Aerosol Inhalation of Yanhuning for Injection in the Adjuvant Treatment of Children Respiratory System In-fections:A Systematic Review / 中国药房

OBJECTIVE:To systematically review the efficacy and safety of the aerosol inhalation of Yanhuning for injection in adjuvant treatment of children respiratory system infections,and provide evidence-based basis for the administration way of off-label drug use in clinic. METHODS:Retrieved from PubMed,Science direct,EMBase,CHKD,VIP and Wanfang Database, randomized controlled trials(RCT)or quasi-randomized controlled trials(qRCT)about the aerosol inhalation of Yanhuning for in-jection in adjuvant treatment of children respiratory system infections were collected. Meta-analysis was performed by using Rev Man 5.3 software after data extraction and quality evaluation. RESULTS:Totally 11 RCTs were enrolled,involving 982 patients. Results of Meta-analysis showed,the aerosol inhalation of Yanhuning for injection in adjuvant treatment of children respiratory sys-tem infections can significantly improve the clinical total effective rate [OR=4.47,95%CI(2.80,7.16),P<0.001],shorten breath shortness duration [MD=-2.05,95%CI(-2.86,-1.24),P<0.001],cough duration [MD=-1.73,95%CI(-2.34,-1.13),P<0.001] and pulmonary rales duration [MD=-2.13,95%CI(-3.38,-0.89),P<0.001],reduce the hospitalization days [MD=-2.38, 95%CI(-2.86,-1.89),P<0.001],and not increase the incidence of adverse reactions [OR=0.65,95%CI(0.21,2.00),P=0.45], nor shorten the fever duration[MD=-1.18,95%CI(-2.58,0.22),P=0.10]. CONCLUSIONS:The aerosol inhalation of Yanhun-ing for injection can improve the clinical efficacy in adjuvant treatment of children respiratory system infection,it helps to improve respiratory symptoms in children and does not increase the incidence of adverse reactions.

Three-year Follow-up of Niemann-Pick Disease with Pulmonary Involvement: A Case Report

Niemann-Pick disease is a rare inherited metabolic storage disease that causes excessive intracellular storage of sphingomyelin in various organs. We present the pulmonary imaging findings with particular emphasis on the CT findings in a case of Niemann-Pick disease type B with pulmonary involvement. The chest radiograph showed fine reticulonodular opacities in both basal lung fields, and the high-resolution chest CT showed centrilobular nodular opacities and smooth thickening of the interlobar fissure and interlobular septum with a basal lung predominance. Coronal reformatted CT revealed a prominent interlobular septal thickening around the diaphragm. The follow-up high-resolution chest CT showed no significant interval changes over a 3-years period.

Small Airway Disease after Mycoplasma Pneumonia in Children: HRCT Findings and Correlation with Radiographic Findings

PURPOSE: To assess the high-resolution CT (HRCT) findings of small airway abnormalities after mycoplasma pneumonia and correlate them with the findings of chest radiography performed during the acute and follow-up phases of the condition. MATERIALS AND METHODS: We retrospectively evaluated HRCT and chest radiographic findings of 18 patients with clinical diagnosis of small airway disease after mycoplasma pneumonia (M:F=8:10, mean age: 8.3 years, mean time interval after the initial infection; 26 months). We evaluated the lung parenchymal and bronchial abnormalities on HRCT (n=18). In addition, presence of air-trapping was assessed on expiratory scans (n=13). The findings of HRCT were correlated with those of chest radiography performed during the acute phase of initial infection (n=15) and at the time of CT examination (n=18), respectively. RESULTS: HRCT revealed lung parenchymal abnormalities in 13 patients (72%). A mosaic pattern of lung attenuation was noted in ten patients (10/18, 56%), and air-trapping on expiratory scans was observed in nine (9/13, 69%). In nine of 14 (64%) with negative findings at follow-up chest radiography, one or both of the above parenchymal abnormalities was observed at HRCT. In four patients (27%), parenchymal abnormalities were seen at HRCT in areas considered normal at acute-phase chest radiography. Bronchiectasis or ateclectasis was observed in eight (44%) and four (22%) patients, respectively, at HRCT. The CT features of Swyer-James syndrome such as a unilateral hyperlucent lung with reduced lung volume and attenuated vessels were noted in two patients (11%). CONCLUSION: HRCT can clearly demonstrate lung parenchymal and bronchial abnormalities of small airway disease after mycoplasma pneumonia in children.

