span style="mso-spacerun: yes;"> </span>the masses per
day for 2 receptions intramuscular;</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Macrolides: suspensia of
Macropeni<span style="mso-spacerun: yes;"> </span>a 50 mg/kg of<span style="mso-spacerun: yes;"> </span>mass per day in 2 receptions, summamed a 10
mg/kg of<span style="mso-spacerun: yes;"> </span>mass per<span style="mso-spacerun: yes;"> </span>day.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>13. Indication to intubation:
hypoxemia (рО<sub>2</sub> below 50
mm Hg) with</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>concentration of oxygen during inspiration
higher 50 %; hypercapnia,</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>acidosis( рСО<sub>2</sub> higher than<span style="mso-spacerun: yes;"> </span>55
mm Hg, </span><span lang="UK" style="font-size: 14.0pt; mso-fareast-language: EN-US;">рН</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> less than 7,35); encreasing</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>of <span style="mso-spacerun: yes;"> </span>languor,
somnolence.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Exercise
performance intubation on a mannequin (a modern </span></b></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>technique with using
a laryngoscope).</span></b></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"><img height="324" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image036.jpg" width="223" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">IV degree.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Intubation with soon
artificial breathing. Advantage it to give</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>nasotracheal intubation, as to more sparing
and simple method.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Clearning of respiratory
tract with the use of warm isotonic solution with </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>hydrocortisoni, euphyllini;
1 % by solution of hydrocarbonatis,</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>antibiotics of wide-spread action (a few times
per days);</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy with
moistened oxygen.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section20">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="212" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image038.jpg" width="298" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Ventilator Vent201, created by the most
modern technologies, provides high quality ventilation and provides an easy
transition from noninvasive to invasive ventilation.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section21">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</div>
<span style="background-color: white;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section22">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="mso-ansi-language: RU;"><img height="355" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image040.jpg" width="400" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Ventilation, neuro-controlled respiratory
support (NAVA) Servo-I (Maquet). Allows you to maintain respiratory activity of
the patient using his own neuro impulses.</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">3 % solution of
prednisoloni intravenously streamly in a dose of<span style="mso-spacerun: yes;"> </span>3-5 mg</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>per the kg of mass or hydrocortisoni
intravenously in drops (15-30</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>drops in 1 minute) in a dose 15-20 mg per the
kg of mass on 100-150</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>ml 0,9 % sodium chloride solution.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Intravenously in drops 10 %
solution of glucose, 0,9 % sodium chloride</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>solution, Reopoliglucini in a dose of 10 ml
per<span style="mso-spacerun: yes;"> </span>the kg of mass.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Correlation of glucose and salt solutions to
the children upto 1 year old </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>is 3:1 or 4:1, from 1 to 2
- 1:1. Fresh-frozen plasma in a dose 10 ml per </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>the kg of mass. Common amount of liquid is
40-50 ml per kg of mass</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>daily. To conduct infusion therapy 2 times per
day.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">With<span style="mso-spacerun: yes;"> </span>infusion solutions intravenously enter 5 %
solution of ascorbic</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>acid 1-2 ml, 10 % solution of chloride
calcium<span style="mso-spacerun: yes;"> </span>1 ml per the year of life,</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Cocarboxilazae in a dose of<span style="mso-spacerun: yes;"> </span>5 ml per<span style="mso-spacerun: yes;">
</span>the kg of mass.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Symptomatic therapy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Dynamic observation of
paediatrician, reanimatologist, otolaryngologist.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">9.<span style="mso-spacerun: yes;"> </span>Determination
of рО<sub>2</sub>, рСО<sub>2</sub>, ЕCG.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">In all stages of stenosis must be indicated</span></b><span lang="EN-US" style="font-size: 14pt;">:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Antienfluenza
gamma-globulini in 1 dose till 1 year; 2 doses till 3 years,<span style="mso-spacerun: yes;">
</span>3 doses to the children more senior then 3 years.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Observation
for the exception of diphtheria (stroke from a nose and<span style="mso-spacerun: yes;"> </span>pharynx).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Consultation
of otolaryngologist.</span></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">At
saving of swallowing- warm alkaline drink (mineral water, flora tea<span style="mso-spacerun: yes;"> </span>with 2 % soda solution ), milk.</span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-15537269418499612232013-04-02T15:27:00.001-07:002013-04-02T15:27:42.618-07:00Differential Diagnosis Of Bronchial Obstructive Syndrome In Children<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt;"><span style="mso-spacerun: yes;"> </span>Bronchial obstructive
syndrome (BOS) is a pathophysiological concept of violations of bronchial
obstruction with a very wide range of acute and chronic diseases. </span></b></span>
<br />
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="FR" style="mso-ansi-language: FR;"><img height="307" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image002.jpg" width="420" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>BOS - is a leading sign, which brings together
a group of acute, recurrent and chronic lung disease, but it is not an
independent nosological form and could not appear as a diagnosis. It should be
noted that the BOS is not synonymous with bronchospasm, although in many cases,
bronchospasm is important, and sometimes a leading role in the genesis of the
disease. Usually BOS is diagnosed in children of the first four years of life,
but can be diagnosed in older age.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In the
genesis of bronchial obstruction are different pathogenetic mechanisms, which
can be divided into:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">• functional or reversible (bronchospasm, inflammatory infiltration,
edema,<span style="mso-spacerun: yes;"> </span>mucociliary insufficiency,
hypersecretion of viscous mucus)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">• irreversible (congenital stenosis of the bronchi, their obliteration,
etc.).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Peculiar features of
the children of the first three years of life have played the certain role in
the development of bronchial obstruction: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">narrowness of the bronchi
and the entire respiratory system greatly increases</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>aerodynamic resistance. Thus,
swelling of the bronchial mucosa by only 1mm</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>causes an increase in
resistance to air flow in the trachea more than 50%. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">softness of cartilage
bronchial tract </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">lack of rigidity of the
bone structure of the thorax, freely reacting indrawing of </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>accommodating places to
increase the resistance in the airways </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">particular position and
the structure of the diaphragm.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>BOS in children may be substantially
aggravated by structural features of bronchial wall, such as a large number of
goblet cells that produce mucus, and</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">increased
viscosity of bronchial secretions associated with high levels of cialic acid. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Early childhood is characterized by the
imperfection of immunological mechanisms: significantly reduced the formation
of interferon in the upper respiratory tract, serum immunoglobulin A, secretory
immunoglobulin A, and reduced functional activity of T-immunity system.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Influence
of premorbid factors of acute obstructive bronchitis: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
Toxicosis of pregnancy <span style="mso-spacerun: yes;"> </span>- Dystrophy
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
Obstructed labor<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>- Hyperplasia of the thymus </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
Hypoxia in childbirth <span style="mso-spacerun: yes;"> </span>- Early
artificial feeding</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
Perinatal encephalopathy <span style="mso-spacerun: yes;"> </span>- A variety
of abnormalities of </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
Prematurity <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>constitution</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
Burdened allergic history<span style="mso-spacerun: yes;"> </span>- The
respiratory disease at the age</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
Bronchial hyperreactivity <span style="mso-spacerun: yes;"> </span>of
6-12 months</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
Rickets<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>-
The presence of atopy</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">A major disadvantage is the
pollution of the environment.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">The scheme of the basic mechanisms of bronchial obstruction.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><img height="254" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image004.jpg" width="272" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">1. material into bronchi (foreign body, mucous etc.)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">2. edema of bronchial mucous membranes (obstructive dronchitis)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">3. retraction of bronchial muscles (bronchial asthma)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">4. compression out of bronchus (mediastinum tumor, dilatation of
pulmonary artery</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>at congenital heart</span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">diseases)</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Etiology</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;">
</span>BOS usually is infectious-allergic nature. Among the viruses that most
commonly cause BOS are respiratory syncytial virus (50%), then parainfluenza,
rarely - influenza and adenovirus. Recently, in the development of BOS big role
is due to intracellular pathogens. According to modern data, chlamydia and
mycoplasma infection are determined in 20% of children with BOS. According to
different authors, about 20-25% of bronchitis in children occur as an acute
obstructive bronchitis (AOB), which is significantly higher than in adults.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Especially high frequency of AOB
is as a manifestation of acute respiratory infections (ARI) in infants. This is
due to the fact that in the first half year of life 80% of the entire surface
of the lungs is small bronchi (diameter less than 2mm), whereas a child 6 years
old - already 20%. According to the Poiseul rule resistance of airways is
inversely proportional to their radius in the 4-th degree. Obstructive syndrome
of is the more probable in the distal lesion of the bronchi.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Pathogenesis </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Regulation of bronchial tone is
controlled by several physiological mechanisms, which include complex
interactions receptor-cell component and mediators system. These include
cholinergic, adrenergic, neurohumoral regulatory system and, of course, the
development of inflammation. Interleukin-1 is the main mediator, initiating the
acute phase of inflammation. It activates a cascade of immune reactions that
contribute to the exit in the peripheral blood of type 1 mediators (histamine,
serotonin and others). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Histamine is released during an
allergic reaction in the interaction of allergen with allergen IgE. In addition
to histamine, a type 2 (eicosanoids) play an important role in the pathogenesis
of inflammatory mediators. Under the action of cyclooxygenase from arachidonic
acid there are synthesing prostaglandins, thromboxane and prostacyclin, while
under the influence lipooxidaze - leukotrienes. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The result is increased vascular
permeability, leading to swelling of the mucous membrane of the bronchi,
hypersecretion of viscous mucus, the development of bronchospasm. The main
mechanism in the pathogenesis of bronchospasm is activation of cholinergic
nerve fibers, leading to increased production of acetylcholine and increasing
concentrations of gualinatecyclase, which promotes the flow of calcium ions
into smooth muscle cells, thereby stimulating of bronhoconstriction.
Stimulation of α<sub>2</sub>-adrenoceptor catecholamines, as well as an
increased concentration of cAMP decreases the manifestations of bronchospasm.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Clinics of BOS</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The clinical picture of BOS in
children is primarily determined by factors of bronhoconstriction. As noted
above, in most cases BOS is associated with manifestations of acute respiratory
viral infection (acute obstructive bronchitis). <span style="mso-spacerun: yes;"> </span>So <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">body temperature is rised</span></span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;"> </span><span lang="EN-US" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; font-size: 14pt; line-height: 150%;">up
early, catarrhal changes in the upper respiratory tract and violation of
general condition</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> of the child appear. The severity and the nature
largely vary depending on what the agent has led to the disease. Signs
expiratory breathing difficulties may occur as the first day of illness, and in
the process of viral infection (3-5-day sickness). Gradually there is <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">increasing the breathing
frequency</span> <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">and
duration of exhalation</span>. Breathing becomes noisy and whistling, which is
due to the fact that with the development of hypersecretion, the accumulation
of secretions in the lumen of the bronchi due to shortness of breath and fever
change viscosity of the secret - he "dries up", which leads to <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">buzzing (low) and whistling (high)
wheezes</span>. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The defeat of the bronchi is
widespread, and therefore hard breathing with dry whistling and buzzing
wheezing are equally audible over the entire surface of the thorax. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Rales may be heard at a distance</span>.
The younger the child, the more frequently he has, in addition to dry, the
moist medium bubbling rales. If in the genesis of bronchial obstruction a major
role plays spastic component, it auscultative data over lungs is generally more
diverse and labile during the day. With increasing dyspnea important role of <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">supporting muscles</span>
becomes increasingly - retraction of the intercostal spaces, epigastric and
supraclavicular fossa, bloating (voltage) of the nostrils. Often there are revealed
perioral cyanosis, pallor of the skin, the child becomes restless, trying to
adopt a sitting position, drawing on his hands. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Respiratory failure more evident than the younger the
child</span>, but usually it is not more than II degree. On physical
examination, in addition to scattered wheezes and hard breathing, there are the
signs of lung swelling: narrowing boundaries of relative cardiac dullness,
boxed shade percussion tone. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The
inflation of the lungs</span> is a result of consequence wears small bronchial
branches during expiration, which leads to the so-called <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">ventilation emphysema</span>.
The volume of the lungs increases. The rib cage is constantly in a state of
inspiration, which increases the anteroposterior size.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Changes in peripheral blood</span> correspond to the nature of viral
infection. Bacterial flora is rarely overlapped - not more than 5%. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Radiologically</span>, in addition to strengthening
bilateral lung pattern and expansion of the roots of the lungs there are revealed:
lowness flattened dome of the diaphragm, increasing the transparency of lung
fields, lengthening the lung fields, a horizontal arrangement of ribs on the
radiograph, which mean the signs of swelling of the lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Diseases
accompanied by BOS </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>There are the following groups of
diseases accompanied by BOS: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Diseases of the respiratory system – Infectious-inflammatory diseases (acute
constrictive laryngotracheitis, bronchitis, bronchiolitis, pneumonia), allergic
diseases (obstructive bronchitis, bronchial asthma), bronchopulmonary dysplasia,
malformation of bronchopulmonary system, tumors of the trachea and bronchi. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Foreign bodies of trachea, bronchus, esophagus. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Diseases of the aspiration genesis (aspiration or obstructive bronchitis) –
gastroesophageal reflux, tracheoesophageal fistula, malformations of the
gastrointestinal tract and diaphragmatic hernia. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Diseases of the cardiovascular system – Congenital and acquired (congenital
heart disease with hypertension, pulmonary circulation, vascular anomalies,
congenital Non-rheumatic carditis, etc.). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Diseases of the central and peripheral nervous system (birth injury, myopathy,
etc.). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Hereditary anomalies of metabolism (cystic fibrosis, α1-antitrypsin
deficiency, mucopolysaccharidosis). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Congenital and acquired immunodeficiency states. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Rare hereditary diseases. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
Other states – Injuries and burns, poisoning, the effects of various physical
and chemical environmental factors, pressure on the trachea and bronchi of
extrapulmonary origin (tumor, venereal disease).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt; line-height: 150%;">Diseases of the
bronchopulmonary system</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">The most frequently differential diagnosis of
bronchial obstruction syndrome in children is made among the diseases of the
bronchopulmonary system.</b></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<h2>
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 16pt;"><span style="mso-spacerun: yes;"> </span>BRONCOOBSTRUCTIVE SYNDROME IN
PNEUMONIA</span></b></span></h2>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">The edema
of mucus membrane of bronchial tubes lies in the basis of syndrome,
hyperproductions of </span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">phlegm</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> and, in a less measure, bronchospasm, more
frequent on a background of congenital or acquired hyperreactivity of bronchial
tubes are also important factor. This syndrome is identified at acute
bronchopneumonia and is the reason of respiratory insufficiency on a
bronchoobstructive type, which quite often determines severity of the state and
needs adequate oxygent therapy.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Clinic.</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> Increase of temperature of body, trouble or oppression, crabbiness,
pallor of skin with perioral and acrocyanosis, unproductive cough, controlled
from distance wheezes, oral crepitation, shortness of breath, with prolonged
one and hard exhalation, drowning in chest of intervals between ribs, another
areas of chest. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Percussion
reveals the tympanic sound with areas of short sound.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Auscultation: hard
breathing with the prolonged exhalation, dissipated dry and moist wheezes, the
locally loosened breathing with the isolated proof moist wheezes.</span></span></div>
<span style="background-color: white;">
</span><h1 style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"> </span></span></h1>
<span style="background-color: white;">
</span><div align="center" class="MsoBodyText" style="line-height: 150%; text-align: center; text-indent: 40.55pt;">
<span style="background-color: white;"><b>Help
on prehospital stage</b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To provide
access of fresh air.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To release
from squeezing clothes.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Clean oral
cavity and larynx from mucus and</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-spacerun: yes;">
</span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">phlegma</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section2">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="240" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image006.jpg" width="240" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Apparatus for cleaning of nose</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section3">
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Oxygentherapy
with clean moistened oxygen through a mask or </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">oxygen</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">pillow.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Inhalation
of dosed aerosol of Atroventi (ipratromium-bromide) 1-2 through spenser.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">6. Inhalation of dosed aerosol </span><span lang="UK" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">b</span></span><sub><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">2-</span></sub><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">antagonists of quick actions (Salbutamoli,</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Ventolini, Berotec) 1-2 doses through spenser 20
minutes during hour.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">When
it is impossible to make inhalations- syrup, tablets of Salbutamoli or
Terbutalini (Bricanili</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">у</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">)<span style="mso-spacerun: yes;"> </span>to children upto 1 year - 1 mg 3 times, 3-6
years – 2 mg 3 times, 7-15 years – 2-3 mg 3 times; Clentuberoli (Spiropent) –
0,005-0,02<span style="mso-spacerun: yes;"> </span>3 times; Broncholitini to<span style="mso-spacerun: yes;"> </span>children upto 3 years– half tea-spoon, 3-10
years<span style="mso-spacerun: yes;"> </span>1 tea-spoon, elder 10 years is a 1
dessert-spoon 3 times per days.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">7. Euphyllini 3-5
mg/kg<span style="mso-spacerun: yes;"> </span>- 2,4 % solution of Euphyllini in
that </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">dose<span style="mso-spacerun: yes;">
</span>intravenously streamly on 10 ml of 10 %<span style="mso-spacerun: yes;">
</span>glucose solution .</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">8. 3
% solution of Prednisoloni 1-2 mg/kg<span style="mso-spacerun: yes;">
</span>intramuscular.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify; text-indent: 1.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">9. Hospitalization.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 0cm; text-align: justify; text-indent: 1.4pt;">
<br /></div>
<div align="center" class="MsoBodyText" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><b>Help on a hospital stage</b></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">1. To provide access of fresh air.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">2. To release from squeezing clothes.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">3. Sucking with electrosucker mucus and phlegma from
upper respiratory tracts.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">4. Oxygenation therapy through a nasal catheter is
the clean moistened oxygen during 20 minutes every 2 hours or 40 % oxygen
constantly.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="241" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image008.jpg" width="360" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Oxygenation therapy through a nasal catheter</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>5. Inhalation
of dosed to the aerosol of Atroventi (ipratromium-bromide) 1-2 dose through
spenser.</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%;"></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">6. Inhalation of dosed<span style="mso-spacerun: yes;"> </span>aerosol </span><span lang="UK" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">b</span></span><sub><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">2-</span></sub><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">antagonists of quick actions (Salbutamoli</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> (</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Ventolini, Berotec) 1-2 doses through spenser 20
minutes during hour. When it is impossible to make inhalations- syrup, tablets
of Salbutamoli or Terbutalini (Bricanili</span><span lang="UK" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">у</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">) children upto 1 year - 1 mg 3 times, 3-6 years – 2 mg 3 times, 7-15
years – 2-3 mg 3 times; Clentuberoli (Spiropent) – 0,005-0,02<span style="mso-spacerun: yes;"> </span>3 times; Broncholitini to<span style="mso-spacerun: yes;"> </span>children upto 3 years– half tea-spoon, 3-10
years- 1 tea-spoon, elder 10 years is a 1 dessert-spoon 3 times per days.</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="180" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image010.jpg" width="252" /></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">7.<span style="mso-spacerun: yes;"> </span>3 %
solution of Prednisoloni 1-2 mg/kg of<span style="mso-spacerun: yes;">
</span>masses<span style="mso-spacerun: yes;"> </span>intravenously<span style="mso-spacerun: yes;"> </span>streamly.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">8. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">2,4 %
solution of Euphyllini 0,15 </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">ml/kg</span><span lang="EN-US" style="mso-ansi-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">of </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">mass of<span style="mso-spacerun: yes;"> </span>intravenously<span style="mso-spacerun: yes;">
</span>in drops on </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>10 %
glucose solution<span style="mso-spacerun: yes;"> </span>10–15 ml/kg.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>9. Cocarboxilazae
of a 5–10 mg/kg of mass on 5,0 ml of 10 % Glucose solution</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>intravenously<span style="mso-spacerun: yes;"> </span>streamly.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">10. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">5 %
solution of sodium ascorbinati 2 </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">ml/kg</span><span lang="EN-US" style="mso-ansi-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">of</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> masses of<span style="mso-spacerun: yes;"> </span>intravenously<span style="mso-spacerun: yes;"> </span>streamly</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>on 5,0 ml of<span style="mso-spacerun: yes;">
</span>10 % glucose solution .</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">11. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Panangini
0,1 ml/kgh of masses on 5,0 ml of 10 % Glucose solution </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>intravenously<span style="mso-spacerun: yes;">
</span>streamly.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">12.<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">In default of effect<span style="mso-spacerun: yes;"> </span>drops intravenously</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">introduction of Prednisoloni 2 – 3 mg/kg of<span style="mso-spacerun: yes;"> </span>the masses (Hydrocortisoni 10 – 15 mg/kg) on
10 % Glucose solution<span style="mso-spacerun: yes;"> </span>a 10 – 15 ml/kg
of<span style="mso-spacerun: yes;"> </span>mass.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">13. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Mucolytic
drugs: salt–alkaline inhalations; Lasolvani,Acetylcycteini<span style="mso-spacerun: yes;"> </span>in inhalations, syrup, tablets;
Bromhexini<span style="mso-spacerun: yes;"> </span>in syrup, tablets; Mucaltini
in tablets.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section4">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image012.jpg" width="200" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Mucolytic
inhalations</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-family: "Times New Roman"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="Section5">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">14. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Vibromassage
of thorax in drainage position with next active aspiration of </span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">phlegm</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">.</span></span></div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;">15. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Alkaline
drink: solution 1 % sodium bycarbonati per day to drink 10 – 12 </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">ml/kg</span><span lang="EN-US" style="mso-ansi-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">of </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">mass slightly.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="339" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%202%20Differential%20diagnosis%20of%20bronchial.files/image014.jpg" width="322" /></span></span></div>
</div>
<div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com2tag:blogger.com,1999:blog-7275300796104068287.post-55922642633769794842013-04-02T15:05:00.001-07:002013-04-02T15:05:37.904-07:00Emergency Therapy For Acute Respiratory Failure<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 16pt; line-height: 150%;">Respiratory
Failure</span></b><span lang="EN-US" style="font-size: 16pt; line-height: 150%;"> <b>(RF)</b></span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></span></div>
<span style="background-color: white;">
</span><div align="right" class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: right;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">Is<span style="mso-spacerun: yes;"> </span>the pathological<span style="mso-spacerun: yes;"> </span>state, at which breathing organs are unable
to provide adequate saturation of organism by oxygen and destroy<span style="mso-spacerun: yes;"> </span>carbon dioxide.</span></span></div>
<div align="right" class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: right;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Anatomic
and physiological<span style="mso-spacerun: yes;"> </span></span></b><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">features of respiratory organs </span></b><b><span style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1.<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">High
metabolism, greater necessities in oxygen, however less compensating
possibilities of organs of breathing;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2.
Uncomplete</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> differentiation of
tissues;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Narrow respiratory tracts;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">4<b>.</b> Undevelopment of additional
cavities of nose, absence of lower nasal passage;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">5. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Propensity to the edema of
mucous - through large amount of <span style="mso-spacerun: yes;"> </span>vessels (ventilation failure);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">6. The features of larynx structure (tender of cartilaginous ring,
narrow upper space, expressed submucous tissue) </span><span style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">®</span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> croup.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoBodyText3" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">•Tender trachea, bronchial tubes, little </span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">amount of<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">elastic tissues </span><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">®</span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">
narrowing of </span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">respiratory </span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">road </span><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">®</span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> swollen mucus, hypersecretion of
bronchial glands </span><span lang="EN-US" style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">®</span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> obstructions (hypo</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">ventilation </span><span style="font-size: 14pt; line-height: 150%;">-</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">emphysema);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">•</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> Undevelopment
of cilia epithelium </span><span style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">®</span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> propensity to violation of evacuation
function of respiratory tract;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">•Lungs</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> sanguineous,
small elastic and many connective tissue<span style="mso-spacerun: yes;">
</span></span><span style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">®</span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> restrictive RF (exudation, </span><span style="font-size: 14pt; line-height: 150%;">а</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">telectasis, emphysema);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">•Horizontal</span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> placing of ribs, low retractive ability of diaphragm </span><span style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">®</span></span><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"> diminish of<span style="mso-spacerun: yes;">
</span>the excursion of lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 16pt; line-height: 150%;">Etiology
of RF</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The reasons
leading to the development of acute respiratory failure are a lot. The most
frequent causes of respiratory failure are listed below. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>1. <b style="mso-bidi-font-weight: normal;">Obstructive
type</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">a) <b style="mso-bidi-font-weight: normal;">Obstruction of the upper respiratory tract</b> may
occur when there are abnormalities of development (atresia choanae, Pierre
Robin syndrome, stenosis of the larynx above the vocal cords), aspiration of
gastric contents, or foreign body, infections (epiglottitis), allergic
laryngism, the tissue changes (tumor, cyst, hypertrophy of tonsils). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">b) <b style="mso-bidi-font-weight: normal;">Obstruction of the lower airways</b> may occur when there
are abnormalities of development (bronhomalacia, lobar Emphysema), aspiration
(in the presence of traheoezophageal fistula, infections (mumps, bronchiolitis,
pneumonia), inflammation, bronchospasm (asthma, bronchopulmonary dysplasia), as
well as foreign bodies.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span><b style="mso-bidi-font-weight: normal;">2.
Restrictive violations </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">a) <b style="mso-bidi-font-weight: normal;">With the defeat of the parenchyma of the lungs</b>.
Hypoplasia of lung, RDS, pneumothorax, hemorrhage, pulmonary edema and pleurisy.
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">b) <b style="mso-bidi-font-weight: normal;">With the defeat of the chest wall</b>. Diaphragmatic
hernia, absence of ribs, hypoplasia and aplasia of the sternum, chest deformity
(rickets), abdominal distension, kyphoscoliosis, trauma restricted mobility of
the chest, severe myasthenia pseudoparalitic, muscular dystrophy, and obesity.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">3. Diseases that lead to inadequate gas alveoli
and </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span>capillaries exchanges</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">a) <b style="mso-bidi-font-weight: normal;">Diseases of the violations of diffusion</b>. <b style="mso-bidi-font-weight: normal;">Diffuse type of
RF</b>: lung edema, interstitial fibrosis, collagenosis, pneumonia
(Pneumocystis carinii), desquamative interstitial pneumonia. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 35.4pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">b) <b style="mso-bidi-font-weight: normal;">Diseases due to inhibition of the respiratory center (Ventilation
type of RF)</b>. Traumatic brain injury, CNS infection, overdose of
sedatives; severe asphyxia and tetanus.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">4. Other
situations that contribute to the development of the </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>acute respiratory distress</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">a) An increase in hydrostatic pressure.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">b) Congestive heart failure.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">c) The excess of fluid injected.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">d) Intestinal obstruction.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">e) Chronic broncho-pulmonary diseases</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 35.4pt; text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="text-align: center;">
<span style="background-color: white;"><b><i><span lang="EN-US" style="font-size: 14pt;">Etiologic classification of respiratory
insufficiency</span></i></b><b><span lang="EN-US" style="font-size: 14pt;"> </span></b></span></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">1. RF related to the obstruction of respiratory
tracts (larynx</span><span style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">-</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">, bronchiolo</span><span style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">-</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">, bronchospasm, foreing body);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">2. RF as a result of violation of diffusion of
gases through an alveolar-capillary membrane (pneumonias, chronic diseases of
lungs);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">RF related to the damage of
respiratory system (trauma of thorax, pneumo- thorax); </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> RF of central genesis - arises up at the damage of
cerebrum (edema of brain, meningitis, cranial-cerebral trauma); </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">5. RF conditioned by violation of neuro-muscular
conductivity (poliomyelitis, myasthenia) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><h3>
<span style="background-color: white;"><span lang="EN-GB" style="font-family: "Times New Roman","serif"; font-size: 14pt;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 16pt;">Clinic
of respiratory insufficiency</span></span></h3>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;">1</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">. Disturbances of function of the external breathing: shortness of
breath, difficulty</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-fareast-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">of breathing, prolonged exhalation, participation
of auxiliary muscles, nod motions by a head, blowing of nostrils,</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">
</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">violation of rhythm of breathing (bradypnoe,
pathological type of breathing);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>2. Signs
of hypercapnia, hypoxia: tachycardia, decreased arterial pressure, pallor of
skin, acrocyanosis, cyanosys, excitation or oppression of child;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>3. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Signs of tissue hypoxia: pallor -gray color of skin, bradycardia,
decreased arterial pressure and comma.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Clinical manifestations are divided into 3 groups. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;">
</span>1. Pulmonary symptoms </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">a) In infants and children with acute
respiratory failure - tachypnea, violations of the depth and rhythm of
respiratory movements, retraction of the intercostal spaces, the expansion of nostrils,
cyanosis, sweating. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">b) possible shortness of breath and wheezing. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><b>2. Neurological symptoms. </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">As a result of increased sensitivity of the
brain to hypoxemia there is developing headache, anxiety, irritability,
convulsions, and sometimes coma. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span><b>3. Symptoms of the cardiovascular system. </b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>There
are bradycardia and hypotension. Severe and /or prolonged </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>respiratory failure can lead to heart<span style="mso-spacerun: yes;"> </span>failure and pulmonary edema.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoHeading8">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 18pt; font-style: normal;">Clinical classification of <span style="mso-bidi-font-weight: bold;">respiratory insufficiency</span></span></b><b><span lang="EN-GB" style="font-size: 18pt; font-style: normal;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>I<span style="mso-spacerun: yes;"> </span>stage: <i>the shortness of breath in rest is
absent, perioral cyanosys, which increases at loading, PS: BR – 3,5-2,5: 1;</i>
РаО<sub>2</sub> – 80-65 mm
Hg</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">The ІІ stage: is<span style="mso-spacerun: yes;"> </span><i>the shortness of breath in rests,
perioral cyanosys, acrocyanosis permanent, participation of auxiliary
musculature in the act of breathing, PS: BR – 2-1,5: 1</i></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><i><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></i><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">РаО<sub>2</sub> – 64-51mmHg</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">The ІІІ stage: is <i>the
expressed shortness of breath in rest, the unrhythmical breathing (paradoxical
breathing), generalized cyanosys is permanent, does not disappear at breathing
by oxygen;</i></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><i><span lang="EN-US" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></i><span lang="EN-US" style="font-size: 14pt; line-height: 150%;">РаО<sub>2</sub> – 50 and </span><span style="font-family: Symbol; font-size: 14pt; line-height: 150%;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">¯</span></span><b><span style="font-size: 14pt; line-height: 150%;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b>Respiratory failure in
acute pneumonia is 3 degrees</b>. </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;">At I degree respiratory insufficiency is compensated
by hyperventilation, there are no breathing disorders. At II degree there are
the clinical and laboratory signs of disorders of external respiration,
hemodynamics, but they are subcompensated. At III degree decompensation is
diagnosed, both external and internal respiration. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="400" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image077.jpg" width="500" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-autospace: none;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-language: EN-US;">Spirography determines the speed and volume of breath</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-autospace: none;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">Clinical features of RDS in newborn</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;">1.</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Tachypnoe</span><span style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> (</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">BR</span><span style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> > 60),<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">bradypnoe</span><span style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> (</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">BR</span><span style="font-size: 14.0pt; line-height: 150%; mso-fareast-language: EN-US;"> <35);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">2. </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Cyanosys</span><span style="font-size: 14.0pt; line-height: 150%;">;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3. Retractions (drawing in of pliable places of chest);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4. Blowing of wings of nose;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">5. Grants (expiration moan);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">6. Disturbance of rhythm or breathing;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">7. Reduced activity.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 16pt; line-height: 150%;">Treatment of respiratory
failure</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The treatment depends on the leading
pathological process, as well as the degree of hypoxemia, pCO<sub>2</sub> and
pH. For the recovery there is necessary to liquidate respiratory failure
(removal of foreign body, the causes of the collapse of the lung: pneumothorax,
lobar emphysema, diaphragmatic hernia).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">1. Oxygenation</b> should begin only
after the removal of the contents of the airways and should be performed using
mixtures containing a minimum amount of oxygen that allows to maintain an
adequate level of arterial pO<sub>2</sub> (> 60 mmHg). The use of excessive
concentrations of O<sub>2</sub>, may provoke pulmonary edema, atelectasis, or
lead to retinopathy in preterm infants. If resistant to treatment forms of
hypoxemia are present it needs intubation for ensuring long-term positive
pressure in the lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>2. Liquidation of <span style="mso-spacerun: yes;"> </span>the disorders in the lungs </span></b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">involves
the removal of bronchial secretion, the appointment of bronchodilators,
intubation, or connecting to a respiration apparatus. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>a) Endotracheal or nasotraheal intubation</span></b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> is
enough to eliminate</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>obstruction
of the upper respiratory tract. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>The correct location of
the tube should be monitored auscultation</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>or
X-ray. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">b) Increasing the humidity of air</b>
reduces the viscosity of bronchial</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>secretion.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">3. Intubation and ventilation with positive
pressure</b> is needed in patients</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>with elevated values of pCO<sub>2</sub>,
accompanied by respiratory acidosis.</span></span></div>
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</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoBodyTextIndent" style="line-height: 150%; text-autospace: none; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="356" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image079.jpg" width="531" /></span></span></div>
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</span><div class="MsoBodyText" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="390" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image081.jpg" width="661" /></span><b><span style="mso-spacerun: yes;"> </span></b></span></div>
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</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="347" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image083.jpg" width="445" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span class="SpellE"><span style="font-size: 14.0pt; line-height: 150%;">Referens</span></span><span style="font-size: 14.0pt; line-height: 150%;">:</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">A - <span class="SpellE">Basic</span>: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">1.<span style="mso-spacerun: yes;"> </span><span class="SpellE">Pediatrics</span>. <span class="SpellE">Textbook</span>. / <span class="SpellE">O. V</span>. <span class="SpellE">Tiazhka</span>, <span class="SpellE">T. V</span>. <span class="SpellE">Pochinok</span>, <span class="SpellE">A. N</span>. <span class="SpellE">Antoshkina</span> <span class="SpellE">et</span> <span class="SpellE">al</span>. / <span class="SpellE">edited</span>
<span class="SpellE">by</span> O. <span class="SpellE">Tiazhka</span> – <span class="SpellE">Vinnytsia</span> : <span class="SpellE">Nova</span> <span class="SpellE">Knyha</span> <span class="SpellE">Publishers</span>, 2011 – 584 <span class="SpellE">pp</span>. : <span class="SpellE">il</span>.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">2.<span style="mso-spacerun: yes;"> </span><span class="SpellE">ISBN</span> 978-966-382-355-3Nelson <span class="SpellE">Textbook</span>
<span class="SpellE">of</span> <span class="SpellE">Pediatrics</span>, 19th <span class="SpellE">Edition</span> <span class="SpellE">Kliegman</span>, <span class="SpellE">Behrman</span>. <span class="SpellE">Published</span> <span class="SpellE">by</span> <span class="SpellE">Jenson</span> & <span class="SpellE">Stanton</span>, 2011, 2608.<span style="mso-spacerun: yes;">
</span><span class="SpellE">ISBN</span>: 978-080-892-420-3.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">3.<span style="mso-spacerun: yes;"> </span><span class="SpellE">Illustrated</span> <span class="SpellE">Textbook</span> <span class="SpellE">of</span> <span class="SpellE">Paediatrics</span>, 4th <span class="SpellE">Edition</span>.<span style="mso-spacerun: yes;"> </span><span class="SpellE">Published</span> <span class="SpellE">by</span><span style="mso-spacerun: yes;"> </span><span class="SpellE">Lissauer</span> & <span class="SpellE">Clayden</span>, 2012, 552 p. <span class="SpellE">ISBN</span>:
978-072-343-566-2.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">4.<span style="mso-spacerun: yes;"> </span><span class="SpellE">Denial</span> <span class="SpellE">Bernstein</span>. <span class="SpellE">Pediatrics</span> <span class="SpellE">for</span> <span class="SpellE">medical</span> <span class="SpellE">Students</span>. – <span class="SpellE">Second</span> <span class="SpellE">edition</span>, 2012. – 650 p.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">B - <span class="SpellE">Additional</span>:
1.http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/шпитальна%20педіатрія/6%20курс/English/Theme%2001%20Differential%20diagnosis%20of%20pneumonia%20in%20children.htm</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">2. http://www.merckmanuals.com/professional/index.html</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span style="font-size: 14.0pt; line-height: 150%;">3. <span class="SpellE">Lichtenstein</span>, <span class="SpellE">et</span> <span class="SpellE">al</span>. <span class="SpellE">Pediatric</span>
<span class="SpellE">Pneumonia</span>. <span class="SpellE">Emergency</span> <span class="SpellE">medicine</span> <span class="SpellE">clinics</span> <span class="SpellE">of</span> <span class="SpellE">north</span> <span class="SpellE">America</span>.<span style="mso-spacerun: yes;"> </span>2010.</span></span></div>
<span style="background-color: white;">
<span style="font-size: 14.0pt; line-height: 150%;">4. <span class="SpellE">Barson</span>.<span style="mso-spacerun: yes;"> </span><span class="SpellE">Clinical</span> <span class="SpellE">manifestations</span> <span class="SpellE">and</span> <span class="SpellE">diagnosis</span> <span class="SpellE">of</span> community-aquired <span class="SpellE">pneumonia</span> <span class="SpellE">in</span> <span class="SpellE">children</span>.
UpToDate.com., 2009.</span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-7997067665509207992013-04-02T15:01:00.002-07:002013-04-02T15:01:42.585-07:00Major Complications Of Pneumonia (Pneumothorax & Acute Abscess Of The Lungs) And Pneumonia Prevention In Children<div align="center" class="MsoHeading7" style="margin-left: 0cm; text-align: center;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 18.0pt; mso-bidi-font-size: 14.0pt;">TENSE PNEUMOTORAX</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div align="left" class="MsoBodyText" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: left; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="color: blue; mso-ansi-language: EN-US;">Pneumothorax is accumulation of air in a pleura cavity
with the valvular mechanism of its receiption, wich makes increasing of pleura
pressure with the following stipulations of collaps of lungs, by displacement
of mediastinum in a healthy side and development of acute respiratory and
cardio-vascular insufficiency on the type of cardio-pulmonary shock. At the
simultaneous receipt in a pleura cavity puss together with air pyopneumothorax
occurs. The reason of disease can be a breach in the pleura cavity of lungs
abscess and staphyloccocus bulles, exydative pleurisy, empyema of pleura; tense
mediastinum emphysema, asthmatic state, trauma of thorax which is accompanied
by the closed damage of lungs. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Clinic</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">At the acute form of syndrome<span style="mso-spacerun: yes;"> </span>tension is sudden acutely, pallor of skin,
sticky death-damp, sick seizes air by the opened mouth, frightened, breathing
is hard, cold sweat , suffering face; cyanosis, with increases; a pulse is
weak, threadlike, increased shallow hard breathing, arterial hypotension,
hypoxic comma.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">At the subacute form of syndrome there is slow
progressive worsening of the state, pain in a thorax and in a stomach during
breathing, sickly cough, increase of pallor of skin, cyanosis, sweating, shortness
of breath, tachycardia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">A chest on a sick side falls behind in breathing,
intraribs intervals are extended. Percussion sound above lungs is tympanic, in
lower regions (in </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">pyopneumothorax</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">)
is shortened, respiratory noises on a sick side are absent. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The tones of heart are displaced to a healthy side,
tones of heart are muffled.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">X-ray shows the depression of lung, absent pulmonary pattern, flat
diaphragm,</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">level of liquid or total darkening in </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">pyopneumothorax</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-autospace: none; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><img height="491" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image063.gif" width="609" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">A
classic anteroposterior view of the chest showing pneumomediastinum. The lifted
thymic shadow above the heart is a typical presentation of pneumomediastinum.
