Raised circulating plasma levels of atrial natriuretic peptide in adolescent and adult patients with cystic fibrosis and pulmonary artery hypertension

Since pulmonary artery hypertension (PH) complicates advanced stages of cystic fibrosis (CF), we wondered whether plasma concentrations of h-ANP would be increased in adult patients with CF. Furthermore, if only the right ventricle is faced with an increased afterload in these patients, the increased h-ANP plasma levels should stem primarily from the right atrium. To test this hypothesis we studied 12 adult patients with CF in a clinically stable condition using right heart catheterization. Mean pressures were measured in the right atrium (Pra) and pulmonary artery (Ppa), pulmonary capillary wedge (PCWP) position, and blood were drawn from the pulmonary artery and from a peripheral vein to determine h-ANP. Plasma levels in the pulmonary artery were significantly higher than in a peripheral vein (54.3 +/- 6.0 pg/ml vs. 32.2 +/- 4.4 pg/ml; p less than 0.001). Four of the 12 patients had PH (Ppa, 25.8 +/- 2.9 mmHg) whereas 8 patients exhibited normal pulmonary artery pressures (Ppa, 15.9 +/- 0.7 mmHg). Patients with PH had higher Pra (4.2 +/- 0.4 mmHg) than patients with CF without PH (1.9 +/- 0.7 mmHg; p less than 0.05). Plasma h-ANP concentrations were significantly higher in patients with CF with PH (70 +/- 10.4 pg/ml in the pulmonary artery; 42.6 +/- 4 pg/ml in a peripheral vein) than in patients with normal pulmonary artery pressure (43 +/- 3.3 pg/ml in the pulmonary artery; p less than 0.01; 24.7 +/- 5.6 pg/ml in a peripheral vein; p less than 0.05). Although our results are derived from a small group of patients with CF, we conclude from our results that in patients with CF PH may cause increased h-ANP secretion. The right atrium seems to be a major source.

[Postnatal weight loss in ventilated premature infants below 1500 g: significance of renal and extra-renal fluid loss]

In 9 ventilated preterm infants (birth weight 810-1310 g, gestational age 26-30 weeks) we measured total body water (D2O dilution), extracellular volume (sucrose dilution) and renal function parameters at birth and when postnatal weight loss exceeded 5% of birth weight together with day to day changes of weight, fluid balance, and serum electrolytes. A significant postnatal weight loss (-89 +/- 47 g) occurred together with a reduction of total body water (-102 +/- 95 ml) and extracellular volume (-98 +/- 59 ml) in the first three days of life. The intracellular volume did not change. At the same time fluid balance was negative due to a high extrarenal water loss on day 1 and an increasing diuresis on the following days. The serum sodium concentration remained unchanged during postnatal water loss, because the negative fluid balance was accompanied by a negative sodium balance.

Body composition, nutrition, and fluid balance during the first two weeks of life in preterm neonates weighing less than 1500 grams

To determine whether body weight during the first 2 weeks of life in preterm infants weighing less than 1500 gm reflects nutritional status or fluid balance, we studied total body water (TBW) (deuterium oxide dilution), extracellular volume (sucrose dilution), and plasma volume (Evans blue dilution), together with intake-output studies of nitrogen, fluid, and sodium on day 1 (median age 0.3 day), at a weight loss of 7.8% of birth weight (median age 3.4 days), and after birth weight was regained (median age 8.9 days) in eight clinically stable preterm infants (birth weight 810 to 1310 gm, gestational age 26 to 30 weeks) receiving ventilatory support. During the initial weight loss we found no evidence of catabolism. Body solids (weight--TBW) remained unchanged, there was nitrogen retention, and energy intake was sufficient to meet energy expenditure by day 2. However, we found evidence of fluid loss: TBW (mean +/- SD, -95 +/- 99 ml), extracellular volume (-98 +/- 63 ml), and interstitial volume (-102 +/- 75 ml) decreased significantly, indicating negative fluid and sodium balances. Blood volume and plasma volume remained unchanged. With the regaining of birth weight there was no increase in body solids despite a high degree of nitrogen retention, but there was a positive fluid balance although no significant increase in any body fluid compartment was found. We conclude that the observed postnatal weight changes reflect changes in interstitial volume.

