[Secretory immunoglobulin A in childhood: does the saliva value reflect the bronchial value?]. / Sekretorisches Immunoglobulin A im Kindesalter: Spiegelt der Speichelwert den Bronchialwert wider?

Immunoglobulin A (IgA) can be found in different body secretions and plays a major role in the local immune response. It inhibits bacterial adherence, neutralizes toxins and protects the mucosa from penetrating antigens and allergens. Whereas measurement of IgA in saliva mostly does not show any problems, difficulties in assessing IgA in bronchial fluids often occur mainly due to variable dilutional effects. Aim of the present study was to find out whether saliva IgA predicts bronchial IgA. In 15 children aged 4 months to 14 years (mean 53.5 months; SEM 12.3) with chronic cough (n = 10), mediastinal mass (n = 1), recurrent airways obstructions (n = 2) and inspiratory stridor (n = 2) we performed a diagnostic rigid bronchoscopy and assessed IgA by means of bronchial lavage (BL). We attempted to control for uncertain dilution by the use of albumin as a denominator and to present our data as ratios of IgA to albumin. As various disease states alter the integrity of the alveolar-capillary membrane and influence the concentration of albumin in the epithelial lining fluid we developed an optical score to describe the state of the bronchial mucosa. Measurement of saliva IgA is easy and can be done without dilutional effects. The mean value of IgA in saliva was 65.49 mg/l (SEM 14.75; range 3.5-227), the one of IgA in bronchial lavage fluid 30.75 mg/l (SEM 7.11; range 3.5-100). IgA-albumin ratio ranged from 0.006 to 1.46 (mean 0.36, SEM 0.12). Saliva IgA did neither significantly correlate with bronchial IgA nor with bronchial IgA-albumin ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

[Is outdoor running exercise suitable for detecting bronchial hyperreactivity in children with mild episodic bronchial asthma?]. / Eignet sich die Laufbelastung im Freien zur Erfassung der bronchialen Hyperreaktivität bei Kindern mit mildem episodischem Asthma bronchiale?

Bronchial hyperreactivity (BHR) can be proved by various methods. 21 children, 14 asthmatics and 7 healthy subjects were submitted to inhalative methacholine challenge as well as to 'free running' as a form of exercise challenge in a randomized sequence. For the methacholine inhalation a standardized procedure was followed and the provocative concentration defined (PC20) at which a decrease of more than 20% in FEV1 was found. There is no real standardisation for 'free running' (concerning temperature and humidity of the inspired air; individual level of exercise) but subjects had to run for 6 minutes while the heart rate should have been between 170 and 180 beats/minute. This increase in pulse rate relates to a submaximal work at which 60-85% of maximal O2 uptake are obtained. A decrease of 15% from basic value of FEV1 was defined as a positive result. By the use of methacholine inhalations we found 16 children (14 diseased, 2 controls) to be hyperreactive, whereas only 3 of them showed a positive result after 'free running'. We conclude, that firstly, methacholine provocations and exercise challenges assess different kinds of bronchial reactivity, secondly, 'free running' as a form of exercise is very difficult to standardize and therefore prone to errors and thirdly, 'free running' is not sensitive enough to assess BHR in children with mild asthma bronchiale if used as the only form of challenge. Problems concerning measurement of BHR are discussed.

Fibrosing alveolitis in an infant.

A three month old female infant presented with unproductive cough, diffuse bilateral fine crackles, tachypnoea and failure to thrive despite a four month therapy with beta 2-agonists and antibiotics. A chest radiograph showing bilateral periphilar infiltrates and a patchy infiltrate in the right upper lobe and lingula did not explain the physical examination with diffuse bilateral fine crackles. As the condition did not improve and arterial oxygen tension (PaO2) and oxygen saturation decreased during the following two months, an open lung biopsy was performed. The surgeon described the lungs as rubbery in consistency and histological findings showed patchy mild interstitial fibrosis and thickened alveolar septa. A therapy with prednisone daily was started and given over a period of four months, but did not show sufficient improvement. Only after addition of azathioprine was clinical improvement and normalization of blood gases noted.

[Food-borne botulism in 2 brothers]. / Nahrungsmittelbotulismus bei zwei Brüdern.

Two boys with symptoms of food borne botulism are presented. Confirmation of diagnosis relied on proof of toxin in the serum of both patients by the so called mouse neutralization test, whereas the EMG showed negative results. Both boys recovered fully without administration of equine antitoxin. Differential diagnosis and treatment of botulism are discussed. Signs of internal and external ophthalmoplegia, dry mouth, descending paralysis, obstipation with weakness, absence of fever and lucid sensorium as cardinal symptoms should always bring botulism to mind.