Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. We reviewed a total of 174 children with foreign body aspiration (FBA). Clinical, radiological, and bronchoscopic findings of these patients were evaluated according to the nature of foreign body and elapsed time from aspiration to diagnosis. Significant differences were noted between patients with organic and inorganic FBA in terms of clinical and radiological findings. Cough, recurrent pneumonia, and fever were the most common presenting symptoms in patients with delayed diagnosis. Long-term follow-up was available for 110 patients for a mean duration of 37.8 +/- 23.7 months (range, 1-88 months). We evaluated the course of recovery after bronchoscopic removal. Organic FBA was of comparable duration as for inorganic FBA, and prolonged follow-up was associated with increased risk of persistent symptoms and bronchiectasis (P < 0.001). The risk of long-term complications increased with increasing elapsed time from aspiration to diagnosis; complications were as high as 60% in children who were diagnosed 30 days after FBA (P = 0.0035). Bronchiectasis was a major complication, found in 25% of patients whose diagnosis was delayed by more than 30 days (P = 0.0001). Three patients with bronchiectasis underwent lobectomy. Patients with persistent asthma-like symptoms such as cough and wheezing required treatment with inhaled corticosteroids and bronchodilators. The positive response to this treatment was thought to be a confirmation of the development of transient bronchial hyperresponsiveness induced by foreign bodies. We conclude that timely diagnosis and appropriate treatment of FBA is important to prevent long-term complications in affected children.

Aims/Methods: We established age- and sex-related reference ranges for serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in 807 healthy Turkish children (428 boys, 379 girls), and constructed a model for calculation of standard deviation scores of IGF-I and IGFBP-3 according to age, sex and pubertal stage. Results: Serum IGF-I and IGFBP-3 concentrations tended to be higher in girls compared to boys of the same ages, but the differences were statistically significant only in pubertal ages (9–14 years) for IGF-I and only in prepubertal ages for IGFBP-3 (6–8 years) (p < 0.05). Peak IGF-I concentrations were observed earlier in girls than boys (14 vs. 15 years, Tanner stage IV vs. V) starting to decline thereafter. IGFBP-3 levels peaked at age 13 and at Tanner stage IV in both sexes with a subsequent fall. Serum levels of IGF-I and IGFBP-3 increased steadily with age in the prepubertal stage followed by a rapid increase in IGF-I in the early pubertal stages. A relatively steeper increase in IGF-I but not in IGFBP-3 levels was observed at age 10–11 years in girls and at 12–13 years in boys which preceded the reported age of pubertal growth spurt. At late pubertal stages, both IGF-I and IGFBP-3 either did not change or decreased by increasing age. Interrelationships between growth factors and anthropometric measurements have been described, and the physiologic consequences of these have been discussed in detail. Conclusions: Differences in the pattern of IGF-I and IGFBP-3 in the present paper and those reported in other studies emphasize the importance of locally established reference ranges. Establishment of this reference data and a standard deviation score prediction model based on age, sex and puberty will enhance the diagnostic power and utility of IGF-I and IGFBP-3 in evaluating growth disorders in our population.

