RESUMEN
The elevated incidence of short stature (body height < (-)x - 2s), skeletal retardation and delayed puberty in children with bronchial asthma or atopic dermatitis is generally attributed to the severity of the disorder. However, a series of findings indicate a causal influence of the atopy and the existence of atopic skeletal retardation per se.The observation that children with atopic disorders, whether bronchial asthma, atopic dermatitis or allergic rhinitis, exhibit a rate of short stature that is twice to five times higher than normal indicates atopic and thus genetically determined influences. The elevated prevalence of short stature associated with allergic rhinitis is especially significant, as this disorder cannot be included among the severe chronic disorders. The fact that skeletal retardation is more prevalent in boys than in girls by a ratio of about 2:1 and that a significantly more marked retardation of bone maturation is found in atopic in comparisons with non-atopic asthmatics also lend support to this postulation. The clinical relevance of atopic growth retardation is also supported by the close interaction of pathophysiological basal mechanisms of bone metabolism and the atopy status. Thus the local growth factor prostaglandin E(2) (PGE(2)), which is important for bone metabolism, is also a messenger substance for the immediate and late allergic reaction. The platelet-activating factor (PAF), as one of the strongest mediators in the pathogenesis of allergic disorders, influences the PGE(2) synthesis in the osteoblasts. These relationships show that atopy-dependent imbalances in the complex system of local and systemic growth factors can certainly lead to disturbance of skeletal maturation which may delay growth and development in atopic children. In order to verify these assumptions it is necessary to research the interaction of local growth factors (particularly the roles of PGE(2), PAF and IGF I) in the skeletons of children of short stature suffering from atopic disorders. This should also include the possible effects on the overall hormonal factors influencing bone maturation. Atopy should be included in the differential diagnosis programme to clarify growth and development disturbances.
Asunto(s)
Asma/complicaciones , Dermatitis Atópica/complicaciones , Trastornos del Crecimiento/etiología , Rinitis Alérgica Perenne/complicaciones , Adolescente , Estatura , Niño , Preescolar , Femenino , Glucocorticoides/efectos adversos , Humanos , Lactante , Masculino , Pubertad Tardía/etiologíaRESUMEN
The objective of the present study was the ascertainment of correct data related to growth prognosis in asthmatic children. For this purpose, 210 young asthmatics including 153 males and 57 females ranging in age from 1.7 to 18.9 years were evaluated. Data were specified for the parameters: chronological age (CA); bone age (KA); height age (LA); height (KH); severity of illness; target adult height (GZG) and predicted adult height (PEG). Among this group, 5.9 % of the boys and 3.5 % of the girls, were found to be of small stature (KH < - 2 s). This corresponds to about 2.5 and 1.5 times the average in a normal distribution. Children with the highest severity of illness showed the strongest negative deviation for the KH-SDS values (boys - 0.59 plus minus 1.1, girls - 0.97 plus minus 0.8). This proved to be statistically significant for females. Development of CA, KA and LA continued unremarkably until the age of 4 years. From age 5, partially a significant growth retardation of KA and LA could be observed in both sexes. To age 16, KA values and, after that LA values, were more strongly affected. Comparison of the GZG and PEG average values within the degree of severity groups made it clear that the PEG values for both sexes, independent of the severity of illness, were without exception, smaller than the GZG. The differences of both parameters proved to be statistically significant for the group with the most severe symptoms of the boys (180.8 plus minus 6.5 cm to 175.8 plus minus 6.2 cm, p < 0.01) and for the entire groups of both sexes (boys 180.2 plus minus 5.3 cm to 178.6 plus minus 7.3 cm, p < 0.05, girls 167.7 plus minus 4.4 cm to 165.8 plus minus 6.8 cm, p < 0.05). However, a separate comparison of GZG and PEG average values, respectively, among the severity groups showed no significant differences. The results argue for a growth-inhibiting influence from bronchial asthma. The cause has to be severity of illness but direct effects of the atopy on skeletal development is also taken in consideration. Confirmation of these findings requires investigation of a larger group of asthmatics and clarification of the pathophysiological processes in the growing skeletons of atopic children.
