ABSTRACT
A congenital diaphragmatic hernia (CDH) occurs when the abdominal contents protrude into the thoracic cavity through an opening in the diaphragm. The main pathology lies in the maldevelopment or defective fusion of the pleuroperitoneal membranes. Delayed diagnosis in later childhood as in the index case reported here can lead to life-threatening complications such as tension gastrothorax and gastric volvulus. Such life-threatening conditions should be managed emergently avoiding misdiagnoses and untoward harm to the patient. We report a pediatric case of an 8-year-old boy who presented with respiratory distress, chest pain, and non-bilious vomiting. He was initially diagnosed with tension pneumothorax, and the chest x-ray was interpreted as hydropneumothorax. A chest tube placement was planned but was withheld due to excessive vomiting. A nasogastric (NG) tube was placed, and a barium-filled radiograph showed an intrathoracic presence of the stomach. A diagnosis of a congenital diaphragmatic hernia with tension gastrothorax was made. The posterolateral (Bochdalek) diaphragmatic hernia was repaired successfully. This case report highlights the importance of including a late-presenting CDH in the differential diagnoses of pediatric patients who present with respiratory distress, chest pain, non-bilious vomiting, and radiological findings suggestive of tension pneumothorax.
ABSTRACT
Hypertension is an unusual finding in premature infants and warrants an extensive workup. Well-known causes of hypertension include endocrine, renal and cardiac anomalies. Coarctation of the thoracic aorta, a well-recognized cardiac anomaly leading to hypertension can manifest at various ages including the newborn period. In contrast, midaortic syndrome (MAS), also known as midaortic dysplastic syndrome, is a rare clinical syndrome involving hypoplasia of the abdominal aorta (AA) 1 with varying degrees of narrowing of the visceral branches, often presenting as intractable hypertension. Though there are case reports describing this condition in older children and adults, the diagnosis of MAS can be extremely difficult in neonates, especially in preterm low-birth-weight infants. We describe a rare case of a premature infant who presented with congestive heart failure in utero and intractable hypertension postnatally. This is the youngest reported case of MAS with autopsy confirmation in the literature.
Subject(s)
Aorta, Abdominal/pathology , Aortic Coarctation/pathology , Heart Failure/etiology , Hydrops Fetalis/etiology , Hypertension/etiology , Infant, Premature, Diseases/pathology , Adult , Angiography , Aorta, Abdominal/physiopathology , Aortic Coarctation/complications , Aortic Coarctation/physiopathology , Fatal Outcome , Female , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/physiopathology , Prenatal Diagnosis , SyndromeABSTRACT
OBJECTIVE: IL-10 is a potent anti-inflammatory cytokine, and IL-10-producing regulatory T cells are effective inhibitors of murine asthmatic responses. This study determined whether IL-10-dependent mechanisms mediated the local inhalational tolerance seen with chronic inhalational exposure to antigen. METHODS: Wildtype and IL-10(-/-) mice were sensitized with ovalbumin (OVA) and then challenged with daily OVA inhalations for 10 days or 6 weeks. RESULTS: The 10-day animals developed allergic airway disease, characterized by BAL eosinophilia, histologic airway inflammation and mucus secretion, methacholine hyperresponsiveness, and OVA-specific IgE production. These changes were more pronounced in IL-10(-/-) mice. The 6-week IL-10(-/-) and wildtype animals both developed inhalational tolerance, with resolution of airway inflammation but persistence of OVA-specific IgE production. CONCLUSION: IL-10 may have anti-inflammatory effects in the acute stage of murine allergic airways disease, but the cytokine does not mediate the development of local inhalational tolerance with chronic antigen exposure.
Subject(s)
Bronchial Hyperreactivity/immunology , Bronchial Hyperreactivity/pathology , Immune Tolerance/immunology , Interleukin-10/metabolism , Ovalbumin/administration & dosage , Ovalbumin/immunology , Acute Disease , Administration, Inhalation , Aerosols , Animals , Bronchial Hyperreactivity/chemically induced , Bronchial Hyperreactivity/metabolism , Chronic Disease , Disease Models, Animal , Disease Progression , Female , Gene Expression Regulation, Developmental , Immunoglobulin E/blood , Inflammation/immunology , Inflammation/metabolism , Inflammation/pathology , Interleukin-10/deficiency , Interleukin-10/genetics , Leukocyte Count , Male , Mice , Mice, KnockoutABSTRACT
OBJECTIVE: To study the impact of neonatal resuscitation program (NRP) guidelines on delivery room (DR) management of infants born through meconium-stained amniotic fluid (MSAF). STUDY DESIGN: A retrospective study of all term (>or=37 weeks) infants born through MSAF was performed. Patients were divided into two periods: pre year 2000 NRP and post year 2000 NRP. Meconium consistency, APGAR scores and intubation (INT) for suctioning and respiratory outcome were recorded. Groups were analyzed using chi (2) tests and stepwise logistic regression. RESULTS: The incidence of MSAF remained constant in period 1 (13.6%) and period 2 (13.1%) while the proportion of infants intubated fell from 67 to 41% (p<0.001). The incidence of meconium aspiration and nonspecific respiratory distress did not differ between groups. CONCLUSIONS: Since the implementation of year 2000 NRP guidelines, the rate of DR INT for tracheal suctioning has fallen significantly without a change in overall respiratory complications. Results of this study support the efficacy of year 2000 NRP recommendations.