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Biomedical subjects

J Riedler

Publications and source records attributed to J Riedler.

53 records · Page 3Linked to original sources
PubMed1994

Hypertonic saline challenge in an epidemiologic survey of asthma in children.

To evaluate sensitivity and specificity of a 4.5% hypertonic saline challenge for a diagnosis of asthma, we studied 393 schoolchildren (13 to 15 yr of age) with "current wheeze," "former wheeze," and without history of wheeze in a community-based, cross-sectional survey. These children were selected from 2.836 schoolchildren in 26 schools in greater Melbourne, Australia who completed a self-administered questionnaire on respiratory symptoms, allergic rhinitis, and eczema. Three hundred eighty-two of 393 children successfully completed a 4.5% hypertonic saline challenge with increasing inhalation periods, and 365 of 393 performed a 6-min standardized, free running exercise challenge. The prevalence of bronchial hyperresponsiveness to hypertonic saline was 20.4%. Sensitivity and specificity for the hypertonic saline challenge to identify children with "current wheeze" were 47% and 92% respectively and for the exercise challenge, 46% and 88%. The agreement of response to hypertonic saline and to exercise was only moderate (kappa = 0.43). Factors associated with increased response to hypertonic saline in a multivariate logistic regression model were a history of "current wheeze," hay fever, response to the exercise challenge, female sex, and a lower baseline predicted FEV1. These results suggest that a 4.5% hypertonic saline challenge shows sensitivity and specificity similar to a standardized exercise challenge and pharmacologic challenges and a higher sensitivity than cold air hyperventilation and distilled water to identify asthma in children in a field study. Measurement of responsiveness to hypertonic saline may be of value as an objective marker of asthma to compare prevalence studies of bronchial hyperresponsiveness and of asthma over time and between countries.

Adolescent↗
PubMed1994

Effect of tidal volume on the output and particle size distribution of hypertonic saline from an ultrasonic nebulizer.

The purpose of the present study was to measure the output and particle size distribution of hypertonic saline from an ultrasonic nebulizer over the range of tidal volumes (VT) used in an epidemiological survey of asthma in children. A Starling pump was used to generate different VTs from 250 to 500 ml, at different respiratory rates of 12 and 20 breaths.min-1, to cover the normal range of respiratory pattern of children aged 7-14 yrs. The Starling pump was connected to a Timeter Compuneb Ultrasonic Nebulizer Model MP 500 with 24 cm of corrugated aerosol tubing, ID 2.2 cm, and a two-way non-rebreathing valve. Nebulizer output was measured by weighing the nebulizer chamber plus tubing and valve before and after each nebulization. To measure particle size distribution, a Malvern Particle Sizer M 3.0 (laser diffraction) was used, with a special adapter attached between valve and Starling pump. Nebulizer output increased linearly from 1.6 to 2.5 ml.min-1 for VT 250 to 500 ml, with little influence by the respiratory frequency. Furthermore, we found that in the range of VT = 300-500 ml the mass median aerodynamic diameter (MMAD) was 2.61 microns, with 100% of the particles less than 5 microns, whereas at VT = 150-250 ml the MMAD was 8.89 microns, with 90% larger than 5 microns. As output from this ultrasonic nebulizer correlates linearly with tidal volumes, size correction may not be necessary in hypertonic saline challenge tests in children. Above a VT of 300 ml, the MMAD is in the respirable range, with 100% of particles less than 5 microns.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Congenital anhidrotic ectodermal dysplasia in a female infant].

Fever of unknown origin, unability to sweat, hypotrichosis, absent eyebrows and thick everted lips were symptoms in a 3 month old female infant and raised the suspicion of anhidrotic ectodermal dysplasia. After several days of high fever and enteritis our patient presented with convulsions which could hardly be interrupted for a couple of days. Two months later brain scanning revealed serious brain damage. Finally the diagnosis of anhidrotic ectodermal dysplasia was confirmed by the unability to sweat by means of the quantitative pilocarpin iontophoresis test. Skin biopsy showed absence of the eccrine glands.

Biopsy↗
PubMed1992

Fibrosing alveolitis in an infant.

