Decreased incidence of extra-alveolar air leakage or death prior to air leakage in high versus low rate positive pressure ventilation: results of a randomised seven-centre trial in preterm infants.

Two different ventilation techniques were compared in a seven-centre, randomised trial with 181 preterm infants up to and including 32 completed weeks gestational age, who needed mechanical ventilation because of lung disease of any type. Technique A used a constant rate (60 cycles/min), inspiratory time (IT) (0.33s) and inspiratory: expiratory ratio (I:E) (1:2). The tidal and minute volume was only changed by varying peak inspiratory pressure until weaning via continuous positive airway pressure. Technique B used a lower rate (30 cycles/min) with longer IT (1.0 s). The I:E ratio could be changed from 1:1 to 2:1 in case of hypoxaemia. Chest X-rays taken at fixed intervals were evaluated by a paediatric radiologist and a neonatologist unaware of the type of ventilation used in the patients. A reduction of at least 20% in extra-alveolar air leakage (EAL) or death prior to EAL was supposed in infants ventilated by method A. A sequential design was used to test this hypothesis. The null hypothesis was rejected (P = 0.05) when the 22nd untied pair was completed. The largest reduction in EAL (-55%) was observed in the subgroup 31-32 weeks of gestation and none in the most immature group (< 28 weeks). We conclude that in preterm infants requiring mechanical ventilation for any reason of lung insufficiency, ventilation at 60 cycles/min and short IT (0.33 s) significantly reduces EAL or prior death compared with 30 cycles/min and a longer IT of 1 s. We speculate that a further increase in rate and reduction of IT would also lower the risk of barotrauma in the most immature and susceptible infants.

Development of height and weight in children with diabetes mellitus: report on two prospective multicentre studies, one cross-sectional, one longitudinal.

Optimal regimen for insulin therapy should lead to normal longitudinal growth and weight gain in children with diabetes mellitus. However, reports published so far indicate that this goal of paediatric diabetology is currently not achieved in a considerable number of patients. In a cross-sectional sample of 89 children with insulin dependent diabetes mellitus (IDDM) for more than 3 years, we found the relation of height to weight to be significantly different compared to 102 healthy school children of similar age. Using bivariate analysis, body shape in these children with diabetes was shifted towards small and obese (P less than 0.05) compared to control children. We subsequently initiated a longitudinal study and followed children from the onset of diabetes for the following 3 years, recording height, weight and bone age as well as glycosylated haemoglobin and daily insulin requirement. At diagnosis, height SDS was identical in children with IDDM (+0.04 +/- 0.10) compared to control children (-0.07 +/- 0.10; M +/- SE), while weight SDS was -0.26 +/- 0.10 in children with diabetes (controls: + 0.01 +/- 0.01). Bone age was identically retarded in newly diagnosed IDDM children (-0.73 +/- 0.12 SDS) and in our control group of children from the same regional background (-0.50 +/- 0.12; n.s.). In this group of children with diabetes mellitus followed prospectively, height to weight relationship differed from controls after 2 and after 3 years of the disease (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Structural and morphometric analysis of parakeratotic and dyskeratotic cells exfoliated from various vulvar lesions. Correlation with data from cervical cytology.

Smears were taken from the vulvar skin of 123 patients (21 with normal-appearing skin and 12 with dystrophic, 29 with benign, 20 with precancerous and 53 with malignant conditions). In each case, 20 nucleated horny squames with the highest visible degree of abnormality were identified in the smear. The cytoplasmic and nuclear structures of these cells were analyzed, and the cytoplasmic and nuclear perimeters were measured by a graphics tablet (digitizing board) equipped with a camera lucida system. Five cytomorphometric parameters were calculated: cytoplasmic and nuclear areas and shape factors and the relative nuclear area. A stepwise multivariate discriminant analysis was used to evaluate the statistical significance of the parameters. Structurally, the cells from different vulvar conditions did not differ much from each other except in the formation of small cellular projections ("pseudopodia"), which were found significantly more frequently in precancerous and cancerous lesions than in others. Nuclear degeneration was a general finding in all examined cases of all conditions. Morphometric analysis revealed cytoplasmic pleomorphism to be the predominant feature associated with increasing degrees of malignancy. There was no significant increase in the relative nuclear area with increasing malignancy because the cytoplasmic and nuclear areas enlarged almost simultaneously. The cellular features found in nucleated horny cells exfoliated from various vulvar lesions are quite different from the well-known attributes of squamous epithelial cells originating from comparable conditions of the uterine cervix.