(From Vidyasagar D: Respiratory disease in the newborn.
<IT+>In:<IT-> Holbrook PR (ed): Textbook of Pediatric Care. Philadelphia, WB Saunders,
1993, pp 551.) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="330" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image065.jpg" width="484" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Right sided pneumothorax</span></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="WordSection4">
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-autospace: none; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="270" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image067.jpg" width="232" /></span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Right
sided emphysema with displacement of mediastenum and heart to healthy side</span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 40.55pt;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Help on
prehospital stage.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To release
from clothes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">To give
the promoted position of body to the child.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Permanent <span style="mso-spacerun: yes;"> </span>moistened oxygen through a mask.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">20 %
solution of Oxybutirati sodium<span style="mso-spacerun: yes;"> </span>50-100
mg/kg of mass<span style="mso-spacerun: yes;"> </span>for one</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>dose intramuscular or
intravenously streamly on 10-15 ml<span style="mso-spacerun: yes;"> </span>of 10
% </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Glucose solution .</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">At fasty
growth of cardio-vascular and respiratory insufficiency punction</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>of pleura cavity must be
conducted: for destroying of air- the place of </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>punction is III-IV </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">intraribs intervals</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> on a front or middle of axillary line;</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>for the delete of liquid (blood,
pus) – in IV-VI </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">intraribs intervals</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"> on a</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>middle or back axillary line. A
puncture is conducted on the overhead</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>edge of lowlised rib on a depth
of 2-3cm after analgesia by 0,5 % </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Novocaine solution . At valvular </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">pneumothorax</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Bylau drainage<span style="mso-spacerun: yes;"> </span>is</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>imposed.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Immediate
hospitalization in the surgical unit. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div align="center" class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: center; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Help
on a hospital stage.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Oxygentherapy
with moistened oxygen through a nasal catheter -40 %</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>oxygen constantly<b>.</b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">20 %
solution of sodium Oxybutirati 100 mg/kg (0,5 ml/kg) of mass is</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>for one<span style="mso-spacerun: yes;"> </span>dose of intravenously very slowly on 10 %
Glucose solution </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>20 ml; or 0,25 % solution of Droperidoli 0,1 ml/kg of mass </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>intravenously streamly slowly on
10 % glucose solution<span style="mso-spacerun: yes;"> </span>15-20 ml. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Pleura
punction (look on prehospital stage). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Solution
of Corgliconi<span style="mso-spacerun: yes;"> </span>0,06 % or Strophantini
0,05 % <span style="mso-spacerun: yes;"> </span>0,01-0,015 mg/kg</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>of<span style="mso-spacerun: yes;"> </span>the masses (but not more than 0,3 ml) for one
dose on a 10 ml of </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>10% glucose solution<span style="mso-spacerun: yes;"> </span>intravenously streamly slowly.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Cocarboxilazae
50-100 mg, 5 % solution of sodium ascorbinaty 2,0-5,0</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>ml, Panangini 0,5 ml per year of
life intravenously streamly on 10 ml of</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>10 % solution of glucose in
separate syringes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Infusion
therapy for desintoxication – 10 % Glucose solution 10-15ml/kg</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>of<span style="mso-spacerun: yes;"> </span>mass.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 40.55pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Antibiotics.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;">Acute abscesses of lungs</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Destruction of lung parenchyma under the influence of pathogens and
emissions of their enzymes leads to the formation of delineated foci of fusion
of lung tissue in the form of cavities filled with purulent exudate and
detritus, and sometimes containing fragments of the sequestered lung tissue. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Abscess formation in the lung develops in the
presence of several conditions, foremost of which, besides purulent creating
pathogenic organisms, are the violation of bronchial patency and local disorder
of pulmonary circulation. On the mechanism of development there are distinguished
bronchogenic (including aspiration), hematogenoembolic, post-traumatic and
lymphogenous lung abscesses. The allocation of so-called para- and postpneumonic
abscess is incorrect, because initial phase of any of lung abscess is
inflammation of lung tissue, and therefore any genesis abscess is para- or
postpneumonic.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-language: EN-US;"><span style="mso-spacerun: yes;">
</span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Moments
predisposing to the development of lung abscesses are low immunity, weakening
of the child's body</span>. Acutely affects the general resistance of the
organism and thus contribute to the development of lung abscesses and
infectious diseases, primarily such conditions as epidemic influenza, severe
injury, blood diseases, hypovitaminosis, prematurity, hypotrophy. A major
predisposing factor for the development of septic complications, including lung
abscesses, is diabetes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Lung abscess may be caused by various microorganisms and
therefore are polyetiologic disease. An important role in the development of
lung abscesses, especially in childhood, play pyogenic cocci, especially
Staphylococci.</span> These microbes emit a large amount of toxins and enzymes
that contribute to necrotic and destructive changes in lung tissue. Some rarer
causes of pulmonary abscess formation are streptococci, Klebsiella pneumoniae,
Enterobacter, Pseudomonas aeruginosa, or their combination with Staphylococcus.
In the past 30 years in the development of lung abscesses there was
significantly increased the role of anaerobic infection, which most often
detected in aspiration genesis abscess. Many patients have a combination of
various microorganisms, and they may vary in different periods of the disease.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>In addition to the already mentioned
division of the mechanism of development, acute lung abscesses are divided into
simple (pus), and gangrenous. The latter include abscesses, containing parts
torn away as a result of necrotic ihorosic inflammation of lung tissue, known
as sequestration. In addition, abscesses are single and multiple, central and
peripheral, unilateral and bilateral, uncomplicated and complicated.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="color: blue;">The
disease usually starts on the background of one or bilateral pneumonia, most
commonly aspiration genesis or influenza. The clinical picture in the formative
stage of purulent cavities in the lung is determined purulent resorbtion fever,
which is based on three factors: suppurant factor, due to the presence of
necrosis and melting of the lung tissue, a factor of resorption, resulting in
absorption of the decay products of tissue and microbial metabolism, and loss
factor, due to loss of protein with purulent discharge. The patients in this
period have a high, sometimes hectic fever, chills, excessive sweating, signs
of intoxication. Patients are often concerned about a dry cough, chest pain.
Physical examination reveal larger or smaller area blunting percussion sounds
over which the breath is weakened, and enhanced voice trembling. After breaking
an abscess in the bronchus cough becomes wet, sometimes suddenly cough up a
large amount of pus, often hemorrhagic sputum, after which the temperature may
decrease. </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The most severe and protracted
are multiple (especially bilateral) and gangrenic abscesses. The latter most
often become chronic or complicated by a breakthrough in the pleural cavity,
haemorrhage and sepsis. In severe, progressive course and the ongoing decay and
suppuration of lung tissue on a background of increasing intoxication functional
disorders of the cardiovascular system, liver and kidneys arise, which with the
progression of the disease may be replaced by organic changes in the internal
organs, characteristic of the septic condition. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Pronounced loss of protein
and electrolytes during the acute phase of inflammation with its insufficient
compensation leads to volemic and hydroelectrolitic disorders, reduces muscle
mass and weight loss. On this background, there may be swelling of the lower
extremities. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>As the disease progresses and complications
develop the purulent resorbtion fever replaces purulent resorbtion<span style="color: blue;"> </span>exhaustation. Typically, this occurs in children
with extensive destruction of the lung complicated with pleural empyema. On the
background of progressive hypoproteinemia patients lose weight and grow thin.
High temperature is replaced subfebril or normal, that is a poor prognostic
sign, indicates a acute decrease in reactivity. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">The suspection of the beginning of abscess formation in a patient with
severe pneumonia may be based on changes in clinical and physical examination
data, but the main role in the diagnosis of lung abscesses has X-ray, which is
preferably performed in a vertical position the patient</span>. The appearance
of one or more translucencies on the background of a homogeneous darkening of lung
indicates the formation of single or multiple abscesses. The widely used term
abscess pneumonia means only a certain period during the inflammatory process
in the lungs and is not an independent nosological form. Later multiple small
cavities may influent <span style="mso-spacerun: yes;"> </span>into larger, in which,
after coughing up sputum levels of the liquid begin to determine. To refine the
localization of abscesses multi-axial fluoroscopy and radiography in frontal
and lateral projections must be performed. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-language: RU;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="mso-ansi-language: RU; mso-fareast-language: RU;"><img height="263" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image069.jpg" width="271" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>An acute
abscess of upper lobe of left lung. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Visible
massive inflammatory infiltration </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>around
the abscess cavity.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="246" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image071.jpg" width="256" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">An acute abscess of
middle lobe of right lung.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="274" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image073.jpg" width="282" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Empty abscess cavity in the S6 of the
right </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>lung.
Thickening of the wall cavity is seen</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>almost throughout the full length.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Lung abscess should be differentiated</span> from
tuberculous cavities, purulant cysts, <span style="mso-spacerun: yes;"> </span>abscess of bronchiectasis and cavitary form of
lung cancer. Important role has bronchoscopy with biopsy, allows to exclude the
presence of a foreign body, tumor of the bronchus, identify signs of specific
inflammation in the bronchi, to obtain material for morphological and
bacteriological studies.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Very often during the
development of the abscess on the periphery of the lung there are difficulties
in its differential diagnosis with encysted pleural empyema and pneumoempyema.
Sometimes it is very difficult to determine where is the purulent cavity: in
the lung or pleura, especially when these cavities are numerous. If on the
multi X-ray scopy the shadow of the visceral pleura or the edge of the lung are
seen, the presence of empyema may be probably excluded. Spherical or slightly
oval form of the cavity is an evidence of lung abscess, elongated in the caudocranial
direction –of <span style="mso-spacerun: yes;"> </span>empyema. At empyema cavity
width at low of the pole is always greater than that of the upper. The walls of
the abscess cavity approximately have the same thickness, whereas the medial
wall of the empyema cavity formed by the visceral pleura, usually thinner than
the lateral. Internal contours of wall abscess are hilly and rough. At the
massive destruction of lung internal boundary of encysted empyema cavity may
not be the visceral pleura but destroyed and distorted lung parenchyma. The
characteristic radiological signs such abscessempyema is unflat, eroded and
thickened medial wall of the cavity. More precisely localize the cavity is due
to a computer and NMR tomography.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="325" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image075.jpg" width="331" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Encysted
pneumoempyema. The rear cavity </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>contours influent
with the chest wall. Vertical</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>cavity size significantly exceeds the
horizontal.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">To complications of acute lung abscesses include empyema,
pleural pneumoempyema, pulmonary hemorrhage and septic conditions.</span> The
development of any complications greatly aggravates the course of the disease
and worsens its prognosis. Outcome of acute lung abscess in addition to a full
recovery with empting and scarring (obliteration) of purulent cavity, may be so
called "Clinical recovery " with the cleanup of well drained through
the bronchi cavity, its stabilization and transformation on the thin-walled air
cysts. Such a cyst in her relatively small size may be completely asymptomatic,
but in adverse circumstances (activation of infection, the violation of
cross-draining bronchi) in it may appear fluid and cause relapse of
suppuration. Less favorable development is the chronical inflammation and its
progression with associated complications leads to death.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Prevention of pneumonia in
children </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Prevention is the
rational<span style="mso-spacerun: yes;"> </span>feeding, active treatment of
diseases, promoting the appearance of pneumonia (prematurity, malnutrition,
rickets, birth trauma, anemia, abnormalities of the constitution, ARVI, etc.). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Primary</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">.
Nutrition, strengthening of the child, active treatment of diseases, leading to
the pneumonia. </span></span></div>
<span style="background-color: white;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Secondary.</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
Clinical supervision for convalescents during the year, restorative therapy 2-4
weeks after discharge from hospital and dynamic monitoring (paying attention to
the nature of repeated respiratory infections); chest X-ray in the dynamics according
indications.</span></span><br />
<br />
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><b>REFERENCES</b></span></span><br />
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">A - Basic:<br /><br />1. Pediatrics. Textbook. / O. V. Tiazhka, T. V. Pochinok, A. N. Antoshkina et al. / edited by O. Tiazhka – Vinnytsia : Nova Knyha Publishers, 2011 – 584 pp. : il.<br /><br />2. ISBN 978-966-382-355-3Nelson Textbook of Pediatrics, 19th Edition Kliegman, Behrman. Published by Jenson & Stanton, 2011, 2608. ISBN: 978-080-892-420-3.<br /><br />3. Illustrated Textbook of Paediatrics, 4th Edition. Published by Lissauer & Clayden, 2012, 552 p. ISBN: 978-072-343-566-2.<br /><br />4. Denial Bernstein. Pediatrics for medical Students. – Second edition, 2012. – 650 p.<br /><br />B - Additional: 1.http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/шпитальна%20педіатрія/6%20курс/English/Theme%2001%20Differential%20diagnosis%20of%20pneumonia%20in%20children.htm<br /><br />2. http://www.merckmanuals.com/professional/index.html<br /><br />3. Lichtenstein, et al. Pediatric Pneumonia. Emergency medicine clinics of north America. 2010.<br /><br />4. Barson. Clinical manifestations and diagnosis of community-aquired pneumonia in children. UpToDate.com., 2009. </span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com1tag:blogger.com,1999:blog-7275300796104068287.post-25252332680893117142013-04-02T14:58:00.000-07:002013-04-02T14:58:06.205-07:00Differential Diagnosis Of Pneumonia In Children<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 20.0pt;">Acute
pneumonia </span></b></span>
<br />
<div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">Pneumonia</span></b><span style="color: blue; font-size: 16.0pt; line-height: 150%;"> - is an infectious
inflammation in the lung tissue, which leads to disruption of gas exchange in
the body of the child and the appearance of</span><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="color: blue; font-size: 16.0pt; line-height: 150%;">respiratory failure. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Actuality
</span></b><span class="SpellE"><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-size: 16.0pt; line-height: 150%;">of</span></b></span><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-size: 16.0pt; line-height: 150%;"> <span class="SpellE">acute</span> <span class="SpellE">pneumonia</span>
in infants and i</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">t</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-size: 16.0pt; line-height: 150%;">s</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"> high rate is </span></b><span class="SpellE"><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-size: 16.0pt; line-height: 150%;">due</span></b></span><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-size: 16.0pt; line-height: 150%;"> to: </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">1. <b style="mso-bidi-font-weight: normal;">A</b></span><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;"> significant spread of the pathology </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">in </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">children </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">of</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;"> the first year of life (
2%</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">, </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>among children of the
first three years - 0.5-0,6%). </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">2. Severity, chroni</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">zation </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>of the </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">bronchopulmonary
</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">diseases</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">3. High mortality rate, which is due to the fact that
pneumonia </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">is</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;"> the primary cause of infant mortality (in the world nearly 5
million children </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">die </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">under the age of </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">5yrs</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%;"> </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">pe</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">r<span style="mso-spacerun: yes;"> </span>year</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">, </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>every 7 seconds one child </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">dies </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: blue; font-size: 16.0pt; line-height: 150%;">from pneumonia). </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="color: green; font-size: 16.0pt; line-height: 150%;">Physicians </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">of </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: green; font-size: 16.0pt; line-height: 150%;">different professions </span></b><b style="mso-bidi-font-weight: normal;"><span style="color: green; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span lang="EN-US">must know</span></span></b><b style="mso-bidi-font-weight: normal;"><span style="color: green; font-size: 16.0pt; line-height: 150%;"> clinic</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">s</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: green; font-size: 16.0pt; line-height: 150%;">, diagnosis, treatment of
acute</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">
pneumonia</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: green; font-size: 16.0pt; line-height: 150%;"> in young children and be
able to prevent this disease.</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="428" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image004.jpg" width="459" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: red;">The etiology, pathogenesis and morbid anatomy. </span></b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>The anatomic and physiological features of the respiratory system in
children are important factors that determine susceptibility to the emergence
of pneumonia, induce its high frequency and the possibility of transition into
the chronic form. The lower the age of the child, the more pronounced these
features, the higher the risk of pneumonia, the severer it will be over. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The anatomic and physiologic
features that are important for the clinician are: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1) incompleteness of
differentiation of tissues of respiratory system (lung inflammation occurs
quickly and with more severe damage) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2)
the relatively smaller size and narrow respiratory tract, the absence of the inferior
concha until 4 yrs old, hypoplasia of the sphenoidal sinuses (reduction of gas
exchange), </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3)
vulnerability, softness, rich vascularization of the mucosa, the tendency to
edema (rapid violation of ventilation), </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4) the rigidity of the
cartilage ring, narrow subglottic larynx space (inflammation →
respiratory failure → stenosis → croup); </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">5) softness, suppleness of the
trachea and bronchi, a small number of elastic fibers (compression of the
thymus, enlarged lymph nodes, forked aortic arch → stridor) cause that
forced expiration results in narrowing of the space, and even collapse</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">of
the trachea and bronchi (mucous edema, hypersecretion of bronchial glands leads
to obstruction of varying degrees of severity: a) obstructive hypoventilation
b) emphysema c) atelectasis); </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">6) the propensity to rapid violation
of the evacuation function of tracheobronchial ways (fragility, immaturity of
ciliated epithelium, mild passive component of hypo- or hypertention types of
dyskinesia);</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">7) a significant proportion of
interstitial tissue in the lungs, little amount of elastic fibres, a lot of
blood vessels, lung is less<span style="mso-spacerun: yes;"> </span>air
(expressed exudative inflammatory component, easy developing of atelectasis,
emphysema); </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">8) the thorax is as in a
constant inspiration phase in a horizontal arrangement of ribs, a small excursion
of the lungs <span style="mso-spacerun: yes;"> </span>(breathing is abdominal in
nature, so conditions such as meteorism, liver enlargement, the presence of air
in the stomach, diaphragm muscle hypotonia drastically impede gas exchange and
increase the severity of pneumonia). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>It must
be emphasized that these anatomical and physiological features are the more pronounced
in the small child's age. That is why pneumonia develops more often in this
period of life. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">In the occurrence of the
disease leading role, along with anatomical and physiological features, have
the adverse external conditions (cooling, improper feeding, in particular, the
artificial defects and health care, long stay in a damp location, etc.) and
internal ( previous acute infectious diseases, rickets, malnutrition, anemia,
exudative-catarrhal constitutional anomaly, birth trauma, asphyxia, etc.) environments.
The state of reactivity of the body of the child and the defensive forces is
important in the genesis and development of pneumonia. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: red;">Etiology </span></b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Community-acquired
pneumonia are caused by: </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">- Children from 1 to 6
months.: Viruses (RS, parainfluenza) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>E. coli and other gram-negative pathogens, Staphylococci.
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">- Children from 6 months to 6
years: Pneumococcus, H.influenzae type B. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">- Children from 7 to 15 years:
Streptococci, Pneumococci. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Nosocomial:</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Escherichia
coli, K.pneumoniae, Proteus, Enterobacteria, Pseudomonas, Staphylococcus. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Acute destructive pneumonia (ADP):</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Staphylococcus,
Pneumococcus, viral-microbial associations, Proteus, Legionella, Pseudomonas
aeruginosa, Klebsiella, Haemophilus influenzae.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Factors that precede the appearance of pneumonia and
contribute to its development: </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Morphological and functional
immaturity of the early age childs and</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>unfavorable premorbid state (birth
defects of respiratory and enzyme</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>systems, the anomalies of the constitution,
prematurity, hypo - and </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>paratrophy, rickets) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Supercooling of the organism </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">For acute pneumonia: inappropriate
antibiotic therapy, respiratory dysbacteriosis, <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>bad premorbid
state, the aggressive agent and its significant </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-size: 14.0pt; line-height: 150%;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%; margin-left: 18pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Pathogenesis </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span class="SpellE">Unfavourable</span>
external and internal environments contribute to disruption of barrier function
of mucous membrane of the bronchi, reduce local immunity of lung tissue and
cause deterioration of the evacuation function of the bronchial tree. The
pathogen agent penetrates bronchogenically (aerogenically), hematogenically or
rarely lymphogenically, causing changes in the mucous membrane of the respiratory
tract. Pathogens may be bacteria (pneumococci, streptococci, staphylococci,
Gram-negative flora), viruses, fungi, parasites (pneumocysts), an association
of various pathogens. </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Factors,
preceding and contributing to disease, create favorable conditions for life and
reproduction of pathogen that causes inflammation. In the pathological process
mucosa of the bronchi and bronchioles, intermediate and alveolar tissue is involved.<span style="mso-spacerun: yes;"> </span>Cinzerling offers such sequence of its
development: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">a)
development of inflammatory focus </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">b)
reproduction of pathogen </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;">с</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">)
spreading infected edematous fluid through the pores in the next few alveoli. </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">In the
alveoli serous exudate is formed with a large number of fibrin, in the
bronchioles and bronchi mucus is accumulated, which causes their obstruction
and appearance of atelectases. Finally, this leads to the formation of
pathological changes in the form of focal (in particular, confluent),
segmental, lobar, interstitial lesions, involvement in the pathological process
of the pleura, lymph nodes (increasing).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>At any of these forms of
pneumonia all the structural elements of lungs are involved in the pathological
process greater or lesser, so in the diagnosis the predominant lesions of the
parenchyma or interstitium are indicated. For example, a focal pneumonia (the
most common form of pneumonia in children 1 year) indicates a lesion of the
parenchyma and bronchi. It is inconceivable that in this disease have remained
intact vessels, intraalveolar septums, lymph nodes, etc. Changes in the
bronchi, bronchioles (<span style="color: blue;">ventilation violation</span>),
swollen interalveolar septums and interstitial tissue (<span style="color: blue;">diffuse
disorders</span>) impede gas exchange between blood and alveolar air. Exception
from gas exchange of alveolars, sub-segments, segments, lobes (<span style="color: blue;">distribution<span style="mso-spacerun: yes;"> </span>violation</span>)
contribute to the development of respiratory hypoxemia. </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">With the
participation of interoreceptors the organism through the respiratory centers
of the child reacts to the last increase in respiratory rate in order to
eliminate hypoxia. However, the increase in respiratory rate o</span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;">т</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
60% leads to a decrease in the depth of breathing in </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">30</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">%,
resulting in an increase in pulmonary ventilation only on 15%. In severe forms
of pneumonia, when the respiration rate increases in 2-2,5 times the depth of
breathing and lung ventilation are acutely reduced. However, the oxygen demand
increases significantly with increasing body temperature, increased metabolism
especially at the expense of activity of the sick organ (lung) and supporting
muscles. Lack of blood arterialization is compensated by increased cardiac
work, particularly right heart. Heart output and minute circulation volume are
increased. All of this causes an acceleration of blood circulation in the
lungs, frequent</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">contact with lung tissue and improvement
of the blood arterialization.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>However,
with further progression of the pathological process in the lungs and prolonged
rise of pressure in the pulmonary circulation, metabolic changes occur in the
heart muscle, which causes its degeneration, diminished activity. This leads to
disruption of blood circulation in the lungs, in hemo-and lymphostasis with the
development of <span style="color: blue;">circulatory hypoxemia</span> . That's
why a severe form of pneumonia is a disease with <span style="color: blue;">respiratory-heart
failure</span>. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Further deepening of the pathophysiological
and pathological changes in broncho-pulmonary system contributes to the
violation of oxid reduced processes, which leads to the accumulation of
incompletely oxidized products of metabolism in the body, increasing the
content of pyruvic and lactic acids, the acidosis shift of acid -alkaline
balance. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">Oxygen uptake in
tissues is stoped (hemical and anemic hypoxemia), hypoxia develops with expressed
severe clinical manifestations. At hypoxemia cyanosis is characteristic, at
hypoxia - ashy-gray color of skin. Phenomena of hypoxemia (and all its 3
phases) results in a disturbed external respiration (the basis of the
pathogenesis of pneumonia), and hypoxia - internal respiration.</span> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>As a result of hypoxemia and
hypoxia, changes occur in all types of metabolism (protein, lipid,
carbohydrate, water and electrolyte), the total </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">enzymopathy appears,
polyhypovitaminosis occures. Infection at pneumonia (exogenous toxicosis), on
the one hand, and the adverse effect of the accumulated products of metabolism
(endogenous toxicosis), on the other hand, lead to functional and sometimes to
organic changes in all organs and systems, as well as to disorders of
immunologic homeostasis. It is clear that the above cascade of profound change
is absent in the mild forms of the disease and rare in children older than 2
years. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>An analysis of 323 child deaths due to
pneumonia (data sections in the Ternopil region), representing 37% of autopsies
over the past 5 years, found that from this disease children die mostly under
the age of 1 year (97%), during the first week – 66% of newborns. In the children
up to 1 month, pneumonia is often a major illness (79%), rarely developed as a
complication of other diseases (21%). In children older than 1 month pneumonia
as the main disease occurs in 17%, as a complication – in 83% of cases. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Neonates primarily have aspiration
pneumonia (53%), influenza (22%) and result of pneumopathy (14%). In children
older than 1 month bronchopneumonia develops in 95% of cases, lobar - 3,5%,
interstitial - in 1,5%. It is dominated polysegmental (43%) and large-focal
(27%) pneumonias. The nature of inflammation in newborns prevail serous
hemorrhagic pneumonia, among older children - fibrinous and purulent. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>In stillborns and premature infants
pneumonia mostly is caused by Gram-negative flora (70%), in the term infants Gram-negative
and Gram-positive flora is found equally frequently. </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Scheme of pathogenesis</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The penetration of patogen in lung
tissue→ the formation of an inflammatory focus→ hypoxemia→respiratory
failure→ respiratory acidosis→hypercapnia→ decreased activity
of respiratory enzymes. Hypoxia (a respiratory acidosis associated with metabolic)→
hypercapnia→ violations of all types of metabolism→ decrease in
cellular and humoral immunity.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 16.0pt; mso-ansi-language: EN-US;">Classification of acute pneumonia</span></b></span></div>
<span style="background-color: white;">
</span><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Types <span style="mso-spacerun: yes;"> </span></span></b></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- focal</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- segmental (mono- or polysegmental)</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- croupous</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- interstitial</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Localization</span></b></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Lung, lobe, segment, one side or both side</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Forms</span></b></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- community-acquired, hospital (nosocomial)</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- at perinatal infections</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- ventilate-associative</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- aspiration</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">- at immune deficiency</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Severity</span></b></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Mild, moderate and severe (severity is in accordance to clinical
features and presence of complications) </span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Complications</span></b></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="411">
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Lung complications</span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">: pleurisy, lung
destructions, pneumothorax etc.</span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Out of lung complications</span></b><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">: infection toxic
shock, cardiovascular failure, DIC-syndrome, respiratory distress syndrome of
adult type</span></span></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Clinics</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Clinical manifestations of
the disease in infants depend on sex (mainly boys are sick, they have also
increasingly concentrated fatal pneumonia), age (in younger children it is more
severe and more frequently fatal), premorbid state of the organism (severe pneumonia
takes place on a background of prematurity, malnutrition, rickets,
exudative-catarrhal anomalies constitution, etc.), the nature of agent (staphylococcal
pneumonia is always severe, pneumococcal - easier). In early childhood
pneumonia mainly developes on the background of ARVI, measles, pertussis and
other diseases, so the course and severity of disease also depend on the nature
of the virus (severer due to respiratory syncytial, influenza, measles) or
bacterial (staphylococcal septicemia) infections. All of the above determines
the individual peculiarities of pneumonia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="color: blue;">For
most children, onset is gradual with manifestation of respiratory symptoms
(sneezing, runny nose, dry cough), a slight increase in temperature, slight
perioral cyanosis with anxiety, pallor of skin, lethargy, sleepiness, negative
reaction to his surroundings. Then signs of external respiration disorders occur:
frequency and shallow breathing, a violation of its rhythm (irregularity,
arrhythmia, periodic apnea), shortness of breath, change in the ratio of
respiration and heart rate (normal - 1:3,5-4) to 1:2, 5 - 1, 5. </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Objectively it is marked
retracted compliant areas of chest during breathing, the participation of
auxiliary muscles. Percussion: shortness or dullness of percussion sounds above
the lesion. Auscultation: the presence of localized moist or dry wheezes. The
physical pattern depends on the type and severity of pneumonia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="mso-ansi-language: RU;"><img height="221" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image006.jpg" width="458" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Points of comparative percussion</span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="375" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image008.jpg" width="250" /></span><span lang="RU" style="mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="540" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image010.jpg" width="360" /></span><span lang="RU" style="mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Auscultation</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">It must be
remembered that in extremely serious condition cardiovascular failure may
develop, characterized by acute increase in the frequency of heart contractions
and frequent apnea. In such situation the ratio of respiration and heart rate
will be "normal" - 1:4. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>We need to pay attention to the characteristic
sing for <span style="mso-spacerun: yes;"> </span>pneumonia in premature and
newborn (50%): selection foamy mucus from<span style="mso-spacerun: yes;">
</span>mouth and nose </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">(Kravets
symptom), synchronous to the breathing head motion on the pillow top to bottom
(the first month of life), thickening of skin folds in chest on the side of
lesion. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Later occur: pale skin,
cyanosis, in severe cases - cyanotic marbling and grey colour of the skin. It
is observed the tension and swelling of the nostris, shortness of breath has
"grasping" nature. Breathing is increased in 1,5-2-2,5 times compared
with the norm, apnea occurs several times a minute, the ratio of respiration
and heart rate - 1:2-1,5. Thorax is emphysematous, barrel, percussion first
shows boxed sound, later - a shortening in the area of confluence of small foci
of affected segments. The presence of disseminated small foci of inflammation
of the lungs may not cause changes on percussion because they are surrounded by
emphysematous changed parts of the lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Diagnostic criteria of
pneumonia</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Clinical
<span style="mso-spacerun: yes;"> </span>Increasing of <span style="mso-spacerun: yes;"> </span>body temperature above 38°C, hyperthermia </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>during 3-5 days and
more; dry cough at first, then </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>moist; signs of
intoxication and respiratory </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>failure; at palpation
<span style="mso-spacerun: yes;"> </span>increased voice fremitus, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>at percussion over
the affected area of lung </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>a shortened
tympanitis, at auscultation - </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>hard breathing, first dry,
then moist sonorous </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>small and medium
bubble wheezing, possible crepitation</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>over the size of
lesions, enforced bronchophonia. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">X-Ray
<span style="mso-spacerun: yes;"> </span>Infiltrative shadows in
the form of foci of different</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>size and intensity,
darkening of one or several segments, lobe or</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>several foci.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Diagnostic criteria of acute destructive pneumonia</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Clinically
<span style="mso-spacerun: yes;"> </span>Manifested intoxication, focal physical<span style="mso-spacerun: yes;"> </span>symptoms (increased voice</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>fremitus over the area of destruction,
shortening of percussion sounds,</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>hard breathing) at infiltrative-destructive
form. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Intoxication, respiratory, cardio-vascular
insufficiency, disseminated<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>wheezing at abscess form. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Syndrome of internal thoracic intensity
(marked paleness of skin,</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Cyanosis of nose-labial
triangle and acrocyanosis, shallow breathing, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>dyspnea, tachycardia),
position on the sick side, the backlog of</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>respiratory
excursions on the side of destruction, percussion –</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>shortening of the sound, auscultation -
relaxed breathing or its</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>absence at lung-pleural
forms. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">X-ray
<span style="mso-spacerun: yes;"> </span>On the background of
infiltration of lung tissue appearance of local </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>small round air formations
(infiltrative - destructive form). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>On the background of polysegmental
infiltration presence of </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>circular formation with expressed
shadow, later - cavity formation with</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>the
level of fluid (abscess form). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Simultaneously with
pulmonary infiltration parietal shadow in the area </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>of the sinuses
(pyothorax). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The presence of air
above the horizontal level of the liquid, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>displacement of the shadow
of the mediastinum, enlargement of </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>intercostal intervals
(pneumoempyema).<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">For pneumonia, which occurs in children 1 year of life,
there are not characteristic percussion changes, but are noted increased
respiratory noises, crepitation<span style="mso-spacerun: yes;"> </span>and
small bubbling rales. Segmental, lobar pneumonia are characterized by
shortening of percussion sounds and bronchial breathing. At atelectasis, except
shortening percussion sounds, breathing is weak or absent. This clinic shows
the need for exclusion exudative pleurisy (radiologically).</span> </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>For putting the diagnosis of
disease it is very important X-ray examination - limited homogeneous shadowing
within one segment (or segments) of the lungs is characteristic for pneumonia
in children older than one year. The same changes are observed at atelectasis,
agenesia, hypoplasia of the lungs. At pneumonia often occurs the infiltrative
enlightenment in the center and the level of liquid in it (abscess). Pneumonia
in young children at X-ray is accompanied by soft, small (1-3cm), round
infiltrative shadows on the background of intensive, stranded lung pattern (bronchitis,
peribronchitis). Net-stranded or stranded spotted lung pattern is characteristic
for influenza and measles, pneumonia, and sometimes for the interstitial forms
of staphylococcal pneumonia.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><img height="501" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image012.jpg" width="750" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">X-ray
examination</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">For illustration we present an excerpt from the
medical card N 8775. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Girl M., 3,5 months, was hospitalized in
the pulmonary department with the acute bilateral bronchopneumonia
viral-bacterial etiology, severe course with the obstructive syndrome during
the crisis period, RF II st.; Iron-deficient anemia, alimentary-infectious origin
moderate form. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Complaints</span></i></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> on
a dry cough, shortness of breath, anxiety. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Anamnesis
of the disease</span></i></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">: the disease occurs acutely 4 days
before hospitalization, after contact with patients with ARVI of family
members. The girl fell appetite, started to cough, body temperature increased
to subfebrile. Over the next two days the state progressively deteriorated: the
body temperature remained high (despite antipyretics, which his mother gave the
child), coughing became more often and severe, the girl refused to eat, short
of breath occured and began to grow. This has forced parents to visit a doctor,
and the child was hospitalized at the District Hospital.
In the District Hospital was during 3 days. In
connection with the further deterioration was tntered to Regional Hospital.
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Anamnesis
of life</span></i></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">: a child of II<span style="mso-spacerun: yes;">
</span>term normal pregnancy, II normal childbirth. Weight at birth - 3100g,
body length - 50cm. Cried at once, breast feeding from the 1-st day, sucked
actively. Umbilical residue dropped on the 4-th day, the wound healed at the 6-th
day; at the 7-th day the girl in a satisfactory condition was discharged at
home. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Breastfeeding lasted
approximately 1.5 months, from 1.5 months of age (due to mother hypogalactia)
the child was transferred to artificial feeding by cow's milk, first diluted
(1:1 - 3 weeks, 2: 1 - 2 weeks). Before the disease, she received whole cow's
milk. Juices and fruit purees were introduced after 3 months. (Gets
occasionally no more than 1 teaspoon a day). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Objective
status</span></i></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">: status of girls at entering to TRH was severe, which
led to her hospitalization in the intensive care unit. The condition was due to
respiratory failure and intoxication. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Normostenic,
a satisfactory nutritional status. Skin was pale with a gray tinge, cyanosis of
the lips and nasolabial triangle, increased by coughing and crying.
Subcutaneous fat developing is satisfactorily (the thickness of skin folds at abdomin
- 1,5cm), distributed evenly. There are palpable single back and front neck
lymph nodes (2-3 in
each group), their diameter - up to 5mm, they are soft-elastic, not soldered to
the surrounding tissues, mobile, not painful. The head is round, without deformation,
large fontanellae (2 x 1, 5cm) at the level of the skull bones, the edges are
dense, smooth. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The boundaries of relative cardiac
dullness: the right-parasternal line, upper - II rib, left - 2cm outward from
the left sternocleidomastoideus line. Cardiac rhythmical tones are slightly
weakened, heart rate - 152 per 1 min. Soft systolic murmur is auscultated above
the apex of the heart. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Thorax somewhat blown, symmetric. Support
muscles are involved in the act of breathing, nostrils are tense. At percussion
over the surface of the lungs it is determined<span style="mso-spacerun: yes;">
</span>clear pulmonary sound with slightly bandboxing , the sound is shortened
paravertebrally. At auscultation - hard breathing, in the lower parts of both
lungs fine bubbling moist rales in large quantities are listened. BR - 66-68 per
1 min, extended exhalation. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Abdomen is slightly distended,
palpation is not painful, the lower edge of the liver is 2 cm under the costal arch,
soft, elastic, smooth. Feces - 2 times a day, mushy, without pathological
impurities. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">X-ray
of lungs</span></i></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">: at both sides in the medial areas there is
focal infiltration of the lung tissue, in other areas - an increase of
pulmonary pattern against the background of acute inflation of the lungs. The
roots are low structured, infiltrated. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>General blood analysis: Er. - 3,02 x10<sup>12</sup>
/ l, Hb - 75 g
/ l, CI 0,7; Leuc. - 8,9 x10<sup>9</sup> / l, e-1, b -10, s -47, l – 39, m - 3, ESR - 3 mm / h. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Analysis
of urine, feces, coprogramm - without pathological abnormalities. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Criteria
of diagnosis of pneumonia in the child: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1.
Signs of respiratory distress (shortness of breath, swelling of the nistrics,
cyanosis</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>of nasolabial
triangle, participation in the act of breathing of axillary musculature. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2.
The symptoms of intoxication. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3.
Local changes: a shortening of percussion sounds paraver- </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>tebrally, hard breathing, in the lower
parts of both lungs - fine </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>bubbling moist rales. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4.
