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Exercise-induced asthma (EIA) is very common in children with asthma. For this reason they avoid every strenuous exercise because they fear a new asthma attack. Working capacity and maturation of motor performance can be insufficient as a consequence. We investigated whether a special training programme in an asthma sports group has positive effects not only on asthma, but also on working capacity and motor performance. 11 children with extrinsic asthma (4 girls, 7 boys), 8 to 14 years old, were studied before and after a 6-month out-patient rehabilitative sports therapy (sports group) with regard to their degree of bronchial hyperreactivity (BHR), frequency of EIA, cardiopulmonary capacity for exercise; knowledge about their asthma, level of coordination and condition, and their movement-related anxiety. There were 9 children with extrinsic asthma (2 girls, 7 boys), 8 to 15 years old, in a control group. They did not take part in any special training programme. After the sports therapy we found in 3 children of the sports group a decrease in BHR, EIA was now present in only 2 of formerly 4 children. Physical working capacity (PWC) at the aerobic/anaerobic threshold improved in the sports group by about 1 W/kg body weight (p = 0.008), efficiency of work from 23.7% to 27.9% (p = 0.009). We also found a remarkable improvement of motor abilities. Movement-related anxiety decreased in the sports group both in Indoor sports (p = 0.0089) and aquatics (p = 0.026). In the control group there was no significant change. Physical training in children with asthma has many positive effects on lung function and motor performance. We believe that the limit for an EIA release is shifted to a higher PWC. The reduction of the anxiety over sports at a higher level of PWC contributes to an improved quality of life for children with asthma.

The human herpesvirus-6 (HHV-6) causes exanthema subitum ("e.s."). "E.s." is characterized by fever, exanthem (rash), in many cases gastroenteritis, occasionally cerebral convulsions (but more frequently general cerebral irritability) and enlargement of all lymph nodes; usually there are mild catarrhal respiratory symptoms of the upper airways (ARD). So-called "complications" of an ARD (pneumonia, acute purulent otitis media, acute sinusitis) due to bacterial infections are very unusual as sequelae of a HHV-6 infection. Here we report the case of 2 small children (toddlers) suffering from bronchopneumonia or pneumonia and acute sinusitis maxillaris associated with an acute HHV-6 infection. It seems that HHV-6 (like other respiratory tract viral pathogens) also can lead to secondary bacterial infections of the lower respiratory tract. So far it is not known, why such complications are so rare, although the extreme granulocytopenia accompanying "e.s." suggests a transient disturbance of the antibacterial defence mechanisms.

Acute respiratory diseases (ARD) due to parvovirus B 19 infection can be observed relative frequently in children. In 21 children (infants, toddlers and school children) we have seen acute or prolonged obstructive bronchitis/bronchiolitis (15 infants), acute subglottic laryngitis (3 toddlers) and acute asthmatic attacks (3 children of school age) in connection with parvovirus B 19 infection. Other respiratory viruses (adeno-, influenza, parainfluenza and RS-virus) could be excluded as agents causing the ARD. We suggest that parvovirus B 19 can provoke ARD with obstructive ventilatory disturbances of the upper or lower airways in children with a specific endogenous predisposition (small or unstable bronchial walls, or bronchial or tracheal mucosal hyperreactivity).

Positive test results with relevance to the patients' history resp. illness' development were seen in all age groups of patients suffering from asthma. In cases with atopic dermatitis, but without asthma or bronchitis, positive test reactions were not relevant; in these cases hyperreagibility of the skin is supposed. The results confirmed that cutaneous testing is indicated in children suffering from asthma, even in those cases with associated atopic dermatitis provided that testing is carried out in lesion-free skin-area and beyond exacerbation of eczema. Test-results should be interpreted only with regard to the patients' history, clinical picture and its development.

Stenosis and malacia of the trachea wall can provoke chronic stridor and/or chronic bronchitis, but usually stenosis and malacia only exist separately. The finding of an infant born with atresia of the oesophagus and a lower tracheoesophageal fistula which was cured by surgery on the 1st day of life are discussed. During the following 8 months we observed persistent stridor, chronic cough and (4-times) relapsing episodes of respiratory insufficiency ("nearly-sudden-infant-death-syndrome"/NSIDS) due to gastrooesophageal reflux (GER with aspiration) and severe tracheomalacia combined with tracheostenosis and bacterial infections (Pseudomonas aeruginosa). The strategy of therapy for GER and for the tracheal abnormality are discussed.

