[Congenital obstruction of the gastric antrum: description of a case]. / Ostruzione congenita dello sbocco gastrico da membrana antrale: descrizione di un caso.

On an average of 100,000 of livebirths congenital obstructive gastric syndromes range from 1 to 3 cases. The syndrome of the congenital antral membrane represents 5% of the total reported cases. It is mostly located 1 to 3 centimeters above the pylorus-duodenal connection and it may occur both in infants and toddlers. In very young patients it might be difficult to differentiate an hypertrophic stenosis of pylorus from a pyloric spasm. In older babies the obstacle to food passage may be moderate and the pathology may not be evident or it can be treated with simple medial therapy. This report presents the case of a 15 months old female with congenital antral membrane.

[Beta-2 agonists, exposure to allergens and bronchial hyperreactivity in children with allergic asthma]. / beta 2-agonisti, esposizione ad allergeni e iperreattività bronchiale nel bambino con asma allergico.

The contribution of beta 2-agonist treatment per se and the effect of beta 2-agonists plus allergen exposure was evaluated in two groups of thirteen asthmatic children being treated respectively at sea level during the period of maximal allergen exposure and at high altitude in an environment free of the offending allergens. Bronchial hyperreactivity was evaluated by standardised exercise tests before and after treatment with salbutamol controlled release tablets (4 mg). Challenges were performed at the beginning and after 2 and 4 weeks of treatment. A fourth test was performed 2 days after stopping the treatment. Children treated with salbutamol at sea level (exposure to allergen) showed baseline delta PEF of 16.9 +/- 3.4 and 13.7 +/- 4.2, 20.7 +/- 4.3, 26.0 +/- 5.1 respectively for the second, third and fourth test. Children treated at high altitude showed respectively delta PEF of 34.9 +/- 5.1, 31.1 +/- 4.9, 26.5 +/- 5.4, 27.9 +/- 5.0. These data suggest that oral salbutamol per se is not responsible for an increase in bronchial responsiveness, but eventually suggest that treatment with beta 2-agonists at the same time as continued allergen exposure may be responsible for an increase in bronchial hyperresponsiveness.

Peak expiratory flow variation and bronchial hyperresponsiveness in asthmatic children during periods of antigen avoidance and reexposure.

Changes of diurnal variation of peak expiratory flow rate (%PEF variation) and their relationship with bronchial hyperresponsiveness (BHR) to methacholine (PC20) were evaluated in 12 children with mild-to-moderate asthma and house-dust mite allergy, during successive periods of stay in a mite-free environment at high altitude (1756 m) and at their home at sea level. The children remained at the high altitude from October until the end of December; then they spent a 3-week period at home and returned to high altitude residence in January. PEF was measured daily, in the morning and in the evening, during the 3 months' stay at high altitude and them for 10 days after the return in January. PC20 was assessed in 8/12 children, once a month from October to December, and at the return in January. Mean absolute PEF values did not change significantly throughout the study. From October to December, patients showed a significant decrease of mean %PEF variation (P = 0.04), while PC20 showed an increase (P = 0.05). After the 3 weeks at home, both %PEF variation (P = 0.03) and PC20 (P = 0.05) significantly worsened. The correlation between PC20 values and mean %PEF variation in the 2 days before and after each methacholine test was r = -0.63 (P = 0.001). Our data suggest that there is a beneficial effect of a prolonged stay in a mite-free environment, on both PEF variability and BHR, also in asthmatic children with good pulmonary function. PEF variability and bronchial responsiveness to methacholine were significantly correlated also for small changes of the two variables.

Ability of a new infant formula prepared from partially hydrolyzed bovine whey to induce anaphylactic sensitization: evaluation in a guinea pig model.

