Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease.

BACKGROUND: Epidemiological studies have shown an association between gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid perfusion may cause bronchial constriction. However, no causative relation has been proven. AIM: To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD. METHODS: Thirty eight children (mean age 10.8 years, range 7.2-16.8; 29 males) with asthma and a reflux index > or =5.0 assessed by 24 hour oesophageal pH monitoring were randomised to 12 weeks of treatment with omeprazole 20 mg daily or placebo. The groups were similar in age, gender, mean reflux index, and asthma severity. Primary endpoints were asthma symptoms (daytime wheeze, symptoms at night, in the morning, and during exercise) and quality of life (PAQLQ). Secondary endpoints were changes in lung function and the use of short acting bronchodilators. At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression. RESULTS: The change in total symptom score did not differ significantly between the omeprazole and the placebo group, and decreased by 1.28 (95% CI -0.1 to 2.65) and 1.28 (95% CI -0.72 to 3.27) respectively. The PAQLQ score increased by 0.62 (95% CI 0.29 to 0.95) in the omeprazole group compared to 0.50 (95% CI 0.29 to 0.70) in the placebo group. Change in lung function and use of short acting bronchodilators were similar in the groups. The acid suppression was adequate (reflux index <5.0) under omeprazole treatment. CONCLUSION: Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD.

Successful thrombolysis by prolonged low-dose alteplase in catheter-directed infusion.

UNLABELLED: Catheter-directed thrombolysis is a sophisticated method in the treatment of thromboembolism with maximum effect on the thrombus and minimal systemic effect. The consequences are enhanced local thrombolysis and a reduction in general bleeding tendency, compared with systemic thrombolysis. At our institution, two children had successful thrombolysis by prolonged continuous catheter-directed low-dose alteplase. The first patient, a boy with Fontan physiology, was successfully treated for a massive pulmonary thromboembolism by catheter-directed very low-dose alteplase for five days. The second patient, who suffered from relapsing nephrotic syndrome, achieved satisfactory thrombolysis of an arterial leg thrombosis after four days of continuous catheter-directed low-dose alteplase. CONCLUSION: Although catheter-directed thrombolysis seems to be a valuable method in thrombolytic therapy, there is a lack of evidence-based recommendations concerning dosage, effect of bolus, simultaneous anticoagulation and duration of treatment for children.

[Metabolic diseases in newborn infants--diagnosis and treatment]. / Metabolske sykdommer hos nyfødte--diagnostikk og behandling.

Different symptoms and clinical signs of metabolic disease in the neonatal period are reviewed. Initial laboratory studies dealing with critically ill neonates are recommended. Different biochemical findings are commented and linked towards the most probable diseases. Finally, treatment in the acute phase of disease is presented.

[Metabolic errors in newborn infants--diagnosis and treatment]. / Metabolske sykdommer hos nyfødte--diagnostikk og behandling.

Different symptoms and clinical signs of metabolic disease in the neonatal period are reviewed. Initial laboratory studies dealing with critically ill neonates are recommended. Different biochemical findings are commented and linked towards the most probable diseases. Finally, treatment in the acute phase of disease is presented.

[Children and tuberculosis--diagnosis, treatment and follow-up]. / Barn og tuberkulose--diagnostikk, behandling og oppfølging.

BACKGROUND: Since the 1980s, there has been an increase in the incidence of tuberculosis (TB) world-wide. Mainly due to immigration, the number of new TB cases in the Norwegian child population is also increasing. In March 2000, a selected group of Norwegian paediatricians interested in infectious diseases held a meeting to discuss the clinical management of tuberculosis in children, and develop recommendations. MATERIAL AND METHODS: The recommendations are based on current British, European and American recommendations. Two recent Norwegian recommendations on the management of tuberculosis in the general population were also reviewed. RESULTS: Epidemiological data from Norway and the clinical characteristics of tuberculosis in children are briefly presented, followed by recommendations regarding diagnostic procedures, chemoprophylaxis, treatment of latent tuberculosis and disease. Local health services play a crucial role in the follow-up of children with tuberculosis, and the importance of co-operation between the hospital paediatrician and the primary health care service is emphasised. INTERPRETATION: Early diagnosis and adequate treatment of tuberculosis is necessary to reduce mortality and morbidity from tuberculosis. Clinical guidelines may aid in management.