[Gastroesophageal reflux as the basis of recurrent and chronic respiratory diseases]. / Gastroezofageální reflux jako podklad recidivujících a chronických respiracních onemocnení.

Among many causes of relapsing and chronic respiratory diseases in children the authors revealed gastrooesophageal reflux (GER) in 53 of 106 examined children, i.e. in 50%. Therefore examination of GER was included in routine examinations of all children admitted on account of the following diseases: laryngitis rec., bronchitis rec., bronchitis obstructiva rec., pneumonia rec., bronchiectasy, bronchitis deformans, asthma bronchiale. GER was detected in 208 children aged 6 months to 15 years. All children were subjected to an X-ray examination by contrast substance and to sonography of the cardia. In clinically serious cases manometric and pH metric examinations were made. When GER was detected the authors recommended conservative treatment: postural position, restricted fluid intake before going to bed, elimination of cocoa and chocolate, antacids. A favourable effect of conservative treatment in the course of 1-2 years was recorded in 60 of 76 children, who attended check-up examinations, i. e. in 79%. In children where serious complaints persisted, in particular rec. pneumonia, the development of deforming bronchitis and bronchiectasy or dyspnoic attacks, the authors indicated after completion of examinations and agreement with surgeons, a surgical approach. Fundoplication was performed in 22 children, i. e. in 10% of the patients where GER was revealed.

Effects of 90% oxygen exposure on the ultrastructure of the tracheal epithelium in rabbits.

Numerous signs of pathological alteration were induced in the pseudostratified ciliated epithelium by a 2-hour exposure to 90% oxygen. The ciliary border injury was especially conspicuous, the mean number of cilia in a given area was significantly (p less than 0.005) reduced and morphological signs of impaired self-cleaning ability were revealed. Ciliated cells were severely injured showing apical blebbing and swelling of cell organelles. The reaction of goblet cells to exposure to O2 was rapid discharge of mucus, but the mechanism of mucus evacuation was not substantially influenced. At the ultrastructural level, only a mild effect of humidification of the oxygen was observed.

Lung function in children and adolescents with idiopathic interstitial pulmonary fibrosis.

Lung function of 65 patients who had idiopathic interstitial pulmonary fibrosis (IIPF) that had been treated with prednisone was evaluated by tests of ventilatory function, lung mechanics, and gas exchange at rest and during exercise. Ages on initial investigation ranged from 5 to 20 years. In 35 of 65 patients the studies were repeated an average of four times over a period of 1 to 9 years. Results of the first testing were as follows: vital capacity (VC)-significantly reduced in all patients; inspiratory capacity (IC)-significantly reduced in all patients; total lung capacity (TLC)-reduced in 91%; functional residual capacity (FRC)-reduced in 31%; residual volume (RV)-reduced in 6%; elastic recoil of the lungs (Pstl)-significantly increased in 97% at 100% TLC, significantly increased in 52% at 90% TLC, reduced in 68% at 60% TLC; 7) static compliance (Cst)-reduced in 83%; 8) dynamic compliance (Cdyn)-reduced in 88%; 9) specific airway conductance at FRC level (Gaw/TGVex)-significantly increased in 50%; 10) maximum expiratory flow rates at 60% TLC (Vmax 60% TLC, in TLC/s)-significantly reduced in 33%; 11) upstream airway conductance (Gus 60% TLC, in TLC/s/cm H2O)-reduced in 32%; 12) diffusing capacity of the lungs for carbon monoxide (DLco) related to body-surface area-abnormal in 58% (when corrected for lung size, i.e., DLco/TLC, abnormal in only 8%); 13) PaO2 at rest and after 6 minutes submaximal exercise-reduced in 25% and 63%, respectively. Changes in lung function that occurred with growth were assessed in terms of percentages of predicted values. Results showed that the VC and IC remained significantly reduced. An actual reduction of TLC, FRC, RV, breathing frequency, DLCO, and Pstl at 100% and 90% TLC was observed. Increases were seen in Pstl at 60% TLC, Gaw/TGVex, Vmax, and Cst. Indices of lung elasticity suggested that regions of fibrosis and emphysema had become present. Smaller patients were also noted to have stiffer lungs.

Ultrastructure of bronchial epithelium in children with chronic or recurrent respiratory diseases.

The ultrastructure of the bronchial epithelium in three children with recurrent bronchopneumonia, four patients with cystic fibrosis and two with Kartagener's syndrome was studied. The children with recurrent bronchopneumonia and those with Kartagener's syndrome had mostly changes in the pseudostratified ciliated epithelium, and two of them had ultrastructural signs of developing squamous metaplasia. Developed stratified squamous epithelium was found in three of four patients with cystic fibrosis and in one patient with recurrent bronchopneumonia. The squamous epithelium showed striking pathological changes, but, only the oldest patient with cystic fibrosis showed signs of onset of keratinization. Both patients with Kartagener's syndrome had the defect of dynein arms typical of the immotile-cilia syndrome. In the youngest patient the partial absence of dynein arms was combined with a defect in the radial structures of the axonemes.