Asunto(s)
Asma/fisiopatología , Crecimiento/fisiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Pronóstico , Caracteres SexualesRESUMEN
Acute pulmonary failure caused by gastric acid aspiration is designated as Mendelson's syndrome. It is characterized by a trias of symptoms comprising bronchial obstruction, pulmonary oedema, and right ventricular failure. The pathomorphological pulmonary alterations show the typical symptoms of ARDS and allow the differentiation of three phases. The initial phase of injury is characterized by cauterization of the bronchial and alveolar epithelium. It is followed by the exsudative second phase during which alveolar oedema are developing. They impair the pulmonary surfactant synthesis and the formation of hyaline membranes. Fibrosis processes are typical of the proliferative third phase. Every of the mentioned three phases may be classified by their corresponding clinical symptoms. The therapy is entirely symptomatic and follows the intensive medical standards of the ARDS-therapy.
Asunto(s)
Neumonía por Aspiración/diagnóstico , Síndrome de Dificultad Respiratoria/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Niño , Preescolar , Humanos , Lactante , Neumonía por Aspiración/terapia , Síndrome de Dificultad Respiratoria/terapia , Insuficiencia Respiratoria/terapia , SíndromeRESUMEN
Asthmatics display a tendency to retarded growth and hyposomia in childhood. The reasons for this are not yet clear, although the atopic disposition seems to occupy a key role. It is a known fact that stimulation of the beta-2 receptors results in inhibiting growth hormone secretion. The purpose of our study was to find out whether the beta-2 mimetic terbutalin, often used in asthma therapy, exercises a negative influence on the spontaneous release of growth hormone in children suffering from asthma. The growth hormone release was studied in 10 prepuberal children suffering from atopic asthma who received intravenous therapeutic doses of terbutalin: testing was done for a total period of 24 hours before and during administration. Terbutalin effected significant inhibition of growth hormone secretion merely during the waking phase (6.2 +/- 1.0 to 3.7 +/- 0.7 ng/ml), but not during the sleep phase (13.1 +/- 1.8 to 12.5 +/- 2.0 ng/ml) and the 24-hour period (11.0 +/- 1.0 to 9.8 +/- 1.5 ng/ml). There was also no significant influence on the average group value for the maximum growth hormone peak (40.8 +/- 9.5 to 42.7 +/- 11.0 ng/ml). These results point to a short-term inhibition of growth hormone secretion, exercised by intravenously administered terbutalin. Terbutalin does not seem to be responsible for any clinically relevant inhibition of growth and development.
Asunto(s)
Agonistas Adrenérgicos beta/efectos adversos , Asma/tratamiento farmacológico , Hormona de Crecimiento Humana/antagonistas & inhibidores , Pubertad/efectos de los fármacos , Terbutalina/efectos adversos , Adolescente , Agonistas Adrenérgicos beta/uso terapéutico , Asma/sangre , Niño , Preescolar , Ritmo Circadiano/efectos de los fármacos , Femenino , Hormona de Crecimiento Humana/sangre , Humanos , Masculino , Tasa de Secreción/efectos de los fármacos , Terbutalina/uso terapéuticoRESUMEN
Children suffering from asthma display a tendency to retarded growth and development, which also includes bone structure. The reason for this phenomenon has not been clarified. There seems to be an adaptative regulatory hypersomatotropism which can be regarded as a disturbance of peripheral growth hormone activity. We studied the question whether this is influenced by theophylline, a preparation often used in the treatment of asthma, since theophylline has been accused of growth hormone inhibition as a result of in vivo studies in adults. In 9 prepubertal boys suffering from atopic asthma we determined the growth hormone concentrations during 24 hours each before and during intravenous administration of theophylline. With this dosage the median values of the 24-hour profile (10.3 +/- 1.5 to 5.2 +/- 0.9 ng/ml), the 8-hour sleep phase (12.7 +/- 1.9 to 5.7 +/- 1.0 ng/ml) and of the maximal growth hormone peak (38.9 +/- 7.0 to 17.6 +/- 2.8 ng/ml) were significantly lower than on the first day on which theophylline was not administered. The multiple possibilities by which theophylline may be exercising this effect, are discussed. Prospective long-term clinical studies will have to clarify whether the effect is clinically significant.
