Treatment of myasthenic patients with anabolic steroids

The authors report of their observations over 52 patients with severe and moderate myasthenia who after diverse forms of therapy (thymusectomy, x-ray therapy, prolonged use of anticholesterase preparations, etc.) did not demonstrate a stable therapeutical effectiveness. However, treatment by retabolil proved to be effective with minimal side effects. The paper contains theoretical prereqisites to therapy by anabolic hormones and the approximate scheme of its use.     

Response and decline of serum IgG antibodies to pertussis toxin, filamentous hemagglutinin and pertactin in children with pertussis

This case report concerns a 30-year-old man who survived a 4.2 g diltiazem overdose. He sustained vasoplegic shock with a junctional escape rhythm which required high doses of norepinephrine and epinephrine. Among other complications, ileus with paralytic intestinal pseudo-obstruction developed on day three. Cecal distention was demonstrated by abdomen computed tomodensitometry. The ileus resolved on day seven following the poisoning. Diltiazem plasma concentrations were determined during the first three days. The possible role of other medications, activated charcoal and sufentanil, is noted.     

The cellular immune response to Bordetella pertussis in two children with whooping cough

There is increasing evidence that the cellular immune response to Bordetella pertussis plays an important role in the immune protection. Particularly in animal models, Bordetella pertussis-specific T-cells have been shown to confer immunity. In this case report, we therefore investigated the cellular immune response to whole cell Bordetella pertussis bacteria, to the pertussis antigens filamentous hemagglutinin and pertussis toxoid defined by lymphoproliferation and cytokine secretion. Two children with whooping cough were compared to three individuals vaccinated against whooping cough with a whole cell pertussis vaccine. In contrast to the vaccinated controls, the cellular immune response to Bordetella pertussis in children with whooping cough was characterized by a strong proliferation of T cells to whole pertussis bacteria as well as to filamentous hemagglutinin and pertussis toxoid. This response was defined by a marked Th-1 type T cell response with IFN-gamma secretion to all Bordetella pertussis antigens. However, in the control individuals IFN-gamma was secreted only to whole cell Bordetella pertussis bacteria and filamentous hemagglutinin but not to pertussis toxoid. A Th-2 type cytokine response could not be detected in any condition. Our observations suggest that in the immune defense of a natural Bordetella pertussis infection, the Th-1 specific T cell response to filamentous hemagglutinin and particularly to pertussis toxoid may play a major role.     

Early use of inhaled steroids in children with asthma. Concluding comments

OBJECTIVE: To describe a rare case of right renal agenesia and left pelvic ectopy. To our knowledge, only 10 such cases have been reported in the world literature. METHODS: A 76-year-old male patient who consulted for irritative prostatic syndrome is described. Patient evaluation included IVP and CT. RESULTS: IVP revealed the absence of the right kidney in addition to an anomalous position of the left kidney. The foregoing findings were confirmed by CT. CONCLUSION: This uncommon congenital anomaly is essentially asymptomatic and is generally diagnosed in infants through its complications. In the case described herein, however, this anomaly had been incidentally detected during IVP and CT assessment of a 76-year-old patient who had consulted for irritative prostatic syndrome.     

Treatment of ureterohydronephrosis in children with kidney doubling

Long-term results of the surgery of 61 children with ureterohydronephrosis of one of doubling kidneys have been estimated. The authors believe that inter-pelvic and ureteropelvic anastomoses are most physiological in ureterohydronephrosis of doubling kidneys in children. In case of absence of vesicoureteral reflux there is no reason to remove the distal part of the ureter.     

Antibody and cell-mediated immune responses to booster immunization with a new acellular pertussis vaccine in school children

235 healthy 10-12 years old school children were randomly immunized with either a booster dose of diphtheria-tetanus-acellular pertussis (dTap) or diphtheria-tetanus (dT) vaccine. For this booster immunization designed for school children and adults, the quantities of Bordetella pertussis antigens in the dTap vaccine had been reduced to one third of those of the Infanrix vaccine (SmithKline Beecham) commonly used for infants. IgG antibodies and cell-mediated immune (CMI) responses to pertussis toxin (PT), pertactin (PRN) and filamentous hemagglutinin (FHA) were assessed by an enzyme immunosorbent assay and in vitro proliferation of peripheral blood mononuclear cells, respectively. Before immunization, 55%, 80% and 99% of children had detectable serum IgG antibodies to PT, PRN and FHA, whereas CMI response was found in 35%, 27% and 50% of children, respectively. After immunization, a 20-30-fold increase in geometric mean level (GML) of antibodies to the pertussis antigens occurred and CMI response to PT, PRN and FHA was seen in 88%, 94% and 100% of children, respectively. Adverse reactions following the immunization were rare. The results show that booster immunization with an acellular pertussis vaccine with reduced concentrations of antigens induces both antibody and CMI responses and support further studies of this pertussis vaccine in school children.     

