bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of chronic pulmonary oxygen toxicity in young rats with liposome‐encapsulated catalase administered intratracheally
Authors: Thibeault D. W. , Rezaiekhaligh M. , Mabry S. , Beringer T.
Published: March 2007

The lungs and hearts of young rats exposed to 100% oxygen (O2) for 8 days (27 to 35 days of age) were studied following recovery in room air at 60 days of age using morphometric, biochemical, and physiological techniques. In an attempt to prevent chronic oxygen toxicity 153 rats had transtracheal catheters surgically implanted and were treated during the O2 exposure with daily intratracheal injections of liposome‐encapsulated superoxide dismutase (SOD) and/or catalase (CAT). Oxygen exposure in this model results in chronic cardiopulmonary alterations which include pulmonary hypertension, right ventricular hypertrophy, and a decrease in number of pulmonary arterioles 25 to 50 μm in diameter with increased muscularization of their walls. The volume densities of the parenchyma, parenchymal air space, and the alveolar space are increased, while that of the combined alveolar ductal and respiratory bronchiolar space is decreased. Daily intratracheal administration of liposome‐encapsulated CAT (160 U) during the O2 exposure prevented these chronic changes. Liposome‐encapsulated SOD (110 U) or SOD (50 U) + CAT (70 U) did not appear to have a preventive effect. During the first 3 to 5 days following oxygen exposure the lung tissue enzymes SOD, CAT, and glutathione peroxidase markedly increased. We conclude that in the young rat animal model liposomeencapsulated CAT (160 U) given intratracheally during the period of O2 exposure is safe and will prevent the chronic vascular and parenchymal damage due to oxygen toxicity.
The effects of diuresis and transfusion on pulmonary function in children with thalassemia major
Authors: Lands L. C. , Woods S. , Katsardis Ch. , Desmond K. , Coates A. L.
Published: March 2007

Previous pulmonary function studies in subjects with thalassemia major (TM) who were on regular transfusion programs have demonstrated results ranging from small airway obstruction to a restrictive pattern. Ten subjects with TM were studied pre‐ and postdiuresis, and again 24 hr after transfusion, in order to evaluate the role of possible fluid overload in altering pulmonary function. Subjects underwent spirometry and had lung volume and flow volume curves (MEFVC) measured in a volume displacement plethysmograph while breathing air and a mixture of 80% helium and 20% oxygen (HeO2). Six patients had pulmonary mechanics measured with esophageal balloons in place. Baseline function was normal and no change occurred following diuresis. Following transfusion, the volume of isoflow (VisoV̇) decreased, but other parameters did not change. Subsequent analysis revealed 5 subjects with an initial VisoV̇ > 20 (% FVC) but, paradoxically, less evidence of flow limitation in the small airways than those with a VisoV̇ < 20 (% FVC). Posttransfusion, in those subjects with an initially high VisoV̇, the V tended to fall without a change of MEFVC in HeO2, resulting in a decreased VisoV̇. This was interpreted as evidence of subtle abnormalities in the small airways caused by volume expansion, raising doubts about the value of the VisoV as a measure of small airway disease. As a group, our subjects did not demonstrate any abnormalities in baseline function. Some subjects had mild flow limitation in small airways while others developed comparable levels of flow limitation following the volume expansion associated with transfusion.
The impact of home monitoring and daily diary recording on patient status in cystic fibrosis
Authors: Finkelstein Stanley M. , Wielinski Catherine L. , Kujawa Susan J. , Loewenson Ruth , Warwick Warren J.
Published: March 2007

An experimental home monitoring system for assessing the progress and planning changes in the care of patients with cystic fibrosis (CF) has been implemented at the University of Minnesota Cystic Fibrosis Center. One group of patients and families did daily recording of physical measurements and symptoms, and sent the diary to the data coordinating center weekly for analysis. The remaining patients were not part of the home monitoring program. Twenty‐five patients were randomly selected from the home monitoring group. They were compared to an age‐ and sex‐matched control group not doing home monitoring to ascertain if home self‐measurement and daily diary recording, in the absence of any therapeutic intervention, produced any change in physical or psychological status, pulmonary function, or growth over a 4‐year study period. Subjects ranged in age from 6 to 43 years. Clinical status was measured by the National Institutes of Health cystic fibrosis scoring system. Pulmonary function was assessed as percent of predicted forced vital capacity and percent of predicted forced expiratory volume in 1 sec (FEV1). Growth was analyzed as percent of predicted weight based on age‐, sex‐, and height‐dependent equations. Psychological status was determined by self‐assessment and referral for counseling. Only percent predicted FEV1 in the control group declined significantly. There were no statistically significant changes in any other measures either within or between diary and nondiary groups over the 4‐year period. As the long held concern regarding the negative impact of such close monitoring on patient health was not realized, home monitoring could become a useful methodology for following slowly developing changes in the condition of patients with CF and other chronic diseases.
Rescue ventilation with high frequency oscillation in premature baboons with hyaline membrane disease
Authors: Delemos Robert A. , Coalson Jacqueline J. , Delemos James A. , King Richard J. , Clark Reese H. , Gerstmann Dale R.
Published: March 2007

