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Kabasser S, Radauer C, Eber E, Haber ME, Hieden K, Zieglmayer P, Kost LE, Sindher SB, Chinthrajah S, Geiselhart S, Hoffmann-Sommergruber K, Nadeau KC, Breiteneder H, Bublin M. Cosensitization to the 3 Nonhomologous Major Cashew Allergens Ana o 1, Ana o 2, and Ana o 3 Is Caused by IgE Cross-reactivity. J Investig Allergol Clin Immunol 2024; 34:38-48. [PMID: 36331131 DOI: 10.18176/jiaci.0867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Cashew nuts often cause strong allergic reactions, which are even more severe than those of peanuts. Ana o 1 (vicilin), Ana o 2 (legumin), and Ana o 3 (2S albumin) are major cashew allergens. Cosensitization to all 3 nonhomologous cashew nut allergens has been observed. We hypothesize that this might be due to IgE cross-reactivity. METHODS IgE cross-inhibitions were performed with Ana o 1-3 using serum samples from cashew nut-allergic patients. The related hazelnut allergens Cor a 11, 9, and 14 were used as controls. For comparison, IgE cross-reactivity between the hazelnut allergens was investigated using serum samples from hazelnut-allergic patients. RESULTS The median percentages of cross-inhibition between Ana o 1, 2, and 3 were 84%-99%. In comparison, the median cross- inhibition values between hazelnut allergens were 33%-62%. The IC50 values revealed the highest IgE affinity to be to Ana o 3 and Cor a 14. Hazelnut legumin Cor a 9 inhibited IgE binding to Ana o 1, 2, and 3, with median percentages of 75%, 56%, and 48%, respectively. No cross-reactivity was observed between allergenic vicilins or between 2S albumins from cashew and hazelnut. Potentially cross-reactive peptides of Ana o 3 identified in silico overlapped with previously reported IgE epitopes of all 3 allergens. CONCLUSION IgE with high affinity to Ana o 3 that cross-reacts with the other 2 major nonhomologous cashew nut allergens might be responsible for the high allergenic potency of cashew nut. These cross-reactive IgE types comprise the major fraction of specific IgE in cashew-allergic patients and might be responsible for cross-reactivity between unrelated tree nuts.
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Affiliation(s)
- S Kabasser
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C Radauer
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - E Eber
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - M E Haber
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - K Hieden
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - P Zieglmayer
- Vienna Challenge Chamber, Allergy Center Vienna West, Vienna, Austria
- Competence Center for Allergology and Immunology, Karl Landsteiner University, Krems, Austria
| | - L E Kost
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, USA
| | - S B Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, USA
| | - S Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, USA
| | - S Geiselhart
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - K Hoffmann-Sommergruber
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - K C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, USA
| | - H Breiteneder
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - M Bublin
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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Radtke T, Kriemler S, Stein L, Karila C, Urquhart D, Orenstein D, Lands L, Schindler C, Eber E, Haile S, Hebestreit H. WS14.03 Cystic Fibrosis-Related Diabetes is not associated with maximal aerobic exercise capacity in cystic fibrosis (CF): a cross-sectional analysis of an international multicentre trial (ACTIVATE-CF). J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Idzko M, Buhl R, Eber E, Hamelmann E, Lamprecht B, Horak F, Pohl W, Taube C. [COVID-19 Vaccination in Asthma Patients Treated with Biologicals - Statement of the Austrian Society of Pneumology and German Respiratory Society]. Pneumologie 2021; 75:259-260. [PMID: 33711848 DOI: 10.1055/a-1373-9381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patients with asthma should be vaccinated against COVID-19. This includes patients with severe asthma. Treatment with a biological for asthma is no contra-indication for vaccination against COVID-19.
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Affiliation(s)
- M Idzko
- Klinischen Abteilung Pulmologie, Universitätsklinik für Innere Medizin II, Wien, Österreich
| | - R Buhl
- III. Med. Klinik, Universitätsmedizin Mainz, Deutschland
| | - E Eber
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - E Hamelmann
- Universitätsklinik für Kinder- und Jugendmedizin, Kinder-Zentrum Bethel, Universität Bielefeld, Deutschland
| | - B Lamprecht
- Klinik für Lungenheilkunde, Kepler Universitätsklinikum, Linz, Österreich
| | - F Horak
- Allergiezentrum Wien West, Wien, Österreich
| | - W Pohl
- Klinikum Hietzing, Karl Landsteiner Institut für experimentelle und klinische Pneumologie, Wien, Österreich
| | - C Taube
- Klinik für Pneumologie Universitätsmedizin Essen - Ruhrlandklinik, Essen, Deutschland
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4
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Goussard P, Pohunek P, Eber E, Midulla F, Di Mattia G, Merven M, Janson JT. Pediatric bronchoscopy: recent advances and clinical challenges. Expert Rev Respir Med 2021; 15:453-475. [PMID: 33512252 DOI: 10.1080/17476348.2021.1882854] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.