Autogenic drainage, PEP mask breathing as well as physical exercise are now well established in the treatment of pulmonary disease in cystic fibrosis, but there are different opinions about oxygen therapy over a long period as well as corticosteroid treatment. First reports on amiloride inhalations seem to be hopeful, but there is no experience with cystic fibrosis children till now, therefore clinical use can not be recommended. Heart lung transplants are not to consider as an alternative treatment for all cystic fibrosis patients, in special cases it may be successful.

The Saccharin test is a non-dangerous, inexpensive, suitable and repeatable method for assessing the mucociliary function of the respiratory epithelium. A small quantity of Saccharin (R) is deposited on the inferior nasal concha; the chemical agent will be transported by the respiratory epithelium (kinocilia) from the nasopharynx to the oropharynx and can be tasted here as "sweet". The time interval between the deposition of Saccharin and the "sweet" taste is the "nasal mucociliary transport time (nmctt)"; data in minutes. In 381 children (age: 3-17 years) we found an average nmctt of 6.6 (+/- 4.8) min (healthy controls) and 8.8 (+/- 5.2) min resp. (CNSRD children). A nmctt longer than 30 min leads one to suspect disturbances of the mucociliary function, the aetiology of which can be analysed by mucosa biopsy and subsequent examination under the electron microscope. We hold the view that Saccharin test is an essential part of the diagnostic program for children suffering from CNSRD; after 3 tests the mucociliary function can be evaluated correctly. The test can be used both for diagnosing the aetiology of respiratory diseases and for the assessment of the efficiency of therapeutic and prophylactic measures.

Changes in PaO2 and parameters of acid-base-status during bronchological investigations were studied. 20 patients of both sexes with chronic nonspecific respiratory diseases have been investigated. The most important results were a respiratory acidosis after intubation and simultaneous hyperoxigenation during controlled (manual) ventilation. A respiratory acidosis with a small metabolic part was observed during extubation and change to normal respiration. In some cases acidosis was decomposated. These changes were found to be more extensive after bronchography than after bronchoscopy. Acidosis was normalized latest 60 minutes after extubation in all cases. The used method of bronchological examination has caused a favourable influence on the conditions of ventilation.

The aim of the study was the cytologic evaluation of both the analysis of nasal and bronchus smears compared with that of the bronchoalveolar lavage (BAL). 137 children (age: 4.8 years; 4 months - 17 years) with chronic nonspecific respiratory diseases (CNSRD) undergoing bronchologic examinations in general anesthesia were divided into 4 groups: relapsing bronchitis (n = 19), chronic bronchitis (n = 26), relapsing or chronic obstructive bronchitis (n = 81) and bronchial asthma (n = 11). Only the smear cytograms (nose, bronchus) enabled to detect allergic patients with bronchial asthma (p less than 0.001) in form of a significant eosinophilia. In contrast, BAL cytograms were too insensitive to detect eosinophilia. The BAL may be helpful in cases of interstitial lung diseases (sarcoidosis, alveolitis, lung fibrosis).

For 18 years we have analysed several parameters directly or indirectly involved in immunologic functions in 713 children (age: 0-14 years) suffering from CNSRD (frequently relapsing bronchitis, chronic bronchitis, frequently relapsing or chronic obstructive bronchitis, asthma bronchiale, cystic fibrosis). In all 6,067 data were evaluated. The estimation of the immunoglobulins (in serum and secretions) and the serum level of alpha-1-antitrypsin (alpha-1-AT) had the highest relevance for diagnosis and prognosis of CNSRD. Immunodeficiencies were detected in form of humoral antibody deficiency syndromes as well as local secretory IgA deficiency (MALT insufficiency). The results suggest that the MALT-insufficiency during early childhood is a high risk factor for the development of CNSRD, especially of obstructive lung diseases. In chronic bronchitis the mean levels of serum-IgA were significantly increased (p less than 0.001) and reactively increased serum mean levels of IgM and/or IgG were observed in some chronic bronchitis forms but not during the whole childhood. In homocygote and heterocygote defective alpha-1-AT types the prognosis of chronic lung disease (chronic obstructive bronchitis and/or bronchial asthma) was especially poor. Despite BCG vaccination in the neonatal period most children had negative tuberculin skin tests. This suggests that also the cellular immunofunctions may be depressed in children with CNSRD. Blood group, isoagglutinins, Zn and Fe serum levels had only limited importance for diagnosis and prognosis of the CNSRD. We recommend the estimation of these parameters in special cases only.