A three month old female infant presented with unproductive cough, diffuse bilateral fine crackles, tachypnoea and failure to thrive despite a four month therapy with beta 2-agonists and antibiotics. A chest radiograph showing bilateral periphilar infiltrates and a patchy infiltrate in the right upper lobe and lingula did not explain the physical examination with diffuse bilateral fine crackles. As the condition did not improve and arterial oxygen tension (PaO2) and oxygen saturation decreased during the following two months, an open lung biopsy was performed. The surgeon described the lungs as rubbery in consistency and histological findings showed patchy mild interstitial fibrosis and thickened alveolar septa. A therapy with prednisone daily was started and given over a period of four months, but did not show sufficient improvement. Only after addition of azathioprine was clinical improvement and normalization of blood gases noted.

Azathioprine↗
PubMed1991

[Comparison of the classical Gibson-Cooke methods and the chloride-sensitive electrode in sweat testing for diagnosis of cystic fibrosis].

In 43 children and adolescents (30 healthy and 13 CF patients) the Quantitative Pilocarpine Iontophoresis Test (QPIT) was compared with the ion-specific electrode. We found an excellent correlation between these two methods (r = 0.93) and no false positive or false negative results. With both procedures the total chloride-ion-concentration in sweat of healthy subjects and patients with CF differed significantly (p less than 0.001). Both, the original Gibson and Cooke-sweat-test (QPIT) and the assessment of chloride with the sensitive electrode are highly reliable procedures for confirming the diagnosis of CF.

Adolescent↗
PubMed1991

[Effectiveness and tolerance of aerosol disodium cromoglycate in children with bronchial asthma].

Thirteen centres studied the efficacy and safety of nebulized cromolyn solution in 53 asthmatic children (36 m., 17 f.; mean age 4.8 +/- 1.7 years). During a fiveweek treatment period a significant reduction of asthmatic symptoms was observed by investigators daily symptom scores, as assessed by the parents, also showed a significant improvement during treatment period. In addition, there was also a marked decrease in the use of other anti-asthmatic medication (beta 2-sympathomimetics, theophylline and antihistamines). There were no side effects of nebulized cromolyn solution treatment.

Aerosols↗
PubMed1991

[What do parents of patients with cystic fibrosis know about their children's disease? Assessment of knowledge using a questionnaire].

A standardized questionnaire was used to assess the knowledge about cystic fibrosis (CF) in 20 parents of our patients with CF. 15 questions about genetics, symptoms and treatment were asked, with each item scored as correct or incorrect. Parents correctly answered an average of 9.5 of the 15 questions. The knowledge test demonstrated good internal consistency (alpha = 0.77). An examination of separate knowledge domains indicated that parents were almost equally knowledged about treatment (M = 63% of the items correct) and symptoms (M = 62%) but less about genetics and reproduction (M = 53%). Internal consistency however amounted to alpha = 0.34 in treatment, alpha = 0.45 in symptoms and alpha = 0.67 in genetics. This study showed that knowledge of disease in parents of our CF-patients was generally good. However there were same deficits in the field of treatment.

Child↗
PubMed1991

[Relation between extent of bronchial reactivity and need for medication (therapy) in bronchial asthma in children].

In 42 schoolchildren we have prospectively examined the relationship between the degree of bronchial responsiveness to methacholine and the treatment to control asthma. Following a standardized protocol for methacholine provocations we determined the provocation concentration causing a fall in FEV1 of 20% (PC20). Patients were grouped into 1 (n = 13), those who required no medication; 2 (n = 8), those who required beta 2-agonists on demand and 3, those who required beta 2-agonists and additional DSCG or topic steroids. Mean PC20 in group 1 was 3.55 mg/ml, in group 2 1.38 mg/ml and in group 3 0.37 mg/ml. There was a significant difference between each group. Generally spoken, those patients showing a high level of bronchial responsiveness to methacholine required more medications to control their asthma symptoms. However, an overlap of responsiveness in each treatment group was noted. The results of the present study show that measurement of airway responsiveness may be useful in some patients to better assess the necessary treatment to control asthma.