Mucopolysaccharidosis: Abnormal Findings on Abdomen and Chest Excluding Musculoskeletal System

PURPOSE: Mucopolysaccharidosis (MPS) is a lysosomal storage disease that causes tissue distortion and dysfunction due to the infiltration of mucopolysaccharide in connective tissue. The purpose of this study was to evaluate the characteristic findings of abdominal CT and plain chest radiography in patients with MPS. MATERIALS AND METHODS: Sixty-two children with MPS diagnosed by urine analysis were involved in this study; 24 of these underwent abdominal CT and the findings were reviewed by two radiologists, who reached a consensus. Organomegaly was classified as severe, moderate or mild. On chest PA radiographs of 42 of the children, the transverse diameter of the trachea was measured and compared with that of 42 normal controls. Student's t test was used for statistical analysis. RESUTLS: At abdominal CT, hepatomegaly was observed in 22 patients (92%; 2 severe, 15 moderate and 5 mild); and splenomegaly was present in 18 (75%; 2 severe, 4 moderate and 12 mild). Among eight patients (33%) with pancreatic enlargement, one had a severly enlarged pancreas, while in the remaining seven, enlargement was mild. Also present were inguinal hernia (n=15), umbilical hernia (n=12), undulation with thickening of the diaphragmatic crura (n=10), abnormalities related to the male genitalia (n=5) and vascular anomaly (n=3). In MPS patients, the mid-point diameter of the trachea (range, 5.6-9 mm; mean, 6.9 mm) was significantly less than in normal controls (range, 8-14 mm; mean, 10.8 mm) (p<0.001). CONCLUSION: An awareness of the characteristic abnormalities observed at abdominal CT and chest PA radiography can lead to a better understanding of MPS in children.

Radiologic Findings of Childhood Lower Respiratory Tract Infection by Influenza Virus

PURPOSE: After the RS (respiratory syncytial) virus, the influenza virus is the most common cause of childhood lower respiratory tract infection. We assessed the radiologic findings of childhood lower respiratory tract infection by the influenza virus. MATERIALS AND METHODS: A total of 105 pediatric patients (76 males and 29 females; mean age, 2.4 years) with symptoms of respiratory tract infection were examined between March 1997 and April 2000. Nasopharyngeal aspirates were obtained and influenza virus infection was confirmed by direct or indirect immunofluorescent assays. Peribronchial infiltration, hyperinflation, atelectasis, pulmonary consolidation, and hilar lymphadenopathy were evaluated retrospectively at simple chest radiography. RESULTS: Bilateral perihilar peribronchial infiltration was noted in 78.1% of patients (n=82), hyperinflation in 63.8% (n=67), atelectasis in 3.8% (n=4; segmental 50%, lobar 50%), and pulmonary consolidation in 16.2% [n=17; segmental 70.6% (n=12), lobar 29.4% (n=5)]. Hilar lymphadenopathy was noted in one patient in whom there was no pleural effusion, and subglottic airway narrowing in 12 of 14 in whom the croup symptom complex was present. CONCLUSION: The major radiologic findings of influenza virus infection were bilateral perihilar peribronchial infiltration and hyperinflation. In some patients, upper respiratory tract infection was combined with subgolttic airway narrowing. Atelectasis or pleural effusion was rare.

HRCT Findings of Asthmatic Children under Maintenance Therapy

PURPOSE: The purpose of this study was to evaluate the HRCT findings of bronchial asthma during maintenance bronchodilator therapy and to determine whether there were irreversible bronchial changes occurred in pediatric patients with this condition. MATERIALS AND METHODS: HRCT findings of the lung in 21 asthmatic children [14 boys and 7 girls aged between 3.5 and 13.8 (mean : 7.7) years] who were receiving maintenance bronchodilator therapy were retrospectively studied. At the time of CT examination, 16 were receiving nonsteroid bronchodilator therapy only, and five were receiving both bronchodilator and steroid therapy. Thirteen patients were defined as allergic and eight were nonallergic. The clinical severity of chronic asthma was graded as severe in seven cases, and moderate in 14. The duration of the disease ranged from 4 months to 6 years (mean 3.2 years). HRCT was performed in 19 cases for evalvation of the atelectasis, hyperinflation, and prominent bronchovascular bundles seen on plain radiographs, and in two cases for evaluation following acute exacerbation. A CT W-2000 scanner (Hitachi Medical Co. Tokyo, Japan) was used during the end inspiratory phase, and in addition, ten patients were scanned during the expiratory phase. Scans were reviewed for evidence of bronchial thickening, bronchiectasis, emphysema, abnormal density, mucus plugs, and other morphological abnormalities. The presence of bronchial wall thickening or air trapping was evaluated according to the duration, severity and type of asthma. RESULTS: Among the 21 patients, 7(33.3%) had normal HRCT findings, while in 14 (66.7%), bronchial wall thickening was demonstrated. Eleven of the 14 patients with bronchial wall thickening (78.6%) also had air trapping. No patient was suffering from bronchiectasis or emphysema. There were no statistically significant correlations between the presence of bronchial wall thickening or air trapping and the duration of the disease, its severity, or type of asthma. There was, however, a statistically significant correlation between bronchial wall thickening and air trapping (p < . 0 5 ). CONCLUSION: In asthmatic children who were under maintenance therapy, the most frequent HRCT findings were bronchial wall thickening and air trapping, with significant correlation between the presence of these two phenomena. No destructive lesion such as bronchiectasis or emphysema was found in these asthmatic children, however, and this is probably due to the short duration of the disease, and different disease processes.

