[Cough. Pathophysiology and pulmonary function testing--paediatric aspects (author's transl)]

Cough is among the most effective clearance mechanisms of the lung. After glossopharyngeal and vagal stimulation glottic closure, leading to increased intrathoracic pressure, is followed by rapid expulsion of air. Normal cough mechanisms appear only after the 35th gestational week. Flow-volume curves may be used for diagnostic purposes.

[Immunotherapy of allergic disease. Studies on 460 patients]

The results and side effects of immunotherapy in atopic dermatitis, bronchial asthma and/or allergic rhinitis are evaluated in 460 patients. The findings are listed in terms of diagnosis, age, sex and preparations as well as duration and number of incorporated allergens of immunotherapy-vaccine. In 82% a good result was reported, while in 18% no improvement could be seen. The results increase gradually from atopic dermatitis to bronchial asthma and allergic rhinitis, although the differences fail to be significant statistically. Males respond better than females. However, in bronchial asthma only, the differences are significant (p less than 0.01). According to the preparations used (Bencard, Novo-Helisen, Allpyral), no differences could be seen. The percentage of side effects is higher than 50%, but is mainly restricted to local swelling, tiredness and itching. Again no significant differences could be seen between the vaccines used.

Mapping the dopamine receptor. 1. Features derived from modifications in ring E of the neuroleptic butaclamol

Several analogues of the neuroleptic agent butaclamol, having modifications in the ring E region of the molecule, have been synthesized. Pharmacological evaluation identified two of the analogues as being equipotent to butaclamol, namely, anhydrobutaclamol (8) and deoxybutaclamol (9a). The molecular structures of both the active and inactive analogues were analyzed and the results have been used for mapping the central dopamine receptor. The existence of a previously proposed lipophilic accessory binding site on the receptor macromolecule has been confirmed. Its minimum dimensions, as well as its locus with respect to the primary binding sites, have been defined. A receptor model incorporating the above features is proposed.

[Results of hyposensitization in children (author's transl)]

The results of specific hyposensitization in 160 children (121 boys) were evaluated using a questionnaire. In 54% complete remission or clear-cut improvement without additional need for medication was achieved. In a further 34% improvement was demonstrated when compared to the pretreatment period. The main initial complaints were allergic rhinitis or allergic asthma. Treatment was pursued for at least 3 months and for a maximum of 3 years. There were no differences in the success rate as regards sex and offending allergen.

[Summer holiday camps for asthmatic children--an attempted assessment (author's transl)]

118 schoolchildred (males:females = 2.5 : 1) with bronchial asthma--defined as recurrent allergic or non-allergic expiratory dyspnoea--were investigated as regards their clinical course, frequency of asthma attacks, exercise tolerance, anti-asthmatic drug requirements and spirometric changes during and after participation in specialized holiday programmes during the summer months in 1974, 1975, and 1976. Clear-cut improvement was observed with regard to asthma attack frequency (up to nearly 100%) and drug requirements (up to 76%). Steroid dependence was observed in most cases. No significant spirometric improvement was demonstrable. All data require critical evaluation and interpretation in view of seasonal variations in asthmatic manifestation and the influence of environmental factors. On reviewing the results it is concluded that treatment of the asthmatic child by supervised high altitude holidays (1400 m above seal level), combined with physical training and a respirator re-education programme, is still a justified therapeutic approach, but it cannot replace specific therapy laid down on the basis of careful diagnostic testing. Particpation of the asthmatic child in school gym classes is recommended. Abstention from physical exercis due to a misplaced protective attitude is not beneficial in most cases.