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Affiliation(s)
- P Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - P Pohunek
- Division of Pediatric Respiratory Diseases, Pediatric Department, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - E Eber
- Department of Paediatrics and Adolescent Medicine, Head, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - F Midulla
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - G Di Mattia
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Merven
- Department Otorhinolaryngology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - J T Janson
- Department of Surgical Sciences, Division of Cardio-Thoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
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Carroll WD, Strenger V, Eber E, Porcaro F, Cutrera R, Fitzgerald DA, Balfour-Lynn IM. European and United Kingdom COVID-19 pandemic experience: The same but different. Paediatr Respir Rev 2020; 35:50-56. [PMID: 32709461 PMCID: PMC7334652 DOI: 10.1016/j.prrv.2020.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
The global healthcare landscape has changed dramatically and rapidly in 2020. This has had an impact upon paediatricians and in particular respiratory paediatricians. The effects in Europe, with its mature healthcare system, have been far faster and greater than most authorities anticipated. Within six weeks of COVID-19 being declared a public health emergency by the World Health Organisation [WHO] in China, Europe had become the new epicentre of disease. A pandemic was finally declared by the WHO on March 11th 2020. Continued international travel combined with the slow response of some political leaders and a variable focus on economic rather than health consequences resulted in varying containment strategies in response to the threat of the initial wave of the pandemic. It is likely that this variation has contributed to widely differing outcomes across Europe. Common to all countries was the stark lack of preparations and initial poor co-ordination of responses between levels of government to this unforeseen but not unheralded global health crisis. In this article we highlight the impact of the first wave of the COVID-19 pandemic in Italy, Austria, Germany, and the United Kingdom.
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Affiliation(s)
- W D Carroll
- Department of Paediatric Respiratory Medicine, Staffordshire Children's Hospital at Royal Stoke, Newcastle Road, Stoke-on-Trent ST4 6QG, UK.
| | - V Strenger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria.
| | - E Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria.
| | - F Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy.
| | - R Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy.
| | - D A Fitzgerald
- Department of Respiratory Medicine, Discipline of Child & Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia.
| | - I M Balfour-Lynn
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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Flick H, Arns BM, Bolitschek J, Bucher B, Cima K, Gingrich E, Handzhiev S, Hochmair M, Horak F, Idzko M, Jaksch P, Kovacs G, Kropfmüller R, Lamprecht B, Löffler-Ragg J, Meilinger M, Olschewski H, Pfleger A, Puchner B, Puelacher C, Prior C, Rodriguez P, Salzer H, Schenk P, Schindler O, Stelzmüller I, Strenger V, Täubl H, Urban M, Wagner M, Wimberger F, Zacharasiewicz A, Zwick RH, Eber E. [Statement of the Austrian Society of Pneumology (ASP)]. Wien Klin Mag 2020; 23:92-115. [PMID: 32427192 PMCID: PMC7232599 DOI: 10.1007/s00740-020-00350-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic is currently a challenge worldwide. In Austria, a crisis within the health care system has so far been avoided. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic. However, COVID-19-specific adjustments are useful. The treatment of patients with chronic lung diseases must be adapted during the pandemic, but must still be guaranteed.
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Affiliation(s)
- H. Flick
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
| | - B. M. Arns
- 1. Medizinische Abteilung, Hanusch Krankenhaus, Wien, Österreich
| | | | - B. Bucher
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - K. Cima
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - E. Gingrich
- Lungenfachärztliche Ordination, Wien, Österreich
| | - S. Handzhiev
- Klinische Abteilung für Pneumologie, Universitätsklinikum Krems, Krems, Österreich
| | - M. Hochmair
- Karl Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - F. Horak
- Allergiezentrum Wien West, Wien, Österreich
| | - M. Idzko
- Klinische Abteilung für Pulmologie, Univ. Klinik für Innere Medizin II, Medizinische Universität Wien/AKH Wien, Wien, Österreich
| | - P. Jaksch
- Klinische Abteilung für Thoraxchirurgie, Univ. Klinik für Chirurgie, Medizinische Universität Wien/AKH Wien, Wien, Österreich
| | - G. Kovacs
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
- Ludwig Boltzmann Institut für Lungengefäßforschung Graz, Graz, Österreich
| | - R. Kropfmüller
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - B. Lamprecht
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - J. Löffler-Ragg
- Pneumologische Ambulanz, Univ. Klinik für Innere Medizin II, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M. Meilinger
- Abteilung für Innere Medizin und Pneumologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - H. Olschewski
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
- Ludwig Boltzmann Institut für Lungengefäßforschung Graz, Graz, Österreich
| | - A. Pfleger
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - B. Puchner
- Department für Pneumologie, Reha Zentrum Münster, Münster, Österreich
| | - C. Puelacher
- Interdisziplinäres Schlaflabor, Telfs, Österreich
| | - C. Prior
- Lungenfachärztliche Ordination, Innsbruck, Österreich
| | - P. Rodriguez
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - H. Salzer
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - P. Schenk
- Abteilung Pulmologie, Landesklinikum Hochegg, Grimmenstein, Österreich
| | - O. Schindler
- Abteilung für Innere Medizin und Pneumologie, LKH Graz II, Standort Enzenbach, Gratwein, Österreich
| | | | - V. Strenger
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - H. Täubl
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - M. Urban
- Abteilung für Innere Medizin und Pneumologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - M. Wagner
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - F. Wimberger
- Ordensklinikum Elisabethinen Linz, Linz, Österreich
| | - A. Zacharasiewicz
- Abteilung für Kinder- und Jugendheilkunde, Wilhelminenspital der Stadt Wien, Lehrkrankenhaus der Medizinischen Universität Wien, Wien, Österreich
| | - R. H. Zwick
- Ambulante Pneumologische Rehabilitation, Therme Wien Med, Wien, Österreich
| | - E. Eber
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
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Weiss S, Van Egmond-Fröhlich A, Hofer N, Pfleger A, Rath R, Schwarz R, Kurz H, Waibel V, Kenzian H, Kommer E, Wadlegger F, Stelzl W, Keck B, Grigorow I, Kerbl R, Sauseng W, Frischer T, Eber E, Bernert G. Long-Term Respiratory Support for Children and Adolescents in Austria: A National Survey. Klin Padiatr 2015; 228:42-6. [PMID: 26697738 DOI: 10.1055/s-0035-1565240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Population-based data on pediatric patients on long-term respiratory support (LTRS) in Austria are lacking. This study aimed to record the pediatric departments active in this field, as well as number and characteristics of patients on LTRS. METHODS A national cross-sectional study was carried out by means of questionnaires sent to all pediatric departments in Austria. RESULTS All departments answered to the questionnaires. On June 1st, 2013, the reference day for this study, 12 of the 41 pediatric departments in Austria were active in the field. At this time, these centers were caring for 143 patients, 111 (77.6%) of them under 18 years, which corresponds to a prevalence of 7.4 per 100 000. The patients suffered from neuromuscular disorders (44%), other neurological disorders (18.9%), disorders of respiratory drive (9.1%), obstructive sleep apnea (8.4%), thoracal and spinal diseases (8.4%), pulmonary disorders (4.9%) and other diseases (6.3%). Continuous positive airway pressure was used in 6.3%, non-invasive ventilation in 60.1% and invasive ventilation in 33.6% of the patients, respectively. LTRS was performed at home in 92.3%. CONCLUSION LTRS represents a common management strategy in children and adolescents with a variety of disorders. Census reports such as this one provide the basis for appropriate planning of resource allocation. The age distribution of our patients shows the need for structured transition into adult care.
