[Aspects of mucociliary clearance in mucoviscidosis]. / Aspekte der mukoziliären Clearance bei Mukoviszidose.

Very often the respiratory tract of patients suffering from mucoviscidosis is infested with Pseudomonas aeruginosa which is accused of forming substances that inhibit ciliary motility. It is the aim of the present study to examine the influence of an acute and clinically relevant pseudomonas infestation on the ciliary beat frequency. The ciliary beat rate was determined in 25 mucoviscidosis patients, 13 of them were hospitalised because of acute bronchopulmonary infections. 12 of the patients did not show any clinical signs of an acute respiratory tract infection. In the group of the 13 hospitalised patients, 10 patients (77%) showed infestation of the respiratory tract with Pseudomonas aeruginosa, the mean ciliary beat frequency being markedly reduced at 8.2 +/- 1.7 Hz compared to that of a healthy group with 9.9 +/- 1.0 Hz. The 12 outpatients without clinical signs of acute respiratory tract infections did not show any reduction of the ciliary beat frequency (9.9 +/- 1.4 Hz). Basing on these results, determination of the ciliary beat frequency may possibly develop into an auxiliary criterion to decide on starting a Pseudomonas-active antibiotic therapy.

[Ciliary function in bronchopulmonary infections in childhood]. / Die Cilienfunktion bei bronchopulmonalen Infekten im Kindesalter.

It was the aim of this study to examine the influence of bacterial or viral infections of the airways on the ciliary beat rate in childhood. In 21 children with bacterial bronchopulmonary infections a mean ciliary beat rate of 9.1 +/- 2.4. Hz was found that did not differ significantly from that of the group of the healthy subjects (9.9 +/- 1 Hz). In 7 of the 21 patients we could identify an infection of the respiratory tract with Haemophilus influenzae; in those children there was a marked reduction of the mean ciliary beat rate at 8 Hz. 13 children with viral bronchopulmonary infections had a mean ciliary beat rate of 11.8 +/- 1.8 Hz, which is significantly enhanced when compared with that of the healthy group. Compared with the mean ciliary beat rate of bacterial infections of the respiratory tract there is a significant difference. In viral infections of the airways no value below 9 Hz was found. In case of markedly reduced ciliary beat rate a bacterial infection must be assumed.

[Effects of an optimized exercise therapy on physical performance of patients with cystic fibrosis]. / Effekte einer "optimierten" Bewegungstherapie auf die Leistungsfähigkeit bei Patienten mit Cystischer Fibrose.

Regular exercise training can increase the physical performance of patients with cystic fibrosis (CF). However, training is often hampered by negative factors such as infections, lack of time, etc. The aim of the present study was to investigate the effects of a 3-week-training-program performed under favourable conditions on physical performance and lung function of CF-patients: 17 patients daily trained at least 2,5 h under suspicious conditions at a sport hotel in Israel (Eilat). During the entire 3 weeks a comprehensive care was applied to the patients including intensive physical therapy and nutrition adapted to the individual demands. Testings of lung function and cycle ergometry ramp tests were performed a week before and after the training program. Additional control measurements were taken 7 months post training. After the 3-week-training vital capacity and FEV1 were increased by 7 % and 6 % (p > 0.05). The results of the cycle ergometry showed bigger and significant improvements in the maximal values of power (12 % - 20 %), oxygen uptake and ventilation. This findings were also valid for the submaximal exercise range indicated by a slower heart rate slope and a lower aerobic-anaerobic threshold. The present results suggest, that relatively large increases in physical performance can be obtained by short, but intensive exercise training including a comprehensive care.

[Effectiveness of Haemophilus influenzae B-diphtheria conjugate vaccination in German children]. / Untersuchung zur Effektivität der Haemophilus-influenzae-B-Diphtherie-Konjugatimpfung bei deutschen Kindern.

BACKGROUND: In 1990 the Haemophilus influenzae b-Diphtheria conjugate vaccine (Hib-D) was introduced in Germany. In addition, most children under 18 months of age failed to develop protective levels of Hib antibodies in response to systemic infections. METHODS: To evaluate the protective efficacy of the Hib-D vaccine in Germany a post marketing case-control study was performed during 1.5. 1990-30.4. 1992. Surveillance for invasive Hib-infections was maintained by pediatricians of 8 hospitals in the Rhein-Main area. The antibody responses to Hib were evaluated by ELISA at the onset (days 0-3) and during remission of disease. RESULTS: During the first year of the study 23 cases per 100,000 children of invasive Hib-infections were recorded. Of these children, 15 suffered from meningitis, 6 from epiglottitis and one from cellulitis and pericarditis respectively. None of these patients had been vaccinated except for one, who received two injections of Hib-D. Due to increased acceptance of the Hib-D vaccine we found a significant reduction of invasive Hib-infections (6 cases per 100,000 children) in the second year of the study. Again, of these children only one child was vaccinated. As expected, in all patients investigated the initial Hib antibody level was below 1 microgram/ml. The development of Hib specific immunity to invasive disease was clearly age dependent: 10 of 11 children below 18 months failed to produce any Hib antibodies (> 0.15 microgram/ml) in response to their infection. In contrast 8 of 10 children older than 18 months developed protective antibody levels to Hib. CONCLUSIONS: The incidence of serious Hib-disease has significantly decreased in Germany since the introduction of the Hib-D vaccine. Because no other Hib vaccine was licensed in Germany our data confirm efficacy and safety of Hib-D reported previously. In addition, children, who contracted disease before 18 months of age, remain susceptible to Hib and require active immunization for protection.