Clinical efficacy of low-dose inhaled budesonide once or twice daily in children with mild asthma not previously treated with steroids

The aim of the present study was to examine the efficacy of low-dose inhaled budesonide (BUD) administered via Turbuhaler once or twice daily on symptoms, lung function and bronchial hyperreactivity in children with mild asthma. One hundred and sixty-three children (mean age 9.9 yrs, 56 females/107 males) with mild asthma (forced expiratory volume in one second (FEV1) 103% of predicted, morning peak expiratory flow (PEF) 87% pred, reversibility in FEV1 3%, fall in FEV1 after exercise 10.4% from pre-exercise value) and not previously treated with inhaled steroids, were included in a double-blind, randomized, parallel-group study. After a two-week run-in period, the children received inhaled BUD 100 microg or 200 microg once daily in the morning, 100 microg twice daily or placebo for 12 weeks. Exercise and methacholine challenges were performed before and at the end of treatment. After 12 weeks of therapy, the fall in FEV1 after an exercise test was significantly less in all three BUD groups (43-5.1%) than in the placebo group (8.6%). Bronchial hyperreactivity to methacholine with the provocative dose causing a 20% fall in FEV1 decreased significantly in the BUD 100 microg twice-daily group compared with placebo (ratio at the end of treatment 156%). Changes in baseline lung function (FEV1 and PEF) were less marked than changes in bronchial responsiveness. In conclusion, low doses of inhaled budesonide, given once or twice daily, provided protection against exercise-induced bronchoconstriction in children with mild asthma and near normal lung function.     

Effect of topical steroids on nasal nitric oxide production in children with perennial allergic rhinitis: a pilot study

It has been hypothesized that concentrations of exhaled nitric oxide (NO) may be related to the extent of cytokine-mediated airway inflammation. Recent findings indicate the nasal airways as an important site of NO production. Our objective was to evaluate whether children with allergic rhinitis show different nasal NO levels when compared with normal healthy subjects and the effect of topical steroids and anti-histamine therapy. We have measured the concentration of NO drawn from the nose of 21 children (5-17 years old) affected by perennial allergic rhinitis (house dust mite) out of therapy for at least 3 weeks. Thirteen children were then treated with nasal beclomethasone dipropionate (BDP) (400 micrograms daily) and eight subjects with nasal anti-histamine levocabastine (200 micrograms daily). Measurements were performed before and after 10 days of treatment. As a control group we evaluated 21 healthy children aged 5-15 years. To measure NO we used a chemiluminescence analyser. Before treatment the whole group of children with allergic rhinitis showed a mean (+/- SEM) nasal NO concentration of 267 +/- 18 ppb, significantly higher (P < 0.01) than the control group (186 +/- 15 ppb). The group of children treated with BDP showed, after 10 days of therapy, a significant (P < 0.05) decrease of nasal NO concentration (271 +/- 21 ppb vs. 212 +/- 20 ppb). Indeed, in the group treated with levocabastine, nasal NO concentrations did not present a significant difference (P not significant) compared with baseline (261 +/- 33 ppb and 252 +/- 31 ppb, respectively). These data suggest that (1) children with allergic rhinitis have higher levels of nasal NO than non-atopic controls and (2) intranasal steroid therapy significantly reduces nasal NO production in children with allergic rhinitis. We speculate that the allergic inflammatory response may influence the nasal NO levels and that NO measurements may be a useful marker of nasal inflammation.     

Treatment of closed femoral diaphyseal fractures with external fixators in children

From August 1992 to July 1996, 57 patients with closed femoral fractures were treated by external fixator in the Orthopaedic and Traumatology Clinics, School of Medicine, Dicle University. The technique was applied to children with closed femoral fractures. Their mean age was 6 (range 4-12) years old. The mean hospitalisation period was 8 (range 5-15) days. Fixators were removed on an average of 55 (range 38-79) days. The mean follow-up period was 18 (range 9-36) months. Pintract infection was observed in 3 and refracture in 1 patient. Infection was controlled with oral antibiotics and local dressing. An external fixator was applied to a patient in whom refracture developed. No patient had malunion, nonunion, or leg length discrepancy. We propose that external fixation in closed femoral shaft fractures of children could be a rational alternative mode of therapy, since it has some advantages and can be easily removed without undergoing a second round of anaesthesia.     

Treatment of intestinal paresis in children

In the paper, a clinical experience with treatment of intestinal paresis in 545 children, aged from 1 day to 13 years, including 225 children operated upon for peritonitis is summarized. The authors differentiate 3 stages in the development of intestinal paresis depending on the degree of intensity of systemic and local disturbances. The employed methods of treatment in intestinal paresis were classified by the principle of their effect as 3 groups. Application of some or other method of the paresis therapy is determined by the stage of its development. In treatment of postoperative intestinal paresis a continuous peridural blockade is considered to be the method of choice. Utilization of the latter enabled the authors to reveal a number of postoperative complications: mechanic intestinal obstruction, incompetent anastomosis, etc.     

Treatment of sleep disorders in children

Sleep disorders require careful evaluation, precise diagnosis and a systematic search for a cause before considering treatment. Hypnotics must never be prescribed directly and when necessary it must be used precautionally during a short period of time, as little is known on their long term effects in children. In addition some psychotropic drugs may lead to tolerance and addiction. Educational and behavioural therapy together with sleep hygiene, have proven to be efficient in most situations. Awaking stimulants are indicated in primary hypersomnia.     

Treatment results for rhabdomyosarcoma in children

The results of treatment in 45 children with rhabdomyosarcoma was presented. Two-years survival was achieved in 63% and five-year in 45%. The importance of location and group of clinical progression discussed was importance prognostic factors in rhabdomyosarcoma.