In the present study we evaluated the allergenicity and immunogenicity of a whey partially hydrolysate formula (PHF) in a guinea pig model. Nine groups of 10 guinea pigs received either a conventional milk formula (CMF) or PHF for 37 days. After intravenous (i.v.) challenge with either beta-lactoglobulin (beta-L) or ultracentrifuged (u)CMF, animals fed CMF showed, respectively, 80% and 100% fatal reactions, whereas animals fed PHF showed no reactions when i.v. challenged both with beta-L and uPHF. Eighty percent fatal reactions, and 10%, respectively, of severe and mild reactions have been observed in the CMF-fed, casein-challenge group. In contrast, only one (10%) mild reaction occurred in the PHF-fed, casein-challenged group. When challenged with u-pasteurized cow's milk (uPCM), CMF-fed animals showed 86% fatal reactions and 14% mild reactions, whereas PHF-fed ones presented 70% no reactions, 20% mild reactions, and one (10%) fatal reaction. Animals fed CMF showed a significantly higher level of specific IgG against cow's milk antigens than PHF-fed ones, which, however, presented higher levels of antibodies than a water-supplemented control group. The present results confirm that PHF is less sensitizing than CMF in a guinea pig model.

Inhaled formoterol in the prevention of exercise-induced bronchoconstriction in asthmatic children.

The duration and magnitude of the effect of inhaled formoterol (12 micrograms) against exercise-induced bronchoconstriction (EIB) was compared with that of inhaled salbutamol (200 micrograms) and that of placebo in 15 children with asthma and EIB in a double-blind, double-dummy, within-patient, placebo-controlled study. The treatments were given by metered dose aerosol on three different days. The exercise test was performed at the 3rd and the 12th hour after dosing. The magnitude of the blocking effect was assessed both by evaluating the lowest FEV1 reading obtained within an hour after each exercise test and by considering the percent decrease below the baseline FEV1 measured before drug administration. Comparison of the lowest values obtained during the hour after each exercise test shows that formoterol was significantly better than both salbutamol (p = 0.022), and placebo (p = 0.001) in limiting exercise-induced bronchoconstriction after the first exercise test (3 h after dosing), while no difference was observed between salbutamol and placebo (p = 0.198). After the second exercise test (12 h after dosing), formoterol again proved to be more effective than both salbutamol (p = 0.008) and placebo (p = 0.001), and no significant difference was observed between salbutamol and placebo (p = 0.391). The evaluation of the mean percentage decrease in FEV1 confirmed the results in favor of formoterol in both the exercise tests. No adverse effects were reported in any treatment group. The protection against EIB is significantly more prolonged after formoterol than after salbutamol, and persists for 12 h after dosing.

Nedocromil sodium vs. sodium cromoglycate pressurized aerosol in the prevention of bronchoconstriction induced by ultrasonic nebulized distilled water in asthmatic children.

To compare the effectiveness of nedocromil sodium (NS) and sodium cromoglycate (SCG), administered by metered dose inhaler (MDI) with a 700 mL holding chamber (Fisonair Fisons UK) in preventing bronchoconstriction induced by inhalation of ultrasonically nebulized distilled water (UNDW), 12 asthmatic children were studied in a randomized, double-blind, placebo-controlled, intrapatient study. Following a baseline challenge with UNDW, the protective effect of NS, SCG, or placebo was evaluated in each subject. Cumulative doses of delivered nebulized water producing a 20% fall in forced expiratory volume in 1 sec (PD20 UNDW) was measured. Mean (+/- SD) PD20 UNDW was 4.83 (+/- 4.84), 10.16 (+/- 7.05), 1.58 (+/- 0.5), and 15.93 (+/- 0.23) respectively, for baseline, and placebo, SCG, and NS-treated groups. A significant (P < 0.05) protection from UNDW induced bronchoconstriction by NS was observed in comparison with placebo, while no such effect was evident when the children were treated with SCG.

Preliminary study on the effect of broxaterol on bronchial hyperresponsiveness in asthmatic children: influence of allergen exposure.