We tested the hypothesis that high‐frequency oscillatory ventilation can be efficacious in hyaline membrane disease (HMD) even after lung injury is established. We compared high frequency oscillatory ventilation (HFOV) rescue (n = 8; 15 Hz; I:E = 1:2) after 8 hours of positive pressure ventilation (PPV) with positive end‐expiratory pressure, to continued PPV (control, n = 7) in premature baboons with HMD over a 24 hour period. Ventilator settings and physiologic parameters were recorded hourly. At necropsy (24 hours), lung status pressure‐volume curves, alveolar phospholipids (PL), platelet activating factor‐like activity (PAF), and lung water were determined. Roentgenographic and morphologic differences in lung inflation were quantified by standard techniques. No intergroup differences were found in heart rate, blood pressures, ventilator settings, FiO2, blood gases, or chest radiographs during the first 8 hours. Both groups had progressive physiologic disease. At 8 hours, HFOV‐rescue animals, in contrast to controls, had immediate significant time‐related improvements in Pa/AO2 (at the same Paw) and in oxygenation index (Pa/AO2/Paw) lasting for 16 hours. No significant intergroup differences in lung/body weight, lung water, lung mechanics, PL, PAF, or frequency of moderate to severe roentgenographic changes existed at 24 hours. Although all animals had morphologic evidence of HMD, saccular aeration was more uniform and airway dilatation less evident in HFOV rescue (P < 0.0001). Based on the improved gas exchange, we conclude that HFOV rescue was efficacious in the “late” treatment of HMD, presumably because of the more uniform saccular aeration. Though HFOV rescue did not appear to reverse lung injury incurred during the first 8 hours of PPV, it may have interrupted the progression of injury, as seen in the PPV control group.
Effects of passive smoking on lung growth in children
Authors: Lebowitz Michael D. , Sherrill Duane , Holberg Catharine J.
Published: March 2007

The objective of this study was to determine the effects of passive smoking on functional lung growth in children and adolescents. It was hypothesized that passive smoking might reduce lung function growth, especially in susceptible children. The assumption was that those most susceptible would be children who started with low lung function, as it had been shown that they had slower growth of lung function, and start to decline earlier. There were 138 non‐Hispanic Caucasian children and adolescents, ages 5 through 15, who had at least three satisfactory longitudinal lung function tests over a 13 year period in the Tucson epidemiological study of airway obstructive diseases. Those who started in childhood with normal function did not show any effect of passive smoking, nor did females who started with low lung function. Males starting with low lung function whose parents smoked showed definite changes. Their forced expiratory volume in 1 second (FEV1) grew even more slowly between ages 13 through 16, related primarily to continuous parental smoking. They also had higher rates of decline for FEV1to forced vital capacity (FVC) ratio and maximum flow at 50% vital capacity to FVC ratios than either the low function group without passive smoking or the normal function groups. This was independent of any symptoms or diagnoses present in this male low function group.
Continuous subcutaneous infusion of β2‐agonists in infantile asthma
Authors: Brémont F. , Moisan V. , Dutau G.
Published: March 2007

Eleven infants presenting with an asthmatic syndrome were treated with subcutaneous infusions of a β2‐agonist (β2 A) during an acute episode. This treatment was used after difficulties with or failure of β2 A infusions and IV nebulizations. No local or general adverse reactions were observed. The serum concentrations of salbutamol obtained at a dose of 0.1 μg/kg/min were measured in six infants and found to be within the generally accepted therapeutic range. This mode of administration proved extremely useful, both by itself and as part of a therapeutic protocol, combined with an antibiotic, a corticosteroid, and theophylline. It avoids the difficulties of administering β2 A intravenously or by nebulization, while preserving some degree of freedom and better general care for the child. The preferred indication is in treatment of severe acute asthmatic episodes after failure of nebulizations. The exact place in the therapeutic arsenal of infantile asthma remains to be defined. Pediatr pulmonol.1992; 12:81–83.
Integrated plasma cortisol concentration in children with asthma receiving long‐term inhaled corticosteroids
Authors: Phillip Moshe , Aviram Micha , Leiberman Esther , Zadik Zvi , Giat Yehudit , Levy Josef , Tal Asher
Published: March 2007

We assessed the effect of long‐term therapy with inhaled beclomethasone dipropionate (BDP) on the pituitary—adrenal axis, by measuring the integrated concentration (IC) of plasma cortisol in eight children with asthma (age, 6–16 years) who regularly used inhaled BDP in doses ranging from 8 to 26.5 μg/kg (200–450 μg/day) for 6 months to 4 years. The control group included six children (age, 6–16 years) who had the IC of plasma cortisol measured as part of an endocrinological evaluation and were found to be healthy. Cortisol concentration was measured in blood samples collected continuously over a 24‐hr period. Mean IC of plasma cortisol in the study group was significantly lower than in the healthy controls (mean ± SD, 4.9 ± 3.3 vs 9.1 ± 1.9 μg/mL P < 0.02). Cortisol response to 0.25 mg ACTH (iv) was abnormal in one of the eight BDP‐treated patients. No correlation was found between IC of plasma cortisol and the BDP dose, severity of asthma, height percentile, or the Tanner stage. We conclude that long‐term therapy, even with relatively conventional doses of inhaled BDP may cause reduction in the normal physiological secretion of cortisol. The clinical relevance of low IC of plasma cortisol is not clear, but it may reflect partial suppression of the pituitary—adrenal axis.
Nonlinear pressure/volume relationship and measurements of lung mechanics in infants
Authors: Neto Galdino Silva , Gerhardt Tilo , Silberberg Ants , Gerhardt Till , Claure Nelson , Duara Shahnaz , Bancalari Eduardo
Published: March 2007

We examined the effects of within‐breath changes in compliance (C) upon the accuracy of measurements of compliance and resistance (R) by linear regression analysis and by Mead and Wittenberger's method. These effects were illustrated by a computer model and by lung models with linear and nonlinear pressure/volume relationships, and were also studied in 14 normal spontaneously breathing premature infants (mean ± SD, BW 1,290 ± 200 g, GA 29.9 ± 2.7 weeks, age 7.4 ± 2.1 days). Flow was measured by pneumotachography and tidal volume was derived as digitally integrated flow, and transpulmonary pressure as airway minus esophageal pressure.