Radiological findings: on both sides in the medial areas infiltration of the
lung</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>tissue. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">5.
general blood analysis: leucocytosis, shift to the left. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Treatment</span></i></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">: Ampicillin
and Gentamicin intramuscularly, Fluimucil, Aktiferin, vitamin A, Linex, infusion
therapy (saline, glucose, aminophylline - 2,4%, vitamin C, Riboxin), massage of
the chest in the drainage position, stimulation of coughing. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The
perculiarities of pneumonia in the child</span></i></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">: the disease
was developed on the background of anemia caused by malnutrition. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Type
of pneumonia was little focal (bronchopneumonia), which is characteristic for
early childhood. There was also obstructive syndrome and severe intoxication. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Segmental and lobar
pneumonia are more common in children of 2-3 years. Characteristic for them are
acute start, severe disturbance of the general condition, hyperthermia. Cough
initially is absent or negligible, expressed pain in the right iliac region,
vomiting, shortening of percussion sounds, up to absolute dullness, expressed
bronchophonia. Shadowing of segment (segments) and lobe on <span style="mso-spacerun: yes;"> </span>X-ray confirms the diagnosis of pneumonia and
eliminates the acute abdomen. Without treatment the course is cyclical.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="502" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image014.jpg" width="285" /><span style="mso-spacerun: yes;"> </span><img height="509" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image016.jpg" width="270" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Right
sided lobar pneumonia</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="mso-ansi-language: RU;"><img height="420" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image018.jpg" width="420" /></span><b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Right
sided polysegmental pneumonia</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="441" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image020.jpg" width="550" /></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">X-ray of the chest in the front projection at left-sided upper
staphylococcus pneumonia: On a massive shadowing in the upper lobe of left lung
there are seen multiple round of enlightenments - cavities.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;">
</span></span><span lang="RU" style="font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="530" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image022.jpg" width="541" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Radiogram of the chest in front projection with focal interstitial
pneumonia: the background of a strengthened and strained lung pattern in both
lung fields, predominantly in the right, there are visible focal shadows of
different sizes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="517" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image024.jpg" width="612" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Radiograph of the chest in front projection with the focal</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">pneumonia: in both lungs are visible clearly delineated shadows</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>diameter of 1-2 cm.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="532" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image026.jpg" width="622" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Roentgenogram of chest in a front projection at croupous upper
right-sided pneumonia: in the right upper lobe there is defined shadowing,
limited by interlobar pleura, the volume of the lobe is not reduced, the
bronchial tree in it is transparent.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><img height="496" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image028.jpg" width="520" /></span><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;">Thermogram of the back surface of the thorax with croupous</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>right-sided pneumonia: in the
right lung there are determined<span style="mso-spacerun: yes;"> </span>confluent</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>foci of hyperthermia (yellow).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="color: blue;">The
diagnosis of pneumonia is justified by the following criteria: respiratory
failure, presence of symptoms of intoxication, the local percussion
(shortening) and auscultatation (crackling or wheezing fine rales) changes,
tension and swelling of the nostris, involving the sternum, intercostal spaces,
over-and subclavian areas; participation in the breath of abdominal press;
focal, segmental, lobar infiltrative shadows (radiologically), neutrophilic
leukocytosis and a shift to the left, increasing of ESR, respiratory or mixed
acidosis.</span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Intrauterine and neonatal pneumonia </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Intrauterine and neonatal pneumonia differ
in clinical manifestations of pneumonia in older children: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1)
it is possible to identify the relationship between changes in intrauterine
fetal development and inflammation in the lungs, the disease may be a
manifestation of sepsis or the first is the respiratory distress syndrome and
later developed pneumonia followed by sepsis, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2)
for younger (in days) and maturity of the child, bright manifest forms of
pneumonia are rear, and therefore their diagnosis increases the value of
supporting research methods, <span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>3) a destructive form of pneumonia tend to
occur in full-term children with septic focus of the pathological process, </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4)
relatively long disease duration (3 weeks) and the recovery period (up to 4-6
weeks). Imunoglobin G and the partial pressure of O<sub>2<span style="mso-spacerun: yes;"> </span></sub>are visibly reduced, the hypovitaminosis
and anemia are observed.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Destructive pneumonia </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>The features of destructive pneumonia
(often staphylococcal origin) are: expressed intoxication, gray colour of skin,
neurotoxicosis, respiratory and cardiovascular failure, severity of disease,
significant changes of all organs and systems, meteorism, significant
neutrophilic leukocytosis with left shift, increased ESR, anemia. If acute
pneumonia lasts more than 6 weeks, according to the<span style="mso-spacerun: yes;"> </span>classification, it is protracted pneumonia.
For destructive pneumonia, this criterion is not relevant, since the acute phase
may last for 8 or more weeks. More specific manifestations is the presence of
pneumatocele (Bullas, thin-walled air cavities in the lungs, which are
determined radiographically), which can swell up to large sizes, lung abscess,
pneumothorax, pneumoempyema, subcutaneous emphysema and mediastinal emphysema,
staphylococcal enterocolitis.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="285" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image030.jpg" width="803" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Pneumoempyema:
A–in standing position, B–in lie position, C–in lateral position.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="256" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image032.jpg" width="803" /></span><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Pneumoempyema:
A–before treatment, B–a week later, C–after treatment.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="331" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image034.jpg" width="390" /><span style="mso-spacerun: yes;"> </span><img height="407" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image036.jpg" width="312" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="352" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image038.jpg" width="458" /><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Pleurisy</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="371" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image040.jpg" width="312" /><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Destructive
pneumonia with abscess.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="334" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image042.jpg" width="399" /><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Abscess
of right lung.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">WHO </span><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">for </span><span lang="EN-GB" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">primary
health care system suggests using such diagnostic test: breathing more than 50
minutes per 1 minute indicates pneumonia, more than 70 per 1 minute -<span style="mso-spacerun: yes;"> </span>the severity of its course. Identify the
causative agent is problematic in connection with the imperfection of modern
methods of investigation.<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Clinical classification of acute pneumonia <span style="mso-spacerun: yes;"> </span>provide the type, severity of disease. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Type of disease is
predominantly determined by X-ray: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l3 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">focal bronchopneumonia </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l3 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">segmental pneumonia; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l3 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">lobar pneumonia; </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l3 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">interstitial pneumonia. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="color: green; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The severity is
determined by the severity of clinical manifestations and the presence of
complications.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: red;">Mild form of disease</span></b> is characterized
by a slight violation of general condition, a moderate increase of temperature
(not more than 38,5°C),
respiratory insufficiency II degree, blood gases at rest are not changed. <span style="mso-spacerun: yes;"> </span>At a mild course of the disease tere are
changes in <span style="mso-spacerun: yes;"> </span>the lungs and no changes in
the other organs and systems. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: red;">Severe pneumonia</span></b> in children is
characterized by changes both of the bronchopulmonary system, as well as other
organs and systems. And, sometimes clinically the disorders of the central
nervous system, heart, digestive organs are the main. For example, the doctor
examines the patient, who expressed hyperthermia (40-41°C), depression of
consciousness or loss of consciousness, seizures. And only the lumbar puncture
showed that the changes in the spinal liquid are absent, and later<span style="mso-spacerun: yes;"> </span>examination of <span style="mso-spacerun: yes;"> </span>the patient define all symptoms of pneumonia. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Therefore it is desirable to specify a
diagnosis not only the severity of the disease, but also a <b style="mso-bidi-font-weight: normal;"><span style="color: green;">meninoencephalitic syndrome</span></b>
(hypoxic encephalopathy). The presence, along with pronounced signs of
respiratory distress, changes in the cardiovascular system (small frequent
pulse, expanding the borders of the heart, deafness tones, systolic murmur, may
be swelling of the neck veins, ECG changes) indicate presence of <span style="mso-spacerun: yes;"> </span>myocardial hypoxia and pronounced <b style="mso-bidi-font-weight: normal;"><span style="color: green;">cardiovascular
syndrome</span></b>. Dyspepsia (vomiting, frequent liquid feces, meteorism)
indicate the <b style="mso-bidi-font-weight: normal;"><span style="color: green;">intestinal
syndrome</span></b>. Acute hypotension, general cyanosis, pulse, which is not
defined or thready, heart rate, which is not countable, vomiting, diarrhea show
the <b style="mso-bidi-font-weight: normal;"><span style="color: green;">adrenal
insufficiency syndrome</span></b>. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Acute moderate pneumonia</span></b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">
is accompanied by a intermediate manifestations compared to the above clinic. It
is marked by disturbed general condition, respiratory insufficiency II degree,
manifested changes in other organs and systems, but they do not predominate
over the symptoms from the lungs.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Standard
classification of acute pneumonia differentiate <b style="mso-bidi-font-weight: normal;"><span style="color: red;">acute course (during 6 weeks) and protracted
(over 6 weeks)</span></b>. But this logic breaks down: acute pneumonia can not
be both protracted. Therefore, during her periods should be distinguished: 1)
initial, 2) the clinical manifestations, 3) regression and 4) recovery. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The
differential diagnosis of the disease is carried</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>primarily with bronchitis, bronchiolitis,
acute respiratory viral diseases. <span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: red;">Scheme of differential diagnosis of acute
pneumonia</span></b></span></span></div>
<span style="background-color: white;">
</span><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="411">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Characteristic for pneumonia</span></b></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="411">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Non characteristic for pneumonia</span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.35pt;" valign="top" width="411">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Body
temperature higher 38°C
more than</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3 days</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Cyanosis</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Hard
breathing</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Unproductive
dray and moist cough</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Dyspnea
with obstructive syndrome</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Local
signs:</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">local moist
rales, weak or harsh breathing, intensive bronchophony,</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">short
percussion sound</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Neutrophyle</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">
</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>leucocytosis more than</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">10x10<sup>9</sup>/l, ESR more than 20 mm/h</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.4pt;" valign="top" width="411">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Body
temperature lower 38°C
</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Body
temperature higher 38°C<span style="mso-spacerun: yes;"> </span>up to</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3 days</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Absent</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Absent</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">May be
different variants</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Absent</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Disseminated
dry and moist rales</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Normal
hematological features</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Differential diagnosis of focal
pneumonia, bronchitis and bronchiolitis</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td rowspan="2" style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.35pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Diseases</span></b></span></div>
</td>
<td colspan="3" style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 211.2pt;" valign="top" width="352">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Functional changes in lungs</span></b></span></div>
</td>
<td colspan="3" style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 211.2pt;" valign="top" width="352">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">X-ray<span style="color: red;"> </span>changes in lungs<span style="color: red;"></span></span></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Percussi-</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on sighs<b style="mso-bidi-font-weight: normal;"><span style="color: red;"></span></b></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Type of</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">breath<b style="mso-bidi-font-weight: normal;"><span style="color: red;"></span></b></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Rales</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Root of </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">the lungs</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Vascular</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">pattern</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Local focal
shadows</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.35pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Focal
pneumonia</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Lung sound
with box inflection</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Harsh,
focally weak with bronchial inflection</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Local fine</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">moist or
crepitation</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Widening</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">nonstructive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on both
sides or on the side of lesion</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Mostly</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">intensive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on the</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">side of
lesion</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Different
size and</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">density</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">sometimes</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">confluent</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.35pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Simple
bronchitis</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Lung sound
with box inflection<b style="mso-bidi-font-weight: normal;"><span style="color: red;"></span></b></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Harsh<b style="mso-bidi-font-weight: normal;"><span style="color: red;"></span></b></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Dissemi-</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">nated moist
and dry rales</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Widening</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">nonstructive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on both
sides<b style="mso-bidi-font-weight: normal;"><span style="color: red;"></span></b></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Intensive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on the</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">both sides</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Absent</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.35pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Obstructive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">bronchitis </span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Bandbox
sound</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Harsh</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Dissemi-</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">nated dry
rales</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Widening</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">nonstructive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on both
sides</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Intensive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on the</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">both sides,
swelling of lungs</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Absent</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.35pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Bronchioli-tis</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Bandbox
sound</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Harsh</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Dissemi-</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">nated moist
fine<span style="mso-spacerun: yes;"> </span>rales</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Widening</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">nonstructive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on both
sides</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Intensive</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">on the</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">both sides,
sharp swelling of lungs</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.4pt;" valign="top" width="117">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Absent</span></span></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Segmental pneumonia must be
differentiated from segmental </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>acute pulmonary edema at
ARVI. </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Unlike pneumonia, segmental
edema occurs more frequently in children older than 2 years. The characteristic
feature of it is the disparity between the clinical picture of X-ray changes.
Respiratory failure is rare. Physical symptoms are not pronounced. Radiological
examination revealed massive homogeneous shadows within one, rarely several, in
segments of the lungs, usually with a localization within the II-III or IV-V
segments of the right lung. Unlike pneumonia, with repeated X-ray examination
after 3-5 days, these shadows disappear and on their place there is only an
intensification of the vascular pattern. The picture of blood in patients with
segmental pulmonary edema is not changed and corresponds to the same virus
infection: leukopenia, lymphocytosis. Normal or slightly elevated ESR. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: blue;">Incorrect diagnosis of acute pneumonia leads
to unnecessary prescription of antibiotics, unreasonably long delay of the
child in hospital.</span></b></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="tab-stops: 152.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; mso-ansi-language: EN-US;"><span style="mso-tab-count: 1;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; mso-ansi-language: EN-US;">Treatment</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="tab-stops: 152.25pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 152.25pt;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: green; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Treatment of the disease
is always complex and aims to eliminate the causative agent, to liquidate
oxygen deficiency and toxicosis, to restore function of organs and systems and increase
resistance.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: red;">Therapeutic and protective regime</span></b> is required for
the inflammatory process subsided, and prevention or minimizing hypoxemia. The
successful treatment is nursing a patient with participation of mother. The
excitation and crying are significant physical activities that enhance oxygen
deficiency. Therefore, it is necessary that the diagnostic and therapeutic
procedures were as forgiving (to hold in the intervals between sleep). It is
necessary to eliminate bright light, noise, provide frequent changes in body
position in bed with head up. Wards for the sick children with pneumonia,
should have sufficient space (at least 6.5m<sup>2</sup> per child). To prevent
reinfection it is required separate boxes, bright, ventilated, with frequent
(4-5 times a day) ultraviolet irradiation. Temperature in the ward - 18-20°C, for newborns – </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">22-24°C. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 152.25pt;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="383" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image044.jpg" width="327" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 152.25pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: red;">Feeding the child</span></b> must be gentle and
easy to digest. The best is breath milk, even the donor milk, in its absence must
be used the adapted milk formulars. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">In
the mild, and occasionally moderate, the disease volume of food and the
intervals between feedings should be the physiological, in severe cases- in the
first days of feeding expressed breast milk (to limit physical activity)
through 2-2,5 hours - in small doses (up to 50% of normal) because appetite extrimely
reduced or absent. Of course, the kid himself regulates the quantitative aspect
of feeding depends on the severity of the pathological process. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Complete denial of food is an indication
for parenteral nutrition. Once markedly reduced toxicity phenomenon and
respiratory failure, the appetite is restored and the child goes to the normal
(end of I and the beginning of the II week of disease). The need for vitamins
increases in 2-5 times, and it should be satisfied (preferably enterally).
Additional fluid loss, on the one hand, and the risk of pulmonary edema (severe
course), on the other hand, is the basis for thorough correction with the help
of rehydration therapy. We must remember that a child should not receive less
than 150 ml / kg. He gets it while eating and drinking </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">(vegetable-water,
apple skins-water, carrot-water, rice-water, 5% glucose solution, Oralit), as
well as infusion therapy. In milder forms of pneumonia, usual diet and
treatment provide the child with all the necessary ingredients of food, because
a mechanism of self-regulation is not distorted.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="color: red;">Aero-and oxygen therapy</span></b> are simple
and effective in tretment or prevention of hypoxemia. This requires periodical
toilet of nose, sucking the mucus from the pharynx (always before feeding),
ventilation the ward, walk in the fresh air with the principle of gradualism
(at environment temperature 17-22°C - maximally, perfectly - around the
clock). Older children need to learn to release mucus from the nose. Pulmonary
office should be boxed, have pleasure chamber used in bad weather. Outdoors
child with this disease calms down, sleep, breathing becomes not so frequent,
cyanosis disappears. In severe pneumonia patient required a 30-minute oxygen
supply (usually through a catheter, a tent, mask) 3-4 times a day to improve
the breathing rhythm, reduction or disappearance of cyanosis, to improve the
general condition. Local action for edemata nasal mucosa (Sol. Norsulfazoli
0,8% - 15 ml; Furacilini 0,01 and Dimedroli 0,05; Ephedrini 0,2; Sol.Adrenalini
hydrochloridi 0,1%, <span style="mso-spacerun: yes;"> </span>10 gtt. MDS -<span style="mso-spacerun: yes;"> </span>2 drops in each nasal passage before
breast-feeding) improves the ventilation function of the upper respiratory
tract. </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">At</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">
severe pneumonia, as a rule, there is marked respiratory and circulatory
hypoxemia, which clinically are manifested by <span style="color: red;">respiratory
failure and cardiovascular syndrome</span>. Therefore, in such cases, treatment
begins with a slow introduction of a cardiac glycosides (Strophanthin
solution<span style="mso-spacerun: yes;"> </span>0,05% or 0,06% Corglikon solution
0,012 ml / kg) in 20% Glucose solution (5 ml / kg) with Cocarboxilaze (5 mg /
kg ) and vitamin C (100-200 mg). Under these conditions there are disorders of <span style="mso-spacerun: yes;"> </span>the microcirculation (especially in the lungs
and heart) and blood rheology, which needs use of antiplatelet agents (Curantil),
hemocorrectors (Reopolyglucine), anticoagulants (Heparin). Whilst the therapy
is aimed to liquidate the cardiovascular insufficiency, its ultimate task - to
eliminate the phenomenon of hypoxemia and the normalization of metabolic
processes.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Not only at severe pneumonia,
but less at moderate, there is marked the phenomenon of <span style="color: red;">toxicity</span>, accompanied by hyperthermia and convulsions. Therefore it
is needed the appointment of desintoxication therapy: Albumin, Plasma, Haemodes
(intravenously, in the warm form,<span style="mso-spacerun: yes;"> </span>5-10
ml / kg / day). To a great extent these qualities are inherent in Albumin, then
- Plasma, then - Haemodes. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>It is known that <span style="color: red;">high temperature</span> requires sharp increases in
metabolism, oxygen demand, therefore, leads to accumulation of toxic metabolic
products and the deepening of hypoxemia and hypoxia. Therefore, advisable to
appoint non-specific anti-inflammatory drugs, Amidopyrine (1% solution), Analgine
(25% solution - 0.25 ml / year); Lytic mixture (solutions of Aminazine 2,5% - 1
ml, Pipolphen 2 5% - 1 ml, Novocaine 0,25% - 4 ml) intramuscular injection of
0.1 ml / kg per injection. In weaky antipyretic effect of drugs at the presence
of convulsive syndrome it should bt prescribed intravenously 20% solution of Oxibutirate
sodium (100 mg / kg) , 0.5% solution of Diazepame <span style="mso-spacerun: yes;"> </span>(intravenously or intramuscularly 0.5 mg /
kg), 0, 25% solution of Droperidoli (0.5 mg / kg). Do not forget about the
methods of natural decreasing of temperature: ice pack on head, on the area of liver,
large vessels, and intestinal water enema at a temperature of 18-20°C, intravenous
solutions at a temperature of 10-15°C.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>With all the severe illnesses in
young children, especially pneumonia, there is a disturbance of acid-alkaline
balance (<span style="color: red;">acidosis</span>). It is known that the enzyme
activity in the body depends on the pH. The lower is pH, the lower is the activity
of enzymes, the lower are the metabolic processes, the more distorted responses
are from the organism to the introduction of therapeutic concentrations of
drugs. There is no doubt that treatment (though it was directed at other parts
of the pathogenetic changes) increases the pH, but the direct antiacidosis
drugs must also be entered: 4% solution of sodium intravenously droply <span style="mso-spacerun: yes;"> </span>3 ml / kg (moderate), 5 ml / kg (severe form)
in the 2-3 receiving, in order to prevent alkalosis. Hormone therapy is rare
(only in severe pneumonia) in large doses (2-3 mg / kg Prednisolone), but short
course (3-5 days) and the simultaneous removal without complying with the
principle of gradualism.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 152.25pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 152.25pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Antibiotic therapy </span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%; tab-stops: 152.25pt;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Antibiotic therapy is effective
only together with pathogenetic treatment. It is assigned after putting or even
the predisposition of the diagnosis of acute pneumonia, and the duration and
intensity depend on the severity of the process and the presence of complications.
Tentatively it looks like this: mild course - 5-7 days, moderate - 10-14 days,
severe - up to 3 weeks, complication (abscess, pyopneumothorax, empyema) - not
less than 4 weeks.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Due to the fact that in most cases
the cause of pneumonia is cocci (pneumo-, streptococci and staphylococci) the
complex therapy includes Penicillins (Benzylpenicillin, Oxacillin, Methicillin,
Dicloxacillin, Ampicillin, Carbenicillin, Azlocillin, Mezocillin etc.). Their
dose at mild course is 50-80 thousand / kg / day, moderate - 80-100 thousand /
kg / day, severe - 100-150 thousand / kg / day, at complicated pneumonia -
250-500 thousand / kg / day, introduced into 3-4 injections.</span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>If </span><span lang="EN-US" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">at mild</span><span lang="EN-GB" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> acute pneumonia, there is assigned one
antiiotic medication, at the moderate - sometimes two, at a severe - two, and
at the complications of pneumonia – obligatory<span style="mso-spacerun: yes;">
</span>two drugs, sometimes three (one - intravenously, the second -
intramuscular, the third - orally) . </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Effective is a combination
of Penicillins with Aminoglycosides (Gentamicin, Sizomicin, Brulamicin,
Tobramicin - 2-4 mg / kg / day in 2 injections), Cephalosporins (Cefalotin,
Cephalexin, Cefazolin - 50-100 thousand / kg / day intravenously,
intramuscularly) , to a lesser extent - with Macrolides (Erythromycin -
intravenously 20 thousand / kg / day, Oleandomycin - 25-50 thousand / kg / day,
intramuscularly) or similar in mechanism of action of Lincomycin (30-60 </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="color: blue; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">mg / kg / day intramuscularly in 2 injection). Combination may be:
Aminoglycosides and Cephalosporins, Aminoglycosides and Macrolides,
Cephalosporins and Macrolides. Tetracyclines are appointed only after 10 yrs
old, due to their toxic effects on the liver and the development of teeth.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Other antibacterial agents are
used less frequently: when drawing up individual treatment plan (Sulfonamides, Nitrofurans,
Fuzidin, Chloramphenicol, etc.).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Antistaphylococcus drugs are prescribed
at destructive pneumonia when you can most likely think about staphylococcus
etiology or after bacteriological confirmation. They are especially effective
on the first week of the disease. They include: Antistaphylococcus Immunoglobulin
<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>(not less than 35 IU / kg intramuscularly
daily, № 3-4), Antistaphylococcus plasma (5-10 ml / kg daily intravenously, №
3-4). Native Staphylococcal Anatoxine (0,1, 0,5, 1 ml, 1 ml, 1 ml
subcutaneously every other day N10), Staphylococcal Antifagine ( 0,1 ml,
increasing daily by 0.1 to 1 ml, or every other day, subcutaneously prescribe
simultaneously or separately in the period of regression of symptoms, but not
earlier than 10 days after the introduction antistaphylococcus antibodies (Plasma,
Immunoglobulin).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><img height="344" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image046.jpg" width="519" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Apparatus physiotherapy</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Apparatus physiotherapy
during the acute clinical manifestations of acute pneumonia is </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">contrindicated</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">.
With the normalization of temperature, the elimination of respiratory and
cardiovascular failure may be prescribed <span style="mso-spacerun: yes;"> </span>diathermia (UHF, </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">M</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">HF,
LHF), in the period of convalescence - electrophoresis (with dionini, calcium,
vitamin C), UVT. The beneficial effect is from ozokerite applications on the
abdomen (especially the liver) in the period of the regression of disease
subsided (20 min, 40°C).
The positive effect is comforting the child (falling asleep, reduced meteorism
and improves the function of the liver and intestine. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Tendency to abscess
formation, prolonged, severe course, the lack of effect of usual antibiotic
therapy are the indication for the appointment of intraorganic electrophoresis with
antibiotic (Ceporin, Azlocillin injected intravenously in saline solution with
the addition of a single dose of aminophylline and heparin and with a
simultaneous electrophoresis). Electrophoresis in this case is longer (30-40
minutes) from the usual methods (15-20 minutes).</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><img height="256" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image048.jpg" width="289" /><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><img height="249" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image050.gif" width="331" /><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Electrophoresis<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">M</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">HF-therapy</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="mso-ansi-language: RU;"><img height="240" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image052.jpg" width="350" /></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="mso-ansi-language: RU;"><img height="262" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image054.jpg" width="410" /></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Ultraviolet irradiation
therapy</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>LHF-therapy</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="183" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image056.jpg" width="229" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Apparatus</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">for</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">UHF</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">-</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">therapy</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> «</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">UHF</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">
30-2» </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">The apparatus <span style="mso-spacerun: yes;"> </span>is intended for therapeutic effect on the
patient by ultra electromagnetic waves of high frequency.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="313" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image058.jpg" width="253" /><span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Laser therapy apparatus </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;">BTL-5110</span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Single-channel laser therapy
apparatus that generates the red and infrared radiation, with an open modular
system that allows to improve the device.</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="250" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image060.jpg" width="313" /></span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Ultrasound therapy apparatus</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">
BTL-4710 Sono Professional</span></span></div>
<span style="background-color: white;">
<span lang="RU" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="WordSection2">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"><img height="313" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/en/med/ptn/Pediatrics/6/Theme%201%20Differential%20diagnosis%20of%20pneumonia%20in.files/image062.jpg" width="313" /></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">A simple and inexpensive
apparatus for combined physiotherapy BTL-4810S Combi Optimal, which provides
two popular physical factors. </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">BTL-4810S Combi Optimal -
Dual-two channel device (single-channel electrotherapy + ultrasound).<span style="mso-spacerun: yes;"> </span></span></span></div>
</div>
<span style="background-color: white;">
<span lang="EN-GB" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: UK;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Etiologic
antibiotic therapy </span></b></span></div>
<span style="background-color: white;">
</span><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 79.25pt;" valign="top" width="132">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Age</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 119.4pt;" valign="top" width="199">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Etiology</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.7pt;" valign="top" width="263">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Medications
of the first line</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 136.4pt;" valign="top" width="227">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Alternative
vedications</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 79.25pt;" valign="top" width="132">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">1-6 mths</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 119.4pt;" valign="top" width="199">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Escherichia
coli,</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">enterobacteria,</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Staphylococcus
aureus, rarely</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Pneumococcus,
Haemophilus influenzae, viruses</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.7pt;" valign="top" width="263">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">i/v, i/m:</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">ampicillin
+ oxacillin</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">amoxicillin
+ clavulanate, ampicillin + sulbactam</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 136.4pt;" valign="top" width="227">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">i/v, i/m:</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">cefazolin,
ceftriaxone, lincomycin, carbapenem, cefuroxime,</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">cefotaxime.</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">All drugs may
be introduced with aminoglycosides.</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 79.25pt;" valign="top" width="132">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">6 mths-6
yrs</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 119.4pt;" valign="top" width="199">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Pneumococcus,
Haemophilus influenzae, viruses</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.7pt;" valign="top" width="263">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">orally:
amoxicillin, phenoximetylpenicillin, macrolides</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 136.4pt;" valign="top" width="227">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Orally:</span><span lang="EN-US"> </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">amoxicillin + clavulanate, cefuroxime,</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">i/v, i/m:</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">ampicillin</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Cephalosporins
II-III generation</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 79.25pt;" valign="top" width="132">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">6-15 yrs</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 119.4pt;" valign="top" width="199">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Pneumococcus</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.7pt;" valign="top" width="263">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">orally:
amoxicillin, phenoximetylpenicillin, macrolides</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 136.4pt;" valign="top" width="227">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Orally: cefuroxime,
amoxicillin + clavulanate</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">i/v, i/m:</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">penicillins,
lincomycin, cefazolin</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 79.25pt;" valign="top" width="132">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">6 mths-15
yrs</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">(pneumonia</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">complicated
by pleurisy</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">or destruction</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">of pulmonary</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>tissue)</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 119.4pt;" valign="top" width="199">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Pneumococcus,
Haemophilus influenzae, Enterobacter</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.7pt;" valign="top" width="263">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">i/v, i/m:</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">amoxicillin
+ clavumanat,</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">ampicillin
+ sulbactam</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">cefurokam</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 136.4pt;" valign="top" width="227">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">i/v, i/m:</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>cefazolin</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">+ aminoglycosides,
cephalosporins III generation, carbepenems.</span></span></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Main antibacterial
medications and their dosage for children</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Medications</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Oral</span></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Parental</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Ampicillin
+ sulbactam </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">augmentin,
Amoxiclav</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">50mg/kg</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">100-150
mg/kg, i/m</span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Cefazolin
(kefzol)</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">50-100
mg/kg, <span style="mso-spacerun: yes;"> </span>i/m, <span style="mso-spacerun: yes;"> </span>i/v</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Cefalexin </span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">30-40
mg/kg </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Cefuroxime </span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">50-100
mg/kg, <span style="mso-spacerun: yes;"> </span>i/m, <span style="mso-spacerun: yes;"> </span>i/v</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Cefuroxime
aksetil (Zinnat) </span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">30-40 mg/kg, </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">during
feeding</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"> </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Cefotaxime
(claforan) </span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">50-100
mg/kg, <span style="mso-spacerun: yes;"> </span>i/m, <span style="mso-spacerun: yes;"> </span>i/v</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Ceftazidime
(Fortum)</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">30-100
mg/kg, <span style="mso-spacerun: yes;"> </span>i/m, <span style="mso-spacerun: yes;"> </span>i/v</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Ceftriaxone</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">20-80
mg/kg, <span style="mso-spacerun: yes;"> </span>i/m, <span style="mso-spacerun: yes;"> </span>i/v</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><u><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Carbepenems:
</span></u></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Imipenem
(Tienam) Meropenem</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">60 mg/kg,
<span style="mso-spacerun: yes;"> </span>i/v</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 10;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><u><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Monobactams
</span></u></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Aztreonam</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">120-150
mg/kg, <span style="mso-spacerun: yes;"> </span>i/v</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 11;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><u><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">Aminoglycosides
</span></u></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">Gentamicin </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">Amicacin </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">Netromicin </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">Netilmicin</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">5 mg/kg,<span style="mso-spacerun: yes;">
</span>i/m,<span style="mso-spacerun: yes;"> </span>i/v</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>15-20 mg/kg,<span style="mso-spacerun: yes;"> </span>i/v<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>10 mg/kg,<span style="mso-spacerun: yes;"> </span>i/v</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>5 mg/kg,<span style="mso-spacerun: yes;"> </span>i/m,<span style="mso-spacerun: yes;">
</span>i/v</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 12;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><u><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Fluoroquinolones
</span></u></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Ciprofloxacin
(Ciprobay,<u> </u>Ciprinol)<u> </u></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Oflaxacin (Tarivid)</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">15 mg/kg</span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">7,5 mg/kg</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">10 mg/kg,<span style="mso-spacerun: yes;"> </span>i/v </span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>5 mg/kg,<span style="mso-spacerun: yes;"> </span>i/v </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 13;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><u><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Macrolides </span></u></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Erythromycin
Clarithromycin (Clacid) Dzhozamizin </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Spiramycin
(Rovamicyn) Roxitromicin (Rulid)</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">40-50mg/kg</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>15 mg/kg</span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>30-50mg/kg</span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">0,5 </span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">mill.U</span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">/</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">kg</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">0,3</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">g</span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>40-50 mg/kg, <span style="mso-spacerun: yes;"> </span>i/v </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 14; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><u><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Preparations
of other groups </span></u></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Lincomycin </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Clindamycin
</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Rifampicin</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><span style="mso-spacerun: yes;"> </span>Clotrimoxazol </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">Metronidazole</span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">30-60mg/kg</span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">20-40mg/kg</span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">10-20mg/kg</span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">8-10mg/kg</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"></span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">(</span><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">trimetoprili</span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">) </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span>22,5 mg/kg</span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU;"></span></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 164.25pt;" valign="top" width="274">
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">10-20mg/kg,<span style="mso-spacerun: yes;"> </span>i/m,<span style="mso-spacerun: yes;"> </span>i/v </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">10-25mg/kg,<span style="mso-spacerun: yes;"> </span>i/m,<span style="mso-spacerun: yes;"> </span>i/v</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">10-20mg/kg,<span style="mso-spacerun: yes;"> </span>i/m,<span style="mso-spacerun: yes;"> </span>i/v</span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-weight: bold;">8-10mg/kg,<span style="mso-spacerun: yes;"> </span>i/v </span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 35.45pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: RU; mso-bidi-font-weight: bold;">22,5 mg/kg,
<span style="mso-spacerun: yes;"> </span>i/v </span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
</tr>
</tbody></table>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: blue; font-size: 16.0pt; line-height: 150%; mso-ansi-language: EN-US;">Algorithm of medical care for a child with pneumonia.</span></b></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">1.
Health-protective regime. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">2.
Antibiotic therapy. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">3.
Oxygen-therapy. The liquidation of respiratory failure and </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>hypoxemia: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
a) To ensure free airway, optimization of ventilation (throwing head back, the </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>output of the lower jaw forward - to prevent
the retraction of the tongue) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
b) the removal of mucus from the nasopharynx, larynx, large bronchi – the</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>stimulation of cough, aspiration of mucus, the
appointment of stimulants, for</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>thinning the phlegm (Bromhexine,
acetylcysteine, mixtures based on the herbas),</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>vibrating
massage with postural drainage </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">•
a) oxygen - inhalation of moistened 40-60% oxygen through a catheter, a mask, in</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>oxygen tent for 30 minutes 3-4 times a day, at
failure - ventilation. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">4.
Liquidation of cardiac, vascular insufficiency: cardiac glycosides
(strophanthin</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>0.05% - 0,012 mg/kg, ckorglikon 0.06% - 0,012
mg/kg) on 20% glucose solution</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>(5
ml/kg) with Cocarboxilaza (5 mg/kg) and vitamin C (100-200 mg). </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">5.
Liquidation of microcirculatory disorders and blood rheology disturbances: </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>the use of antiplatelet agents (Curantil -
5mg/kg, Haemocorectors </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>(Reopolyglucine 10 ml/kg/day, Heparin) </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">6.
Liquidation of toxicity: albumin, plasma, Haemodesum 5-10 ml/kg/day. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">7.
Decreasing of hyperthermia: antipyretics of central action (analgine 25% - 0,25
</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>ml/year), lytic mixture (chlorpromazine
2,5% - 1 ml, pipolfen 2,5% - 1 ml,</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>procaine 0,25% - 4 ml, i/m<span style="mso-spacerun: yes;"> </span>0.1 ml/kg per injection), physical methods of
cooling. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">8.
Correction of acid-alkaline balance: 4% solution of sodium carbonate (3.5 ml/kg
in </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>2-3 reception. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">9.
With the threat of ICS - syndrome: heparin 200-250 U/kg/day in the stage of</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>hypercoagulation, 50-100 U/kg/day in stage
of hypocoagulation. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">10.
Immunotherapy of <span style="mso-spacerun: yes;"> </span>directed action (at Staphilicoccal,
Proteus, Pseudomonas </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>pneumonia): hyperimmune plasma 5-15 ml/kg,
immunoglobulin 100 IU N 3-5. </span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">11.
Stimulative Therapy: adaptogens of plant origin - Eleutherococcus, Ginseng</span></span></div>
<span style="background-color: white;">
</span><div class="MsoNormal" style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 150%;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>echinacea, medicine – pentoxyl, dibasol, metacil
in combination with vitamins. </span></span></div>
<span style="background-color: white;">
<span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">12.
Physiotherapy: UHF, electrophoresis, UVI, inhalation, microwave therapy. </span></span><br />
<br />
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><b>REFERENCES </b></span></span><br />
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">A - Basic:<br /><br />1. Pediatrics. Textbook. / O. V. Tiazhka, T. V. Pochinok, A. N. Antoshkina et al. / edited by O. Tiazhka – Vinnytsia : Nova Knyha Publishers, 2011 – 584 pp. : il.<br /><br />2. ISBN 978-966-382-355-3Nelson Textbook of Pediatrics, 19th Edition Kliegman, Behrman. Published by Jenson & Stanton, 2011, 2608. ISBN: 978-080-892-420-3.<br /><br />3. Illustrated Textbook of Paediatrics, 4th Edition. Published by Lissauer & Clayden, 2012, 552 p. ISBN: 978-072-343-566-2.<br /><br />4. Denial Bernstein. Pediatrics for medical Students. – Second edition, 2012. – 650 p.<br /><br />B - Additional: 1.http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/шпитальна%20педіатрія/6%20курс/English/Theme%2001%20Differential%20diagnosis%20of%20pneumonia%20in%20children.htm<br /><br />2. http://www.merckmanuals.com/professional/index.html<br /><br />3. Lichtenstein, et al. Pediatric Pneumonia. Emergency medicine clinics of north America. 2010.<br /><br />4. Barson. Clinical manifestations and diagnosis of community-aquired pneumonia in children. UpToDate.com., 2009.<b> </b></span></span>Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-46377311240392434172013-02-28T23:58:00.004-08:002013-02-28T23:58:40.815-08:00Diagnosis And Treatment Of Ischemic Heart Disease (IHD) In Ambulatory Conditions; Prophylaxis And Medical Examinations Of These Patients<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwpenXY9gc6DNLdjYfg3mJDYCSYXHyZUYPrHd_5Gm55sjQyxcS5b0b1Jz8MOm2xJGtoKsj1YZrF7aA5na3AenXOIwAyLjWfL_0RDvL00uVVFJrk7YdczxoIpFCNkjCN8RS73atlyUl8Q9P/s1600/arteries-clear-and-clogged.jpg" imageanchor="1" style="background-color: white; margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwpenXY9gc6DNLdjYfg3mJDYCSYXHyZUYPrHd_5Gm55sjQyxcS5b0b1Jz8MOm2xJGtoKsj1YZrF7aA5na3AenXOIwAyLjWfL_0RDvL00uVVFJrk7YdczxoIpFCNkjCN8RS73atlyUl8Q9P/s1600/arteries-clear-and-clogged.jpg" /></a></div>
<span style="background-color: white;"><br /></span>
<span style="background-color: white;"><br /></span>
<br />
<div class="MsoNormal">
<span style="background-color: white;"><span lang="EN-US" style="background-position: initial initial; background-repeat: initial initial; font-size: 14pt;">Myocardial
infarction is ischemic necrosis due to occlusion of coronary artery by thrombus
or <span class="SpellE">subintimal</span> hemorrhage at the site of <span class="SpellE">atheromatous</span> narrowing</span><span lang="EN-GB" style="background-position: initial initial; background-repeat: initial initial; font-size: 14pt;">.
