Room temperature Fe2+:Cd1-xMnxTe laser generating at 5.4-6 µm.

Six-µm laser generation at room temperature was achieved from Fe2+-doped Cd1-xMnxTe solid-solution active media for the first time, to the best of our knowledge. Laser properties of Fe2+:Cd1-xMnxTe crystals with various concentrations of manganese Mn (x=0.1, 0.52, 0.56, 0.68, and 0.76) were investigated. The increase of Mn content in these crystals was shown to result in an almost similar long-wavelength shift of absorption, fluorescence, and laser output spectra of about ∼60 nm per each 10% of Mn. Laser generation was achieved in all crystals with maximum output energies up to 30 µJ (for x=0.52). The laser central oscillation wavelength is significantly influenced by Mn concentration and varies in the range from 5400 nm up to 6000 nm.

Spectroscopic and laser properties of bulk iron doped zinc magnesium selenide Fe:ZnMgSe generating at 4.5 - 5.1 µm.

The Fe:Zn(1-x)Mg(x)Se (x = 0.19, 0.27, and 0.38) solid solutions spectroscopic properties were investigated and laser oscillations were achieved for the first time. The increase of the magnesium concentration in the Fe:ZnMgSe crystal was shown to result in an almost similar long wavelength shift of both absorption and fluorescence spectra of about 60 nm per each 10% of magnesium. With the Fe:ZnMgSe crystal temperature decrease, the fluorescence spectrum maximum shifts towards shorter wavelength resulting mainly from strong narrowing of the longest wavelength fluorescence line. Laser radiation wavelength dependence on the magnesium concentration as well as on temperature was observed. The Fe:ZnMgSe x = 0.38 laser oscillation wavelength increased from 4780 nm at 80 K to 4920 nm at 240 K using the optical resonator without any intracavity spectrally-selective element. In comparison with the Fe:ZnSe laser operating in similar conditions, these wavelengths at both temperatures were shifted by about 500 nm towards mid-IR region.

[Pregnancy and delivery in a patient with pure 46,XY karyotype. Summary of actual knowledge about XY women]. / Tehotenství a porod u pacientky s cistým karyotypem 46,XY Souhrn dosavadních poznatku o XY zenách.

TYPE OF STUDY: Summary review and a case report. SETTINGS: GEST IVF, Centre of Reproductive Medicine, Prague. INTRODUCTION: In scientific literature there two syndrome have been described in the presence of pure 46,XY karyotype when an individual is phenotypically and psychosexually identified as a woman. Androgen insensitivity syndrome (AIS) and pure gonadal dysgenesis XY (GD XY, Swyer syndrome). Thanks to the presence of a uterus in Swyer syndrome we can treat this type of sterility with donated oocytes. METHOD: The paper describes both syndromes from prenatal, genetical, endocrinological, oncological, reproductive and perinatological points of view. A case study concerning a patient with pure gonadal dysgenesis XY, who successfully became pregnant through a donated oocytes programme, is also described. The pregnancy progressed physiologically, and a healthy boy, 3820g/52cm, was delivered in term by ceasarean section. DISCUSSION: In world scientific literature at least fifteen successful pregnancies with pure gonadal dysgenesis XY have been described. In spite of the expectation of diminished uterine capacity, children are born to term with a normal delivery weight. CONCLUSION: This article should be considered as a summary of all actual knowledge about these patients. This article should be available and usefull for clinicians who come across XY females. The case study provides evidence that even an individual with male genetic gender can be pregnant and deliver a healthy child.

[Late effect of treatment of nephroblastoma in patients treated in 1980-2001 in a single centre]. / Pozdní následky Wilmsova tumoru a jeho lécby u pacientu lécených v letech 1980-2001 na jediném pracovisti.

