Pediatric pulmonary and thoracic aspergillosis.

Aspergillus infection can cause significant disease in an immunocompromised host and lungs are the most common site of infection. Various forms of aspergillus involving lung parenchyma have been described including aspergilloma, allergic bronchopulmonary aspergillosis (ABPA), and semi-invasive and invasive pulmonary aspergillosis (IPA). Pulmonary aspergilloma usually occurs in patients with pre-existing cystic lung diseases. The classic radiographic finding is a discrete, round or oval mass in a pulmonary cavity, which moves with gravity. Allergic bronchopulmonary aspergillosis is characterized by clinical asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen. Central bronchiectasis in patients with asthma is highly suggestive of ABPA. Invasive pulmonary aspergillosis is usually fatal infection in patients taking immunosuppressants. Infection can also spread to other visceral organs. Multiple and solitary nodular densities as well as diffuse or focal consolidation have been reported. CT halo sign and CT hypodense signs are suggestive of IPA. Other forms of thoracic aspergillosis may include pleural aspergillosis, which can cause empyema. Osteomyelitis of the thoracic cage has been reported particularly in association with chronic granulomatous disease. We would like to demonstrate pertinent clinical and radiographic features of pulmonary and thoracic involvement of aspergillosis including radiographic differential diagnoses.

Risk factors of pneumothorax during the first 24 hours of life.

BACKGROUND: Pneumothorax is one of the air leak syndrome and is more common in the newborn period than in any other childhood periods. It can be divided into spontaneous pneumothorax and secondary pneumothorax from underlying lung pathology or assisted ventilation. Pneumothorax results in longer hospital stays and even deaths in some cases. To date, there are few studies that focus on identifying risk factors of pneumothorax. We conducted this study to ascertain risk factors for pneumothorax, in order to create a guideline to prevent this condition. MATERIAL AND METHOD: This is a retrospective case-control study. Cases were infants with the diagnosis of pneumothorax (P25.1 Pneumothorax originating in the perinatal period) between January 2001 and December 2004. Controls were those whose birth times followed in the immediate chronology to the cases. Case: control ratio was 1:2. Univariate analysis was used to compare the two groups. Odds ratio and 95% confidence interval were used to identify possible risk factors. Statistical significance was considered as p < 0.05. RESULTS: There are 44 cases and 88 controls. Risk factors are shown as Odds ratio and 95% confidence interval. Infant factors associated with higher risk of pneumothorax are male (2.6; 1.2, 5.6), low birth weight (19.3; 2.3, 160.2), vacuum extraction (20.9; 1.1, 403.4), meconium-stained amniotic fluid (4.5; 1.8, 11.0), low 1-minute Apgar score (78.3; 4.5, 1357.8), and the administration of bag and mask positive-pressure ventilation (29.0; 3.6, 233.5). Maternal factor associated with higher risk of pneumothorax is poor antenatal care (3.5; 1.04, 11.9). CONCLUSION: All pregnant women should be encouraged to have good antenatal care. Mother who has complication(s) during pregnancy and delivery should receive special care to prevent perinatal depression. For mothers with meconium-stained amniotic fluid, close fetal monitoring and tracheal suction for meconium after delivery should be appropriately considered to prevent meconium aspiration. Finally, neonatal resuscitation, when needed, should be done very carefully by following the American Heart Association and the American Academy of Pediatrics guidelines, especially for bag and mask positive-pressure ventilation.

Imaging findings and prevalence of central precocious puberty at Siriraj Hospital.

Central precocious puberty occurs as a result of premature pituitary stimulation and increased secretion of gonadotropins. The differential diagnosis of true precocious puberty includes cerebral and idiopathic categories. This differentiation, which cannot be made endocrinologically due to similarities in pituitary gonadotropin and sex steroid levels, may facilitatic by Magnetic Resonance Imaging (MRI) of the brain. Objective: To analyze MR imaging findings and incidence of each pathology in central precocious puberty, and to compare pituitary height in patients with central precocious puberty with patients in a control group. Materials and methods: A retrospective study of central precocious puberty in 22 patients was performed from March 2002 to July 2003. The control group consisted of 54 boys and 46 girls. Analyzed parameter included pituitary height, shape and posterior bright spot. The shape was assessed by a pituitary grading system which was based on the concavity of the upper pituitary surface (grade 1 = marked concavity, grade 2 = mild concavity, grade 3 = flat, grade 4 = mild convexity, grade 5 = marked convexity). Bone age, and pelvic ultrasonography were evaluated in the study group. Results: Twenty two children with central precocious puberty (4 boys and 18 girls) were divided into two subgroup according to MRI findings as follows : idiopathic 15 patients (68.18%) and noidiopathic 7 patients (3 patients had nodule at pituitary stalk, 2 had microadenoma, 1 had germ cell tumour at pinealgland, and 1 had hypothalamic harmatoma). The mean pituitary height in the study group was 5.59 mm (SD 1.7). The mean height of the control group was 5.25 mm. There was significant difference among the two groups (p < 0.005). Conclusion: The most common cause in central precocious puberty is idiopathic. However the MRI is necessary to necessary to excluding the surgical cause as tumor. Pituitary height of more than 5.25 mm may be a helpful variable for follow up the result of medical treatment in precocious children.