[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.

[Pilot study of amiloride inhalation in children with cystic fibrosis]. / Pilotstudie zur Amiloridinhalation bei Kindern mit cystischer Fibrose.

Bronchial clearance is impaired in cystic fibrosis (CF). Respiratory secretions contain less sodium and chlorid, resulting in reduced airway water content. Aerosolized amiloride, a sodium transport blocker, was shown to normalize the amount of sodium in bronchial mucus, leading to an improvement in mucociliary clearance. In a controlled, double blind crossover study on nine CF children we tried to assess the efficacy of twice daily inhaled amiloride (10(-3)M) on sputum weight, consistency of sputum and lung function (FEF1, FVC, FEF50, FEF25, PEF). Each treatment period (amiloride versus 0.9% saline) lasted for two months. We could show that inhaled amiloride was able to increase mean sputum weight per day from 11.75 g (+/- 5.96) up to 18.5 g (+/- 10.34). This was equal to an increase of 57%. Some children felt that sputum expectoration lasted longer while using amiloride and that even for some hours after inhalation they expectorated a sputum-like fluid. We were able to detect, at least in some patients, that their sputum consisted of two parts, one showing more solid contents, the other more fluid-like contents. This was, however, not a consistent feature. No significant or clinical important differences were found for pulmonary function test data. There were no pulmonary or extra pulmonary side effects from treatment with amiloride. Further studies should be undertaken to assess the efficacy of longer lasting amiloride inhalation on the course of the disease in CF patients.

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.

[Quantitative studies of the collagen content of the human amnion and chorion]. / Quantitative Untersuchungen über den Gehalt an Kollagen im menschlichen Amnion und Chorion.

The content of collagen in the amniotic and chorionic connective tissue was determined with the quantitative investigation method of hydroxyprolin. Significant differences do not exist between the amount of collagen in the amniotic and chorionic connective tissue. The difference in the tension stability must be based on the variegating pattern of the collagen fibrils.