Less often, complete occlusion by intimal plagues or by </span><span lang="EN-US" style="background-position: initial initial; background-repeat: initial initial; font-size: 14pt;">hemorrhage
into a plague is responsible/ <span class="GramE">Coronary</span> vasoconstriction
or spasm may be intense and prolonged and has been proved to result in
myocardial infarction in a small number of cases</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">.<o:p></o:p></span></span></div>
<div align="center" class="MsoBodyTextIndent2" style="text-align: center;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; letter-spacing: -0.05pt;"><v:group coordorigin="-2,-2" coordsize="9902,7742" editas="canvas" id="_x0000_s1032" style="height: 387.1pt; mso-position-horizontal-relative: char; mso-position-vertical-relative: line; width: 495.1pt;"><br /><v:group coordorigin="2678,6051" coordsize="1303,698" id="_x0000_s1049" style="height: 698px; left: 2678px; position: absolute; top: 6051px; width: 1303px;"><v:rect coordsize="21600,21600" fillcolor="#bbe0e3" id="_x0000_s1047" stroked="f" style="height: 698px; left: 2678px; position: absolute; top: 6051px; width: 1303px;"></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1048" strokecolor="#339" strokeweight=".5pt" style="height: 698px; left: 2678px; position: absolute; top: 6051px; width: 1303px;"><v:stroke endcap="round"></v:stroke></v:rect></v:group><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1050" stroked="f" style="height: 285px; left: 2785px; mso-wrap-style: none; position: absolute; top: 6120px; width: 645px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.593pt; margin-top: 0.093pt; mso-fit-shape-to-text: t; top: auto; width: 32.25pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<b><span lang="EN-US" style="font-family: Arial;">Foam</span></b></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1051" stroked="f" style="height: 285px; left: 3406px; mso-wrap-style: none; position: absolute; top: 6120px; width: 75px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.125pt; margin-top: 0.093pt; mso-fit-shape-to-text: t; top: auto; width: 3.75pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<b><span lang="EN-US" style="font-family: Arial;">-</span></b></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1052" stroked="f" style="height: 285px; left: 3485px; mso-wrap-style: none; position: absolute; top: 6120px; width: 390px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.343pt; margin-top: 0.093pt; mso-fit-shape-to-text: t; top: auto; width: 19.5pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<span class="GramE"><b><span lang="EN-US" style="font-family: Arial;">cell</span></b></span></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1053" stroked="f" style="height: 285px; left: 2792px; mso-wrap-style: none; position: absolute; top: 6412px; width: 1095px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.187pt; margin-top: 0.437pt; mso-fit-shape-to-text: t; top: auto; width: 54.75pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<span class="GramE"><b><span lang="EN-US" style="font-family: Arial;">formation</span></b></span></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:group coordorigin="6083,5771" coordsize="1901,991" id="_x0000_s1056" style="height: 991px; left: 6083px; position: absolute; top: 5771px; width: 1901px;"><v:rect coordsize="21600,21600" fillcolor="#bbe0e3" id="_x0000_s1054" stroked="f" style="height: 991px; left: 6083px; position: absolute; top: 5771px; width: 1901px;"></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1055" strokecolor="#339" strokeweight=".5pt" style="height: 991px; left: 6083px; position: absolute; top: 5771px; width: 1901px;"><v:stroke endcap="round"></v:stroke></v:rect></v:group><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1057" stroked="f" style="height: 285px; left: 6191px; mso-wrap-style: none; position: absolute; top: 5841px; width: 1740px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.625pt; margin-top: 0.375pt; mso-fit-shape-to-text: t; top: auto; width: 87pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<b><span lang="EN-US" style="font-family: Arial;">Adherence
and</span></b></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1058" stroked="f" style="height: 285px; left: 6191px; mso-wrap-style: none; position: absolute; top: 6134px; width: 1665px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.625pt; margin-top: 0.031pt; mso-fit-shape-to-text: t; top: auto; width: 83.25pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<span class="GramE"><b><span lang="EN-US" style="font-family: Arial;">aggregation</span></b></span><b><span lang="EN-US" style="font-family: Arial;">
of </span></b></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1059" stroked="f" style="height: 285px; left: 6560px; mso-wrap-style: none; position: absolute; top: 6422px; width: 960px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.343pt; margin-top: 0.187pt; mso-fit-shape-to-text: t; top: auto; width: 48pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<span class="GramE"><b><span lang="EN-US" style="font-family: Arial;">platelets</span></b></span></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:group coordorigin="6470,4893" coordsize="2344,699" id="_x0000_s1062" style="height: 699px; left: 6470px; position: absolute; top: 4893px; width: 2344px;"><v:rect coordsize="21600,21600" fillcolor="#bbe0e3" id="_x0000_s1060" stroked="f" style="height: 699px; left: 6470px; position: absolute; top: 4893px; width: 2344px;"></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1061" strokecolor="#339" strokeweight=".5pt" style="height: 699px; left: 6470px; position: absolute; top: 4893px; width: 2344px;"><v:stroke endcap="round"></v:stroke></v:rect></v:group><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1063" stroked="f" style="height: 285px; left: 6798px; mso-wrap-style: none; position: absolute; top: 4960px; width: 1740px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.218pt; margin-top: 0.593pt; mso-fit-shape-to-text: t; top: auto; width: 87pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<b><span lang="EN-US" style="font-family: Arial;">Adherence
and</span></b></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1064" stroked="f" style="height: 285px; left: 6577px; mso-wrap-style: none; position: absolute; top: 5253px; width: 2175px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.437pt; margin-top: 0.218pt; mso-fit-shape-to-text: t; top: auto; width: 108.75pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<span class="GramE"><b><span lang="EN-US" style="font-family: Arial;">entry</span></b></span><b><span lang="EN-US" style="font-family: Arial;">
of
leukocytes</span></b></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:group coordorigin="4271,5934" coordsize="1303,699" id="_x0000_s1067" style="height: 699px; left: 4271px; position: absolute; top: 5934px; width: 1303px;"><v:rect coordsize="21600,21600" fillcolor="#bbe0e3" id="_x0000_s1065" stroked="f" style="height: 699px; left: 4271px; position: absolute; top: 5934px; width: 1303px;"></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1066" strokecolor="#339" strokeweight=".5pt" style="height: 699px; left: 4271px; position: absolute; top: 5934px; width: 1303px;"><v:stroke endcap="round"></v:stroke></v:rect></v:group><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1068" stroked="f" style="height: 285px; left: 4617px; mso-wrap-style: none; position: absolute; top: 6003px; width: 150px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.687pt; margin-top: 0.218pt; mso-fit-shape-to-text: t; top: auto; width: 7.5pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<b><span lang="EN-US" style="font-family: Arial;">T</span></b></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1069" stroked="f" style="height: 285px; left: 4762px; mso-wrap-style: none; position: absolute; top: 6003px; width: 75px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.437pt; margin-top: 0.218pt; mso-fit-shape-to-text: t; top: auto; width: 3.75pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<b><span lang="EN-US" style="font-family: Arial;">-</span></b></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1070" stroked="f" style="height: 285px; left: 4841px; mso-wrap-style: none; position: absolute; top: 6003px; width: 390px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.625pt; margin-top: 0.218pt; mso-fit-shape-to-text: t; top: auto; width: 19.5pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<span class="GramE"><b><span lang="EN-US" style="font-family: Arial;">cell</span></b></span></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1071" stroked="f" style="height: 285px; left: 4379px; mso-wrap-style: none; position: absolute; top: 6295px; width: 1110px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.031pt; margin-top: 0.593pt; mso-fit-shape-to-text: t; top: auto; width: 55.5pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<span class="GramE"><b><span lang="EN-US" style="font-family: Arial;">activation</span></b></span></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1072" stroked="f" style="height: 225px; left: 416px; mso-wrap-style: none; position: absolute; top: 6897px; width: 3810px;"><v:textbox inset="0,0,0,0" style="height: 11.25pt; left: auto; margin-left: 0.625pt; margin-top: 0.687pt; mso-fit-shape-to-text: t; top: auto; width: 190.5pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<span class="SpellE"><span class="GramE"><span lang="EN-US" style="font-family: Arial; font-size: 9pt;">VSMC</span></span></span><span class="GramE"><span lang="EN-US" style="font-family: Arial; font-size: 9pt;">,
vascular smooth muscle cell migration.</span></span><span lang="EN-GB"><o:p></o:p></span></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1074" stroked="f" style="height: 285px; left: 841px; mso-wrap-style: none; position: absolute; top: 75px; width: 105px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.125pt; margin-top: 0.093pt; mso-fit-shape-to-text: t; top: auto; width: 5.25pt;"><table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<br /></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1075" stroked="f" style="height: 285px; left: 1921px; mso-wrap-style: none; position: absolute; top: 75px; width: 105px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.125pt; margin-top: 0.093pt; mso-fit-shape-to-text: t; top: auto; width: 5.25pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<br /></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1076" stroked="f" style="height: 285px; left: 3326px; mso-wrap-style: none; position: absolute; top: 75px; width: 105px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.625pt; margin-top: 0.093pt; mso-fit-shape-to-text: t; top: auto; width: 5.25pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<br /></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:rect coordsize="21600,21600" filled="f" id="_x0000_s1077" stroked="f" style="height: 285px; left: 3544px; mso-wrap-style: none; position: absolute; top: 75px; width: 105px;"><v:textbox inset="0,0,0,0" style="height: 14.25pt; left: auto; margin-left: 0.281pt; margin-top: 0.093pt; mso-fit-shape-to-text: t; top: auto; width: 5.25pt;">
<table cellpadding="0" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td>
<div>
<div class="MsoNormal">
<br /></div>
</div>
</td></tr>
</tbody></table>
</v:textbox></v:rect><v:group coordorigin="9157,7190" coordsize="743,550" id="_x0000_s1080" style="height: 550px; left: 9157px; position: absolute; top: 7190px; width: 743px;"><v:shape coordsize="21600,21600" id="_x0000_s1078" style="height: 550px; left: 9157px; position: absolute; top: 7190px; width: 743px;" type="#_x0000_t75"><v:imagedata o:title="" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image003.emz"></v:imagedata></v:shape><v:shape coordsize="21600,21600" id="_x0000_s1079" style="height: 550px; left: 9157px; position: absolute; top: 7190px; width: 743px;" type="#_x0000_t75"><v:imagedata o:title="" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image004.emz"></v:imagedata></v:shape></v:group><w:wrap type="none"></w:wrap><w:anchorlock></w:anchorlock></v:group></span><span lang="EN-US" style="font-size: 14pt; letter-spacing: -0.05pt;"><o:p></o:p></span></span></div>
<div class="MsoBodyTextIndent2">
<br /></div>
<div class="MsoBodyTextIndent2">
<br /></div>
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; letter-spacing: -0.05pt;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" /></span>
</span><div class="MsoBodyTextIndent2">
<br /></div>
<div class="MsoBodyTextIndent2">
<span style="background-color: white;"><o:wrapblock><v:shape coordsize="21600,21600" id="_x0000_s1026" style="height: 442.9pt; left: 0px; margin-left: 0px; margin-top: 0px; position: absolute; width: 470.25pt; z-index: 2;" type="#_x0000_t75"><v:imagedata o:title="Рисунок2" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image006.jpg"></v:imagedata><w:wrap type="topandbottom"></w:wrap></v:shape><v:shape coordsize="21600,21600" id="_x0000_s1026" style="height: 442.9pt; left: 0px; margin-left: 0px; margin-top: 0px; position: absolute; width: 470.25pt; z-index: 2;" type="#_x0000_t75"><br /></v:shape></o:wrapblock><br clear="all" /><span lang="EN-US" style="color: windowtext; font-size: 14pt;"><o:p></o:p></span></span></div>
<div class="MsoBodyTextIndent2">
<br /></div>
<div class="MsoBodyTextIndent2">
<br /></div>
<div class="MsoBodyTextIndent2">
<br /></div>
<div class="MsoBodyTextIndent2">
<span style="background-color: white;"><span lang="EN-US" style="background-position: initial initial; background-repeat: initial initial; color: windowtext; font-size: 14pt;">The location and
extent of infarction depend upon the anatomic distribution of the vessel, the
site of current and previous occlusions, and the adequacy of collateral
circulation. Thrombosis occurs most commonly in the anterior descending branch
of the left coronary artery, resulting in infarction of the anterior left
ventricle. Occlusion of the left circumflex artery produces <span class="SpellE">anterolateral</span> infarction. Right coronary thrombosis leads to
infarction of the <span class="SpellE">posteroinferior</span> portion of the left
ventricle and might involve the right ventricular myocardium</span><span lang="EN-US" style="color: windowtext; font-size: 14pt;">.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><o:wrapblock><v:shape coordsize="21600,21600" id="_x0000_s1027" style="height: 451.6pt; margin-left: 0px; margin-top: 0px; mso-position-horizontal: center; mso-position-vertical: top; position: absolute; width: 517.15pt; z-index: 3;" type="#_x0000_t75"><v:imagedata o:title="fg025_1" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image008.png"></v:imagedata><w:wrap type="topandbottom"></w:wrap></v:shape></o:wrapblock><br clear="all" /><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">The hemodynamic findings are
related directly to the extent of necrosis or scarring of the myocardium. In
mild infarction</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">,</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> toe <span class="SpellE">hemodynamics</span> may be normal</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">.</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> With more severe
disease, there may be a raised left ventricular end-diastolic pressure with
associated increase in the pulmonary artery diastolic pressure, decreased
cardiac output, and decreased ejection fraction. When the patient is <span class="SpellE">hypotensive</span> or in shock, the cardiac output is considerably
reduced in conjunction with evidences of left ventricular failure and a high
left ventricular filling pressure. The “wedge” and left ventricular diastolic
pressure may be raised, with no abnormality in the right ventricular diastolic
pressure or the right <span class="SpellE">atrial</span> pressure; thus, the
superior Vena cava or right <span class="SpellE">atrial</span> pressures are often
misleading because they do not reflect left ventricular events. They are,
however, valuable if the pressures are very low, indicating the possibility of
<span class="SpellE">hypovolemia</span>; the response to volume loads may be
helpful in producing an increased cardiac output. The presence of a large V wave
in the pulmonary wedge pressure pulse is helpful in diagnosing acute mitral
insufficiency due to papillary muscle dysfunction in patients who abruptly
worsen, with development of cardiac failure. Similarly, raised oxygen content in
the right ventricle under similar circumstances helps in diagnosis of perforated
ventricular septum.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-top: 8pt;">
<b><span lang="EN-US" style="background-color: white; font-size: 14pt;">Clinical
Findings<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%; text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-US;">A.
Symptoms:</span></b><b><span lang="EN-GB" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-GB;">
CLINICAL<o:p></o:p></span></b></span></div>
<div class="MsoNormal" style="margin-top: 8pt;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">History:</span></b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;"> Most patients with
angina pectoris report of <span class="SpellE">retrosternal</span> chest
discomfort rather than frank pain. The former is usually described as a
pressure, heaviness, <span class="GramE">squeezing</span>, burning, or choking
sensation. <span class="SpellE">Anginal</span> pain may be localized primarily in
the <span class="SpellE">epigastrium</span>, back, neck, jaw, or shoulders.
Typical locations for radiation of pain are arms, shoulders, and neck.
Typically, angina is precipitated by exertion, eating, exposure to <span class="GramE">cold,</span> or emotional stress. It lasts for approximately 1-5
minutes and is relieved by rest or <span class="SpellE">nitroglycerin</span>.
Chest pain lasting only a few seconds is not usually angina pectoris. The
intensity of angina does not change with respiration, cough, or change in
position. Pain above the mandible and below the <span class="SpellE">epigastrium</span> is rarely <span class="SpellE">anginal</span> in
nature.<b><o:p></o:p></b></span></span></div>
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%; margin: 0cm 2.75pt 0pt 0.7pt; text-align: center; text-indent: 16.9pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; letter-spacing: 0.05pt; line-height: 150%;"><v:shape coordsize="21600,21600" id="_x0000_i1026" style="height: 528pt; width: 6in;" type="#_x0000_t75"><v:imagedata o:title="heart attack" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image010.png"></v:imagedata></v:shape></span><span lang="EN-US" style="font-size: 14pt; letter-spacing: -0.1pt; line-height: 150%;"><o:p></o:p></span></span></div>
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Ask
patients about the frequency of angina, severity of pain, and number of <span class="SpellE">nitroglycerin</span> pills used during angina
episodes.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Angina
<span class="SpellE">decubitus</span> is a variant of angina pectoris that occurs
at night while the patient is recumbent. Some have suggested that it is induced
by an increase in myocardial oxygen demand caused by expansion of the blood
volume with increased venous return during <span class="SpellE">recumbency</span>.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">The
Canadian Cardiovascular Society grading scale is used for classification of
angina severity, as follows:<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Class I -
Angina only during strenuous or prolonged physical
activity<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Class II -
Slight limitation, with angina only during vigorous physical
activity<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Class III -
Symptoms with everyday living activities, <span class="SpellE">ie</span>, moderate
limitation<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Class IV -
Inability to perform any activity without angina or angina at rest, <span class="SpellE">ie</span>, severe limitation<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">The New
York Heart Association classification is also used to quantify the functional
limitation imposed by patients' symptoms, as follows:<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Class I -
No limitation of physical activity (Ordinary physical activity does not cause
symptoms.)<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span style="background-color: white;"><span class="GramE"><span lang="EN-GB" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-GB;">Class II -
Slight limitation of physical activity (Ordinary physical activity does cause
symptoms.)</span></span><span lang="EN-GB" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Class III -
Moderate limitation of activity (Patient is comfortable at rest, but less than
ordinary activities cause symptoms.)<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Class IV -
Unable to perform any physical activity without discomfort, therefore severe
limitation (Patient may be symptomatic even at rest.)<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Unstable
angina is defined as new-onset angina (<span class="SpellE">ie</span>, within 2 mo
of initial presentation) of at least class III severity, significant recent
increase in frequency and severity of angina, or angina at
rest.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Physical:
<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">For most
patients with stable angina, physical examination findings are normal.
Diagnosing secondary causes of angina, such as aortic <span class="SpellE">stenosis</span>, is important.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">A positive
Levine sign (characterized by the patient's fist clenched over the sternum when
describing the discomfort) is suggestive of angina
pectoris.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Look for
physical signs of abnormal lipid metabolism (<span class="SpellE">eg</span>, <span class="SpellE">xanthelasma</span>, <span class="SpellE">xanthoma</span>) or of
diffuse atherosclerosis (<span class="SpellE">eg</span>, absence or diminished
peripheral pulses, increased light reflexes or <span class="SpellE">arteriovenous</span> nicking upon ophthalmic examination, carotid
bruit).<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Examination
of patients during the angina attack may be more helpful. Useful physical
findings include third and/or fourth heart sounds due to <st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> systolic and/or
diastolic dysfunction and mitral regurgitation secondary to papillary muscle
dysfunction.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-top: 8pt;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Pain produced by chest wall
pressure is usually of chest wall origin.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">1.</span></b><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Premonitory
pain-</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">Over one-third of patients
give a history of alteration the pattern of angina, sudden onset of typical or
atypical angina, or unusual "indigestion" felt in the
chest.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 19pt;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">2.</span></b><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Pain of
infarction-</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">This may begin during rest
(even in sleep) or activity. It is similar to angina in location and radiation
but is more severe, does not subside with rest, and builds up rapidly or in
waves to maximum intensity in the space of a few minutes or longer.
Nitroglycerin has little effect. The pain may last for hours if unrelieved by
narcotics and is often unbearable. Patients break out in a cold sweat, feel weak
and apprehensive; and move about, seeking a position of comfort. They prefer not
to lie quietly. Lightheadedness, syncope, <span class="SpellE">dyspnea</span>,
<span class="SpellE">orthopnea</span>, cough, wheezing, nausea and vomiting, or
abdominal bloating may be present singly or in any
combination.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">3.</span></b><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Painless
infarction-</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">In</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
5-15%</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
of cases, pain is absent or minor and is overshadowed by the immediate
complications, notably acute pulmonary edema or rapidly developing heart
failure, profound weakness, shock, syncope, or cerebral
thrombosis.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; margin-left: 10pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">B. Signs:</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Physical findings
are highly variable; the presence of <span class="SpellE">rales</span>, gallop
rhythm, tachycardia, arrhythmia or <span class="SpellE">bradycardia</span>, and
hypotension correlate well with hemodynamic and clinical evidences of the
severity of the attack and the extent of the <span class="SpellE">necrosed</span>
myocardium.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 19pt;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">1.</span></b><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Shock</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">. Shock may be
described as a systolic blood pressure below</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
<st1:metricconverter productid="80 mm" style="background-image: url(res://ietag.dll/#34/#1001); background-position: left bottom; background-repeat: repeat-x;" tabindex="0" w:st="on">80<span lang="EN-US">
mm</span></st1:metricconverter><span lang="EN-US"> Hg; (or slightly higher with
prior hypertension) along with gray facial color, mental dullness, cold clammy
skin, peripheral cyanosis, decreased urine output, tachycardia or <span class="SpellE">bradycardia</span>, and weak pulse. Shock is present only in severe
attacks (incidence about</span> 8-14%).</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Shock may be caused primarily
by the pain rather than the hemodynamic effects of the infarction; if so,
distinct improvement occurs within</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
30-60</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
minutes after relief of pain and administration of oxygen.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">2.</span></b><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Cardiac
effects-</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">In the severe attack, the
first and second heart sounds are faint, are often indistinguishable on
auscultation, and assume the so-called "tic-tac" quality. Gallop rhythm,
distended neck veins, and basal <span class="SpellE">rales</span> are often
present. Acute pulmonary edema or progressive congestive failure may dominate
the picture. In less severe attacks, examination is normal or there may be
diminished intensity of the first sound or low systolic blood pressure;
arrhythmia, hypoxemia, radiologic evidence of pulmonary venous congestion, and
<span class="SpellE">echocardiographic</span> evidence of left ventricular
distention may be present. Pericardial friction rub appears in</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
20%</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> of
cases between the second and fifth days; it is often transient or intermittent
and is rarely of clinical significance unless the patient is taking
anticoagulants, in which case a large hemorrhagic effusion may
develop.<o:p></o:p></span></span></div>
<div align="center">
<table border="0" cellpadding="0" cellspacing="10" class="MsoNormalTable">
<tbody>
<tr>
<td style="padding-bottom: 7.5pt; padding-left: 7.5pt; padding-right: 7.5pt; padding-top: 7.5pt;" valign="top">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="background-color: white;"><span lang="RU" style="font-family: Tahoma; font-size: 7pt;"><v:shape alt="" coordsize="21600,21600" id="_x0000_i1027" style="height: 405pt; width: 334.5pt;" type="#_x0000_t75"><v:imagedata o:href="http://medbook.medicina.ru/images/165/2055/6_34.gif" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image012.png"></v:imagedata></v:shape></span><span style="font-family: Tahoma; font-size: 7pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="text-indent: 18pt;">
<br /></div>
<div align="center">
<table border="0" cellpadding="0" cellspacing="10" class="MsoNormalTable">
<tbody>
<tr>
<td style="padding-bottom: 7.5pt; padding-left: 7.5pt; padding-right: 7.5pt; padding-top: 7.5pt;" valign="top">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="background-color: white;"><span lang="RU" style="font-family: Tahoma; font-size: 7pt;"><v:shape alt="" coordsize="21600,21600" id="_x0000_i1028" style="height: 327pt; width: 324.75pt;" type="#_x0000_t75"><v:imagedata o:href="http://medbook.medicina.ru/images/165/2056/6_35.gif" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image014.png"></v:imagedata></v:shape></span><span style="font-family: Tahoma; font-size: 7pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="text-indent: 18pt;">
<br /></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">The presence of
right ventricular failure with raised venous pressure disproportionate to left,
ventricular failure in the presence of an inferior myocardial infarction should
make one consider right ventricular infarction. In the usual case of severe left
ventricular failure followed by right ventricular failure, the former dominates.
When the reverse is true, right ventricular infarction associated with
enlargement and <span class="SpellE">hypokinesis</span> of the right ventricle may
be present. The ventricular septum and the posterior left and right ventricles
are usually <span class="SpellE">infarcted</span>.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">3.</span></b><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Fever-Fever-</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">is absent at the
onset (in contrast to acute <span class="SpellE">pericarditis</span>) and during
prolonged shock. It usually rises to</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
37.8-<st1:metricconverter productid="39.4 ᄚC" style="background-image: url(res://ietag.dll/#34/#1001); background-position: left bottom; background-repeat: repeat-x;" tabindex="0" w:st="on">39.4 °C</st1:metricconverter> – </span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">rarely to
</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">40.6</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> °C</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">—</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">within</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
24</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
hours and persists for</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;"> 3-7
</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">days
(rarely longer).<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">C. Laboratory
Findings:</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> <span class="SpellE">Leukocytosis</span> of </span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">10-20</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> thousand <span class="GramE">cells/<span lang="RU" style="font-family: Symbol; mso-ansi-language: RU; mso-ascii-font-family: 'Times New Roman'; mso-char-type: symbol; mso-hansi-font-family: 'Times New Roman'; mso-symbol-font-family: Symbol;">m</span>L</span>
usually develops on the second day and disappears in</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
1</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
week. The sedimentation rate is normal at onset, rises on the second or third
day, and remains elevated for</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
1-3</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
weeks. <span class="SpellE">SGOT</span> activity increases in</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
6-12</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
hours, reaches a peak in</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;"> 24—48
</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">hours,
and returns to normal in</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
3—5</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
days. Serum lactic acid <span class="SpellE">dehydrogenase</span> may remain
elevated for</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;"> 5-7
</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">days.
Serial determinations are helpful in equivocal instances. <span class="SpellE">Creatine</span> <span class="SpellE">phosphokinase</span> (<span class="SpellE">CPK</span>) <span class="SpellE">isoenzyme</span> activity may
increase earliest (especially -the MB <span class="SpellE">isoenzyme</span>,
derived almost exclusively from the myocardium), and, when determined
every</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
2</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
hours, gives an estimate of the magnitude of the infarction, although for
diagnosis, <span class="SpellE">CPK</span> determination every</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
6—12 </span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">hours is
adequate.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">D.
Electrocardiography:</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Electrocardiographic changes
do not correlate well with the clinical severity of the infarction. The
characteristic pattern consists of specific changes that undergo a stereotyped
"evolution</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
''</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
over a matter of weeks in the average case</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">.</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> At the onset there
are elevation of ST segment and T wave and abnormal Q waves; fee ST segment
progressively returns to the baselines as T waves become symmetrically inverted.
An unequivocal electrocardiographic diagnosis of infarction can only be made in
the presence of all</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
3</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">
abnormalities. Serial ST-T changes alone are compatible with but not diagnostic
of infarction. The characteristic changes are not seen in the presence of left
bundle branch block or when a previous infarct has permanently altered fee <span class="SpellE">ECG</span>. Even in these instances an <span class="SpellE">ECG</span> taken early in an attack often shows ST segment
displacement.</span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><br /></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Chest radiograph findings are
usually normal in patients with angina pectoris. However, they may show <span class="SpellE">cardiomegaly</span> in patients with previous MI, ischemic <span class="SpellE">cardiomyopathy</span>, pericardial effusion, or acute pulmonary
<span class="SpellE">edema</span>. Calcification of coronary arteries frequently
correlates with major coronary artery disease.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="background-color: white; font-size: 14pt; line-height: 150%;"><br /></span></div>
<div class="MsoNormal">
<span style="background-color: white; font-size: 14pt; line-height: 150%;">These test
results must be interpreted in the context of the likelihood of the presence of
coronary artery disease determined from the patient's history and physical
examination findings. In a population with low prevalence, the predictive
abilities of these tests are low; however, in patients with a high likelihood of
coronary artery disease, the predictive value is much
higher.</span></div>
<div class="MsoNormal">
<span style="background-color: white; font-size: 14pt; line-height: 150%;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Stress
echocardiography can be used to evaluate segmental wall motion during exercise.
It detects changes in regional wall motion that occur during myocardial
ischemia. Normal myocardium becomes <span class="SpellE">hyperdynamic</span>
during exercise; ischemic segments become <span class="SpellE">hypokinetic</span>
or <span class="SpellE">akinetic</span>.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Stress
echocardiography has the advantage of simultaneous evaluation of <st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> function, cardiac
dimensions, and <span class="SpellE">valvular</span> disease. It is especially
useful in patients with baseline <span class="SpellE">ECG</span> abnormalities and
those with systolic murmurs suggestive of aortic <span class="SpellE">stenosis</span> or hypertrophic <span class="SpellE">cardiomyopathy</span>.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">It is also
helpful for localizing ischemia and evaluating its
severity.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Signs of
severe coronary artery disease during exercise stress echocardiography include
<st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> dilation, a
decrease in global systolic function, and new or worsening mitral regurgitation.
However, with <span class="SpellE">dobutamine</span> stress echocardiography, even
in patients with severe coronary artery disease, the <st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> cavity may not dilate
and global systolic function may improve.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">A major
problem with stress echocardiography is the technical difficulty with obtaining
adequate images in some patients.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt; line-height: 150%;">Thallium
<span class="SpellE">Tl</span> 201 and technetium <span class="SpellE">Tc</span> 99m
<span class="SpellE">sestamibi</span> are the most frequently used myocardial
perfusion <span class="SpellE">scintigraphy</span> tests. These tests are
especially useful in patients with baseline <span class="SpellE">ECG</span>
abnormalities, to localize the region of ischemia, and as prognostic indicators.
The presence of increased lung uptake upon thallium imaging is associated with a
poor prognosis. Increased lung uptake, together with <span class="SpellE">poststress</span> dilation of the <st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> and multiple perfusion defects, is
suggestive of either left main coronary artery disease or severe 3-vessel
disease. The number of affected myocardial segments is predictive of long-term
survival. Smaller perfusion defects are usually associated with peripheral
coronary artery lesions, which are associated with a better prognosis. The
absence of perfusion defects even in the presence of symptoms indicates an
excellent prognosis.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 16pt;"><v:shape coordsize="21600,21600" id="_x0000_i1029" style="height: 342pt; mso-position-horizontal: absolute; mso-position-vertical: absolute; width: 390.75pt;" type="#_x0000_t75"><v:imagedata o:title="06f1" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image016.jpg"></v:imagedata></v:shape></span></b><span lang="RU" style="font-size: 14pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; margin-top: 9pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">Differential
Diagnosis</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">In acute <span class="SpellE">pericarditis</span>, fever often precedes fee onset of pain, which
may be predominantly <span class="SpellE">pleuritic</span> and is significantly
relieved by breath-holding and leaning forward and made worse by swallowing. The
friction rub appears earlier, is louder, is heard over a greater area, and is
more persistent than in infarction, and a <span class="SpellE">pleuropericardial</span> rub is often present. There are no <span class="SpellE">QRS</span> changes, and ST elevation and T wave inversion are more
widespread, without reciprocal changes (except in <span class="SpellE">aVR</span>). <span class="SpellE">SGOT</span> and <span class="SpellE">LDH</span> are rarely elevated.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Dissection of fee
aorta causes violent chest pain feat is often of maximum severity at onset. It
typically spreads up or down fee chest and back over a period of hours. Changes
in pulses, changing aortic murmurs, and left pleural effusion or cardiac <span class="SpellE">tamponade</span> are distinctive features. Blood pressure does not
fall early. Syncope or neurologic abnormalities are common. Electrocardiographic
changes are not diagnostic of infarction unless fee coronary <span class="SpellE">ostia</span> arc involved in fee proximal
dissection.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Acute pulmonary
embolism may cause chest pain indistinguishable from myocardial infarction as
well as hypotension, <span class="SpellE">dyspnea</span>, and distended neck
veins, but fee <span class="SpellE">ECG</span>, regardless of <span class="SpellE">coronarylike</span> changes, will often show right axis deviation
or right ventricular conduction defect early in fee course of fee acute process.
<span class="SpellE">SGOT</span> and <span class="SpellE">LDH</span> are often
elevated, as in myocardial infarction. The myocardial band <span class="SpellE">isoenzyme</span> of <span class="SpellE">CPK</span> is not elevated
in acute pulmonary embolism. If the attack is not fatal, pulmonary infarction
may follow, frequently causing <span class="SpellE">pleuritic</span> pain, <span class="SpellE">hemoptysis</span>, and localized lung findings. <span class="SpellE">Thrombophlebitis</span> is often found when careful examination is
made of the legs, the groins, and the lower abdomen.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Cervical or thoracic spine
disease produces sudden, severe chest pain similar to myocardial infarction; but
orthopedic measures give relief and the <span class="SpellE">ECG</span> is
normal.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Reflux <span class="SpellE">esophagitis</span> may simulate the pain of infarction, and the T
waves may be flat or even inverted during the attack, but there is no
hypotension or subsequent fever, <span class="SpellE">leukocytosis</span>, or
increase in sedimentation rate, <span class="SpellE">SGOT</span>, <span class="SpellE">LDH</span>, or <span class="SpellE">CPK</span>.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Acute pancreatitis and acute
<span class="SpellE">cholecystitis</span> may superficially mimic infarction by
causing ST-T changes; Q wave abnormalities are rare. A past history of
gastrointestinal symptoms, present findings in the abdomen, jaundice, elevated
serum amylase, and x-ray findings differentiate these. Most helpful is the
absence of diagnostic serial electrocardiographic changes and absence of
elevated <span class="SpellE">CPK</span>-MB;<o:p></o:p></span></div>
<div class="MsoBodyTextIndent2">
<span lang="EN-US" style="background-color: white; color: windowtext; font-size: 14pt;">Spontaneous <span class="SpellE">pneumothorax</span>, <span class="SpellE">mediastinal</span>
emphysema, preemptive herpes zoster, and severe <span class="SpellE">psychophysiologic</span> cardiovascular reactions may have to be
differentiated from myocardial infarction.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; margin-top: 9pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">Complications</span></b><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">Congestive heart failure and
shock may be present at onset of infarction or may develop insidiously or
abruptly following an arrhythmia or pulmonary <span class="SpellE">embolization</span>. Sedation and weakness may mask the presence of
<span class="SpellE">dyspnea</span> and <span class="SpellE">orthopnea</span>.
Distension of neck veins, persistent basal <span class="SpellE">rales</span>,
gallop rhythm</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">,
</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">the
appearance of the murmur of mitral insufficiency, abnormal cardiac pulsations,
an enlarging tender liver, and peripheral edema should besought daily. If
increasing cardiac failure or evidence of poor cardiac output develops, a
Swan-<span class="SpellE">Ganz</span> flow-directed balloon catheter should be
inserted to determine precisely the hemodynamic abnormalities and to assist in
treatment</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">.</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Portable chest
x-ray films to recognize pulmonary venous congestion are desirable. If
anticoagulants are not given, pulmonary embolism secondary to phlebitis of the
leg or pelvic veins occurs in </span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">5-10%</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> of patients during
the acute and convalescent stage.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><br /></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">Arrhythmias occur commonly
after myocardial infarction and are thought to be the cause of death in
about</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
40%</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> of
patients. The mechanism is either cardiac arrest or ventricular fibrillation;
the former occurs following shock or heart failure, and the latter is more apt
to be a primary event (although it can be secondary). Continuous monitoring has
revealed a higher incidence of ventricular tachycardia, complete <span class="SpellE">atrioventricular</span> block, and other less serious arrhythmias
than was formerly suspected. The appearance of left anterior <span class="SpellE">hemiblock</span>, especially combined with right bundle branch
block, often precedes the development of complete <span class="SpellE">atrioventricular</span> block and requires insertion of a
prophylactic pacemaker. Ventricular premature beats often precede more serious
arrhythmias in late or secondary but <span class="GramE">may</span> not in early
or primary ventricular fibrillation. <span class="SpellE">Atrial</span>
arrhythmias are less common and often transient, as is the case with <span class="SpellE">atrial</span> fibrillation. The prompt recognition of arrhythmias
is essential in order to initiate treatment.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><br /></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">Cerebrovascular</span></span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> accident may
result from a fall in blood pressure associated with myocardial infarction or
from embolism secondary to a mural thrombus. It is advisable to take an <span class="SpellE">ECG</span> in all patients with "<span class="SpellE">cerebrovascular</span> accident.</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">"</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">Recurrent
myocardial infarction or extension of the infarction occurs in about</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">
5%</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> of
patients during recovery from the initial attack.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><br /></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Rupture of the
heart is uncommon. When it occurs, it is usually in the first
week.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Perforation of the
ventricular septum is rare, characterized by the sudden appearance of a loud,
harsh systolic murmur and thrill over the lower left <span class="SpellE">parastemal</span> area or apex and acute heart failure. This must
be distinguished from mitral insufficiency caused by papillary muscle infarction
or dysfunction. The diagnosis may sometimes be made by passing (at the bedside)
a pulmonary artery flow-directed catheter and noting the size of the v wave in
the wedged position and the oxygen content in the right ventricle.