BACKGROUNDS: The aim of the study was to describe the late effects in a cohort of patients in long-term remission (> 5 years from end of treatment) diagnosed and treated for nephroblastoma at the single paediatric centre during 1980- 2001. PATIENTS AND METHODS: 151 patients were examined for renal function, lipid profile, sonography, echocardiography, exercise capacity and postural status. Age at diagnosis was 3.7 +/- 2.7 years, median 3.1, range 0.01-17.2 years. The cohort included 55% of women. Age in the study 19.4 +/- 5.8, median 19.6 years, range 7.8-36 years. Anthracyclines (ATC) were administered to 25.9% of the cohort. Abdominal radiotherapy (RTA) was required in 34.2%. RESULTS: Creatinine clearance was on average 1.56 +/- 0.56 ml/s/1.73m2, (median 1.49 ml/s/1.73m2). Proteinuria was 0.18 +/- 0.30 g/24 h/m2, median 0.13 mg/24 h/m2. Three patients had proteinuria above 1 g/24 h with a normal glomerular filtration rate and s-albumin. Hypertension was treated in 8.6% of patients (6% by pharmacotherapy). Increased diastolic blood pressure (DBP) and systolic blood pressure (SBP) was found in adolescents: DBP > 90 Torr was found in 10.2% of patients and SBP > 135 Torr in 8.3%, all of them above the age of 15 years. ECHO did not reveal any pathology even in patients treated by ATC. Plasma cholesterol, LDL, HDL, triglycerides were outside the recommended range in two or more parameters in 28.9% of the cohort. Lipoprotein Lp(a) > 500 mg.l(-1) (more than 200% higher than the upper limit) was found in 15.2%. Low peak oxygen consumption (VO2peak) was found in 40% of the cohort. Scoliosis (Sc) was anamnestically found in 46%. Prevalence of Sc according to the age of treatment has a similar trend as the reduced use of the RTA. Pulmonary function test showed a moderate increase in the functional residual capacity (the average Z-score of 1.35). VO2 peak correlates positively with the inspiratory capacity (p < 0.05). CONCLUSION: Based on the found pathologies and known risks, a schedule of late effect prevention and monitoring of patients in long-term NFB remission was established. It should include clinical examination, kidney function and blood pressure monitoring, sonographic and echocardiography examination, long-term physiotherapeutic care and prevention of cardiovascular diseases.

Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment.

The aim was to describe diaphragmatic behavior during postural limb activities and examine the ventilatory and stabilizing functions of the diaphragm. Thirty healthy subjects were examined in the supine position using a dynamic MRI system assessed simultaneously with specialized spirometric readings. The diaphragmatic excursions (DEs) were measured at three diaphragmatic points in the sagittal plane; the diaphragm positions (DPs) as related to a reference horizontal baseline were determined. Measurements were taken during tidal breathing (TB) and isometric flexion of upper or lower extremities against external resistance together with TB. Mean DE in both upper and lower postural limb activities was greater compared with the TB condition (P < 0.05), with the effect greater for lower limb activities. Inspiratory DPs in the upper and lower extremity activities were lower compared with TB alone (P < 0.01). Expiratory DP was lower only for lower extremity activities (P < 0.01). DP was most affected at the apex of the crescent and crural (posterior) portion of the diaphragm. DEs correlated strongly with tidal volume (Vt) in all conditions. Changes in DEs relative to the initial value were minimal for upper and lower extremities but were related to lower values of Vt (P < 0.03). Significant involvement of the diaphragm in the limb postural activities was found. Resulting DEs and DPs differed from the TB conditions, especially in lower extremity activities. The differences between the percent changes of DEs vs. Vt found for lower extremity activities were confirmed by both ventilatory and postural diaphragm recruitment in response to postural demands.

Increased pregnancy weight gain in women with latent toxoplasmosis and RhD-positivity protection against this effect.

OBJECTIVE: RhD-positive subjects are protected against toxoplasmosis-associated impairment of psychomotor performance. Here we searched for RhD-positivity-associated maternal protection against the effects of toxoplasmosis. METHODS: In the present retrospective cohort study, we analysed data from 785 (139 RhD-negative) Toxoplasma-free and 194 (27 RhD-negative) Toxoplasma-infected pregnant women. We searched for effects of toxoplasmosis and Rhd-phenotype on maternal weight before pregnancy, pregnancy weight gain, fetal ultrasound data (biparietal diameter, abdominal circumference, femur length) and on birth length and weight. RESULTS: At pregnancy week 16, the RhD-negative mothers with toxoplasmosis gained more weight than others (P < 0.001). The difference of about 1600 g remained approximately constant from pregnancy week 16 until the end of pregnancy. Neither toxoplasmosis nor RhD phenotype had any effect on fetal bioparameter data or birth length and weight. CONCLUSION: The most parsimonious explanation for the observed data is that the RhD-positive phenotype might protect infected subjects against a broad spectrum of detrimental effects of latent toxoplasmosis, including excessive gestational weight gain.

