Delay of growth and development in children with bronchial asthma, atopic dermatitis and allergic rhinitis.

The elevated incidence of short stature (body height < (-)x - 2s), skeletal retardation and delayed puberty in children with bronchial asthma or atopic dermatitis is generally attributed to the severity of the disorder. However, a series of findings indicate a causal influence of the atopy and the existence of atopic skeletal retardation per se.The observation that children with atopic disorders, whether bronchial asthma, atopic dermatitis or allergic rhinitis, exhibit a rate of short stature that is twice to five times higher than normal indicates atopic and thus genetically determined influences. The elevated prevalence of short stature associated with allergic rhinitis is especially significant, as this disorder cannot be included among the severe chronic disorders. The fact that skeletal retardation is more prevalent in boys than in girls by a ratio of about 2:1 and that a significantly more marked retardation of bone maturation is found in atopic in comparisons with non-atopic asthmatics also lend support to this postulation. The clinical relevance of atopic growth retardation is also supported by the close interaction of pathophysiological basal mechanisms of bone metabolism and the atopy status. Thus the local growth factor prostaglandin E(2) (PGE(2)), which is important for bone metabolism, is also a messenger substance for the immediate and late allergic reaction. The platelet-activating factor (PAF), as one of the strongest mediators in the pathogenesis of allergic disorders, influences the PGE(2) synthesis in the osteoblasts. These relationships show that atopy-dependent imbalances in the complex system of local and systemic growth factors can certainly lead to disturbance of skeletal maturation which may delay growth and development in atopic children. In order to verify these assumptions it is necessary to research the interaction of local growth factors (particularly the roles of PGE(2), PAF and IGF I) in the skeletons of children of short stature suffering from atopic disorders. This should also include the possible effects on the overall hormonal factors influencing bone maturation. Atopy should be included in the differential diagnosis programme to clarify growth and development disturbances.

[Inhibition of growth hormone secretion by theophylline in asthmatic children]. / Hemmung der Wachstumshormonsekretion durch Theophyllin bei asthmakranken Kindern.

Children suffering from asthma display a tendency to retarded growth and development, which also includes bone structure. The reason for this phenomenon has not been clarified. There seems to be an adaptative regulatory hypersomatotropism which can be regarded as a disturbance of peripheral growth hormone activity. We studied the question whether this is influenced by theophylline, a preparation often used in the treatment of asthma, since theophylline has been accused of growth hormone inhibition as a result of in vivo studies in adults. In 9 prepubertal boys suffering from atopic asthma we determined the growth hormone concentrations during 24 hours each before and during intravenous administration of theophylline. With this dosage the median values of the 24-hour profile (10.3 +/- 1.5 to 5.2 +/- 0.9 ng/ml), the 8-hour sleep phase (12.7 +/- 1.9 to 5.7 +/- 1.0 ng/ml) and of the maximal growth hormone peak (38.9 +/- 7.0 to 17.6 +/- 2.8 ng/ml) were significantly lower than on the first day on which theophylline was not administered. The multiple possibilities by which theophylline may be exercising this effect, are discussed. Prospective long-term clinical studies will have to clarify whether the effect is clinically significant.

[Effect of the beta-2 mimetic drug terbutaline of growth hormone secretion in prepubertal asthmatic children]. / Zum Einfluss des Beta-2-Mimetikums Terbutalin auf die Wachstumshormonsekretion präpubertärer asthmakranker Kinder.

Asthmatics display a tendency to retarded growth and hyposomia in childhood. The reasons for this are not yet clear, although the atopic disposition seems to occupy a key role. It is a known fact that stimulation of the beta-2 receptors results in inhibiting growth hormone secretion. The purpose of our study was to find out whether the beta-2 mimetic terbutalin, often used in asthma therapy, exercises a negative influence on the spontaneous release of growth hormone in children suffering from asthma. The growth hormone release was studied in 10 prepuberal children suffering from atopic asthma who received intravenous therapeutic doses of terbutalin: testing was done for a total period of 24 hours before and during administration. Terbutalin effected significant inhibition of growth hormone secretion merely during the waking phase (6.2 +/- 1.0 to 3.7 +/- 0.7 ng/ml), but not during the sleep phase (13.1 +/- 1.8 to 12.5 +/- 2.0 ng/ml) and the 24-hour period (11.0 +/- 1.0 to 9.8 +/- 1.5 ng/ml). There was also no significant influence on the average group value for the maximum growth hormone peak (40.8 +/- 9.5 to 42.7 +/- 11.0 ng/ml). These results point to a short-term inhibition of growth hormone secretion, exercised by intravenously administered terbutalin. Terbutalin does not seem to be responsible for any clinically relevant inhibition of growth and development.

[Intensive care problems in congenital polycystic lung abnormality]. / Intensivtherapeutische Probleme bei angeborener polyzystischer Lungenfehlbildung.