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Affiliation(s)
- S Weiss
- Department of Pediatrics, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | - N Hofer
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - A Pfleger
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - R Rath
- Department of Pediatrics, Hospital Moedling, Moedling, Austria
| | - R Schwarz
- Department of Pediatrics, Women's and Children's Hospital Linz, Linz, Austria
| | - H Kurz
- Department of Pediatrics, SMZ Ost Danube Hospital, Vienna, Austria
| | - V Waibel
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - H Kenzian
- Department of Pediatrics, Hospital Villach, Villach, Austria
| | - E Kommer
- Department of Pediatrics, Hospital Mistelbach, Mistelbach, Austria
| | - F Wadlegger
- Department of Pediatrics, Clinical Center Klagenfurt, Klagenfurt, Austria
| | - W Stelzl
- Department of Pediatrics, Hospital Feldkirch, Feldkirch, Austria
| | - B Keck
- St. Anna Children's Hospital, Vienna, Austria
| | - I Grigorow
- Department of Pediatrics, Hospital Leoben, Leoben, Austria
| | - R Kerbl
- Department of Pediatrics, Wilhelminenspital, Vienna, Austria
| | - W Sauseng
- Medical Services, Youth and Child Welfare Services, City of Graz, Austria
| | - T Frischer
- Department of Pediatrics, Wilhelminenspital, Vienna, Austria
| | - E Eber
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - G Bernert
- Department of Pediatrics, Kaiser Franz Josef Hospital, Vienna, Austria
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Pfleger A, Eber E. [Infectious upper airway obstruction]. ACTA ACUST UNITED AC 2015; 50:53-56. [PMID: 32287398 PMCID: PMC7101730 DOI: 10.1007/s00608-015-0240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infektiöse Erkrankungen der oberen Luftwege können besonders beim Säugling und Kleinkind zum Notfall mit partieller bis kompletter Luftwegsobstruktion und respiratorischer Insuffizienz führen. Sie erfordern ein besonnenes, ruhiges Vorgehen, manchmal aber auch ein rasches Eingreifen des erstversorgenden Mediziners. Fragen nach dem Symptombeginn, begleitender Rhinitis und Fieber sowie eine orientierende Anamnese zu möglicherweise bereits bekannten Atemwegsproblemen seit der Geburt oder in den ersten Wochen danach (z. B. kongenitale Malformationen von Larynx oder Trachea) und eine sorgfältige Beobachtung zur Einschätzung des Ausmaßes der Atemnot und Zuordnung des Atemgeräuschs zu den Atemphasen stehen am Beginn jeder Untersuchung. Die systemische Applikation von Steroiden und Inhalation von Epinephrin (Adrenalin) sind Standard bei der viralen Laryngotracheobronchitis, der häufigsten infektiösen Luftwegserkrankung mit oberer Luftwegsobstruktion. Seltene Differenzialdiagnosen wie die bakterielle Tracheitis, der Retro- und Parapharyngealabszess oder die Epiglottitis erfordern ein spezielles Management.
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Affiliation(s)
- A Pfleger
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - E Eber
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
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Zacharasiewicz A, Eber E, Riedler J, Frischer T. Evaluation und Therapie des chronischen Hustens bei Kindern. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rödl S, Resch B, Hofer N, Marschitz I, Madler G, Eber E, Zobel G. Prospective evaluation of clinical scoring systems in infants with bronchiolitis admitted to the intensive care unit. Eur J Clin Microbiol Infect Dis 2012; 31:2667-72. [PMID: 22526870 DOI: 10.1007/s10096-012-1612-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/18/2012] [Indexed: 10/28/2022]
Abstract
The objective of this investigation was to compare different scoring systems to assess the severity of illness in infants with bronchiolitis admitted to a tertiary paediatric intensive care unit (PICU). Over an 18-year period (1990-2007), infants with bronchiolitis aged up to 12 months and admitted to the PICU were prospectively scored using the Pediatric Risk of Mortality III (PRISM III) score, the Organ System Failure (OSF) score and the Acute Physiologic Score for Children (APSC) within 24 h. Infants were compared as to whether or not bronchiolitis was associated with respiratory syncytial virus (RSV). There was no difference between 113 RSV-positive and 80 RSV-negative infants regarding gestational age, birth weight, rate of premature delivery or bronchopulmonary dysplasia (BPD). The PRISM III score differed significantly between RSV-positive and RSV-negative cases (3.27 ± 0.39 vs. 1.96 ± 0.44, p = 0.006), as did the OSF score (0.56 ± 0.05 vs. 0.35 ± 0.06, p = 0.049) and the APSC (5.16 ± 0.46 vs. 4.1 ± 0.53, p = 0.048). All scores were significantly higher in the subgroup with mechanical ventilation (p < 0.0001). The mean time of ventilation was significantly higher in the RSV-positive group compared to the RSV-negative group (6.39 ± 1.74 days vs. 2.4 ± 0.47 days, p < 0.001). Infants suffering from RSV-positive bronchiolitis had higher clinical scores corresponding with the severity of bronchiolitis.