Bronchoalveolar lavage fluid cellular characteristics, functional parameters and cytokine and chemokine levels in interstitial lung diseases.

Idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis (HP) and sarcoidosis belong to interstitial lung diseases (ILD) where an imbalance of regulatory, profibrotic and antifibrotic cytokines is hypothesized. The relationship of bronchoalveolar lavage (BAL) fluid (BALF) cytokines, BALF cell profile and ILD course is supposed. The aim of our study was to correlate BALF cytokine and chemokine levels with BALF cellular characteristics and lung function parameters in different ILD. Twenty-two sarcoidosis, seven IPF and 11 HP patients underwent lung function tests and BAL. The BALF differential cell counts and superficial cell markers were characterized, and MCP-1, MIP-1alpha, MIP-1beta, RANTES, epithelial neutrophil-activating protein (ENA)-78, FGF, G-CSF, GM-CSF, IFN-gamma, interleukin (IL)-1alpha, IL-1RA, IL-1beta, -2beta, -4beta, -5beta, -6beta, -8beta, -10beta, -17beta, tumour necrosis factor (TNF)-alpha, thromobopoietin (Tpo) and vascular endothelial growth factor (VEGF) values measured. The BALF VEGF values were highest in sarcoidosis (P = 0.0526). IL-1RA values were higher in IPF and HP compared with sarcoidosis (P = 0.0334). IL-8/ENA-78 ratio positively correlated with BALF neutrophil counts in IPF (r = 0.89, P = 0.04). Vital capacity and TL(CO) values positively correlated with VEGF and negatively with IL-8 BALF levels in all ILDs but the correlations were most significant in sarcoidosis group. We suppose that VEGF plays a role in ILDs' early phases and has rather angiogenic than profibrotic effect. On the contrary, IL-8 is probably upregulated in advanced ILDs with prominent fibrosis and marked lung functions decline. We state that BALF VEGF, IL-8 and ENA-78 levels and IL-8/ENA-78 ratio could become useful markers of ILDs' phase, activity and prognosis. They might also be helpful in treatment modality choice.

Prevalence of tidal expiratory flow limitation in preschool children with and without respiratory symptoms: application of the negative expiratory pressure (NEP) method.

Negative expiratory pressure (NEP) applied at the mouth during tidal expiration provides a non-invasive method for detecting expiratory flow limitation. Forty-two children were studied, i.e. 25 children with different respiratory symptoms (R) and 17 without any respiratory symptoms (NR). Children were examined without any sedation. A preset NEP of -5 cm H(2)O was applied; its duration did not exceed duration of tidal expiration. A significance of FL was judged by determining of a flow-limited range (in % of tidal volume). FL was found in 48 % children of R group. No patient of the NR group elicited FL (P<0.001 R vs. NR). The frequency of upper airway collapses was higher in R group (12 children) than in NR group (5 children). In conclusion, a high frequency of tidal FL in the R group was found, while it was not present in NR group. A relatively high frequency of expiratory upper airway collapses was found in both groups, but it did not differ significantly. NEP method represents a reasonable approach for tidal flow limitation testing in non-sedated preschool children.

Correlation of IL-1alpha and IL-4 gene polymorphisms and clinical parameters in idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a serious disease characterized with progressive scarring of the lungs in which a genetic background is supposed. We have tested correlation of promotor regions of IL-1alpha and IL-4 gene polymorphisms with clinical parameters in IPF. We investigated the group of 30 patients with IPF. The correlations of vital capacity (VC) and diffusing capacity for carbon monoxide (DL(CO)), bronchoalveolar lavage (BAL) fluid cell counts and high resolution computed tomography (HRCT) alveolar and interstitial scores with different genotypes of IL-4 at (-1098), (-590) and (-33) positions and IL-1 alpha at (-889) position were tested. The PCR method was used for genotyping. The carriers of CT genotype at IL-1 alpha (-889) position had higher VC at the time of diagnosis. The CC genotype at this position was more frequent in patients with higher counts of HLADR+ T lymphocytes in BAL. The GT genotype at IL-4 (-1098) position correlated with higher counts of CD4(+) T lymphocytes, and inversely the TT genotype with higher counts of CD8(+) T lymphocytes in BAL fluid. According to dynamic changes of HRCT score the CT genotype at IL-4 (-33) was more frequent in patients with progressive disease compared to that with stable disease. We assume from our data that the gene polymorphisms of the promotor region of IL-4 at position (-1098) and (-33) and IL-1 alpha at position (-889) are likely to play a pathogenic role in IPF and in modification of its clinical presentation and severity.

