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A 5-month-old male presented with fever, hepatosplenomegaly, leukocytosis with atypical lymphoblasts, anemia and thrombocytopenia. Severe combined imunodeficiency syndrome (T−, B+, NK+), B lymphoproliferative disease and hemophagocytic lymphohistiocytosis triggered by Epstein–Barr virus (EBV) were diagnosed. As his clinical situation deteriorated rapidly, BMT was performed with unmanipulated marrow stem cells from his EBV-positive HLA-identical sister after conditioning with dexamethasone (1.75 mg/kg/day), cyclophosphamide (114 mg/kg) and etoposide (10 mg/kg), with no immunosuppression given post transplant. Engraftment occurred on day 6 with explosive proliferation of donor CD8+ T cells. The patient died 3 days later from acute respiratory distress syndrome. Autopsy revealed full donor engraftment and no signs of hemophagocytic lymphohistiocytosis or B lymphoproliferative disease. Thus, transplanted T cells can expand very rapidly within days after BMT and clear EBV lymphoproliferative disease and hemophagocytic lymphohistiocytosis. Bone Marrow Transplantation (2002) 29, 519–521. doi:10.1038/sj.bmt.1703396

Long segment malacia of the trachea or main stem bronchi in children is not always suitable for surgical correction; patients may therefore remain ventilator-dependent and/or experience severe obstructive crises. We treated 7 children (ages, 4 months to 9 years) with extreme structural central airway obstruction with stent implantations. Six were mechanically ventilated; 5 had frequent life-threatening obstructive spells requiring deep sedation or paralysis. Diagnoses were: syndrome-associated tracheobronchomalacia (n = 4), malignancy infiltrating the carina (n = 1), congenital tracheal stenosis (n = 1), and tracheobronchial compression by a malpositioned aorta (n = 1). Six tracheal and 13 bronchial stents were endoscopically placed. The prostheses included mesh titan (n = 5), the newer shape memory material nitinol (n = 13), and 1 Y-shaped carina stent. Follow-up was reported for 7 weeks to 72 months. All patients showed marked improvement of their respiratory obstruction. Six children were weaned at least temporarily from ventilation. No significant bleeding, stenosis, or perforation was observed. Seven stents were changed after up to 14 months. Three children are well and at home. In 2 children airway stabilization was successful, but they later died from causes unrelated to stent placement, and 2 children died due to generalized airway disease. Soft metal mesh airway stents can offer a therapeutic option in life-threatening inoperable obstruction of the trachea and main stem bronchi in children.

Der akute Asthmaanfall ist als rasches (min bis Stunden) Auftreten von neuen (bzw. Verschlechterung von vorbestehenden) obstruktiven Atemwegssymptomen definiert. Ein Anfall wird als Status asthmaticus bezeichnet, wenn trotz in Dosis- und Applika-tionsform adaquaten β-Mimetika-lnhalationen keine Besserung bzw. eine weitere Verschlechterung eintritt.

Ethnic origin has been reported to affect the prevalence of atopic diseases in several studies in different parts of the world. However, little is known about the prevalence of asthma and atopy in immigrants living in Europe. The objective of this study was to evaluate the prevalence of asthma and atopy in Turkish children living in Germany and to investigate the role of ethnic origin on the development of asthma and atopy in this population. In a cross-sectional survey the prevalence of physician-diagnosed asthma, atopy, skin-prick tests and bronchial hyperresponsiveness (BHR) to cold dry air challenge was assessed in 7,445 school children aged 9-11 yrs, living in Munich, south Germany. Questionnaires were distributed to the parents for self-completion and children underwent skin prick tests and cold air hyperventilation challenge. The Turkish children showed a significantly lower prevalence of asthma (5.3 versus 9.4%, p

