Passive smoke exposure in infants and children with respiratory tract diseases.

1. The adverse effect of passive smoke exposure on the respiratory tract, particularly in infants and children, is not an issue of dispute. It was the objective of this study to analyse the extent and the intensity of passive smoke exposure in infants and children with respiratory tract diseases, and compare the information obtained with parents' subjective assessment. At the time of admission to the hospital, the parents of 295 infants and children (aged 1 month to 11 years) were questioned by the physician as to the smoking habits in the families' homes. An HPLC method was employed to determine simultaneously nicotine, cotinine and trans-3'-hydroxycotinine in the children's urine. 2. The sum of the nicotine metabolites turned out to be a sensitive marker in determining passive smoke exposure. Measurements revealed passive smoke exposure in 66% of the children, the frequency in younger children being significantly (P < 0.001) higher than in children over 5 years (84% vs 52%). The average concentration of nicotine metabolites in younger passive smokers was significantly (P < 0.001) higher when compared to the older ones (193 nmol/l vs 86 nmol/l). Forty-nine per cent of the parents assessed that their children had experienced passive smoke exposure, and another 10% emphasised that they only smoked in the absence of their child. In children with cystic fibrosis and bronchial asthma, the number of passive smokers as assessed by their parents were lower by 65% and 29% respectively when compared to the findings obtained from measurements. In children without respiratory diseases, the difference was as little as 18%. 3. Parents when questioned in conjunction with an illness of their children, tended to understate, or even withhold the truth about, passive smoke exposure. Therefore, reliable information on passive smoke exposure of patients can only be obtained through objective measurements.

[Genetics of bronchial asthma with reference to allergy]. / Untersuchungen zur Genetik des Asthma bronchiale unter Berücksichtigung der Atopie.

No uniform opinion exists to date in respect of the transmission of a genetic disposition to asthma bronchiale and atopy. Literature references discuss both monogenic, autosomal dominant or recessive and multifactorial-polygenic heredity. The following contribution discusses the results of an own study on the occurrence of atopy and asthma bronchiale in 153 families. Multifactorial-polygenic heredity with threshold value range is most suitable for the interpretation of our findings, even though an autosomal dominant heredity with reduced penetrance and variable expressivity might well be the basis for the transmission of a disposition to atopy and asthma bronchiale. In multifactorial-polygenic heredity with threshold value range, empirical risk data are important for predicting the disease risk. Such data can be obtained only on the basis of extensive family research and apply only to the population for which they were obtained. The risk of occurrence of atopy or asthma bronchiale in families already affected by the increases, in our experience, with the number of the patients already suffering from the disease and with the closeness of relationship with the patients concerned. We found a recurrence risk for further children of 40-45% for atopy and of 5-10% for asthma bronchiale in those marriages where both one parent and already one child are suffering from the disease.

[Findings of combined ventilation/perfusion scintigraphy in children with abnormalities of the bronchi, the lung and lung blood vessels]. / Befunde der kombinierten Ventilations-/Perfusionsszintigraphie bei Kindern mit Fehlbildungen der Bronchien, der Lungen und Lungengefässe.

Combined ventilation/perfusion scintigraphy with 133Xe/99mTc-HAM was performed within the framework of bronchological diagnostics in 38 children suffering from malformations of the bronchi, lungs and pulmonary vessels, and in 9 children after surgery of hernia of the diaphragm. The findings in stenoses, cysts in the bronchial system and in children with pulmonary vessel malformations, in one child with pulmonary agenesia and in a few other malformations, are presented. The significance of these findings in bronchological diagnosis in case of pulmonary malformations or clinical follow-up is discussed. Combined ventilation/perfusion scintigraphy is a valuable contribution to preliminary diagnosis and in follow-up of children with pulmonary malformations.

[Treatment strategy in childhood bronchial asthma]. / Behandlungsstrategie des kindlichen Asthma bronchiale.

Although bronchial asthma is the most frequent chronic disease in childhood, not all of the affected children are readily recognised as asthmatics well in time for appropriate treatment. Since most of the children can get rid of the symptoms if all the available treatment methods are made use of systematically, early diagnosis and correct estimation of the disease pattern are essential for good long-term prognosis. New pathogenetic knowledge on the importance of inflammatory processes affecting the bronchial mucosa has definitely shifted the points of emphasis in asthma treatment as is evident from the international consensus recommendations. Focus of drug therapy is on prophylactic antiphlogistic treatment. Only in cases of severe asthma continual bronchodilatory medication is also recommended. The inhalative route is beneficial and feasible for all age groups. Long-term treatment, wherever necessary, also includes continual medical supervision in consultation with a paediatric pneumologist.

Influence of infant diets on the ecology of the intestinal tract of human flora-associated mice.