Medicine, Pittsburgh, PA I n c o n t r a s t t o normotensive adults, b o r d e r l i n e hypertensives S t r a t e e i e s f o r management o f children attending DC f a c i l i t i e s do n o t demonstrate forearm v a s o d i l a t i o n w i t h a h i a h sodium d i e t a f t e r occErrence of a Ease of HIB disease a r e controversial. ?he success o f chemoprophylaxis has been v a r i a b l e. Failure of rifam-p i n prophylaxis a s c u r r e n t l y recommended, may r e s u l t from usage limited t o d i r e c t contacts o f t h e index case. ?his prospective study was designed t o a s c e r t a i n the e x t e n t of colonization i n household contacts o f colonized children attending DC f a c i l i t i e s with an index case of HIB disease. Outer membrane p r o t e i n (OMP) analysis was used t o determine s i m i l a r i t y between s t r a i n s i s o l a t-ed from contacts and index cases. In DC children from 6 f a c i l i t-i e s , 15% were colonized with i d e n t i c a l subtypes of HIB. In add-i t i o n , 7% o f children i n the l a r g e r DC centers c a r r i e d non-iden-t i c a l subtypes. Colonization with i d e n t i c a l subtypes i n children from DC homes was g r e a t e r than i n t h e l a r g e r DC centers (91% vs 8%, p<0.00001). Within families o f children with i d e n t i c a l OMP subtypes, 25% (17% of parents and 44% o f s i b l i n g s) were colonized despite lack of d i r e c t contact with t h e index case. ?his colon-i z a t i o n r a t e was comparable t o t h a t of household contacts o f index cases. Of household contacts o f DC children with non-ident-i c a l subtypes of HIB, 13% were colonized. W e conclude t h a t colonized household contacts a r e a p o t e n t i a l source of HIB i n f e c t i o n f o r susceptible D C children and may a l s o warrant prophylaxis. and show augmented nevrogenic v a s o c o n s t r i c t o r responses d u r i n g b a r o r e f l e x s t i m u l a t i o n. Children from t h e lower (LoQ) and upper (HiQ) q u i n t i l e s o f blood pressure (BP) d i s t r i b u t i o n were examined. Six adolescent males from each group were studied on each o f three d i e t s : ad l i b , low sodium (10 mEq) and h i g h sodium (310 mEq). U r i n a r y sodium, aldosterone and k a l l i k r e i n and plasma r e n i n confirmed d i e t a r y compl iance and sodium balance. Weight, BP and h e a r t r a t e (HR) d i d n o t change. During h i g h sodium, f o r e-arm vascular r e s i s t a n c e (FVR) decreased from 16.2 t o 10.4 U (p< 0.05) i n LoQ. However, HiQ d i d n o t show a decrease i n FVR, 16.3 vs 15.6 U (p>0.05). Both groups responded s i m i l a r l y t o c a r d i o-pulmonary b a r o r e f l e x i n h i b i t i o n induced by lower body negative pressure w i t h s i g n i f i c a n t l y (p<0.01) increased HR, decreased forearm blood f l o w and increased FVR. HR response was augmented d u r i n g low sodium (p<0.001). P o s i t i v e and negative pressure applied t o t h e neck a f f e c t e d t h e h i g h pressure b a r o r e f l e x c o n t r o l ...

Meningococcal disease is one of the most important causes of morbidity and mortality among children in many parts of the world. Main reservoir of carriage and site of meningococcal dissemination appears to be the upper respiratory tract. Colonization of Neisseria meningitidis and lactamica and factors affecting this carriage were determined in a group of healthy children aged 0-10 years. Meningococcus and N. lactamica carriage were detected in 17 (1.23%) and 245 (17.7%) of 1382 subjects, respectively. Number (%) of serogroups for meningococci was 1 (6), 5 (29), 0 (0), 1 (6), 1 (6), and 9 (53) for A, B, C, D, W135, and Y, respectively. Having more than three household members, elementary school attendance, pharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae were associated with carriage of meningococci, whereas age less than 24-month was associated with carriage of N. lactamica. There was a reverse carriage rate between N. meningitidis and N. lactamica by age which may suggest a possible protective role of N. lactamica against meningococcal colonization among pre-school children.