The development of bilateral tension cysts in a 6-month-old child suffering from inborn honeycomb lung resulted in acute cardiorespiratory insufficiency. First of all, we succeeded in controlling the recurrent rises in intrathoracic pressure by puncturing and chest draining performed by suction and by the Bülau method. The child thus became fit to be operated on. The right lower lobe, and, 7 days later, the left upper lobe, were resected and multiple single cysts excised from both residual lungs. The postoperative course of the disease was not free from complications, but five years of follow-up showed that the child's general development had become normal. Possibilities of treatment of pulmonary insufficiency, a typical symptom of polycystic lung malformation, are discussed, and the necessity for an early operation is emphasised.

[Atopic skeletal retardation as a possible cause for short stature and thoracic deformity in children with asthma]. / Die atopische Skelettretardierung als eine mögliche Ursache für Kleinwuchs und Brustkorbdeformierung asthmakranker Kinder.

Deformities of the chest occur not only in asthmatics suffering from severe attacks, but also in those having a mild form of the disease. It also occurs in children with atopic dermatitis and in members of atopic families without concomitant bronchial asthma. This observation and the fact that asthmatic children tend towards hyposomia, has prompted auxological investigations of asthmatic children. It was of interest to see whether asthma itself or the atopic disposition is responsible for disturbances of growth and development. The investigation was carried out as a cross-sectional study involving 173 asthmatic boys aged 1 1/2-18 years. The programme included among other things age, bone age, bone maturity difference (BMD: difference age minus bone age) height, type and severity of asthma (measured by means of scope of therapy). The rate of hyposomia (height < mean -2 SD) amounted in the whole group to 4.7 per cent. It rose in the extrinsic asthmatics to 6.6 per cent. This corresponds with a rise of two or three times the normal rate. 11.6 per cent of the probands showed a skeletal retardation of more than 2 years. The degree of BMD showed a significant dependence on age and type of asthma but not on the duration of the disease, severity or glucocorticoid therapy. Skeletal retardation cannot, therefore, be regarded as a direct consequence of bronchial asthma, whereas the significantly different averages of BMD in extrinsic and intrinsic asthmatics point to an atopic genesis, hence it might be possible to speak of an atopic retardation of the skeleton.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of postoperative pulmonary insufficiency in newborn with congenital diaphragmatic hernia]. / Zur Behandlung der postoperativen Ateminsuffizienz bei Neugeborenen mit kongenitalem Zwerchfelldefekt.

Treatment of postoperative pulmonary insufficiency in congenital diaphragmatic hernia has two aims: on the one hand, it serves to assist in achieving full pulmonary development, whereas on the other hand it aims at lowering pulmonary hypertension. Full development of the hypoplastic lung is the decisively important factor with regard to improving ventilation and perfusion. The same degree of importance is attached to correcting hypoxia as well as acidosis. The different performance of the lungs in respect of mechanics of breathing can be influenced most effectively by a well-balanced application of several measures exercising an influence on pulmonary pressure, such as positive ventilatory pressure and thoracic suction drainage. If these measures are unsuccessful and in case of a clinically relevant ductal right-left shunt, it is recommended to administer vasodilators; in exceptional cases, ductal ligature can be the procedure of choice. These therapeutic problems are discussed on the basis of an evaluation of the authors' own patients treated between 1976 and 1980 (10 cases).

[Morphology and differential histological diagnosis of BCG histiocytosis]. / Morphologie und histologische Differentialdiagnose der BCG-Histiozytose.

Two cases of mycobacterial histiocytosis in infants with the morphological signs of a combined immune defect are reported. In the first case the seven months aged male infant died of a generalized BCG infection. In the second case the mycobacterial histiocytosis of mesenterial lymph nodes was an incidental finding of autopsy in a female infant four month of age, whose cause of death was a generalized cytomegaly. The morphological picture and the histological differential diagnosis of mycobacterial histiocytosis are discussed.

[Effect of bronchial asthma on growth and physical development]. / Der Einfluss des Asthma bronchiale auf Wachstum und körperliche Entwicklung.

Radiologic bone measurements for determination of the skeletal maturation were conducted in 243 children with bronchial asthma. The authors describe marked retardation of skeletal maturation as a general phenomenon of the atopic asthma. The grade of retardation is greater in atopics than in non-atopic asthmatics. The grade of quantitative response to allergic tests is significantly correlated with the extent of retardation of the skeletal maturation. It is discussed that in addition to asthma, eczema and allergic rhinitis the retardation of the skeletal bone maturation could be a further original manifestation of atopia.

[Mendelson syndrome in infancy and childhood]. / Das Mendelson-Syndrom im Säuglings- und Kindesalter.

Acute pulmonary failure caused by gastric acid aspiration is designated as Mendelson's syndrome. It is characterized by a trias of symptoms comprising bronchial obstruction, pulmonary oedema, and right ventricular failure. The pathomorphological pulmonary alterations show the typical symptoms of ARDS and allow the differentiation of three phases. The initial phase of injury is characterized by cauterization of the bronchial and alveolar epithelium. It is followed by the exsudative second phase during which alveolar oedema are developing. They impair the pulmonary surfactant synthesis and the formation of hyaline membranes. Fibrosis processes are typical of the proliferative third phase. Every of the mentioned three phases may be classified by their corresponding clinical symptoms. The therapy is entirely symptomatic and follows the intensive medical standards of the ARDS-therapy.