Acute effects on pulmonary haemodynamics of nifedipine in adult patients with cystic fibrosis

Hypoxic pulmonary vasoconstriction is considered to be the primary cause of pulmonary hypertension and cor pulmonale in adult patients with cystic fibrosis (CF). The acute effect on pulmonary haemodynamics of a single sublingual dose of nifedipine 20 mg has been studied in 9 adult patients with CF. Nifedipine significantly attenuated the rise in mean pulmonary artery pressure and pulmonary vascular resistance induced by inhalation of a 13% oxygen gas mix. It also slightly reduced baseline pulmonary artery pressure and pulmonary vascular resistance and lowered pulmonary artery hypertension in the patients. Oxygen delivery was unchanged. Nifedipine is potentially useful for the treatment of hypoxic pulmonary hypertension in patients with CF.

Normal responsiveness of superficial hand veins to alpha- and beta-adrenergic stimuli in allergic asthma: effects of terbutaline and prednisolone on beta-adrenergic responsiveness

Impaired function of the adrenergic-receptor system has been postulated to contribute to the pathogenesis of bronchial asthma. Using the dorsal hand-vein compliance technique, we compared the changes in diameter of superficial hand veins in response to phenylephrine, an alpha-adrenoceptor agonist, and to isoproterenol, a beta-adrenoceptor agonist, in 14 untreated patients with allergic asthma and in 16 nonatopic control subjects. There were no significant differences in the median effective dose of phenylephrine that produced 50% of maximal venoconstriction (ED50) or in the maximal response (Emax) between the two groups. Bronchial hyperreactivity (assessed by methacholine-challenge tests) in the patients with asthma was uncorrelated with the ED50 or Emax of isoproterenol. These results demonstrate no evidence for a generalized change in alpha- or beta-adrenergic responsiveness on smooth muscle cells in asthma. Hand-vein responsiveness to isoproterenol was unchanged after treatment for 7 days with oral terbutaline (5 mg three times per day). Thus, unlike leukocytes, smooth muscle appears not readily susceptible to beta-adrenoceptor desensitization in vivo. Local infusions of prednisolone or dexamethasone during 2 hours and systemic administration of dexamethasone (24 hours) caused a significant fall in the Emax for isoproterenol. The mechanism of attenuation of beta-adrenoceptor responsiveness by corticosteroids remains to be determined.

Formation of target-specific neuronal projections in organotypic slice cultures from rat visual cortex

A characteristic feature of the mammalian cortex is that projection neurons located in distinct cortical layers send their axons to different targets. In visual cortex, cells in layers 2 and 3 project to other cortical areas, whereas cells in layers 5 and 6 project to subcortical targets such as the lateral geniculate nucleus. The proper development of these projections is crucial for correct functioning of the visual system. Here we show that specific connections are established in an organotypic culture system in which rat visual cortex slices are co-cultured with another slice of the visual cortex or with a thalamic slice. The laminar origin and cellular morphology in vitro of cortical projections to other cortical regions or to subcortical targets are remarkably similar to those seen in vivo. In addition, axons of projecting cells are not restricted to particular pathways, but appear instead to grow directly towards their appropriate target. These observations raise the possibility that chemotropic attraction from the target areas may play an important part in the development of the cortical projection pattern.

Reflection of changes in membrane constituents in various regions of Alzheimer brains to differential scanning thermograms

To test whether changes in basic biochemical membrane constituents were reflected in membrane fluidity measurements, protein, total lipids, triglycerides, lecithin, cholesterol and alkaline phosphatase were determined in frontal cortex, hippocampus, putamen and nucleus basalis Meynert (NbM) of DAT brains and controls and compared to differential scanning thermograms. Biochemical changes were most pronounced in the hippocampus, while thermostability was altered in the NbM and the frontal cortex. The results indicate that changes in protein content, but not in lipid composition were reflected in alterations of thermostability of the brain regions examined.

