Laryngeal papillomatosis presenting as acute airway obstruction in a child.

Upper airway obstruction, regardless of cause, can masquerade or be misdiagnosed as lower airway disease in children. In such cases, therapeutic trials of antibiotics, bronchodilators, and over-the-counter medications for symptom relief routinely fail; however, the original diagnosis often goes unchallenged. If the obstructive process is progressive, then acute occlusion of the airway may occur, rapidly leading to suffocation and death if resuscitation is unsuccessful. Outlined in this report is the case of a young female with a history of asthma, poorly responsive to outpatient treatment, who presented with respiratory arrest. The cause of the respiratory collapse was later identified as a large laryngeal papilloma, a condition rarely encountered by emergency physicians.

Changes in blood pressure and dipsogenic responsiveness to angiotensin II during chronic exposure of rats to cold.

Hypertension accompanies chronic exposure of rats to cold (5-6 degrees C). Systolic, diastolic, and mean blood pressures become elevated, and hypertrophy of the heart occurs. A previous study from this laboratory suggested that the renin-angiotensin system may play a role. The present study was carried out to assess this further. Thus, in addition to measurement of systolic blood pressure at intervals during exposure to cold, plasma renin activity and the dipsogenic responsiveness to acute administration of angiotensin II were also measured to assess the functional status of the renin-angiotensin system. The results showed a significant (p less than 0.05) increase in systolic blood pressure during the third week of exposure to cold. In contrast, plasma renin activity (PRA) increased within the first week of exposure to cold, and declined thereafter to reach the level of the control by the third week of exposure to cold. By the fourth week, PRA decreased to a level significantly (p less than 0.05) below that of the control group. The responsiveness to acute administration of angiotensin II (AII), as assessed by the drinking response, increased significantly (p less than 0.05) by the third week of exposure to cold and remained significantly elevated during the fourth week. There was a significant (p less than 0.01) direct relationship between dipsogenic responsiveness to AII and blood pressure in the cold-treated (r = .57), but not the control group (r = .12). There was also a significant (r = -.91) indirect linear relationship between PRA and dipsogenic responsiveness to AII. Cold-treated rats had significant increases in urinary norepinephrine output and weights of heart, kidneys, adrenals, and brown adipose tissue characteristic of rats acclimated to cold.(ABSTRACT TRUNCATED AT 250 WORDS)