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Affiliation(s)
- S Rödl
- Paediatric Intensive Care Unit, Department of Paediatrics, Medical University of Graz, Graz, Austria
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Zacharasiewicz A, Berger A, Eber E, Frischer T, Kurz H, Resch B, Zach M. Kommentar zur Post-RSV-Atemwegserkrankung. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Halmer M, Müller W, Eber E, Resch B. Kongenitaler Chylothorax – Eine systematische Untersuchung eigener Fälle und Review der Literatur. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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14
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Kotecha S, Barbato A, Bush A, Claus F, Davenport M, Delacourt C, Deprest J, Eber E, Frenckner B, Greenough A, Nicholson AG, Antón-Pacheco JL, Midulla F. Congenital diaphragmatic hernia. Eur Respir J 2011; 39:820-9. [PMID: 22034651 DOI: 10.1183/09031936.00066511] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.
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Affiliation(s)
- S Kotecha
- Dept of Child Health, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, UK.
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Hedlin G, Eber E. The changing perspectives of respiratory diseases in infancy and childhood. Breathe (Sheff) 2011. [DOI: 10.1183/20734735.012111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Eber E, Lødrup Carlsen KC, Ratjen F, Turner SW, Dankert-Roelse JE, Ross-Russell RI, Midulla F, Aurora P, Hedlin G. Paediatrics in Barcelona: highlights from the 2010 ERS Annual Congress. Eur Respir J 2011; 37:1514-21. [PMID: 21478214 DOI: 10.1183/09031936.00026311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this update is to describe the paediatric highlights from the 2010 European Respiratory Society Annual Congress in Barcelona, Spain. Abstracts from the seven groups of the Paediatric Assembly (Respiratory physiology, Asthma and allergy, Cystic fibrosis, Respiratory infection and immunology, Neonatology and paediatric intensive care, Respiratory epidemiology and Bronchology) are presented in the context of the current literature.
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Affiliation(s)
- E Eber
- Department of Paediatrics, University Children's Hospital, Medical University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria.
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Hedlin G, Eber E, Aurora P, Lødrup Carlsen KC, Ratjen F, Dankert-Roelse JE, Ross-Russell RI, Turner S, Midulla F, Baraldi E, Bush A. Paediatric respiratory disease: past, present and future. Eur Respir J 2010; 36:225-8. [PMID: 20675775 DOI: 10.1183/09031936.00085510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kuehni CE, Frischer T, Strippoli MPF, Maurer E, Bush A, Nielsen KG, Escribano A, Lucas JSA, Yiallouros P, Omran H, Eber E, O'Callaghan C, Snijders D, Barbato A. Factors influencing age at diagnosis of primary ciliary dyskinesia in European children. Eur Respir J 2010. [PMID: 20530032 DOI: 10.1183/09031936.00001010.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary ciliary dyskinesia (PCD) is a hereditary disorder of mucociliary clearance causing chronic upper and lower airways disease. We determined the number of patients with diagnosed PCD across Europe, described age at diagnosis and determined risk factors for late diagnosis. Centres treating children with PCD in Europe answered questionnaires and provided anonymous patient lists. In total, 223 centres from 26 countries reported 1,009 patients aged < 20 yrs. Reported cases per million children (for 5-14 yr olds) were highest in Cyprus (111), Switzerland (47) and Denmark (46). Overall, 57% were males and 48% had situs inversus. Median age at diagnosis was 5.3 yrs, lower in children with situs inversus (3.5 versus 5.8 yrs; p < 0.001) and in children treated in large centres (4.1 versus 4.8 yrs; p = 0.002). Adjusted age at diagnosis was 5.0 yrs in Western Europe, 4.8 yrs in the British Isles, 5.5 yrs in Northern Europe, 6.8 yrs in Eastern Europe and 6.5 yrs in Southern Europe (p < 0.001). This strongly correlated with general government expenditures on health (p < 0.001). This European survey suggests that PCD in children is under-diagnosed and diagnosed late, particularly in countries with low health expenditures. Prospective studies should assess the impact this delay might have on patient prognosis and on health economic costs across Europe.
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Affiliation(s)
- C E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Berne, Berne, Switzerland
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Kuehni CE, Frischer T, Strippoli MPF, Maurer E, Bush A, Nielsen KG, Escribano A, Lucas JSA, Yiallouros P, Omran H, Eber E, O'Callaghan C, Snijders D, Barbato A. Factors influencing age at diagnosis of primary ciliary dyskinesia in European children. Eur Respir J 2010; 36:1248-58. [PMID: 20530032 DOI: 10.1183/09031936.00001010] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a hereditary disorder of mucociliary clearance causing chronic upper and lower airways disease. We determined the number of patients with diagnosed PCD across Europe, described age at diagnosis and determined risk factors for late diagnosis. Centres treating children with PCD in Europe answered questionnaires and provided anonymous patient lists. In total, 223 centres from 26 countries reported 1,009 patients aged < 20 yrs. Reported cases per million children (for 5-14 yr olds) were highest in Cyprus (111), Switzerland (47) and Denmark (46). Overall, 57% were males and 48% had situs inversus. Median age at diagnosis was 5.3 yrs, lower in children with situs inversus (3.5 versus 5.8 yrs; p < 0.001) and in children treated in large centres (4.1 versus 4.8 yrs; p = 0.002). Adjusted age at diagnosis was 5.0 yrs in Western Europe, 4.8 yrs in the British Isles, 5.5 yrs in Northern Europe, 6.8 yrs in Eastern Europe and 6.5 yrs in Southern Europe (p < 0.001). This strongly correlated with general government expenditures on health (p < 0.001). This European survey suggests that PCD in children is under-diagnosed and diagnosed late, particularly in countries with low health expenditures. Prospective studies should assess the impact this delay might have on patient prognosis and on health economic costs across Europe.