A method to determine the end point of decalcification of hard tissue and bone

A method for decalcification end point determination of mineralized tissue is described. The calcium content of the decalcification solution was determined colorimetrically with a "continuous automatic analyzer" with a high degree of accuracy. The end point method used has been tested on two decalcification methods, 5% nitric acid with or without ultrasonic treatment. The results suggest it is possible to quantitate the decalcification process.

Development of vasoactive intestinal polypeptide (VIP)-containing neurons in organotypic slice cultures from rat visual cortex

Using immunohistochemistry we have been studying the postnatal maturation of vasoactive intestinal polypeptide (VIP)-positive neurons in organotypic slice cultures from rat visual cortex. The development in vitro is compared with the occurrence of VIP-containing cells in vivo, where they are first observed around postnatal day 5. A further increase in number and morphological maturation occurs within the following 3 weeks. In cultures prepared from 1- or 2-day-old rats, i.e. before VIP is expressed in vivo, VIP-containing neurons appear after about 5 days and gradually increase in number over the next 2 weeks. Thus the time course of postnatal expression of VIP in vitro and the morphology of VIP-immunoreactive neurons in culture closely matches the situation in vivo. These observations suggest that the maturation of VIP-containing neurons occurs independently of cortical afferents and that the intrinsic connectivity and activity is sufficient for their postnatal maturation. Therefore organotypic slice cultures should be a suitable system to study mechanisms of neurochemical maturation in the cortex.

[Systemic side effects in immunotherapy of allergic diseases--a comparative study]

Data on systemic side effects (SSE) of specific immunotherapy of allergic diseases recorded in 99 publications over the past 10 years were evaluated and compared with the figure of 0.4% SSE, according to number of injections, published in 1987 by the authors of the present study. The latter figure ranks among the lowest of comparable publications and under present conditions represents the standard. Reasons for the small number of side effects may be found in persistent use of antihistamine premedication before each injection and reduction of vaccination dosage to 50,000 SQ units maximally. Chemically modified allergens are by no means less liable to produce side effects than other allergens. The comparison was undertaken with respect to the following preparations: Alavac P, Allergovit, Allpyral, Alutard, Aquagen (ALK aqueous), Conjuvac, Diephuis, Migen, Novo Helisen, Pangramin Depot, Pharmalgen, Pollinex, Reless, Spectralgen, Stallergenes Depot, and some vaccines, prepared by the authors themselves.

13C-NMR study of autotrophic CO2 fixation in Thermoproteus neutrophilus

The pathway of autotrophic CO2 fixation has been investigated in the extremely thermophilic sulfur-respiring anaerobic archaebacterium Thermoproteus neutrophilus. [1,4-13C2]Succinate was used as a tracer since this compound was incorporated in small amounts virtually into all cell compounds without affecting the organism's ability to synthesize all cell constituents from CO2. Three representative amino acids, glutamate, aspartate and alanine were isolated from cells after growth for several generations in the presence of [1,4-13C2]succinate and their labelling patterns were determined by 13C NMR spectroscopy. The data is consistent with CO2 fixation by a reductive citric acid cycle, as proposed earlier for the green sulfur bacterium Chlorobium limicola, the sulfate-reducing Desulfobacter hydrogenophilus and the microaerophilic Knallgasbacterium Hydrogenobacter thermophilus. The presence of a reductive citric acid cycle in archaebacteria indicates that this CO2 fixation mechanism which is an alternative to the Calvin cycle is present in many anaerobic or facultative anaerobic microorganisms.

Management of asthma: a consensus statement

In developing these international guidelines there were several unifying themes in the diagnosis and simple management of childhood asthma. For the purposes of the meeting, asthma was operationally defined as 'episodic wheeze and/or cough in a clinical setting where asthma is likely and other rarer conditions have been excluded'. In making a diagnosis of asthma, a full history is a prerequisite. Additional tests are only used to support clinical impression and to provide objective evidence for therapeutic recommendations. General features of a multidisciplinary approach include an appreciation of the importance of psychosocial factors, counselling, and education. Drugs should be prescribed in a rational sequence: beta 2-stimulants for mild episodic wheeze; sodium cromoglycate for mild to moderate asthma; inhaled steroids for moderate to severe asthma; with xanthines, ipratropium bromide, and oral steroids having their place in more persistent and severe cases. Children and their parents should be reassured that if asthma is properly controlled there is no reason why the child should not lead a normal and physically active life. The management of asthma is rewarding and return to 'normal' lifestyle is nearly always possible with active participation in sporting activities.