We found that C and R calculated from the equation of motion is accurate only if C and R remain constant throughout the respiratory cycle. Calculated compliance depends more on C at the end than at the beginning of inspiration. A decreasing C leads to underestimation or R, while an increasing C leads to an overestimation of inspiratory R. Calculated total R may be accurate, but with low r values for measurement points. Mead and Wittenberger's method and the regression method are similarly affected by changing C; however, since the regression method is based on many more measurement points and therefore allows the detection and analysis of within‐breath changes of C and R, it is less prone to erroneous results secondary to signal artifacts than Mead and Wittenberger's method.
Transfusion‐induced changes in the breathing pattern of healthy preterm anemic infants
Authors: Sasidharan P. , Heimler R.
Published: March 2007

In order to evaluate the effects of transfusion on breathing pattern in growing, otherwise healthy, anemic preterm infants, we studied 14 infants whose mean ± SD birthweight was 1,212 ± 294 grams, gestational age 29.28 ± 2.23 weeks and hematocrit 25.86 ± 2.24%. At a mean postnatal age of 41.35 ± 19.45 days 12 hour nocturnal (transthoracic impedance) pneumocardiograms were obtained 24 hours prior to and after transfusion with 10 mL/kg of packed red blood cells. Posttransfusion pneumocardiograms revealed significant reduction of periodic breathing, of apnea episodes with 11–15 second duration, of apnea density, and of heart rate. These findings indicate that transfusion with packed red blood cells significantly alters certain cardiorespiratory variables in anemic preterm infants.
Pulmonary dysfunction after primary closure of an abdominal wall defect and its improvement with bronchodilators
Authors: Nakayama Don K. , Mutich Rebecca , Motoyama Etsuro K.
Published: March 2007

To determine the extent of pulmonary dysfunction following primary closure of an abdominal wall defect, we obtained pulmonary function tests (PFT) in 11 newborn infants with gastroschisis and 6 with large omphaloceles admitted to a newborn ICU in a children's hospital. Patients were 1 to 30 days of age at the time of the PFT; all required endotracheal intubation and mechanical ventilation for operative procedures or for postoperative ventilatory support. Full‐term infants (n = 21) undergoing minor surgical procedures provided comparative measurements. Flow‐volume curves were obtained with manual inflation of the lungs followed by forced deflation using negative pressure, or by passive expiration, under sedation and pharmacologic paralysis. Deflation flow‐volume curves gave measurements of forced vital capacity (FVC) and maximal expiratory flow at 25% of vital capacity from residual volume (MEF25). Modified passive mechanics technique gave passive expiratory curves that provided measurements of respiratory system compliance (Crs) and resistance (Rrs). Tests were done: within 48 h (period A), 3–7 days (period B), and 8–30 days after surgical repair (period C). Pulmonary function testing after nebulized 0.1% isoetharine (a bronchodilator), to test for bronchial reactivity, began midway during the study period in 15 patients. Preoperative and postoperative tests were obtained in 5 patients. Closure of an abdominal wall defect decreased FVC, Crs, and MEF25 by up to 50% of normal, reference values after surgery (P < 0.05). FVC and MEF25 approached values of normal infants' by 4 weeks, whereas Crs remained 50% lower. Bronchodilators improved FVC by 21% and MEF25 by up to 48% during the first week of life (both, P < 0.05), but MEF25/FVC was not significantly altered, reflecting the opening of new lung units with no effect on upstream conductance. Bronchodilators may benefit babies who have respiratory difficulties following closure of abdominal wall defects.
Changes in the CA 19‐9 antigen and lewis blood group with pulmonary disease severity in cystic fibrosis
Authors: Kane Robert E. , Penny June , Walker Kay , Rubin Bruce K. , Wu James
Published: March 2007

The altered carbohydrate structure of sputum from patients with cystic fibrosis (CF) has been thought to be due to the inflammatory airway response. Carcinoembryonic antigen (CEA) and CA 19‐9 detect sialosylated carbohydrates in mucus. The epitope of CA 19‐9 is part of the Lewis A (Lea) blood group antigen. Serum concentrations of CEA and CA 19‐9 were determined by radioimmunoassay in 41 CF patients, aged 6–34 years; 16 were asymptomatic Outpatients, and 25 had been admitted for pulmonary exacerbations. There was no difference in CEA between groups. The CA 19‐9 serum concentration was elevated in 90% of patients who had at least one of the two Lewis antigens. The CA 19‐9 concentration of Inpatients with exacerbations was 2.7 times that of stable Outpatients (263 ± 44 versus 99 ± 13 U/mL P < 0.02). CA 19‐9 correlated significantly with age (r = 0.35, P < 0.05), Brasfield score (r = 0.39, P < 0.015), pulmonary function tests, cough severity (r = 0.50, P < 0.001) and NIH clinical score (r = 0.57, P < 0.001). CA 19‐9 concentration of Inpatients decreased by 44% from admission to discharge (302 ± 45 to 169 ± 39, P < 0.02).