Late Lung Parenchymal Changes on HRCT in Children with mycoplasma Pneumonia

PURPOSE: To evaluate late lung parenchymal change, as seen on high-resolution CT(HRCT) in children with mycoplasma pneumonia MATERIALS AND METHODS: Twenty-three patients [15 boys and 8 girls aged two to 13 (mean, 6) years] with mycoplasma pneumonia underwent HRCT four to 39 (mean, 10) months after initial infection. Using increased mycoplasma antibody titer(> 1:640) mycoplasma pneumonia was diagnosed, and patients were divided into two groups : high titer group (antibody titer>1: 5120), and lower titer group (<1:5120). CT scans were performed using 2mm collimation and 5-10mm interval from apex to diaphragm. In seven patients who were cooperative, both inspiratory and expiratory scans were obtained at a window width of 1600 HU and level of -700. HRCT findings of mosaic low attenuations and changes in bronchioles and bronchial walls were assessed by three radiologists and correlated with initial chest radiographic findings. RESULTS: On HRCT, 17 of 23 patients (74 %) demonstrated abnormal findings. These included mosaic attenuation of lung density alone in 11 of 17 patients (65%), mosaic attenuation associated with bronchiectasis in five ( 29 %), and bronchiectasis only in one (6 %). Mosaic attenuation was more accentuated on expiratory scans than on inspiratory. These findings were obtained in 10 of 12 high titer group and in 7 of 11 in the lower titer group. In 15 of 23 patients (65 %), involved ageas seen on HRCT exactly corresponded with initially involved areas seen on chest radiographs (CXR). Two patients in whom findings on initial CXR were normal showed mosaic attenuation on HRCT. Six patients in whom such findings were abnormal showed normal findings on HRCT, a fact which reflected their complete recovery. CONCLUSION: The most common late parenchymal change in mycoplasma pneumonia, as seen on HRCT, was mosaic attenuation of lung density followed by bronchiectasis. The latter is presumably due to bronchiolitis obliterans, a well-known complication. We believe that HRCT is very useful for the evaluation of long-term sequelae of mycoplasma pneumonia in children.

Lung parenchymal change after the resolution of Adenovirus Pneumonia: Chest Radiographs and High-resolution CTfindings

PURPOSE: To evaluate lung parenchymal change as seen on chest radiographs and high-resolution CT (HRCT) afterthe resolution of adenovirus pneumonia (a common cause of lower respiratory infection in infants and children),and the usefulness of HRCT during follow-up. MATERIAL AND METHODS: Four to 13(mean, 8) months after recovery, tenpatients infected with adenovirus pneumonia underwent HRCT and chest radiographs. Eight were boys and two weregirls, and their mean age was 26(range, 14-45) monthes. Adenovirus pneumonia had been confirmed by viral isolationin culture or serologic test. CT scanning was performed during quiet breathing ; collimation was 2mm and theinterval from apex to diaphragm was 5-10mm. Lung settings were 1600 HU (window width) and -700 HU(level). CTfindings were assessed and compared with chest radiographs by two chest radiologists, who reached a consensus. Thepatients were clinically followed up for one year. RESULT: On chest radiographs, hyperlucent lung was seen in 8of 10 patients (80%) ; in one other there was partial collapse, and in one, findings were normal. The most commonHRCT finding was a mosaic pattern of lung attenuation with decreased pulmonary vascularity in the area of lowerattenuation ; this was seen in 8 of 10 patients (80%). Other findingss were partial collapse, bronchiectasis, andbronchial wall thickening, each seen in two patients, and reticulonodular density, seen in one. In two patientsHRCT findings were normal ; in one of these, chest findings were noraml but a mosaic pattern of lung attenuationwas found in all lobes. During follow-up, three patients wheezed continously. CONCLUSION: In cases of adenoviruspneumonia, HRCT demonstrated more specific parenchymal change than did chest radiographs ; a mosaic pattern oflung attenuation was seen, with decreased pulmonary vascularity in areas of lower attenuation ; bronchiectasis,bronchial wall thickening, and reticulo-odular density were also noted. These findings were presumably due tobronchiolitis obliterans, a well known complication of adenovirus pneumonia, and are prognostically helpful.