[Chronic dysplasia of the respiratory ciliary epithelium]

We report on a 14-year-old Turkish boy who suffered for more than seven years from recurrent pneumonia and bronchiectases. This led to the surgical removal of the left lower lobe. Brush biopsies taken from the bronchus and nose revealed severe dysmorphy of the ciliary epithelium with an altered cell-distribution of the normal surface pattern.

[Psychological management of patients and families with cystic fibrosis]

The care of families with a child with cystic fibrosis requires a concept which includes psychological and social aspects caused by the disease. The contribution of a psychologist offers a valuable support for this. Methods for the emotional care of patients are presented. The importance of counselling and the possibility of preventive work and distribution of information are underlined. The example of psychosocial stress (coping with the diagnosis, self esteem, life crises etc.) permit insight into the requirements of patients and their relatives and contribute to increase the awareness of the caregiver for age-independent and for age-specific problems.

[Reactions of patients and families with cystic fibrosis to psychological management]

A model of care for patients with cystic fibrosis including the possibility for continuous psychological counselling besides medical care is presented. In order to evaluate reactions of those affected to the offer of counselling 243 sessions between 81 patients or/and parents and the psychologist (IJK) were attributed to one of the following reaction types: type 1: negation/rejection, type 2: acceptance of talks, type 3: reactive wish to be counselled, type 4: active acceptance. The high proportion of reaction type 4 in the age groups 0; 1-1 (65.0%), 1-3 (45%) and in adult patients (46.6%) shows that the majority of parents approach the psychologist with questions, anxieties and worries in the first months and years after the diagnosis has been established. In the adult age group patients themselves request support for coping with a variety of difficulties. Type 2 sought contact with the psychologist on the assumption that in the future they could draw on the help of someone familiar in moments of crisis; this reaction dominated in the 3 groups aged 3-15 years. In adolescents the offer of a counselling session is made use of to discuss current problems (type 3).

Portal venous blood flow in cystic fibrosis: assessment by Duplex Doppler sonography

Changes of portal venous hemodynamics were investigated in 32 patients with cystic fibrosis (CF) with a mean age of 11.6 years. Hepatic profile of these patients included total bilirubin and albumin together with determination of size and echogenicity of the liver and spleen, determination of the diameter of the portal vein by real-time sonography and quantitation of flow volume of the portal vein using Duplex Doppler sonography. As a control, 35 age matched healthy children were also examined. Diameter of the portal vein was significantly increased in CF patients versus controls. Comparison of the mean flow volume of the portal vein showed a significant increase in CF-patients over 12 y old versus controls. In patients less than 12 y no significant difference of flow volume of the portal vein between CF-patients and controls was noted. The increase of diameter and flow volume of the portal vein suggest an adaptive mechanism in the pressure-volume relationship of the portal venous system in patients with CF.

Right ventricular performance and pulmonary haemodynamics in adolescent and adult patients with cystic fibrosis

A combined haemodynamic and radionuclide approach was used to evaluate right ventricular performance in 16 adolescent and adult patients with cystic fibrosis (CF). There were nine patients with mild arterial hypoxaemia (PaO2 greater than 80% of predicted) and normal resting pulmonary artery pressure and seven patients with severe arterial hypoxaemia (PaO2 less than 70% of predicted) and resting pulmonary arterial hypertension (PH). The right ventricular ejection fraction (RVEF) by equilibrium angiocardiography using krypton 81m as a tracer and stroke volume index (SVI) by thermodilution techniques were measured simultaneously and right ventricular end-diastolic and end-systolic volumes were derived. RVEF was normal in CF patients without PH (58.9 +/- 7.2%) but was reduced in those with PH (45.4 +/- 2.6%). There was a statistically significant inverse linear correlation between RVEF and afterload as assessed by mean pulmonary artery pressure (Pap: r = -0.76) and pulmonary vascular resistance (PVR: r = -0.78), indicating that RVEF ist afterload-dependent. Right ventricular function, however, as assessed by right ventricular end-systolic pressure-volume relations was even higher in CF patients with PH, indicating preserved or even increased right ventricular function in the face of an increased afterload stress.

