P. KRAEMER and F. GEUBELLE, Dept, of Paediatrics of tk R.OLEGARD+,K.-G.SABEL+,B.SANDIN+,M. ARONSON and 5 Universities of Berne/Switzerland and LiGge/Belgium. 8 M.KYLLERMAN+(I~~~.~~P.Karlberg),Dept of Pediatrics Bronchial Distensibility in Asthmatic Children. University of Gotebora.GStebora.Sweden. Among adult asthmatic patients distinction into "primary bronchial Jutcome of children to-alcoholic mothers reiated to social condi- tions during upbringing' disease" and "emphysematic" can be made on the Dasls 01 the elastic, recoil/lung conductance relationship. We wish to know if these The 99 living children of 30 women with chronic alcoholism were functional distinction also could be done in asthmatic children. retrospectively investigated at age 2-29yrs.Sufficient data concern p,e lungconductance is influencedby the state of inflation of the ing size at birth,symptoms of brain damage(defined),mental capacity lung and the volume history. Thus, the question arose whether lung and psycho-social symptoms(defined)were obtained in 90 children.The conductance could be reliably determined taking into account the children were divided into 4 groups: (A)care in one fosterhome or adoption.(B) several changes of environment before steady foster presence of trapped gas and asynchronous ventilation. Static lung compliance and lung conductance measurements were made on home care,(C) several changes before care by the mother,(D) always 23 asthmatic children. It can be demonstrated that during this care by the mother.Mean birth weight for gestational agd was 1 SD below the mean of the reference population.Birth weight for gest. manoeuvre alveolar space can be recruited, the determination of jtatic compliance being significantly changed. In addition, age was signif. lower in groups A+B,compared to C+D.Symptoms of elasticrecoil measurements are altered by the presence of trapped brain damage(48190) and slight to moderate mental retardation(43190P aas. On the basis of these methodological considerations it was were equally distributed in groups A-D.Psycho-social symptoms were possible to divide clinically similar asthmatic children into not signif.correlated to low IQ or brain damage symptoms.Psycho- 1) normal static compliance, decreased bronchial disten- social problems were signif. less frequent in group A(7127)than in sibility, 2) increased static compliance, better distensibility, C(20123) or D(9/12).A signif.difference was also found between 3) increased static compliance due to loss of elastic recoil, high B(10128)and C.Group A had a signif.less psycho-social symptoms than distensibility. By analogy with results from adult patients we B+C,but no difference was found between D and B+C. suggest that the first functional abnormalities of "emphysema" In conc1usion:Foster care could not prevent mental retardation or begin in childhood but remain undetected. Hence, this functional symptoms of brain damage to occur.Children brouhgt up their biolog- distinction may be clinically relevant, since it has been demon- ical parents probably had a slighter degree of intrauterine damage strated in adults, that pharmalogical vagal blockade has an in- (higher birth weights),but significantly more psycho-social symptom$ fluence predominantly on central airways (Group l), whereas beta- than children brought up in one foster home. mimetics influence more the peripheral-airways- (Gr&os 2 and 3)

* SCEOENI MARTIN, M.D., KnAEMER RICHARC, M.D., J.ZERVAS ,HELEN VALASSI-ADAM C.CONSTANTOPOU- 6 MORDASINI RUSINO, M.D., ROSSI ETTCRE, M.D.~ 9 LOS*,D. ZOUMBOULAKIS*,F.FESSAS&,N.MATSANIOTIS. 3hildrents hospital, University of Berne, Switzerland. First Department of Pediatrics of Athens Serum lipoprctelns and major apoproteins in Cystic FibrosislCF) - University and 1st Department of Internal Medicine of effect of short term Cimetidine (C) application. Athens University. HLA antigens in children with menin- 4, receptors are blocked bv C. This increases low DH values in qoccocal meninqitis. ggstric'and duodenal fluid: In CF the pH in duodenal fluid is in a HLA antigens were studied in 37 children with menin- suboptimal range, resulting in a lowered pancreatic inte3 tinal fat gococcal meningitis- B27 antigen was found in 10(27%) 3bsorption. As a pilot study we administered C (600 mg/m daily of the patients. The incidence is significantly higher durjng 7 days under controlled clinical and dietary observaticn and in the patients as compared with the incidence in normal studied the plasma lipopro~einand major apoprotein alterations. In controls (x2 14.76 p 0.001 ) Relative risk is 5.39. addition stool analysis, based on 24 hour excretion of fat and , ( . No statistically significant difference was observed nitrogen, was performed. It As compared to controls (triglycerides, TC:62+20,2 mg/100 ml) CF in any other antigen. is of interest that B27 has been related with other common infections such as those showed increased levels of total- (120 + h,l mL/l00 ml) and VLDL-TG, caused by salmonella and shigella, which occasionally whereas total cholesterol (CH) and LDL-THwere decreased. The finding cf low LDL was confirmed by low apoprotein-B (apo-B) levels have uncommon clinical expressions i.e. arthritis. It In CF. HDL-CtI as weii as the major apoproteins of the HDL-fraction is believed that a strong association of the disease with a certain phenotype might prove valuable for A1 + A2 were both decreased in CF. After C administration total TG and VLDL-TG showed a further increase.On the other hand total- clinicians even though evidence for genetic linkage is and LDL-CH as well as apo-B were slightly decreased by drug still lacking. treatment. Stool fat and nitrogen excretion were diminished in parallel, suggesting a better absorption of nutrient fat under C treatment. Pulmonary side effects under short time C application were not seen but must be considered in a long term application trial.

