Spontaneous perirenal urinoma associated with ureteropelvic junction obstruction in a child: a case report.

We report a case of a 10-year-old Taiwanese boy with a perinephric urinoma, whose health had previously been good, but who experienced a sudden onset of severe Left flank pain. Radiological examination revealed ureteropelvic junction obstruction with grade IV hydronephrosis and perinephric urinoma of the left kidney. ercutaneous drainagewas performed successfully to relieve these symptoms. ication of congenital obstruction of the urinary tract, and it following renal trauma.

Nasal nitric oxide in infants before and after extubation.

The endogenous production of nitric oxide (NO) in the upper airways is known to be high, but reports of the exact level vary, especially in newborn infants. Currently there is still no standard methodology for nasal NO measurements in neonates. In this study, we compared the levels of NO from the nasal cavity, and from the lower respiratory tracts in intubated infants together with the differences in nasal NO before and after extubation. A total of 35 intubated infants were enrolled in the study. The sampling was conducted with a fast-response chemoluminescence analyzer using the on-line tidal breathing techniques. The levels of NO in the nasal cavity were sampled using two different methods, namely nasal catheterization (Group 1), and nasal occlusion (Group 2). In both groups, the NO levels in the nasal cavity were found to be significantly higher than in the lower airway (P < 0.001). After extubation, the concentration of nasal NO in Group 1 was found to be significantly lower than before extubation (P < 0.05). There was no difference found between the levels of nasal NO in Group 2 before and after extubation (P = 0.95). Generally speaking, the concentrations of nasal NO in Group 2 were significantly higher than in Group 1 after extubation (P < 0.05). For the sample that used nasal occlusion, the nasal NO levels were more stable before and after extubation and the concentration was not affected by the breathing pattern or crying. The infants were more comfortable as well. We therefore conclude that nasal occlusion is a better method for measuring the levels of nasal NO in infants and neonates.

A decremental PEEP trial for determining open-lung PEEP in a rabbit model of acute lung injury.

A positive end-expiratory pressure (PEEP) above the lower inflection point (LIP) of the pressure-volume curve has been thought necessary to maintain recruited lung volume in acute lung injury (ALI). We used a strategy to identify the level of open-lung PEEP (OLP) by detecting the maximum tidal compliance during a decremental PEEP trial (DPT). We performed a randomized controlled study to compare the effect of the OLP to PEEP above LIP and zero PEEP on pulmonary mechanics, gas exchange, hemodynamic change, and lung injury in 26 rabbits with ALI. After recruitment maneuver, the lavage-injured rabbits received DPTs to identify the OLP. Animals were randomized to receive volume controlled ventilation with either: (a) PEEP = 0 cm H2O (ZEEP); (b) PEEP = 2 cm H2O above OLP (OLP + 2); or (c) PEEP = 2 cm H2O above LIP (LIP + 2). Peak inspiratory pressure and mean airway pressure were recorded and arterial blood gases were analyzed every 30 min. Mean blood pressure and heart rate were monitored continuously. Lung injury severity was assessed by lung wet/dry weight ratio. Animals in OLP + 2 group had less lung injury as well as relatively better compliance, more stable pH, and less hypercapnia compared to the LIP + 2 and ZEEP groups. We concluded that setting PEEP according to the OLP identified by DPTs is an effective method to attenuate lung injury. This strategy could be used as an indicator for optimal PEEP. The approach is simple and noninvasive and may be of clinical interest.

Endogenous nitric oxide in the nasal airways of healthy term newborn infants in Taiwan.

BACKGROUND: Nitric oxide (NO) in the respiratory tract is an important regulator of pulmonary homeostasis during the perinatal transition. In humans, much of the nitric oxide is derived from the upper airways, and autoinhalation of nasal NO has been suggested to influence pulmonary function. No standard methods for measuring nasal NO in neonates currently exist, and previous studies have reported varying levels of nasal nitric oxide in infants, due to the different measuring methods used. The use of nasal olives with a central lumen placed securely in the nares was recommended as a standardized procedure for the measurement of nasal NO in adults and children in 1999. We attempted to establish a safe, convenient and practical method for measuring nasal NO in healthy newborn infants, and investigated possible correlations between nasal NO and gender, postnatal age, gestational age, birth weight, and the differences between the right and left nostrils. METHODS: Nasal NO was studied in healthy newborn infants within the first 3 postnatal days. Gas was sampled from the nostril, and NO concentrations were determined using a fast response chemiluminescence analyzer. Each newborn infant underwent NO measurements on the first, second and the third postnatal days. Ninety-one newborn infants completed the study. RESULTS: Peak nasal NO in 91 newborn infants was 42.52 +/- 16.82 (mean +/- SD) parts per billion (ppb) (right nostril) and 40.86 +/- 16.08 ppb (left nostril) on the first postnatal day, 48.75 +/- 17.64 ppb (right nostril) and 49.47 +/- 17.26 ppb (left nostril) on the second postnatal day, and 59.65 +/- 19.72 ppb (right nostril) and 59.29 +/- 20.09 ppb (left nostril) on the third postnatal day. Nasal NO increased significantly with postnatal age (p < 0.001). There were no significant differences in nasal nitric oxide between sexes, or in relation to gestational age or birth weight, or between left or right nostrils. CONCLUSION: We conclude that nasal NO increased significantly in the first 3 days of life.

Determinants of airleak flow during humming V high-frequency oscillatory ventilation in an open-compartment ex-vivo model of airleak.

High-frequency oscillatory ventilation (HFOV) using small tidal volumes and maintaining sufficient end-expiratory lung volume may be beneficial in the treatment of airleak. However, few published guidelines exist to advise clinicians on appropriate ventilator settings in this clinical scenario. The present experiment aimed to determine the effect of frequency, stroke volume (SV) and mean airway pressure (MAP) on airleak from an isolated lung model ventilated with a Humming V HFOV. We performed a crossover non-randomized experiment using the repeated measurement method to test the hypothesis that MAP is the major determinate for airleak. The lungs of 13 healthy juvenile New Zealand white rabbits were isolated and ventilated with high peak pressure to create airleak. The dataset obtained was analyzed using the generalized estimating equation method. We found that airleak flow did not change as frequency was raised from 13 to 17 Hz (P = 0.463) with MAP and SV kept constant. SV was positively correlated to the amount of change in airleak (P < 0.01, coefficients +/- SEM = 1.2 +/- 0.1 ml/min/ml). Leakage flow increased significantly from 275 +/- 168 ml/min to 1,721 +/- 552 ml/min as MAP was increased from 5 cm H(2)O to 30 cm H(2)O (P < 0.001, coefficients +/- SEM = 56.1 +/- 3.0 ml/min/cm H(2)O) while inspiratory flow increased less and amplitude pressure remained about the same. We concluded that MAP (lung volume) was the main independent factor for airleak, whilst SV (tidal volume) exerted a lesser effect. Within the operational range of the Humming V, frequency did not affect airleak.