Women infected with parasite Toxoplasma have more sons.

The boy-to-girl ratio at birth (secondary sex ratio) is around 0.51 in most populations. The sex ratio varies between societies and may be influenced by many factors, such as stress and immunosuppression, age, primiparity, the sex of the preceding siblings and the socioeconomic status of the parents. As parasite infection affects many immunological and physiological parameters of the host, we analyzed the effect of latent toxoplasmosis on sex ratios in humans. Clinical records of 1,803 infants born from 1996 to 2004 contained information regarding the mother's age, concentration of anti-Toxoplasma antibodies, previous deliveries and abortions and the sex of the newborn. The results of our retrospective cohort study suggest that the presence of one of the most common parasites (with a worldwide prevalence from 20 to 80%), Toxoplasma gondii, can influence the secondary sex ratio in humans. Depending on the antibody concentration, the probability of the birth of a boy can increase up to a value of 0.72, C.I.95 = (0.636, 0.805), which means that for every 260 boys born, 100 girls are born to women with the highest concentration of anti-Toxoplasma antibodies. The toxoplasmosis associated with immunosuppression or immunomodulation might be responsible for the enhanced survival of male embryos. In light of the high prevalence of latent toxoplasmosis in most countries, the impact of toxoplasmosis on the human population might be considerable.

Th1/Th2 cytokine gene polymorphisms in patients with idiopathic pulmonary fibrosis.

We investigated 30 patients with idiopathic pulmonary fibrosis (IPF) and 103 healthy volunteers for the cytokines polymorphisms of the IL-1alpha, IL-1beta, IL-1R, IL-1RA, IL-2, IL-4, IL-6, IL-10, IL-12, tumor necrosis factor-alpha, interferon-gamma, transforming growth factor-beta, IL-1beta, IL-2, IL-4, and IL-4RA genes. The strongest correlation of a genotype with the disease was found for gene polymorphisms at the promotor region of IL-4, where the CT genotypes at the positions (-590) and (-33) were more frequent in the IPF group (P < 0.0001, P(corr) < 0.0022; vs P < 0.0001, P(corr) < 0.0022). Our results support the idea of the pathogenic role of cytokine gene polymorphisms in the etiology and pathogenesis of IPF, with emphasize on the IL-4 promotor gene polymorphisms.

Er:YAG and alexandrite laser radiation propagation in root canal and its effect on bacteria.

OBJECTIVE: The objective of this study was to compare the bactericidal effect of the Er:YAG (wavelength 2.94 microm) and the Alexandrite (wavelength 0.75 microm) laser radiation. The spreading laser energy in the surrounding hard dental tissues round the root canal was evaluated and the bactericidal effect of both these different laser wavelengths was analyzed. SUMMARY BACKGROUND DATA: The use of a laser to clean and shape the root canal space is the latest method used for cleaning of root canals. The interest in laser endodontics was concentrated on the possibility to extirpate the contents of the root canal, to sterilize and to "melt" the walls of the root canals. The previous reports were performed with CO2, excimer, argon, Nd:YAG, Ho:YAG, and Er:YAG lasers. METHODS: Er:YAG laser system (2.94 microm, energy 100 mJ or 300 mJ, repetition rate 1 Hz, 30 pulses) and alexandrite laser system (0.75 microm, energy 250 mJ, repetition rate 1 Hz, 30 pulses) were prepared and three experimental arrangements were used during the measurements. First the energy transport through the tooth tissue was observed (frontal and side experimental setups) and then, the bactericidal effect was evaluated. RESULTS: It was demonstrated that due to the absorption in the hydroxyapatite and water content in the dentin, the Er:YAG laser radiation is fully absorbed in the root canal wall. This direct influence of the radiation could be expected only close to the sapphire tip. It was found that the tissue, which was not directly affected by the laser radiation, cannot be disinfected by the subablative effect of Er:YAG laser radiation. In the second part of the experiment the real bactericidal effect of Er:YAG ablative energy (300 mJ) could be observed. It was also shown that the alexandrite laser radiation with a wavelength of 0.75 microm spreads through the canal system space and leaks into the surrounding tooth tissues. Both lasers have bactericidal effect. CONCLUSIONS: The pulsed Er:YAG and alexandrite lasers can be efficiently used for killing dental bacteria but the spreading of their radiation in the tooth tissues are different.

