Bartter's Syndrome: 10 Cases in Childhood: RESULTS OF LONG-TERM INDOMETHACIN THERAPY

Ten children with Bartter's syndrome are described. Their agesat diagnosis ranged from three months to 15 years and therewas an equal sex distribution. A wide spectrum of severity ofclinical and biochemical features was found. Hypercalcaemia,hypophosphataemia, hypercalcuria, nephrocalcinosis, ricketsand urine acidification defects were seen in some patients.Two affected children were siblings. Six children were treatedover periods of six to 24 months with indomethacin with remarkableclinical and biochemical improvement. Catch-up growth was demonstratedin all treated cases. Tolerance to indomethacin appeared todevelop in some children. Only one serious complication wasseen with this therapy, a duodenal ulcer in a child on highdosage. Of those children not treated with indomethacin, onedied, one is now on indomethacin elsewhere and two are wellwithout therapy.     

Prevalence, severity and medical management of asthma in European school children in 1985 and 1991

This present study, conducted in 1991, examined trends in the prevalence, severity and medical management of asthma in European school children by repeating the protocol of a study performed in 1985, using the same schools and questionnaire. One thousand, nine hundred and one children in 1991 were compared with 1084 children in 1985. The prevalence of respiratory symptoms increased significantly by approximately one-third, although the increase in the diagnostic label ‘asthma’ did not increase significantly. Asthma severity indices (< 12 asthma attacks in the last 12 months and symptoms in the last month) were not significantly increased, except for night cough in the last month (1985 7.0%, 1991 9.9%, P= 0.008). In 1991, children with wheeze in the last 12 months were more likely to be diagnosed as having asthma and treated with bronchodilators and prophylactic drugs than in 1985. We conclude that the prevalence of asthma symptoms has increased from 1985 to 1991, but the two indices of severity of asthma are mostly unchanged. Diagnosis of asthma in children with symptoms has improved but asthma still appears underrecognized. Drug treatment of asthma has increased.     

Reduction of house dust mite allergen levels in the home: use of the acaricide, pirimiphos methyl

House dust mite sensitivity is very common in patients with bronchial asthma, yet dust mite avoidance frequently receives little attention in clinical management. It is likely that any reduction in allergen levels associated with routine cleaning is insufficient to allow clinical improvement. In the present study the acaricide pirimiphos methyl is shown to reduce the levels of Dermatophagoides pteronyssinus, antigen P₁ in homes. Following a single application the level of antigen P₁ in dust from carpets was reduced by up to 73% and by more than 50% in soft furnishings. Serial sampling showed a reduction for 6 weeks under conditions where carpets and chairs treated with solvent showed a progressive rise in allergen level. Furthermore the survival of mites in cultures or infested carpet segments was markedly inhibited, with antigen PI accumulation reduced by >90%. These results suggest major reductions in house dust mite allergen levels in the home can be achieved.