Radiologic Features of Lower Respiratory Tract Infections Assocciated with Adenovirus in Children

PURPOSE: To describe the radiologic features of lower respiratory infections associated with adenovirus inchildren and to determine whether these can be differentiated from other lower respiratory infections. MATERIALS AND METHODS: We retrospectively reviewed the radiologic features of 48 lower respiratory tract infectionsassociated with adenovirus in children and diagnosed between December 1990 and August 1996 at Seoul NationalUniversity Children's Hospital. Adenovirus was identified by either viral culture or immunofluorescent staining ofnasal aspirates and/or pleural fluid, and serotested by microneutralization. They were divided into three groups,as follows: type 7 epidemic infection (group I); type 3 sporadic infection (group II); and other(types 1, 2, 4,5, 6) sporadic infection (group III). Each radiological finding was tested for differences among three groups withFisher's exact test. RESULTS: The major radiologic features of adenoviral lower respiratory infection(n=48) werebilateral parahilar peribronchial infiltration(90%), hyperaeration(73%), consolidation(58%), atelectasis(56%) andpleural effusion (31%). In group I(n=27), II(n=8), and III(n=13), bilateral parahilar peribronchialinfiltration(93%, 88%, 85%, respectively), hyperaeration(63%, 88%, 85%), atelectasis(52%, 38%, 77%), pulmonaryconsolidation(81%, 63%, 8%) and pleural effusion(44%, 38%, 0%) were seen. In groups I and II, pulmonaryconsolidation was multiple(82%, 80%, respectively), bilateral(55%, 60%), or extensive(36%, 40%). The prevalence ofconsolidation and pleural effusion in groups Iand II was significantly higher than in group III(p < .05). CONCLUSION: Pulmonary consolidation and pleural effusion, regarded as characteristics of bacterial pneumonia,were common findings in types 7 and 3 adenovirus infections. Parahilar peribronchial infiltration, hyperaeration,and bilateral, multiple, extensive consolidation may be features which can determine whether an infection isadenoviral or due to bacterial pneumonia.

Mycoplasma Pneumonia in Children: Radiographic Pattern Analysis and Difference in Resolution

PURPOSE: By analysing frequency and disease progression, this study aimed to investigate and predict the prognosis of mycoplasma pneumonia according to radiographic pattern. MATERIALS AND METHODS: We retrospectively reviewed plain chest radiographs of 230 patients in whom mycoplasm pneumonia had been serologically confirmed.Their age ranged from two months to 14 years and two months, and 203(88.3%) were younger than eight years. Radiographic patterns were classified as air space consolidation, bronchopneumonic, interstitial pneumonic ordiffuse mixed infiltrating type. The radiologic resolution period for each type was analysed by the resolution of symptoms and normalization of radiologic findings. RESULTS: The bronchopneumonic type, which was the most common, was seen in 82 patients (35.6%), airspace consolidation in 58 (25.2%), interstitial in 55 (23.9%), and diffuse mixedin 22 (9.57%). In thirteen patients (5.7%), chest radiographs were normal, though the clinical and radiologic resolution period for each type was variable. The mean resolution period of the air space consolidation type was 14.5 days, bronchopneumonic, 7.6 days ; interstitial, 10.5 days, and diffuse mixed, 15.6 days. The airspace consolidation type needed the longest recovery period, exceeded only by the diffuse mixed type. CONCLUSION: The bronchopneumonic type was the most common radiographic pattern of mycoplasma pneumonia. The prognosis of the airspace consolidation type seems to be poorest, since this required the longest recovery period.

CT fo Pulmonary Tuberculosis in Children

This paper illustrates the spectrum of CT findigns of pulmonary tuberculosis in children and shows the advantages and complementary nature of CT compared with conventional radiography. Common CT manifestations of pulmonary tuberculosis in children are mediastinal or hilar lymphadenopathy, air-space consolidation, atelectasis and disseminated nodules. CT is useful in the detection of the disease in equivocal chest radiographs, in the characterization of lesions, by demonstrating caseation necrotic areas, calcification and bronchogenic spread nodules, and in defining the extent of the disease and its complications. This in formation will be helpful in the diagnosis and evaluation of tuberculosis in children.