Flow limitation and dyspnoea in healthy supine subjects during methacholine challenge.

The purpose of this study was to assess whether during standard methacholine (Mch) challenge (concentration up to 128 mg x mL(-1)) healthy supine subjects a) develop tidal expiratory flow limitation (FL) and hyperinflation, and b) whether the onset of tidal FL is associated with dyspnoea. Eight healthy subjects were studied. Dyspnoea was assessed using the Borg scale, FL by the negative expiratory pressure (NEP) method and hyperinflation in terms of decrease in inspiratory capacity (IC). Seven patients became flow limited at Mch doses ranging 4-64 mg x mL(-1), with FL encompassing 34-84% of the control tidal volume. In six of them the onset of tidal FL was associated with little or no dyspnoea and a modest degree of hyperinflation (deltaIC <-0.4 L). In one subject, however, onset of FL was associated with a substantial reduction in IC (0.58 L) and moderately severe dyspnoea. In all of these seven subjects FL was transiently reversed after an IC manoeuvre. In conclusion, the results show that a) most healthy subjects may develop flow limitation and hyperinflation during methacholine challenge in supine position, and b) at onset of flow limitation there is little or no dyspnoea, suggesting that onset of dynamic airway compression per se does not elicit significant dyspnoea. Significant dyspnoea probably only occurs with marked dynamic hyperinflation.

High-power Nd:YAG laser picosecond pulse delivery by a polymer-coated silver hollow-glass waveguide.

An oscillator-amplifier high-power Nd:YAG laser system was used for transmission of a single 50-ps-long pulse or a train of pulses through a cyclic olefin polymer-coated silver hollow-glass waveguide. The maximum energy that was transmitted was 150 mJ for the train of pulses and 40 mJ for the single pulse, from which followed a delivered power of 100 GW/cm(2) . The characteristics that were obtained make these waveguides promising for the delivery of high-power laser pulses in medical as well as other applications.

Pulmonary function in children with atrial septal defect before and after heart surgery.

OBJECTIVE: To test the effect of heart disease and heart surgery on lung function. DESIGN: A pulmonary function study of children undergoing surgery for atrial septal defect (ASD). SETTINGS: University hospital. PATIENTS: 26 children tested before surgery (at mean (SD) age 11.8 (3.8) years) and 24 patients tested 1.8 (0.2) years after surgical correction. METHODS: Lung volumes, lung elasticity, and airway patency indices were measured using standard techniques. RESULTS: Before surgery: pulmonary function test abnormalities were found in 18 of the 26 patients. Stiff lung was found in 12, lung hyperinflation in five, and indices of decreased airway patency in four. Total lung capacity decreased in only two patients. After surgery: pulmonary function test abnormalities were found in 12 of the 24 patients (informed consent not given for two patients). Stiff lung was detected in nine and indices of peripheral airway obstruction in four. Mean values of specific airway conductance and peak expiratory flow were all normal. Lung hyperinflation was found only in one of 24 patients. No correlation between perioperative events and pulmonary function test data was found. CONCLUSIONS: Pulmonary function test abnormalities persist in half the patients almost two years after surgery for ASD. A decrease in the total frequency of pulmonary function test abnormalities (in 19% of the patients), with a decrease in stiff lung in 8% and lung hyperinflation in 15%, was not significant. Impairment of lung function related to ASD is associated with the disease itself rather than the surgical procedure.

Good exercise tolerance and impaired lung function after atrial repair of transposition.

