[Increase in prevalence of childhood asthma in Budapest in relation to the air pollution data and the total pollen count]. / A gyermekkori asthma bronchiale prevalenciájának növekedése Budapesten, összefüggésben a légszennyezettségi adatokkal és a pollenszámmal.

The authors surveyed the prevalence of bronchial asthma in childhood in Budapest in 1995 and in February 1999, via questionnaires directed to paediatricians. In 1995, replies were received from 118 paediatricians in 11 districts, who were responsible for the supervision of 104,087 children, of these, 1.88 +/- 0.87% had been diagnosed as having asthma. In 1999, replies were sent by 153 physicians in 22 of the 23 districts, who had a total of 142,684 children under their care. These included 3228 asthmatics, i.e. a prevalence of 2.26 +/- 0.95%. The difference between the two data was highly significant (p = 0.0001). The prevalence increased by 20% in 4 years. The dust, CO, NO2 and SO2 concentrations in the air were measured constantly at 8 points in Budapest, while ozone level measurements were also made at 2 stations. The counts of pollens and of fungal elements in the air were calculated separately for Buda and for Pest. These data overall revealed that the level of air pollution in Budapest did not deteriorate in the period in question, and the pollen counts from allergizing plants did not rise relative to earlier years. An interesting question (though it is far from certain that this is a causal correlation) can be upposed whether the 13% drop in the number of live births in Hungary during this 4-year period can be connected with the 20% rise in prevalence of childhood asthma.

High prevalence of silent celiac disease in preschool children screened with IgA/IgG antiendomysium antibodies.

BACKGROUND: Because of the different sensitivity and specificity of serologic tests, the search for silent celiac disease is usually performed with the combined or sequential use of several tests. Among these, the IgA-class endomysium antibody test has the highest specificity and positive predictive value, but it may overlook IgA-deficient patients. METHODS: To test a new one-step screening approach, serum samples from 427 apparently healthy, 3- to 6-year-old Hungarian children were investigated for IgA-class and IgG-class endomysium antibodies using monkey esophagus and human jejunum as substrates. RESULTS: Five new cases with flat mucosa were identified by strong endomysium antibody positivity and subsequent jejunal biopsy, yielding a celiac disease prevalence of 1:85. An additional child may have latent celiac disease (slight histologic changes at present). Two of the screening-detected celiac patients exhibited only IgG-class endomysium antibodies due to associated IgA-deficiency. Despite the young age of the screened population, antigliadin antibodies were positive in only three of the five celiac patients. CONCLUSIONS: Prevalence of celiac disease in the study population was much higher than expected on the basis of antigliadin antibody-based studies. The screening system used detected celiac cases in which there was IgA-deficiency and those in which there was not and also those negative for antigliadin antibodies. The findings suggest the importance of the primary testing of autoantibodies in future celiac disease screening policies.

Beneficial effect of pentoxifylline on thyroid associated ophthalmopathy (TAO)*: a pilot study.

We have previously found that pentoxifylline (Ptx) inhibited cytokine induced HLA-DR expression and glycosaminoglycan (GAG) synthesis by retroorbital fibroblasts. We have now tested the clinical efficacy of Ptx in treating TAO. Ten patients with moderately severe ophthalmopathy were selected for study. All patients were euthyroid before and during the 12 weeks of the Ptx therapy. Serum GAG, TNF-alpha, anti-TSH-receptor, anti-eye muscle, anti-thyroglobulin and anti-thyroid peroxidase antibodies were determined sequentially. At the end of 12 weeks eight of the ten patients showed improvement in soft tissue but not in proptosis or extraocular muscle involvement. At baseline the levels of GAG (5.2+/-0.92 mg/dl v.s. 0.7+/-0.14 mg/dl, p<0.001) and TNF-alpha (33.6+/-6.6 pg/ml v.s. 5.4+/-1.3 pg/ml, p<0.001) were increased in patients compared to controls. They gradually decreased in the eight patients who responded to Ptx: after 4, 8 and 12 weeks of therapy serum GAG was 3.4+/-0.42 mg/dl, 2.5+/-0.77 mg/dl (p<0.01) and 1.1+/-0.2 mg/dl (p<0.001), respectively and serum TNF-alpha was 20.9+/-4.8 pg/ml, 14.9+/-2.2 pg/ml (p<0.05) and 9.7+/-1.8 pg/ml (p<0.01), respectively. Serum GAG and TNF alpha did not fall in the two patients who did not respond. The titre of anti-eye muscle antibodies but not anti-thyroid antibodies were lower at 12 weeks. Ptx has a beneficial effect on inflammatory symptoms of TAO and associated laboratory parameters in the majority of patients.