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Affiliation(s)
- C E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Berne, Berne, Switzerland
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Uhlig T, Eber E, Sly PD. Primary prevention of allergic sensitisation: how might it work? BioDrugs 2010; 12:13-8. [PMID: 18031158 DOI: 10.2165/00063030-199912010-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Allergic diseases, particularly allergic asthma, are among the most frequent disorders seen in paediatric practice and clinic. Epidemiological data as well as recent immunological studies have largely contributed to the identification of risk factors eventually leading to the clinical manifestation of allergy. Various strategies of primary prevention are being developed and most of them include avoidance of identified or presumed risk factors. Another promising field of research investigates pharmacological approaches in the prevention of allergy, and drugs have been identified which interfere with the pathophysiological pathways. It seems likely that they may play an important role in future primary prevention strategies especially targeting infants at high risk.
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Affiliation(s)
- T Uhlig
- Department of Allergy and Pulmonology, Margaritenhospital Schwäbisch Gmünd, Schwäbisch Gmünd, Germany.
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Gappa M, Noël JL, Séverin T, Baraldi E, Busari J, Bush A, Carlsen KH, de Jongste J, Eber E, Fauroux B, McKenzie S, Palange P, Pohunek P, Primhak R, Priftis K, Wildhaber J, Zivkovic Z, Zach M, Paton J. Paediatric HERMES: European Curriculum Recommendations for Training in Paediatric Respiratory Medicine. Breathe (Sheff) 2010. [DOI: 10.1183/18106838.0701.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Barbato A, Frischer T, Kuehni CE, Snijders D, Azevedo I, Baktai G, Bartoloni L, Eber E, Escribano A, Haarman E, Hesselmar B, Hogg C, Jorissen M, Lucas J, Nielsen KG, O'Callaghan C, Omran H, Pohunek P, Strippoli MPF, Bush A. Primary ciliary dyskinesia: a consensus statement on diagnostic and treatment approaches in children. Eur Respir J 2009; 34:1264-76. [DOI: 10.1183/09031936.00176608] [Citation(s) in RCA: 324] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lenney W, Boner AL, Bont L, Bush A, Carlsen KH, Eber E, Fauroux B, Gotz M, Greenough A, Grigg J, Hull J, Kimpen J, Sanchez Luna M, de Benedictis FM. Medicines used in respiratory diseases only seen in children. Eur Respir J 2009; 34:531-51. [DOI: 10.1183/09031936.00166508] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gappa M, Paton J, Baraldi E, Bush A, Carlsen KH, de Jongste JC, Eber E, Fauroux B, McKenzie S, Noël JL, Palange P, Pohunek P, Priftis K, Séverin T, Wildhaber JH, Zivkovic Z, Zach M. Paediatric HERMES: update of the European Training Syllabus for Paediatric Respiratory Medicine. Eur Respir J 2009; 33:464-5. [PMID: 19251793 DOI: 10.1183/09031936.00001209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Brand PLP, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, de Blic J, de Jongste JC, Eber E, Everard ML, Frey U, Gappa M, Garcia-Marcos L, Grigg J, Lenney W, Le Souëf P, McKenzie S, Merkus PJFM, Midulla F, Paton JY, Piacentini G, Pohunek P, Rossi GA, Seddon P, Silverman M, Sly PD, Stick S, Valiulis A, van Aalderen WMC, Wildhaber JH, Wennergren G, Wilson N, Zivkovic Z, Bush A. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2009; 32:1096-110. [PMID: 18827155 DOI: 10.1183/09031936.00002108] [Citation(s) in RCA: 493] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.
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Affiliation(s)
- P L P Brand
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands.
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Thalhammer G, Eber E, Oberwaldner B, Dacar D, Zach M. Experience with totally implantable venous access devices in CF patients. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60456-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eber E, Grasemann H, Thalhammer G, Widmann R, Ratjen F. Safety tolerability and efficacy of multiple doses of aerosolised Moli1901 in adolescents and adults with cystic fibrosis. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Eber E, Thalhammer GH, Zach MS. Eradication of Pseudomonas aeruginosa in cystic fibrosis. Eur Respir J 2006; 27:438-9. [PMID: 16452606 DOI: 10.1183/09031936.06.00118805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pichler G, Eber E, Thalhammer G, Muntean W, Zach MS. Arthralgia and digital clubbing in a child: hypertrophic osteoarthropathy with inflammatory pseudotumour of the lung. Scand J Rheumatol 2004; 33:189-91. [PMID: 15228191 DOI: 10.1080/03009740310004702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Arthralgia in childhood is an unspecific symptom. One rare cause of arthralgia is hypertrophic osteoarthropathy associated with digital clubbing. We present a child where hypertrophic osteoarthropathy led to the rare diagnosis of an inflammatory pseudotumour of the lung. In a 12-year-old girl with arthralgia and digital clubbing, a chest radiograph disclosed a large round mass in the right upper lobe, and the following chest computed tomography scan showed a large solid homogenous, round, well marginated lesion with little contrast enhancement. A lobectomy of the right upper lobe was performed, and histological examination showed an inflammatory pseudotumour. The postoperative course was without problems: arthralgia and digital clubbing disappeared.