BACKGROUND—Relatively little is known about risk factors for the persistence of asthma and respiratory symptoms from childhood into adolescence, and few studies have included objective measurements to assess outcomes and exposure. METHODS—From a large cross sectional study of all 4th grade school children in Munich (mean age 10.2 years), 234 children (5%) with active asthma were identified. Of these, 155 (66%) were reinvestigated with lung function measurements and bronchial provocation three years later (mean age 13.5years). RESULTS—At follow up 35.5% still had active asthma. Risk factors for persisting asthma symptoms in adolescence were more severe asthma (OR 4.94; CI 1.65 to 14.76; p = 0.004) or allergic triggers (OR 3.54; CI 1.41 to 8.92; p = 0.007) in childhood. Dampness was associated with increased night time wheeze and shortness of breath but not with persisting asthma. Risk factors for bronchial hyperreactivity in adolescence were bronchial hyperreactivity in childhood (p= 0.004), symptoms triggered by allergen exposure (OR 5.47; CI 1.91 to 25.20; p = 0.029), and damp housing conditions (OR 16.14; CI 3.53 to 73.73; p

Dieses Kapitel gibt kurz und knapp einen Uberblick uber die chirurgische und traumabedingte Intensivtherapie. Zunachst werden die pra-, peri- und postoperative Intensivtherapie diskutiert. Anschliesend wird auf die Besonderheiten von Elektrounfallen hingewiesen, bevor abschliesend Polytrauma und einzelne Organtrauma – Schadel-Hirn-Trauma, Abdominal-, Wirbelsaulentrauma, stammnahe und Extremitatenfrakturen – beschrieben werden.

Dieses Kapitel gibt kurz und knapp einen Uberblick uber Vergiftungen im Kindesalter, Osophagusveratzungen und allergische Reaktionen inkl. Anaphylaxie.

Externe Uberhitzung und Anstrengung. Nichts oder nur salzarme Flussigkeit getrunken? Im Sommer im geschlossenen Auto zuruckgelassener Saugling!

Hyperglykamie (meist BZ > 300 mg/dl) mit Ketose (Ketonkorper im Serum/Urin), pH < 7,3 und Bicarbonat < 15 mmol/1.

Om specialet Et af de væsentligste aspekter ved miljøpolitikken siden "Rio-Konferencen" i 1992 er, at diskussionen om ansvaret for bl.a. forvaltning af biologisk mangfoldighed er blevet institutionaliseret i statslige og mellemstatslige organisationer. Denne institutionalisering er efter min overbevisning meget central, fordi den fremover vil sætte rammerne for de politikker og diskurser, der vil dominere reguleringen og forvaltningen af den biologiske mangfoldighed. Dette speciale er et forsøg på at fortolke den strategiske betydning af de diskurser eller magtrationaliteter, der udspringer af implementeringen af "Konventionen om Biologisk Mangfoldighed". Det teoretiske udgangspunkt for specialet er Foucaults diskursfortolkning og målet med specialets fortolkninger er at gennemføre en konkret Foucault-inspireret casefortolkining af biodiversite.tsbevaringens implementering. Valget af Foucaults diskursfortolkning er inspireret ud fra et ønske om at undersøge, hvor langt det er muligt at komme ved en mere kritisk og postmodernistisk tilgang til forståelsen af naturforvaltningen, frem for den planlægningsoptimistiske tilgang, der efter min mening dominerer megen naturbeskyttelsesforskning.

We assessed the prevalence of asthma and allergic disorders in 9-11 year old children in Leipzig and Halle in East Germany, and Munich, West Germany. Both East German cities were heavily polluted due to private coal burning and industrial emissions, whereas Munich has moderate industry but heavy car traffic. All fourth grade pupils in Munich (n = 7445) were compared with those in Leipzig, 1990 (n = 1429) and Leipzig and Halle, 1991 (n = 3105). The prevalence of hay fever and skin test reactivity to common aeroallergens was considerably higher in West Germany as compared to East Germany. Furthermore, the prevalence of asthma was also higher in the West German study area. However, when atopy was taken into account, there was no longer a significant difference in the prevalence of asthma between the two parts of the country.

