Peter Ahrens

Lipid-laden alveolar macrophages (LLAM): A useful marker of silent aspiration in children

At present there is no test available which identifies children suffering from silent aspiration due to gastroesophageal reflux (GER). The purpose of this study was to determine whether lipid‐laden alveolar macrophage (LLAM) scoring is a useful method to arrive at the diagnosis. We evaluated bronchoalveolar lavage fluid (BALF) from 68 children aged 6 months to 14 years (median 3.75 years) for the presence of lipid‐laden alveolar macrophages. We compared children with chronic chest disease (CCD) and GER to healthy surgical controls without known lung disease, and to children with recurrent pneumonia without GER. By grading the amount of intracellular Sudan Red‐positive material, we determined a semiquantitative lipid‐laden macrophage (LLAM) score for each patient.

New Immunoassay in Stool Provides an Accurate Noninvasive Diagnostic Method for Helicobacter pylori Screening in Children

Objective. The noninvasive13C-urea breath test (UBT) is a reliable diagnostic method for detection of Helicobacter pylori infection in children, and it avoids invasive gastrointestinal endoscopy. In this study, we compared a noninvasive, newly developed fecal H pylori antigen test with the UBT. Methodology. One hundred sixty-two children (76 girls and 86 boys) were tested for H pylori infection using the UBT and a new antigen test in stool samples. The H pylori stool test is based on a sandwich enzyme immunoassay with antigen detection. Results. Twenty-four of the children (14.8%) with dyspepsia tested positive for H pylori according to the breath test results. In 22 of the 24 patients, H pyloriantigen could be detected in the stool (sensitivity: 91.6%). Of 138 patients with negative UBT results, 136 were H pylori-negative in the stool test (specificity: 98.6%). Conclusions. The new, noninvasive, low-cost H pylori antigen test in stool can replace the UBT for detection of H pylori infection in children with comparable reliability and accuracy.

Alport syndrome with diffuse leiomyomatosis

Alport syndrome (AS) is a hereditary nephropathy with hematuria progressing to end‐stage renal failure (ESRF), sensorineural deafness, and specific eye signs (lenticonus, macular flecks, and congenital cataracts). Inheritance is X‐linked in about 85% of the cases, caused by different mutations in the COL4A5 gene. Rarely AS is seen in combination with diffuse leiomyomatosis (DL). DL is a tumorous process involving smooth muscle cells, mostly of the esophagus, but also of the tracheobronchial tree and the female genital tract. Characteristically, the patients have deletions of the 5′‐end of both the COL4A5 and the COL4A6 genes, respectively. We here present a 9‐year‐old boy who was admitted because of a newly diagnosed sensorineural deafness. He was born with cataracts and presented symptoms of dysphagia and bronchial irritation in the first year of life. Macroscopic hematuria was first noticed at 2 years during a febrile infection. Since early childhood the boy suffered from severe constipation. Taking together these symptoms, the diagnosis of Alport syndrome with diffuse leiomyomatosis (AS‐DL) has to be considered. Genetic analysis demonstrated the predicted deletion of the COL4A5/COL4A6 genes.

Surgical treatment of tracheomalacia by bronchoscopic monitored aortopexy in infants and children.

BACKGROUND Aortopexy has become an established surgical procedure for the treatment of severe tracheomalacia (TM) in infancy. However, postoperative outcome may be improved by intraoperative bronchoscopic control of the aortopexy. METHODS Between 1992 and 2000, 16 infants and children (2 female, 14 male) with TM were treated by pexis of the aorta via a right (15 patients) or left (1 patient) anterior thoracotomy. Patients age ranged from 4 to 122 months (mean, 26 mon). Three infants had previous surgery for esophagus atresia and tracheoesophageal fistula. Another four patients were operated for gastroesophageal reflux. In all cases, the aortopexy was monitored intraoperatively by bronchoscopy. Respiratory function was verified for each patient by comparing pre- and postoperative tidal expiratory flow values (TEF 25% in ml/sec). RESULTS Mean follow-up was 36 months (range, 2 to 60 mo). There was no intraoperative or postoperative mortality. 13 patients showed permanent relief of symptoms. Postoperative median TEF 25% increased significantly compared with preoperative values (81 ml/sec vs. 56 ml/sec; p = 0.016). In one patient repeat aortopexy was necessary. CONCLUSIONS Aortopexy through a right anterior thoracotomy is an efficient and feasible method in the surgical treatment of TM in infancy and, therefore, can improve postoperative respiratory function. Intraoperative bronchoscopy is advantageous.

