Successful transcatheter coil embolizations of complex pulmonary arteriovenous fistulas: the first case in Thailand.

Successful transcatheter coil embolizations of the left lower lobe pulmonary arteriovenous fistulas, the first case in Thailand, in a 6-year-old boy presenting with increased cyanosis was reported. Transcatheter management of unusual sites of right-to-left intrapulmonary shunting can provide gratifying clinical improvement in some children.

Serological response to respiratory syncytial virus infection in pediatric patients with a comparison to immunofluorescence and virus isolation.

The serological response to respiratory syncytial virus (RSV) in 125 pediatric patients hospitalized with acute lower respiratory infection was investigated by enzyme linked immunosorbent assay (ELISA) for specific immunoglobulin (Ig) A, IgG, and IgM and complement fixation (CF) test. By ELISA, a 4-fold rise in IgG titre in paired sera was most commonly found, followed by a rise in IgA and IgM titres. Investigation by ELISA and CF leads to the suggestion that major CF activity against RSV antigens resides in the IgG and not the IgA and IgM classes. No case with CF activity failed to be diagnosed by ELISA. The youngest infant who could develop seroconversion was one month old, nevertheless two children older than two years could not. When the three diagnostic methods were compared, ELISA serology was the most sensitive followed by indirect immunofluorescence (IIF) for antigen detection and virus isolation, respectively, ELISA could diagnose RSV infection in 45% of the study cases, whereas IIF and virus isolation only diagnosed 26% and 14%, respectively. Half of the cases was diagnosed by all of the three methods together.

Incidence of Mycoplasma pneumoniae, Chlamydia trachomatis, and viral infections in pneumonia cases under six months of age, Bangkok, Thailand.

The incidence of infections by Mycoplasma pneumoniae, Chlamydia trachomatis and respiratory viruses was investigated in 76 pneumonic patients aged under 6 months who attended Ramathibodi and Siriraj Hospitals in Bangkok during two study periods. M. pneumoniae infection was not found in any case from either hospital by serological diagnosis. By the isolation method, C. trachomatis infection was found in 7(16.7%) of 42 patients from Ramathibodi Hospital and 5(21.7%) of 23 patients from Siriraj Hospital with the average male:female ratio of 2.6:1; and 91.7% of the infected cases were under 3 months old. Laboratory diagnosis of respiratory virus infection was performed by indirect immunofluorescence (IIF), isolation, and by antibody detection. Data from Ramathibodi Hospital showed that 11 (24.4%), 4 (8.9%), 3 (6.7%) of the 45 patients were infected by respiratory syncytial virus (RSV), adenoviruses, parainfluenza virus type 3, and some other viruses, respectively; infection rates of 10 (32.3%), 4 (12.9%), 1 (3.2%) and 1 (3.2%) by those viruses respectively, were observed in the 31 patients from Siriraj Hospital.

Sinusitis in Thai asthmatic children.

The radiographic appearance of sinuses was studied in 146 Thai asthmatic patients aged 1-13 years. Forty-eight percent of cases showed sinusitis by the radiographic criteria. The maxillary sinus was most commonly involved (98.6%). Thirty-three percent had ethmoidal sinusitis and 7% of those with developed frontal sinuses had frontal sinusitis. Thirty-three percent had more than one sinus involved. Those with frontal sinusitis always had maxillary and/or ethmoidal involvement. Sixteen cases had signs and symptoms of sinusitis and all of the cases had the radiographic appearance of sinusitis. There was no correlation between the occurrence of sinusitis and duration or severity of asthma. There was no difference in the occurrence of sinusitis between those with or without allergic rhinitis. No correlation between severity of sinusitis and age of patients was observed.

Urticaria in Thai children.

In this study, 142 patients under 12 years of age with the diagnosis of urticaria accompanied or not by angioedema were examined. In all 72.6% of the patients were under 6 years of age. Boys and girls were equally affected, 13.4% of the cases had chronic urticaria, 56.3% had a previous history of urticaria, 88.0% had generalized urticaria, and about half of the cases had associated angioedema. The causes of the urticaria were identified or suspected in 32.4% of the cases. Drugs, foods, insect bites and stings, infections and cold were the most common or associated precipitating agents in that order. Histories revealed 27.5% of the cases had records of other allergic diseases, and 76.1% had allergic diseases in the family. Dermographisms were found in 16.2% of the cases, and 22.5% of cases had eosinophilia. The means of IgE levels in both acute and chronic urticaria were within normal limits, and there was no statistically significant difference between the two groups. Skin testing was of little practical value in evaluating the etiology of the urticaria. Clinical trials of drugs for symptomatic treatment revealed that clemastine, ketotifen and hydroxyzine gave approximately equally high response rates. All these three medications gave significantly greater response rates than chlorpheniramine.

Electrocardiographic study in asthmatic children.

Electrocardiograms of 105 asthmatic children, three to 12 years old, divided into four groups according to their severity and stages of attack, were studied. The significant abnormal findings were abnormal P wave, QRS axis, R and S waves which suggested right atrial and right ventricular overload. Deep q waves in leads II, III and a VF indicated a large initial vector to the right and were found in some cases of status asthmaticus. ST-T change may be non-specific. These abnormalities were increased in the more symptomatic cases.

Diagnostic significance of pH, lactic acid dehydrogenase, lactate and glucose in pleural fluid.

The pH, lactic acid dehydrogenase, lactate and glucose of pleural fluid simultaneous with serum lactic acid dehydrogenase, blood lactate and glucose were determined in 105 pediatric patients. The patients were classified into groups according to the diagnosis. The pleural fluid of empyema cases was found to have the lowest pH with a mean value of 6.83 (p less than 0.0075). The malignant pleural fluid has a relatively low pH with a mean value of 7.32. The lactic acid dehydrogenase in pleural fluid of empyema cases has the highest mean of 1,470.68 (p less than 0.05). The lactic acid dehydrogenase was found increased in malignancy, tuberculosis and parapneumonic effusion cases. Lactate level was found extremely high in empyema cases with a mean value of 13.68. It was also found extremely high in malignancy, tuberculosis and parapneumonic effusion cases. The glucose level was markedly decreased in empyema cases. There exists correlation of pleural fluid lactate to pH, lactic acid dehydrogenase and glucose, as well as that of pH to lactic acid dehydrogenase.