The elevated C3 level was possibly due to induction by pro-inflammatory cytokines such as tumour necrosis factor-alpha (TNF-alpha) and interleukin-1 (IL-1). The probable mechanisms of C3 involvement in the pathophysiology of bronchial asthma were discussed.

Accidental kerosene ingestion is still a common problem in Libya. It causes considerable morbidity and occasionally mortality. The role and choice of antibacterial agents in its management remain unsettled. Pulmonary damage has been reported as resulting from aspiration. In aspiration pneumonia, anaerobic organisms may be important pathogens and metronidazole may have a place in therapy. The present randomized trial in 100 children with accidental kerosene ingestion assesses the role of ampicillin, carbenicillin and metronidazole in its management. The results are not conclusive but chemoprophylaxis appears to decrease morbidity. Of the various regimens used, the ampicillin/metronidazole combination was found to be slightly better than the others. Further study is recommended.

Liver function tests, including serum alanine aminotransferase (ALT) activity, serum bilirubin, alkaline phosphatase, serum proteins, blood ammonia levels and intravenous glucose utilization, were monitored in 50 children with acute rheumatic fever receiving anti-rheumatic doses of aspirin. There was a significant increase in blood ammonia levels and serum ALT after aspirin therapy. A significant fall in glucose utilization coefficient was also recorded. Serum alkaline phosphatase, bilirubin and total proteins did not change significantly. Twenty-two of the 50 children recorded a rise in serum ALT; in 12, the rise was five- to tenfold. These 12 children developed adverse symptoms to aspirin. Also, all had a marked rise in blood ammonia levels. The children improved clinically and biochemically on withdrawal of aspirin. There was no constant relationship between hepatocellular function and serum salicylate levels.

Immunoglobulin isotypes (IgG, IgA, IgM, IgD, IgE) in serum were investigated in 64 Libyan children with mild to moderately severe asthma (age: 1-12 years; sex: 39 males, 25 females) (Group A) and in 57 healthy Libyan children (age: 1-12 years; sex: 30 males, 27 females (Group B). The patients were classified according to age into three groups (A1: 1-3 years; A2: > 3-5 years; A3: > 5-12 years); according to disease activity into two groups (AA: active disease; NA: inactive disease); and according to age plus disease activity into six groups (AA1, NA1; AA2, NA2; AA3, NA3). The healthy children were also divided according to age into three groups (B1: 1-3 years; B2: > 3-5 years; B3: > 5-12 years). IgG, IgA, IgM and IgD were measured by radial immunodiffusion method and IgE was estimated by enzyme immunoassay technique utilizing immunokits from bioMerieux, France. Serum levels of IgG, IgD and IgE were elevated significantly in patients compared to controls (A vs B: p < 0.05) while IgA and IgM levels were normal (p > 0.05). IgG and IgD levels were raised in A3 (p < 0.05), while IgD levels were raised in both A2 and A3 (p < 0.05) and IgE was elevated in all age groups (p < 0.05). However, IgG was elevated significantly in AA only, while IgD and IgE levels were high in both AA and NA (p < 0.05) and IgE was even considerably higher in AA compared to NA (p < 0.02). Further elevated levels were observed for IgG in AA3 only (p < 0.05), for IgD in NA2 (p < 0.01), AA3 (p < 0.01) and NA3 (p < 0.05) and IgE was much higher in patients with active disease than with inactive disease in all age groups (p < 0.05). The fact that asthmatic attack in majority of our patients can be explained as mediated through IgE and the possibilities that IgG and IgD may play roles as aetiopathogenetic or protective regulatory factors in childhood asthma are discussed.

Presentation of hydatid disease is uncommon in children, and cardiac hydatid cyst is rare at any age. The authors discuss a pediatric patient with cardiac hydatid cyst in the posterior wall of the left ventricle. The cyst was diagnosed by two-dimensional echocardiography and by serology. A 3 month course of mebendazole therapy was only partially effective. The patient remains asymptomatic 2 years after diagnosis. HYDATID DISEASE is endemic in the Middle East. In a study from a surgical hospital in eastern Libya, the disease accounted for 0.89 percent of all hospital admissions. The echinococcus cyst grows very slowly and unless located in a critical anatomic site, it takes many years to evolve. Consequently, presentation in pediatric patients is distinctly uncommon. In an epidemiologic study from Benghazi, only 11.7 percent of patients were under 10 years old. Cardiac hydatid disease is rare at any age, accounting for less than 2 percent of all hydatid disease. Since the introduction of two-dimensional echocardiography, more cases are being diagnosed. All the reports in the recent literature are in adult patients. We report here, however, a cardiac hydatid cyst in the left ventricular wall in a child.