Fourteen of 25 (56%) of the Inpatients were Lea positive versus only 3/15 (20%) of Outpatients who had milder lung disease (P < 0.002). Of the Inpatients, 25% with more advanced lung disease were Le (a+b+), a rare blood group in the normal population, and one not observed in the Outpatients with milder disease.

The results suggested that the serum CA 19‐9 concentration is an index of pulmonary disease severity in 94–95% of patients with CF who express the Lewis antigens, and it can be used to monitor response to therapy.
Effect of posture on regional ventilation in children
Authors: Davies H. , Helms P. , Gordon I.
Published: March 2007

Little information has been published concerning the pattern of regional ventilation in children, yet many differences in lung and chest wall mechanics in childhood, supported by clinical observation, have led to the hypothesis that the pattern of regional ventilation seen in children may not be the same as in adults.

Forty‐three children and 16 adult volunteers underwent Krypton (Kr) 81m radionuclide ventilation lung scans in the supine and right and left decubitus postures.

In children aged 2–10 years mean fractional ventilation to the right lung (VfR) was 46.1%. This fell to 36% when dependent and rose to 56.1% in the uppermost position. Redistribution of ventilation away from the dependent towards the uppermost lung was seen in all children. In children aged 10–18 years VfR was 57.2% (supine), 48.0% (dependent), and 62.9% (uppermost). An identical pattern was seen in children with normal or abnormal pulmonary function tests (peak expiratory flow rate, and FEV1: FVC ratio). In subjects over 18 years of age a different pattern was seen: mean VfR was 52.4% (supine), rising to 53.4% (dependent), and falling to 48.9% (uppermost).

Postural redistribution of ventilation, as assessed by Kr81m ventilation imaging, changes late in the second decade of life. This will have clinical consequences in the management of children with unilateral lung disease.
Technique and use of transbronchial biopsy in children and adolescents
Authors: Whitehead B. , Scott P. J. , Helms P. , Malone M. , Macrae D. , Higenbottam T. W. , Smyth R. L. , Wallwork J. , Elliott M. , De Leval M.
Published: March 2007

Since July 1988, a total of 92 transbronchial biopsies (TBB) have been performed in 18 patients (aged 3–16 years). Twelve patients (67%) were heart‐lung transplant (HLT) recipients undergoing surveillance for pulmonary graft rejection and infection. The remainder included immunocompromised patients at risk of opportunistic infections (n = 4), patients with fibrosing alveolitis (n = 1) and a collagen vascular disorder with suspected lung involvement (n = 1). TBB was performed through either a fiberoptic (n = 50) or a rigid (n = 41) bronchoscope, all under general anesthesia. On one occasion a cardiac bioptome was used through an endotracheal stent. The sensitivity of TBB for diagnosing acute and chronic rejection in HLT patients was 88% and 60%, respectively (specificity, 91% and 100%). Definitive diagnoses were made in 4 (67%) of the non‐HLT group. Bronchoalveolar lavage (BAL) was performed during each procedure for microbiological and cytological examination. Thirty‐four pathogenic organisms including Pseudomonas aeruginosa (16/34), Staphylococcus aureus (8/34), and Candida albicans (5/34) were isolated from BAL culture. Complications included pneumothorax (8%), transient pyrexia (7%), and dyspnea (2%).
Ultrathin fiberoptic bronchoscopy for airway toilet in neonatal pulmonary atelectasis
Authors: Shinwell Eric S.
Published: March 2007

Pulmonary atelectasis is often seen in young infants with respiratory disease and it may contribute to increased ventilatory requirements and the development of chronic lung disease such as bronchopulmonary dysplasia. Standard management consists of postural drainage (chest physiotherapy and suction) and selective intubation with suction of a major bronchus. This report describes a new approach consisting of removal of bronchial secretions under direct vision via ultrathin fiberoptic bronchoscopy, without interruption of mechanical ventilation. The procedure was performed safely in ten cases and resulted in significant rapid improvement in the infants' respiratory condition and in complete resolution of the atelectasis in eight cases. In two infants, partial improvement was seen. No adverse effects of the procedure were encountered. It is concluded that this approach is a safe and potentially valuable therapeutic maneuver in the management of pulmonary atelectasis in sick intubated neonates. © 1992 Wiley‐Liss, Inc.
High‐frequency jet ventilation and surfactant treatment of newborns with severe respiratory failure
Authors: Davis Jonathan M. , Richter Susan E. , Kendig James W. , Notter Robert H.
Published: March 2007

Twenty‐eight newborn infants (birthweight, 2.4 ± 1.1 kg; gestational age, 34.6 ± 6.1 weeks) with respiratory distress syndrome (RDS), meconium aspiration syndrome, or pneumonia who deteriorated in spite of optimal conventional mechanical ventilation (CMV) and exogenous surfactant therapy were treated with high‐frequency jet ventilation (HFJV) and continued surfactant therapy. For enrollment, infants had to have a limited response to surfactant therapy and conventional ventilation, and meet clinical criteria that confirmed clinical deterioration and severity of illness. Study infants had received exogenous calf lung surfactant extract (CLSE) and conventional ventilation prior to the start of HFJV at 46.3 ± 8.2 hours of age. Patients initially responded to HFJV alone with significant improvement in several respiratory variables, but deteriorated subsequently and received additional doses of exogenous surfactant on HFJV. Exogenous surfactant and HFJV resulted in significant and sustained improvement in several respiratory variables. Only ten patients deteriorated to meet criteria for a second surfactant dose on HFJV, and two patients received a third dose. Twenty‐five of the 28 patients studied survived (89%). No patients received extracorporeal membrane oxygenation or were discharged home on oxygen. The results of this pilot study suggest that the combination of HFJV and exogenous surfactant replacement may be effective in treating infants with more severe respiratory failure, and indicate the need for more extensive controlled investigations. © 1992 Wiley‐Liss, Inc.
Intensive care course and outcome of patients infected with respiratory syncytial virus
Authors: Stretton Mark , Ajizian Samuel J. , Mitchell Ian , Newth Christopher J. L.
Published: March 2007