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Affiliation(s)
- G Pichler
- Division of General Paediatrics, Department of Paediatrics, University of Graz, Austria.
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Abstract
Paediatric fibreoptic bronchoscopy is used for ever wider indications, and increasingly used in many contexts, including paediatric and neonatal intensive care. The report of this Task Force contains an overview on the current applications of paediatric bronchoscopy. The report discusses the facilities and equipment needed for the procedure, including the newly developed bronchoscopes which are allowing intervention even in very small children. The indications of both flexible and rigid bronchoscopes in the context of newer and smaller flexible endoscopic equipment are also considered. The care of the instruments, including disinfection and sterilisation, is fully documented. Patient management is described, including the relative merits of conscious sedation and general anaesthesia, as well as special settings for the procedure, including the needs in intensive care. Special procedures, increasingly performed bronchoscopically are described. These include bronchoalveolar lavage, endobronchial and transbronchial biopsy, laser therapy, bronchography, and endoscopic intubation and drug therapy. Finally, neonatal bronchoscopy is discussed, and the ethics of bronchoscopic procedures, including bronchoscopic research in children. Advances in instrumentation, and also improved anaesthetic techniques, allow fibreoptic bronchoscopy to be safely performed in even very small, sick infants, provided proper precautions are taken.
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Affiliation(s)
- F Midulla
- Istituto di Clinica Pediatrica, Servizio Speciale Fibrosi Cistica, Università di Roma La Sapienza, Roma, Italy.
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Abstract
We report three cystic fibrosis (CF) patients with hypersplenism who underwent partial splenectomy. The postoperative course was uneventful in two patients; one patient developed a complication necessitating resection of the rest of the spleen. Haematological parameters improved and oesophageal varices regressed in all patients. On follow up, one patient showed a normal spleen, the other a normally functioning accessory spleen; the third patient again developed splenomegaly with hypersplenism. Partial splenectomy is a promising therapeutic option for CF patients with hypersplenism.
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Affiliation(s)
- G H Thalhammer
- Respiratory and Allergic Disease Division, Paediatric Department, University of Graz, Austria
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Abstract
Nedocromil and salbutamol are effective drugs in preventing exercise-induced asthma (EIA). The aim of this study was to compare the protective effects of both drugs and a combination of both drugs against cold dry air-induced bronchoconstriction, using cold dry air challenges (CACh) as a surrogate for exercise. Twenty-five atopic children (mean age 13.7, range 8-18 yrs) with EIA participated in the study. Lung function tests were performed before medication, 30 min after medication and just before CACh, and 3 and 15 min after the challenge on four consecutive days. CACh consisted of a 4-min isocapnic hyperpnoea of -10 degrees C, absolutely dry air. Treatment consisted of nedocromil (two puffs of 2 mg) plus placebo, salbutamol (two puffs of 100 microg) plus placebo, the combination of both drugs, and placebo alone, in a random order. Both active drugs were significantly more protective than placebo and the combination showed an additive effect. Mean maximum postchallenge decrease in forced expiratory volume in one second after placebo was 27+/-8.1%, 12+/-9.5% after nedocromil, 8+/-10.4% after salbutamol, and 4.5+/-6.71% after the combination of both drugs, respectively. These results suggest that both drugs protect against exercise-induced asthma. Although not as effective as salbutamol and combined medication, nedocromil can give sufficient protection for many patients.
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Affiliation(s)
- A Pfleger
- Paediatric Dept, University of Graz, Austria.
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Abstract
BACKGROUND Laser acupuncture, a painless technique, is a widely used alternative treatment method for childhood asthma, although its efficacy has not been proved in controlled clinical studies. METHODS A double blind, placebo controlled, crossover study was performed to investigate the possible protective effect of a single laser acupuncture treatment on cold dry air hyperventilation induced bronchoconstriction in 44 children and adolescents of mean age 11.9 years (range 7.5-16.7) with exercise induced asthma. Laser acupuncture was performed on real and placebo points in random order on two consecutive days. Lung function was measured before laser acupuncture, immediately after laser acupuncture (just before cold dry air challenge (CACh)), and 3 and 15 minutes after CACh. CACh consisted of a 4 minute isocapnic hyperventilation of -10 degrees C absolute dry air. RESULTS Comparison of real acupuncture with placebo acupuncture showed no significant differences in the mean maximum CACh induced decrease in forced expiratory volume in 1 second (27.2 (18.2)% v 23.8 (16.2)%) and maximal expiratory flow at 25% remaining vital capacity (51.6 (20.8)% v 44.4 (22.3)%). CONCLUSIONS A single laser acupuncture treatment offers no protection against exercise induced bronchoconstriction in paediatric and adolescent patients.
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Affiliation(s)
- W Gruber
- Respiratory and Allergic Disease Division, Paediatric Department, University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria
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Benesch M, Kurz H, Eber E, Varga EM, Göpfrich H, Pfleger A, Popper H, Setinek-Liszka U, Zach MS. Clinical and histopathological findings in two Turkish children with follicular bronchiolitis. Eur J Pediatr 2001; 160:223-6. [PMID: 11317643 DOI: 10.1007/pl00008432] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED We report on two Turkish children who presented with progressive airway obstruction. Open lung biopsy revealed follicular bronchiolitis. The children were treated with systemic steroids and various topical medications. Whereas the respiratory situation of patient 1 required immunosuppressive therapy, the condition of patient 2 stabilised without systemic medication. CONCLUSION Diagnosis of follicular bronchiolitis should be considered when children present with recurrent respiratory tract infections, progressive dyspnoea, and chronic bronchial obstruction. Children in whom follicular bronchiolitis is suspected should undergo open lung biopsy for confirmation of diagnosis.