The transepithelial potential difference of the gastrointestinal mucosa as a diagnostic parameter obtains increasing importance in clinical medicine. Therefore it is necessary to consider methodical aspects of the tPD-measurement under in-vivo conditions. The current paper presents methodical considerations for instance electrode arrangement, positions, composition of the electrolyte electrodes, diffusion potentials, rate of perfusion and unstirred water layer and their influence on the tPD-measurement.

The dator on the care of children with CNSLD obtained from pediatricians working at out-patient departments in 15 districts of the Rostock and Neubrandenburg counties (in the north-eastern region of the GDR) are analyzed in a pilot study. This survey shows that there are 6 standard bronchitis dispensaries and on additional dispensary with highly specialized diagnostic equipment (Pediatric Clinic of the University of Greifswald) in 7 of the districts. In the remaining districts care of these children is provided within the framework of general medical outpatient care. 2% of the children having CNSLD only 36% receive medical treatment, which is a rather low percentage. This situation will be improved on the basis of better cooperation with the family doctors and the out-patient departments for lung diseases.

During 78 bronchological examinations in children of all age groups out of 6 centers of children bronchology of the GDR PaO2, PaCO2 and pH were registered, in a part of them additionally pulse, systolic and diastolic blood pressure. Following to the intubation--under ventilation with 100% oxygen or a halothane-NO2-oxygen mixture--there was a marked rise of PaO2, which normalized after extubation quickly. After extubation a slight hypoxemia occurred for a short period, a quick rise of PaCO2 and a slight acidosis, too. Besides, the hearth rate, systolic and diastolic blood pressure elevated following to the intubation and diminished after extubation.

Gastric and enteric cysts represent genuine duplications. With regard to their genesis opinions are divided. These duplications may perforate into the lung parenchyma and/or the bronchial system, giving rise to specific symptoms. The only possible therapy is complete extirpation. The intrapulmonary metastases are drained and aspirated and can be cured without loss of lung tissue. A report is given on a thoracic cystic gastric duplication with haemorrhagic inflammation of the mucous membrane associated with erosions in a 8-week old boy. Clinically, the duplication was reflected by poor general health, dyspnea and tachypnea. The perforation into the bronchial system caused respiratory insufficiency. Using antibiotic therapy, immune substitution and surgery in combination, the boy was cured. The morphological findings, causative embryological factors, and diagnostic possibilities and problems are discussed.

The transmural electric potential difference (PD) of the gastric mucosa was investigated in children, teen-agers, and adults. Acetylsalicylic acid, a well known barrier breaker, causes in adults a characteristic decrease of the gastric PD. This effect in teen-agers is considerably weaker than in adults, while in children there is no significant decrease of the potential difference after local acetylsalicylic acid application.

Primary bronchial tumors are a rarity in childhood. According to the WHO-classification of 1981 Bronchial Carcinoid tumors and Mucoepidermoid carcinoms are listed as the most frequent histological types of the malignoma group and will be not longer associated with attributed benign tumors. In the literature especially the prognostic important early diagnosis and the difficulty of histological differentiation ist emphasized. In this paper is described a 12-year old girl suffering from a bronchial tumor. Throughout the 3 months of disease the diagnosis had been establisted by endoscopy. Surgically the resection of right middle and lower lobe was necessary. 7 years after bilobectomia the patient is without trouble of problems. The classification of the tumor ist problematic within the frame of in the WHO-classification and was discussed.

In 338 children suffering from CNSRD were carried out firstly the 99mTc perfusions scintigraphy of the lung and secondly the bronchoscopy/bronchography. Finally the results were compared and a good correlation was found between both the methods. Therefore the perfusions scintigraphy of the lung can be recommended as a screening method in children with CNSRD. Only in case of pathologic findings by the lung scintigram the endoscopic exploration is earnestly indicated but in normal findings not usually.

Investigations were performed into school-certificates of 70 school-children suffering from CNSLD (controllgroup: 360 healthy children). Although the quantity of the days of the absence from school in the CNSLD-group is more than six times higher--most differences between the two groups were not significant, or the results of the sick children were even rather better than those of healthy ones. The eventual causes of this phenomenon are discussed (a good attitude in learning? a systematic promotion of this children at school and in the family? etc.).

The transepithelial electric potential difference (tPD) of the colonic mucosa was investigated in children in-vivo. The potential difference was measured by so-called "flowing"-electrodes. The current paper presents methodical considerations, for instance electrolyte concentration of the luminal electrode and position of the serosal electrode (reference-electrode), and their influence on the tPD-measurement.