Cellular and noncellular components of bronchoalveolar lavage fluid in HIV-1-infected children with radiological evidence of interstitial lung damage.

Children with acquired immune deficiency syndrome (AIDS) commonly have recurrent infectious and noninfectious lung complications that ultimately end in death. To study the intensity of alveolar inflammation and to evaluate the clinical utility of bronchoalveolar lavage (BAL) in children with HIV-1 infections, we retrospectively analyzed differential cell counts, lymphocyte subsets, and fibronectin and hyaluronic acid concentrations in BAL fluid of 18 HIV-1-positive children (9 boys, mean age 3.5 years, range 5 months-8 years) with radiological evidence of interstitial lung disease, and 19 control children who had undergone BAL for clinical indications not involving the lung parenchyma (13 boys, mean age 3 years, range 2 months-14 years). BAL fluid from 89% of the HIV-1 infected children showed CD8+ve lymphocytic alveolitis expressing HLA-DR, CD54, and CD 69 antigens. BAL fluid from HIV-infected patients typically contained markedly increased percentages and numbers of lymphocytes (P < 0.0001) and eosinophils (P < 0.04) and significantly higher concentrations of albumin (P < 0.05) and fibronectin (P < 0.0006) than fluids from control children. Whereas BAL cellular components did not differ in P. carinii-positive and P. carinii-negative HIV-1-infected children, fibronectin concentrations were significantly higher in P. carinii-positive than negative children. BAL cell differentials and noncellular components were related neither to severity of disease nor to patients' disease progression. These findings indicate that BAL is useful in studying the intensity of lung inflammation in children with HIV-1 infections and radiologically documented interstitial lung disease, but provides no information on the subsequent clinical course.

Idiopathic esophagopleural fistula in the newborn. A review, with a case report.

Idiopathic rupture of the esophagus in the neonate is a rare event, probably related to the same mechanism of ischemic necrosis responsible for other "spontaneous" g.i. tract perforations in the newborn. The laceration is usually located on the right aspect of the distal esophagus and is complicated by esophagopleural fistula and hydropneumothorax. Plain chest film and esophagography are diagnostic. The condition is an emergency one and usually carries a bad prognosis without prompt surgical repair. A typical case is reported in a baby who survived without early surgery; a residual tiny blind pouch and a small hiatal hernia required surgery at 1 year of age.

Persistent esophagotrachea: description of a case.

Esophagotrachea is the most severe form of laryngo-tracheo-esophageal cleft. This congenital anomaly is due to the anomalous differentiation of the primitive cephalic gut into trachea and esophagus. We present a case of a new born female with a common tracheoesophageal canal up to the carina. Atresia ani, a vulvo-vestibular fistula, sacral ipoplasia and others associated anomalies were also present. The baby underwent surgery after a laringo-tracheoscopy and a barium study of the esophagus. The prognosis of this extremely rare malformation is generally poor and the baby died on the fifth day after surgery for a serious ipertensive pneumothorax.

Management of primary megaureter in infancy.

The natural history of primary megaureter was evaluated in 26 infants (20 boys, 6 girls) with 38 nonrefluxing primary megaureters. Prenatal ultrasound diagnosis had been made in 21 infants. In all patients, primary megaureter was associated with pelvicaliceal dilatation. Two patients with urinary tract infection and two with agenesis of the contralateral kidney underwent surgical treatment. Asymptomatic infants with good differential renal function on DTPA scanning were managed conservatively regardless of their postfurosemide drainage curve. One of these infants later developed a slight deterioration in function and was submitted to surgery. One patient was lost to follow-up. Twenty patients, after a period ranging from 4 months to 8 years, showed partial or complete regression of ureteral dilatation with stable good renal function. In conclusion, many asymptomatic primary megaureters in infancy improve spontaneously and do not require surgical treatment.

[High resolution computerized tomography in cystic fibrosis. Clinico-radiologic correlations in 25 patients]. / La tomografia computerizzata ad alta risoluzione nella fibrosi cistica. Correlazioni clinico-radiologiche in 25 pazienti.

