ABSTRACT
The clinical data of 50 children with tracheal bronchus, 35 males and 15 females with a mean age of 1.3 months (9 days to 10 years), diagnosed by bronchoscopy in the First Affiliated Hospital of Xiamen University from July 2017 to September 2021 were collected, including gender, age, symptoms, signs, bronchoscopy manifestations, imaging manifestations, associated diseases, and outcomes. There were 26 cases (52%) of severe pneumonia, 14 cases (28%) of recurrent wheezing, 8 cases (16%) of recurrent cough, and 2 cases (4%) of foreign bodies. The clinical symptoms were cough in 45 cases (90%), phlegm in 37 cases (74%), asthma in 28 cases (56%), and fever in 25 cases (50%). The physical signs were wet rale in 33 cases (66%), dry rale in 24 cases (48%), shortness of breath in 23 cases (46%), and triple concave sign in 21 cases (42%). The site of occurrence of tracheal bronchi was the right wall of the lower segment of the trachea. All 50 patients underwent complete pulmonary imaging examinations, but the presence of tracheal bronchus was reported in only 3 cases (6%). There were 24 cases (48%) with other types of tracheal malformations, including 9 cases (18%) of single malacia, 6 cases (12%) of single tracheal stenosis, 1 case (2%) of external tracheal compression, and 8 cases (16%) of multiple tracheal malformations. There were other underlying diseases in 27 cases (54%), congenital heart disease was the most common (17 cases, 34%), followed by premature infants (9 cases, 18%). In addition, there were 3 cases (6%) of chromosomal diseases, esophageal atresia, tracheoesophageal fistula, and polydactyly. All children were discharged after anti-infection and bronchoscopy alveolar lavage. It is suggested that tracheobronchial malformation can cause infection, as well as other tracheal deformities such as tracheal softening and stenosis.
ABSTRACT
Objective:To explore the feasibility and safety of long-term home mechanical ventilation(HMV) in children with chronic respiratory failure.Methods:Clinical data of 11 children with chronic respiratory failure, who underwent HMV with the care of the First Affiliated Hospital of Xiamen University from January 2013 to December 2019, were retrospectively reviewed. The clinical manifestation, growth and development, quality of life, adverse events and prognosis of HMV children were analyzed.Results:There were 8 boys and 3 girls with the onset age of 26 days to 13 years old; and the age at starting HMV was 3 months to 13 years old. Eight children were diagnosed as neuromuscular diseases, and 3 children were diagnosed as respiratory diseases. The duration of institutional mechanical ventilation was 2 weeks to 8 months. Six patients underwent invasive HMV via a tracheostomy, and 5 received non-invasive ventilation via nasal and face masks. Bi-level positive airway pressure ventilation mode was applied in all the patients. The duration of HMV was 3 months to 27 months. During follow-up, no HMV related adverse events were observed. Both the quality of life and nutritional status were improved in all cases. One patient lost follow-up 9 months later and 1 patient died of severe adenovirus pneumonia during hospitalization for examination, the remaining 9 cases survived. Liberation from HMV was obtained in 4 patients. The frequency of readmission was 1 to 2 times.Conclusion:It is suggested that long-term HMV is safe and feasible for children with chronic respiratory failure.
ABSTRACT
Severe pneumonia is a common respiratory disease in pediatric intensive care unit(PICU). Airway lesions can be observed and specimens can be obtained by bronchoscopy to help to diagnose the cause and pathogen of severe pneumonia.For severe pneumonia, bronchoscopy interventional therapy is mainly used to relieve airway obstruction, remove necrosis material in the airway, and administer locally.In addition, bronchoscopy can guide tracheal intubation in the rescue of severe pneumonia.In conclusion, bronchoscopy is used in children with severe pneumonia in PICU, which can improve the diagnosis rate, improve the function of ventilation, and shorten the hospitalization time.It is worthy of clinical promotion and application.