Obstructive sleep apnea: a polysomnographic study of sleep apnea before and after tonsillectomy and adenoidectomy

We report about polysomnographic studies including EEG, EOG, EMG, ECG, measurement of oropharyngeal airflow, recording of chest wall movements and transcutaneous measurements of pO2 and pCO2 in a 4-year-old girl with severe obstructive sleep apnea. Her sleep profile was characterized by a disturbed cyclic pattern of sleep stages with onset of sleep at stage 4, shortening of REM-sleep periods and of sleep stages 1 and 2, and an increased quantity of sleep stage 4. The total time spent in apneic episodes was 11.3% of the total sleep period (only obstructive events). Apneic attacks were recorded mainly in REM and light NREM sleep states. Tonsillectomy and adenoidectomy resulted in marked improvement without further evidence of abnormal sleeping pattern or of sleep apneas.

Reproducibility of skin prick testing with allergen extracts from different manufacturers

Allergen extracts for skin prick testing (SPT) are available from several manufacturers. Although these solutions are specified according to well-defined internal company standards, there is no generally accepted overall standardization. To assess the comparability of skin prick test solutions of various manufacturers, we compared extracts of nine different allergens from four companies by SPT in 29 children sensitive to one or more of the allergens, in a double blind fashion. RAST (Pharmacia) and EAST (Kallestad) were determined in simultaneous blood samples. Allergen extracts were also examined by rocket immunoelectrophoresis for their content of major allergens. Skin reactions, assessed by mean diameter of wheals, to identical allergen extracts varied significantly between the four vendors (P less than 0.05-0.001). Correlation between RAST and EAST was good for all allergens except birch pollen and mugwort. Content of the major allergen in corresponding extracts varied significantly between the different companies (less than 1%-2000%). These data underline the need for international reference extracts as intracompany standardization of test solutions alone is not enough to yield general reproducibility of skin prick test results.

Interventional assessment of physical and mental health in children and adolescents with cystic fibrosis

In spite of being an integral part of health care the subjective estimation of health status in patients with cystic fibrosis is frequently neglected. In a prospective study in 65 patients maternal, paternal, and patients' ratings were determined and correlated with objective data such as Shwachman scores and lung function tests. No statistically relevant correlations were obtained for parental physical assessment versus Shwachman and lung function data. The adolescents' own assessment of health had a significant relationship to clinical evaluation (r = 0, 42; p less than 0.05). Misjudgements, mainly in the form of overestimations, occurred with a frequency of 28.6% to 53.8%, reflecting inadequate understanding of the disease and its psychological consequences.

Right ventricular contractility is preserved in patients with cystic fibrosis and pulmonary artery hypertension

A combined hemodynamic and radionuclide approach was used to evaluate right ventricular contractility in 16 adolescent and adult patients with cystic fibrosis (CF). Nine patients had normal resting pulmonary artery pressure, and seven had resting pulmonary artery hypertension (PH). Right ventricular ejection fraction (RVEF) was observed by radionuclide angiocardiography, and stroke volume index (SVI) by thermodilution techniques. By combination of these measures right ventricular end-diastolic and end-systolic volumes were derived. RVEF was normal in CF patients without PH (58.9 +/- 7.2%) but was reduced in those with PH (45.4 +/- 2.3%). There was a strong inverse linear correlation between RVEF and afterload, as assessed by mean pulmonary artery pressure (r = -0.76), indicating RVEF being afterload-dependent. Right ventricular contractility, however, as assessed by right ventricular end-systolic pressure-volume relations was even higher in CF patients with PH, indicating preserved or even increased contractility in the face of an increased afterload stress. The acceleration time, evaluated by pulsed Doppler echocardiography, was normal in CF patients without PH (117.3 +/- 5.5 msec) and significantly reduced in those with PH (85.1 +/- 6.4 msec). Both RVEF and AT were efficient in estimating pulmonary artery pressure in these patients.

