An increasing rate of occurrence of bile duct cyst is reported in adults. Type IV cysts are more frequent in adults than children. Presentation tends to be non-specific abdominal discomfort. Related hepatobiliary or pancreatic disease frequently precedes recognition, and may complicate the postoperative course. Surgical treatment aims to relieve complications deriving from the cysts and to reduce the significant risk of malignant change within the biliary tree. Complete cyst resection, cholecystectomy and Roux-en-Y hepaticojejunostomy reconstruction is standard. Controversy exists about the role of hepatic resection in type IV and V cysts, and the role of minimally invasive and laparoscopic treatment. In general, the outcome is good and a near-zero mortality rate has been reported in institutional series over the past decade.

Children with severe wheezing during the first year of life and subsequent recurrent wheezing are characterized by a normal or high eosinophil count in response to viral infections.

Fluticasone propionate is a synthetic steroid for use by the inhaled route. It's high topical potency and low systemic bioavailability make it suitable for use in asthmatic children. A total of 258 children were randomised in a double-blind study to receive fluticasone propionate (50 micrograms bd) as the dry powder formulation inhaled via a Diskhaler inhaler, or matched placebo (with current therapy) for 4 weeks throughout which time diary cards were completed. During clinic visits lung function and adrenal function were measured. Fluticasone propionate produced a significantly greater increase in morning peak expiratory flow rate (PEFR) (adjusted mean difference over days 1-28, 17 l/min (95% CI; 10, 24); P < 0.001) and evening PEFR (adjusted mean difference over days 1-28, 16 l/min (95% CI; 9, 23); P < 0.001). In addition, diary card symptom scores, beta 2-agonist rescue and clinic lung function improved significantly on fluticasone propionate. There were few adverse events and basal plasma cortisol remained within the normal range. In conclusion fluticasone propionate at 50 micrograms bd is superior to placebo (current therapy) in the treatment of childhood asthma with no evidence of adverse effects.

Havnen, J., Amlie, P. A., Hvatum, M., Oseid, S., Veggan, T., and Aas, K. (1973). Archives of Disease in Childhood, 48, 850. IgE concentrations in allergic asthma in children. Serum concentrations of immunoglobulin E (IgE) were determined in 197 children, aged 2 to 16 years, with bronchial asthma. 47% of the children had raised concentrations of IgE in serum. Patients hypersensitive to two or more allergens showed a higher incidence of raised IgE in serum (52%) than those reacting to only one allergen (23%), whereas only 1 of the 10 children in whom allergy investigation proved negative had raised serum IgE. In children where bronchial asthma was the only atopic disease, the incidence of raised serum IgE was low (14%), whereas high incidences (58-84%) were found when atopic dermatitis, urticaria, and gastrointestinal allergy occurred in addition to bronchial asthma. Patients with food allergy had a higher incidence of raised serum IgE than the total group of patients with allergic bronchial asthma. No significant difference in serum IgE concentrations was found in children subjected to hyposensitization therapy as compared with those who had not received such treatment.It is concluded that serum IgE determination is a valuable diagnostic tool in distinguishing between allergic and nonallergic asthma in selected cases, when it is used as a supplement to a thorough allergy investigation.There is now ample evidence that the reaginic antibody responsible for the immediate hypersensitivity type of human allergy belongs to immunoglobulin E (IgE) in most, if not all, instances