Twenty five patients with a clinical and radiological diagnosis of cystic fibrosis underwent high resolution Computed Tomography (HRCT) with the aim to study pulmonary parenchymal localization of disease. Both patients with initial pulmonary alterations and patients in a more advanced phase of the disease were studied. HRCT proved an excellent method for detecting very early lesions such as bronchiolar ectasia and bronchiolar obstruction by mucous accumulation. Moreover, HRCT proved to be very useful in detecting centrolobular and panlobular parenchymal lesions, with diagnostic information on axial and peripheral interlobular connective tissue. HRCT provided a better spatial definition of bronchiectasia and subpleural air if compared to conventional radiology. It also allowed for correct diagnosis of pneumothorax and detection of pleural fibrosis as a result of iatrogenic complications.

[Osteomyelitis and arthritis caused by Streptococcus group B in a 40-day-old boy]. / Osteomielite ed artrite causate da streptococco di gruppo B in un bambino di 40 giorni di vita.

Group B streptococci (GBS) have gained much attention in recent years as a cause of serious infection in the newborn. Traditionally two clinical syndromes have been defined as "early onset", with fulminant septicemia, pneumonia and meningitis, and "late onset", with a mild meningitis. More recently some previously unrecognized clinical presentations of GBS disease have been documented. These include asymptomatic bacteremia, septic arthritis, osteomyelitis, ethmoiditis with orbital cellulitis, pneumoniae with empyema, conjunctivitis. The literature to date reports 30 instances of osteomyelitis due to GBS. This report describes a forty days infant with a group B streptococcal osteomyelitis of the proximal humerus. Has been also emphasized the increased frequency and the benign clinical course of streptococcal osteomyelitis in the neonate.

Respiratory distress in newborn: evaluation of chest X-rays.

We discuss the anatomic and pathophysiological patterns of preterm and term newborn. Particular attention is directed to technical artefacts relating to the interpretation of chest radiography. We analyze the reading of chest X-Ray of preterm with low birth weight and poor lung maturation. Are also taken into account X-Ray features relating to alveolar "recruitment" and radiographic changes after surfactant's administration. We highlight the most important paintings of bruncopulmonary dysplasia and its evolution. The most frequent neonatal pulmonary inflammation and thoraco-pulmonary malformation, that may affect more the neonatologist, are mentioned. We discuss the new diagnostic approach with non invasive techniques (ultrasound) in the neonatal distress. Some easily recognizable congenital heart disease are finally describes.

Double right tracheal bronchus. A case report in an infant.

An apparently unique case of double right tracheal bronchus supplying the whole right upper lobe is described in a 12-month-old infant presenting with a right paratracheal opacity, persisting cough, and ventricular septal defect. The two tracheal bronchi, initially discovered on tomography, were confirmed by tracheobronchography, which demonstrated also the absence of other upper lobe branches. At surgery, the upper lobe was atelectatic, and its blood supply was abnormal.

Primary gastro-oesophageal reflux disease and irritable oesophagus syndrome as causes of recurrent abdominal pain in children.

Cases of two adolescents with recurrent abdominal pain, localized in the periumbilical area, due to primary oesophageal disorders are reported. Food allergy or intolerance, as well as other paediatric causes, were not involved in the pathogenesis of recurrent abdominal pain in these two patients. Case 1 was affected by primary gastro-oesophageal reflux disease: upper endoscopy with biopsies and oesophageal 24-hour pH-monitoring showed mild oesophagitis and pathological reflux index, respectively. Case 2 was affected by "irritable oesophagus syndrome": upper endoscopy with biopsies was normal and oesophageal 24-hour pH-monitoring showed a close correlation between gastro-oesophageal reflux and recurrent abdominal pain episodes. Both patients were successfully treated with cisapride (0.2 mg/kg t.i.d.) and ranitidine (2.5 mg/KG b.i.d.). These reports suggest that primary gastro-oesophageal reflux disease and irritable oesophagus syndrome may cause recurrent abdominal pain in children.

Delayed gastric emptying in an infant with Sandifer syndrome.

The case of an infant with Sandifer syndrome is reported. Real-time ultrasonography showed delayed gastric emptying time, which returned to normal when the patient was asymptomatic. The importance of gastric motility investigations in Sandifer syndrome is stressed since delayed gastric emptying could play a role in the pathogenesis of this disease.

Integrated diagnostic imaging of primary thoracic rhabdomyosarcoma.