[Specific IgE antibodies to cow's milk and individual cow's milk proteins in children with suspected allergy to cow's milk]

Specific IgE antibodies against whole-milk-antigen mixture and against casein, alpha-lactalbumin and beta-lactoglobulin were determined using the radioallergosorbent test (RAST) in 125 sera of children with an initial diagnosis of suspected cow milk allergy. The results of the RAST were correlated with the clinical diagnosis. No specific IgE antibodies could be demonstrated in 98 children. Of these, 20 (20%) showed clinically intolerance to cow milk presumably on the basis of other immunological mechanisms. Specific IgE antibodies could be demonstrated in the sera of 27 children. Of these, 16 (60%) actually showed allergy to cow milk. A statistically significant association with chi 2 test could be established between positive RAST and clinical diagnosis (p = 0.001).

[Intrapulmonary percussion in cystic fibrosis]

Endobronchial percussion was performed in eight cystic fibrosis patients of 15 to 26 years of age using a high-frequency ventilator system. Lung function changes and blood gas parameters were examined. The method resulted in an improved FEV1 (P less than 0.025) and in blood gas improvements such as pO2, base excess (P less than 0.001) and oxygen saturation (P less than 0.001). Endobronchial percussion offers the advantage of being largely independent of patient cooperation in chronic obstructive lung disease such as cystic fibrosis. The decision in favour of long-term treatment depends in each case on the individual acceptance by the patient.

[Pulmonary infections in cystic fibrosis: pathogenesis and therapy]

Infections of airways and lung in patients with cystic fibrosis determine quality of life and prognosis. Despite overall improvement of management of infections the underlying causes leading to infection early in life remain an enigma. As a consequence of infection various morphologic alterations arise. The most prominent are development of bronchiectases afflicting more than 70% of patients at age two. The spectrum of bacterial involvement has undergone significant changes. In contrast to earlier reports Pseudomonas aeruginosa at present is the most commonly encountered pathogen. Mucoid forms are typical for cystic fibrosis and are rarely seen in other conditions. Pseudomonas cannot be eradicated once it is established. Antipseudomonas chemotherapy leads to a diminution of bacteria from 10(8)/ml sputum to 10(6) at best. However, clinical results are convincing. Thus regular antispeudomonas treatment has been advocated by one CF-centre. Apart from conventional chemotherapy alternative approaches of treatment such as vaccination or immunoregulation need to be explored in greater detail.

[Allergic alveolitis in cow milk allergy]

The case history of a 12 months old boy with recurrent pneumonia following ingestion of cow's milk is described. After receiving cow's milk containing formula he presented with fever, tachypnea, diffuse rales and crepitations over both lungs. The chest X-ray revealed marked bilateral alveolar shadows. A high titer of antibodies against the four major antigenic components of cow's milk protein was demonstrated by Ouchterlony's precipitation test and the fluorescent immunosorbent test. Withdrawal of cow's milk from the diet resulted in complete resolution of clinical and radiological findings.

[Myocarditis caused by Salmonella typhimurium]

A 53-year-old man died on the eight day of an acute enteritis caused by Salmonella typhimurium. Clinical signs of shock were pronounced; the electrocardiogram, initially not pathological, showed a peripheral low voltage with decreased R-amplitudes and distinct disturbances in repolarization. Laboratory findings demonstrating Salmonella typhimurium in blood cultures and stools and 45% band forms in the differential count were remarkable. The autopsy showed deep, fibrin-covered ulcera in the colon area and a dense submucous lympho-histiocyte cell infiltration. Histologically, a granulomatous myocarditis of the left ventricle with lymphocyte and histiocyte infiltration and a focal myolysis was observed. In the right ventricle, however, only a minimal interstitial edema was found.

[Bird breeder's lung with conversion to fatal fibrosing alveolitis]

An 11-year-old girl developed typical symptoms of bird breeder's lung after several years of contact with budgerigars and other birds. The clinical diagnosis was confirmed by immunological and lung-function tests. Despite exclusion of exposure to allergens and treatment with steroids and D-penicillamine no improvement occurred, the exogenous allergic alveolitis progressing to fibrosing alveolitis of which the girl died.

