Faculty Reflections on International Travel to Reach the Medically Underserved.

One approach to preparing students to engage in culturally diverse health-care settings around the world is to incorporate faculty-led short-term cultural immersion programs in medically underserved nations. This reflective summary analyzes the impact of a faculty-led international health-care trip on students' global health-care experience and needed health-care services in developing countries. A content analysis of the journals of two advanced practice registered nurse (APRN) faculty members was performed to gain perspectives on a trip with undergraduate and graduate nursing students and medical students to a small city in Nicaragua.

Albert Uffenheimer: pediatrician and public health advocate before Nazi rule.

Before World War lI the number of Jewish physicians practicing pediatric medicine in Germany was very high, but soon after the National Socialists came to power the discrimination against Jewish physicians began. One of them, Dr. Albert Uffenheimer, serves as a moving example of this persecution.

Ostomy options for clients with ileostomies.

Quality of life with an external appliance has a significant impact on decision making when considering an incontinent or continent ostomy. A majority of clients with external pouches are content with their pouches and enjoy a good quality of life. For others, not having to deal with an external appliance is reason enough to consider surgery.

Passive smoke exposure in infants and children with respiratory tract diseases.

1. The adverse effect of passive smoke exposure on the respiratory tract, particularly in infants and children, is not an issue of dispute. It was the objective of this study to analyse the extent and the intensity of passive smoke exposure in infants and children with respiratory tract diseases, and compare the information obtained with parents' subjective assessment.

[Genetics of bronchial asthma with reference to allergy].

No uniform opinion exists to date in respect of the transmission of a genetic disposition to asthma bronchiale and atopy. Literature references discuss both monogenic, autosomal dominant or recessive and multifactorial-polygenic heredity. The following contribution discusses the results of an own study on the occurrence of atopy and asthma bronchiale in 153 families.

[Treatment strategy in childhood bronchial asthma].

Although bronchial asthma is the most frequent chronic disease in childhood, not all of the affected children are readily recognised as asthmatics well in time for appropriate treatment. Since most of the children can get rid of the symptoms if all the available treatment methods are made use of systematically, early diagnosis and correct estimation of the disease pattern are essential for good long-term prognosis. New pathogenetic knowledge on the importance of inflammatory processes affecting the bronchial mucosa has definitely shifted the points of emphasis in asthma treatment as is evident from the international consensus recommendations.

[Findings of combined ventilation/perfusion scintigraphy in children with abnormalities of the bronchi, the lung and lung blood vessels].

Combined ventilation/perfusion scintigraphy with 133Xe/99mTc-HAM was performed within the framework of bronchological diagnostics in 38 children suffering from malformations of the bronchi, lungs and pulmonary vessels, and in 9 children after surgery of hernia of the diaphragm. The findings in stenoses, cysts in the bronchial system and in children with pulmonary vessel malformations, in one child with pulmonary agenesia and in a few other malformations, are presented. The significance of these findings in bronchological diagnosis in case of pulmonary malformations or clinical follow-up is discussed.

Influence of infant diets on the ecology of the intestinal tract of human flora-associated mice.

The effect of diet on intestinal ecology was studied in germ-free mice that were inoculated orogastrically with predominant intestinal flora components isolated from the feces of breast-fed human infants. The flora components colonized the intestines of mice and persisted at fixed population levels. Groups of flora- associated mice were fed either human milk, bovine milk, whey-dominant formula, or formula modifications exclusively for 2 weeks, and then examined for changes in small intestinal and cecal flora composition, cecal pH, and resistance to intestinal colonization with Salmonella typhimurium.

[Results of specific hyposensitization in children with pollinosis].

Hyposensitization was carried out in 120 children aged 5 to 15 years with proven sensitivity to various pollen for 3 to 5 years before the start of the season. By reason of the results of intracutaneous tests 90 patients were treated with mixed pollen allergen and 30 patients with grass pollen allergen. A retrospective study was undertaken on the base of a questionnaire.

[The significance of the flow-volume curve in pediatric lung diseases].

Even slight obstructions in small airways are detectable by means of the flow-volume curve. Therefore this method is to recommend for early diagnosis and especially in infancy. Advantages were demonstrable at the examination of different groups of asthmatics and in children with cystic fibrosis.

[Value of bronchography in childhood with special reference to nuclear medicine preliminary examinations].

One month to 16 years old 288 children suffering from recurrent and chronic bronchitis, asthma, cystic fibrosis, malformations and various other lung diseases have been undergone 133Xe-Gas/99mTc-HAM lung scintigraphy. By means of results and taking in consideration scintigraphic findings the strategy of bronchographic indication is laid open being of higher load for the children based on anaesthesia and x-ray. Thus the number of bronchographs could be reduced from 47 (1984) via 33 (1985) to 22 (1986) by means of lung-scintigraphic imaging.

