Adult respiratory distress syndrome and artificial surfactant replacement in the pediatric patient.

Adult respiratory distress syndrome (ARDS) frequently develops after near-drowning, smoke inhalation, burns, blunt trauma to chest, and overwhelming sepsis. Surfactant depletion, inactivation or destruction by the accumulation of proteinaceous material in the alveoli, and changes in the relative composition of phospholipids or protein component have been associated with ARDS. Artificial surfactant reverses these changes in experimental animals. Seven cases of ARDS have been treated on an experimental basis with artificial surfactant after approval and in accordance with ethical standards of the institution's committee on human experimentation. Informed consent was obtained from parents prior to administering artificial surfactant. We identified five cases of ARDS in retrospective analysis and used them as historical controls. Mortality between these two groups was analyzed with Fisher's exact test. One of seven (14.2%) children treated with surfactant died of overwhelming infection, and 2/5 (40%) of the historical controls died of pulmonary causes (P = 0.523). Statistically, surfactant therapy did not improve survival in patients with ARDS; however, ARDS patients receiving surfactant improved in their pulmonary dynamic compliance and had a tendency to stabilize earlier in gas exchange, allowing us to decrease ventilatory support.

Pediatric fiberoptic video bronchoscopy: the use of computer interfacing.

Conventional video-recordings of pediatric bronchoscopic procedures are routinely performed in many centers. The limitations of conventional video-recordings include an inability to concurrently compare serially recorded images, lack of color fidelity of the displayed image, difficulty in image retrieval of archived video, and the inability to subject the image to mathematical analysis. We describe a computer interface which addresses each of these limitations.

Intrapulmonary agenesis of venous system and bronchopulmonary arterial anastomosis.

Agenesis of the intrapulmonary and extrapulmonary veins of the right lung was found by angiography and histological examination in a three year old boy. Blood supplied by the intersegmental arteries drained via the pulmonary arteries of the right lung into main and left pulmonary arteries. This caused a shunt between the aorta and pulmonary artery. Agenesis of the pulmonary venous system as a cause of left to right shunt has not been reported before.

Lipoid pneumonia in infants: a radiological-pathological study.

A series of nine infants, 2-8 months of age, with a history of animal or vegetable fat intake within 10 days after birth, is presented. The infants developed respiratory problems and failure to thrive. Plain films and computed tomography showed areas of consolidation in the medial-posterior parts of the lungs. The areas of consolidation showed three types of changes at computed tomography. Attenuation measurements did not reveal fat. To establish the diagnosis, fine needle aspiration biopsy, tru-cut biopsy and/or open lung biopsy was done in eight infants and bronchopulmonary lavage in one patient. The pathological findings were an intense lymphocytic infiltration with scattered granulomas which contained lipid deposit.

The role of sigmoidoscopy for asymptomatic patients. Results of three annual screening sigmoidoscopies, polypectomy, and subsequent surveillance colonoscopy in a primary-care setting.

A total of 329 asymptomatic patients (aged 50 or older) underwent flexible sigmoidoscopy to screen for colonic neoplasia. Of these, 258 underwent a second examination after 1 year and 143 underwent a third examination after another year. Of 60 patients in whom polyps were found on one of the three examinations, 58 underwent colonoscopy and polypectomy; 77 adenomatous polyps were present in 39 of these patients. The incidence of adenomatous polyps was 7.9% for the first examination, 3.9% for the second, and 2.1% for the third. Of patients with an index polyp found by sigmoidoscopy, 57.5% had synchronous polyps discovered by colonoscopy. Thirty-six of 77 polyps in 24 patients showed dysplasia; 9 were less than 0.5 cm, 14 were 0.5 cm to 0.9 cm, and 13 were 1 cm or larger. Forty-four surveillance colonoscopies (done after initial colonoscopy and polypectomy) have been performed in 28 patients. Eighteen examinations resulted in finding 30 adenomatous polyps, of which 10 showed dysplasia. This study 1) is the first report of flexible sigmoidoscopy data to support the American Cancer Society recommendation of two serial screening sigmoidoscopies a year apart, 2) reinforces the concept that an index polyp indicates a need for a complete colonoscopy, 3) reinforces the need for ongoing surveillance by colonoscopy after detection of adenomas, and 4) adds to reports of dysplasia in diminutive polyps.

Cystic fibrosis in Saudi Arabia.

Cystic fibrosis (CF) is generally believed to be rare or nonexistent in Saudi Arabia. The aim of this report is to document the occurrence of CF in Saudi Arabia. Thirteen Saudi children were diagnosed as having CF, evidenced by typical clinical features and elevated sweat chloride concentrations (greater than 60 mmol/l). Duration of symptoms prior to diagnosis varied from 1 month-5 years (mean 23 months). The main clinical manifestations of the children were abdominal distention, failure to thrive, steatorrhoea, hepatomegaly, rectal prolapse and recurrent respiratory infections, often with Pseudomonas aeruginosa. In addition, eight patients with symptoms and a family history highly suggestive of CF, but without confirmatory sweat test results are presented. We hope that this report will increase the awareness of CF and ensure an earlier diagnosis of the disease in Saudi Arabia.

Occurrence of the adult respiratory distress syndrome in neutropenic patients.

Neutrophils are believed to play an essential role in the pathogenesis of the adult respiratory distress syndrome (ARDS). This concept is largely based on the observation that neutrophil depletion protects against altered pulmonary vascular permeability in several models of acute lung injury produced in laboratory animals. Four patients who developed ARDS during periods of profound neutropenia are presented. These patients met commonly accepted clinical and roentgenographic criteria for the syndrome, and each had the characteristic findings of diffuse alveolar damage by lung histologic examination. The failure of this degree of neutropenia to protect against ARDS in humans raises questions about whether neutrophils or neutrophil products are essential in the pathogenesis of the syndrome.