Biomedical subjects
Publications and source records attributed to W Leupold.
Cough and wheezing are typical symptoms of asthma in childhood. But depending on age there are also other causes for the appearance of such complaints. A systematic approach to the differential diagnosis will clarify the situation in most of the patients.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The term sinobronchial syndrome is often used, but there is no generally accepted definition. Due to the functional and clinical unity of the whole respiratory tract infectious and allergic irritations lead to homogeneous reactions of the bronchi and the paranasal sinuses. On the other hand there are hints that a disease in one region can cause problems in the other or reinforce it. Probably bronchi and sinuses can also become infected simultaneously from the pharynx. In chronic cases sinusitis and bronchitis are often only symptoms masking an underlying disease that requires differentiated diagnostics and treatment, e.g. cystic fibrosis, primary ciliary dyskinesia, and immunological defects.
House-dust mite allergy (Dermatophagoides pteronissinus and Dermatophagoides farinae) is an important causative factor for allergic asthma or rhinitis in children. There is a clear relationship between the degree of allergen exposure and the subsequent development of asthma or the risk of sensitisation. It is therefore useful to know how intensive a patient is exposed to house-dust allergen. This can be managed either by counting all mites in the dust, by measuring of the content of Der p I and Der f I (major antigens of the two mites) per gram dust or using the Acarex test. These methods are also suitable for the control of sanitation measurements, e.g. avoidance of all dust sources in the bedroom and living-room, use of suitable materials for bedding, application of acaricide products and covering mattresses with polyurethane-coated materials.
Hymenoptera venom allergy is relatively rare in childhood. In 59 children, aged 2-16 years, with a systemic allergic reaction we could detect the following findings: There was no difference between males and females. Relatives of these children had more atopic diseases than normals. The degree of clinical manifestation was not so pronounced as in adults. RAST was more sensitive in detecting bee venom allergy whereas intradermal test showed a higher sensitive in wasp venom allergy. The diagnostic value of prick test was low without any obvious reason.
The management goals common to all age groups are to reduce symptoms, to permit a normal physically active lifestyle, and to prevent irreversible airway obstruction. Main measures are environmental manipulation (avoidance of allergen contact, cigarette smoke and pets; psychotherapeutic management), assessment of severity, training for self management, hyposensitization (pollen, HDM, insect venoms) and pharmacotherapy. Medication should be adapted to age and severity of the disease, and the different drugs should be used stepwise. The first step includes the application of bronchodilators in which beta-2-stimulants are to be preferred. If we use spacers or jet nebulizers infants can also be treated successfully. The value of xanthines is discussed controversially. The next steps tend to reduce the inflammatory reaction. In this direction sodium cromoglycate and ketotifen are useful especially in childhood, and inhaled steroids have increasing importance. The use of oral corticosteroids should be the last step.
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Theophylline concentrations in serum between 10 to 20 micrograms/ml cannot be obtained with usual dosage of theophylline in children with individual very short elimination half time of theophylline. Multiple corrections of dosage and repeated controls of theophylline concentrations in serum are necessary for empirical adjustment of individual optimal dosage. Pharmacokinetic investigations were made to shorten this management. 12 patients with bronchial asthma, 6 to 18 years of age, received 1.5 to 3 tablets of Aminophyllin under conditions of steady state. Blood samples were taken up to 6 hours after oral application. As a result of statistical analysis we found that the biological half time of theophylline could be determined from 2 to 3 blood samples. Estimation of optimal individual dosage is possible by simple mathematical pharmacokinetic formulas.
Despite some similarities and fluent changes of the clinical feature it is proposed to distinguish on principle between bronchiolitis, obstructive bronchitis and asthma. Main reasons for such a practice are: age-related peculiarities of the respiratory system, different aetiology and pathogenesis, variable therapeutic measures and a different prognosis.
Treatment of malignant diseases in children has become more an more aggressive during the last 15-20 years. In order to detect unwanted side-effects on the lung we investigated several parameters of lung function in 78 children with different malignancies. 1.5-15 years after termination of therapy, 43 patients (55.1%) showed a disturbed lung function. In 33.3% we found a restriction; 22 of 64 patients (34.9%) had a drop of PaO2 during exercise as an expression of disturbed diffusion. The number of patients with pathological pulmonary function raised with the intensity of irradiation of the lung. But also in 10 of 25 children who had only received a chemotherapy we could detect a disturbed lung function. Check-up at different times after completion of therapy (5, 8 and 11 years) revealed nearly the same percentage of patients without normal pulmonary function. Younger children (at the time of therapy) were more concerned (66.7%) than older ones (33.7%).
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.
The authors give a survey on the problems of sport activities in CF patients, which is based on own experience and the data of the literature. All these patients should take part in endurance sport. The regular training program should be carefully planned according to the state of each single patient. Regular medical supervision of it is necessary. Only in selected cases CF patients, too, can take part in marathon races.
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Parents of 100 paediatric patients hospitalized in the Gondar College of Medical Sciences were interviewed on their knowledge of and experience with indigenous medicine in the region. The result has provided an orienting review of methods used for common childhood disorders and attitudes towards traditional and modern medicine, resp. and some understanding of ideas of the rural population on the "etiology" of some diseases. Among the methods some are dangerous. Traditional medicine is the primary (and often the only) source of health care for major parts of the population in developing countries. Some knowledge of this system is also necessary for modern style medical staff working in such regions for a variety of reasons. Some of these aspects are discussed.
In the GDR are at present living more than 800 patients with cystic fibrosis, 113 of them are in the age of 18 years and over. The prognosis is in first place depending upon the state of the lung. Thus, a continuous observation of the lung function is mandatory. The alterations of the lung are starting in the small airways (inflammation with ulceration, stenoses, obliteration) with primary disturbances of the relation between ventilation and perfusion, and with obstructive disturbances of the ventilatory distribution. The periphery of the lung is considerably inflated (increase of RV/TLC, trapped air). With progressing disease, obstructions are also observed in the larger airways, and due to progressing loss of parenchyma, VC, FEV1, and TLC become reduced. In about one third of the patients bronchial hyperreactivity is developing. The efficacy of treatment with bronchodilating drugs is not uniform and must individually be checked. The physical performance is reduced in an extent which depends upon the severity of the disease.