Immunologic status in pediatric cardiosurgical patients with chylothorax.

OBJECTIVE: The impact of lymphocyte and immunoglobulin loss on immunologic status has not been extensively studied in children with chylothorax. The purpose of this study was to evaluate immunologic profile of pediatric cardiosurgical patients who developed infection while suffering from prolonged postoperative chylothorax. METHODS: We retrospectively reviewed immunologic findings in 16 pediatric cardiac patients with post-operative chylothorax persisting ?7 days. Patients were on total parenteral nutrition, received colloides for replacement of chylous losses, and antibiotics and/or antimycotics for treatment of infection. Immunologic evaluation included immunoglobulin levels, cellular immunity, and phagocytic activity. For every parameter z-score was calculated according to age-dependent nomograms and t-test was used to compare z-score distribution with normal distribution. RESULTS: The immunoglobulin (IgG, IgM, and IgA) levels did not significantly differ from normal values, although 25% patients had IgG levels below normal range. The relative and absolute counts of peripheral blood lymphocytes were lower (p < 0.001) than normal values. Absolute numbers of blood B-lymphocytes (CD19+), T-lymphocytes (CD3+), helper/inducer T-cells (CD4+), and suppressor/cytotoxic T-cells (CD8+) were also below normal range (p < 0.001); however, their relative percentages and a CD4+/CD8+ ratio were within normal limits. The percentage and absolute number of natural killer cells (CD16+), phagocytic and metabolic activity of polymorphonuclear leukocytes did not differ from normal values. CONCLUSIONS: Persisting chylothorax results in B-cell and T-cell lymphopenia with proportional decline of CD4+ and CD8+ cells. Hypogammaglobulinemia observed in other studies has not been detected in this series probably due to administered plasma. Effects of these immunologic alterations on development of infection are unknown (Tab. 2, Ref. 13).

[Is allergy a contraindication for tonsillectomy?]. / Je alergia kontraindikáciou tonzilektómie?

Many immunologists indicate that tonsillectomy (TE) performed in patients with allergy has an unfavourable impact on the development of allergy and asthma. This warning has significantly decreased the number of TE in children, and resulted in an increase in the occurrence of peritonsillar abscesses, and high incidence of obstructive breathing disturbances during sleep associated with developmental physical and mental consequences in children. The subjective of this study was to find out the influence of TE on the development of allergy in 29 children, in whom their allergy was confirmed 1-5 years after TE. The allergic disease has improved or disappeared in 24 children (82.8%), no changes were recorded in 4 children (13.8%), deterioration has occurred only in 1 child (3.4%) who developed asthma, while in common population, asthma occurs in 10% of children. The results of this study confirm that TE does not have an unfavourable impact on the development of allergy, and therefore allergy does not represent a contraindication for tonsillectomy. (Fig. 1, Ref. 22.)

[IgG subclasses in children with recurrent respiratory diseases]. / Podtriedy IgG u detí s recidivujúcimi respiracnými chorobami.

The authors examined IgG sub-classes, using the ELISA method, in 35 patients with relapsing respiratory diseases and 27 children of a control group aged 3-15 years. In children with relapsing respiratory diseases without deficiency of the main immunoglobulin classes they found a statistically significantly reduced value in sub-class IgG2 (P < or = 0.01). The changes found in other sub-classes were not statistically significant. The authors draw attention to the fact that deficiency in IgG sub-classes should be considered in case of repeated respiratory infections caused by encapsulated microorganisms--H. influenzae, Str. pneumoniae--and also when reduced levels of IgG and IgA are found. However, even normal levels do not rule out deficiency.

[Biostim in the treatment of recurrent respiratory diseases in children]. / Biostim v liecbe recidivujúcich respiracných chorôb u detí.

The authors treated with Biostim (Roussel Uclaf Co., France) 20 children aged 3 to 15 years with relapsing and chronic diseases of the respiratory system. A favourable clinical effect was observed in 45% and improvement in 40% of the patients. In the investigated immunological indicators the response to treatment Biostim was manifested in the antibody immunity by a reduction of IgE values (P < 0.01) and of IgM (P < 0.05). As to cellular immunity, there was a significant increase of the phagocytic activity (P < 0.05). The tolerance of the preparation was very good.