We examined the clinical features and laboratory findings of 30 asthmatic patients with positive scratch test against extracts of orchard grass-pollen. One patient was sensitized only by grass-pollen. Others were co-sensitized by multiple antigens including mites and molds. There are no clear relations between the seasons of grass-pollens and clinical symptoms in these patients except one typical case, K. F., indicating that other antigens, such as mites and molds, play more important roles in asthma development in most patients. However, substantial numbers of patients were cosensitized by grass-pollens as shown in this paper, indicating the importance of grass-pollens as antigens of bronchial asthma, although this is concealed by the high incidence of mite-antigen positivity. The mechanism of sensitization in certain patients by only one group of antigens such as grasspollens should be further investigated.
Most children with allergic rhinitis have nasal obstruction all year round. In Chiba Children's Hospital we performed surgical treatments on children whose nasal obstruction was not improved by medication, hyposensitization and so on. In the last 3 years,25 children underwent operations such as turbinotomy, submucous turbinotomy and submucous resection of the nasal septum. There were 15 boys and 10 girls aged 6 to 15 years. We followed them for 6 months to 3 years postoperativety. Questionnaires were sent out to assess the effectiveness of surgery and 20 children responded. The following results were obtained: 1. The nasal obstruction improved remarkably after surgery. 2. Symproms such as nasal discharge, snore, sneeze, nasal voice and minor disturbances decreased after the operation. Children seldom had heavy sensations in the head or dyspnea on exertion, as they had often had before the operation. Significant improvements were observed in the ability to concentrate. Thus their daily lives had become comfortable. 3. Besides rhinitis,20 of 25 children had other allergic diseases such as atopic dermatitis and bronchial asthma. Though 7 children had bronchial asthma,5 of them seldom had asthma attacks after the operation. 4. Our study shows that surgical treatment for nasal obstruction in pediatric allergic rhinitis is an effective therapy, when symptoms are not responsive to nonoperative treatments.
One case each of central and obstructive sleep apnea in children are reported. Case 1 had the sleep apnea associated with congenital central alveolar hypoventilation (Ondine's Curse Syndrome), and was hospitalized for “failure to thrive” after birth. The transcutaneous monitoring of hypoxemia revealed hypoventilation during sleep. His respiratory status while sleeping was improved by artificial ventilation. Case 2 was a 4 year old girl who after one month history of obstruction of upper air way during sleep associated with an adenoid vegetation, based into a secondary cor pulmonale. The adenotonsillectomy immediatly improved the cardiorespratory disfunctions.
We report the peculiar clinical course of a boy who swallowed a ten-yen coin at the age of 8 months. The coin penetrated the esophageal wall, forming a granuloma around it. The granuloma pressed the trachea forward resulting in respiratory symptoms misdiagnosed as bronchial asthma at the age of 3. His clinical course suggests the importance of fundamental diagnostic procedures in the differential diagnosis of bronchial asthma.