Occurrence of Chlamydia trachomatis and Chlamydia pneumoniae in paediatric respiratory infections.

An emerging body of evidence suggests that half of asthma in both children and adults is associated with chronic lung infection. The aim of the present study was to determine the frequency of viable Chlamydia pneumoniae (Cp) and C. trachomatis (Ct) in the respiratory tracts of paediatric patients with chronic respiratory diseases. Bronchoalveolar lavage fluid (BALF) samples obtained from 182 children undergoing bronchoscopy for clinical reasons were assayed using PCR analysis, in vitro tissue culture and immunofluorescence staining for the presence of Cp and Ct. Chlamydia-specific DNA was detected by PCR in 124 (68%) out of 182 patients; 79 were positive for Cp, 77 positive for Ct and 32 for both organisms; 75 patients had cultivable Chlamydia. Ct DNA prevalence decreased, whereas Cp positivity generally increased with age. A total of 59 out of 128 asthma patients and 16 out of 54 nonasthmatics were Chlamydia culture positive. When the patients were divided into inflammatory versus noninflammatory airway disease, there were 69 (46%) out of 150 and six (18%) out of 32 BALF samples with cultivable Chlamydia, respectively. Viable Chlamydia pneumoniae and Chlamydia trachomatis occur frequently in children with chronic respiratory diseases and may be more prevalent in asthma patients. To the current authors' knowledge, this is the first report of viable Chlamydia trachomatis in the lungs of children.

Safety of endobronchial biopsy in 170 children with chronic respiratory symptoms.

BACKGROUND: There is a paucity of bronchial biopsy data in children. A major limitation is concern over the safety of the procedure. This paper reports the results of efforts to develop a method that is safe and provides adequate specimen for evaluation. METHODS: 170 children aged 2.5 to 16 years with chronic respiratory symptoms were studied under general anaesthesia in an outpatient surgery setting. Bronchoalveolar lavage and biopsies were obtained using a 4.9 mm flexible bronchoscope through a laryngeal mask airway. At least three bioipsies were taken. RESULTS: No patient required topical adrenaline to control bleeding, nor was there a change in the state of any of the patients. There were no episodes of pneumothorax, haemoptysis, pneumonia, or significant fever. All children less than four years old received a single dose of antibiotic intravenously after the procedure. The average length of time for the procedure was 12 minutes (range 6 to 27). Recovery time averaged 90 minutes. The limiting factor was the ability of the child's airway to accomodate the bronchoscope. CONCLUSIONS: This report should encourage clinicians to incorporate endobronchial biopsy into the evaluation of children with difficult respiratory problems.

TNF-alpha, IL-8, soluble ICAM-1, and neutrophils in sputum of cystic fibrosis patients.

The cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and intercellular adhesion molecule-1 (ICAM-1) have important roles in regulating neutrophil migration and the inflammatory response. To determine whether the concentration of these cytokines and soluble ICAM-1 (sICAM-1) in sputum was increased in patients with cystic fibrosis during acute exacerbations, we conducted (1) a cross-sectional study of 40 patients, 22 who were clinically well and 18 with acute pulmonary exacerbations; and (2) an 11 months longitudinal study of 16 patients. Significant differences in clinical scores, pulmonary function, and sputum neutrophil density were found between the acutely ill and the well group. There was a strong linear relationship (P < 0.0005) between TNF-alpha and IL-8 concentrations in sputum, but no association between clinical status and cytokine concentrations. The concentration of sICAM-1 was lower in acutely ill compared with well patients in the cross-sectional study. Recovery of exogenous IL-8 added to sputum was complete, while recovery of TNF-alpha averaged 70%. Recovery of exogenous sICAM-1 was only 43%, and the recoveries were lower in sputum samples from acutely ill patients than those from stable patients (P = 0.018). These data indicate that in cystic fibrosis patients, sputum concentrations of TNF-alpha and IL-8 are not increased during acute exacerbations of pulmonary inflammation.

