Dynamic thoracoplasty for asphyxiating thoracic dystrophy.

The life-saving procedures to expand the chests of infants born with Jeune asphyxiating thoracic dystrophy provide a static solution incapable of responding to the growth demands of thriving patients. We describe an instrument that provided a dynamic solution for an infant, where an initial methyl methacrylate midsternotomy spacer placed at 4 months of age was followed at 11 months with recurrence of his difficulties. At 8 months after the second operation the patient was stable and thriving with no recurrence of symptoms. The instrument modifications, limitations, and possible complications are described.

Foreign body retrieval in children with respiratory symptoms and no history of aspiration.

To asses the role of bronchoscopy and its yield in children with respiratory symptoms and no typical history of radiological evidence of foreign body aspiration (FBA), we reviewed the records of all patients who underwent bronchoscopy at our institution between 1985 and 1995 and had no history of choking, witnessed FBA or clear radiological evidence of FBA (N = 54, age range 4 months to 16 years). These were subdivided into two subgroups, those with positive bronchoscopy, and those with negative bronchoscopy. Respiratory symptoms and their duration, signs and radiological findings did not differ in both subgroups.

Transient hypertrophic cardiomyopathy in the newborn following multiple doses of antenatal corticosteroids.

Postnatal exposure to steroids has been associated with hypertrophic cardiomyopathy (HCM) in the newborn. Such an effect has not been described in infants born to mothers who received antenatal steroids. We report three newborns whose mothers were treated with betamethasone prenatally in different doses, duration of time, and who developed various degrees of HCM diagnosed by echocardiography. There was no maternal evidence of diabetes except for one infant whose mother had a normal fasting and post-prandial blood glucose prior to steroid therapy, but an abnormal one hour postprandial glucose after 8 weeks of betamethasone therapy, with a normal HbA1 C level. There was no family history of HCM, no history of maternal intake of other relevant medications, and no hypertension in all three newborns. Follow-up echocardiography revealed complete resolution of the HCM changes in all infants. We suggest that repeated antenatal maternal steroid intake may cause changes of HCM in the newborn. These changes appear to be dose- and duration-related and are mostly reversible. Further prospective controlled studies to evaluate these observations and to investigate potential mechanisms are warranted.

Relationship of dietary intake to DDE residues in breast milk of nursing mothers in Beirut.

Milk samples were collected from 32 nursing mothers living in the Beirut area, Lebanon. Dietary intakes of participating mothers were obtained from data of their diet histories, 24 h dietary recalls and food frequency questionnaires. Milk samples were screened for the presence of organochlorine pesticide residues and DDE levels were estimated using gas chromatographic techniques. The relationship between consumption of various food groups and DDE content of milk was investigated. A positive correlation was found between the consumption of either/or high fat meat, tuna fish and DDE levels in milk. Consumption of poultry products showed a weak correlation with DDE content of milk, whereas consumption of vegetable oils showed a negative correlation.

Prevalence of allergic diseases in children in Beirut: comparison to worldwide data.

OBJECTIVE: To report on the prevalence of allergic rhinitis and atopic eczema in school children in Beirut, Lebanon, and compare the prevalence rates of allergic diseases in Beirut to the rest of the world. SUBJECTS AND METHODS: A random sample of school children aged 13-14 years completed the ISAAC written and video questionnaires. Data was entered using a special program prepared by ISAAC and analyzed using SPSS version 6.0. RESULTS: The prevalence rates of allergic rhinitis and rhinoconjunctivitis were 25.5% and 15.9% respectively. Atopic eczema was more common among males, with a total prevalence rate of 11%. CONCLUSION: The prevalence rates of allergic diseases in childhood was along the 50th percentile worldwide. The prevalence rates of uncontrolled asthma was very high while that of allergic rhinitis was low as compared to the rest of the world.

Recommendations for the school health physical examination in Lebanon.

School health developed gradually over the years; starting with efforts to keep contagion out of schools to global programs of comprehensive services. One of its components, school medicine, covers screening examinations, record maintenance, emergency care, immunization monitoring and health counseling. This paper proposes the essential health activities to be performed during a screening school examination in Lebanon. The recommendations are based on a combination of international literature review of evidence and the existence of Lebanese epidemiological reports identifying specific problems. Vaccination record review, tuberculin testing, vision, hearing, dental and skin disorders screening procedures are proposed as essential activities of the school physical examination.

Prevalence of asthma and asthma symptoms in children in urban Lebanon.

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Post immunization Hib antigen detection in the CSF of a patient with meningococcal meningitis.

We report a case of meningococcal meningitis where the cerebrospinal fluid was negative for Neisseria meningitidis but positive for Haemophilus influenzae type b by rapid antigen detection test. We believe that this was due to prior immunization with Haemophilus influenzae type b vaccine. We recommend caution in interpretation of the rapid antigen detection tests especially in patients who had been vaccinated against organisms screened by these tests.