Asunto(s)
Asma/tratamiento farmacológico , Broncodilatadores/efectos adversos , Hormona del Crecimiento/antagonistas & inhibidores , Teofilina/efectos adversos , Adolescente , Asma/sangre , Broncodilatadores/administración & dosificación , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Hormona del Crecimiento/deficiencia , Humanos , Masculino , Tasa de Secreción/efectos de los fármacos , Teofilina/administración & dosificaciónRESUMEN
BACKGROUND: Asthmatic children tend towards hyposomia. Although quite a number of suggestions have been made, the real cause of this phenomenon has not yet been revealed. Investigation of the growth hormone secretion and the IGF-I serum levels aims at clarifying whether an atopy-caused disturbance in the interaction between both the hormones is responsible for retardations in the growth and development of asthmatic children. METHODS: In 19 prepubertal extrinsic asthmatics the spontaneous growth hormone secretion was reviewed in form of a 24 h-profile. In addition, the IGF-I serum levels were measured. RESULTS: With a mean 24 h-secretion of 10.7 +/- 1.0 ng/ml and a maximum growth hormone peak of 39.5 +/- 5.8 ng/ml prepubertal extrinsic asthmatics showed an increased hormone secretion which, however, could not be observed with all the children. The IGF-I mean values were in 11 asthmatics within the normal range, decreased in 5 cases and increased in only 3 children.
Asunto(s)
Asma/sangre , Hormona del Crecimiento/sangre , Hipersensibilidad Respiratoria/sangre , Adolescente , Estatura/fisiología , Niño , Preescolar , Ritmo Circadiano/fisiología , Femenino , Humanos , Factor I del Crecimiento Similar a la Insulina/análisis , Masculino , Valores de Referencia , Fases del Sueño/fisiologíaRESUMEN
Deformities of the chest occur not only in asthmatics suffering from severe attacks, but also in those having a mild form of the disease. It also occurs in children with atopic dermatitis and in members of atopic families without concomitant bronchial asthma. This observation and the fact that asthmatic children tend towards hyposomia, has prompted auxological investigations of asthmatic children. It was of interest to see whether asthma itself or the atopic disposition is responsible for disturbances of growth and development. The investigation was carried out as a cross-sectional study involving 173 asthmatic boys aged 1 1/2-18 years. The programme included among other things age, bone age, bone maturity difference (BMD: difference age minus bone age) height, type and severity of asthma (measured by means of scope of therapy). The rate of hyposomia (height < mean -2 SD) amounted in the whole group to 4.7 per cent. It rose in the extrinsic asthmatics to 6.6 per cent. This corresponds with a rise of two or three times the normal rate. 11.6 per cent of the probands showed a skeletal retardation of more than 2 years. The degree of BMD showed a significant dependence on age and type of asthma but not on the duration of the disease, severity or glucocorticoid therapy. Skeletal retardation cannot, therefore, be regarded as a direct consequence of bronchial asthma, whereas the significantly different averages of BMD in extrinsic and intrinsic asthmatics point to an atopic genesis, hence it might be possible to speak of an atopic retardation of the skeleton.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Determinación de la Edad por el Esqueleto , Asma/inmunología , Dermatitis Atópica/inmunología , Enanismo/inmunología , Tórax en Embudo/inmunología , Inmunoglobulina E/análisis , Hipersensibilidad Respiratoria/inmunología , Adolescente , Estatura/fisiología , Niño , Preescolar , Humanos , Lactante , Pruebas Intradérmicas , Masculino , Factores de RiesgoRESUMEN
Efficacy and safety of oral ciprofloxacin were studied in a prospective study at three cystic fibrosis centres, covering 24 in-patients suffering from cystic fibrosis and acute bronchopulmonary exacerbation. The patients were between 10 and 17 years of age. Pseudomonas infection was present in 75% of these patients. Despite frequent persistence of the pathogens, clinical improvement was noted in 75% of the treated children. A definite increase of the average MIC was not seen in 20 cases of persisting strains. No serious side effects occurred during the 14-day oral treatment course. Ciprofloxacin is a useful alternative to conventional parenteral treatment with antibiotics in patients suffering from cystic fibrosis and infections of the airways.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Ciprofloxacina/uso terapéutico , Fibrosis Quística/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Adolescente , Niño , Ciprofloxacina/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Masculino , Proyectos Piloto , Estudios ProspectivosRESUMEN
Autopsy-findings in infants with rare inflammatory disorders or infectious diseases esp. opportunistic infections may suggest defects of the unspecific and specific defence. The histopathological appearances of different lesions were correlated with possible underlying alterations or generalized defects of the immune system.