Two-dimensional echocardiography may demonstrate the perforation of the
ventricular septum and so obviate the need for catheterization. Both lesions may
precipitate cardiac failure and require cardiac surgery when the patient's
condition has stabilized in weeks or months and right and left heart
catheterization reveals a significant hemodynamic lesion. 'Emergency surgical
repair is sometimes required but has a high mortality rate. An effort should be
made to delay surgery for at least a month.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">Ventricular
aneurysm and peripheral arterial embolism may occur early or not for months
after recovery. The spectrum of ventricular aneurysm is now recognized to extend
from frank <span class="SpellE">outpocketing</span> of an area of myocardium with
well-demarcated <span class="SpellE">paradoxic</span> pulsations to localized poor
contraction or irregular pulsation seen on <span class="SpellE">cineangiography</span>. Approximately </span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">20%</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> or patients
develop some form of aneurysm or left ventricular <span class="SpellE">hypokinesis</span>, recognized clinically by abnormal <span class="SpellE">paradoxic</span> <span class="SpellE">precordial</span> pulsations
and proved by gated pool <span class="SpellE">scintigraphy</span>, 2-dimensional
echocardiography, <span class="SpellE">cinefluoroscopy</span>, or left ventricular
<span class="SpellE">cineangiography</span>. Some of these patients develop
refractory cardiac failure and benefit from surgical
excision.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><br /></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-indent: 18pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;">The shoulder-hand
syndrome is a rare preventable disorder caused by prolonged immobilization of
the arms and shoulders, possibly due to "reflex sympathetic
dystrophy.</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-no-proof: yes;">''</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"> Early pain and
tenderness over the affected shoulder are followed by pain and swelling and
weakness of the hand, with excessive or deficient sweating. <span class="SpellE">Oliguria</span>, <span class="SpellE">anuria</span>, or, rarely,
tubular necrosis may result if shock persists.<o:p></o:p></span></span></div>
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt;"><br clear="all" style="page-break-before: always;" /></span></b>
</span><div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">TREATMENT<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">Medical Care:</span></b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;"> The main goals of
treatment in angina pectoris are to relieve the symptoms, slow the progression
of disease, and reduce the possibility of future events, especially MI and
premature death. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;"><br /></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">General
measures<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Smoking cessation results in a
significant reduction of acute adverse effects on the heart and <span class="GramE">may</span> reverse, or at least slow, atherosclerosis. Strongly
encourage patients to quit smoking, and take an active role in helping them to
achieve this goal. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Treat risk factors, including
hypertension, diabetes mellitus, obesity, and <span class="SpellE">hyperlipidemia</span>. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Several clinical trials have
shown that in patients with established coronary artery disease, reduction of
low-density lipoprotein (<span class="SpellE">LDL</span>) level with a beta-<span class="SpellE">hydroxy-beta-methylglutaryl</span> coenzyme A <span class="SpellE">reductase</span> inhibitor (<span class="SpellE">ie</span>, <span class="SpellE">statin</span>) is associated with significant reductions in both
mortality rate and major cardiac events. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">These benefits are present
even in patients with mild-to-moderate elevations of <span class="SpellE">LDL</span> cholesterol level. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Recent trials with
cholesterol-lowering agents have confirmed the benefits of the therapeutic <span class="SpellE">LDL</span> lowering in older persons.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Angiographic studies
demonstrate that a reduction of the <span class="SpellE">LDL</span> level in
patients with coronary artery disease could cause slowing of progression,
stabilization, or even regression of coronary artery
lesions.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">A recent study demonstrates a
significant reduction of symptomatic myocardial ischemia in patients with
unstable angina or non–Q-wave infarction with the administration of a <span class="SpellE">statin</span> during the early acute phase.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In a more recent study of
10,001 patients with stable coronary artery disease, an aggressive
cholesterol-lowering approach with <span class="SpellE">atorvastatin</span> 80 mg
daily (mean cholesterol level of 77 mg/<span class="SpellE">dL</span>) compared to
a less-aggressive approach with <span class="SpellE">atorvastatin</span> 10 mg
daily (mean cholesterol level of 101 mg/<span class="SpellE">dL</span>) resulted
in a 2.2% absolute reduction and a 22% relative reduction in the occurrence of a
first major cardiovascular event (defined as death from coronary heart disease;
nonfatal, non–procedure-related myocardial infarction; resuscitation from
cardiac arrest; or fatal or nonfatal stroke).This occurred with a greater
incidence of elevated <span class="SpellE">aminotransferase</span> levels with the
aggressive cholesterol-lowering approach (1.2% <span class="SpellE">vs</span>
0.2%, p<0.001).<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">On the basis of several recent
studies that have demonstrated the benefits of more aggressive <span class="SpellE">LDL</span>-lowering therapies in high-risk patients with coronary
artery disease, the Committee of the National Cholesterol Education Program
recently made the following modifications to the Adult Treatment Panel III (ATP
III) guidelines. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In high-risk patients, a serum
<span class="SpellE">LDL</span> cholesterol level of less than 100 mg/<span class="SpellE">dL</span> is the goal. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In very high-risk patients, an
<span class="SpellE">LDL</span> cholesterol level goal of less than 70 mg/<span class="SpellE">dL</span> is a therapeutic option. Patients in the category of very
high risk are those with established coronary artery disease with one of the
following: multiple major risk factors (especially diabetes), severe and poorly
controlled risk factors (especially continued cigarette smoking), multiple risk
factors of the metabolic syndrome (especially high triglyceride levels [>200
mg/<span class="SpellE">dL</span>] plus non-<span class="SpellE">HDL</span>
cholesterol level [>130 mg/<span class="SpellE">dL</span>] with low <span class="SpellE">HDL</span> cholesterol level [<40 mg/<span class="SpellE">dL</span>]), and patients with acute coronary syndromes.
<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">For moderately high-risk
persons (2+ risk factors), the recommended <span class="SpellE">LDL</span>
cholesterol level is less than130 mg/<span class="SpellE">dL</span>, but an <span class="SpellE">LDL</span> cholesterol level of 100 mg/<span class="SpellE">dL</span>
is a therapeutic option. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Some triglyceride-rich
lipoproteins, including partially degraded very <span class="SpellE">LDL</span>
levels, are believed to be independent risk factors for coronary artery disease.
In daily practice, non-<span class="SpellE">HDL</span> cholesterol level (<span class="SpellE">ie</span>, <span class="SpellE">LDL</span> + very <span class="SpellE">LDL</span> cholesterol [total cholesterol - <span class="SpellE">HDL</span> cholesterol]) is the most readily available measure of
the total pool of these <span class="SpellE">atherogenic</span> lipoproteins.
Thus, the ATP III has identified non-<span class="SpellE">HDL</span> cholesterol
level as a secondary target of therapy in persons with high triglyceride levels
(>200 mg/<span class="SpellE">dL</span>). The goal for non-<span class="SpellE">HDL</span> cholesterol level (for persons with serum triglyceride
levels >200 mg/<span class="SpellE">dL</span>) is 30 mg/<span class="SpellE">dL</span> higher than the identified <span class="SpellE">LDL</span>
cholesterol level goal. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Patients with established
coronary disease and low <span class="SpellE">HDL</span> cholesterol levels are at
high risk for recurrent events and should be targeted for aggressive <span class="SpellE">nonpharmacological</span> (<span class="SpellE">ie</span>, dietary
modification, weight loss, physical exercise) and pharmacological
treatment.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">A recent study demonstrated
that in patients with established coronary artery disease who have low <span class="SpellE">HDL</span> and low-risk <span class="SpellE">LDL</span> levels, drug
therapy with medications that raise <span class="SpellE">HDL</span> cholesterol
levels and lower triglyceride levels but have no effect on <span class="SpellE">LDL</span> cholesterol levels (<span class="SpellE">eg</span>, <span class="SpellE">gemfibrozil</span>) could significantly reduce the risk of major
cardiac events. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Currently, the accepted
approach to the management of patients with coronary artery disease and low
<span class="SpellE">HDL</span> levels is as follows: <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In all persons with low <span class="SpellE">HDL</span> cholesterol levels, the primary target of therapy is to
achieve the ATP III guideline <span class="SpellE">LDL</span> cholesterol level
goals with diet, exercise, and drug therapy as needed. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">After reaching the targeted
<span class="SpellE">LDL</span> level goal, emphasis shifts to other issues. That
is, in patients with low <span class="SpellE">HDL</span> cholesterol levels who
have associated high triglyceride levels (>200 mg/<span class="SpellE">dL</span>), the secondary priority is to achieve the non-<span class="SpellE">HDL</span> cholesterol level goal of 30 mg/<span class="SpellE">dL</span> higher than the identified <span class="SpellE">LDL</span>
cholesterol level goal. In patients with isolated low <span class="SpellE">HDL</span> cholesterol levels (triglycerides <200 mg/<span class="SpellE">dL</span>), drugs to raise the <span class="SpellE">HDL</span>
cholesterol level (<span class="SpellE">eg</span>, <span class="SpellE">gemfibrozil</span>, nicotinic acid) can be
considered.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Exercise training results in
improvement of symptoms, increase in the threshold of ischemia, and improvement
of patients' sense of well-being. However, before enrolling a patient in an
exercise-training program, perform an exercise tolerance test to establish the
safety of such a program. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Consider enteric-coated
aspirin at a dose of 80-325 mg/d for all patients with stable angina who have no
contraindications to its use. In patients in whom aspirin cannot be used because
of allergy or gastrointestinal complications, consider <span class="SpellE">clopidogrel</span>. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Although early observational
studies suggested a cardiovascular protective effect with the use of hormone
replacement therapy, recent large randomized trials failed to demonstrate any
benefit with hormone replacement therapy in the primary or secondary prevention
of cardiovascular disease. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In fact, these studies even
demonstrated an increased risk of coronary artery disease and stroke in patients
on hormone replacement therapy. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">The Women's Health Initiative
study demonstrated that the use of hormone replacement therapy for 1 year in
10,000 healthy postmenopausal women is associated with 7 more instances of
coronary artery disease, 8 more strokes, 8 more pulmonary emboli, 8 more
invasive breast cancers, 5 fewer hip fractures, and 6 fewer colorectal
cancers.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Based on these data, the risks
and benefits of hormone replacement therapy must be assessed on an individual
basis for each patient.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Sublingual <span class="SpellE">nitroglycerin</span> has been the mainstay of treatment for angina
pectoris. Sublingual <span class="SpellE">nitroglycerin</span> can be used for
acute relief of angina and <span class="SpellE">prophylactically</span> before
activities that may precipitate angina. No evidence indicates that long-acting
nitrates improve survival in patients with coronary artery disease.
<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Beta-blockers are also used
for symptomatic relief of angina and prevention of ischemic events. They work by
reducing myocardial oxygen demand and by decreasing the heart rate and
myocardial contractility. Beta-blockers have been shown to reduce the rates of
mortality and morbidity following acute MI. <o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Long-acting heart rate–slowing
calcium channel blockers can be used to control <span class="SpellE">anginal</span> symptoms in patients with a contraindication to
beta-blockers and in those in whom symptomatic relief of angina cannot be
achieved with the use of beta-blockers, nitrates, or both. Avoid short-acting
<span class="SpellE">dihydropyridine</span> calcium channel blockers because they
have been shown to increase the risk of adverse cardiac
events.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">Anginal</span></span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;"> symptoms in
patients with <span class="SpellE">Prinzmetal</span> angina can be treated with
calcium channel blockers with or without nitrates. In one study, supplemental
vitamin E added to a calcium channel blocker significantly reduced <span class="SpellE">anginal</span> symptoms among such patients.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In patients with syndrome X
and hypertension, ACE inhibitors may normalize thallium perfusion defects and
increase exercise capacity.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">Surgical Care:
<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Revascularization therapy
(<span class="SpellE">ie</span>, coronary revascularization) can be considered in
patients with left main artery <span class="SpellE">stenosis</span> greater than
50%, 2- or 3-vessel disease and LV dysfunction (ejection fraction, <45%),
poor prognostic signs during <span class="SpellE">noninvasive</span> studies, or
severe symptoms despite maximum medical therapy. The 2 main coronary
revascularization procedures are <span class="SpellE">percutaneous</span> <span class="SpellE">transluminal</span> coronary angioplasty, with or without coronary
<span class="SpellE">stenting</span>, and coronary artery bypass
grafting.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Patients with 1- or 2-vessel
disease and normal <st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> function who have anatomically suitable
lesions are candidates for <span class="SpellE">percutaneous</span> <span class="SpellE">transluminal</span> coronary angioplasty and coronary <span class="SpellE">stenting</span>. <span class="SpellE">Restenosis</span> is the major
complication, with symptomatic <span class="SpellE">restenosis</span> occurring in
20-25% of patients. <span class="SpellE">Restenosis</span> mostly occurs during
the first 6 months after the procedure and can be managed by repeat angioplasty.
Several recent trials have demonstrated that the use of drug-eluting stents
(<span class="SpellE">eg</span>, <span class="SpellE">sirolimus</span>-eluting
stents, <span class="SpellE">paclitaxel</span>-coated stents) can remarkably
reduce the rate of in-stent <span class="SpellE">restenosis</span>. Recently, with
the introduction of these drug-coated stents, patients with <span class="SpellE">multivessel</span> coronary artery disease are more frequently
treated with <span class="SpellE">percutaneous</span> revascularization as opposed
to the surgical revascularization.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Patients with single-vessel
disease and normal ventricular function treated with <span class="SpellE">percutaneous</span> <span class="SpellE">transluminal</span> coronary
angioplasty show improved exercise tolerance and fewer episodes of angina
compared with those who receive medical treatment. However, no difference in the
frequency of MI or death has been shown between these two
groups.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Patients with significant left
main coronary artery disease, 2- or 3-vessel disease and LV dysfunction,
diabetes mellitus, or lesions anatomically unsuitable for <span class="SpellE">percutaneous</span> <span class="SpellE">transluminal</span> coronary
angioplasty have better results with coronary artery bypass grafting. The
overall operative mortality rate for coronary artery bypass grafting is
approximately 1.3%. The rate of graft patency 10 years after surgery is less
than 50% for vein grafting, although more than 90% of grafts using internal
mammary arteries are patent at 10 years. In recent years, interest has increased
regarding surgery without cardiopulmonary bypass (<span class="SpellE">ie</span>,
off-pump) in an attempt to avoid the morbidity associated with cardiopulmonary
bypass. A recent randomized study demonstrated that off-pump coronary surgery
was as safe as on-pump surgery and caused less myocardial damage. However, the
graft-patency rate was lower at 3 months in the off-pump group than in the
on-pump group.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Recently, laser <span class="SpellE">transmyocardial</span> revascularization has been used as an
experimental therapy for the treatment of severe, chronic, stable angina
refractory to medical or other therapies. This technique has been performed with
either an <span class="SpellE">epicardial</span> surgical technique or by a <span class="SpellE">percutaneous</span> approach. In both approaches, a series of <span class="SpellE">transmural</span> <span class="SpellE">endomyocardial</span> channels
are created to improve myocardial perfusion. The surgical <span class="SpellE">transmyocardial</span> revascularization technique has been
associated with symptomatic relief for end-stage chronic angina in the short
term. However, no published data address the long-term efficacy of surgical
<span class="SpellE">transmyocardial</span> revascularization. Nonetheless, this
technique appears to provide at least symptomatic relief for end-stage chronic
angina in the short term.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">Diet: A</span></b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;"> diet low in
saturated fat and dietary cholesterol is the mainstay of the Step I and Step II
diet from the American Heart Association. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">Activity</span></b><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">: The level of
activity that aggravates <span class="SpellE">anginal</span> symptoms is different
for each patient. However, most patients with stable angina can avoid symptoms
during daily activities simply by reducing the speed of
activity.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">MEDICATION<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">The goals of pharmacotherapy
are to reduce morbidity and to prevent complications.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Drug Category: <span class="SpellE"><em>Antiplatelet</em></span><em> agents</em> -- Prevent thrombus
formation by inhibiting platelet aggregation. Aspirin is proven beneficial in
primary and secondary prevention of coronary artery disease. In patients with
aspirin intolerance, use <span class="SpellE">clopidogrel</span>. <span class="SpellE">Clopidogrel</span> is also used in combination with aspirin after
coronary stent placement. Recently, <span class="SpellE">clopidogrel</span> use in
addition to aspirin has been shown to be significantly superior to aspirin alone
in patients with acute coronary syndrome without ST-segment elevation
MI.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Aspirin
(Bayer, <span class="SpellE">Empirin</span>, Anacin) -- Prevents platelet
aggregation by irreversible <span class="SpellE">cyclooxygenase</span> inhibition
with subsequent suppression of <span class="SpellE">thromboxane</span> A2.
</span><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Antiplatelet</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">effect</span> <span class="SpellE">can</span> <span class="SpellE">last</span> <span class="SpellE">as</span> <span class="SpellE">long</span> <span class="SpellE">as</span> 7 <span class="SpellE">d</span>. </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="RU" style="font-family: Arial; font-size: 14pt;">81-325 <span class="SpellE">mg</span> <span class="SpellE">PO</span> <span class="SpellE">qd</span>
</span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; liver damage; <span class="SpellE">hypoprothrombinemia</span>;
vitamin K deficiency; bleeding disorders; asthma<br />Because of association with
Reye syndrome, do not use in children (<16 y) with flu </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Antacids
and urinary <span class="SpellE">alkalinizers</span> may decrease effects;
corticosteroids decrease <span class="SpellE">salicylate</span> serum levels;
anticoagulants may cause additive <span class="SpellE">hypoprothrombinemic</span>
effects and increased bleeding time; may antagonize <span class="SpellE">uricosuric</span> effects of <span class="SpellE">probenecid</span>
and increase toxicity of <span class="SpellE">phenytoin</span> and <span class="SpellE">valproic</span> acid; doses >2 g/d may potentiate
glucose-lowering effect of sulfonylurea drugs </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">D</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> - <span class="SpellE">Unsafe</span> <span class="SpellE">in</span> <span class="SpellE">pregnancy</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">May
cause transient decrease in renal function and aggravate chronic kidney disease;
avoid use in patients with severe <span class="SpellE">anemia</span>, history of
blood coagulation defects, or taking anticoagulants; adverse effects include
prolonged bleeding time, rhinitis, asthma, <span class="SpellE">urticaria</span>,
and exacerbation of gout; monitor BP, BUN, and uric acid level; consider
discontinuing 7 d before surgery</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Clopidogrel</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Plavix</span>) -- Selectively inhibits ADP binding to
platelet receptor and subsequent ADP-mediated activation of <span class="SpellE">GPIIb/IIIa</span> complex, thereby inhibiting platelet aggregation.
</span><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Consider</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">in</span> <span class="SpellE">patients</span> <span class="SpellE">with</span> <span class="SpellE">contraindication</span> <span class="SpellE">to</span> <span class="SpellE">aspirin</span>. </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="RU" style="font-family: Arial; font-size: 14pt;">75 <span class="SpellE">mg</span> <span class="SpellE">PO</span> <span class="SpellE">qd</span>
</span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; active pathological bleeding </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Naproxen
associated with increased occult GI blood loss; prolongs bleeding time; safety
of <span class="SpellE">coadministration</span> with <span class="SpellE">warfarin</span> not established </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Caution
in patients at increased risk of bleeding from trauma, surgery, or other
pathological conditions; caution in patients with lesions with propensity to
bleed (<span class="SpellE">eg</span>, ulcers); adverse effects include rash,
<span class="SpellE">diarrhea</span>, <span class="SpellE">purpura</span>, GI
ulcers, <span class="SpellE">neutropenia</span>, and rare cases of <span class="SpellE">agranulocytosis</span>; consider discontinuing 7 d before
surgery</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><v:shape coordsize="21600,21600" id="_x0000_i1030" o:allowoverlap="f" style="height: 373.5pt; mso-position-horizontal: absolute; mso-position-vertical: absolute; width: 585pt;" type="#_x0000_t75"><v:imagedata o:title="" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image018.emz"></v:imagedata></v:shape><o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Drug Category:
<em>Beta-adrenergic blocking agents</em> -- Work by competing with endogenous
<span class="SpellE">catecholamines</span> for beta-adrenergic receptors. Reduce
myocardial oxygen consumption via several effects, including decrease in resting
and exercise heart rates and reductions in myocardial contractility and <span class="SpellE">afterload</span>. Classified as <span class="SpellE">nonselective</span>, beta-1 selective, and having intrinsic <span class="SpellE">sympathomimetic</span> effects.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Metoprolol</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Lopressor</span>, <span class="SpellE">Toprol</span> XL) --
Selective beta1-adrenergic receptor blocker that decreases automaticity of
contractions. </span><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Is</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">lipophilic</span> <span class="SpellE">and</span> <span class="SpellE">penetrates</span> <span class="SpellE">CNS</span>. </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="RU" style="font-family: Arial; font-size: 14pt;">50-200 <span class="SpellE">mg</span> <span class="SpellE">PO</span> <span class="SpellE">bid</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; uncompensated <span class="SpellE">CHF</span>; <span class="SpellE">bradycardia</span>; asthma; <span class="SpellE">cardiogenic</span>
shock; AV conduction abnormalities </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Aluminum</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
salts, barbiturates, <span class="SpellE">NSAIDs</span>, <span class="SpellE">penicillins</span>, calcium salts, <span class="SpellE">cholestyramine</span>, and <span class="SpellE">rifampin</span> may
decrease bioavailability and plasma levels, possibly resulting in decreased
pharmacologic effects; <span class="SpellE">sparfloxacin</span>, <span class="SpellE">phenothiazines</span>, <span class="SpellE">astemizole</span>,
calcium channel blockers, <span class="SpellE">quinidine</span>, <span class="SpellE">flecainide</span>, and contraceptives may increase toxicity; may
increase toxicity of <span class="SpellE">digoxin</span>, <span class="SpellE">flecainide</span>, <span class="SpellE">clonidine</span>,
epinephrine, <span class="SpellE">nifedipine</span>, <span class="SpellE">prazosin</span>, <span class="SpellE">verapamil</span>, and <span class="SpellE">lidocaine</span> </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">B
- Usually safe but benefits must outweigh the risks. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Beta-adrenergic
blockade may mask signs and symptoms of acute <span class="SpellE">hypoglycemia</span> and may decrease clinical signs of
hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism,
including thyroid storm; monitor patient closely and withdraw drug slowly;
during IV administration, carefully monitor BP, heart rate, and <span class="SpellE">ECG</span>; adverse effects include hypotension, decreased libido,
impotence, lethargy, depression, and decreased <span class="SpellE">HDL</span>;
may cause less bronchial tree and arterial smooth muscle
constriction</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Atenolol</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Tenormin</span>) -- Selectively blocks beta-1 receptors with
little or no effect on beta-2 receptors. </span><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Is</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">hydrophilic</span> <span class="SpellE">and</span> <span class="SpellE">does</span> <span class="SpellE">not</span> <span class="SpellE">penetrate</span> <span class="SpellE">CNS</span>. </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="RU" style="font-family: Arial; font-size: 14pt;">50-200 <span class="SpellE">mg</span> <span class="SpellE">PO</span> <span class="SpellE">qd</span>
</span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; <span class="SpellE">CHF</span>; pulmonary <span class="SpellE">edema</span>; <span class="SpellE">cardiogenic</span> shock; AV
conduction abnormalities; heart block (without pacemaker) </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Aluminum</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
salts, barbiturates, calcium salts, <span class="SpellE">cholestyramine</span>,
<span class="SpellE">NSAIDs</span>, <span class="SpellE">penicillins</span>, and
<span class="SpellE">rifampin</span> may decrease effects; haloperidol, <span class="SpellE">hydralazine</span>, loop diuretics, and <span class="SpellE">MAOIs</span> may increase toxicity </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Beta-adrenergic
blockade may hide symptoms of acute <span class="SpellE">hypoglycemia</span> and
mask signs of hyperthyroidism; abrupt withdrawal may exacerbate symptoms of
hyperthyroidism and cause thyroid storm; monitor patients closely and withdraw
drug slowly; adverse effects include <span class="SpellE">bradycardia</span>,
hypotension, decreased libido, impotence, and decreased <span class="SpellE">HDL</span>; beta1-selective blockers may cause less bronchial tree
and arterial smooth muscle constriction; titrate dose carefully to level of
patient tolerance and effectiveness</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Propranolol</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Inderal</span>) -- <span class="SpellE">Nonselective</span>
beta-blocker that is <span class="SpellE">lipophilic</span> (penetrates CNS).
Although generally short-acting agent, long-acting preparations also available.
</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">IR</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">:
40-160 mg PO bid<br />SR: 60-320 mg <st1:place w:st="on">PO</st1:place> <span class="SpellE">qd</span> </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; history of <span class="SpellE">bronchospasm</span>;
uncompensated <span class="SpellE">CHF</span>; <span class="SpellE">bradycardia</span>; <span class="SpellE">cardiogenic</span> shock; AV
conduction abnormalities </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Aluminum</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
salts, barbiturates, <span class="SpellE">NSAIDs</span>, <span class="SpellE">penicillins</span>, calcium salts, <span class="SpellE">cholestyramine</span>, and <span class="SpellE">rifampin</span> may
decrease effects; calcium channel blockers, <span class="SpellE">cimetidine</span>, loop diuretics, and <span class="SpellE">MAOIs</span> may increase toxicity; may increase toxicity of <span class="SpellE">hydralazine</span>, haloperidol, benzodiazepines, and <span class="SpellE">phenothiazines</span> </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Beta-adrenergic
blockade may mask signs of acute <span class="SpellE">hypoglycemia</span> and
hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism,
including thyroid storm; withdraw drug slowly and monitor closely; adverse
effects include bronchial constriction, <span class="SpellE">Raynaud</span>
phenomenon, hypotension, decreased libido, impotence, lethargy, depression, and
decreased <span class="SpellE">HDL</span>; caution in Wolff-Parkinson-White
syndrome and renal or hepatic dysfunction</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Drug Category: <em>Calcium
channel blockers</em> -- Reduce <span class="SpellE">transmembrane</span> flux of
calcium via calcium channels. Cause smooth muscle relaxation, resulting in
peripheral arterial <span class="SpellE">vasodilation</span> and <span class="SpellE">afterload</span> reduction. Indicated when symptoms persist despite
treatment with beta-blockers or when beta-blockers are contraindicated. <span class="GramE">Also indicated in patients with <span class="SpellE">Prinzmetal</span>
angina with or without nitrates.</span><o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Amlodipine</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Norvasc</span>) -- During depolarization, inhibits calcium
ions from entering slow channels and voltage-sensitive areas of vascular smooth
muscle and myocardium. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="RU" style="font-family: Arial; font-size: 14pt;">5-10 <span class="SpellE">mg</span> <span class="SpellE">PO</span> <span class="SpellE">qd</span>
</span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; severe <span class="SpellE">CHF</span>; sick sinus syndrome;
second- or third-degree AV block; hypotension (<<st1:metricconverter productid="90 mm" st="on" style="background-image: url(res://ietag.dll/#34/#1001); background-position: left bottom; background-repeat: repeat-x;" tabindex="0" w:st="on">90 mm</st1:metricconverter> Hg systolic)
</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Fentanyl</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
may increase <span class="SpellE">hypotensive</span> effects; may increase
cyclosporine levels; H2 blockers (<span class="SpellE">eg</span>, <span class="SpellE">cimetidine</span>) may increase toxic effects </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Severe
aortic <span class="SpellE">stenosis</span>, <span class="SpellE">CHF</span>,
hepatic dysfunction; adverse effects include headache, <span class="SpellE">edema</span>, flushing, palpitation, drowsiness, and
fatigue</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Diltiazem</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Cardizem</span> CD, <span class="SpellE">Dilacor</span>) --
During depolarization, inhibits calcium ions from entering slow channels and
voltage-sensitive areas of vascular smooth muscle and myocardium. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">IR</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">:
120-360 mg PO divided <span class="SpellE">tid/qid</span><br />SR: 120-480 mg
<st1:place w:st="on">PO</st1:place> <span class="SpellE">qd</span> </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; severe <span class="SpellE">CHF</span>; sick sinus syndrome;
second- or third-degree AV block; hypotension (<<st1:metricconverter productid="90 mm" st="on" style="background-image: url(res://ietag.dll/#34/#1001); background-position: left bottom; background-repeat: repeat-x;" tabindex="0" w:st="on">90 mm</st1:metricconverter> Hg systolic)
</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">May
increase <span class="SpellE">carbamazepine</span>, <span class="SpellE">digoxin</span>, cyclosporine, and <span class="SpellE">theophylline</span> levels; when administered with <span class="SpellE">amiodarone</span>, may cause <span class="SpellE">bradycardia</span>
and decrease in cardiac output; when given with beta-blockers may increase
cardiac depression; <span class="SpellE">cimetidine</span> may increase levels
</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Caution
in impaired renal or hepatic function; may increase <span class="SpellE">LFT</span> levels, and hepatic injury may occur; adverse effects
include constipation, AV conduction block, worsening of heart failure,
peripheral <span class="SpellE">edema</span>, <span class="SpellE">bradycardia</span>, and AV dissociation</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Verapamil</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Calan</span>, <span class="SpellE">Covera</span>) -- During
depolarization, inhibits calcium ion from entering slow channels or
voltage-sensitive areas of vascular smooth muscle and myocardium. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">IR</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">:
80-120 mg PO <span class="SpellE">tid/qid</span><br />SR: 120-240 mg <st1:place w:st="on">PO</st1:place> <span class="SpellE">qd</span>/bid </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; severe <span class="SpellE">CHF</span>; sick sinus syndrome;
second- or third-degree AV block; hypotension (<<st1:metricconverter productid="90 mm" st="on" style="background-image: url(res://ietag.dll/#34/#1001); background-position: left bottom; background-repeat: repeat-x;" tabindex="0" w:st="on">90 mm</st1:metricconverter> Hg systolic)
</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">May
increase <span class="SpellE">carbamazepine</span>, <span class="SpellE">digoxin</span>, <span class="SpellE">theophylline</span>, and
cyclosporine levels; <span class="SpellE">amiodarone</span> can cause <span class="SpellE">bradycardia</span> and decrease in cardiac output; when
administered concurrently with beta-blockers may increase cardiac depression;
<span class="SpellE">cimetidine</span> may increase levels </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Hepatocellular</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
injury may occur; transient elevations of <span class="SpellE">transaminases</span> with and without concomitant elevations in
alkaline <span class="SpellE">phosphatase</span> and <span class="SpellE">bilirubin</span> have occurred (elevations have been transient and
may disappear with continued treatment); monitor liver function periodically;
adverse effects include constipation, AV dissociation, worsening heart failure,
<span class="SpellE">bradycardia</span>, negative <span class="SpellE">inotropism</span>, and hypotension</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Drug Category:
<em>Short-acting <span class="SpellE">nitroglycerins</span></em> -- Suitable for
immediate relief of <span class="SpellE">exertional</span> or rest angina. <span class="GramE">Can also be used for prophylaxis several minutes before planned
exercise to avoid angina.</span> Reduce myocardial oxygen demand by reduction of
<st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> and arterial
pressure, primarily by reducing preload.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Nitroglycerin</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Nitrostat</span>, Nitro-bid, <span class="SpellE">Nitrol</span>) -- Causes relaxation of vascular smooth muscle by
stimulating intracellular cyclic <span class="SpellE">GMP</span> production.
</span><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Result</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">is</span> <span class="SpellE">decrease</span> <span class="SpellE">in</span> <span class="SpellE">BP</span>. </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">0.3-0.6
mg SL <span class="SpellE">prn</span><br />0.4 mg metered-dose spray <st1:place w:st="on">PO</st1:place> <span class="SpellE">prn</span><br />0.1-0.8 mg/h patch TD
<span class="SpellE">qd</span> </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; severe <span class="SpellE">anemia</span>; shock; postural
hypotension; head trauma; closed-angle glaucoma; cerebral <span class="SpellE">hemorrhage</span>; hypertrophic obstructive <span class="SpellE">cardiomyopathy</span> </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Concurrent
<span class="SpellE">sildenafil</span> (Viagra) may cause severe hypotension and
death; aspirin may increase serum concentrations; calcium channel blockers may
cause markedly symptomatic orthostatic hypotension (dose adjustment of either
agent may be necessary) </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Caution
in coronary artery disease and low systolic BP; adverse effects include
hypotension, flushing, headache, light-headedness, and tolerance (8- to 12-h
nitrate-free interval is most effective method to prevent development of
tolerance); high IV doses may cause <span class="SpellE">methemoglobinemia</span>,
heparin resistance, and ethanol intoxication; ischemia may worsen upon
withdrawal</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Drug Category: <em>Long-acting
<span class="SpellE">nitroglycerins</span></em> -- Reduce LV preload and <span class="SpellE">afterload</span> by venous and arterial dilation, which
subsequently reduces myocardial oxygen consumption and relieves angina. Also
cause dilation of <span class="SpellE">epicardial</span> coronary arteries, which
is beneficial in patients with coronary spasm. In addition, <span class="SpellE">nitroglycerin</span> has antithrombotic and <span class="SpellE">antiplatelet</span> effects in patients with angina pectoris. No
evidence suggests that nitrates improve survival or slow progression of coronary
artery disease.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 29.62%;" width="29%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Isosorbide</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Isordil</span>, <span class="SpellE">ISMO</span>) -- Relaxes
vascular smooth muscle by stimulating intracellular cyclic <span class="SpellE">GMP</span>. Decreases <st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> pressure (<span class="SpellE">ie</span>,
preload) and arterial resistance (<span class="SpellE">ie</span>, <span class="SpellE">afterload</span>). Reduces cardiac oxygen demand by decreasing
<st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> pressure and
dilating arteries. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Isosorbide</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
<span class="SpellE">dinitrate</span>:<br />2.5-10 mg SL <span class="SpellE">prn</span> <span class="SpellE">IR</span><br />10-30 mg PO bid/<span class="SpellE">tid</span> SR<br />80-120 mg PO <span class="SpellE">qd</span> <span class="SpellE">IR</span><br /><span class="SpellE">Isosorbide</span> <span class="SpellE">mononitrate</span>:<br />10-20 mg PO bid SR<br />30-120 mg <st1:place w:st="on">PO</st1:place> <span class="SpellE">qd</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; severe <span class="SpellE">anemia</span>; closed-angle
glaucoma; postural hypotension; head trauma; cerebral <span class="SpellE">hemorrhage</span> </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Alcohol
may cause severe hypotension and cardiovascular collapse; aspirin may increase
serum concentrations and actions; calcium channel blockers may increase
symptomatic orthostatic hypotension (adjust dose of either agent); may decrease
effects of heparin </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Tolerance
to vascular and <span class="SpellE">antianginal</span> effects of nitrates may
develop; minimize tolerance by using smallest effective dose or pulse therapy
(intermittent dosing) or by alternating with other coronary vasodilators (take
last daily dose of short-acting agent no later than 7 pm); caution when
administering to patients with glaucoma</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">Drug Category: <span class="SpellE"><em>Angiotensin</em></span><em>-converting enzyme inhibitors</em>
-- Recently shown to reduce rates of death, MI, stroke, and need for
revascularization procedures in patients with coronary artery disease or
diabetes mellitus and at least one other cardiovascular risk factor,
irrespective of the presence of hypertension or heart failure.</span><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB; mso-fareast-language: UK;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Ramipril</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Altace</span>) -- Prevents conversion of <span class="SpellE">angiotensin</span> I to <span class="SpellE">angiotensin</span> II, a
potent vasoconstrictor, resulting in lower <span class="SpellE">aldosterone</span>
secretion. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">2.5-5
mg <st1:place w:st="on">PO</st1:place> <span class="SpellE">qd</span>; not to
exceed 20 mg/d </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; history of <span class="SpellE">angioedema</span> </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">May
increase <span class="SpellE">digoxin</span>, lithium, and <span class="SpellE">allopurinol</span> levels; <span class="SpellE">probenecid</span> may
increase levels; <span class="SpellE">coadministration</span> with diuretics
increases <span class="SpellE">hypotensive</span> effects; <span class="SpellE">NSAIDs</span> may reduce <span class="SpellE">hypotensive</span>
effects </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Category
D in second and third trimesters of pregnancy; adverse effects include
persistent cough, <span class="SpellE">angioedema</span>, hypotension, and <span class="SpellE">prerenal</span> <span class="SpellE">azotemia</span>; caution in
renal impairment, <span class="SpellE">valvular</span> <span class="SpellE">stenosis</span>, or severe <span class="SpellE">CHF</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<br /></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">Drug Category:
<em>Anti-ischemic agents, miscellaneous</em> -- <span class="SpellE">Ranolazine</span> elicits action unlike beta-blockers, calcium
antagonists, or nitrates. It does not affect <span class="SpellE">hemodynamics</span> or contractile and conduction
parameters.</span><span lang="EN-US" style="font-size: 14pt; mso-ansi-language: EN-US;"><o:p></o:p></span></span></div>
<div align="center">
<table border="1" cellpadding="0" class="MsoNormalTable" style="background-position: initial initial; background-repeat: initial initial; width: 75%px;">
<tbody>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt; width: 30%;" width="30%">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Drug</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Name</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Ranolazine</span></span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">
(<span class="SpellE">Ranexa</span>) -- <span class="SpellE">Cardioselective</span>
anti-ischemic agent (<span class="SpellE">piperazine</span> derivative) that
partially inhibits fatty acid oxidation. Also inhibits late sodium current into
myocardial cells and prolongs <span class="SpellE">QTc</span> interval. Indicated
for chronic angina unresponsive to other <span class="SpellE">antianginal</span>
treatments. Used in combination with <span class="SpellE">amlodipine</span>,
beta-blockers, or nitrates. Unlike beta-blockers, calcium channel blockers, and
nitrates, does not reduce blood pressure or heart rate. Effect on angina rate or
exercise tolerance appears to be smaller in women than in men. </span><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Absorption</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">is</span> <span class="SpellE">highly</span> <span class="SpellE">variable</span> <span class="SpellE">but</span> <span class="SpellE">unaffected</span> <span class="SpellE">by</span> <span class="SpellE">food</span>. </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Adult</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">500
mg PO bid initially; if necessary, may increase to 1000 mg <st1:place w:st="on">PO</st1:place> bid </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pediatric</span></b></span><b><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">Dose</span></span></b><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span class="SpellE"><span lang="RU" style="font-family: Arial; font-size: 14pt;">Not</span></span><span lang="RU" style="font-family: Arial; font-size: 14pt;"> <span class="SpellE">established</span> </span><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Contraindications</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Documented
hypersensitivity; <span class="SpellE">preexisting</span> QT prolongation; hepatic
impairment (Child-Pugh class A [mild], B [moderate], or C [severe]);
QT-prolonging drugs (see Interactions); potent or moderate CYP4503A inhibitors
(<span class="SpellE">eg</span>, <span class="SpellE">ketoconazole</span>, <span class="SpellE">diltiazem</span>) </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Interactions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">CYP4503A
and P-<span class="SpellE">gp</span> substrate; potent CYP3A inhibitors (<span class="SpellE">eg</span>, <span class="SpellE">ketoconazole</span> at 200 mg bid)
increase levels approximately 3.2-fold, moderate CYP3A inhibitors (<span class="SpellE">eg</span>, <span class="SpellE">diltiazem</span> at 180-360 mg/d)
increase levels approximately 1.8- to 2.3-fold, and <span class="SpellE">verapamil</span> (a CYP3A and P-<span class="SpellE">gp</span>
inhibitor) increases levels approximately 2-fold; caution with other P-<span class="SpellE">gp</span> inhibitors (<span class="SpellE">eg</span>, <span class="SpellE">ritonavir</span>, cyclosporine); toxicity may occur when <span class="SpellE">coadministered</span> with other drugs that increase <span class="SpellE">QTc</span> interval (<span class="SpellE">eg</span>, class I and III
<span class="SpellE">antiarrhythmic</span> agents, certain <span class="SpellE">macrolide</span> and <span class="SpellE">quinolone</span>
antibiotics, <span class="SpellE">phenothiazines</span>, <span class="SpellE">TCAs</span>) <br />Inhibits CYP4503A, <span class="SpellE">CYP</span>
4502D6, and P-<span class="SpellE">gp</span>; may increase plasma levels of <span class="SpellE">digoxin</span>, <span class="SpellE">simvastatin</span>, <span class="SpellE">dextromethorphan</span>, <span class="SpellE">TCAs</span>, and
antipsychotics </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Pregnancy</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">C
- Safety for use during pregnancy has not been established. </span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr>
<td style="padding-bottom: 0.75pt; padding-left: 0.75pt; padding-right: 0.75pt; padding-top: 0.75pt;">
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<span style="background-color: white;"><span class="SpellE"><b><span lang="RU" style="font-family: Arial; font-size: 14pt;">Precautions</span></b></span><b><span style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background-position: initial initial; background-repeat: initial initial; padding: 0.75pt;">
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;">Causes
dose-related <span class="SpellE">QTc</span>-interval prolongation (obtain
baseline and follow-up <span class="SpellE">ECGs</span> to monitor for <span class="SpellE">torsades</span> de pointes and potential for sudden death; mild and
moderate hepatic impairment increases <span class="SpellE">QTc</span> interval
compared with normal hepatic function at same plasma level; increases blood
pressure by approximately <st1:metricconverter productid="15 mm" st="on" style="background-image: url(res://ietag.dll/#34/#1001); background-position: left bottom; background-repeat: repeat-x;" tabindex="0" w:st="on">15 mm</st1:metricconverter> Hg in persons
with severe renal impairment; common adverse effects include dizziness,
headache, constipation, and nausea</span><span lang="EN-GB" style="font-family: Arial; font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">FOLLOW-UP<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">Deterrence/Prevention:<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Coronary atherosclerosis is
the main preventable cause of mortality in the <st1:place w:st="on"><st1:country-region w:st="on">United
States</st1:country-region></st1:place>. A rigorous effort to address
correctable risk factors is the mainstay of preventive cardiovascular
medicine.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Smoking cessation is the
single most effective preventive intervention to reduce coronary atherosclerosis
prevalence. It has been associated with a coronary artery disease reduction of
7-47% in primary prevention settings.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Aggressive treatment of
diabetes mellitus, hypertension, <st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> hypertrophy, <span class="SpellE">hyperlipidemia</span>, and obesity has an important role in the
prevention of coronary artery disease.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">The most important recent
development in coronary atherosclerosis risk modification is the introduction of
inhibitors of beta-<span class="SpellE">hydroxy-beta-methylglutaryl</span>
coenzyme A <span class="SpellE">reductase</span>. Reductions of total and <span class="SpellE">LDL</span> cholesterol levels by 25% and 35%, respectively, can
achieve a similar reduction in rates of total and coronary mortality, MI, and
need for coronary revascularization.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">Complications:
<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Complications of angina
pectoris include unstable angina, MI, and death.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span style="background-color: white;"><o:wrapblock><v:shape alt="" coordsize="21600,21600" id="_x0000_s1029" style="height: 251pt; margin-left: 0px; margin-top: 0px; mso-position-horizontal: center; mso-position-vertical: top; position: absolute; width: 192pt; z-index: 5;" type="#_x0000_t75"><v:imagedata o:href="http://medbook.medicina.ru/images/172/131427/6_45.gif" src="Lesson%203%20Diagnostics%20and%20treatment%20of%20ischemic%20heart%20disease%20c.files/image020.gif"></v:imagedata><w:wrap type="topandbottom"></w:wrap></v:shape></o:wrapblock><br clear="all" /><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">Prognosis:
<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Important prognostic
indicators in patients with angina pectoris include <st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> function, severity and
location of atherosclerotic lesions, and response of symptoms to medical
treatment.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="background-color: white;"><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;">LV</span></st1:city></st1:place><span lang="EN-GB" style="font-size: 14pt; mso-ansi-language: EN-GB;"> function is the
strongest predictor of long-term survival. Elevated <st1:city w:st="on">LV</st1:city> end-diastolic pressure and volume along with reduced
<st1:place w:st="on"><st1:city w:st="on">LV</st1:city></st1:place> ejection
fraction (<40%) are poor prognostic signs.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Critical lesions of left main
and proximal left anterior descending coronary arteries are associated with a
greater risk. Mortality rates are also directly associated with the number of
<span class="SpellE">epicardial</span> arteries involved.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Unstable angina, recent MI, or
both is a sign of atherosclerotic plaque instability, which is a strong
predictor of increased risk of short-term coronary events.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">A number of signs during <span class="SpellE">noninvasive</span> testing are predictive of a higher risk of
coronary events, including ST-segment depression of more than
<st1:metricconverter productid="2 mm" st="on" style="background-image: url(res://ietag.dll/#34/#1001); background-position: left bottom; background-repeat: repeat-x;" tabindex="0" w:st="on">2 mm</st1:metricconverter> at a low workload,
ST-segment depression that persists for more than 5 minutes after termination of
exercise, and failure of blood pressure to rise or an actual drop in blood
pressure.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Patients who continue to smoke
after an MI have a 22-47% increased risk of <span class="SpellE">reinfarction</span> and death.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In general, <span class="SpellE">Prinzmetal</span> angina and syndrome X are associated with
excellent long-term prognoses.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">Patient Education:
<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">Educating patients about the
benefits of smoking cessation, a low-cholesterol diet, physical activity, and
periodic screening for diabetes mellitus and hypertension is the prime component
of a long-term management plan.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">For excellent patient
education resources, visit <span class="SpellE">eMedicine's</span> Circulatory
Problems <span class="SpellE">Center</span>, Cholesterol <span class="SpellE">Center</span>, Heart <span class="SpellE">Center</span>, and <span class="SpellE">Statins</span> <span class="SpellE">Center</span>. Also, see <span class="SpellE">eMedicine's</span> patient education articles Angina Pectoris, High
Cholesterol, Understanding Your Cholesterol Level, Lifestyle Cholesterol
Management, Understanding Cholesterol-Lowering Medications, Chest Pain, Coronary
Heart Disease, and Heart Attack.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial; text-align: center;">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">MISCELLANEOUS<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<b><span lang="EN-GB" style="background-color: white; font-size: 14pt;">Medical/Legal Pitfalls:
<o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In patients with stable angina
pectoris, even the most carefully performed history and physical examination
have limitations. Classification of these patients solely on the basis of
history and physical examination findings may lead to serious mistakes. Some
type of stress testing is usually indicated to confirm the diagnosis and <span class="SpellE">quantitate</span> the severity of ischemia.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;">In women, elderly persons, and
diabetic patients, coronary artery disease may manifest with atypical
presentations other than angina pectoris, such as silent ischemia or infarction.