Objective: To investigate the relation between different types of heating and the prevalence of atopic diseases, skin test reactivity, and bronchial hyperresponsiveness. Design: Cross sectional survey among schoolchildren aged 9-11 years. Skin prick tests, pulmonary function tests, and bronchial challenge in the children and self completion of a written questionnaire by the children9s parents. Subjects: 1958 children in a rural area in southern Bavaria, Germany. Main outcome measures: Prevalence of asthma, hay fever, and atopic dermatitis as determined by parents9 answers to a questionnaire; the atopic status of the child assessed by skin prick tests; and bronchial responsiveness to cold air challenge in the children. Results: After possible confounders were controlled for, the risk of developing hay fever (odds ratio=0.57; 95% confidence interval 0.34 to 0.98), atopy defined as at least one positive reaction to a panel of common aeroallergens (0.67; 0.49 to 0.93), sensitisation to pollen (0.60; 0.41 to 0.87), and of bronchial hyperresponsiveness (0.55;0.34-0.90) was significantly lower in children living in homes where coal or wood was used for heating than in children living in homes with other heating systems. Conclusions: Factors directly or indirectly related to the heating systems used in rural Bavarian homes decrease the susceptibility of children to becoming atopic and to developing bronchial hyperresponsiveness. Key messages This study shows that in a rural population children of families using wood or coal for heating and cooking had a significant lower prevalence of hay fever, atopy, and bronchial hyperresponsiveness than children living in homes with other heating systems Factors directly related to home wood or coal combustion may explain these findings Alternatively, using coal and wood burning stoves indoors may be related to a more traditional life style with unknown protective factors that have been lost in families using other sources of energy such as gas, oil, or a central heating system

The objective of this study was to compare psychosocial characteristics of children with asthma and children with bronchial hyperreactivity with those of normal children. A population-based study of 2634 children (mean age, 10 years) was carried out. Pulmonary function tests of children were performed in children before and after cold air hyperventilation challenge to determine bronchial hyperreactivity. Parental assessment of children's behavior was evaluated with 15 questions about school/learning habits, level of activity, communication/affection, and sleeping patterns. A factor analysis was performed and the factor loading adjusted for confounders compared in the different groups. Asthmatic children sleep less well than normal and hyperreactive children (p < 0.001). Unexpectedly, however, all other single items did not differ significantly. As a result of the factorial analysis we obtained two factors. On the first factor, measuring school behavior and learning, there was a small difference between asthmatic and normal children, which could not be found on the second factor indicating activity and communication. We conclude that psychosocial differences of asthmatic children are less remarkable than expected. As a result of the examination of the hyperreactive children it is likely that asthmatic children are influenced more by secondary psychosocial factors than by any primary effect of asthmatic disease.

In a random sample of children (aged 9-11 years; n = 5629), who were studied according to the ISAAC phase II protocol, heterozygosity of the alpha1 antitrypsin (alpha1-AT) Pi genotypes MS or MZ, or low alpha1-AT plasma levels, were not associated with an increased risk of developing asthma. Asthmatics with low levels of alpha1-AT were particularly prone to develop airway hyperresponsiveness and reduced lung function.

The German reunification offers a unique opportunity to study the impact of environmental factors on the development of childhood respiratory and allergic disorders in ethnically similar populations. We investigated the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness (BHR) in 9- to 11-year old children in West Germany (n = 5,030) and East Germany (n = 2,623). A self-administered questionnaire was distributed to the parents. Children underwent cold air challenge and allergy skin prick tests. Atopic sensitization was considerably more frequent in West German children than in their peers in East Germany (36.7% versus 18.2%; odds ratio [OR] = 2.6, p < 0.0001). The prevalence of current asthma and hay fever was significantly higher in West Germany when compared with that in East Germany (5.9% versus 3.9%; OR = 1.5, p < 0.0001 and 8.6% versus 2.7%; OR = 3.4, p < 0.0001, respectively). Bronchitis, however, was more prevalent in East Germany than in the western part of the country. The prevalence of BHR as assessed by cold air challenge was higher in West Germany compared with that in East Germany (8.3% versus 5.5%, OR = 1.6, p < 0.001). Logistic regression showed that the West German study area was no longer a significant independent determinant of asthma once sensitization to mites, cats, and pollen was taken into account. We conclude that sensitization to aeroallergens is strikingly more frequent in West Germany than in East Germany and this may explain the differences in the prevalence of asthma and hay fever between the two parts of the country.