ABSTRACT
Objective:To compare the clinical characteristics of Mycoplasma pneumoniae pneumonia and adenoviral pneumonia in children. Methods:Clinical data of 151 children with pneumonia admitted to our hospital from January 2019 to June 2019 were retrospectively analyzed, including 106 cases of Mycoplasma pneumoniae pneumonia (MP group) and 45 cases of adenoviral pneumonia (ADV group). The general conditions, clinical manifestations, laboratory results, pulmonary imaging, proportion of severe cases, respiratory support style and length of hospital stay were compared between two groups. Results:The MP group had shorter fever time compared to the ADV group ( t=15.910, P<0.01); and the maximum temperature in the MP group was lower than the ADV group ( Z=3.561, P<0.01). In the comparison of shortness of breath, wet rales in the lungs, tri-concave sign, hypoxemia, the differences were all significant between two groups (χ 2=11.203, 6.807, 36.746, 21.177, all P<0.01). The WBC in the MP group was lower than that in the ADV group ( t=33.960, P<0.01); the PCT, IL-6, LDH and 25-(OH) D 3 levels in the MP group were lower than those in the ADV group ( Z=5.986, 3.146, 4.203, 2.094, all P<0.05); while there was no significant difference in CRP levels between two groups ( Z=1.360, P>0.05). Pulmonary imaging in the MP group mainly involved unilateral lung, and the ADV group mainly involved bilateral lungs (χ 2=27.055, P<0.01). There was no significant difference in pulmonary patchy exudation between two groups(χ 2=0.298, P>0.05). There were 30 patients (28.3%) with severe pneumonia in MP group and 33 patients (73.3%) in the ADV group ( t=26.345, P<0.01). Twelve patients (11.3%) in the MP group were given non-invasive respiratory support, 1 patient (0.9%) was given invasive respiratory support; while 31 patients (68.9%) were given non-invasive respiratory support in the ADV group, and 5 patients (11.1%) were given invasive respiratory support (χ 2=66.439, P<0.01). The MP group had shorter hospital stays than ADV group ( t=31.014, P<0.01). Conclusion:The conditions of disease are more severe, and length of hospital stay is longer in children with adenoviral pneumonia than those with Mycoplasma pneumoniae pneumonia.
ABSTRACT
Severe pneumonia is a common respiratory disease in pediatric intensive care unit(PICU). Airway lesions can be observed and specimens can be obtained by bronchoscopy to help to diagnose the cause and pathogen of severe pneumonia.For severe pneumonia, bronchoscopy interventional therapy is mainly used to relieve airway obstruction, remove necrosis material in the airway, and administer locally.In addition, bronchoscopy can guide tracheal intubation in the rescue of severe pneumonia.In conclusion, bronchoscopy is used in children with severe pneumonia in PICU, which can improve the diagnosis rate, improve the function of ventilation, and shorten the hospitalization time.It is worthy of clinical promotion and application.
ABSTRACT
Objective@#To review children′s primary ciliary dyskinesia (PCD) in the pathogenesis, clinical manifestation, diagnosis and treatment.@*Method@#To summarize and analyze the clinical data of a patient who was admitted to the first affiliated hospital of Xiamen University with primary ciliary dyskinesia in April 2014 while referring to related literature.@*Result@#An 11 years old boy, weighting about 22 kg, had a course of more than 10 years with repeated cough, stuffy and runny nose shortly after the birth. Examinations after admission to hospital showed that he presented with visible clubbing, bilateral paranasal sinus area tenderness, pharynx posterior wall with visible yellow pussy stuff drip and bilateral lung had scattered wet rales. Auxiliary examination revealed bilateral maxillary sinus, ethmoid sinus inflammation and bronchitis with left lower lung bronchiectasis. Fiberoptic bronchoscopy discovered congestion and a lot of sputum; ciliary biopsy pathology displayed that cilia were sparse and partial cilia 9+ 2 microtubules structural abnormalities. Full sequence of exon gene sequencing revealed two mutations located at chromosome 16 chr16: 71061369 (non-coding regions) and chr16: 70993591 (coding). Two novel mutations m. 3362A>G(E20) and c. 6101G>A(E39) in exon 16 of the HYDIN gene were identified. With the" ciliary motility disorder, gene" as keywords , the CNKI, Wanfang digital knowledge service platform and PubMed were searched for relevant articles from the establishment to July 2016. The studies retrieved included 9 cases and these cases were summarized. Comprehensive analysis showed that HYDIN gene mutations related PCD patients had the typical PCD performance such as repeatedly wet cough, sinusitis, bronchiectasis, and otitis media. The majority of patients have a history of acute respiratory distress syndrome in infancy and no visceral dislocation was not found. Most of the patients had no obvious structural abnormalities in cilia electron microscopic examination.@*Conclusion@#The PCD patients with HYDIN genes mutations have clinical manifestations such as sinusitis, otitis media, bronchiectasis but without transposition of viscera. Cilia structure can be normal under the electron microscopic examination in some of patients.