Physicians should use a careful approach when evaluating these
patients.<o:p></o:p></span></div>
<div class="MsoNormal" style="background-position: initial initial; background-repeat: initial initial;">
<span lang="EN-GB" style="background-color: white; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="background-color: white;"><span style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><b><span lang="EN-US" style="font-size: 14pt;">LITERATURE</span></b><span style="font-size: 14pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 36pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="RU" style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span lang="EN-GB" style="font-size: 14pt;">Allen KB,
<st1:street w:st="on"><st1:address w:st="on">Dowling
RD</st1:address></st1:street>, Fudge TL, et al: Comparison of <span class="SpellE">transmyocardial</span> revascularization with medical therapy in
patients with refractory angina. </span><span class="SpellE"><span lang="RU" style="font-size: 14pt;">N</span></span><span lang="RU" style="font-size: 14pt;"> <span class="SpellE">Engl</span><a href="" name="section~bibliography"> </a><span class="SpellE">J</span> <span class="SpellE">Med</span> 1999
<span class="SpellE">Sep</span> 30; 341(14): 1029-36.
<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 36pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="RU" style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span class="SpellE"><span lang="EN-GB" style="font-size: 14pt;">Ambrosio</span></span><span lang="EN-GB" style="font-size: 14pt;"> G,
<span class="SpellE">Betocchi</span> S, Pace L, et al: Prolonged impairment of
regional contractile function after resolution of exercise-induced angina.
Evidence of myocardial stunning in patients with coronary artery disease.
</span><span class="SpellE"><span lang="RU" style="font-size: 14pt;">Circulation</span></span><span lang="RU" style="font-size: 14pt;"> 1996 <span class="SpellE">Nov</span> 15;
94(10): 2455-64. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 36pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span lang="EN-GB" style="font-size: 14pt;">Cannon CP, <span class="SpellE">Braunwald</span> E, McCabe CH, et al: Intensive versus moderate
lipid lowering with <span class="SpellE">statins</span> after acute coronary
syndromes. <st1:place w:st="on">N <span class="SpellE">Engl</span></st1:place> J
Med 2004 Apr 8; 350(15): 1495-504. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 36pt; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="background-color: white;"><span lang="EN-GB" style="font-family: Symbol; font-size: 10pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span lang="EN-GB" style="font-size: 14pt;">Gibbons RJ,
<span class="SpellE">Balady</span> <span class="SpellE">GJ</span>, Bricker JT, et
al: ACC/AHA 2002 guideline update for exercise testing: summary article: a
report of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing
Guidelines). Circulation 2002 Oct 1; 106(14): 1883-92. <o:p></o:p></span></span></div>
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</span></span><span lang="EN-GB" style="font-size: 14pt;">Grundy SM, <span class="SpellE">Cleeman</span> <span class="SpellE">JI</span>, <span class="SpellE">Merz</span> <span class="SpellE">CN</span>, et al: Implications of
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</span></span><st1:place w:st="on"><st1:city w:st="on"><span class="SpellE"><span lang="EN-GB" style="font-size: 14pt;">Lanza</span></span></st1:city><span lang="EN-GB" style="font-size: 14pt;">
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</span></span><span lang="EN-GB" style="font-size: 14pt;">National
Cholesterol Education Program: Executive Summary of <span class="GramE">The</span>
Third Report of The National Cholesterol Education Program (<span class="SpellE">NCEP</span>) Expert Panel on Detection, Evaluation, And Treatment
of High Blood Cholesterol In Adults (Adult Treatment Panel III). <span class="SpellE">JAMA</span> 2001 May 16; 285(19): 2486-97. <o:p></o:p></span></span></div>
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</span></span><span lang="EN-GB" style="font-size: 14pt;">Scandinavian
<span class="SpellE">Simvastatin</span> Survival Study Group: Randomised trial of
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<span class="SpellE">Blauw</span> <span class="SpellE">GJ</span>, <st1:place w:st="on"><st1:city w:st="on">Murphy</st1:city> <st1:state w:st="on">MB</st1:state></st1:place>, et al: <span class="SpellE">Pravastatin</span> in elderly individuals at risk of vascular
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Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com1tag:blogger.com,1999:blog-7275300796104068287.post-30091706430655746642013-02-28T12:10:00.000-08:002013-02-28T12:10:27.228-08:00Immunization And A Typical Example Of A National Vaccination Plan, Taking Ukraine As A Case Study<div class="separator" style="clear: both; text-align: center;">
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Protection from infectious diseases</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> is referred to immunity. That’s why immune prophylaxis is the most potential method of infectious diseases prevention. World experience shows that potential risk of post immunization reactions and complications is very low. And risk of infectious diseases’ complications and mortality really overweight them. Ambulatory pediatrician plays the main role in immune prophylaxis program. Organization of immune prophylaxis is the main prophylactic work of the ambulatory pediatrician.<b><o:p></o:p></b></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">The immunoprophylaxis task</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> is management by immunological answer to prevent the disease beside separate persons and groups of the population.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">The ways of the immunoprophylaxis</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">:<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Active - stimulation of own antibodies production,<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Passive - introduction of ready antibodies.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccines preparations characteristic<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccines, which include complete killed microorganisms (pertussis, typhoid, cholera) or inactivated viruses (influenza, poliomyelitis Salk vaccine)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Anatoxins, which contains inactivated toxin of the bacteria (diphtheria, tetanus)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">The vaccines from <span class="GramE">alive</span> attenuated viruses (measles, mumps and others.)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccines, which contains crossing alive microorganisms (BCG)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Chemical vaccines from fraction of killed microorganisms (pneumococcal, meningococcal)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Gene-engineering recombinant, chemical synthesized (hepatitis В, influenza)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">7.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Associated (in composition of which enters several vaccines)<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Composition of vaccines:<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1. Active or immunizing antigens<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2. Fluid base<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3. Preservatives, stabilizers, antibiotics<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4. Auxiliary facilities<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Ways of the vaccination<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1. Intramuscular (DTP, DT, DT-M, antirhabic, meningococcal B)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2. Subcutaneous (measles, mumps, rubella, meningococcal A+C)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3. Intracutaneous (BCG)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4. <span class="GramE">On</span> skin (plague, tularemia, brucellosis)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5. Peroral (poliomyelitis)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6. Intranasal (Influenza, inactivated)<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Ukrainian Immunization Schedule</span></b><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">The Calendar of preventive vaccinations in <st1:country-region w:st="on"><st1:place w:st="on">Ukraine</st1:place></st1:country-region> (hereinafter - Calendar) includes four sections: vaccination by the age, vaccination by the health, vaccination, conducted in endemic and enzootic areas and the epidemic evidences for recommended vaccinations.<o:p></o:p></span></div>
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<span class="GramE"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Section 1.</span></b></span><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> Vaccination by the Age <o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman';"> Age</span></b><b><span style="font-family: 'Times New Roman';"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination for prevention</span></b><b><span style="font-family: 'Times New Roman';"><o:p></o:p></span></b></div>
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<b><span style="font-family: 'Times New Roman';">Notes<o:p></o:p></span></b></div>
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<span style="font-family: 'Times New Roman'; font-size: 10pt;">1</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">day</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Hepatitis</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"> В<sup>2</sup><o:p></o:p></span></div>
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</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
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</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">3-7 </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">days</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Tuberculosis</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">1</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">1 mo.<o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Hepatitis</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"> В<sup>2</sup><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">3 mo.<o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Diphtheria, tetanus, pertussis<sup>3</sup><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Poliomyelitis<sup>4</sup>,</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">IPV</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Hemophilus influenza infection</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">5</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">By DTaP vaccine for children with a high risk of postvaccinal complications<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">4 mo.<o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Diphtheria, tetanus, pertussis<sup>3</sup><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Poliomyelitis<sup>4</sup>,</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">IPV</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Hemophilus influenza infection</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">5</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">By DTaP vaccine for children with a high risk of postvaccinal complications<o:p></o:p></span></div>
</td></tr>
<tr><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">5 mo.<o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Diphtheria, tetanus, pertussis<sup>3</sup><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Poliomyelitis<sup>4</sup>,</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">OPV</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Hemophilus influenza infection</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">5</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">By DTaP vaccine for children with a high risk of postvaccinal complications<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">6 mo.<o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Hepatitis</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"> В<sup>2</sup><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">12mo.<o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Mumps, measles, rubella<sup>6</sup><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">18 mo.<o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Diphtheria, tetanus, pertussis<sup>3</sup> ,<br />By aDTP vaccine<o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Poliomyelitis<sup>4</sup>,</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">OPV</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Hemophilus influenza infection</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">5</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">6 years<o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Diphtheria, tetanus</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">3</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Poliomyelitis<sup>4</sup>,</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">OPV</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Mumps, measles, rubella<sup>6</sup><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">7 years<o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Tuberculosis</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">1</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">14 years<o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Tuberculosis</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">1</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Diphtheria, tetanus</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">3</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Poliomyelitis<sup>4</sup>,</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">OPV</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">15 years<o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">Rubella<br />(</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">girls</span><span style="font-family: 'Times New Roman'; font-size: 10pt;">),</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Mumps</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><br />(</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">boys</span><span style="font-family: 'Times New Roman'; font-size: 10pt;">)<sup>6</sup><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Times New Roman'; font-size: 10pt;">18 years<o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Diphtheria, tetanus</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">3</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="background-color: #eaf4f4; background-position: initial initial; background-repeat: initial initial; border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td></tr>
<tr><td style="border-bottom-color: black; border-bottom-width: 1pt; border-left-color: black; border-left-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Adults</span><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: none solid solid none; padding: 3.75pt;"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 10pt;">Diphtheria, tetanus</span><sup><span style="font-family: 'Times New Roman'; font-size: 10pt;">3</span></sup><span style="font-family: 'Times New Roman'; font-size: 10pt;"><o:p></o:p></span></div>
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<sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1</span></sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> Vaccines are injected to all newborns, which has no contraindications. Immunization is done by a vaccine to prevent tuberculosis (hereinafter - the BCG). For vaccination of premature infants weighing ≥ <st1:metricconverter productid="2000 g" w:st="on">2000 g</st1:metricconverter> should be used TB vaccine with reduced antigen content (hereinafter - the BCG-M).<o:p></o:p></span></div>
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<span lang="EN-US"> </span><img height="400" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image002.jpg" v:shapes="_x0000_i1025" width="408" /> </div>
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<span lang="EN-US" style="color: red; font-family: 'Times New Roman'; font-size: 14pt;">Vaccination for tuberculosis prevention could not be done in the same day with other vaccines or other parenteral manipulations.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Children, who were not vaccinated in the maternity hospital for any reason, need to be vaccinated in children's ambulatory departments. For vaccination of children not immunized in the maternity hospital because of medical contraindications BCG-M or half-dose of BCG vaccine must be injected.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">If the child is not vaccinated in the maternity hospital because of no medical contraindications, BCG vaccine is used. Children who are under 2 months don’t need Mantoux test before vaccination against TB. Mantoux test before vaccination against TB should be done for babies elder than 2 months. A negative test result allows making vaccination.<o:p></o:p></span></div>
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<img height="342" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image007.jpg" v:shapes="_x0000_i1028" width="255" /> <img height="298" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image009.jpg" v:shapes="_x0000_i1029" width="454" /><span lang="EN-US"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">"Lemon peel" after the injection of tuberculin<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Positive Mantoux test<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Booster (revaccination) by BCG is given to children aged 7 and 14 years with negative Mantoux test.<o:p></o:p></span></div>
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<img height="372" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image012.jpg" v:shapes="_x0000_i1031" width="254" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">In the absence of vaccination (BCG) navel children with negative Mantoux test should have additional vaccine 2 years after vaccination.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Mantoux test is done with 2 tuberculin unites (TU). <span style="color: red;">Due to the fact that preventive vaccination may affect the sensitivity to tuberculin, that’s why Mantoux test needs to be planned before preventive vaccination. In the other case Mantoux test should be done no earlier than 1 month after vaccination.<o:p></o:p></span></span></div>
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<sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2</span></sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> <b><span style="color: #3366ff;">Immunization by monovalent hepatitis B vaccine</span></b> is done to all newborns.<o:p></o:p></span></div>
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<img height="254" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image014.jpg" v:shapes="_x0000_i1032" width="254" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">If mother of a newborn is HBsAg "-" (negative), which is documented, the child may begin vaccination during the first months of life, or combined with vaccination against pertussis, diphtheria, tetanus, polio. In the case of immunization with a combination of vaccination against pertussis, diphtheria, tetanus, polio recommended scheme: 3-4-5-18 months, or: 3-4-9 months.<o:p></o:p></span></div>
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<img height="225" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image016.gif" v:shapes="_x0000_i1033" width="385" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Newborns weighing <<st1:metricconverter productid="2000 g" w:st="on">2000 g</st1:metricconverter> born by HBsAg negative mothers, vaccination is done when the child’s weight will be <st1:metricconverter productid="2000 g" w:st="on">2000 g</st1:metricconverter> or at the age of 1 month.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">If the newborn child is in critical condition, the child immunization should be done when he will better before hospital discharge.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccination against viral hepatitis B of newborns, whose mothers are carriers of HBsAg, is necessary to do by the accelerated scheme: 0-1-2 and 12 months (0 - date of first vaccination at birth, the minimum interval between the first, second and third vaccine – 1 month, third and fourth vaccine - 10 months). The first dose is entered in the first 12 hours of a child's life regardless of body weight. If there is a specific immunoglobulin against hepatitis B with vaccine in other parts of the body is entered a specific immunoglobulin 40 IU / kg body weight, but not less than 100 IU, in this case vaccination may be used for pattern: 0-1-6 months. If the weight of a newborn child less than <st1:metricconverter productid="2000 grams" w:st="on">2000 grams</st1:metricconverter>, vaccination is required, but this dose is not count as a dose of primary immunization; when the child reaches the age of 1 month a series of three doses of vaccine should be done 0-1-6 (0 - date of first vaccination, the minimum interval between the first and second vaccine - 1 month, second and third vaccine - 5 months). <o:p></o:p></span></div>
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<img height="332" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image017.jpg" v:shapes="_x0000_i1034" width="492" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">If mother’s HBsAg status is unknown, child requires vaccination in the first 12 hours of life, while the HbsAg status of mother is researched. If a result is positive a newborn baby is vaccinated as a newborn of HBsAg "+" mother.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">For vaccination of children and adults against hepatitis B outside the vaccinations calendar a scheme 0, 1, 6 months is recommended.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Do not start the vaccination series, if the dose was omitted, no matter how much time has passed. You must enter a doze, for missing the schedule with the minimum spacing (see section 1.2 "Vaccination of children in violation of the calendar”).<o:p></o:p></span></div>
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<span class="GramE"><sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3</span></sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> Vaccinations for the prevention of</span><span lang="EN-US" style="font-family: 'Times New Roman';"> </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">diphtheria, tetanus and pertussis in the age 3, 4 and 5 months by diphtheria-tetanus-pertussis vaccine (hereinafter - DTP), or vaccine with acellular pertussis component (hereinafter - DTaP).</span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> The interval between the first and second, second and third vaccination is 30 days. The interval between the third and fourth vaccination should be not less than 12 months.<o:p></o:p></span></div>
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<img height="256" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image019.jpg" v:shapes="_x0000_i1035" width="345" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">The first booster at 18 months is done by DTaP.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">DTaP is used for further inoculations for children who have had previous complications after DTP vaccination, and immunization for all children with high risk of complications. For the prevention of</span><span lang="EN-US" style="font-family: 'Times New Roman';"> </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">diphtheria, tetanus, pertussis, polio, hepatitis B and infections caused by bacteria Haemophilus influenza type b (hereinafter - Hib), you can use the combined vaccine (with variations of antigens combinations) that are registered in <st1:place w:st="on"><st1:country-region w:st="on">Ukraine</st1:country-region></st1:place>.<o:p></o:p></span></div>
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<img height="181" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image021.jpg" v:shapes="_x0000_i1036" width="384" /> <img height="347" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image022.jpg" v:shapes="_x0000_i1037" width="510" /><span lang="EN-US"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccination of children less than 4 years off the calendar dates should be done with such calculation, that the child will be managed to get DTP or DTaP immunization fourfold up to 3 years 11 months and 29 days.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">For children who received primary vaccinal complex (in 3, 4, 5 and 18 months) DTaP or have received three doses DTaP and one DTP, revaccination in 6 and 14 years by diphtheria-tetanus-pertussis acellular vaccine with reduced antigen content (hereinafter - DTaP-M).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">For children who received for primary vaccinal complex DTP or received two doses DTP and two doses</span><span lang="EN-US" style="font-family: 'Times New Roman';"> </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">DTaP the first vaccination against diphtheria and tetanus (6 years) by a diphtheria-tetanus toxoid (hereinafter - DT), second (in 14 years) and third (at 18) - by a diphtheria-tetanus toxoid with reduced antigen content (hereinafter - DT-M ). For children, vaccinated against tetanus because the injury by tetanus toxoid (hereinafter - T) over the past two years, a regular vaccination against diphtheria only with a reduced content of diphtheria antigen in diphtheria toxoid (hereinafter - D-M) should be done.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Children under 5 years 11 months 29 days, which had pertussis, receive DT. Vaccination is triple, interval between the first and second inoculation 30 days between the second and third - 9-12 months.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">The first routine adult vaccination by age and epidsituation that were previously vaccinated should be made by DT-M at interval of 5 years after the last vaccination. <span class="GramE">Further routine vaccinations for adults by DT-M with a minimum 10 years interval from the previous vaccination.</span><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Teenagers and adults who have not previously been vaccinated or do not have data on immunization, vaccination is triple by DT-M (interval between the first and second inoculation should be 30-45 days between the second and third - 6-12 months). <span class="GramE">Revaccination of those teenagers (who are vaccinated outside the scheme) with a minimum interval of 3 years after the last diphtheria and tetanus vaccination.</span><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">For active immunization against tetanus person elder than 60 years, not vaccinated last 10 years, a shortened vaccination scheme is used (single inoculation T-toxoid in double dose - <st1:metricconverter productid="20 oz" w:st="on">20 oz</st1:metricconverter> / ml, with a booster dose at 12 months - <st1:metricconverter productid="10 oz" w:st="on">10 oz</st1:metricconverter> / ml) and further every 10 years with no age restrictions.<o:p></o:p></span></div>
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<span lang="EN-US" style="color: red; font-family: 'Times New Roman'; font-size: 14pt;">Do not start the vaccination series, if the dose was omitted, no matter how much time has passed. You must enter a doze, missing the schedule, with a minimum spacing.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Because of possible postvaccinal reactions (after DTP-input), such as increased body temperature, which may lead to convulsions, recommend paracethamol in age doses within 1 day after vaccination.<o:p></o:p></span></div>
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<sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4</span></sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> <b><span style="color: #3366ff;">Inactivated vaccine to prevent polio (hereinafter - IPV)</span></b> is used for the first two immunizations, while <b><span style="color: #3366ff;">the oral polio vaccine (hereafter - OPV)</span></b> contraindications - for all these immunizations on the calendar.<o:p></o:p></span></div>
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<img height="210" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image023.jpg" v:shapes="_x0000_i1038" width="300" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">OPV vaccine is used for 3 - 6th vaccination (third vaccination and age revaccination) with no contraindications to OPV.<o:p></o:p></span></div>
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<img height="306" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image025.jpg" v:shapes="_x0000_i1039" width="408" /></div>
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<img height="307" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image027.jpg" v:shapes="_x0000_i1040" width="409" /></div>
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<span lang="EN-US" style="color: red; font-family: 'Times New Roman'; font-size: 14pt;">After the OPV is proposed to restrict injections, parenteral <span class="GramE">intervention, routine operations for 40 days, exclude</span> contact with HIV-infected.<o:p></o:p></span></div>
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<span lang="EN-US" style="color: red; font-family: 'Times New Roman'; font-size: 14pt;">Do not start the vaccination series, if the dose was omitted, no matter how much time has passed. Enter dose, which lacks the schedule, with minimum spacing.<o:p></o:p></span></div>
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<b><sup><span lang="EN-US" style="color: #3366ff; font-family: 'Times New Roman'; font-size: 14pt;">5</span></sup></b><b><span lang="EN-US" style="color: #3366ff; font-family: 'Times New Roman'; font-size: 14pt;">Vaccination to prevent Hib-infection</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> can be done by mono- and combined vaccines containing Hib- components. In the case of Hib-vaccine and DTP-vaccine are from various manufacturers they should be inserted in different parts of the body. <u>It is advisable to use combined Hib-vaccines for primary vaccination.<o:p></o:p></u></span></div>
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<img height="354" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image029.jpg" v:shapes="_x0000_i1041" width="216" /> <img height="238" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image031.jpg" v:shapes="_x0000_i1042" width="234" /> <img height="301" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image032.jpg" v:shapes="_x0000_i1043" width="442" /></div>
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<span class="GramE"><sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6</span></sup><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> <b><span style="color: #3366ff;">Vaccination to prevent measles, mumps and rubella</span></b> by the combined vaccine (hereafter - MMR) at the age of 12 months.</span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> <span class="GramE">The second vaccine to prevent measles, mumps and rubella - in 6 years.</span><o:p></o:p></span></div>
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<img height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image033.jpg" v:shapes="_x0000_i1044" width="300" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Kids who were not vaccinated against measles, mumps or rubella by age 12 months and 6 years, vaccination can begin at any age before 18 years. In this case, the child should receive 2 doses in compliance with the minimum spacing between them.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Children age 15 who received 1 or 2 vaccinations against measles, but not vaccinated against rubella and mumps and didn’t ill with these infections, vaccinations against mumps (guys) or rubella (girls) is scheduled.<o:p></o:p></span></div>
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<img height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image034.gif" v:shapes="_x0000_i1045" width="233" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">18 years or older who have not previously been vaccinated against these infections can be vaccinated with one dose of vaccine at age to 30 years.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Previous diseases as measles, mumps or rubella are not contraindications to vaccination by trivaccine. In a history of these two diseases, vaccination should be done by monovaccine against the infection, which the child was not ill before.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Women of childbearing age that were not sick and have not been vaccinated against rubella may receive vaccination at their own request in accordance with the instruction to vaccines.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="color: #993300; font-family: 'Times New Roman'; font-size: 14pt;">1.2. Vaccination of children in violation of the calendar<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">In deciding on the vaccination of children in violation of the calendar, you should plan with the following minimum intervals.<o:p></o:p></span></div>
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<strong><span lang="EN-US">For children from 4 months to 6 years 11 months 29 days</span></strong><span lang="EN-US"><o:p></o:p></span></div>
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<span lang="EN-US">Vaccines<o:p></o:p></span></div>
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<span lang="EN-US">Minimal interval between doses<o:p></o:p></span></div>
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<span lang="EN-US">1<sup>st</sup> and 2<sup>nd</sup> doses<o:p></o:p></span></div>
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<span lang="EN-US">2<sup>nd</sup> and 3<sup>rd</sup> doses</span></div>
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<span lang="EN-US">3<sup>rd</sup>and 4<sup>th</sup> doses</span></div>
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<span lang="EN-US">DTP</span>, <span lang="EN-US">DTaP</span></div>
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1 month</div>
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1 month</div>
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12 month<span lang="EN-US">s</span></div>
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<span lang="EN-US">DT</span></div>
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1 month</div>
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9 month<span lang="EN-US">s<o:p></o:p></span></div>
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<span lang="EN-US">Polio vaccine<o:p></o:p></span></div>
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1 month</div>
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1 month</div>
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12 month<span lang="EN-US">s</span></div>
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<span lang="EN-US">Hepatitis B vaccine</span></div>
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1 month</div>
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1 month</div>
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<br /></div>
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<span lang="EN-US">MMR<o:p></o:p></span></div>
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1 year<span lang="EN-US"><o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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Hib - vaccine</div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">4 weeks: if the first dose is introduced to 12 months.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">8 weeks (as the last dose): if first dose is entered at the age of 12-14 months.<o:p></o:p></span></div>
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<span lang="EN-US">Do not put: if the first dose is entered in 15 months or later<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">4 weeks: if a second dose is introduced to 12 months.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">8 weeks (as the last dose): if a child age 12 months or more and a second dose was put under 15 months.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Do not put: if the first dose is entered in 15 months or older<o:p></o:p></span></div>
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<br /></div>
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<strong><span lang="EN-US">For children from 7 to 18 years</span></strong><span lang="EN-US"><o:p></o:p></span></div>
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<strong><span lang="EN-US">Minimal interval between doses</span></strong><span lang="EN-US"><o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">1<sup>st</sup> and 2<sup>nd</sup> doses<o:p></o:p></span></div>
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<span lang="EN-US">2<sup>nd</sup> and 3<sup>rd</sup> doses</span></div>
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<span lang="EN-US">3<sup>rd</sup>and 4<sup>th</sup> doses</span></div>
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<span lang="EN-US">DT</span>-м</div>
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1 month</div>
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6-9 <span lang="EN-US">months<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">MMR</span></div>
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1 <span lang="EN-US">year<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<span lang="EN-US">Hepatitis B vaccine</span></div>
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1 month</div>
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1 month</div>
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<br /></div>
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<span lang="EN-US">Polio vaccine<o:p></o:p></span></div>
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1 month</div>
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1 month</div>
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12 <span lang="EN-US">months<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 9pt;"> </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">When planning the application of certain vaccines or toxoids for prevention of various infectious diseases should observe the following features:<o:p></o:p></span></div>
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<br /></div>
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<b><span lang="EN-US">Combination of drugs for vaccination<o:p></o:p></span></b></div>
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<b><span lang="EN-US">Recommended intervals<o:p></o:p></span></b></div>
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<span lang="EN-US">>= 2 inactivated vaccines and / or toxoid<o:p></o:p></span></div>
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<span lang="EN-US">Vaccine could be introduced with time interval as in immunization Calendar<o:p></o:p></span></div>
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<span lang="EN-US">Living vaccines + inactivated vaccine or toxoids<o:p></o:p></span></div>
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<span lang="EN-US">>= 2 live vaccines for parenteral administration (except BCG)<o:p></o:p></span></div>
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<span lang="EN-US">Vaccines can be introduced simultaneously in different parts of the body or with an interval no less 1 month<o:p></o:p></span></div>
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<span lang="EN-US">BCG vaccine combination with other vaccines<o:p></o:p></span></div>
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<span lang="EN-US">BCG vaccine does not spend the same day with other vaccines.<br />Other preventive vaccination eligible taken at intervals not less than 2 months before or after vaccination with BCG vaccine (except hepatitis B vaccine)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">If necessary, the doctor has the right to enter all vaccines, toxoids, which are shown on the plan (except BCG), per one visit, providing injections in different parts of the body. Otherwise, the doctor plans vaccination with the minimum intervals between vaccines, toxoids and their combination against various infectious diseases.<o:p></o:p></span></div>
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<br /></div>
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<b><span lang="EN-US" style="color: #993300; font-family: 'Times New Roman'; font-size: 14pt;">1.3. HIV / AIDS children Vaccination<o:p></o:p></span></b></div>
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<b><span lang="EN-US">Defining the situation</span><o:p></o:p></b></div>
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<b><span lang="EN-US">Vaccines</span><o:p></o:p></b></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman';">Holding vaccinations<o:p></o:p></span></b></div>
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<br /></div>
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<span lang="EN-US">A baby is born HIV-infected mother (Z20.6; R75) - child HIV status is not defined<o:p></o:p></span></div>
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<span lang="EN-US">OPV*, BCG, measles, mumps, rubella<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Do not vaccine before HIV status<o:p></o:p></span></div>
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<span lang="EN-US">identifying<o:p></o:p></span></div>
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<span lang="EN-US">Inactivated vaccines</span>, <span lang="EN-US">toxoids</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">By the calendar<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Asymptomatic HIV carrier state (Z21) or with weakly expressed clinic (clinical stage I and II **) in the absence of immunosuppression (CD4 +> 25%) or with moderate immunosuppression (CD4 +> 15%)<o:p></o:p></span></div>
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<span lang="EN-US">OPV*, BCG,</span></div>
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<span lang="EN-US">Do not vaccine</span></div>
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<span lang="EN-US">Other vaccines, toxoids</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">By the calendar<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Child AIDS (clinical stage III, stage II by WHO with severe immunosuppression (CD4 + <15%)<o:p></o:p></span></div>
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<span lang="EN-US">Do not vaccine</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">* </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 9pt;">OPV</span><span lang="EN-US" style="font-family: 'Times New Roman';"> Vaccination is replaced with IPV throughout the calendar. </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 9pt;">OPV</span><span lang="EN-US" style="font-family: 'Times New Roman';"> is not given to family members of HIV-positive person who cares for him.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">** Classification of the World Health Organization (hereinafter - WHO)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">When vaccine vitamins that contain vitamin A should be administered.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccinations are carried out in outpatient or inpatient departments.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">A child patronage by medical workers on 3-4<sup>th</sup> and 10<sup>th</sup>-11<sup>th</sup> day of postvaccinal period should be done.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Persons with HIV / AIDS passive immunization by immunoglobulin preparations because of epidemic is independent from previously held active immunization.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Persons with HIV / AIDS need to receive additional vaccinations as provided in Calendar section 2, "Vaccinations for health".<o:p></o:p></span></div>
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<span class="GramE"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Section 2.</span></b></span><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> Vaccinations for health<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccinations for health are required in the medical support of patients with high risk of infection and its possible severe course, against which vaccination by age is not provided in terms of vaccinations.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="color: #3366ff; font-family: 'Times New Roman'; font-size: 14pt;">2.1. Vaccination scheme for children by health<o:p></o:p></span></b></div>
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<b><span lang="EN-US">Vaccination against</span><o:p></o:p></b></div>
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<b><span lang="EN-US">Vaccination scheme<o:p></o:p></span></b></div>
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<b><span lang="EN-US">Indications</span><o:p></o:p></b></div>
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<b><span lang="EN-US">Note</span><o:p></o:p></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Flu<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Annually. Permission for vaccination of children 6 - month old. The optimal time for vaccination is October-November. <o:p></o:p></span></div>
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<span lang="EN-US">Children under the age of 9 years that had not received vaccination against influenza, vaccination is carried out with minimum 2 doses at intervals of 1 month.<o:p></o:p></span></div>
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<span lang="EN-US"> HIV infection</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">See Calendar subsection 1.3<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">“Immunization of HIV-infected Children and AIDS patients”<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Primary immunodeficiency (select IgA deficit , IgG subclasses deficiency, transient hypogammaglobulinemia, phagocytosis deficits, complement system deficits)<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Chronic liver disease (including cirrhosis and fibrosis)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Bronchial asthma<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Renal (chronic renal failure or nephrotic syndrome)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Chronic lung disease (birth abnormalities, acquired disease, cystic fibrosis)<o:p></o:p></span></div>
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<br /></div>
</td></tr>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Chronic lesions of the cardiovascular system (birth and acquired heart defects, cardiomyopathy)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Functional or Anatomic asplenia (including - sickle-cell anemia)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Transplantation of bone marrow</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination is not earlier than 6 months after transplantation<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Patients continued hold acetylsalicylic acid<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Lymphoma<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Multiple Myeloma<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Leukemia<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination is made not earlier than 3-4 weeks after<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">immunosuppressive therapy (chemotherapy) and the increase granulocytes and lymphocytes in peripheral blood > 1000 cells / mcl (> 1.0 *10<sup>9 </sup>/ l)<o:p></o:p></span></div>
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<span lang="EN-US">Staphylococcus pneumonia infection<o:p></o:p></span></div>
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<span lang="EN-US">Vaccination by unconjugated Polysaccharide vaccine patients 2 years or older, once (except for recipients of bone marrow) with the need to revaccination no earlier than 5 years<o:p></o:p></span></div>
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<span lang="EN-US">HIV infection</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">See Calendar subsection 1.3<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">"Immunization of HIV-infected Children and AIDS patients<o:p></o:p></span></div>
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<span lang="EN-US"><br /><br /><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Renal (chronic renal failure or nephrotic syndrome)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Primary immune deficiency - deficiency of complement system (early proteins - C1, C4, C2, C3), selective IgA deficiency<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Bronchial asthma</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Vaccine is carried out at PSV OFV1 or 80% of the required parameters, variability in performance or PSV OFV1 <20-30% with stable severe disease<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Functional or anatomic asplenia (including sickle-cell anemia)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination 2 weeks before planned splenectomy. Otherwise the most earlier after it<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Chronic liver disease (including cirrhosis and fibrosis)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Nasal liquorrea (chronic, remittent)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Diabetes type 1<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Chronic lung disease (birth abnormalities, acquired disease, cystic fibrosis)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Tuberculosis (infected ILO)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Chronic lesions of the cardiovascular system (birth and acquired heart defects, cardiomyopathy)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Lymphoma<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Multiple Myeloma<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Leukemia<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Hodgkin's disease<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';"><br />Vaccines are held 2 weeks prior to the immunosuppressive<o:p></o:p></span></div>
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<span class="GramE"><span lang="EN-US">therapy</span></span><span lang="EN-US">. Otherwise - 3 months after cessation of immunosuppressive therapy<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Immunosuppressive hormone therapy (as defined. "List of Medical Contraindications to preventive vaccination" this order)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination is made 2 weeks before the beginning of immunosuppressive therapy or after its termination<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Bone marrow transplantation<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">The optimal vaccination is at 12 and 24 months after transplant<o:p></o:p></span></div>
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<span lang="EN-US">Internal organs transplantation<o:p></o:p></span></div>
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<span lang="EN-US">Optimal vaccination 6 months after transplantation<o:p></o:p></span></div>
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<span lang="EN-US">Meningococcal infection<o:p></o:p></span></div>
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<span lang="EN-US">Persons older than 18 months are vaccinated only once <o:p></o:p></span></div>
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<span lang="EN-US">Functional or anatomic asplenia (including sickle-cell anemia)<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Deficiency of complement system (early proteins - C1, C4, C2, C3, </span>С<span lang="EN-US">5-</span>С<span lang="EN-US">9 ), properdyn, </span>В<span lang="EN-US"> factor<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Varicella zoster vaccine</span></div>
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<span lang="EN-US">Is made to persons over 12 months are vaccinated only once <o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<span lang="EN-US">While vaccination persons older than 13 years - double with 4-weeks intervals<o:p></o:p></span></div>
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<span lang="EN-US">Chronic renal failure</span></div>
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<br /></div>
</td></tr>
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<br /></div>
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<span lang="EN-US">HIV infection </span>/AIDS<span lang="EN-US"><o:p></o:p></span></div>
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<br /></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Vaccines are held at the level of CD4 + > 25% of the age range, CDC class N1 or A1, two doses with3 - month intervals<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<span lang="EN-US">Transplantation of bone marrow</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination is not earlier than 24 months and the absence of Immunosuppression (increased granulocytes and lymphocytes in peripheral blood > 1000 cells / mcl / > 1.0 *10<sup>9</sup> / l <o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Primary immunodeficiency without T-cell lesions<o:p></o:p></span></div>
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<br /></div>
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<tr><td rowspan="5" style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Hepatitis B</span></div>
</td><td rowspan="5" style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Vaccination of children not vaccinated before<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Chronic liver damage (infectious and noninfectious genesis)<o:p></o:p></span></div>
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<br /></div>
</td></tr>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Transplantation<o:p></o:p></span></div>
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<br /></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Children who are on hemodialysis<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">See subsection 2.2. Scheme vaccination hepatitis in children with malignant neoplasms, children are on hemodialysis and receiving long-term repeated blood transfusion<o:p></o:p></span></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Children who receive long term repeated blood transfusion<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Children who need a landmark surgery<o:p></o:p></span></div>
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<br /></div>
</td></tr>
<tr><td rowspan="2" style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Hepatitis</span> А</div>
</td><td rowspan="2" style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Is made to persons over 12 months of life double at intervals of 6 months<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Chronic liver damage (infectious and noninfectious genesis)<o:p></o:p></span></div>
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<br /></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Liver transplantation</span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Optimal to vaccinate before transplantation. Otherwise - best 6 months after transplantation<o:p></o:p></span></div>
<div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
</td></tr>
</tbody></table>
</div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<img height="461" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image036.jpg" v:shapes="_x0000_i1046" width="533" /></div>
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<br /></div>
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<img height="383" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image037.jpg" v:shapes="_x0000_i1047" width="575" /></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="font-family: 'Courier New'; font-size: 12pt;">Influenza vaccine</span><span style="font-family: Arial; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<img height="292" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image038.jpg" v:shapes="_x0000_i1048" width="389" /></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
Vaccine against meningococcal infection</div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<img height="268" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image039.jpg" v:shapes="_x0000_i1049" width="220" /></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
Varicella-Zoster vaccine</div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.2. Hepatitis B vaccination <span class="GramE">scheme in</span> children with malignant neoplasms, children that are on hemodialysis and receiving long-term repeated blood transfusion<o:p></o:p></span></b></div>
<div align="center">
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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<b><span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination</span></b><b><span style="font-family: 'Times New Roman';"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination Term</span></b><b><span style="font-family: 'Times New Roman';"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman';">Notes</span></b><b><span style="font-family: 'Times New Roman';"><o:p></o:p></span></b></div>