[Bone metabolism markers in patients with Basedow-Graves disease]. / A csontanyagcsere markereinek vizsgálata Basedow-Graves-kóros betegekben.

Collagen type I is the main collagen type found in bones. Carboxyterminal propeptide, deriving and cleaved from procollagen type I (PICP) during collagen synthesis, is delivered into the blood, where it might represent an useful marker of bone formation similarly to osteocalcin. PICP, osteocalcin, alkaline phosphatase, serum and urinary calcium excretion were measured in 58 premenopausal females affected by Graves' disease and also 28 of them after attainment of euthyroidism by methimazole treatment to study these biochemical indices of bone remodelling before and after treatment. Before therapy PICP (mean +/- S.D.: 244.2 +/- 112.3 vs. 136.8 +/- 32.4 micrograms/l), osteocalcin (mean +/- S.D.: 17.8 +/- 6.7 vs. 7.5 +/- 2.7 micrograms/l) and other markers were significantly (p < 0.05) higher than sex and age matched controls (n = 24). Treatment induced a significant decrease of PICP, alkaline phosphatase, calcaemia and calciuria compared to pretreatment values, while osteocalcin did not significantly differ (mean +/- S. D.: 17.8 +/- 6.7 vs. 14.7 +/- 8.7 micrograms/l). These data suggest that hyperthyroidism due to Graves' disease causes an increase of serum levels of these markers, but further studies are necessary to asses the differences between PICP and osteocalcin as markers of osteoblast activity in hyperthyroidism.

A longitudinal study of ambient air pollutants and the lung peak expiratory flow rates among asthmatic children in Hungary.

BACKGROUND: We conducted this study in Budapest, Hungary, to better characterize the effects of exposure to ambient air pollutants on the lung function of asthmatic children. METHODS: The 60 study participants were 9-14 years old, had physician-diagnosed asthma, and were symptomatic during the previous year. Their ambient air pollutant exposures to total suspended particulates (TSP) and sulphur dioxide (SO2) were estimated from measurements made at the air monitor nearest their residence. We used analysis of variance and a fixed-effects model to assess the impact of the pollutants upon their morning and evening peak expiratory flow rates (PEFR) from 13 September to 5 December 1993. RESULTS: Total suspended particulates and SO2 concentrations exceeded World Health Organization guideline limits on several days. Pollutant concentrations and PEFR increased during the study period. After adjusting for temperature, humidity, weekend/weekday, and the time trend, we found no consistent association between air pollutant concentrations and PEFR. CONCLUSIONS: Fall to winter seasonal changes had a large influence on PEFR and may have overshadowed the effects of the air pollutants during the study period. Seasonal influences should be carefully considered when planning future studies.

[Immunomodulatory effect of pentoxifylline in Graves ophthalmopathy]. / A pentoxifyllin immunmoduláns hatása Graves-ophthalmopathiában.

