Differential lung ventilation and venovenous extracorporeal membrane oxygenation for traumatic bronchopleural fistula.

A 16-year-old adolescent boy sustained traumatic bronchopleural fistula, refractory to conventional management, which was treated successfully with differential lung ventilation and extracorporeal membrane oxygenation support. This case highlights a novel approach for managing traumatic bronchopleural fistula in children.

Severe ocular reactions after neonatal ocular prophylaxis with gentamicin ophthalmic ointment.

In this study, we report 4 infants who developed severe ocular reactions after neonatal ocular prophylaxis with gentamicin ophthalmic ointment during a period of erythromycin ophthalmic ointment shortage. In light of this experience, gentamicin ophthalmic ointment should not be used as an alternative for neonatal ocular prophylaxis.

The effect of oral leucine on protein metabolism in adolescents with type 1 diabetes mellitus.

Lack of insulin results in a catabolic state in subjects with insulin-dependent diabetes mellitus which is reversed by insulin treatment. Amino acid supply, especially branched chain amino acids such as leucine, enhances protein synthesis in both animal and human studies. This small study was undertaken to assess the acute effect of supplemental leucine on protein metabolism in adolescents with type 1 diabetes. L-[1-(13)C] Leucine was used to assess whole-body protein metabolism in six adolescent females (16-18 yrs) with type 1 diabetes during consumption of a basal diet (containing 58 µmoles leucine/kg/h) and the basal diet with supplemental leucine (232 µmoles leucine/kg/h). Net leucine balance was significantly higher with supplemental leucine (56.33 ± 12.13 µmoles leucine/kg body weight/hr) than with the basal diet (-11.7 ± -5.91, P < .001) due to reduced protein degradation (49.54 ± 18.80 µmoles leucine/kg body weight/hr) compared to the basal diet (109 ± 13.05, P < .001).

Effect of insulin with oral nutrients on whole-body protein metabolism in growing pubertal children with type 1 diabetes.

Insulin treatment of children with insulin-dependent diabetes mellitus improves whole body protein balance. Our recent study, conducted in pubertal children with type 1 diabetes with provision of both insulin and amino acids, indicated a positive effect of insulin on protein balance, primarily through decreased protein degradation. The current study was undertaken to assess the effect of insulin on protein metabolism in adolescents with type 1 diabetes during oral provision of a complete diet. Whole-body protein metabolism in six pubertal children (13-17 y) with type 1 diabetes mellitus was assessed with L-[1-13C]leucine during a basal (insulin-withdrawn) period and during infusion of 0.15 U/kg/h regular insulin with hourly meals to meet protein and energy requirements. Net leucine balance was significantly higher with insulin and nutrients (13.1 +/- 6.3 micromol leucine/kg/h) than in the basal state (-21.4 +/- 2.8, p < 0.01) with protein degradation decreased from 138 +/- 5.6 mumol leucine/kg/h to 108 +/- 5.9 (p < 0.01) and no significant change in protein synthesis. Even with an ample supply of nutrients, insulin does not increase whole-body protein synthesis in pubertal children with type 1 diabetes mellitus and positive protein balance is solely due to a substantial reduction in the rate at which protein is degraded.