Objectives: The effect of economic status (ES) on growth, insulin-like growth factor (IGF)-I and IGF-binding protein (IGFBP)-3 in healthy children is not well characterized. We aimed to study the interrelationship between height, weight, IGF-I, IGFBP-3, mid-parental height (MPH) and ES. Design/subjects: Eight hundred and fourteen healthy children (428 boys, 386 girls; age 3-18 years) were classified according to income of the families as low, middle and high. Standard deviation scores (SDSs) of height, weight, MPH, IGF-I and IGFBP-3 were compared between the groups. The combined effect of these parameters and ES on height SDS was investigated with complex statistical models. Results: There was a significant trend for height and weight SDSs to increase with higher income levels in boys, but not in girls. Body mass index (BMI) SDSs were similar in three groups. There was a general trend for MPH SDS to increase with income levels in both sexes. In boys, IGF-I SDS was significantly higher in high ES group than low ES. In girls, IGFBP-3 SDSs were significantly higher in high ES group than in middle ES group. For both genders, height SDS was highly correlated with weight SDS and moderately correlated with BMI SDS, MPH SDS and IGF-1 SDS. All correlations were significant and positive. Complex models showed that MPH (19%), IGF-I (13%) and ES (3%) in boys, and MPH (16%) and IGF-I (7%) in girls have significant contribution to height SDSs. Conclusions: ES per se, independent of overt malnutrition, affects height, weight, IGF-I and IGFBP-3 with some gender differences in healthy children. Influence of income on height and weight show sexual dimorphism, a slight but significant effect is observed only in boys. MPH is the most prominent variable effecting height in healthy children. Higher height and MPH SDSs observed in higher income groups suggest that secular trend in growth still exists, at least in boys, in a country of favorable economic development.

Sir: Since there is little information on the epidemiology of pharyngeal carriage and infection due to Streptococcus pneumoniae in Turkish children [3], suspected cases of bacterial pneumonia and meningitis are treated empirically; blood cultures are not routinely collected and have little value in areas where antibiotic use before seeking medical care is common. Conjugated pneumococcal vaccine coverage has not been evaluated with large scale studies in Turkey. Between 12 January and 25 April 2000, pharyngeal swab specimens were collected from 1382 healthy infants and children in 24 randomly selected centres, including 6 well-child clinics (WCCs, 438 samples), 11 day-care centres (DCCs, 440 samples), and 7 elementary schools (ESs, 504 samples). S. pneumoniae was identi®ed by standard methods and serogrouped/serotyped using Pneumotest kits (Statens Serum Institute, Denmark). All isolates were screened for penicillin susceptibility using 1 lg oxacillin disks and penicillin minimal inhibitory concentrations (MIC) were detected by the penicillin E test. Penicillin-resistant isolates were tested for other antibiotics. Median age ( SD) of participants at WCCs was 6.0 months (10 days±24 months); at DCCs, 5 years (2±6 years); and at ESs, 8 years (7±10 years). S. pneumoniae carriage was detected in 118 (8.5%) of subjects. Of 118 S. pneumoniae isolates, 34 (28.8%) were resistant to penicillin. Carriage rate for penicillin-resistant Pneumococcus (PRSP) was 1.1% in WCCs, 3.6% in DCCs, and 2.6% in ESs. A total of 91 (77%) of 118 pneumococcal isolates were typable with the available antisera. Serogroups 6 (24%), 23 (21%), 19 (19%) and 9 (11%), comprised 75% of typable pneumococcal isolates. Of 34 PRSP isolates, 32 (94%) were typable. Serogroups 6 (28%), 23 (28%), 19 (17%), and 9 (12%) comprised 85% of all typable PRSP isolates. Serotypes 1, 4, 5, and serogroup 18 were not found at all. The 7, 9, and 11-valent conjugate pneumococcal vaccines covered 59%, 59%, and 65% of all S. pneumoniae isolates and 82%, 82%, and 88% of PRSP isolates, respectively. MIC of PRSP isolates were between 0.05 and 1.0 lg/ml. None of the isolates had a MIC>2.0 lg/ml. Cross-resistance to trimethoprim-sulfamethoxazole, tetracycline, erythromycin, chloramphenicol, and cipro¯oxacin was detected in 85%, 62%, 18%, 18%, and 3% of PRSP isolates, respectively. All PRSP isolates were susceptible to ceftriaxone and rifampicin. However, 23 (68%) of the PRSP isolates were resistant to two or more dierent classes of antibiotics in addition to penicillin. Of multi-resistant isolates, 87% were covered by the heptavalent vaccine.The carriage rate of Pneumococcus was low in our study, similar to that found in Italy [2] and Russia [1]. The rate of penicillin resistance was not as high as in other European countries. An adequate level of serogroup coverage of currently licensed conjugated pneumococcal vaccines for the most frequent circulating and multiple-resistant pneumococcal isolates may be expected in Turkish children.

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