[A method for the noninvasive measurement and recording of intracranial pressure via the open fontanelle of infants]. / Methode zur nichtinvasiven Messung und Registrierung des intrakraniellen Druckes (ICP) über die offene Fontanelle des Säuglings.

Measurement and checking of the behaviour of the intracranial pressure (ICP) are of considerable clinical interest for the appraisal and treatment of primary or concomitant cerebral diseases. A non-invasive method of the measurement of the cerebral pressure is presented, which permits measurements and graphic recording according to the aplanation principle of the ICP via the open fontanelle. The pressure uptake of the instrument transformer is effected by a resistance strain gauge, measurement and recording by means of an equipment combination of VEB Messgerätewerk Zwönitz (GDR). Methodological and theoretical foundations are described and normal values of the fontanelle pressure of 80 newborns and babies are submitted.

[Investigation of growth prognosis in asthmatic children]. / Untersuchungen zur Wachstumsprognose asthmakranker Kinder.

The objective of the present study was the ascertainment of correct data related to growth prognosis in asthmatic children. For this purpose, 210 young asthmatics including 153 males and 57 females ranging in age from 1.7 to 18.9 years were evaluated. Data were specified for the parameters: chronological age (CA); bone age (KA); height age (LA); height (KH); severity of illness; target adult height (GZG) and predicted adult height (PEG). Among this group, 5.9 % of the boys and 3.5 % of the girls, were found to be of small stature (KH < - 2 s). This corresponds to about 2.5 and 1.5 times the average in a normal distribution. Children with the highest severity of illness showed the strongest negative deviation for the KH-SDS values (boys - 0.59 plus minus 1.1, girls - 0.97 plus minus 0.8). This proved to be statistically significant for females. Development of CA, KA and LA continued unremarkably until the age of 4 years. From age 5, partially a significant growth retardation of KA and LA could be observed in both sexes. To age 16, KA values and, after that LA values, were more strongly affected. Comparison of the GZG and PEG average values within the degree of severity groups made it clear that the PEG values for both sexes, independent of the severity of illness, were without exception, smaller than the GZG. The differences of both parameters proved to be statistically significant for the group with the most severe symptoms of the boys (180.8 plus minus 6.5 cm to 175.8 plus minus 6.2 cm, p < 0.01) and for the entire groups of both sexes (boys 180.2 plus minus 5.3 cm to 178.6 plus minus 7.3 cm, p < 0.05, girls 167.7 plus minus 4.4 cm to 165.8 plus minus 6.8 cm, p < 0.05). However, a separate comparison of GZG and PEG average values, respectively, among the severity groups showed no significant differences. The results argue for a growth-inhibiting influence from bronchial asthma. The cause has to be severity of illness but direct effects of the atopy on skeletal development is also taken in consideration. Confirmation of these findings requires investigation of a larger group of asthmatics and clarification of the pathophysiological processes in the growing skeletons of atopic children.

[Increase in spontaneous growth hormone secretion in asthmatic children--a symptom of atopic disposition?]. / Steigerung der spontanen Wachstumshormon-Sekretion bei asthmakranken Kindern--Ein Symptom der atopischen Disposition?

BACKGROUND: Asthmatic children tend towards hyposomia. Although quite a number of suggestions have been made, the real cause of this phenomenon has not yet been revealed. Investigation of the growth hormone secretion and the IGF-I serum levels aims at clarifying whether an atopy-caused disturbance in the interaction between both the hormones is responsible for retardations in the growth and development of asthmatic children. METHODS: In 19 prepubertal extrinsic asthmatics the spontaneous growth hormone secretion was reviewed in form of a 24 h-profile. In addition, the IGF-I serum levels were measured. RESULTS: With a mean 24 h-secretion of 10.7 +/- 1.0 ng/ml and a maximum growth hormone peak of 39.5 +/- 5.8 ng/ml prepubertal extrinsic asthmatics showed an increased hormone secretion which, however, could not be observed with all the children. The IGF-I mean values were in 11 asthmatics within the normal range, decreased in 5 cases and increased in only 3 children.

[Treatment of chronic infantile hepatitis with D-penicillamine (author's transl)]. / Die Behandlung der chronischen kindlichen Hepatitis mit D-Penicillamin.

Detailed discussion of action, indication and side effects of D-Penicillamine which was used for the treatment of chronic hepatitis of infancy. Of 18 patients, 7 had chronic-active hepatitis, 6 chronic persisting hepatitis, 2 subacute hepatitis and 3 fibrosis of the liver. Control of results was based on numerous clinical chemical investigations and repeated liver biopsies. The transaminases and histology of the biopsies were the essential parameters. Doses between 15 and 35 mg/kg of body weight gave very favorable results in these 18 patients, treated over 5 to 24 months. Australia antigen-negative, chronic active hepatitis appeared to be particularly suited for this type of treatment.