PICU admissions of 97 children positive for respiratory syncytial virus on fluorescent antibody screening were reviewed; 68% of 44 patients without history of preceding disease (Group I) and 79% of 53 patients with preceding pulmonary, cardiac, or other disease (Group II) required ventilation. In Group I ventilated children weighed significantly less (P = 0.001) and were of lower chronological (P = 0.02) and post‐conceptional ages (P = 0.02) than those not ventilated. Eighteen infants ventilated for apnea weighed significantly less (P = 0.003), were more often born at ≦37 weeks gestation (P = 0.001) and were at lower post‐conceptional age than 11 infants ventilated for progressive respiratory deterioration. There was no significant difference in mean weight, chronological age, post‐conceptional age, CO2, or pH between 12 admissions with BPD who required ventilation for RSV infection and 5 who did not require ventilation. Ribavirin administration to five ventilated patients with BPD did not significantly alter the duration of intubation or PICU stay. Six patients with cardiac disease required longer periods of ventilation than others (Group I, P = 0.001; all others in Group II, P = 0.04). No deaths occurred in Group I, while 6 of 53 (11%) patients in Group II died. In this series immuno compromise placed patients at greatest risk of dying. Mechanical ventilation can be safely managed in previously healthy, RSV infected infants and should be initiated before significant cardiorespiratory compromise arises. © 1992 Wiley‐Liss, Inc.
Comparison of helium dilution and nitrogen washout measurements of functional residual capacity in infants and very young children
Authors: Tepper Robert S. , Asdell Steve
Published: March 2007

In infants and very young children, functional residual capacity (FRC) is the lung volume most frequently measured and gas dilution techniques are most frequently used to measure FRC. We compared measurements of FRC by helium dilution (FRCHe) and nitrogen washout (FRC) in a lung model of known volumes (20,40,60,80 mL), in 8 normal infants (NL), 8 infants with acute respiratory illness (ARI), and 7 infants with chronic lung disease (CLD). In the model lung, measurements of FRCHe had a significantly greater coefficient of variation compared to FRC (6.5 vs 1.5%, P < 0.02), but there was no such difference in the results from all infants combined (6.5 vs 6.2%). In the model lung, the difference between known volumes and the measured values was significantly different from zero only for FRCHe at 20 mL (−4.4 mL, P 0.02). For both FRCHe and FRC, the slopes of the regression equations were 0.99 and the intercepts not significantly different from zero. We conclude that techniques for measuring FRCHe and FRC yield accurate, reproducible, and comparable results in normal, healthy infants and very young children, and in those with respiratory disease. © 1992 Wiley‐Liss, Inc.
Aplasia of respiratory tract cilia
Authors: DeBoeck K. , Jorissen M. , Wouters K. , Van der Schueren B. , Eyssen M. , Casteels‐VanDaele M. , Corbeel L.
Published: March 2007

We report on ciliary aplasia of the respiratory tract, a rare disorder of the mucociliary apparatus, that is insufficiently recognized as a distinct entity. A culture method for ciliogenesis was developed by our laboratory and offers the advantage of studying cilia free of secondary changes associated with infection. Three cases of primary ciliary aplasia were documented histologically in direct biopsy specimens and also in biopsy specimens cultured specifically for ciliogenesis. Primary ciliary aplasia should be differentiated from secondary ciliary aplasia in which basal bodies are present and ciliogenesis takes place in specific culture. Only hereditary ciliary abnormalities are expressed in cell cultures. We critically review the cases of ciliary aplasia reported to date. © 1992 Wiley‐Liss, Inc.
Spirometric and endoscopic evaluation of airway collapse in infants with bronchopulmonary dysplasia
Authors: McCoy Karen S. , Bagwell Charles E. , Wagner Mary , Sallent Jorge , O'Keefe Michael , Kosch Phillip C.
Published: March 2007

We evaluated eight infants with bronchopulmonary dysplasia (BPD) at ages from 2 to 13 months who had repeated episodes of clinical respiratory deterioration associated with agitation. These episodes limited further weaning from ventilation or necessitated recurrent intubation and reinstitution of ventilation. All infants underwent spirometric evaluation and six also had endoscopic examination during simulated agitation episodes (elicited by toe pinching). All babies were found to have a very prolonged near zero expiratory airflow pattern, accompanied by vigorous diaphragmatic and abdominal muscle activity and rapid development of hypoxia. Six patients had endoscopically documented tracheal collapse under the same simulated circumstances. The episodes ceased with calming or sedation of the infants. © 1992 Wiley‐Liss, Inc.
Response to inhaled bronchodilators and nonspecific airway hyperreactivity in children with cystic fibrosis
Authors: Sanchez Ignacio , Powell Richard E. , Chernick Victor
Published: March 2007