In the pathomechanism of the thyroid associated ophthalmopathy (TAO) the inflammatory cytokines produced by infiltrating lymphocytes of the retroorbital tissues are involved. The activated lymphocytes have been shown to secrete a number of cytokines including tumour necrosis factor-alpha, interleukin-1 and interferon-gamma. The widely used immunosuppressive therapies have potential serious side effects. The pentoxifylline (Ptx) is known to have effect on production of cytokines. The aim of this study was to investigate the effect of Ptx on expression of HLA-DR molecules and production of glycosaminoglycan of human retroorbital tissue cultures and potential efficacy in patients with TAO. It was found that pentoxifylline (Ptx) was able to inhibit significantly the HLA-DR expression and glycosaminoglycan synthesis induced by inflammatory cytokines including TNF-alpha, IFN-gamma and IL-1. Ten patients with untreated moderate severe ophthalmopathy (8 female and 2 male) were excluded from steroid treatment due diabetes mellitus and psychiatric disease. Classification of eye changes was made by NOSPECS categories and total eye score. All patients were euthyroid during the study and was no remarkable difference in thyroid function and eye symptoms. Before and during Ptx therapy the laboratory parameters were also determined including glycosaminoglycan. TNF-alpha, anti-TSH-receptor, anti-eye muscle, anti-thyroglobulin and anti-thyroid peroxidase antibodies in the patients'sera. It was found a remarkable improvement in the eye symptoms in eight of ten patients. The levels of glycosaminoglycan (uronic acid) and TNF-alpha gradually decreased in eight patients who considered to be responders. The levels of uronic acid in plasma of the responders were found to be significantly lower after Ptx treatment. Before Ptx therapy the TNF-alpha in the sera was not different remarkably in non-responders and responders. After 4 weeks Ptx treatment the TNF-alpha decreased significantly in responders compared to non-responders (20.9 +/- 4.8 pg/ml v. s. 28.3 +/- 6.1 pg/ml) (p < 0.01). The titre of anti-eye muscle antibodies were found to be lower at the end of observation, however, the anti-thyroid antibodies were not changed remarkably. It was concluded that Ptx in the majority of patients (8/10) has a beneficial effect on inflammatory symptoms of TAO and laboratory parameters and suggested to use as an additive therapy, however, further comparative studies are required for final evaluation of Ptx in the treatment of TAO.

Osteoarticular manifestations of congenital insensitivity to pain with anhydrosis.

We report the case history of a boy who suffered from congenital insensitivity to pain with anhydrosis. We discuss the orthopaedic disorders occurring in 21 cases reported in the literature.

Idiopathic carpotarsal osteolysis with Bartter's syndrome. A case report and review of the literature.

Idiopathic carpotarsal osteolysis is 1 of the rare types of disappearing bone diseases characterized by painful limitation of movement and deformity of the wrist and tarsal joints, and associated with frequent episodes of joint inflammation and a radiographic appearance of osteolysis. Reported here is an 8-year-old girl with idiopathic carpotarsal osteolysis and Bartter's syndrome with significantly decreased re-absorption of chloride at distal renal tubules, low level of serum potassium, a metabolic alkalosis, and high levels of aldosterone and renin. Bartter's syndrome associated with idiopathic carpotarsal osteolysis has not been published previously. The typical plantar nodule in this patient confirmed the presence of fibromatosis with aggressive histologic signs in light and electron microscopic examination.

[Behavior of adamantinoma of the long bones based on long-term follow up studies]. / Csöves csontok adamantinomáinak viselkedése hosszútávú utánkövetés alapján.

Authors report on the long time (in average 12 years, range: 5-36 years) follow-up results of 5 cases of adamantinoma, localized on the tibia. In one case recurrence was found very late, 20 and 36 years after the primary wide resection, and resection was repeatedly performed. Because of problems of differential diagnosis in one case the tumor was excised intralesionally (curettage + plasty with cancellous bone). 7 years later the persistence of the process was found only. 1 patient died in consequence of pulmonary metastasis 9 years after the primary operation. Wide resection is suggested both for the removal of the primary tumor and the recurrences, appearing very late. For the reconstruction of the bone autologous fibula is proposed. Adamantinoma is thought to be a low malignity tumor, the outcome of which cannot be predicted from the clinical and histological findings. Considering the late recurrences and metastasis a long range, minimally 10 years, following of the patient is thought to be necessary.

[Experience with surgical treatment of osteosarcoma]. / Osteosarcomák sebészi kezelésével szerzett tapasztalataink.