OBJECTIVES--To examine whether road traffic in a big city has a direct effect on pulmonary function and respiratory symptoms in children. DESIGN--Cross sectional study. SETTING--Of all 7445 fourth grade children (aged 9-11 years) in Munich, 6537 were examined. Of the children with German nationality and the same residence during the past five years and known exposure data, 4678 questionnaires and 4320 pulmonary function tests could be analysed. MAIN OUTCOME MEASURES--Variables of pulmonary function by forced expiration and respiratory symptoms reported in a questionnaire; census data on car traffic collected in the school district. RESULTS--Density of car traffic ranged from 7000 to 125,000 cars per 24 hours. Multiple regression analysis of peak expiratory flow showed a significant decrease of 0.71% (95% confidence interval 1.08% to 0.33%) per increase of 25,000 cars daily passing through the school district on the main road. Maximum expiratory flow when 25% vital capacity had been expired was decreased by 0.68% (1.11% to 0.25%). In contrast, response to cold air challenge was not increased. The adjusted odds ratio for the cumulative prevalence of recurrent wheezing with the same exposure was 1.08 (1.01 to 1.16). Cumulative prevalence of recurrent dyspnoea was increased, with an odds ratio of 1.10 (1.00 to 1.20). Lifetime prevalence of asthma (odds ratio 1.04; 0.89 to 1.21) and recurrent bronchitis (1.05; 0.98 to 1.12) were not significantly increased. CONCLUSIONS--High rates of road traffic diminish forced expiratory flow and increase respiratory symptoms in children.

Information on long-term respiratory symptoms in prematurely born children is scanty. We studied an unselected population of 9- to 11-year-old schoolchildren. A self-administered questionnaire was distributed to the parents. Children underwent lung function testing, cold air challenge, and skin prick tests. A gestational age37 weeks in children with a birth weightor = 2500 gm was reported by 5% of the parents. Premature girls had significantly more current asthma (odds ratio (OR) 2.6; 95% confidence interval (CI) 1.4, 4.7; p0.05), recurrent wheezing (OR 1.7; 95% CI 1.1, 2.7; p0.001), recurrent shortness of breath (OR 2.4; 95% CI 1.5, 3.9; p0.001), and frequent cough with exercise (OR 1.8; 95% CI 1.1, 2.9; p0.05) than term girls, especially if they required mechanical ventilation after birth. No such differences could be shown in boys. More prematurely born children who required mechanical ventilation (OR 3.7; 95% CI 2.2, 6.4; p0.0001) had a family history of asthma than children born at term. Significant decrements could be demonstrated for different measurements of lung function in premature girls. These results remained significant after control for confounders in a multivariate regression analysis. No difference was found between groups for bronchial hyperresponsiveness to cold, dry air or for atopic sensitization. We conclude that a family history of asthma may predispose premature children to more severe respiratory disease. Respiratory symptoms and decrements in lung function seen in girls may reflect abnormalities of lung function in survivors of severe neonatal respiratory disease.

The measurement of bronchial hyperreactivity (BHR) may give additional information to questionnaire-based studies of asthma prevalence. It is desirable to have a provocation method with high specificity that avoids the use of pharmacologic provocations in large numbers of healthy children. It was the aim of this study to establish a range of values for responsiveness to cold-air challenge in normal children, to describe its specificity and sensitivity for a diagnosis of asthma in a large unselected sample of schoolchildren in a field study, and to measure factors associated with hyperresponsiveness. All fourth-grade schoolchildren (9 to 11 yr of age) in Munich and several southern Bavarian communities (n = 9,403) were surveyed with a questionnaire (response rate, 87%), baseline lung function, and cold-air hyperventilation challenge (n = 5,697). A diagnosis of asthma was reported in 7.9% of children. In the reference group, the ninety-fifth percentile (%ile) for the change of FEV1 (DFEV1) was -9.0%; the 90%ile was -7.3%. Asymptomatic children fulfilling all criteria for the reference group showed a significantly increased reactivity if they had a family history of asthma (p = 0.038). With a cutoff for DFEV1 of -9.0% or -7.3% the respective sensitivities to "detect" a diagnosis of asthma were 21.6 and 30.7%, and for asthma with symptoms during the previous 12 months it was 26.2 and 35.1%. Reactivity to cold air increased with the number of episodes of asthma in the previous 12 months. In a multiple linear regression model, factors associated with increased reactivity to cold air were diagnosed asthma, hay fever, male sex, younger age, and a positive skin test.(ABSTRACT TRUNCATED AT 250 WORDS)

The importance of the viscoelastic properties of the tissues of the respiratory system has recently been recognized, and lung models have been produced to describe the resistive and viscoelastic properties of the lung. The pulmonary mechanics of 10 rabbits were studied using the interrupter technique to assess the effect of volume history on the resistive and viscoelastic elements of the respiratory system. The influence of the tone of the muscles of respiration was also studied. In healthy lungs, the resistive and viscoelastic elements of the lung are dependent on the volume history of the respiratory system and are significantly lower if these elements do not reach a resting position before expiration. The chest wall made a significant contribution to the resistive and viscoelastic elements of the respiratory system, which was also dependent on the lung volume history. The tone of the muscles of respiration had no effect on the resistive or viscoelastic elements of the respiratory system.