</td></tr>
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<span lang="EN-US">The first </span><span lang="EN-US" style="font-size: 9pt;"> </span><span style="font-size: 9pt;"><o:p></o:p></span></div>
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<span lang="EN-US">Begins at any age</span><span style="font-size: 9pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Vaccination by a double dose of vaccine in an outpatient department<o:p></o:p></span></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Or in a specialized department where the child receives the first course of treatment - if not vaccinated earlier.<o:p></o:p></span></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Those HBsAg "+" (positive) are also subject to vaccination<o:p></o:p></span></div>
<div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">The second</span><span style="font-size: 9pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1 month after first vaccination<o:p></o:p></span></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Third</span><span style="font-size: 9pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1 month after the second vaccination<o:p></o:p></span></div>
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<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
The fourth</div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">6 months after the third vaccination</span><span lang="EN-US" style="font-size: 9pt;"><o:p></o:p></span></div>
</td></tr>
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</div>
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<br /></div>
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<span class="GramE"><b><span lang="EN-US" style="color: #993300; font-family: 'Times New Roman'; font-size: 14pt;">Section 3.</span></b></span><b><span lang="EN-US" style="color: #993300; font-family: 'Times New Roman'; font-size: 14pt;"> Vaccines, held in endemic and enzootic areas and the epidemic evidences<o:p></o:p></span></b></div>
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<br /></div>
<div align="center">
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<b><span lang="EN-US">Vaccines for the prevention</span></b><b><span lang="EN-US" style="font-size: 9pt;"><o:p></o:p></span></b></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<b><span lang="EN-US"> Vaccination Date</span></b><b><span style="font-size: 9pt;"><o:p></o:p></span></b></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<b><span lang="EN-US">Revaccination Dates</span></b><b><span style="font-size: 9pt;"><o:p></o:p></span></b></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<b><span lang="EN-US">Notes</span></b><b><span style="font-size: 9pt;"><o:p></o:p></span></b></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Tularemia<sup>1</sup></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">From 7 years</span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Every 5 years</span></div>
</td><td rowspan="2" style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Rroutine immunization for separate professional groups and those living in endemic regions<o:p></o:p></span></div>
<div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Brucellosis</span><sup>2</sup></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">From 18 years of age<o:p></o:p></span></div>
<div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">After 1 year</span></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Anthrax</span><sup>3</sup></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">From 14 to 60 years</span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">After 1 year</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td><td rowspan="4" style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Unscheduled Immunization is conducted by a territorial<o:p></o:p></span></div>
<div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">authorities, local government and health service<o:p></o:p></span></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Leptospir</span>osis<span lang="EN-US"><o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">From 7 years</span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">After 1 year</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Ku fever<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">From</span> 14 <span lang="EN-US">years<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">According vaccine application instruction<o:p></o:p></span></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Tick borne encephalitis<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Since 4 years<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Every year for three years<o:p></o:p></span></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Plague</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Since 2 years</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">According vaccine application instruction<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
</td></tr>
<tr><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Typhoid fever<sup>4</sup></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Since 7 years</span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Two years<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Immunization is done in determining territory as unfavourable 2-3 months before epidemiological growth by a territoryChief Medical Officer <o:p></o:p></span></div>
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<span lang="EN-US">Influenza</span><sup>5</sup></div>
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<span lang="EN-US">According vaccine application instruction</span></div>
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<span lang="EN-US">According vaccine application instruction</span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Yellow fever</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Since 9 months</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">In 10 years<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Immunization 10 days before traveling to countries endemic for this infection<o:p></o:p></span></div>
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<span lang="EN-US">Rabies</span><sup>6</sup></div>
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<span lang="EN-US">When applying for medical assistance at the biting, scratches, salivation by animals ill or suspicious of rabies <o:p></o:p></span></div>
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<span lang="EN-US">According vaccine application instruction</span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">Routine immunization of rabies risky individuals.<o:p></o:p></span></div>
<div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">A course of vaccine and antirabic immunoglobulin<o:p></o:p></span></div>
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<span lang="EN-US">Diphtheria</span><sup>7</sup></div>
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<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">According vaccine application instruction</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Tetanus<o:p></o:p></span></div>
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<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">According vaccine application instruction</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Hepatitis</span> А<sup>8</sup></div>
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<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">According vaccine application instruction</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
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<span lang="EN-US">Polio</span><sup>9</sup></div>
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<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">According vaccine application instruction</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
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<span lang="EN-US">Measles</span><sup>10</sup></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">According vaccine application instruction</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
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<span lang="EN-US">Mumps</span><sup>10</sup></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">According vaccine application instruction</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
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Rubella<sup>10</sup></div>
</td><td style="border: 1pt inset; padding: 2.25pt;" valign="top"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">According vaccine application instruction</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">Meningococcal infection</span><sup>11</sup></div>
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<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="font-family: 'Times New Roman';">According vaccine application instruction</span><span style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 137.75pt;" valign="top" width="184"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<br /></div>
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<span lang="EN-US">Hepatitis</span> В<sup>12</sup></div>
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<span lang="EN-US">Vaccination by the epidemiological evidences<o:p></o:p></span></div>
</td><td style="border: 1pt inset; padding: 2.25pt; width: 112.4pt;" valign="top" width="150"><div align="left" style="font-size: 12pt; margin: 0cm 0cm 3.75pt;">
<span lang="EN-US">According vaccine application instruction</span></div>
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<br /></div>
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<br /></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccinations for:<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Personal of business items harvesting the industrial animal skin, their primary processing;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vegetable, grain, sugar mills, elevators workers;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Hunters, forest guard, meliorators;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Medical staff of the especially dangerous infections departments and laboratories, plague agencies that work with live tularemia cultures or infected material;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Mills, feed mills, linen factories, enterprises processing agricultural products and raw materials of animal origin workers, who work with feed; shepherds, farmers, meliorators, geologists, builders who work in natural foci of tularemia;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Others.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -18pt;">
<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Livestock farms workers, not prosperous for brucellosis, regardless of ownership;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Meat workers, slaughter points and other enterprises on processing of raw materials and livestock products in the coming agricultural animals or raw materials originating from raising farms, not prosperous for brucellosis;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Veterinary staff who work with live Brucella cultures or contaminated material, and serve economy not prosperous for brucellosis;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Other categories of the population in case of trouble sustainable territories according to the decision of the territorial institutions of state sanitary-epidemiological service, emergency and preventive antiepizootic commissions.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Employees of the especially dangerous infections laboratory departments of sanitary-epidemiological and veterinary laboratory workers who work with live anthrax cultures or infected material.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Waterway and sewage networks employees;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Others.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Groups of medical risk (high chance of influenza clinical complications):<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Courier New'; font-size: 14pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">persons with chronic diseases (respiratory and cardiovascular system, kidneys, metabolism);<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Courier New'; font-size: 14pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">persons aged over 60 years;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Courier New'; font-size: 14pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span class="GramE"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">persons</span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> who are in special groups (orphanages, homes for the elderly, children's homes, etc.).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Epidemic risk groups (high possibility of influenza infection):<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Courier New'; font-size: 14pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">children of preschool age, children, adolescents, students of secondary and tertiary institutions;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Courier New'; font-size: 14pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">healthcare personnel;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Courier New'; font-size: 14pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">preschool staff, secondary and other schools, orphanages, children’s homes and homes for the elderly, etc.;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Courier New'; font-size: 14pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">service sector workers, trade, transport, military, and persons who are in contact with many people;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Courier New'; font-size: 14pt;">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span class="GramE"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">personnel</span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> of enterprises, institutions and organizations (to prevent outbreaks).<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Employees of veterinary laboratories and clinics, hunters, veterinarians, dogs catchers, slaughter-houses workers;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Person applying for medical help because the bites, scratches, salivation by ill or rabies suspected animals.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">7<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">In case of diphtheria focus:<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccination (after quarantine in this focus) persons not vaccinated against diphtheria (vaccination and the first booster vaccination according the age);<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Booster immunization according the calendar to individuals who are subject to re-vaccination in the current year;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Supplementary immunization to persons vaccinated without scheme violating by one-dose D or D-M toxoid vaccination according the age, if the last vaccination for diphtheria has been more than a year.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">8<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">With the epidemic rise:<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Children from 2 to 10 years living in endemic areas (average incidence of hepatitis A in the last 5 years higher than average incidence in Ukraine more than 2 times);<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">In case of focus development contacts need to be vaccinated during the first week;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Staff of the water treatment facilities, water mains, sewerage service and sewage treatment facilities;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Persons involved in peacekeeping activities, humanitarian assistance, etc.;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Travelers to regions with high hepatitis A.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">9<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">In case of importation of "wild" poliovirus to <st1:country-region w:st="on"><st1:place w:st="on">Ukraine</st1:place></st1:country-region>.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">10<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">In case of measles, mumps or rubella focus vaccination in the first three days from the date of contact children over 1 year who were not ill these infections and were not vaccinated. Adults (before 30 years) if they were not ill these infections and were not vaccinated and revaccinated against them.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">11<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">When epidemic rise of morbidity with generalized forms vaccination of:<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Persons living in endemic areas;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">In infection focus caused by appropriate serogroup of meningococcus.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">12<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Medical staff, students of secondary and higher educational institutions that have professional contact with blood, its preparations and carry parenteral manipulations;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Persons who have contact with hepatitis B patients;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Recipients of donor blood and blood products;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Children in the orphanages and child homes;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Family members who have hepatitis B patients and hepatitis B virus carriers;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Patients with chronic liver disease;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Patients who are planned to the surgical intervention.<o:p></o:p></span></div>
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<span class="GramE"><b><span lang="EN-US" style="color: #993300; font-family: 'Times New Roman'; font-size: 14pt;">Section 4.</span></b></span><b><span lang="EN-US" style="color: #993300; font-family: 'Times New Roman'; font-size: 14pt;"> Recommended vaccinations<o:p></o:p></span></b></div>
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<b><span lang="EN-US">Vaccines for the prevention</span><o:p></o:p></b></div>
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<b><span lang="EN-US"> A high risk groups</span><o:p></o:p></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Varicella zoster<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Healthy children who have reached 15 months of age and wasn’t ill by chicken pox before;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Children enrolling schools that have not been sick for varicella (according to documentation);<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Employees of health and education, with high risk of infection and not sick of chicken pox before<o:p></o:p></span></div>
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<span lang="EN-US">Hepatitis A</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Medical staff;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Nurseries staff;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- The catering and food industry staff , which is involved in the preparation of (production), transportation and sales of food;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Military personnel, firefighters, special services personnel (operational service);<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Personnel of water treatment facilities, water mains, sewerage service and sewage treatment facilities;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Staff and patients of private institutions (psychiatric institutions, detention facilities for mentally retarded persons, etc.);<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Personnel and persons who are in penitentiary institutions;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Students of medical schools;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Persons who participate in peacekeeping activities, humanitarian assistance, etc.;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Persons who use intravenous drugs, HIV-positive, individuals with venereal diseases;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Persons living in endemic areas for hepatitis A;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Persons traveling to regions with high hepatitis A level;<o:p></o:p></span></div>
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<span lang="EN-US">- Persons who have communicated with hepatitis A patients <o:p></o:p></span></div>
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<span lang="EN-US">Hepatitis B</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Soldiers, police, firefighters, social services personnel (operational service);<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Staff and patients of private institutions (psychiatric institutions, detention facilities for mentally retarded persons, etc.);<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Personnel and persons who are in penitentiary institutions;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Staff of the service sector that may have contact with human biological fluids (hairdressers, the staff of beauty salons, masseurs, etc.) as well as those studying in these fields;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Athletes;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Persons who use intravenous drugs, HIV-positive, individuals with venereal diseases;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Persons who frequently change sexual partners, prostitute, homosexual;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Young people aged 20-40 years, especially women;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Patients with chronic diseases and cancer, with chronic liver failure;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Persons traveling to regions with high hepatitis B morbidity<o:p></o:p></span></div>
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<span lang="EN-US">Flu</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Soldiers, builders, workers of the State Automobile Inspection, etc.;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- People who care for flu patients at home;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Pre-school children and students;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Collectives of enterprises, institutions and organizations;<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Women who will likely be in the 2nd or 3 rd trimester of pregnancy during flu epidemic<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Pneumococcal<o:p></o:p></span></div>
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<span lang="EN-US">infection</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- Children older than 2 years;<o:p></o:p></span></div>
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<span lang="EN-US">- Adults with impaired immune status and the elderly, especially those living in boarding<o:p></o:p></span></div>
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<b><span lang="EN-US" style="color: #339966; font-family: 'Times New Roman'; font-size: 16pt;">Passive immunization is indicated<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To children with insufficient antibodies syntheses as a result of congenital or acquired cellular defects of В-lymphocytes.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">At absence of vaccines against infection, when single way of protection is introduction of ready antibodies.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">If required immediate preventive maintenance of the disease for epidemiological causes (the contact with sick on measles, preventive maintenance of rabies, tetanus).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">For neutralization of the antigen-toxin by specific antitoxic antibodies.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">With medical purpose at the beginning of the diseases (at diphtheria, botulism, tetanus).<b><o:p></o:p></b></span></div>
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<b><span style="color: #3366ff;"><img height="225" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image040.jpg" v:shapes="_x0000_i1050" width="300" /></span></b><b><span lang="EN-US" style="color: #3366ff;"> </span><span style="color: #3366ff;"><img height="220" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image041.jpg" v:shapes="_x0000_i1051" width="328" /></span></b><b><span lang="EN-US" style="color: #3366ff;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: green; font-family: 'Times New Roman'; font-size: 14pt;">Va</span></b><b><span style="color: green; font-family: 'Times New Roman'; font-size: 14pt;">с</span></b><b><span lang="EN-US" style="color: green; font-family: 'Times New Roman'; font-size: 14pt;">cinal process</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> - is a change of homeostasis, which appears in organism in response to introduction of vaccinal preparation and include the complex of reactions to which belongs: formation of antibodies, adaptation and postvaccinal reactions, postvaccinal complications.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="color: green; font-family: 'Times New Roman'; font-size: 14pt;">Vaccinal reactions</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> appear in response to entering the vaccines, are characterized by appearance of clinical manifestations typical to this type of vaccine, which have a round-robin duration, are short, do not cause serious changes of vital activity in the organism.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="color: #3366ff; font-family: 'Times New Roman'; font-size: 14pt;">List of the preventive vaccinations medical contraindications<o:p></o:p></span></b></div>
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<b><span lang="EN-US">Vaccine</span></b><b><span style="font-size: 9pt;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US">Contraindications</span></b><b><span style="font-size: 9pt;"><o:p></o:p></span></b></div>
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<span lang="EN-US">All vaccines and toxoids</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Severe complications from the previous dose in the form of anaphylactic shock.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Allergy to any vaccine component.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Progressive diseases of the nervous system, hydrocephalus in decompensation stage, epilepsy, epileptic syndrome with convulsions 2 times a month and more often.<o:p></o:p></span></div>
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<span lang="EN-US">Acute illness or chronic disease exacerbation<o:p></o:p></span></div>
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<span lang="EN-US">All live vaccines</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Congenital combined immunodeficiency, primary hypogammaglobulinemia (entering the vaccine is not contraindicated in selective Ig A and Ig M immunodeficiency), transitional hypogammaglobulinemia and malignant tumors, pregnancy, AIDS, immune suppression therapy<o:p></o:p></span></div>
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<span lang="EN-US">BCG<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">baby weight less than 2000 g:<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1500 - <st1:metricconverter productid="1999 g" w:st="on">1999 g</st1:metricconverter> vaccinations are not done up to 1 month.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1000 - <st1:metricconverter productid="1499 g" w:st="on">1499 g</st1:metricconverter> - up to 2 months.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Complicated reactions to previous vaccine (adenitis, cold abscess, skin ulcers over <st1:metricconverter productid="10 mm" w:st="on">10 mm</st1:metricconverter> in diameter, kelloid scar, osteomyelitis, generalized BCG infection).<o:p></o:p></span></div>
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<span lang="EN-US">Tubinfection.<o:p></o:p></span></div>
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<span lang="EN-US">Defects of phagocytosis</span></div>
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<span lang="EN-US">OPV</span></div>
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<span lang="EN-US">Children whom live vaccine is contraindicated, as well as to members of their families is recommended vaccination by polio inactivated vaccine (IPV)<o:p></o:p></span></div>
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<span lang="EN-US">DTP</span></div>
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<span lang="EN-US">A history of convulsions (instead DTP vaccine - DTaP vaccine or DT toxoid is injected)<o:p></o:p></span></div>
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<span lang="EN-US">MMR</span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Allergic reactions to aminoglycosides.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">Anaphylactic reaction to egg protein.<o:p></o:p></span></div>
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<span lang="EN-US">Introduction of blood preparations<o:p></o:p></span></div>
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<i><span style="font-family: 'Times New Roman'; font-size: 14pt;">Notes:<o:p></o:p></span></i></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Routine vaccination is delayed until the acute manifestations of the disease and exacerbation of chronic diseases will disappear and carried out immediately after recovery or during remission. Acute respiratory disease, that has a mild course and no increase in body temperature, is not a contraindication for the routine vaccinations. Contact with infectious patients, quarantine is not a contraindication for the routine vaccinations. Features of vaccination against tuberculosis – see paragraph 3 of these notes.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Immunosuppressive therapy is a therapy carried out by cytotoxic drugs, including cyclosporine <span class="GramE">A</span> monotherapy, and others, immunosuppressive doses of corticosteroids and radiotherapy. Immunosuppressive therapy with corticosteroids is recognized, if the prednisolone dose is more than 1mg/kg/day and it lasts longer than 14 days, as systemic use. Routine vaccinations with inactivated vaccines and toxoids are conducted after the end of therapy, vaccination with live vaccines - at least 1 month after cessation of therapy. If the duration of corticosteroid therapy is less than 14 days regardless of dose or more than 14 days and a dose of prednisolone is less than 1mg/kg/dayi, or it is used as replacement therapy, or locally, such therapy is not immunosuppressive and is not a contraindication for the routine vaccination.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">It is unacceptable to unite in a same day immunization against tuberculosis with other vaccines, and parenteral manipulations. BCG and Mantoux test should be done within 4 weeks after infection, which was accompanied by fever or quarantine.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">After OPV vaccination is proposed to restrict parental interventions during the 40 days.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccinations against measles, mumps and rubella after the introduction of blood products (whole blood, plasma, immunoglobulin preparations, packed red blood cells), except for washed red blood cells, is possible within the time specified in the instructions to the drug, but not earlier than 3 months. After the emergency prevention of neonatal tetanus by tetanus human immune globulin BCG vaccination is carried out according to the standard scheme. If the interval between vaccination against measles, mumps, rubella and the introduction of blood products with therapeutic and prophylactic purposes less than 14 days, vaccination against these infections should be repeated<b>.</b><o:p></o:p></span></div>
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<b><span lang="EN-US" style="color: #3366ff; font-family: 'Times New Roman'; font-size: 14pt;">Recommended intervals between the administration of blood products containing specific antibodies, and vaccination against measles, mumps, rubella and varicella<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">Drug / indication for use</span></b><span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">The recommended</span></b><span lang="EN-US" style="font-size: 12pt;"></span><b><span style="font-family: 'Times New Roman'; font-size: 12pt;">interval (months)</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">Tetanus emergency immunoprophylaxis by the tetanus immunoglobulin<o:p></o:p></span></div>
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<span style="color: #333333;">3<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">Hepatitis A passive immunoprophylaxis by the normal human<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 12pt;">immunoglobulin</span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span style="color: #333333;">3<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">Hepatitis B passive immunoprophylaxis by the specific immunoglobulin<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 12pt;">against hepatitis B</span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span style="color: #333333;">3<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">Measles passive immunoprophylaxis by the normal human<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">immunoglobulin<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">- Standard contact (without immunodeficiency)<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 12pt;">- Immunocompromised</span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span style="color: #333333;">5<br />6<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">Blood Transfusion<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">- The washed erythrocytes<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">- Red blood cells with the addition of preservative (adenine saline)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">- Whole blood (Ht 65%)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">- Whole blood (Ht 35-50%)<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 12pt;">- Plasma / Platelets<o:p></o:p></span></div>
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<span style="color: #333333;">-<br />6<o:p></o:p></span></div>
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<span style="color: #333333;">6<br />6<br />7<o:p></o:p></span></div>
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CMV Immunoglobulin IV</div>
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<span style="color: #333333;">6<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">IV immunoglobulin<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">- Sepsis<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt;">- Thrombocytopenic purpura<o:p></o:p></span></div>
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<span lang="EN-US">- <st1:place w:st="on"><st1:city w:st="on">Kawasaki</st1:city></st1:place> disease<o:p></o:p></span></div>
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<span style="color: #333333;">8<br />10<br />11<o:p></o:p></span></div>
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<b><span lang="EN-US" style="color: green; font-family: 'Times New Roman'; font-size: 14pt;">Postvaccinal complications</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> - all pathological phenomena, which appear after vaccination and are not inherent to the usual vaccinal process, but obvious, their relationship with performed vaccination:<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1. Postvaccinal unusual reactions and complications, caused strictly by vaccine ("true").<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2. Joining of intercurrent infections in postvaccinal period.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3. Exacerbation of chronic diseases and primary manifestations of latent diseases.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="color: green; font-family: 'Times New Roman'; font-size: 14pt;">Postvaccinal reactions and complications<o:p></o:p></span></b></div>
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<b><i><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Postvaccinal reactions:<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Increased temperature to 39˚ C.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Increased temperature over 39˚ C (severe total reaction).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Temperature, which is not registered in medical documentation.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Pain, soft tissue swelling > <st1:metricconverter productid="50 mm" w:st="on">50 mm</st1:metricconverter>, hyperemia in the place of injection > <st1:metricconverter productid="80 mm" w:st="on">80 mm</st1:metricconverter>, infiltration > <st1:metricconverter productid="20 mm" w:st="on">20 mm</st1:metricconverter> (severe local reaction).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Lymphadenopathy.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Headache.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">7.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Irritability, sleep disturbance.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">8.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Non allergic rash.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">9.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Anorexia, nausea, abdominal pain, indigestion and diarrhea.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">10.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Catarrhal phenomena.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">11.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Myalgia, arthralgia.<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Postvaccinal complications</span></i></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">:<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Abscesses.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Anaphylactic shock and anaphylactic reactions.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Allergic reaction (Quincke’s edema, urticaria rash, Stevens-Johnson’s, Lyell’s syndrome).<o:p></o:p></span></div>
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<img height="314" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image043.jpg" v:shapes="_x0000_i1052" width="420" /><span lang="EN-US"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Quincke’s edema<o:p></o:p></span></div>
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<img height="438" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image045.jpg" v:shapes="_x0000_i1053" width="328" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span class="GramE"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">urticaria</span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> rash<o:p></o:p></span></div>
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<img height="563" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image047.jpg" v:shapes="_x0000_i1054" width="328" /><span style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Stevens-<span class="GramE">Johnson’s syndrome</span></span><span style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<img height="242" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image049.jpg" v:shapes="_x0000_i1055" width="365" /><span style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Lyell’s syndrome</span><span style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Hyporesponsive-hypotensive syndrome (acute circulatory failure, hypotension, decrease muscle tone, short-term breach or loss of consciousness, vascular abnormalities in anamnesis).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Arthritis.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Continuous scream (duration of 3 hours or more).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">7.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Febrile seizures.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">8.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Afebrile seizures.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">9.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Meningitis / encephalitis.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">10.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Anesthesia / paresthesia.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">11.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Acute flaccid paralysis.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">12.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Vaccinassociated paralytic polio.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">13.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Guillain-Barre syndrome (poliradiculoneuritis).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">14.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Subacute sclerotizing panencephalitis.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">15.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Mumps, orchitis.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">16.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Thrombocytopenia.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">17.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Subcutaneous cold abscess.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">18.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Superficial ulcers over <st1:metricconverter productid="10 mm" w:st="on">10 mm</st1:metricconverter>.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">19.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Regional lymphadenitis.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">20.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Kelloid scar.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">21.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Generalized BCG infection, osteomyelitis, <span class="GramE">osteitis</span>.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">22.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> </span></div>
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<img height="377" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_5_Immune_prophylaxis_of_the_infectious_diseases_in_children.files/image050.jpg" v:shapes="_x0000_i1056" width="504" /><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></div>
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<br /></div>
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<b><span lang="EN-US">Postvaccinal reactions<o:p></o:p></span></b></div>
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<b><span lang="EN-US">Postvaccinal complications<o:p></o:p></span></b></div>
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<b><span lang="EN-US">DTP-vaccination<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Temperature 37.5-39 ºС, anxiety, poor sleeping, rarely - vomiting.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Local reaction (more often on revaccination) - in the manner of hyperemia, infiltration.<o:p></o:p></span></div>
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<span lang="EN-US">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Reinforcement of the allergic manifestations (in children with exudative-catarrhal diathesis)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Quincke’s edema.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Anaphylactic shock, collapse.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Continuous scream (duration of 3 hours or more)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Febrile seizures (on background of the quick ascent of the temperature).<o:p></o:p></span></div>
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<span lang="EN-US">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Afebrile seizures, absances.<o:p></o:p></span></div>
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<span lang="EN-US">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Encephalitis</span><span lang="EN-US"><o:p></o:p></span></div>
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<b><span lang="EN-US">OPV-vaccination<o:p></o:p></span></b></div>
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<span lang="EN-US">Does not call any reactions<o:p></o:p></span></div>
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<span lang="EN-US">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Reinforcement of the allergic manifestations (in children with exudative-catharrhal diathesis)<o:p></o:p></span></div>
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<span lang="EN-US">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Quincke’s edema, urticaria.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Vaccine associated poliomyelitis in immunized and in contact persons (on background of immunodeficiency) - 1:1,500,000.<o:p></o:p></span></div>
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<b><span lang="EN-US">Vaccination against measles<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1. Specific vaccinal reaction from 4 to 14 days:<o:p></o:p></span></div>
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<span lang="FR" style="font-family: 'Times New Roman';">- temperature 37,5-38 º</span><span lang="EN-US" style="font-family: 'Times New Roman';">С</span><span lang="FR" style="font-family: 'Times New Roman';">,<o:p></o:p></span></div>
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<span lang="FR" style="font-family: 'Times New Roman';">- catarrhal manifestations, conjunctivitis,<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- pale-rose rash in a small amount,<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- duration - 2-3 days,<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">- is not contagious<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">2. Lymphadenopathy.<o:p></o:p></span></div>
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<span lang="EN-US">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">In children with exudative-catarrhal diathesis: Quincke’s edema, urtica<o:p></o:p></span></div>
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<span lang="EN-US">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Hemorrhagic vasculitis.<o:p></o:p></span></div>
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<span lang="EN-US">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Hyperthermia 39-40<sup> </sup>ºС with febrile seizures<o:p></o:p></span></div>
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<tr style="page-break-inside: avoid;"><td colspan="2" style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 515.5pt;" valign="top" width="687"><div class="BodyText" style="font-size: 12pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<b><span lang="EN-US">Vaccination against mumps<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">In some cases from 4 to 12 days - fever, catarrhal manifestations.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Rare - a slight enlargement of parotid glands for a short time.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Hyperthermia.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Febrile seizures.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Abdominal syndrome.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Allergic rash.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Very rare - serous meningitis.<o:p></o:p></span></div>
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<tr style="page-break-inside: avoid;"><td colspan="2" style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 515.5pt;" valign="top" width="687"><div class="BodyText" style="font-size: 12pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<b><span lang="EN-US"> BCG-Vaccination<o:p></o:p></span></b></div>
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<span lang="EN-US">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Local reaction: papule, vesicle, rib; lymphadenitis<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Subcutaneous cool abscess (BCG-tis).</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"></span><span lang="EN-US" style="font-family: 'Times New Roman';"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Superficial ulcers over <st1:metricconverter productid="10 mm" w:st="on">10 mm</st1:metricconverter>.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Purulent lymphadenitis.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Kelloid scars.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Lymph nodes calcification.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman';">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman';">Generalized BCG-infection on background of immune deficiency (4: 1000000).<o:p></o:p></span></div>
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<span lang="EN-US">7.<span style="font-size: 7pt;"> </span></span><span lang="EN-US">Osteitis, osteomyelitis with dominating damage of long bones.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> </span></b><b><span style="font-family: 'Times New Roman'; font-size: 14pt;">References:<o:p></o:p></span></b></div>
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<st1:place w:st="on"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Main</span></b></st1:place><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">:</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> <b><u> <o:p></o:p></u></b></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="DE" style="font-family: 'Times New Roman'; font-size: 14pt;">Behrman RE, Kliegman RM, Jenson HB, eds. </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Nelson Textbook of Pediatrics. 16th ed. <st1:city w:st="on"><st1:place w:st="on">Philadelphia</st1:place></st1:city>: WB Saunders; 2000.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Current therapy in pediatric infectious diseases – 2 edited by John D. Nelson, M. D. – B.C. Decker inc. Toronto, Philadelphia, 1988.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Dershewitz RA, Macknin ML: Ambulatory Pediatric Care, 3rd ed. Lippincot – Raven, 1999.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><st1:street w:st="on"><st1:address w:st="on"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Feigin RD</span></st1:address></st1:street><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">, Cherry JD, eds. Textbook of Pediatric Infectious Diseases. Vol 2. 4th ed. WB Saunders Co; 1998.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Krugman, Saul, et al. <i>Infectious Diseases of Children</i>. <st1:city w:st="on"><st1:place w:st="on">St. Louis</st1:place></st1:city>: Mosby Year Book, 1992.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Oski's Pediatrics: Principles and Practice. 3rd ed. Lippincott Williams and Wilkins; 1999.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">7.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Principles and Practice of Pediatric Infectious Diseases. / Edited by Saran S. Long, Larry K. Pickering, Charles G. Prober, <st1:place w:st="on"><st1:city w:st="on"><span class="GramE">Philadelphia</span></st1:city>, <st1:state w:st="on">Pa</st1:state></st1:place>: Churchill Livingstone; 1997. – 1921 p.<o:p></o:p></span></div>
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<b><span style="font-family: 'Times New Roman'; font-size: 14pt;">Additional:</span></b><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2000 Red Book: Report of the Committee on Infectious Diseases. <st1:place w:st="on"><st1:placename w:st="on">American</st1:placename> <st1:placetype w:st="on">Academy</st1:placetype></st1:place> of Pediatricians. 2000: 243-7.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Bella J, Rossmann MG: Review: rhinoviruses and their ICAM receptors. J Struct<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Bellet, Paul S. <i>The Diagnostic Approach to Common Symptoms and Signs in Infants, Children, and Adolescents.</i> </span><span style="font-family: 'Times New Roman'; font-size: 14pt;">New York: Lea and Febiger, 1989.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Bialecki C, Feder HM Jr, <span class="GramE">Grant</span>-Kels JM: The six classic childhood exanthems: a review and update. J Am Acad Dermatol 1989 Nov; 21(<st1:metricconverter productid="5 Pt" w:st="on">5 Pt</st1:metricconverter> 1): 891-903<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Chameides L, Hazinski MF, eds. Textbook of pediatric life support. <st1:city w:st="on"><st1:place w:st="on">Dallas</st1:place></st1:city>: American Heart Association, 1994:5-55-6.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Collins PL, McIntosh K, Chanock RM: Respiratory Syncytial Virus. In: Fields' Virology. 3rd ed. 1996: 1313-1351.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">7.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Committee on Infectious Diseases; <st1:place w:st="on"><st1:placename w:st="on">American</st1:placename> <st1:placetype w:st="on">Academy</st1:placetype></st1:place> of Pediatrics: Respiratory Syncytial Virus. In: <st1:city w:st="on"><st1:place w:st="on">Pickering</st1:place></st1:city> LK, ed. 2000 Red Book: Report of the Committee on Infectious Diseases. 2000: 483-487.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">8.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Dudas RA, Karron RA: Respiratory syncytial virus vaccines. Clin Microbiol Rev 1998 Jul; 11(3): 430-9<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">9.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Emmerson AM, Hawkey PM, Gillespie SH: Principles and Practice of Clinical Bacteriology. John Wiley & Sons; 1997: 373-88.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">10.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Fleisher, GR, Ludwig, SL: Gastrointestinal infections. In: Textbook of Pediatric Emergency Medicine. 4th ed. <st1:place w:st="on"><st1:city w:st="on">Baltimore</st1:city>, <st1:state w:st="on">Md</st1:state></st1:place>: Williams & Wilkins; 2000:757-762.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">11.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Garwood, John, and Amanda Bennett. <i>Your Child's Symptoms.</i> <st1:state w:st="on">New York</st1:state>: <st1:city w:st="on"><st1:place w:st="on">Berkeley</st1:place></st1:city> Books, 1995.<b><o:p></o:p></b></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">12.<span style="font-size: 7pt;"> </span></span><span lang="FR" style="font-family: 'Times New Roman'; font-size: 14pt;">Griffin, DE: Billeter M, ed. </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Measles Virus. <st1:place w:st="on"><st1:city w:st="on">New York</st1:city>, <st1:state w:st="on">NY</st1:state></st1:place>: Springer-Verlag; 1995: 117-34.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">13.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Hostetter MK: Epidemiology of travel-related morbidity and mortality in children. Pediatr<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">14.<span style="font-size: 7pt;"> </span></span><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Ledwith</span></st1:city><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> <st1:state w:st="on">CA</st1:state></span></st1:place><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">: Fluids and electrolytes. In: Handbook of Pediatrics. 17th ed. 1994:94-99.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Levin M, Nadel S: Bacterial meningitis: pathophysiology and causes and therapeutic approach. In: <st1:city w:st="on"><st1:place w:st="on">Oxford</st1:place></st1:city> Textbook of Critical Care. <st1:place w:st="on"><st1:placename w:st="on">Oxford</st1:placename> <st1:placetype w:st="on">University</st1:placetype></st1:place> Press; 1999.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Nadel S, Levin M, Habibi P: Treatment of meningococcal disease in childhood. In: Meningococcal Disease. John Wiley & Sons; 1995:207-43.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Nelson, WE, Behrman, RE: Infections due to Salmonellae. In: Textbook of Pediatrics. 14th ed. 1992:729-734.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Ng VL, Balistrera WF: Hepatitis B-clinical perspectives in pediatrics. Clin Liver Dis 1999; 3 (2): 267-90.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Northrup RS, Flanigan TP. Gastroenteritis. Pediatr Rev 1994<span class="GramE">;15:461</span>-72.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Pediatrics <span class="GramE">( 2<span style="position: relative; top: -5pt;">nd</span></span> edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">7.<span style="font-size: 7pt;"> </span></span><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Smith</span></st1:city><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> <st1:state w:st="on">MB</st1:state></span></st1:place><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">: Acute rhinitis and pharyngitis. In: Evidence-Based Pediatrics. 2000: 83-90.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">8.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –<st1:city w:st="on"><st1:place w:st="on">London</st1:place></st1:city>, 1989.-661p.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">9.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Viral Infections of Humans. Epidemiology and Control</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">. 4th edition. <st1:place w:st="on"><st1:city w:st="on">New York</st1:city>, <st1:state w:st="on">NY</st1:state></st1:place>: Plenum Medical Book Company, 1997.<b><o:p></o:p></b></span></div>