Functional activity of peripheral mononuclear cells in cystic fibrosis: antibodies and plaque formation

Chronic pulmonary infection is known to constitute a major complication of cystic fibrosis (CF). In order to determine whether a defect of antibody formation is associated with this clinical finding, we have investigated antibody production on the cellular level by using a haemolytic plaque forming cell (PFC) assay. The ability of peripheral mononuclear cells (MNC) derived from patients with CF to form PFC upon stimulation by pokeweed mitogen was significantly decreased as compared to healthy control individuals (P less than 0 . 01). Levels of serum immunoglobulins of the G, A, and M classes and of sheep red blood cell agglutinating antibodies were estimated as well, but no correlation was obtained between these parameters and the number of PFC in patients with CF.

[Sonography of the upper abdomen in cystic fibrosis (author's transl)]

Ultrasound scans of the upper abdomen were carried out in fifty patients with cystic fibrosis (age 2 to 26 years). 38% showed an abnormal hepatic sonogram. On eight occasions it was possible to confirm these changes by a liver biopsy. In 14% there was homogenous increase in liver echoes. 22% showed an non-homogeneous liver structure due to fibrotic and cirrhotic changes and cholangitis. Four of these patients had splenomegaly due to portal hypertension. 85% of the pancreatic scans which could be evaluated showed small pancreases with high echoes. Cholelithiasis was not present in any. Sonography of the upper abdomen is the method of choice for evaluating the liver, biliary system, pancreas and spleen.

[Exercise-induced asthma (EIA) and radioallergosorbenttest (RAST) (author's transl)]

38 children with bronchial asthma were investigated for allergy (RAST), non-specific bronchial hyperreactivity (acetylcholine challenge) and reaction to physical exercise (free running and bicycle ergometry). 17 patients showed EIA caused by free running and 11 by cycloergometry. Patients with clear-cut allergy (n = 27, high RAST values, class 3 and 4) showed exercise-induced bronchoconstriction in a high percentage of cases (16 of 27 following running, 10 of 27 after bicycle ergometry). Such patients also had non-specific bronchial hyperreactivity. This would explain treatment failures after correctly performed specific immunotherapy.

[Shortening of interval between first and second TBE vaccination in asthmatic children (author's transl)]

37 children suffering from asthma had to be vaccinated against tick-borne encephalitis (TBE) with an interval of only 10 days between the first two vaccinations. Sufficient antibodies were detected in samples taken 14 days after the second injection. No differences were found between the results in this group of asthmatic children and in children who were vaccinated with the usual interval of 1 to 3 months elapsing between the first two injections. The asthmatic children tolerated the vaccination very well, moreover the indicence of side reactions was not different from that of the control group.

Influence of aerobiology and weather on symptoms in children with asthma

Local and central European weather, pollen (Castanea and Poaceae) and spore (alternaria and cladosporium) counts, and asthmatic complaints and drug requirements (expressed as "attack score") were correlated in a group of 40 asthmatic children (21 with recurrent symptoms) during a summer holiday camp for 6 weeks. It was shown that there are significant correlations between the cumulative 24-hour pollen count over 6 weeks and the attack frequency. 2-Hourly counts or daily counts did not correlate with complaints. Consecutive 10-day averages of attacks and pollen and spore counts showed good agreement. The influence of local weather was negligible. Low pressure gradients or high atmospheric pressure was not beneficial. Improvements of lung function are ascribed to training effects.

[Suppression of non-specific bronchial hyperreactivity by DSCG (Disodium cromoglycate) and ipratropium bromide (author's transl)]

The protective activity of DSCG was investigated in 18 children with established non-specific bronchial hyperreactivity induced by bronchial challenge with acetylcholine. Ipratropium bromide, the anticholinergic agent, was used for comparison. DSCG showed a statistically significant inhibitory action on the decrease in specific airway conductance. Besides the well-established inhibition of mast cell degranulation a direct action on cholinergic irritative receptors seems likely. Application of DSCG in immunologically ill-defined forms of bronchial asthma may be considered. As expected, the direct acetylcholine antagonist, ipratropium bromide, showed an overall protective effect.