The effect of diet on intestinal ecology was studied in germ-free mice that were inoculated orogastrically with predominant intestinal flora components isolated from the feces of breast-fed human infants. The flora components colonized the intestines of mice and persisted at fixed population levels. Groups of flora- associated mice were fed either human milk, bovine milk, whey-dominant formula, or formula modifications exclusively for 2 weeks, and then examined for changes in small intestinal and cecal flora composition, cecal pH, and resistance to intestinal colonization with Salmonella typhimurium. Dietary variations influenced the composition of the flora to a moderate degree but the differences were generally not statistically significant. However, the addition of bovine lactoferrin to the whey-dominant formula resulted in significantly greater counts of Bifidobacterium, Bacteroides, Enterococcus and total aerobes in the small intestine when compared with mice fed unsupplemented formula. Bifidobacterium was present in large numbers in both the ceca and small intestines of mice fed the lactoferrin-supplemented formula. Despite similarities in intestinal flora patterns among mice fed the various diets, human milk consumption resulted in a lower pH of cecal contents and a greater resistance to colonization by Salmonella typhimurium after orogastric challenge than the consumption of the other diets.

[Results of specific hyposensitization in children with pollinosis]. / Ergebnisse der spezifischen Hyposensibilisierung bei Kindern mit Pollinose.

Hyposensitization was carried out in 120 children aged 5 to 15 years with proven sensitivity to various pollen for 3 to 5 years before the start of the season. By reason of the results of intracutaneous tests 90 patients were treated with mixed pollen allergen and 30 patients with grass pollen allergen. A retrospective study was undertaken on the base of a questionnaire. Every year after the season duration and severity of symptoms as well as consumption of medicine were registered. The total success of hyposensitization amounted to 70.8% and this result varied on the one hand in dependence of the duration of disease on the other hand in dependence of the duration of treatment. A more inconvenient result was seen in those children who suffered from asthmatic symptoms exclusively compared to patients with hay fever. Local side effects resulted sporadically in 71.5% and systemic side effects in 15.7% by subcutaneous injection of depot-pollen allergen. Despite of extensive and not indifferent mode of treatment, hyposensitization should be performed in a correct way as soon as possible after exact indication.

[The significance of the flow-volume curve in pediatric lung diseases]. / Zur Bedeutung der Flussvolumenkurve in der pädiatrischen Pulmologie.

Even slight obstructions in small airways are detectable by means of the flow-volume curve. Therefore this method is to recommend for early diagnosis and especially in infancy. Advantages were demonstrable at the examination of different groups of asthmatics and in children with cystic fibrosis. The great sensitivity of the flow values was also shown at the bronchospasmolytic test and for provocation tests particularly. The flow-volume curve is an important routine method in pediatric pulmonology to determine the dimension and location of ventilation disorders and for follow-up studies and therapy supervision.

[Value of bronchography in childhood with special reference to nuclear medicine preliminary examinations]. / Stellenwert der Bronchographie im Kindesalter unter besonderer Berücksichtigung nuklearmedizinischer Vorfelduntersuchungen.

One month to 16 years old 288 children suffering from recurrent and chronic bronchitis, asthma, cystic fibrosis, malformations and various other lung diseases have been undergone 133Xe-Gas/99mTc-HAM lung scintigraphy. By means of results and taking in consideration scintigraphic findings the strategy of bronchographic indication is laid open being of higher load for the children based on anaesthesia and x-ray. Thus the number of bronchographs could be reduced from 47 (1984) via 33 (1985) to 22 (1986) by means of lung-scintigraphic imaging.

[The development of pediatric bronchology]. / Zur Entwicklung der Kinder-Bronchologie.

The authors give a statistical survey about the development of paediatric bronchology in the German Democratic Republic since 1957. They draw conclusions from this survey about the future trends in this field, which is part of paediatric bronchopneumology.

[Current aspects of the therapy of bronchial asthma in childhood]. / Neue Aspekte zur Therapie des Asthma bronchiale in Kindesalter.

The management goals common to all age groups are to reduce symptoms, to permit a normal physically active lifestyle, and to prevent irreversible airway obstruction. Main measures are environmental manipulation (avoidance of allergen contact, cigarette smoke and pets; psychotherapeutic management), assessment of severity, training for self management, hyposensitization (pollen, HDM, insect venoms) and pharmacotherapy. Medication should be adapted to age and severity of the disease, and the different drugs should be used stepwise. The first step includes the application of bronchodilators in which beta-2-stimulants are to be preferred. If we use spacers or jet nebulizers infants can also be treated successfully. The value of xanthines is discussed controversially. The next steps tend to reduce the inflammatory reaction. In this direction sodium cromoglycate and ketotifen are useful especially in childhood, and inhaled steroids have increasing importance. The use of oral corticosteroids should be the last step.

[Initial experiences with "Oranienburg" slow-release theophylline in asthma therapy of children and adolescents]. / Erste Erfahrungen mit Theophyllin retard "Oranienburg" in der Asthmatherapie bei Kindern und Jugendlichen.

Experiences in 50 patients show that Theophyllin retard Oranienburg (280 mg theophylline) could be used as an effective bronchospasmolytic drug on conditions of mono- and combination-therapy. Advantages of this preparation are improvement of the compliance and an undisturbed night-sleep in patients. However an optimum dosage is hardly maintained in children by the present dose of a single tablet of 280 theophylline content. The effectiveness in therapy of childhood asthma could be improved by stronger sustained release effect and different doses of tablets.