Adolescent↗
PubMed1990

[Inhalation bronchodilators in infancy--comparative study between salbutamol and ipratropium bromide].

The effectiveness of bronchodilators in infancy still remains uncertain. The objective of the present study was, on the basis of clinical scores, to determine the effect of salbutamol and ipratropium bromide in the treatment of acute airways obstruction in infants. For this purpose, we investigated a total of 22 infants whose ages ranged between 1 and 12 months and who were randomized to three different treatment groups. Infants in group 1 were given 0.9% NaCl to inhale, those in group 2 received ipratropium bromide, and those in group 3 salbutamol. The response to treatment was assessed on the basis of a decrease in the clinical score. A statistically significant decrease in the score was found only for those infants given ipratropium to inhale. None of the infants in this group failed to respond to treatment. Ipratropium bromide proved to be more effective than salbutamol in the treatment of infants with acute airways obstruction.

Airway Obstruction↗
PubMed1990

[Tracheal compression caused by a foreign body in the esophagus].

A two-year-old girl presented with a four month history of chronic cough and recurrent lower respiratory tract infections. Reduction of appetite and especially refuse of solid food was accompanied with weight loss of 3 kg over a period of four months. Therapy with beta 2 adrenergic drugs, theophyllines and antibiotics proved ineffective. Both inspiratory and expiratory stridor were noted, prominently during eating. On the chest radiograph a coin shaped foreign body in the upper part of the esophagus was found, leading to a compression of the trachea.

Airway Obstruction↗
PubMed1989

[Genetic study in 8 families with a child with cystic fibrosis].

Cystic Fibrosis (CF) is the most common genetically determined disease in Caucasians. Major advances in our understanding of the genetics of cystic fibrosis have occurred during the past couple of years. The CF gene has been localized at 7 q31 by the use of linkage analysis with protein and DNA polymorphisms. DNA probes showing close linkage to the CF gene have been discovered and are being used to identify the gene itself and also for purposes of genetic diagnosis. We investigated 35 blood samples from members of 8 CF families with the probes J3.11/MspI, metH/TaqI, metH/MspI, metD/TaqI and 7 c22/EcoRI. In 8 out of 11 siblings of our CF patients we got full information about the carrier status. Since we investigated the siblings as well as the parents of our patients, these results may be of benefit for a later prenatal diagnosis.

Child↗
PubMed1988

[Cibalen poisoning in an infant].

A toxicological investigation of urine could finally explain abnormal neurological symptoms with apnea. 2 Cibalen-suppositories for children were given to an 7 week old infant as treatment of an upper respiratory infect. 12 hours were between the application of the 2 suppositories. 2 hours after the second application coma, hypertonus, opisthotonus, miosis and depression of ventilation were found. 10 hours later an apnea occurred. These symptoms were due to the synergistic effect of Phenobarbital, Aminophenazon and Codeinphosphat in an overhigh dose.

Aminopyrine↗
PubMedDate not supplied

[Secretory immunoglobulin A in childhood: does the saliva value reflect the bronchial value?].

Immunoglobulin A (IgA) can be found in different body secretions and plays a major role in the local immune response. It inhibits bacterial adherence, neutralizes toxins and protects the mucosa from penetrating antigens and allergens. Whereas measurement of IgA in saliva mostly does not show any problems, difficulties in assessing IgA in bronchial fluids often occur mainly due to variable dilutional effects. Aim of the present study was to find out whether saliva IgA predicts bronchial IgA. In 15 children aged 4 months to 14 years (mean 53.5 months; SEM 12.3) with chronic cough (n = 10), mediastinal mass (n = 1), recurrent airways obstructions (n = 2) and inspiratory stridor (n = 2) we performed a diagnostic rigid bronchoscopy and assessed IgA by means of bronchial lavage (BL). We attempted to control for uncertain dilution by the use of albumin as a denominator and to present our data as ratios of IgA to albumin. As various disease states alter the integrity of the alveolar-capillary membrane and influence the concentration of albumin in the epithelial lining fluid we developed an optical score to describe the state of the bronchial mucosa. Measurement of saliva IgA is easy and can be done without dilutional effects. The mean value of IgA in saliva was 65.49 mg/l (SEM 14.75; range 3.5-227), the one of IgA in bronchial lavage fluid 30.75 mg/l (SEM 7.11; range 3.5-100). IgA-albumin ratio ranged from 0.006 to 1.46 (mean 0.36, SEM 0.12). Saliva IgA did neither significantly correlate with bronchial IgA nor with bronchial IgA-albumin ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Pilot study of amiloride inhalation in children with cystic fibrosis].