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Affiliation(s)
- M Benesch
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Auenbruggerplatz 30, 8036 Graz, Austria.
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Affiliation(s)
- E Eber
- Respiratory and Allergic Disease Division, Paediatric Department, University of Graz, Austria.
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Affiliation(s)
- M S Zach
- Respiratory and Allergic Disease Division, Paediatric Department, University of Graz, Austria.
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Abstract
UNLABELLED We report on the clinical, laboratory, and molecular genetic findings in a 15-month-old boy who initially presented with disseminated cytomegalovirus and concomitant para-influenza virus infection. Hyper-IgM syndrome, suspected on clinical grounds, was confirmed by immunological investigations. In addition, a previously unreported potentially disease-causing mutation in the CD40 ligand gene was detected in this patient. CONCLUSION The present case illustrates that disseminated cytomegalovirus infection with atypical clinical features should be included in the spectrum of the hyper-IgM syndrome.
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Affiliation(s)
- M Benesch
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Graz, Austria
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Abstract
Tracheobronchomegaly (Mounier-Kuhn syndrome) is characterized by dilatation of the central airways, tracheobronchial outpouchings, and chronic tracheobronchitis. Most cases are diagnosed in adulthood. We report the clinical, radiographic, and bronchoscopic findings in a 14-year-old boy with tracheobronchomegaly, ptosis of the right eyelid, and redundant skin and mucosa of the upper lip, who presented with a 2-year history of recurrent lower respiratory tract infections. Pediatricians should be aware of the possibility that tracheobronchomegaly may cause clinical symptoms in childhood and adolescence. Pediatr Pulmonol. 2000; 29: 476-479.
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Affiliation(s)
- M Benesch
- Respiratory and Allergic Disease Division, Department of Pediatrics, University of Graz, Graz, Austria.
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Abstract
This case study reports on two infants, 5 and 6 months of age, respectively, with chronic interstitial lung disease who presented with failure to thrive, tachypnoea, rales and mild hypoxaemia. Epstein-Barr virus (EBV) was detected by in situ hybridization in lung biopsy specimens and by EBV-deoxyribonucleic acid-polymerase chain reaction (PCR) in bronchoalveolar lavage (BAL) fluid in one patient and by in situ hybridization and PCR analysis in BAL fluid in the second patient. There was serological evidence of immunoglobulin G antibodies to EBV capsid antigen by indirect immunofluorescence in both patients. After 7 months of respiratory symptoms one patient was successfully treated with a 10 day course of intravenous ganciclovir followed by oral acyclovir for 20 days. The other patient became symptom free after 3.5 months of respiratory symptoms, without any specific antiviral medication. During a follow-up of 2 and 1.5 yrs, respectively, both infants remained symptom free and showed normal physical development.
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Affiliation(s)
- A Pfleger
- Paediatric Department, University of Graz, Austria
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Modl M, Eber E, Weinhandl E, Gruber W, Zach MS. Assessment of bronchodilator responsiveness in infants with bronchiolitis. A comparison of the tidal and the raised volume rapid thoracoabdominal compression technique. Am J Respir Crit Care Med 2000; 161:763-8. [PMID: 10712319 DOI: 10.1164/ajrccm.161.3.9812063] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Whether bronchodilators should be used for the treatment of infants with bronchiolitis is subject to debate, partly because of the low sensitivity of the methods for assessing lung function changes in infants. In the present study, we compared the recently introduced raised volume (RVRTC) with the conventional end-tidal rapid thoracoabdominal compression (ETRTC) technique in infants with acute viral bronchiolitis. In 17 infants lung function was assessed by both methods, at baseline values and after salbutamol inhalation. Forced expiratory volumes (FEV(0.5), FEV(0.75), FEV(1.0)) were used for the quantification of RVRTC measurement, and maximal expiratory flow at functional residual capacity (Vmax (FRC)) for ETRTC measurements. A significant individual change was defined by a mean postbronchodilator value that differed from baseline value by more than twice the within-subject coefficient of variation (CV). Group mean intrasubject CVs ranged from 4.7% to 5.3% for FEV parameters; it was 14.0% for Vmax (FRC). For the group, post-bronchodilator measurements did not differ significantly from baseline measurements. For the majority of infants, however, the within-subject comparison of responses revealed substantial differences between both techniques; while no infant demonstrated a significant increase in Vmax (FRC), eight (47%) infants responded with significantly improved timed volumes. The RVRTC technique provides the investigator with a more sensitive diagnostic tool for documenting the effectiveness of therapeutic interventions on an individual basis. Furthermore, the findings of the present study provide a rationale for the application of bronchodilators in a subgroup of infants with acute bronchiolitis.