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<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">10.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Ward DG: Acute infectious diarrhea disease and dehydration. In: Rosen P, Barkin RM. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby; 1998:1200-1212.</span></div>
Anonymoushttp://www.blogger.com/profile/17593882680759139071noreply@blogger.com0tag:blogger.com,1999:blog-7275300796104068287.post-7057803545544835132013-02-26T13:24:00.002-08:002013-02-26T13:24:46.816-08:00ACUTE VIRAL UPPER RESPIRATORY TRACT INFECTIONS<div class="separator" style="clear: both; text-align: center;">
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Acute Viral Upper Respiratory Tract Infections </span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">– is a large group of infectious diseases,<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span class="GramE"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">which</span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> are caused by viruses, transmitted by droplet way, characterized by intoxication and catarrhal syndrome with predominant changes in mucous membranes of the upper respiratory tract.<o:p></o:p></span></span></div>
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<b><span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Etiology:<o:p></o:p></span></b></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• <b><i>Parainfluenza</i></b>, 5 types of human parainfluenza virus that belong to paramyxovirus family (large RNA viruses 150-200 nm, contain hemagglutinine and neuraminidase with stable antigen structure).<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• <b><i>Respiratory syncitial (RS) virus</i></b>, belong to paramyxovirus family (large polymorph RNA viruses 120-200 nm) doesn’t have neuraminidase and without hemagglutination ability, grew only on the tissues cultures.<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• <b><i>Rhinoviruses</i></b>, with over 100 serotypes, belong to picornavirus family (small RNA <span class="GramE">viruses</span> 20-30 nm, instable in the environment).<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• <b><i>Adenoviruses</i></b> – <span class="GramE">a stable DNA-viruses</span> of medium size, 70-90 nm, have A, B, C<o:p></o:p></span></div>
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<span style="background-color: white;"><span class="GramE"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">antigens</span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">, could agglutinate the blood.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• <b><i>Rheoviruses </i></b>– 3 serotypes RNA-viruses of medium size, 70-80 nm, stable in the<o:p></o:p></span></div>
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<span style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">environment.<o:p></o:p></span></div>
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<span style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• <b><i>Enteroviruses<o:p></o:p></i></b></span></div>
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<b><i><span style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Coronaviruses<o:p></o:p></span></i></b></div>
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<span style="background-color: white;"><b><span lang="UK">Epidemiology </span></b><span lang="UK"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">A source </span><span lang="EN-US">of infection are</span><span lang="UK"> patients with URT viral infection, </span><span lang="EN-US">and virus-carriers</span><span lang="UK"> (Adenovirus, Rhinovirus, Rheovirus and RS-virus)<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Mechanism of transmission<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: 'Courier New';">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span class="GramE"><span lang="EN-US">droplet</span></span><span lang="EN-US"> with inhalation of small or large airborne drops during coughing, sneezing</span><span lang="UK">, speaking, by contact with </span><span lang="EN-US">contaminated hands, toys </span><span lang="UK">ets.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: 'Courier New';">o<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">also fecal-oral (for Adenovirus</span><span lang="EN-US">, </span><span lang="UK">Rheovirus</span><span lang="UK"> </span><span lang="UK">infection)<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Receptiv</span><span lang="EN-US">ity</span><span lang="UK"> – early age children, from 6 month and under-fives, contagiousness is high (40-80%)<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Seasonality – autmn-winter or winter-spring flashes and sporadic diseases during </span><span lang="EN-US">a</span><span lang="UK"> year</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="UK">Pathogen</span></b><b><span lang="EN-US">esis</span></b><b><span lang="UK"> </span></b><b><span lang="EN-US">- </span></b><span lang="EN-US">inoculation</span><span lang="EN-US"> </span><span lang="UK">of viruses in upper respiratory tract epitheliocytes, conjunctiva, lymph nodes</span><span lang="UK"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK">-<span style="font-size: 7pt;"> </span></span><span lang="UK">Local reproduction of virus<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK">-<span style="font-size: 7pt;"> </span></span><span lang="UK">Development of inflammatory process in upper respiratory tract, destructive changes<o:p></o:p></span></span></div>
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<span lang="UK" style="background-color: white;">-<span style="font-size: 7pt;"> </span></span><span style="height: 35px; left: 0px; margin-left: 371px; margin-top: 17px; position: absolute; width: 35px; z-index: 5;"><span style="background-color: white;"><img height="35" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_4_Differential%20diagnosis_and_emergency_states_in%20influenza_and_ARVI_in_children.files/image066.gif" v:shapes="_x0000_s1062" width="35" /></span></span><span style="height: 26px; left: 0px; margin-left: 282px; margin-top: 17px; position: absolute; width: 12px; z-index: 6;"><span style="background-color: white;"><img height="26" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_4_Differential%20diagnosis_and_emergency_states_in%20influenza_and_ARVI_in_children.files/image067.gif" v:shapes="_x0000_s1063" width="12" /></span></span><span style="background-color: white;">Start of immune reactions<span lang="UK"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US">delete of the virus </span><span lang="EN-US"> </span><span lang="UK">immune factors</span><span lang="EN-US"> possible viremia</span><span lang="UK"><o:p></o:p></span></span></div>
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<span style="height: 26px; left: 0px; margin-left: 466px; margin-top: 4px; position: absolute; width: 12px; z-index: 4;"><span style="background-color: white;"><img height="26" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_4_Differential%20diagnosis_and_emergency_states_in%20influenza_and_ARVI_in_children.files/image067.gif" v:shapes="_x0000_s1061" width="12" /></span></span><span style="background-color: white;"><span lang="UK"> </span><span lang="EN-US">suppression</span><span lang="UK"> <o:p></o:p></span></span></div>
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<span style="height: 26px; left: 0px; margin-left: 270px; margin-top: 3px; position: absolute; width: 12px; z-index: 3;"><span style="background-color: white;"><img height="26" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_4_Differential%20diagnosis_and_emergency_states_in%20influenza_and_ARVI_in_children.files/image067.gif" v:shapes="_x0000_s1060" width="12" /></span></span><span lang="UK" style="background-color: white;"> damage of organs<o:p></o:p></span></div>
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<span lang="UK" style="background-color: white;"> bacterial and systems<o:p></o:p></span></div>
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<span style="background-color: white;"><span lang="UK"> complication</span><span lang="EN-US">s<o:p></o:p></span></span></div>
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<b><span lang="EN-US" style="background-color: white;">Clinical classification of an Acute Upper Respiratory Tract Viral Infections<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="background-color: white;">Etiology<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="background-color: white;">Clinical forms<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="background-color: white;">Severity<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="background-color: white;">Course<o:p></o:p></span></b></div>
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<span lang="EN-US" style="background-color: white;">Adenoviruses<o:p></o:p></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Pharyngoconjunctival fever, catarrh of the Upper Respiratory Tract, keratoconjunctivitis, tonzyllopharyngitis, diarrhea (intestinal syndrome), mesadenitis, hepatosplenomegaly</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="background-color: white;">Mild<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Moderate<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Severe<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">1. Without complications<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Paramyxoviruses<o:p></o:p></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Croup syndrome, catarrh of the Upper Respiratory Tract, tonzyllopharyngitis,</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="background-color: white;">2. With complications<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">RS-viruses<o:p></o:p></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Acute bronchitis, bronchiolitis, Croup syndrome</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="background-color: white;">Rhinoviruses<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Rhinitis, rhinopharyngitis, catarrh of the Upper Respiratory Tract, interstitial pneumonia, Croup syndrome (seldom)<o:p></o:p></span></div>
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<b><span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Clinical criteria<o:p></o:p></span></b></div>
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<b><span style="background-color: white; font-size: 14pt;">Common clinical symptoms:<o:p></o:p></span></b></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Complaints: more or less severe symptoms of general intoxication, catarrhal symptoms are sore throat (considerably rarer is pharyngeal pain), cold, dry cough.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Moderate hyperemia, mainly palatal arch, soft palate, uvula, back pharyngeal wall with the presence of grittiness (lymphoidc follicles are enlarged).<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span style="font-size: 14pt;">Hyperemia of nasal mucosa.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Tonsils are mainly intact (except adenoviral infection).<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Conjunctivitis (more or less severe, in dependence on the type of URTI).<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Signs of a few parts of upper respiratory tract inflammation.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">For every type of infection the prominent inflammation of one part of upper respiratory tract is characteristic with development of typical clinical signs.<o:p></o:p></span></span></div>
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<b><span lang="UK" style="background-color: white;"> Parainfluenza:<o:p></o:p></span></b></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Sporadic morbidity, grows in winter.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Latent period </span><span lang="EN-US">is </span><span lang="UK">2-7 days.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Acute</span><span lang="UK"> beginning.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Toxic</span><span lang="UK"> syndrome is </span><span lang="EN-US">mild or moderate</span><span lang="UK">.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">C</span><span lang="UK">atarrhal phenomena are not severe.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">A basic clinical sign is a catarrh of </span><span lang="EN-US">upper</span><span lang="UK"> respiratory tract.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><i><span lang="EN-US">Peculiarities in infants and under-fives</span></i><span lang="EN-US">: </span><span lang="UK">a croup syndrome is </span><span lang="EN-US">o</span><span lang="UK">ften the first display.<o:p></o:p></span></span></div>
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<b><span lang="UK" style="background-color: white;">Adenovirus infection:<o:p></o:p></span></b></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Sporadic morbidity and epidemic flashes.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Winter seasonality, possible flashes in summer.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Latent period is 2-12 days.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Acute</span><span lang="UK"> beginning.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">The first symptom is a catarrh of </span><span lang="EN-US">upper </span><span lang="UK">respiratory tract<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Toxic</span><span lang="UK"> syndrome is </span><span lang="EN-US">moderate</span><span lang="UK">.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Conjunctivitis (photo 89, 90).<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Lymphoprolipherative </span><span lang="FR">syndrome (acute viral tonsillitis, neck lymph nodes enlargement, hepatomegaly (rare splenomegaly)</span><span lang="UK">.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Intestinal syndrome.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><i><span lang="UK" style="font-size: 14pt;">Peculiarities in infants: </span></i><span lang="UK" style="font-size: 14pt;">often dyspeptic syndrome (vomiting, diarrhea), bronchitis, interstitial pneumonia, rare – lymph nodes enlargement, conjunctivitis</span><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span style="font-family: 'Times New Roman'; font-size: 14pt;"><img height="252" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_4_Differential%20diagnosis_and_emergency_states_in%20influenza_and_ARVI_in_children.files/image069.jpg" v:shapes="_x0000_i1049" width="335" /></span><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
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<span style="background-color: white;"><span style="font-family: 'Times New Roman'; font-size: 14pt;">Conjunctivitis</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span style="font-family: 'Times New Roman'; font-size: 14pt;"><img alt="IMG_90" height="200" src="http://intranet.tdmu.edu.ua/data/kafedra/internal/pediatria2/classes_stud/%d1%96%d0%bd%d1%84%d0%b5%d0%ba%d1%86%d1%96%d0%b9%d0%bd%d1%96%20%d1%85%d0%b2%d0%be%d1%80%d0%be%d0%b1%d0%b8/English/6%20course/Lesson_4_Differential%20diagnosis_and_emergency_states_in%20influenza_and_ARVI_in_children.files/image070.jpg" v:shapes="Рисунок_x0020_7" width="266" /></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span style="font-family: 'Times New Roman'; font-size: 14pt;">Conjunctivitis</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="UK">RS-infection:</span></b><span lang="UK"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Latent period is 3-7 days.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Winter seasonality, acute beginning.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">The children of senior age have </span><span lang="EN-US">mild forms</span><span lang="UK"> (as an </span><span lang="EN-US">acute</span><span lang="UK"> bronchitis).<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK" style="font-size: 14pt;">Croup is less common.<b><o:p></o:p></b></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><i><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt;">Peculiarities in infants: </span></i><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt;">often bronchiolitis, interstitial pneumonia<b><o:p></o:p></b></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US">Rhinovirus </span></b><b><span lang="UK">infectio</span></b><b><span lang="EN-US">n</span></b><b><span lang="UK">:<i><o:p></o:p></i></span></b></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Epidemic flashes (in winter, in autumn).<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK">Latent period is 1-5 days.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK" style="font-size: 14pt;">Intoxication is absent or </span><span lang="EN-US" style="font-size: 14pt;">mild</span><span lang="UK" style="font-size: 14pt;">,</span><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">A</span><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt;">cute rhinitis with large effusion (mucus</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">) f</span><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt;">rom the first days </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">of illness<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Often bacterial complications (later – </span><span lang="UK" style="font-size: 14pt;">purulent</span><span lang="UK" style="font-size: 14pt;"> </span><span lang="UK" style="font-size: 14pt;">effusion from the nose).</span><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><i><span lang="UK" style="font-size: 14pt;">Peculiarities in infants: </span></i><span lang="EN-US" style="font-size: 14pt;">rhinoviral infection with often development of tracheobronchitis<o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Common peculiarities in infants:</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Poor feeding,<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Decrease of body weight,<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Less acute beginning,<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Less intoxication,<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Bacterial complications (otitis, pneumonia, etc.) and mortality appear more often.<o:p></o:p></span></span></div>
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<b><span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Laboratory and instrumental investigations<o:p></o:p></span></b></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-weight: normal;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK" style="font-weight: normal;">Identification of virus </span><span lang="EN-US" style="font-weight: normal;">from nasopharyngeal smears (also feces or blood in </span><span lang="UK" style="font-weight: normal;">Adenovirus infection ) </span><span lang="UK" style="font-weight: normal;">by culture, immunofluorescence, or ELISA.</span><span lang="EN-US" style="font-weight: normal;"><o:p></o:p></span></span></h4>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol; font-weight: normal;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="UK" style="font-weight: normal;">Serologic diagnosis</span><span lang="EN-US" style="font-weight: normal;"> to find antibodies against viruses (CBR, DHAR) with fourfold increasing of antibodies title in 10-14 days</span><span lang="UK" style="font-weight: normal;"> may be used.<o:p></o:p></span></span></h4>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">In CBC<span class="GramE">, mainly</span> leucopenia (normocytosis) with a shift to the left and relative lymphomonocytosis.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">During X-ray – strengthening of the pulmonary picture<o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><i><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Etiological diagnosis</span></i></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> may be put in case of the virus identification, in other case diagnosis will be <u>URT viral infection</u> + <u>leading clinical syndrome</u> (for example: <i>URT viral infection: rhinopharyngitis</i>, or <i>URT viral infection: obstructive bronchitis, Respiratory insufficiency 2<sup>nd</sup> degree; with intestinal syndrome.<o:p></o:p></i></span></span></div>
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<span style="background-color: white;"><b><i><u><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Differential diagnosis</span></u></i></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> should be performed between other viral respiratory tract infections, allergic rhinitis, foreign body aspiration, epiglottitis, bacterial tracheitis, pertussis, measles, Epstein-Bar Virus infection, bacterial croup.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Rhinoviral infection</span><span lang="UK">: </span><span lang="EN-US">with allergic rhinitis, foreign body of the nose</span><span lang="UK">.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">RS</span><span lang="UK">-</span><span lang="EN-US">infection</span><span lang="UK">: </span><span lang="EN-US">whooping cough, chlamidiosis, mycoplasmosis</span><span lang="UK">.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Adenoviral infection</span><span lang="UK">: </span><span lang="EN-US">with infectious mononucleosis</span><span lang="UK">, </span><span lang="EN-US">micoplasmosis, and measles</span><span lang="UK">.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Parainfluenza</span><span lang="UK">: </span><span lang="EN-US">with true croup in diphtheria, other viral croup (i.e</span><span lang="UK">.</span><span lang="EN-US"> in measles).</span><span lang="UK"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Differential Diagnosis </span></b><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">between Viral Respiratory Infections<o:p></o:p></span></b></span></div>
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<tr style="height: 20.7pt;"><td style="border: 1pt solid windowtext; height: 20.7pt; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div class="Subtitle" style="font-family: Arial; font-size: 12pt; font-weight: bold; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Signs and symptoms<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">Influenza<o:p></o:p></span></div>
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<b><span lang="EN-US" style="background-color: white; font-size: 14pt;">Parainfluenza<o:p></o:p></span></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; height: 20.7pt; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="heading1" style="font-size: 12pt; font-weight: bold; margin: 0cm -2.75pt 0.0001pt 0cm; page-break-after: avoid; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Adenoviral infection<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; height: 20.7pt; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="heading1" style="font-size: 12pt; font-weight: bold; margin: 0cm -2.75pt 0.0001pt 0cm; page-break-after: avoid; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">RS-infection<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; height: 20.7pt; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><span lang="EN-US" style="background-color: white; font-size: 14pt;">Rhinoviral infection<o:p></o:p></span></b></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Respiratory tract<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">Tracheitis<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Laryngitis<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Pharyngotonsillitis<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">Bronchitis, bronchiolitis, pneumonia<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Rhinitis<o:p></o:p></span></div>
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<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Intoxication<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Severe<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">Mild<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Catarrhal s-m<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Mild<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Expressed<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">Expressed<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">Expressed<o:p></o:p></span></div>
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<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Temperature<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">High<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">High, for long period<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Subfebril<o:p></o:p></span></div>
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<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Eye pain<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Present<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Rarely<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Myalgias, Arthralgia<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Expressed<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Rarely<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Hemorrhages<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">May be present<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Rhinitis<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Expressed<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Expressed<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Cough<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Dry<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">dry, hoarseness, “barking”<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="footer" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Rarely<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Often repeated, with obstructive component<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Rarely<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Conjunctivitis<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Often<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="heading5" style="font-size: 10pt; font-weight: bold; margin: 0cm -2.75pt 0.0001pt 0cm; page-break-after: avoid; text-align: center;">
<i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Pharyngeal hyperemia<o:p></o:p></span></i></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Expressed<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Expressed, tonsillitis<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">lymphadenopathy<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Polyadenopathy<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">rarely: neck, submandibular<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Liver<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span style="background-color: white;"><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-size: 14pt;">Normal</span></st1:city></st1:place><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span style="background-color: white;"><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-size: 14pt;">Normal</span></st1:city></st1:place><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Often enlarged<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">May be enlarged<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span style="background-color: white;"><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-size: 14pt;">Normal</span></st1:city></st1:place><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Spleen<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span style="background-color: white;"><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-size: 14pt;">Normal</span></st1:city></st1:place><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span style="background-color: white;"><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-size: 14pt;">Normal</span></st1:city></st1:place><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">May be enlarged<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span style="background-color: white;"><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-size: 14pt;">Normal</span></st1:city></st1:place><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span style="background-color: white;"><st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US" style="font-size: 14pt;">Normal</span></st1:city></st1:place><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 97pt;" valign="top" width="129"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<b><i><span lang="EN-US" style="background-color: white; font-size: 14pt;">Diarrhea<o:p></o:p></span></i></b></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 72.6pt;" valign="top" width="97"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.4pt;" valign="top" width="115"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 101.35pt;" valign="top" width="135"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">May be present<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 86.85pt;" valign="top" width="116"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 68.8pt;" valign="top" width="92"><div align="center" class="Normal" style="font-size: 10pt; margin: 0cm -2.75pt 0.0001pt 0cm; text-align: center;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Absent<o:p></o:p></span></div>
</td></tr>
</tbody></table>
</div>
<div align="center" class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: center;">
<b><span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Croup Syndrome<o:p></o:p></span></b></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Stenotic laryngotracheitis, or false croup, exists in case of ARVI (influenza, parainfluenza, аdenoviral infection), measles, Chickenpox. Diphtheria of the respiratory ways has clinic of true croup, which necessary to differentiate with false croup.<o:p></o:p></span></div>
<table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 6.75pt; margin-right: 6.75pt; width: 718px;"><tbody>
<tr><td rowspan="2" style="border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 93.45pt;" valign="top" width="125"><div align="center" class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Symptoms</span></b><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td><td colspan="5" style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0cm 5.4pt; width: 445.35pt;" valign="top" width="594"><div align="center" class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: center;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Croup stages</span></b><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 103.75pt;" valign="top" width="138"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">1<sup>st</sup></span></b><span lang="EN-US"> </span><b><i><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">(compensated)</span></i></b><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td><td colspan="2" style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 110.4pt;" valign="top" width="147"><div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">2<sup>nd</sup></span></b><b><i><span lang="EN-US" style="font-size: 14pt;">(subcompensated)<o:p></o:p></span></i></b></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 130.35pt;" valign="top" width="174"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">3<sup>rd</sup></span></b><b><i><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">(decompensated)</span></i></b><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 100.85pt;" valign="top" width="134"><div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><b><span lang="EN-US" style="font-size: 14pt;">4<sup>th</sup></span></b><b><i><span lang="EN-US" style="font-size: 14pt;"> (asphyxia)<o:p></o:p></span></i></b></span></div>
</td></tr>
<tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0cm 5.4pt; width: 93.45pt;" valign="top" width="125"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">acute beginning, more often at night with URTI previous signs (high temperature, catarrhal syndrome, pharyingitis: hyperemia of the pharynx and soft palate, catarrhal conjunctivitis, scleritis may be present);</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;">
<span style="background-color: white;"><b><i><span lang="EN-US" style="font-size: 14pt;">Typical triad</span></i></b><span lang="EN-US" style="font-size: 14pt;">:<o:p></o:p></span></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Barking cough;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Hoarseness;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Stridor.<o:p></o:p></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 103.75pt;" valign="top" width="138"><div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.45pt; text-align: justify;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Typical triad, but Stridor appears only when child is irritable, during physical exercises.<o:p></o:p></span></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Laboratory signs of breath failure are absent (lips are pink, blood gases are normal), metabolic acidosis may be present.</span><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 107.35pt;" valign="top" width="143"><div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.9pt; text-align: justify; text-indent: 0.25pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Moderate breath failure (skin pallor, perioral cyanosis, tachycardia);<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">irritability;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.9pt; text-align: justify; text-indent: 0.25pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Stridor with moderate involvement of all respiratory muscles;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.9pt; text-align: justify; text-indent: 0.25pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Barking cough;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.9pt; text-align: justify; text-indent: 0.25pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">Hoarseness;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.9pt; text-align: justify; text-indent: 0.25pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">рО<sub>2</sub> is decreased or on the lower normal grade;<o:p></o:p></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">рСО<sub>2 </sub> is normal;</span><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td><td colspan="2" style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 133.4pt;" valign="top" width="178"><div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Severe breath failure (stable cyanosis of lips, acrocyanosis, pallor); Expressed irritability, anxiety; Stridor with moderate involvement of all respiratory muscles with depression of lower part of sternum; tachycardia, deficit of pulse during inspiration; dullness of cardiac tones, myocardial dilatation may be present, cardio-pulmonary insufficiency; рО<sub>2</sub>is decreased (50-<st1:metricconverter productid="70 mm" w:st="on">70 mm</st1:metricconverter> Hg.); рСО<sub>2</sub> is increased (48-<st1:metricconverter productid="50 mm" w:st="on">50 mm</st1:metricconverter> Hg.)</span><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0cm 5.4pt; width: 100.85pt;" valign="top" width="134"><div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.85pt; text-align: justify; text-indent: -0.85pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">skin is pallor-gray, cyanotic, cold extremities;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.85pt; text-align: justify; text-indent: -0.85pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">breathing is superficial, gasping, or apneal;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.85pt; text-align: justify; text-indent: -0.85pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">progressive bradycardia;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.85pt; text-align: justify; text-indent: -0.85pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">subnormal temperature;<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">unconsciousness, seizures;<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-size: 14pt;">no controlled urination and defecation;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.85pt; text-align: justify; text-indent: -0.85pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">p О<sub>2</sub> decreases to 50-<st1:metricconverter productid="40 mm" w:st="on">40 mm</st1:metricconverter> Hg.;<o:p></o:p></span></div>
<div class="Normal" style="font-size: 10pt; margin: 0cm 0cm 0.0001pt 0.85pt; text-align: justify; text-indent: -0.85pt;">
<span lang="EN-US" style="background-color: white; font-size: 14pt;">р СО<sub>2</sub> increases to 70-<st1:metricconverter productid="100 mm" w:st="on">100 mm</st1:metricconverter>Hg.;<o:p></o:p></span></div>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt 0.85pt; text-align: justify; text-indent: -0.85pt;">
<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Death.</span><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></b></span></div>
</td></tr>
<tr height="0"><td style="border: none;" width="129"></td><td style="border: none;" width="131"></td><td style="border: none;" width="155"></td><td style="border: none;" width="2"></td><td style="border: none;" width="154"></td><td style="border: none;" width="146"></td></tr>
</tbody></table>
<div class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
<div align="left" class="MsoNormal" style="font-family: Calibri; font-size: 11pt; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div align="center" class="22" style="text-align: center; text-indent: 0cm;">
<b><span lang="EN-US" style="background-color: white;">Differential Diagnosis of the Respiratory Tract Diphtheria<o:p></o:p></span></b></div>
<div align="center" class="22" style="text-align: center; text-indent: 0cm;">
<br /></div>
<div align="center">
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: -37.15pt; width: 709px;"><tbody>
<tr><td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 106.35pt;" width="142"><div align="center" class="22" style="text-align: center; text-indent: 0cm;">
<b><span lang="EN-US" style="background-color: white;">Signs<o:p></o:p></span></b></div>
</td><td style="border-bottom-color: black; border-bottom-width: 1pt; border-right-color: black; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: black; border-top-width: 1pt; padding: 0cm 5.4pt; width: 108.45pt;" width="145"><div align="center" class="22" style="text-align: center; text-indent: 0cm;">
<b><span lang="EN-US" style="background-color: white;">Parainfluenza <o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="background-color: white;">Diphtheria <o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="background-color: white;">Chicken pox<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="background-color: white;">Measles<o:p></o:p></span></b></div>
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<b><i><span lang="EN-US" style="background-color: white;">Beginning<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white;">acute<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">gradual<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">acute<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">acute<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="background-color: white;">Main signs<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white;">Catarrhal symptoms from the upper respiratory tract, laryngitis<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Laryngitis, slowly development of airways obstruction, low intoxication<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">rashes<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Catarrhal symptoms from the upper respiratory tract, conjunctivitis, rashes<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="background-color: white;">Catarrhal symptoms (cough, corryza)<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white;">Expressed, moderate<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">absent<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">mild<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">expressed<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="background-color: white;">Character of the cough<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white;">dry, rough, barking<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">“ barking”, then soundless<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">is rare<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">dry, or moist<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="background-color: white;">Voice<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white;">Hoarse <o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Hoarse, then soundless<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Is not changed<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">May be hoarse<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="background-color: white;">Oropharyngeal changes<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white;">Moderate hyperemia<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Absent or may be combined with oropharyngeal diphtheria<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">absent<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Exanthema, light hyperemia<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="background-color: white;">Lymphadenitis<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white;">absent<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">regional<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">absent<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">May be plural<o:p></o:p></span></div>
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<b><i><span lang="EN-US" style="background-color: white;">Pathomorphology<o:p></o:p></span></i></b></div>
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<span lang="EN-US" style="background-color: white;">Edema of the larynx<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Obstruction by fibrinous membranes<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Edema of the larynx<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white;">Edema of the larynx<o:p></o:p></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">TREATMENT:</span></b><b><i><u><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></u></i></b></span></div>
<h5 style="font-family: Calibri; font-size: 13pt; font-style: italic; margin: 0cm 0cm 3pt;">
<span style="background-color: white;"><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt;">Basic:</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal;"><o:p></o:p></span></span></h5>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">1.<span style="font-size: 7pt;"> </span></span><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">Bed rest</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;"> up to the normalization of body temperature</span><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">,</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;"><o:p></o:p></span></span></h5>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">2.<span style="font-size: 7pt;"> </span></span><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">adequate </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">re</span><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">hydration with oral fluids</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;"> (lemon tea</span><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">, </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">raspberry tea, warm alkalic drinks<o:p></o:p></span></span></h5>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">3.<span style="font-size: 7pt;"> </span></span><span lang="UK" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">vitaminized </span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt; font-style: normal; font-weight: normal;">milk-vegetable food;<o:p></o:p></span></span></h5>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">4.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Control of fever and myalgia (when the temperature is more than 38.5-39˚C); in children before 2 mo and in case of perinatal CNS damage, seizures in the history, severe heart diseases – when the temperature is up to 38˚C with <i>acetaminophen</i> (paracetamol 10-15 mg/kg not often than every 4 hours (not more than 5 times per day) or<i>ibuprophen</i> 10 mg/kg per dose, not often than every 6 hours. <i>Aspirin </i>is contraindicated for children before 12 years.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">5.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Nasal drops (in infants before 6 mo – physiologic saline solutions as Salin; in elder children – naphtizin, rhinasolin, nasivin for children 1-2 drops 3 t.d. in the nostrils, not more than 3 days<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">6.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">In case of dry cough – cough supressors (such as dextramethorphan, synecod)<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-size: 14pt;">7.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 14pt;">Mucolytics in case of the moist nonproductive cough (ambroxol, acetylcystein etc.)<o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Antiviral treatment </span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">may be used<b><o:p></o:p></b></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Arbidol to the children elder than 12 yrs. — <st1:metricconverter productid="0.2 g" w:st="on">0.2 g</st1:metricconverter>; children of 6-12 yrs. — for <st1:metricconverter productid="0,1 g" w:st="on">0,1 g</st1:metricconverter>, children of 2-6 yrs. — <st1:metricconverter productid="0.05 g" w:st="on">0.05 g</st1:metricconverter> 4 t.d. for 3-5 days</span><span lang="UK"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Thiloron to the children elder than 7 yrs. through a mouth: 60 mg/day in 1, 2, 4, 6 day of treatment<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US">Innosini pranobex 50 mg/kg daily for 5 days</span><span lang="UK"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="UK" style="font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><i><span lang="EN-US">Adenovirus conjunctivitis</span></i><span lang="EN-US"> treatment – antiviral eye drops: poludanum, interferon, 0.05% deoxyribonuclease or 0.5% tebrophen ointment; corticosteroids <span class="GramE">as Dexamethazonum</span> for 4-5 days.</span><span lang="UK"><o:p></o:p></span></span></div>
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<b><span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Antibiotics are appointed<o:p></o:p></span></b></div>
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<span style="background-color: white;"><st1:metricconverter productid="1. In" w:st="on"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1. In</span></st1:metricconverter><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> case of complications caused by bacteria, micoplasm or chlamydia, as:<o:p></o:p></span></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Middle otitis<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Sinusitis<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Acute tonsillitis<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Bronchitis<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Pneumonia<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">2. At suspicion of secondary bacterial infection, children that are risky for bacterial infection development, with body temperature > <st1:metricconverter productid="38 ᄚC" w:st="on">38 °C</st1:metricconverter> more than 3 days, leucocytosis more<span class="GramE">than 15x10<sup>9</sup></span>/l. Antibiotics from the following groups are used:<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Aminopenicillines protected by clavulanic acid (amoxicillin clavulanate);<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Cefoperason in combination with sulbactam, cefuroxim, cefpodoxim<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Macrolydes (clarythromycin, azithromycin, spiramycin);<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• Cephalosporines of 3rd-4th generation also are used.<o:p></o:p></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">• At presence of the methycillin resistant staphylococcus – vancomycin, in case of nosocomeal pneumonia carbapenems are appointed.<o:p></o:p></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Management of croup</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"> depends on the severity of disease.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">At the 1<sup>st</sup> degree of stenosis </span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">treatment of the child should be started at home:</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Air in an apartment must be moistened. An emotional and physical comfort is provided for a child.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Local therapy is directed on the improvement of venous outflow and normalization of lymph outflow: warming of interscapular area, shin muscles, heels.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">A dry heat should be placed on a neck.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span style="font-family: 'Times New Roman'; font-size: 14pt;">Warm dosed al</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">k</span><span style="font-family: 'Times New Roman'; font-size: 14pt;">alic drink.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Inhalations by antioedematous mixture, steam inhalations.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">From medicinal therapy: vitamin C and P, and antihistaminic medicine in age-old doses.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Hospitalization only in the case of presence of problems in a transport connection between a hospital and child’s placement.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">At the 2<sup>nd</sup> degree of stenosis </span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">a child must be transported into the hospital, where is possibly of artificial pulmonary ventilation.</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Treatment of child must begin on the prehospital stage with continuation in the hospital.<o:p></o:p></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Inhalation of water-wet and warmed oxygen.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Sedative medicine with the purpose of diminishing the inspiratory efforts.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Glucocorticoids 10 mg/kg per day by prednisolon. A dose is distributed on 4-6 receptions without the observance of biological rhythm.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Antihistaminic preparations in age-old doses (dimedrolum).<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Careful treatment of bronchial obstructive syndrome: broncholytics, mucosolvents. At a considerable obstruction tracheobronchial tree lavage is done during a few hours.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">A decrease of child’s body weight on 3-4% (stimulation of urination with reduction of daily liquid receipts to 80% of physiological amount).<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Sanation of tracheobronchial tree and feeding the child before next introduction of Sedative medicines. <o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">At the 3<sup>rd</sup> degree of stenosis </span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">next is added:</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Obligatory providing of artificial respiratory ways ventilation (intubation of trachea, tracheotomy if it’s impossible to put an intubation tube into the trachea)<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Under the heart rate control it is possible to use adrenalin inhalations (1:20, 1:15) that enables the edema of subvocal space decrease quickly, but not for a long time.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">At the 4<sup>th</sup> degree of stenosis </span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">a pneumo-cardial reanimation, treatment of cerebrum edema-swelling is performed.</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;"><o:p></o:p></span></span></div>
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<b><span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Prophylaxis of URT viral infection<o:p></o:p></span></b></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt; font-weight: normal;"> </span></span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Intranasal alpha<sub>2</sub>-interferon was active only against rhinoviruses and prevented a cold in only 40% of cases. It must be given not longer than 1-2 weeks.<b><o:p></o:p></b></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt; font-weight: normal;"> </span></span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Arbidol to the children elder than 12 yrs. — 0,2 gs; children of 6-12 yrs. — for 0,1 gs, children of 2-6 yrs. — 0,05 gs 1 t.d. for 10-15 days<b>, </b>or Thiloron to the children elder than 7 yrs. through a mouth: 60 mg once a week during 6 wks.<b><o:p></o:p></b></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Adaptogens, multivitamins<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To avoid a contact with persons which have displays of URT infection;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To limit visits of places with large accumulation of people;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To ventilate an apartment often;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To teach children to wash hands often with soap during 20 seconds;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To teach children to cough and sneeze in a serviette;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To aim not to touch eyes, nose or mouth by unwashed hands;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To avoid cuddles, kisses and greeting by hands;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To cover a nose and mouth at a sneeze or cough by nasal serviette which at once it is needed to throw out after the use;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">To teach children not to suit to the patients nearer than on one and a half - two meters;<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Ill children must stay at a home (not to visit preschool establishments and schools);<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">The moist cleaning up of apartments is needed not less than two times a day.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Key words and phrases</span></b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">: viral upper respiratory tract infections, common cold, Croup,<o:p></o:p></span></span></div>
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<span lang="FR" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">mist tent, humidification, Ribavirine, parainfluenza, adenovirus, RS-virus, rhinovirus.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">References<o:p></o:p></span></b></div>
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<span style="background-color: white;"><st1:place w:st="on"><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Main</span></b></st1:place><b><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">:<o:p></o:p></span></b></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Ambulatory pediatric care\ edited by Robert A. Derchewitz;-2- nd ed. Lippincot-Raven, 1992.- P.602-605, 611-615, 618-623, 753-755.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Current therapy in pediatric infections disease-2\ edited by D.Nelson, M.D.-B.C.Decker Inc. <st1:place w:st="on"><st1:city w:st="on">Toronto</st1:city></st1:place>. <st1:place w:st="on"><st1:city w:st="on">Philadelphia</st1:city></st1:place>, 1988- P. 38-40, 44-45, 49-51.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">3.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Principles and Practice of Pediatric Infectious Diseases. / Edited by Saran S. Long, Larry K. Pickering, Charles G. Prober, <st1:place w:st="on"><st1:city w:st="on"><span class="GramE">Philadelphia</span></st1:city>, <st1:state w:st="on">Pa</st1:state></st1:place>: Churchill Livingstone; 1997. – 1921 p.<o:p></o:p></span></span></div>
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<b><span style="background-color: white; font-family: 'Times New Roman'; font-size: 14pt;">Additional:<o:p></o:p></span></b></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –<st1:place w:st="on"><st1:city w:st="on">London</st1:city></st1:place>, 1989.-661p.<o:p></o:p></span></span></div>
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<span style="background-color: white;"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">2.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 14pt;">Pediatrics <span class="GramE">( 2<sup>nd</sup></span> edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.</span></span></div>
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