We tested the hypothesis that children with CF who have a significant response to bronchodilator (ED) would respond positively to standard methacholine (Mch) challenge. Our objective was to correlate the response to BD with the concentration that produced a 20% fall (PC20) in forced expiratory volume in 1 second (FEV1). We studied 22 patients (12 males), aged 10.5 ± 0.7 years (mean ± SE), with a Shwachman‐Kulczycki score 82 ± 2.6 and baseline FEV11 of 80 ± 4.5% predicted. Baseline expiratory flows, static lung volumes, and airway resistance were measured before and 30 min after inhaled salbutamol. On a separate day, within 2 weeks, a Mch challenge was given, with doubling concentrations from 0.03 to 8.0 mg/mL. A positive challenge was defined as a PC20≦ 2.0 mg/mL, and a positive response to BD as a >6%0 of FEV1 increase. Mch challenge yielded 17 responders (R) with a PC20 of 0.5 ± 0.1 mg/mL, and 5 nonresponders (NR) with a PC20 of 8.8 of 2.9 mg/mL. Baseline FEV11 was 77 ± 5.3% predicted in R compared to 89 ± 6.3% in NR (P = < 0.001). History of springtime rhinitis was positive in 9/17 R and 2/5 NR. No significant correlation was found between baseline FEV1 1 and PC20 or between change in FEV1 1 post‐BD and PC20 A >6% increase in FEV1 1 was seen in 14/17 R (83% sensitivity) and in none of the 5 NR (100% specificity). In R, 8/17 patients had baseline FEV1 1 < 80% predicted, compared to 1/5 in NR. We conclude that a change in FEV11 > 6% from baseline after bronchodilator in children with CF suggests nonspecific airway hyperreactivity. © 1992 Wiley‐Liss, Inc.
Soluble interleukin‐2 receptor levels in infants with bronchopulmonary dysplasia
Authors: Stefano John L. , Spear Michael L. , Pearlman Stephen A. , Fawcett Paul , Proujansky Roy
Published: March 2007

Soluble interleukin‐2 receptors (sIL2R) in plasma have been identified as a marker of lymphocyte activation. Lymphocyte activation as a manifestation of inflammation may be important in the pathogenesis of bronchopulmonary dysplasia (BPD). To test the hypothesis that infants with BPD have higher slL2R levels, 12 infants with or at risk of developing BPD (GA ± SD, 27 ± 5 weeks; BW ± SD 1,053 ± 733 g) had plasma slL2R levels determined and were compared to 20 infants being ventilated for respiratory distress syndrome (RDS) (GA 2 SD, 28 ± 3.5 weeks; BW ± SD, 1,133 ± 390 g: P=NS for both GA and BW, t test). Tracheal aspirates in both groups were also analyzed for slL2R levels. To control for the effects of postnatal age (PNA) and study weight (SW) on the slL2R levels, another group of 16 nonventilated babies (NVB) had plasma analyzed for slL2R (PNA t SD: 39 ± 40 days NVB vs. 48 ± 36 days BPD; P =NS); (SW ± SD: 1391 ± 250 g NVB vs. 1212 ± 700 g BPD; P =NS). The following data were obtained for the plasma slL2R levels (mean 2 SEM U/mL): RDS controls, 1,231 ± 80; BPD infants, 1,790 ± 120; NVB controls, 1,319 ± 76; P =0.0005 RDS vs. BPD and P =0.002 BPD vs. NVB. There was no significant difference in the sIL2R levels for the infants at risk of developing BPD vs. the infants with established BPD. Also, when analyzed separately, infants at risk of BPD and the infants with established BPD had higher slL2R levels than the RDS and NVB controls. No differences were noted in the tracheal slL2R levels in the BPD vs. RDS groups. These data indicate that infants with BPD had significantly higher slL2R levels in plasma than either RDS or NVB controls. Therefore, lymphocyte activation may play a role in the pathogenesis of BPD. © 1992 Wiley‐Liss, Inc.
The relationship of nasal disorders to lower respiratory tract symptoms and illness in a random sample of children
Authors: Barr Marisa B. , Weiss Scott T. , Segal Mark R. , Tager Ira B. , Speizer Frank E.
Published: March 2007

We examined the relationship of nasal disorders, defined as frequent colds and sinus trouble, to lower respiratory tract symptoms in a random population of 718 children aged 4 to 11 years in East Boston, Massachusetts. Frequent colds were significantly associated with maternal smoking (odds ratio (OR) = 3.00; 95% confidence interval (Cl) = 1.97, 4.58), and so was sinus trouble (OR = 4.73; 95% Cl = 1.78, 12.51). After adjustment for maternal smoking, age and sex, frequent colds (OR = 2.88; 95% Cl = 1.87, 4.42) and sinus trouble (OR = 4.95, 95% CI = 1.83, 13.39) remained significant predictors of lower respiratory tract symptoms in separate logistic regressions. If one restricted the cohort to the 513 children who also had personal smoking information and adjusted for this variable as well, the results for colds were unchanged (OR = 2.94; 95% Cl = 1.78, 4.84) but the results for sinus trouble were now not statistically significant (OR = 2.30, 95% Cl = 0.67, 7.94). We conclude that nasal disorders are associated with lower respiratory tract symptoms in children. © 1992 Wiley‐Liss, Inc.
Respiratory compliance in infants—a preliminary evaluation of the multiple interrupter technique
Authors: Fletcher M. E. , Dezateux C. A. , Stocks J.
Published: March 2007

Measurements of total respiratory system compliance (Crs) using the multiple occlusion technique (MOT) in spontaneously breathing infants can be difficult to interpret in the presence of an unstable end‐expiratory level. Similarly, measurements using the passive flow volume technique (PFV) are invalidated if there is a linearity of the expiratory time constant (Trs), irrespective of respiratory effort. For possibly overcoming these problems, we assessed the feasibility of a technique using multiple interruptions of of a single expiration (MIT), obtaining several pairs of volume‐pressure data, from one expiration, which relate to a single end‐expiratory level.