Anabolic steroids: interest among parents and nonathletes.

To determine the nature and extent of public interest in anabolic steroids, questionnaires were sent to 1290 family physicians and pediatricians in Texas. Of the 517 respondents, 55% reported being asked about steroids or seeing possible steroid users in their practices during the previous 5 years; 261 physicians (51%) reported 1682 inquiries. High school aged boys were the subject of 60% of all inquiries, 26% of which were made by parents and were exclusively related to sports. Football and athletics in general were the most common reasons for inquiry (62%), but 36% of the adolescents were interested in steroids for psychosocial reasons. Nearly 60% of the inquiries by adolescents and 36% of those by parents were considered to be serious, as opposed to casual. All inquiries regarding adolescents were for boys, and less than 1% were nonwhite. On hundred seventy-seven physicians (34%) reported 802 possible steroid users. Only 17 patients fit the stereotype of a steroid user (ie, competitive bodybuilders or professional and collegiate athletes); football players comprised 12.4% of the total. Those thought to be using steroids for psychosocial reasons equaled almost 10% of the total. All those identified as steroid users were male and only nine were nonwhite. The survey results suggest that interest in and use of anabolic steroids are common, rather than the exclusive purview of competitive athletes. This study is the first to demonstrate parental interest in anabolic steroids.

Anabolic steroids and growth hormone in the Texas Panhandle.

We conducted a survey of family physicians and general pediatricians in the Texas Panhandle to learn about patient interest in anabolic steroids and growth hormone. Responses were anonymous. Fifty-five percent of those surveyed responded. Of these, 48.5% had received inquiries about anabolic steroids, 29% had seen patients they felt were taking steroids, and 15% had received inquiries concerning growth hormone. All inquirers about steroids and growth hormone and all perceived steroid users were male, and almost all were white. Adolescents (from 13 to 17 years old) accounted for 48% of the inquiries, young adults (18 to 25 years old) 48%, and adults 4%. Twenty percent of the inquiries were made by parents. Adolescents accounted for 31% of the perceived steroid users, young adults 68%, and adults 1%. Weight lifters and body builders comprised 60% of this group, football players 26%, and those taking steroids primarily for psychological reasons 13%. Nearly all inquiries about growth hormone were made by parents, and 44% were made on behalf of children for purposes of augmenting their normal height or for athletic enhancement.

Cyclic taurine analogs. Synthesis and effects on ATP-dependent Ca2+ uptake in rat retina.

Syntheses of (+/-)trans- and (+/-)cis-2-aminocyclohexane sulfonic acid (TAHS and CAHS) and (+/-)trans-2-aminocyclopentane sulfonic acid (TAPS) were achieved. In solution, the preferred conformations of TAHS and CAHS have been determined by high field NMR to be diequatorial and equatorial (sulfonic acid moiety)-axial (amino moiety) respectively. When these agents were evaluated as cyclic analogs of taurine in rat retina, TAHS and TAPS inhibited ATP-dependent calcium uptake in the micromolar range, whereas CAHS stimulated calcium uptake in the millimolar range in a manner similar to taurine. TAHS and TAPS are the most potent inhibitors of ATP-dependent calcium uptake in the rat retinal preparation yet reported.

3,7-Diazabicyclane: a new narcotic analgesic.

The synthesis of a series of 9-phenyl-3,7-diazabicyclanes and 9-(m-hydroxyphenyl)-3,7-diazabicyclanes is described. Members of both series were tested for antinociception in rat tail withdrawal and mouse acetic acid writhing assays. Their affinities for opiate receptors in rat brain homogenate were also determined. The 9-phenyl compounds, 1a-c, were inactive. However, the 9-(m-hydroxyphenyl) analogues, 2a-c, were found to possess significant activity in the writhing assay, comparable to that of morphine. All activity was reversed by naloxone.