Keto~enicdiets in the treatment of children with INTRAVENTRICULAR AND OR INTRALUMBAR TREATMENT OF PURU- 7 severe epilepsy: Clinical efficacy and metabolic 10 LENT MENINGITIS IN INFAlTS effects. L. Corbeei, K. De Boeck . N. ~o~~he*.F. Eggenont,* RUBY H. SLYWARl'Z,' S. HOYZS,' JANZ EATOFJ,' B.D. BOWER,' and A. R. ~eckels*. P. Casaer , J. Vandepitte*, L. Verbist* AYNSLEY4:~J. Departments of Paediatrics and Bacteriology,University of Leuven. Department of Paediatrics, John Radcliffe Hospital, Oxford. When treated with only intravenous antibiotics, purulent meningitis There is little i".formation or. the clinical efficacy or the in infants less than 3 months of age has a fatality rate of 40-70%. -rchnnis~of actio- of ketocenlc diets in the treatnent of children This is explained by the delay in the diagnosis, the frequency of wlth epilepsy. We have st~lied:_' children (a~emnse 6/12-15 years) ventriculitis, and the low concentrations of antibiotics in the with intractable erilepsy on norral dier (ND) and then on one of two cerebrospinal fluid (CSF). ~etoqenic".ets - t!:e 'Classical n'et' (0)(4:l fat:carbohydrate Thirty-nine infants less than 3 months of age were treated with earl) and protein) or Vediun Chain Triglyceridr Diet (EICTD) 763., daily intrathecal (intraventricular and/or intralumbar administration of calories as KCoil:. 1'0th diets were nftective in reciucing neizL:re antlblotlcs. The weight was 6 2500 kg In 9 (23%{ of them, 17 (43%) freq :ency; overall, 6% of child re:^ studied had 7 3TL reductio? in were neonates. There were 21 (53%) infections due to gram negative seizures. 10 of 12 children on the CD and 11 of 15 or. the MCTD had organisms and 9 due to streptococci. Ventriculitis was demonstrated )>Od decrease in s~izures. Tne ?ar~edclinical iqprove-ent did not in 21 (53%) cases. and in 82% of the newborns. There were 6 deaths correlate with tile Em. Th.ere were rini-a1 side effects, and ar.ti- (15%). Sequelae were observed in 8 (20%) of the patients and normal convulsant neciicatior, co.~ldbe reduced. blood rl~icore,acetoacetate outcome in 25 (65%). Fatality rate was 9.5% and 33% for infections f -?ydroxyhr;tyrote an3 alnnine levels were -.eas.sred luring a 2'1 to-r due to gram negative organisms and streptococci respectively; 5/6 ?erlod on r.orial a~dthera~eutic ciets. >!sari tlood gl,~rose deaths occurred in newborns within 36h of treatment, all of them concentratior, cii-i not rhar.qe. 1r.cr.eased ?eon blooll keto7.e body were in severe shock or acidosis on admission. 4/6 of them were levels occ~rrela:. C3 and I.!CTD (5.12 + 1.75 .n?ol/l a7.d 1.53 t 3.10 treated within 24h after the first symptoms with exchange trans- 7-ol/l re.?pectivel:r v.s. tO.?1 r '-.?: 1-.?01/1on 1;D). Xean blood fusion and antibiotics. Early diagnosis did not affect the fatality nlari~elevel was si~:~ificantl~rer;scl:l on O :3.:'1 + ?.TO3 zmol/l rate in our series but did influence the number of patients with V.S. !).!A0 + q.21; r,r.o1/1 o:i :::;. >;e conclude ?tat keto5er.i~diets sequelae. Indeed. 6/8 cases with sequelae were treated after a :,re ni~hlyeffective in trentizg srl.ected chllriren with severe delay of 24h or more after the first symptoms. A scoring system epileps:~. Several possitle Kecha.?isrs of effect are suceested -:? bas been developed which enables early prognosis in 87% of the tt.e nptaholic ot~..iies. cases.