Crs was measured in 16 infants aged 0.5 to 20 months using the MOT, MIT, and PFV technique. The MOT and the MIT each failed in one (different) infant, both succeeding where the other failed. The PFV technique failed in five infants in whom no acceptable plateau of airway pressure during occlusion and no Trs could be obtained from a single breath. Failure to obtain a linear Trs was accompanied by failure of the MIT in only one infant. Individual differences between the MIT and the MOT were less than 9%. However, the PFV measurements varied from −16.3% to +25.7% of the values from MIT or MOT. The greatest differences between Crs values coincided with the greatest differences between volume intercepts of the extrapolated volume‐pressure (MOT, MIT) and flow‐volume (PFV) data.

From this preliminary study, the MIT proved as successful as the MOT, requiring fewer occluded breaths to measure Crs. In infants with a rapid respiratory rate, the data from several expirations can be merged and analyzed as for the MOT. © 1992 Wiley‐Liss, Inc.
A scoring system for lung function tests in infants
Authors: Hampton F. , Beardsrnore C. S. , Morgan W. , Williams A. , Taussig L. , Thompson J. R.
Published: March 2007

Measurements of thoracic gas volume (TGV), airway resistance (Raw), and airway conductance (Gaw) were calculated in a group of 42 normal infants using a whole‐body plethysmograph. Maximum expiratory flow at functional residual capacity was measured in a separate group of 108 normal infants. Using data obtained from these infants the following regression equations were calculated:

The standard errors of prediction are a measure of the scatter of individual results from the normal population about the true regression line. They were used to define limits of the normal ranges for these tests of lung function, and to develop a scoring system. This approach is preferable to expressing results as percent predicted, which gives no indication of how likely a measurement is to be within normal limits. © 1992 Wiley‐Liss, Inc.
Lung recoil and the determination of airflow limitation in cystic fibrosis and asthma
Authors: Zapletal Alois , Desmond Katharine J. , Demizio Debbie , Coates Allan L.
Published: March 2007

A reduction of lung recoil pressure could aggravate any air flow limitation that might be present in patients with cystic fibrosis (CF) or asthma. In a group of 22 children and young adults (8 with cystic fibrosis, 8 with asymptomatic asthma, and 6 healthy controls) aged 8–24 years, lung recoil pressure (Pst) at l00%, 90%, and 60% of TLC and static lung compliance (Cst) were measured using an esophageal balloon. The indices of airflow limitation, including maximal expiratory flow at 25% VC (Vmax25,), forced expiratory volume in 1 second (FEV1,), and specific airway conductance (sGaw), were also measured. In all patients, Vmax25 was reduced, the airway obstruction being more pronounced in patients with CF. Pst was reduced in CF and asthma, again more in the patients with CF. Cst was normal in both groups because the pressure volume curve was shifted up and to the left. There were significant correlations between Pst at 60%, 90%. and 100% of TLC and both Vmax25 and FEV1, (P < 0.01). sGaw correlated with Pst90 and Pst6O (r = 0.47 and 0.53, respectively; P < 0.05 for both). No correlation was found between Cst and Pst at any lung volume. No correlations were observed between Cst and Vmax25, FEV1, or sGaw. These results suggest that loss of elastic lung recoil pressure is a factor in airflow limitation of children and young adults with CF or asthma. © 1993 Wiley‐Liss, Inc.
Pulmonary mechanics and gas exchange: Effect of lateral positioning during recovery from respiratory distress syndrome
Authors: Schlessel Jerrold S. , Rappa Heidi A. , Lesser Martin , Harper Rita G.
Published: March 2007

Sixteen stable intubated premature infants without a clinically significant patent ductus arteriosus were studied during recovery from respiratory distress syndrome in order to determine the effects of left and right lateral, as compared to supine, positioning. Pulmonary mechanics were measured for spontaneous breaths 5 and 15 minutes after positioning, and arterial blood gases 15 minutes after positioning. Infants were randomized to 1 of 2 position sequences: (1) supine, left, supine, right or (2) supine, right, supine, left. No significant differences were detected between positions for dynamic compliance, tidal volume/kg, and total, inspiratory and expiratory pulmonary resistance. Likewise, no significant differences in PaO2 or PaCO2, were detected between the positions. The sequence of positions did not affect the pulmonary mechanics of spontaneous breaths or arterial blood gases. This suggest that short‐term lateral positioning as well as supine positioning can be utilized without deleterious effects on pulmonary mechanics and gas exchange in neonates recovering from respiratory distress syndrome. © 1993 Wiley‐Liss, Inc.
Pulmonary function between 6 and 18 years of age
Authors: Wang Xiaobin , Dockery Douglas W. , Wypij David , Fay Martha E. , Ferris Benjamin G.
Published: March 2007