[The development of pediatric bronchology].

The authors give a statistical survey about the development of paediatric bronchology in the German Democratic Republic since 1957. They draw conclusions from this survey about the future trends in this field, which is part of paediatric bronchopneumology.

[Current aspects of the therapy of bronchial asthma in childhood].

The management goals common to all age groups are to reduce symptoms, to permit a normal physically active lifestyle, and to prevent irreversible airway obstruction. Main measures are environmental manipulation (avoidance of allergen contact, cigarette smoke and pets; psychotherapeutic management), assessment of severity, training for self management, hyposensitization (pollen, HDM, insect venoms) and pharmacotherapy. Medication should be adapted to age and severity of the disease, and the different drugs should be used stepwise.

[Initial experiences with "Oranienburg" slow-release theophylline in asthma therapy of children and adolescents].

Experiences in 50 patients show that Theophyllin retard Oranienburg (280 mg theophylline) could be used as an effective bronchospasmolytic drug on conditions of mono- and combination-therapy. Advantages of this preparation are improvement of the compliance and an undisturbed night-sleep in patients. However an optimum dosage is hardly maintained in children by the present dose of a single tablet of 280 theophylline content.

[The effect of bronchologic studies on blood gases and hemodynamics in children].

During 78 bronchological examinations in children of all age groups out of 6 centers of children bronchology of the GDR PaO2, PaCO2 and pH were registered, in a part of them additionally pulse, systolic and diastolic blood pressure. Following to the intubation--under ventilation with 100% oxygen or a halothane-NO2-oxygen mixture--there was a marked rise of PaO2, which normalized after extubation quickly. After extubation a slight hypoxemia occurred for a short period, a quick rise of PaCO2 and a slight acidosis, too.

Impact of LY146032 on Streptococcus (Enterococcus) faecalis translocation in mice.

The susceptibility of Swiss White mice to colonization with Streptococcus (Enterococcus) faecalis was greatly increased when the animals were given 5 mg of streptomycin sulfate per ml in their drinking water. One week after initiation of streptomycin treatment, the mice were challenged orogastrically with graded doses of streptomycin-resistant S. faecalis.

[Bronchologic studies in East Germany: current status and perspectives].

Within a period of 8 years (1979 to 1986) there were performed in 21 centres of the German Democratic Republic 15,049 bronchoscopic investigations (in 49.6 per cent combined with a subsequent bronchography) in 11,717 children, including 2,054 (17.5 per cent) up to one year of age.

[Noninvasive examination methods in the detection of right heart hypertrophy in children with mucoviscidosis].

Pulmonary hypertension with right ventricular hypertrophy (Cor pulmonale) is a critical complication in cystic fibrosis patients. Early detection and therapy might decrease mortality. Noninvasive diagnostic methods as vector-ECG, m-mode echocardiography and thallium myocardial scintigraphy were performed in 50 children with cystic fibrosis to determine the degree of right ventricular hypertrophy.

[ECG changes in the long-term management of children with mucoviscidosis].

123 ECG were analysed in 33 patients with cystic fibrosis. The authors investigated the criteria of right and left ventricular hypertrophy and discussed their frequency and validity.

[Combined 113Xe/99mTC human serum albumin microspheres lung scintigraphy in children with recurrent and chronic bronchitis].

A total of 117 children with recurrent and chronic bronchitis aged from 2 months to 16 years were subjected to combined ventilation-perfusion scan of the lungs with 133Xe-gas and 99mTc-HAM. It served as a screening before bronchological examination with the aim to get a more exact indication for bronchography which leads to a higher stress in children because of anaesthesia and radioscopy. Due to combined lung scan, the number of bronchological examinations could be reduced from 109 in 1984 to 79 in 1985 and even to 54 in 1986.

[Ultrasonic evaluation of the upper abdomen in cystic fibrosis].

Abdominal sonography should compulsory be used in patients with cystic fibrosis (CF). It is not difficult to detect early morphologic changes at liver, gall-bladder, pancreas, spleen, and vessels by ultrasound. As a non-invasive method sonography is a very useful tool for a comprehensive special care of outpatients with CF.

[Peculiarities of theophylline therapy in childhood].

Profound knowledge of the pharmacokinetics of theophylline is a prerequisite to successful therapy. In children the clearance of theophylline is considerably greater than in adults. The required higher dosage in relation to body weight results in more pronounced oscillations of drug levels in serum.