We report a rare case of primary thoracic rhabdomyosarcoma in a girl who was referred with acute chest pain, hacking cough, and wheezing. A chest X-ray revealed a complete opacity of the right hemithorax. Ultrasound revealed a right-sided pleural effusion and a solid mass above the liver dome, suggesting a neoplastic disease, which quickly led to further specific examination. Use of CT and MRI together with bone scintigraphy completed the investigation. The biopsy specimen showed a pattern of alveolar rhabdomyosarcoma. This case was reported to emphasize the role of US in the evaluation of a child with hemithorax opacity.

Respiratory status of infants with esophageal atresia.

In infants with esophageal atresia (EA), lung opacities on a chest radiograph (CXR) are usually considered the cause of respiratory distress (RD). However, in some instances signs of RD and CXR changes show no correlation. The aim of this study was to investigate the pathogenesis of RD in EA patients with a normal CXR. In 41 infants with EA, CXR findings were correlated with clinical manifestations and blood-gas analysis data. The degree of abnormal gas exchange was quantitated by the arterial/alveolar oxygen tension ratio (a-ARO2). Of the 41 infants, 39(95%) presented with RD. No lung opacities were found in 130 of 294 CXRs examined (44%). An a-ARO2 below 0.75 (lower limit of normal) was calculated in 215 of 247 arterial blood samples analyzed (87%). When a temporal correlation was established, RD with a clear CXR was characterized by signs of extra- and intrathoracic airway obstruction, often associated with an a-ARO2 below 0.75. The degree of hypoxemia was greater than the degree of hypercapnia. We conclude that in infants with EA, RD with a clear CXR is related to both tracheomalacia and upper-airway obstruction that may cause miliary atelectasis not detected by conventional CXR with intrapulmonary shunting and hypoxemia.

Primary pulmonary rhabdomyosarcoma in childhood: clinico-biologic features in two cases with review of the literature.

The cases of two children under three years of age with primary pulmonary rhabdomyosarcoma and no associated lung malformations are reported and a review of the literature is presented. In both, complete surgical removal of the tumor was performed and histologic examination revealed embryonal subtype. Flow cytometric assessment showed a tumor-cell diploid DNA content. Postoperative radio- and chemotherapy were carried out, but in spite of treatment both girls died because of disease progression, fourteen and nine months after diagnosis. The importance of associated cystic lung malformations and DNA content in predicting clinical outcome of primary pulmonary rhabdomyosarcoma is evaluated.

Radiological changes of the ileum in children with coeliac disease: is "intestinal adaptation" a specific radiographic sign?

We retrospectively reviewed the radiographic findings of 86 children with chronic diarrhoea and/or short stature. Radiographic small intestine examination showed morphologic changes characteristic for the malabsorption syndrome in 58 children with coeliac disease on a gluten-containing diet. In addition, 32 (55%) of these children showed "intestinal adaptation" or "jejunalization" (increase in the number and thickness of the folds). In the control group (28 children, cross-matched) 11 (39%) presented non specific radiological changes while the others presented a normal mucosal pattern. No features of "intestinal adaptation" were noted. No significant differences between CD patients with and without "intestinal adaptation" were found in the evaluation of the nutritional status, including serum levels of albumin, iron, transferrin, ferritin and zinc, and in the results of the one-hr xylose test and 72-hr faecal fat absorption test, and anti-gliadin antibody levels (IgA and IgG). No significant correlation was noted between the duration of gluten-containing diet and the presence of "intestinal adaptation". It appears that "intestinal adaptation" lends specificity to the radiographic small intestine examination, also in paediatric practice.

[Multiple simultaneous stratigraphy. Results with a 5-plane system for pediatric use]. / Stratigrafia multipla simultanea. Risultati di un sistema a 5 strati per uso pediatrico.

The authors report the results of a five-layer simultaneous multisection tomographic technique to be used in pediatric radiology, based on an appropriately selected series of Trimax rare-earth intensifying screens arranged in progressive speed order. The technique has been so far employed with excellent results in 100 children, especially during IVP, when X-ray examination is very frequently disturbed by ileocolic gas. The many advantages of the technique are emphasized: a) all sections are perfectly parallel and simultaneous, in the same respiratory phase and body position; b) film density is practically identical in all sections; c) there is considerable saving in time, machine consumption, and radiation dose.