[The effect of bronchologic studies on blood gases and hemodynamics in children]. / Der Einfluss bronchologischer Untersuchungen auf Blutgase und Hämodynamik bei Kindern.

During 78 bronchological examinations in children of all age groups out of 6 centers of children bronchology of the GDR PaO2, PaCO2 and pH were registered, in a part of them additionally pulse, systolic and diastolic blood pressure. Following to the intubation--under ventilation with 100% oxygen or a halothane-NO2-oxygen mixture--there was a marked rise of PaO2, which normalized after extubation quickly. After extubation a slight hypoxemia occurred for a short period, a quick rise of PaCO2 and a slight acidosis, too. Besides, the hearth rate, systolic and diastolic blood pressure elevated following to the intubation and diminished after extubation.

Impact of LY146032 on Streptococcus (Enterococcus) faecalis translocation in mice.

The susceptibility of Swiss White mice to colonization with Streptococcus (Enterococcus) faecalis was greatly increased when the animals were given 5 mg of streptomycin sulfate per ml in their drinking water. One week after initiation of streptomycin treatment, the mice were challenged orogastrically with graded doses of streptomycin-resistant S. faecalis. The number of S. faecalis cells required to implant the intestinal tract of 50% of untreated mice was 2.9 X 10(9), but was only 4.8 X 10(3) for streptomycin-treated animals. When both groups of mice were challenged orogastrically with 4.6 X 10(6) viable S. faecalis cells, the cecum and small intestine of 100% of the streptomycin-treated animals, but only 10% of the untreated animals, were colonized with the organism. Similarly, translocation of S. faecalis to extraintestinal sites occurred in a majority of streptomycin-treated mice, but in only a small number of untreated mice. Subcutaneous administration of the experimental antibiotic LY146032 (Eli Lilly & Co., Indianapolis, Ind.) to streptomycin-treated mice concomitant with orogastric challenge with 5.5 X 10(5) viable S. faecalis cells resulted in a significant decrease in the incidence of intestinal colonization by the organism, a significant reduction in S. faecalis populations, and the absence of the organism in the liver, spleen, and heart. However, once intestinal colonization had occurred and extraintestinal infections were established, LY146032 did not significantly reduce S. faecalis populations or ameliorate the infections. We conclude that LY146032 effectively prevents translocation of S. faecalis from the intestinal tract of mice but does not resolve established extraintestinal infections.

[Combined 113Xe/99mTC human serum albumin microspheres lung scintigraphy in children with recurrent and chronic bronchitis]. / Die kombinierte 133Xe-/99mTc-HAM-Lungenszintigraphie bei Kindern mit rezidivierender und chronischer Bronchitis.

A total of 117 children with recurrent and chronic bronchitis aged from 2 months to 16 years were subjected to combined ventilation-perfusion scan of the lungs with 133Xe-gas and 99mTc-HAM. It served as a screening before bronchological examination with the aim to get a more exact indication for bronchography which leads to a higher stress in children because of anaesthesia and radioscopy. Due to combined lung scan, the number of bronchological examinations could be reduced from 109 in 1984 to 79 in 1985 and even to 54 in 1986. Among the 117 children suffering from bronchitis, we found normal scans in 16 cases, perfusion defects in 59 cases, combined ventilation-perfusion defects in 41 cases and one case showed a pure ventilation defect. The lung scan should be applied in the framework of bronchopulmonary standard diagnosis.

[ECG changes in the long-term management of children with mucoviscidosis]. / EKG-Veränderungen bei langzeitbetreuten Kindern mit Mukoviszidose.

123 ECG were analysed in 33 patients with cystic fibrosis. The authors investigated the criteria of right and left ventricular hypertrophy and discussed their frequency and validity.

[Noninvasive examination methods in the detection of right heart hypertrophy in children with mucoviscidosis]. / Nichtinvasive Untersuchungsmethoden zur Erkennung der Rechtsherzhypertrophie bei Kindern mit Mukoviszidose.

Pulmonary hypertension with right ventricular hypertrophy (Cor pulmonale) is a critical complication in cystic fibrosis patients. Early detection and therapy might decrease mortality. Noninvasive diagnostic methods as vector-ECG, m-mode echocardiography and thallium myocardial scintigraphy were performed in 50 children with cystic fibrosis to determine the degree of right ventricular hypertrophy.

[Bronchologic studies in East Germany: current status and perspectives]. / Bronchologische Untersuchungen in der DDR: Aktueller Stand und Perspektiven.

Within a period of 8 years (1979 to 1986) there were performed in 21 centres of the German Democratic Republic 15,049 bronchoscopic investigations (in 49.6 per cent combined with a subsequent bronchography) in 11,717 children, including 2,054 (17.5 per cent) up to one year of age. The detailed analysis shows important trends, which allow a reasonable prognosis of the perspectives of pediatric bronchology in the GDR.