Lung development.

The development of the human lung starts at 4 weeks of gestation with the appearance of the tracheal outgrowth from the foregut and continues into early childhood. Survival at birth is dependent on adequate development and maturation of the lung in utero. Abnormal bronchopulmonary development results in congenital lung malformations, and inadequate development is thought to contribute to bronchopulmonary dysplasia. Complex processes and factors influencing lung development are beginning to be elucidated, and further knowledge will hopefully lead to improved interventions to enhance outcomes in vulnerable or affected infants.

Is the grass greener? A survey of female pediatric surgeons in the United Kingdom.

BACKGROUND/PURPOSE: Since 1990, at least 50% of UK medical school entrants have been females, although women comprise only 2% of surgical consultants. If women continue to reject surgical careers, recruitment will be limited to a decreasing pool of male applicants. A recent North American study suggested lack of mentorship and role models may be contributory factors. We undertook a survey of UK female pediatric surgeons to ascertain career satisfaction and professional development. METHODS: UK female pediatric surgeons were identified from the British Association of Pediatric Surgeons members' handbook 2004 and via personal communication. Postal or e-mail questionnaires were sent and anonymized responses were analyzed. RESULTS: Thirty-three questionnaires were distributed to all 16 female consultants (13% of BAPS consultant workforce) and 17 trainees (SpRs [specialist registrars/higher surgical trainees]). Twenty-seven (82%) replies were received. Of 27 (85%) respondents, 23 worked full time; "on-call" commitments range from 1 in 2 (2 consultants) to 1 in 8, with several trainees working shifts. Eighteen (67%) respondents had taken a career break-11 for maternity leave. Twelve (44%) are planning further "time-out," of whom 10 are SpRs. Ninety-three percent are contented with their career and would choose pediatric surgery again. However, 19 (70%) reported factors that had hindered their development, 13 (68%) included insufficient research time, whereas only 3 cited a lack of mentorship. CONCLUSIONS: Female representation in medicine is increasing. In contrast to North American experience, very few UK female pediatric surgeons felt hampered by lack of mentorship or role models. Education and training committees need to work proactively to ensure training programs achieve clinical excellence to continue to attract women into pediatric surgery. For women in the United Kingdom, pediatric surgery challenges will also be met by ensuring healthy "work-life balance," along with flexibility in training and established consultant practice.

Developing rat lung has a sided pacemaker region for morphogenesis-related airway peristalsis.

Prenatal airways from diverse species are capable of spontaneous peristaltic contractions in each trimester. The function of this smooth muscle activity is unknown. We demonstrate that peristalsis of the embryonic airway originates from a sided pacemaker focus, is stimulated in a calcium-dependent fashion by the pulmonary morphogen fibroblast growth factor-10 (FGF-10), and appears coupled to lung growth. Airway peristalsis may be crucial for lung development (thereby providing a physiologic role for airway smooth muscle) and play a hitherto unanticipated role in reported transgenic mutant lung phenotypes.

Octreotide for treatment of chylothorax after repair of congenital diaphragmatic hernia.

Chylothorax is a recognized cause of morbidity after repair of congenital diaphragmatic hernia (CDH). Management may include prolonged hospitalization with cessation of enteral feedings, repeated aspiration, chest tube drainage, total parenteral nutrition, and introduction of a medium chain triglyceride (MCT) diet as the effusion resolves. The authors report that the successful deployment of octreotide, a somatostatin analogue, hastened resolution of a postoperative chylothorax in a newborn infant with CDH.

Congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is a lethal human birth defect. Hypoplastic lung development is the leading contributor to its 30-50% mortality rate. Efforts to improve survival have focused on fetal surgery, advances in intensive care and elective delivery at specialist centres following in utero diagnosis. The impact of abnormal lung development on affected infants has stimulated research into the developmental biology of CDH. Traditionally lung hypoplasia has been viewed as a secondary consequence of in utero compression of the fetal lung. Experimental evidence is emerging for a primary defect in lung development in CDH. Culture systems are providing research tools for the study of lung hypoplasia and the investigation of the role of growth factors and signalling pathways. Similarities between the lungs of premature newborns and infants with CDH may indicate a role for antenatal corticosteroids. Further advances in postnatal therapy including permissive hypercapnia and liquid ventilation hold promise. Improvements in our basic scientific understanding of lung development may hold the key to future developments in CDH care.