OBJECTIVE: Evaluation of long-term results of atrial correction of transposition of the great arteries (TGA), focusing on the relationship between pulmonary function and exercise tolerance. METHODS: A prospective population-based study-56 out of 60 survivors of Mustard/Senning repair, born in Bohemia in 1980-1984 (median age at surgery 0.85 years) were followed up over 13.4 +/- 1.2 years and studied by complete lung function and bicycle exercise testing. RESULTS: Maximum heart rate on exercise reached 181 +/- 14 bpm (Z-score: -1.06 +/- 1.66, range -6.7 to +1.6); VO2max: 40.6 +/- 6.7 ml/kg per min (Z-score: -0.97 +/- 1.4, range -5 to +1.8). A total of 73.6% had abnormal lung function, most frequently features of stiff lung (39.6%) and lung restriction (32.1%). Static recoil pressure of the lungs measured at 100, 90 and 60% of total lung capacity reached 137, 126 and 130%, respectively (Z-score: 1.93 +/- 2.33, 1.64 +/- 1.96, and 1.14 +/- 1.95, respectively). There was an inverse relationship between static recoil pressure of the lungs and VO2max (r = -0.306, P = 0.043), indicating the impact of lung function abnormalities on exercise tolerance. Comparison with lung function study of the group of 'pioneer' Mustard patients operated at the mean age of 4.4 years revealed a similar pattern and frequency (73.6% in current series vs. 88%, NS). CONCLUSIONS: Long-term follow-up has shown good exercise tolerance in the majority of patients after atrial correction of TGA performed in infancy. Many of them, however, have impaired lung function, especially stiff lung, although less frequently than original patients operated at a later age. The stiff lung can impair the exercise tolerance.

A simple method to monitor performance of forced vital capacity.

The forced vital capacity (FVC) maneuver is the most common lung function test. One of its major prerequisites is that it be performed with sufficient effort to achieve the maximal flows that are due to expiratory flow limitation. To verify this, in nine normal subjects, short (0.25-s) pulses of negative pressure (-5 to -20 cmH2O) were applied at the mouth at different times (0.25-1 s) after the onset of 1) FVC maneuvers and 2) vital capacity expirations with submaximal expiratory efforts (SVC). All subjects were experienced in FVC maneuvers. With FVC, the expiratory flow did not change with application and removal of negative-pressure pulses, apart from brief flow transients, mainly reflecting displacement of air from the compliant oral and neck structures. With SVC, flow increased throughout the application of the negative-pressure pulses. Thus application of pulses of negative pressure provides a simple method for on-line recognition of whether an FVC maneuver is performed with sufficient effort to achieve flow limitation.

Lung function in VSD patients after corrective heart surgery.

Static lung volumes, lung elasticity, and airway patency indices were measured in 47 children operated on for ventricular septal defect (VSD). Open-heart surgery was performed at the age of 0.6-12.0 years (median 4.1 years). In the first group (34 subjects), after primary repair of the VSD, there was an increase in lung recoil pressure at 100% of total lung capacity (TLC) (128% of the predicted value) and a reduction in specific airway conductance (sGaw) (75% of the predicted value). In the second group (13 patients), who had had previous pulmonary artery banding at 0.2-4.0 years (median 0.7 year) there was an increased functional residual capacity/TLC ratio (111% of predicted value), reduced sGaw (69% of predicted value), and reduced maximum expiratory flow at 25% of vital capacity (79% of predicted value). Lung volumes were insignificantly reduced in both groups. The frequency of lung function disturbances was similar in the two groups (71% of patients in the former group and 77% of patients in the latter group). A linear positive correlation between specific airway conductance and the mean pulmonary artery pressure (mPAP) (r = 0.793, p < 0.006) was observed in children with an mPAP <30 mmHg prior to open-heart surgery. A positive correlation between static recoil pressure at full inflation and mPAP (r = 0.545, p < 0.03) was found in children with an mPAP > 30 mmHg. The severity of congenital heart disease prior to surgery and the influence of the timing of the surgical procedures may cause the differences in lung function tests between the groups.

[Long-term follow-up of the quality of life in children after surgery for vascular compression of the respiratory tract]. / Kvalita zivota detí dlouhodobe po operaci pro útlak dýchacích cest cévní strukturou.

The aim of this study is the analysis of long-term results of surgery for vascular airway compression. Out of those operated within last 14 years at our institution, thirty two have a longer than five years follow up, being now 9.1 +/- 3.0 years following surgery. All are in excellent clinical condition. One quarter of patients show occasional stridor and one third frequent respiratory infections. Eighty percent have some lung function abnormality, 72% features of central airways obstruction. Pulmonary perfusion scintigraphy demonstrated in 19% asymmetric pulmonary blood flow. Magnetic resonance imaging showed relationship between vessels and airways. Although long-term outcome of surgery for vascular airway compression is excellent, high percentage of pathologic lung functions is of concern and substantiates the need for close long-term follow-up.