[Relations between gastroesophageal reflux and chronic respiratory diseases in children].
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Biomedical subjects
Publications and source records attributed to W Thal.
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Based on own experience and recent literature, signs and symptoms, diagnostics and therapy of acute respiratory diseases in children are described. In first place inflammatory diseases are discussed. Confirmed scientific results and approved therapeutic measures are reported.
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During infancy bronchoscopic removal of a foreign body firmly embedded in the granulation tissue sometimes causes considerable difficulties so that surgical procedures (bronchotomy) must be envisaged. On the basis of 4 observations, the distinct influence of daily prednisolone inhalations (25 mg of prednisolone) and antibiotic therapy on the retrogression of endobronchial granulation tissue has been proved: resulting in a spontaneous expectoration of the foreign bodies or in enabling the bronchoscopic removal of the foreign bodies. If chronic foreign bodies cannot be removed immediately and especially before undertaking surgical measures, treatment by prednisolone inhalation should be tried.
Since 1974 the authors have used fibre optics of Olympus, Tokyo, particular the models BF Type 4B and BF Type 3A applicable for children. Even in children, tube bronchoscopy can not at all be replaced by fibre optic bronchoscopy. By fibre optic bronchoscopy diagnostics may by improved considerably. Laryngotracheoscopy proved to be of special advantage in newborns with the sign of stridor. Fibre optic bronchoscopy should be used as a supplementary procedure in bronchological centres for children.
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Swallowed foreign bodies, fixed in the esophagus, are not uncommon in childhood. Their symptoms, complications, diagnosis and treatment are discussed. An expectant attitude is justified in regard to smaller fistulas and in big fistulas due to foreign bodies up to the remission of the localized inflammatory reaction. The present surgical methods are reviewed in the light of recent literature and a case study of a child cured by segmental resection of the trachea.
One thousand specimens of bronchial secretion from children with non-specific respiratory diseases have been examined bacteriologically. In spite of the complex nature of acute and especially of chronic respiratory disease the role of bacterial infection should not be underestimated. Thirty per cent of the specimens were sterile. More than 20 per cent of the bacterial species isolated from bronchial secretion were pathogenic. Relatively frequent was the isolation of E. coli and of pathogenic staphylococci. Nearly 40 per cent of all isolated bacteria were alpha-haemolytic streptococci. The latter have been found more frequently in children with, than in children without bronchological alterations. The pathogenicity of alpha-haemolytic streptococci in the bronchial tree is discussed.
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