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Affiliation(s)
- M Modl
- Respiratory and Allergic Disease Division, Pediatric Department, University of Graz, Graz, Austria
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de Blic J, Midulla F, Barbato A, Clement A, Dab I, Eber E, Green C, Grigg J, Kotecha S, Kurland G, Pohunek P, Ratjen F, Rossi G. Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society. Eur Respir J 2000; 15:217-31. [PMID: 10678650 DOI: 10.1183/09031936.00.15121700] [Citation(s) in RCA: 235] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
The end-tidal rapid thoracoabdominal compression (ETRTC) technique is an established method for lung function testing in infancy. Previous work in healthy infants, however, has shown that measurements with the newly developed raised volume rapid thoracoabdominal compression (RVRTC) technique are more reproducible than those with the ETRTC technique. So far, reproducibility of the two techniques has not been compared in infants with acute airway disease. Twenty-three infants with acute viral bronchiolitis underwent lung function assessment with both the ETRTC and the RVRTC technique. A series of 8-10 measurements with each technique was done in randomized order. Forced expired volumes at 0.5, 0.75, and 1 sec after chest compression (FEV(0.5), FEV(0.75), and FEV(1.0)) were measured with the RVRTC technique; maximum expiratory flow at functional residual capacity (V'(maxFRC)) was measured with the ETRTC technique. Group mean intrasubject coefficients of variation (CV) were 4.84% for FEV(0.5), 5.01% for FEV(0.75), 5.43% for FEV(1. 0), and 13.79% for V'(maxFRC), respectively. Differences between FEV parameters were statistically insignificant, whereas the difference between each FEV parameter and V'(maxFRC) was highly significant (P < 0.001). In infants with acute viral bronchiolitis, RVRTC measurements have significantly less intraindividual variability than flow rates assessed with the conventional ETRTC technique. This finding provides the basis for assessing disease course and effects of therapeutic interventions on an individual basis.
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Affiliation(s)
- M Modl
- Division of Respiratory and Allergic Disease, Department of Pediatrics, University of Graz, Graz, Austria
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Frischer T, Eber E, Eichler I, Horak E, Riedler J, Götz M, Zach M. [Consensus guidelines for drug therapy of bronchial asthma in children and adolescents. Austrian Society of Pediatrics and Adolescent Medicine and Austrian Society for Lung Diseases and Tuberculosis]. Wien Klin Wochenschr 1999; 111:900-2. [PMID: 10599154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- T Frischer
- Universitäts-Kinderklinik, Wien, Osterreich
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Eber E, Zach MS. Diagnostic procedures in ventilator-dependent infants. Crit Care Med 1999; 27:2073-4. [PMID: 10507668 DOI: 10.1097/00003246-199909000-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gruber W, Eber E, Pfleger A, Modl M, Meister I, Weinhandl E, Zach MS. Serum eosinophil cationic protein and bronchial responsiveness in pediatric and adolescent asthma patients. Chest 1999; 116:301-5. [PMID: 10453855 DOI: 10.1378/chest.116.2.301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Serum eosinophil cationic protein (ECP) has been promoted as a marker of inflammatory activity in bronchial asthma. Bronchial responsiveness, measured either by inhaling pharmacologically active substances such as histamine or methacholine, or by applying physical stimuli such as the hyperventilation of cold dry air, is also considered to be an indirect marker of bronchial inflammation. OBJECTIVES In this study, we investigated the possible relationship between serum ECP and bronchial responsiveness to both cold dry air and histamine in presently symptom- and medication-free pediatric and adolescent asthma patients. SUBJECTS Thirty-six children and adolescents with atopic asthma were studied. METHODS On 2 consecutive days, bronchial responsiveness was assessed nonpharmacologically by cold dry air and pharmacologically by histamine in random order. Blood samples for determination of ECP were collected before each challenge. RESULTS Serum ECP levels correlated with neither cold dry air-induced changes in FEV1 nor the provocation concentrations of histamine causing a 20% fall in FEV1. Subjects with bronchial hyperresponsiveness to cold dry air and histamine had somewhat higher levels of serum ECP than subjects with normal responses, but these differences were insignificant. CONCLUSIONS Our results indicate a lack of relationship both between serum ECP and bronchial responsiveness to cold dry air and between serum ECP and bronchial responsiveness to histamine.
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Affiliation(s)
- W Gruber
- Pediatric Department, University of Graz, Austria
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Gruber W, Eber E, Mileder P, Modl M, Weinhandl E, Zach MS. Effect of specific immunotherapy with house dust mite extract on the bronchial responsiveness of paediatric asthma patients. Clin Exp Allergy 1999; 29:176-81. [PMID: 10051720 DOI: 10.1046/j.1365-2222.1999.00391.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Allergic asthma is common in children, and house dust mite (HDM) is an important source of perennial allergens. Bronchial hyperresponsiveness is a functional hallmark of asthma. Specific immunotherapy (SIT) with HDM extracts were shown to decrease symptoms, but its effect on bronchial responsiveness, as measured by non-pharmacological challenges, has not been evaluated. METHODS Twenty-six paediatric asthma patients allergic to HDM participated in this study. Fourteen patients received SIT with a HDM extract (Alavac, Bencard) for 2 years, and 12 served as controls. Bronchial responsiveness was assessed non-pharmacologically by cold dry air challenge (CACh) before and 3, 6, 12 and 24 months after SIT, and 12 months after termination of SIT. RESULTS After 24 months, the SIT group showed a statistically significant reduction of the mean CACh-induced changes of both forced expiratory volume in one second (-21.8+/-2.7% vs. -13.7+/-2.4%; P = 0.03) and maximal expiratory flow at 25% remaining vital capacity (-48.9+/-4.9% vs. -27.9+/-6.2%; P = 0.01). In contrast, no significant changes of bronchial responsiveness were observed in the control group. In the SIT group more patients lost their bronchial hyperresponsiveness than in the control group (6/14 vs. 1/12; P<0.05). One year after terminating SIT, the treatment group showed a tendency towards returning bronchial hyperresponsiveness. CONCLUSION These results demonstrate that during 2 years of SIT there was a reduction of bronchial hyperresponsiveness in HDM-allergic paediatric asthma patients.
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Affiliation(s)
- W Gruber
- Paediatric Department, University of Graz, Austria
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