ABSTRACT
<p><b>OBJECTIVE</b>To analyze the clinical manifestations of refractory Mycoplasma pneumoniae pneumonia (RMPP) which unresponded to methylprednisolone in the dosage of 2 mg/(kg·d) for 3 days.</p><p><b>METHOD</b>Retrospective analysis was performed on the clinical data of 110 children (64 boys and 46 girls) with RMPP. The patients were divided into "effective group" and "ineffective group" according to initial effect of 2 mg/(kg·d) methylprednisolone. The clinical manifestations, laboratory examination, radiological features and bronchofibroscopic findings of the children were compared. In order to seek the reference indexes which indicate nonresponsive to 2 mg/(kg·d) methylprednisolone, an ROC curve was made, of which the diagnostic cut-off was five independent correlation factors while grouping was made according to patients' different response to glucocorticosteroid.</p><p><b>RESULT</b>The effective group had 86 (86/110, 78.2%) children while ineffective group had 24 (24/110, 21.8%). The ineffective group children had the following performance: 16 children (16/24, 66.7%) in ineffective group had ultrahyperpyrexia (T ≥ 40 °C), which was significantly more severe compared to those in effective group (32/86, 37.3%, P < 0.01); the levels of white blood cell (WBC) count, percentage of neutrophils count (N), C-reactive protein (CRP), serum ferritin (SF), alanine transaminase (ALT), lactic dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB) and fibrinogen (Fib) in ineffective group were significantly higher than those in effective group(P < 0.01); while percentage of lymphocyte count (L) was lower than that in effective group(P < 0.01). Proportion of mixed infection in ineffective group was higher than that in effective group (33.3% vs. 4.7%). Radiological manifestations: It was more frequently seen in ineffective group that chest CT scan indicated high density consolidation in no less than a whole pulmonary lobe and pulmonary necrosis (41.7% vs. 0%). Abundant secretions blockage (45.0% vs. 16.9%) and mucosal necrosis (37.5% vs. 8.1%) on bronchofibroscopy were more frequently seen in ineffective group. The critical values of the five independent correlation factors were CRP 110 mg/L, SF 328 mg/L, LDH 478 IU/L, N 0.78, L 0.13.</p><p><b>CONCLUSION</b>Treatment with 2 mg/(kg·d) methylprednisolone can improve clinical symptoms and radiological manifestations of most children with RMPP quickly, but it may be ineffective in some situations such as lasting high fever or ultrahyperpyrexia for more than 7 days, CRP ≥ 110 mg/L, N ≥ 0.78, L ≤ 0.13, serum LDH ≥ 478 IU/L, SF ≥ 328 µg/L, chest CT scan indicating high density consolidation in more than a whole pulmonary lobe involved and moderate-abundant pleural effusion.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Adrenal Cortex Hormones , Therapeutic Uses , Anti-Bacterial Agents , Therapeutic Uses , Bacterial Infections , Drug Therapy , Epidemiology , C-Reactive Protein , Coinfection , Ferritins , Blood , Fever , Diagnosis , Drug Therapy , Infusions, Intravenous , Leukocyte Count , Lung , Diagnostic Imaging , Pathology , Methylprednisolone , Therapeutic Uses , Mycoplasma pneumoniae , Pneumonia, Mycoplasma , Blood , Diagnosis , Drug Therapy , Radiography, Thoracic , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Objective To explore the therapeutic value of bronchoscopy in pediatric status asthmaticus.Methods A total of 16 children with status asthmaticus received standard medical therapies (therapy group) from January 2008 to August 2010 in pediatric intensive care unit (PICU) at First Hospital,Xiamen University.However,l0 of them underwent fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) (bronchoscopy group) along with standard medical therapies from September 2010 to July 2012.The values of oxygenation index (PaO2/FiO2),arterial partial pressure of carbon dioxide (PaCO2),blood oxygen saturation (SaO2),heart rate (HR),respiratory rate (RR) within 1 hour before bronchoscopy procedure,within 6 hour post procedure and within 24 hour post procedure were observed.The extinction time of wheezing sound,PICU length of stay and admission length of stay were observed between therapy and bronchoscopy groups.Results Bronchoscopies revealed a lot of thick mucus plugs and secretions.Large airways were lavaged for clearance of obstructive secretions with normal saline.Within BAL fluid counts of the bronchoscopy group,there were neutrophilia (n =8),eosinophilia (n =4) and neutrophilia/ eosinophilia (n =3).Within BAL fluid cultivation of the bronchoscopy group,4 patients had positive results for Streptococcus pneumoniae (n =2),Pseudomonas aeruginosa (n =1) and Staphylococcus aureus (n =1).In bronchoscopy group,the values of PaO/FiO2,PaCO2,SaO2,HR and RR were 319 ± 19,(40 ±4) mm Hg(1 mm Hg =0.133 kPa),(92.6 ± 1.5) ％,(128 ± 12) rates/min and (35 ± 4) breaths/min within 6 hour post procedure versus 255 ± 24,(54 ± 5) mm Hg,(89.2 ± 2.6) ％,(148 ± 10) rates/min and(50 ± 6)breaths/min within I hour before procedure (P ＜ 0.01).At 24 hour post procedure,the values of PaO2/FiO2,PaCO2,SaO2,HR,RR for bronchoscopy group were 354 ± 21,(40 ± 3) mm Hg,(93.4 ±1.1)％,(125±9)rates/min and(34 ±3)breaths/min versus 317 ±21,(46 ±4)mm Hg,(90.1±2.5) ％,(138 ± 8) rates/min and (43 ± 3) breaths/min respectively for therapy group (P ＜ 0.01).The extinction time of wheezing sound was (67 ± 22) hours for bronchoscopy group vs.(98 ± 23) hours for therapy group(P ＜ 0.01).The mean PICU length of stay was (1.6 ± 0.7) days for bronchoscopy group vs.(2.6 ± 0.7) days for therapy group (P ＜ 0.01).The mean admission length of stay was (5.0 ± 0.7) days for bronchoscopy group vs.(6.6 ± 1.2) days for therapy group(P ＜ 0.01).All patients for bronchoscopy group tolerated the procedure without any complications.Conclusion As a safe adjunctive therapy in pediatric status asthmaticus,flexible bronchoscopy with bronchial lavage may reduce the admission and PICU length of stay and alleviate clinical symptoms.
ABSTRACT
The nerve growth factor(NGF) belongs to the neurotrophin family, comes from many immune cells and lung resident cells, and regulates the functions of many immune cells. Recent studies suggest that NGF may play an important role in the pathogenesis of bronchial asthma. In this review, we will provide information about NGF in the airways, describe its expression and regulation, and point out its potential role in inflammation,hyperresponsiveness, and remodelling process observed in asthma.