BackgroundInterstitial lung diseases (ILD) are chronic inflammatory disorders leading to pulmonary fibrosis. Monocyte chemotactic protein 1 (MCP-1) promotes collagen synthesis and deletion of the MCP-1 receptor CCR2 protects from pulmonary fibrosis in ILD mouse models. We hypothesized that pulmonary MCP-1 and CCR2+T cells accumulate in pediatric ILD and are related to disease severity.MethodsBronchoalveolar lavage fluid was obtained from 25 children with ILD and 10 healthy children. Levels of pulmonary MCP-1 and Th1/Th2-associated cytokines were quantified at the protein and the mRNA levels. Pulmonary CCR2+, CCR4+, CCR3+, CCR5+and CXCR3+T cells were quantified by flow-cytometry.ResultsCCR2+T cells and MCP-1 levels were significantly elevated in children with ILD and correlated with forced vital capacity, total lung capacity and ILD disease severity scores. Children with lung fibrosis had significantly higher MCP-1 levels and CCR2+T cells in bronchoalveolar lavage fluid compared to non-fibrotic children.ConclusionThe results indicate that pulmonary CCR2+T cells and MCP-1 contribute to the pathogenesis of pediatric ILD and might provide a novel target for therapeutic strategies.

The different ventilatory pattern of HFOV and conventional ventilation (IPPV) may differently affect cerebral hemodynamics in neonates. Using color Doppler sonography we measured left ventricular output (LVO), the mean blood flow velocity (BFV,cm/s) in the median cerebral artery (MCA) and in the great cerebral vein (GCV) in 10 critically ill neonates [GA 27 (25-37) wks, weight 980 530-2500) g, age a (1-36) d] during IPPV and 3 (2-18) h after initiating HFOV (Infant Star). Indication for HFOV: Air leak (n = 8), failure of IPPV (n = 2). RESULTS: Data are medain and range. MAP = mean airway pressure (mmHg) OI = oxygenation index (OI = FiO2 × MAP × 100 / paO2). * = p < 0.05. During IPPV, LVO was low and MCA-BFV normal compared to data of 54 stable ventilated (IPPV) preterm neonates [GA 28(23-35)wks; LVO: 248(212-316), mean MCA-BFV: 10(5-28)]. During HFOV the blood flow in the MCA was oscillating synchroneously with the oscillations of the ventilator and arterial cerebral BFV was increased in all infants (increased pCO2) compared to IPPV. Venous cerebral BFV however was decreased (up to 45%), possibly due to the increased PEEP during HFOV. CONCLUSION: HFOV affects cerebral hemodynamics and may cause cerebral congestion in neonates at risk of intracranial hemorrhage.

There is evidence that morbidity and mortality from asthma as well as the prevalence of allergic diseases is increasing. As data were missing in Germany, we studied in a crossectional design 9 403 schoolchildren (age 9-11 years) in an urban and rural area of Bavaria using a questionnaire, skin prick tests and pulmonary function tests before and after cold air challenge. The responserates were: 87% for questionnaires, 77% for allergy or pulmonary function tests. Evaluation of the questionnaires gave the following prevalences: 18,1% allergic rhinitis, 19,7% atopic dermatitis, 2,5% asthma and 5,5% recurrent wheezy bronchitis. Beyond this 8,3% had recurrent wheezing and 3,4% chronic cough by night or exercise without any diagnose of asthma or wheezy bronchitis. 42 % of all german children are atopic, ie exhibit at least one positive prick test reaction for the six aeroallergens tested. Bronchial hyperreactivity was found in 9% of german children. Atopic diseases and asthma are more frequent in the urban than the rural area. In summary there is an important underdiagnosis of asthma in this pediatric population.