Time trends and seasonal variations in hospital admissions for childhood asthma in Taiwan from 1990 to 1998.

The aim of the study was to determine the trends and seasonal variations in hospital admissions for childhood asthma in a tertiary medical center since 1990. Data were collected according to the age and sex of patients and obtained from hospital registries between 1990 and 1998. Children between 2 and 14 years of age admitted with the diagnosis of asthma, or asthmatic bronchitis (ICD-9 code 493) were included. Age-specific and sex-specific hospital admission rates for asthma were calculated for each calendar year. The asthma admission rates were defined as the number of asthma admissions divided by the total number of all pediatric admissions in a year. Seasonal admission rates were calculated in a similar fashion. In addition, the number of readmissions was also calculated during the study period with comparisons of sex and age differences. The asthma admission rates showed a significant upward trend throughout the period studied, particularly among the 2-4 years of age group (relative risk = 2.08; p = 0.0001). Seasonal admission rates revealed a statistically significant increase during the October-December period, peaking in November or December of each calendar year (relative risk = 1.84; p = 0.0001). There was a male predominance in both age categories during the 9-year period. Comparisons of readmissions for asthma (at least three admissions) disclosed that girls were far more likely to be readmitted than boys among the 5-14 years of age group (p = 0.01). Our results indicate 1) an increased prevalence and severity of childhood asthma in Taiwan; 2) boys and younger children aged 2-4 years with asthma had increased risks of admission for asthma (relative risks were 1.22 and 1.96, respectively) and 3) girls among the older children with asthma tend to present with greater severity than boys owing to higher relative risks of readmission for asthma.

Paradoxical vocal cord adduction mimicking as acute asthma in a pediatric patient.

We report an adolescent girl with paradoxical vocal cord adduction who presented with acute onset of hyperventilation, wheezing and stridor that did not respond to bronchodilator and anti-inflammation therapy. The paradoxical vocal cord motion was confirmed by flexible fiberoptic bronchoscopic examination. We found the stridor was induced by hyperventilation, and was caused by paradoxical vocal cord movement. The abnormal cord motion may be psychogenic and could be misdiagnosed as asthma. It is important to investigate the underlying background and social history and to avoid unnecessary use of beta-agonists, steroids, and even endotracheal intubation or tracheostomy.

Correlation of total and specific serum immunoglobulin E levels with the severity of chronic sinusitis in children.

Chronic sinusitis is frequently associated with allergy and asthma. Previous studies have shown that serum immunoglobulin E (IgE) levels correlate with allergy and asthma in adults. Because the role of allergic inflammation in the severity of chronic sinusitis remains controversial in children, we set out to determine whether a correlation exists between serum levels of total and specific IgE and the severity of chronic sinusitis in children. Forty-four children with chronic sinusitis were enrolled in the study. Computed tomographic scans were reviewed and scored for the severity of sinusitis. All children were mite-sensitive. Serum samples were assayed for total IgE and specific IgE antibodies to mite allergen using a fluoroimmunoassay. Fourteen subjects had extensive sinus disease. There was no significant difference in the average of total and specific IgE between the subjects with extensive and limited disease (p = 0.562 and 0.755, respectively). Thirty-four subjects were diagnosed with asthma. The subjects with extensive sinus disease had a higher prevalence of moderate to severe asthma than the subjects with limited disease (p = 0.006), but there was no significant difference in the average of total and specific IgE between the subjects with different severities of asthma. (p = 0.833 and 0.425, respectively). The data suggests that levels of total or specific IgE do not correlate with severity of chronic sinusitis in children. Nonetheless, the severity of chronic sinusitis and asthma correlate well with each other irrespective of total and specific IgE.

Atopic cataracts in a child with atopic dermatitis: a case report and review of the literature.

Cataracts induced by atopic dermatitis rarely occur in adolescent and young adult patients suffering from this problem. Lenticular opacity is an important ocular complication in atopic dermatitis. Although the cause of atopic dermatitis and its ocular complications are unknown, cataracts have been observed to develop and progress during periods of exacerbation of the dermatitis. We report the case of a 16-year-old boy with atopic dermatitis who abruptly developed cataracts in both eyes while suffering from severe skin itching which began 2 months before the initial examination. His peroxidation test result was very high, and we postulate the retinal peroxidation might play a key role in cataractogenesis. Lens aspiration and intraocular artificial lens implantation were performed smoothly with restoration of visual acuity in both eyes.

Circulating interleukin (IL)-1 beta, IL-6 and tumor necrosis factor-alpha in children with febrile infection--a comparison with C-reactive protein.