Complement in cystic fibrosis

Complement components C3, C4, and C3A were estimated in 30 patients with cystic fibrosis aged 1 to 21 years (M:F = 16:14) and were compared with results in 40 healthy, age-matched subjects. The influences of the clinical score, sputum microbiology, and the patients' sex were also investigated. In contrast to most previous communications, this paper shows that, compared to the control group, a significant decrease of C3 (P less than 0.001) and C4 (P less than 0.02) was observed whereas C3A levels were not altered. There were no increases in complement. Shwachman-scores above or below 70 did not influence the complement levels, nor did exacerbations of the disease change the levels. No influence of the patients' sex could be shown. Pseudomonas aer. in the sputum was clearly associated with complement defects (14/18). Alternative-pathway involvement of complement activation could be demonstrated in 32%. The results make complement activation due to pulmonary infection most likely. The defects observed probably represent secondary changes.

[Treacher-Collins-syndrome (author's transl)]

The Treacher-Collins syndrome is characterised by an anti-mongoloid slant of the eyes, hypoplasia of the facial bones, in particular the the mandible, and malformations of the external and middle ear with hearing loss. Early diagnosis of hearing defects is of prime importance as nowadays suitable treatment can prevent the resulting delay in speech development and secondary intellectual retardation.

[Cholelithiasis in children and adolescents (authors transl)]

Cholelithiasis is a rare, but important condition to be considered in the differential diagnosis of abdominal symptoms in childhood and adolescence. A survey over a 20-year period revealed 10 cases between the ages of 11 and 20 years, with a clinical history of cholelithiasis of between 5 days and 6 years. The most consistent finding was epigastric or right upper quadrant pain. Serum chemistry did not contribute conclusively towards the diagnosis. Hereditary spherocytosis was demonstrated in 3 cases, 2 had familial gall bladder disease, whilst in the rest no cause could be found. Two patients are described in some detail: one girl with spherocytosis and a bilirubin of 78 mg/100 ml, presenting with choledochal obstruction and pancreatitis, and another girl with a history of recurrent abdominal pain, negative radiologial and chemical pathological findings and a tentative diagnosis of neurosis. Oral cholecystograms lead to the diagnosis in most cases; however i. v. cholangiograms should be considered whenever the diagnosis appears in doubt. All cases were treated by cholecystectomy and recovery was uneventful in 9 patients. Cholecystectomy should be performed in all patients with gall stones, even in the absence of symptoms.

Neonatal respirator allowing simultaneous ventilation and suction

A new type of respirator for newborns allowing tracheal suction and ventilation simultaneously is presented. Additional characteristics are: a partly disposable air supply system, no apparatus deadspace and with one exception no moving parts. The performance of the respirator under varied conditions of lung mechanics was tested using a pneumatic lung thorax analogue. The procedure of tracheal suction was simulated and the effect on tidal volume and alveolar pressure investigated. Triggervolume and response time were also determined. Analysis shows that the respirator has qualities of flow- and pressure preset ventilators. Tracheal suction during ventilation does not impair the delivery of tidal volume. In mechanical ventilation with PEEP the alveolar pressure remains positive throughout the respiratory cycle despite suction.

[Long-term use of medium chain triglycerides in cystic fibrosis (author's transl)]

Conventional treatment of 15 children (aged 4 to 17 years) with cystic fibrosis and persistent failure to thrive was supplemented on an out-patient basis by a daily oral intake of 35 g of medium chain triglycerides (MCT) fat. Follow-up investigations were pursued for a longer period than described in the literature, namely up to 6 months after initiation of the MCT diet. While frequency of the bowel movements was reduced and abdominal discomfort disappeared no weight gain was observed. Clinically, steatorrhoea was clearly diminished. Pre-treatment serum cholesterol levels were lower (121 mg/dl, n=25) than in healthy subjects (182.2 mg/dl, n=56). No significant changes in either serum cholesterol or serum triglycerides were detected over the 6-month period. There were no clinical signs of an essential fatty acid deficiency in 4 patients followed up for 2 years so far. MCT fat should be included in the standard dietary regimen used in the management of any child with cystic fibrosis and failure to thrive. Its use is fully justified by the clinical improvement and alleviation of the steatorrhoea.