Pulmonary function of children aged 6–18 years is described based on 82,462 annual measurements of forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and forced expiratory flow between 25% and 75%of FVC (FEF25–75%) from 11,630 white children and 989 black children. Median height, FVC, FEV1 FEV1/FVC1 and FEF25–75% for each 3 months of age are compared among race and sex subgroups. Race— and sex‐specific percentile distributions of FVC, FEV1, FEV1/FVC, and FEF25—75% are presented for each centimeter of height (growth curves). For the same height, boys have greater lung function values than girls, and whites have greater ones than blacks. Lung function increases linearly with age until the adolescent growth spurt at about age 10 years in girls and 12 in boys. The pulmonary function vs. height relationship shifts with age during adolescence. Thus, a single equation or the pulmonary function‐height growth chart alone does not completely describe growth during the complex adolescent period. Nevertheless, race‐ and sex‐specific growth curves of pulmonary function vs. height make it easy to display and evaluate repeated measures of pulmonary function for an individual child. Race‐, sex‐, and age‐specific regression equations based on height are provided, which permit the evaluation of growth during adolescence with improved accuracy and, more importantly, in comparison with previous observations for the same child. © 1993 Wiley‐Liss, Inc.
In vitro branching morphogenesis of the fetal rat lung
Authors: Massoud Emad A. S. , Sekhon Harmanjatinder S. , Rotschild Avi , Puterman Martin L. , Matsui Reiko , Thurlbeck William M.
Published: March 2007

We studied the pattern of airways branching in the fetal rat lung in vitro. Lung primordia of gestational ages 13, 14, and 15 days were allowed to grow in culture to a gestational age equivalent to 21 days. The first generation airways appear by a single new bud (monopodial budding) from the left main airway (lateral appearing before the medial). They elongate to form branches and then bud dichotomously (2 buds occurring simultaneously and adjacent to each other) at their tips. Then monopodial branching takes place along their sides. The same cycle of budding and branching seems to be repeated for the following generation of the airways. The total number of the peripheral (subpleural) buds was greatest in the day 15 explants and least in day 13 explants throughout the whole culture period, but the statistical model used indicated faster budding in the 13 day explants. Morphometric assessment showed no difference in the ratios between the lung components in the 3 age groups and that the peripheral epithelial measurements were the same in the 3 groups at an equivalent gestational age of 21 days. We have also shown that lobes do not form in the right lung, although appropriate airways do. This may indicate the importance of mesothelial covering of the lung in the process of lobe formation. The method is useful for studying the control of lung morphogenesis. © 1993 Wiley‐Liss, Inc.
Evaluation of pulmonary functions during pressure‐limited manual ventilation in preterm neonates
Authors: Reiterer F. , Sivieri E. , Abbasi S. , Bhutani V. K.
Published: March 2007

Manual ventilation (MAV) or handbagging is a frequent and often life—saving procedure for neonates; however, few studies allow for an objective evaluation of techniques or possible risks. We compared parameters of ventilation and pulmonary mechanics obtained during routine pressure—limited MAV to those obtained during spontaneous breathing (SPB) in the same infant at approximately the same time. We selected 20 preterm neonates in the recovery phase of respiratory distress syndrome who received periodic MAV and were capable of optimum spontaneous minute ventilation ( > 300 mL/kg/min). During MAV compared to SPB we measured higher tidal volume (8.1 ± 0.5 SE vs. 5.4 ± 0.4 SE mL/kg, P < 0.001), lower total pulmonary compliance (0.65 ± 0.05 vs. 1.16 ± 0.11 SE mL/cmH2O, P < 0.001). end—inspiratory compliance, higher pulmonary resistance (121 ± 11 vs. 61 ± 7 SE cmH2O/L/s, P < 0.001) and higher peak inspiratory airflow (2.8 ± 0.2 vs. 1.6 ± 0.1 L/s, P < 0.001). Inspiratory time (Ti) was consistently longer during MAV (0.49 ± 0.02 vs. 0.36 ± 0.02 SE, P < 0.001) such that during MAV the difference between actual Ti and minimal effective Ti (fivefold inspiratory time constant) was larger (0.29 ± 0.03 vs. 0.13 ± 0.03 s, P < 0.05). Our study suggests that operator—dependent ventilatory variables such as tidal volume, inspiratory time, frequency, and airflow need to be further evaluated in order to develop standardized guidelines for the safe administration of MAV. Until then the ventilator used for brief or augmented ventilatory support is a reasonable alternative to administering MAV by inconsistent standards. © 1993 Wiley‐Liss, Inc.
Role of calmodulin as an endogenous initiatory factor in compensatory lung growth after pneumonectomy
Authors: Ofulue Anwuli F. , Matsui Reiko , Thurlbeck William M.
Published: March 2007

Compensatory lung growth after pneumonectomy is a well established phenomenon in young humans and experimental animals. To date, the cellular initiating and/or regulatory factor(s) responsible for this growth response have yet to be established. We have studied changes in lung content and activity of calmodulin, a calcium‐dependent regulatory protein in relation with lung mass and DNA content during postpneumonectomy compensatory lung growth in 4‐week‐old rats. We observed that after left pneumonectomy, right lung calmodulin content (measured by radioimmunoassay) and calmodulin activity (measured by cyclic nucleotide phosphodiesterase activation) were increased at days 1 and 2 after surgery in the pneumonectomized rats, preceding the increase of lung mass and DNA content which started at day 3. Treatment of the pneurnonectomized rats with a highly specific calmodulin antagonist, trifluoperazine, immediately after the surgery, resulted in diminished lung calmodulin activity, sparing the calmodulin content, and in concomitant reduction of lung mass and DNA content to values intermediate between those of controls and the pneumonectomized animals. Based on these findings, we conclude that calmodulin may be an important intracellular (possibly, autocrine) initiatory or facilitatory factor in compensatory hyperplastic lung growth after pneumonectomy. © 1993 Wiley‐Liss, Inc.