Asunto(s)
Inflamación/patología , Infecciones Oportunistas/patología , Bazo/patología , Timo/patología , Infecciones por Adenoviridae/patología , Autopsia , Humanos , Lactante , Recién Nacido , Inflamación/inmunología , Linfocitos/patología , Infecciones Oportunistas/inmunología , Infecciones por Pneumocystis/patologíaRESUMEN
Radiologic bone measurements for determination of the skeletal maturation were conducted in 243 children with bronchial asthma. The authors describe marked retardation of skeletal maturation as a general phenomenon of the atopic asthma. The grade of retardation is greater in atopics than in non-atopic asthmatics. The grade of quantitative response to allergic tests is significantly correlated with the extent of retardation of the skeletal maturation. It is discussed that in addition to asthma, eczema and allergic rhinitis the retardation of the skeletal bone maturation could be a further original manifestation of atopia.
Asunto(s)
Determinación de la Edad por el Esqueleto , Asma/fisiopatología , Estatura/fisiología , Desarrollo Infantil/fisiología , Hipersensibilidad Respiratoria/fisiopatología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
At the examination of 55 children from a regular care group suffering from asthma bronchiale by an ENT-specialist, in two third of them pathological findings demanding treatment were found. Since the majority of the findings remained clinically silent, the need of co-operation of ENT-specialist and pediatrician is obvious. According to our results, one single examination as it is usually done routinely at the onset of the disease is not sufficient.
Asunto(s)
Asma/diagnóstico , Hipersensibilidad Respiratoria/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Adolescente , Resistencia de las Vías Respiratorias , Niño , Preescolar , Femenino , Humanos , Masculino , Sinusitis/diagnóstico , Tonsilitis/diagnósticoRESUMEN
By the quantitative acetylcholine-test, described in details, the threshold amount of acetylcholine is determined, which after inhalation is able to provoke bronchial obstruction just measureable. By double-determinations nearly identical results are obtained. Errors may result from the patient's non-cooperation, especially in young children and from unexact dosage of acetylcholine by the nebulizer. There exists a circadian periodicity of bronchial reactivity having its climax in the night an the early morning. Therefore the test should be performed always at the same hour in the morning.
Asunto(s)
Acetilcolina , Pruebas de Provocación Bronquial , Aerosoles , Ritmo Circadiano , Errores Diagnósticos , HumanosRESUMEN
79 children with classical collagenoses, streptococcaldiseases, arthralgia of unclear genesis and infection arthritis as well as juvenile rheumatoid arthritis and 25 normal children were submitted to an intracutaneous allergentest with various collecting extracts (legumens and cereals, house allergens, vegetables). Positive reactions to cereals in a high percentage were observed only in patients with juvenile rheumatoid arthritis and fewer also in children with unclear arthralgia and infection arthritis.