Bronchial clearance is impaired in cystic fibrosis (CF). Respiratory secretions contain less sodium and chlorid, resulting in reduced airway water content. Aerosolized amiloride, a sodium transport blocker, was shown to normalize the amount of sodium in bronchial mucus, leading to an improvement in mucociliary clearance. In a controlled, double blind crossover study on nine CF children we tried to assess the efficacy of twice daily inhaled amiloride (10(-3)M) on sputum weight, consistency of sputum and lung function (FEF1, FVC, FEF50, FEF25, PEF). Each treatment period (amiloride versus 0.9% saline) lasted for two months. We could show that inhaled amiloride was able to increase mean sputum weight per day from 11.75 g (+/- 5.96) up to 18.5 g (+/- 10.34). This was equal to an increase of 57%. Some children felt that sputum expectoration lasted longer while using amiloride and that even for some hours after inhalation they expectorated a sputum-like fluid. We were able to detect, at least in some patients, that their sputum consisted of two parts, one showing more solid contents, the other more fluid-like contents. This was, however, not a consistent feature. No significant or clinical important differences were found for pulmonary function test data. There were no pulmonary or extra pulmonary side effects from treatment with amiloride. Further studies should be undertaken to assess the efficacy of longer lasting amiloride inhalation on the course of the disease in CF patients.

Administration, Inhalation↗
PubMedDate not supplied

[Is outdoor running exercise suitable for detecting bronchial hyperreactivity in children with mild episodic bronchial asthma?].

Bronchial hyperreactivity (BHR) can be proved by various methods. 21 children, 14 asthmatics and 7 healthy subjects were submitted to inhalative methacholine challenge as well as to 'free running' as a form of exercise challenge in a randomized sequence. For the methacholine inhalation a standardized procedure was followed and the provocative concentration defined (PC20) at which a decrease of more than 20% in FEV1 was found. There is no real standardisation for 'free running' (concerning temperature and humidity of the inspired air; individual level of exercise) but subjects had to run for 6 minutes while the heart rate should have been between 170 and 180 beats/minute. This increase in pulse rate relates to a submaximal work at which 60-85% of maximal O2 uptake are obtained. A decrease of 15% from basic value of FEV1 was defined as a positive result. By the use of methacholine inhalations we found 16 children (14 diseased, 2 controls) to be hyperreactive, whereas only 3 of them showed a positive result after 'free running'. We conclude, that firstly, methacholine provocations and exercise challenges assess different kinds of bronchial reactivity, secondly, 'free running' as a form of exercise is very difficult to standardize and therefore prone to errors and thirdly, 'free running' is not sensitive enough to assess BHR in children with mild asthma bronchiale if used as the only form of challenge. Problems concerning measurement of BHR are discussed.

Airway Resistance↗
PubMedDate not supplied

[Right-sided lung hypoplasia in a 13-year-old boy].

Initially a right sided pulmonary hypoplasia was diagnosed in our patient at the age of 9 years. The previous years were characterized by recurrent pneumonia, bronchitis and daily coughing fits. Findings of the chest radiograph suggested the diagnosis of right sided hypoplasia. The right hemithorax was small with mediastinal structures being pushed to the right and a clearly reduced blood flow on the same side. DSA of the arteria pulmonalis showed hypoplasia of the right arteria pulmonalis and confirmed our diagnosis. In addition to that an obstructive airway disease was assessed by measurement of lung function. Since the time when the diagnosis was found our patient has inhaled DSCG and beta 2-adrenergic drugs and no surgical treatment has been required as there have been no further episodes of pneumonia.

Adolescent↗