Antireflux surgery in children suffering from reflux-associated respiratory diseases

The aim of our study was to evaluate the success, complications, and morbidity following a modified Thal fundoplication in children with reflux‐associated respiratory disease (RARD). We used a procedure consisting of retroesophageal hiatal plasty, wrapping the gastric fundus around the gastroesophageal junction 180°, and fixation of the lesser curvature at the abdominal wall. Follow‐up by questionnaire of 128 (77 male, 51 females) out of 196 antireflux procedures between 1992 and 1995 was achieved. Surgical therapy was considered justified whenever there was gastroesophageal reflux resulting in severe recurrent respiratory symptoms. Eleven percent of the children suffered from bronchiectasis. The diagnosis of RARD was based on a high index of suspicion, barium swallow with fluoroscopy, 24‐hr two‐level pH‐monitoring, bronchoscopy, bronchoalveolar lavage and detection of lipid‐laden alveolar macrophages, esophago‐gastroscopy, and esophageal biopsy. Patients with bronchopulmonary diseases such as allergy, immunodeficiency, cystic fibrosis, primary ciliary dyskinesia, and malformation of the bronchial tree or vessels had been excluded.

Aortopexy in Infants and Children—Long-term Follow-up in Twenty Patients

BackgroundAortopexy has become an established surgical procedure for the treatment of tracheomalacia (TM) in infants and children. The aim of the present study was to evaluate the clinical outcome and respiratory function after aortopexy in the long term.MethodsBetween 1992 and 2006, 20 patients (6 female, 14 male) with TM were treated by bronchoscopically monitored pexis of the aorta via a right anterior thoracotomy. Patient age ranged from 4 months to 11 years (mean: 29 months). Five infants had previous surgery of esophageal atresia or tracheo-esophageal fistulae, and five other patients were operated on for gastroesophageal reflux. Postoperative tidal expiratory flow (TEF25%) was compared to age-related values.ResultsMean follow-up was 7.8 years (range: 13 months to 10.7 years). There was no early or late mortality. Most patients (n = 16) showed immediate and permanent relief of symptoms. Compared to corresponding age groups, median TEF25% was slightly but not significantly decreased after aortopexy (p = 0.15). In one patient a re-aortopexy was necessary. Another patient experienced recurrent tracheo-esophageal fistula 3 years after aortopexy.ConclusionsThe bronchoscopically guided aortopexy is an efficient and simple method in the surgical treatment of TM in infants and children. The follow-up data in this series of 20 patients showed improvement of respiratory function and permanent relief of symptoms in the long term.

Immunoglobulin levels in bronchoalveolar lavage fluid of children with chronic chest disease.

The concentration and distribution of immunoglobulin isotypes (IgG, IgM, sIgA) and IgG‐subclass levels (IgG‐1–4) were measured in bronchoalveolar lavage fluid (BALF) in 47 children with chronic chest disease (age range 1.0–9.9 years) and 18 healthy controls (age range 1.0–6.25 years). Of these patients, 19 had nonallergic asthma (Group A), 19 suffered from recurrent pneumonia or chronic bronchitis (Group B), and 9 patients had IgG‐2 deficiency (Group C).

Congenital unilobar pulmonary lymphangiectasis

A premature female infant is described in whom a cystic malformation of the left lung was observed on the second day of life. A lobectomy was carried out on day 31 of life, and histological examination revealed congenital pulmonary lymphangiectasis with isolated left upper lobe involvement. Pediatr Pulmonol. 1999; 27:290–292.

A decision support system for lung function diagnosis in infants

Abstract This paper describes an automatic medical decision support system for lung function diagnosis in infants. The method is based on tidal breathing flow volume loops and air flow resistance measurements, obtained noninvasively from sedated infants. In order to obtain a diagnosis from these signals, a neural network classification algorithm has been implemented for pattern recognition purposes. At the moment, the system allows the classification of about 70% of the breaths, with a failure rate of 15% and 15% rejections.

Methoden zur automatisierten Lungenfunktionsdiagnose bei Säuglingen

Im folgenden Beitrag wird ein Verfahren zur Automatisierung der Lungenfunktionsdiagnose bei Säuglingen vorgestellt. Zunächst werden die physiologischen und meßtechnischen Grundlagen der Ruheatmungsspirometrie und der Messung des Atemwiderstandes beschrieben. Anschließend werden mögliche mathematische Verfahren zur Extraktion von geeigneten Symptomen aus Atemflußmessungen vorgestellt. Die Verwendung dieser Symptome zur Vorhersage der zugehörigen Diagnosen stellt ein typisches Mustererkennungsproblem dar. Im Verlauf dieses Beitrags wird gezeigt, daß sich zur Lösung dieser Aufgabe neuronale Netze vom Perzeptron-Typ erfolgreich einsetzen lassen.