Circulating interleukin (IL)-1 beta, IL-6, and tumor necrosis factor (TNF)-alpha were examined in 42 febrile children with fever lasting more than 4 days. Their diagnosis were probable viral syndrome in 22, urinary tract infection (UTI) in 10, and probable bacterial pneumonia in 10. None of our study patients had detectable serum IL-1 beta. TNF-alpha levels were significantly higher in children with pneumonia than in those with viral syndrome (p < 0.01). Children with UTI and pneumonia had significantly higher IL-6 and CRP, compared to those with probable viral syndrome (p < 0.01 for both IL-6 and CRP). When appropriate cutoff values are chosen, IL-6 had greatly improved specificity (86.4%, > 20 pg/ml) to demonstrate UTI and pneumonia, as compared to that using CRP (48%, > 40 mg/l). After three days' antibiotic treatment, IL-6 fell to control levels in children with UTI and pneumonia, while CRP remained elevated. There was no difference in TNF-alpha values before and after treatment. Thus, IL-6, rather than IL-1 beta and TNF-alpha, may be a helpful diagnostic tool for evaluation of pediatric febrile infection. Sequential studies involving more patients are needed to determine whether IL-6 is better than CRP in this clinical setting.

Serum eosinophil cationic protein determination in asthmatic children-effect of different collecting tubes used for blood sampling.

We compared the effect of using 2 different serum collecting tubes, serum separation tubes (SST, with clot activator and gel barrier) and conventional glass tubes (with no additives), on circulating levels of eosinophil cationic protein (ECP) in asthmatic children and controls. The serum ECP values obtained from both SST and glass tubes were significantly higher in asthmatic children than in corresponding controls. ECP values were higher in serum samples using SST than in those using glass tubes (P<0.01), while no difference was found between the two in controls. ECP levels correlated with peripheral eosinophil counts, for SST samples and glass tube samples alike. The difference in ECP levels between these two tubes also correlated with circulating eosinophil counts (r = 0.62, P = 0.004) After 18-hour storage at room temperature, the ECP values increased significantly in samples obtained from asthmatic children. No difference in ECP values between SST samples and glass tube samples was found for 18 hour samples. Thus, ECP levels obtained from SST samples and glass tube samples, though reliable, should not be directly compared, especially in asthmatic children with eosinophilia.

Use of standard radiography to diagnose paranasal sinus disease of asthmatic children in Taiwan: comparison with computed tomography.

Paranasal sinus disease and bronchial asthma are frequently associated. Computed tomography imaging is currently the most reliable method for confirming the diagnosis of sinusitis. Due to the cost and amount of radiation during computed tomography, our aim was to analyze whether standard radiography, under computed tomography-control, had a reasonable degree of confidence in the diagnosis of sinusitis. Fifty-three asthmatic patients (42 males and 11 females) with a mean age of 9 years (range 4-14) were enrolled. We evaluated the maxillary sinuses, ethmoidal sinuses, frontal sinuses, and sphenoidal sinuses using standard radiography (Waters' view, Caldwell view, and lateral view) and compared with computed tomography (coronal views), the latter served as a standard. Computed tomography (CT) showed paranasal sinusitis in 58% (31/53) of the asthmatic children. Compared with the results of computed tomography, standard radiography revealed a sensitivity of 81.1% and a specificity of 72.7% for maxillary sinusitis. The sensitivity and specificity for ethmoidal, frontal, and sphenoidal sinusitis were 51.8%, 84.8%; 47.3%, 87.2%; and 40.8%, 93.3%, respectively. In 21 (40%) of the 53 patients, discrepancies were seen between the interpretations of standard radiography c and those of CT scans. In patients with maxillary sinusitis, the correlation between standard radiography and CT was good. However, ethmoidal, frontal, and sphenoidal sinusitis were poorly demonstrated using radiography. Standard radiography can be recommended as a screening method for maxillary sinusitis, but it is not recommended for the diagnosis of other paranasal sinusitis.

Henoch-Schönlein purpura in Chinese children and adults.

From 1987 to 1996, we retrospectively analyzed 84 children and 38 adults admitted to Chang Gung Memorial Hospital with the diagnosis of Henoch-Schönlein purpura (HSP). All of the adult patients had skin biopsy finding showing leukocytoclastic vasculitis. Male predominance was noted in children, but not in adults. Preceding infection was noted in 40.5% of children and 31.6% of the adults (P = 0.46). 8.3% of children and 13.2% of adults had medication intake at disease onset (P = 0.62). Children had more frequent abdominal pain than the adults (70.2% vs 28.9%, P < 0.01). Renal involvement was more common and severe in adults, manifested as more frequent hypertension (P < 0.05) and heavy proteinuria (P < 0.01). During acute attack, leukocytosis, thrombocytosis, elevation of serum C-reactive protein levels were more frequently observed in children, while elevated serum IgA and cryoglobulin levels were more common in adults. The overall prognosis was good in both age groups, although two adults developed end stage renal disease. Our study demonstrated the different expression of HSP in Chinese children and adults.

Sulphasalazine therapy in chronic uveitis of children with chronic arthritis.

Four children with chronic arthritis (3 juvenile rheumatoid arthritis and 1 juvenile ankylosing spondylitis) and poorly controlled chronic uveitis, were given sulphasalazine (SASP) therapy for a mean period of 3.3 years. Three patients showed an excellent response, as evidenced by a reduction of inflammatory cells in the anterior chamber of the eyes and improvement of visual acuity. The response occurred after a mean of 7.7 weeks. These data suggested SASP therapy may have a role in the treatment of chronic anterior uveitis in children with chronic arthritis.