Increased bronchial hyperresponsiveness (BHR) has been reported in adult asthmatic patients after regular treatment with beta 2-agonists. In this study we evaluated the effect of a 4-weeks treatment period with broxaterol, a new beta 2-agonist, on BHR in asthmatic children living in two different environmental conditions. Two groups of patients, 24 domiciled at sea level, allergen exposed (group 1), and 24 resident at high altitude (Misurina, 1,756 m) in an allergen-free environment (group 2), have been tested. Children were randomly treated with broxaterol 400 micrograms q.i.d. or sodium chromoglycate 10 mg q.i.d. (as control treatment) by the metered dose inhaler for 4 weeks. Pulmonary function tests and methacholine challenge were performed at the beginning and at the end of the study. Throughout the study period a diary card was completed and peak expiratory flow rate (PEFR) was measured three times daily. Forty-two of the patients admitted concluded the study. No significant change was observed in the methacholine PC20 throughout the study period regardless of the type of treatment and/or environment. The amplitude percentage mean of diurnal changes in PEFR during the study period showed no statistically significant differences between treatments or centres, or in the interaction of treatment with centre, time with treatment, time with centre, time with centre and treatment (p > 0.05). Therefore in this pilot study regular treatment with broxaterol for 4 weeks did not cause an increase in BHR in asthmatic children both in conditions of allergen exposure and in an environment free of offending allergens.

Reproducibility of late phase pulmonary response to exercise and its relationship to bronchial hyperreactivity in children with chronic asthma.

To determine the reproducibility of the delayed response to exercise and its effect on bronchial hyperreactivity, we had 26 asthmatic children perform treadmill exercise challenge on two occasions 1 week apart. Both challenges were preceded by 2 control days and 1 histamine challenge day, and were followed by another histamine challenge day. Peak expiratory flow rate (PEFR) was measured hourly for 12 hours on each control day and for 12 hours after each exercise or histamine challenge. During the first week, five patients showed a late reaction (PEFR change > 15%) after exercise, which was present in only two of them the following week. These two patients, however, also showed a spontaneous fall > 15% of PEFR from baseline during the other control study days. A similar pattern was seen in two other patients who had a late response during the second exercise challenge but not during the first. No significant change occurred in histamine PC-20 FEV1 between before and after the exercise challenges. An apparent late asthmatic response after exercise challenge may represent a within-day fluctuation in pulmonary mechanics that develops spontaneously in children with asthma.

Evaluation of the allergenicity of infant formulas in a guinea pig model.

In the present study we evaluated the allergenicity of infant formulas using a guinea pig model. Seven groups of ten guinea pigs each maintained on a diet free of cow milk received either water or pasteurized cow milk (PCM) or a conventional cow milk infant formula (CMF) or whey hydrolysate formula (WHF) to drink. On day 37 all the animals were challenged by intravenous injection with 0.5 mL of supernatant of either PCM or WHF. The reactions to the challenge were expressed as none, mild, severe nonfatal, and fatal. A score ranging from 0 to 3 was assigned to each animal and considered in the statistical analysis; P values are expressed as comparisons to the negative water-fed control group. Animals fed WHF and challenged with WHF (group 1), showed 10% fatal reactions and 50% severe but not fatal reactions (P less than .05). When challenged with PCM (group 2), 40% showed a mild reaction. Cow milk formula-fed animals showed 10% fatal reactions and 70% severe reactions when challenged with WHF (group 3). The same challenge caused 40% severe reactions in animals fed PCM (group 4) (P greater than .05). Animals fed and challenged with PCM (group 5) showed 100% fatal reaction (P less than .01). Animals fed water showed no reaction when challenged with either WHF (group 6) or PCM (group 7). The results suggest that WHF has less anaphylactic sensitizing power than PCM and CMF.

Anaphylactic sensitizing power of selected infant formulas.

The purpose of the present study was to evaluate the anaphylactic sensitizing power of cow milk, soy milk, casein hydrolysate, and a new cow collagen soy protein hydrolysate (CCSPH) infant formula in a guinea pig model of anaphylactic sensitization. Various groups of animals were fed these formulas for 37 days following which they were challenged intravenously either with the sensitizing constituent or one of the infant formulations. The results of these studies indicate a high degree of sensitizing capability of cow milk formula (80% fatal and 20% nonfatal) with reactions in guinea pigs challenged with BLG and no reactions when challenged with casein hydrolysate. In animals sensitized to soy formula there were only nonfatal reactions in 30% when challenged with soy protein. Casein hydrolysate and CCSPH were shown to be nonsensitizing. The results of these studies support he use of derivative infant formulas for the prevention of cow's milk hypersensitivity in infants.