The authors treated 79 patients with osteosarcoma by surgery and chemotherapy 1975 through 1991. The appearance, localization and differential diagnosis are discussed. Attention is called to the doctor's delay. The effective pre- and postoperative chemotherapy decreased the incidence of the lung metastases and increased the survival rate (71% 3 years overall survival and 41% 5 years survival) and made the limb-sparing surgery possible. The development of the reconstructive surgical technique and new designs of tumor endoprostheses enabled us to perform limb-sparing surgery in more than one third of the cases at the same survival chance. The limb-sparing means a decisive change in the quality of the rehabilitation of the osteosarcoma patients.

Aneurysmal bone cyst. A review of 52 primary and 16 secondary cases.

Authors report on the results of treatment of 52 primary and 16 secondary aneurysmal bone cysts (ABC). ABC grow rapidly; 84% of them have already destroyed more than the half of the bone width at recognition. En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. Careful curettage and bone grafting still remains the surgical method of choice in the majority of cases, when the ABC is more destructive and affects the subchondral bone of the joints. Segmental resection is only indicated when removal of the affected bone does not influence the function of the extremity. Superselective embolization of the cyst was performed in seven cases with excellent results. This method is suggested for ABC in certain locations inaccessible to surgical intervention, e.g., the pelvis, or to avoid excessive bleeding in hypervascularized tumors. In one case, however, an incomplete rebuilding of the ABC could only be achieved by the administration of calcitonin. The 16 cases of secondary ABC were observed mostly in association with osteoblastomas, giant-cell tumors, and osteosarcomas. The incidence of the secondary ABC was 23% in the whole ABC group but not more than 2-4% among the osteosarcomas and giant-cell tumors. Secondary ABC may confuse the histological and clinical diagnoses and that, especially in cases of osteosarcoma, may have fatal consequences.

[A case of choledochal cyst simulating kyphoscoliosis]. / Kyphoscoliosis gyanúját keltö choledochus cysta esete.

The authors describe a patient's case with choledochus cyst whose leading symptom was antalgetic oblique carriage giving rise to the suspicion of kyposcoliosis. They briefly survey the etiopatogenesis, diagnosis and therapy of the choledochus cyst.

[Experience with methylprednisolone-acetate therapy of juvenile bone cysts]. / A juvenilis csontcysta methylprednisolon-acetáttal történö kezelésével szerzett tapasztalataink.

Authors injected until 1989 in 92 patients with juvenile bone cyst Methylprednisolone-acetate locally after punction of the cyst. They report on the results and give a short literary review.

Surgical treatment of the hip in cerebral palsy.

Hips are affected generally in CP but in favourable cases we can prevent dislocation by adductor tenotomy performed in time (530 cases). Posterior transposition of the origins of the adductor muscles is performed if the patient walks with inwood rotated inferior extremities (105 cases). In the treatment of real subluxation and valgus deformity the open tenotomy of adductor muscles and femur osteotomy with derotation and varisation were used (180 cases). We accomplish open reduction in frank dislocation (35 cases). In such cases it is often necessary to shorten the femur. Also normal acetabulum is found in elder children.

[Development in the treatment of congenital dislocation of hip (author's transl)]. / A veleszületett csípöficam kezelésének fejlödése.

Authors review the development in the treatment of congenital dislocation and dysplasy of hip and demonstrate the results with various methods. Results with treatment according to Lorenz (1040 cases) were unsatisfactory because of frequent occurance (66.3 percent) of osteochondritis. The treatment with Frejka cushion (360 cases) did not improve basically the results. Pavlik's strapping, especially when started under 1 month of age gave excellent results (3156 cases). In operative treated the results of 332 Colonna operations were unsatisfactory because of consecutive deformation of the hip and restriction of movements. Open reduction with varisation derotation osteotomy (474 cases) provided good acetabular development especially in cases where articular cartilage and upper limbus could be saved. Salter's operation is successful when proper indications are considered, but should be performed only after 1--2 years of observation of the acetabular development in non improving cases. The Chiari procedure can improve the weight bearing surfaces in cases of steep acetabular roof flat acetabulum and consecutive subluxation. In 557 cases of varisation derotation osteotomy subcapital coxa valga occured frequently. Basic principle of treatment remains prevention, early recognition and treatment after birth.