bluuebunny/crossref_metadata_2025 huggingface dataset:
Phospholipid composition and surface‐active properties of tracheobronchial secretions from patients with cystic fibrosis and chronic obstructive pulmonary diseases
Authors: Girod S. , Galabert C. , Lecuire A. , Zahm J. M. , Puchelle E.
Published: March 2007

Among the various components of tracheobronchial secretions, lipids and particularly phospholipids have been shown to influence rheological properties of airway secretions in patients with cystic fibrosis. We studied the phospholipid composition of tracheobronchial secretions, collected from patients suffering from cystic fibrosis (CF) and other chronic obstructive pulmonary diseases (COPD), and we analyzed the possible relationship between the phospholipid profile and the wettability of tracheobronchial secretions evaluated by the measurement of contact angle. Although total phospholipid content and contact angle of tracheobronchial secretions were significantly increased (P < 0.01) in CF compared to COPD, no significant relationship existed between these two parameters. The concentrations of the different phospholipid subclasses were not homogeneously modified according to the origin of the secretions. Compared to COPD secretions, the CF secretions were characterized by a significant (P < 0.001) increase in rigidifying fractions such as sphingomyelin and phosphatidylserine/phos‐phatidylinositol and a significant (P < 0.001) decrease in surface‐active fractions, such as phosphatidylcholine and phosphatidylglycerol (PG) (P < 0.001). In the two groups, the surface‐active phospholipid fraction, PG, was negatively correlated to the contact angle of tracheobronchial secretions. These results suggest that a decrease in PG content in CF secretions may be one factor responsible for an increase in their adhesivity to the respiratory mucosa, and, consequently, for mucus stasis and severity of bronchial obstruction in cystic fibrosis. © 1992 Wiley‐Liss, Inc.
Machinal properties of the upper airway wall in children and their influence on respiratory impedance measurements
Authors: Marchal F. , Hauouzi P. , Peslin R. , Duvivier C. , Gallina C.
Published: March 2007

The upper airway wall impedance (Zuaw) may be responsible for a large artifact in the measurement of respiratory system impedance (Zrs) in children. In 17 normal children aged 3.5‐13 years Zuaw and Zrs were estimated by varying transrespiratory pressure directly at the mouth (conventional method:Z1) and around the subject's head (head generator method: Z2) from 4 to 32Hz. Zrs and Zuaw were calculated from Z1 = Zrs · Zuaw/(zrs + Zuaw) and Z2 = Zrs (1 =Zp/Zuaw), where Zp is the impedance of the pneumotachograph. From the real and imaginary part of Z1, Z2, Zrs, and Zuaw, the corresponding resistance, inertance, compliance and resonant frequency were calculated assuming simple REC models. No significant difference was found between the mean ± SE of parameters derived from Zrs (respectively, 6.8 ± 0.4 cmH2O·L−1·s, o.034 ± 0.001 cmH2O·L−1· s2, 10.4 ± 0.8 m. cmH2O·L−1, 9.1 ± 0.3Hz) and Z2 (6.8 ± 0.4 cmH2O·L−1· s, 0.038 ± 0.002 cmH2O·L−1· s2, 10.7 ± 0.7 ml. cmH2O−1, 8.7 ± 0.4 Hz). All but the compliance, derived from Z1 were significantly different (p<0.01) from those derived from Zrs (5.3 ± 0.3 cmH2O·L−1· s, 0.008 ± 0.001 cmH2O·L−1· s2, 11.9 ± 1.2 ml. cmH2O−1, and 20.3 ± 1.6 Hz). Respiratory resistance and compliance correlated significantly with height (r= −0.56 and 0.86, respectively), in contrast to upper airway wall resistance (Ruaw) and compliance (Cuaw). Ruaw (8.6 ± 0.8 cmH2O·L−1·s), Cuaw (1.2 ± 0.2 m· cmH2O−1), and upper airway wall inertance (0.030 ± 0.004 cmH2O·L−1· s2) were close to those obtained by direct measurements in adults. The mechanical properties of the upper airway wall are responsible for a significant error in the measurement of Zrs by the conventional method in normal children. Most of the artifact may be corrected for by applying pressure around the child's head. © 1992 Wiley‐Liss, Inc.
Elastase α‐proteinase inhibitor and lactoferrin concentrations in endotracheal aspirates of ventilated newborns
Authors: Tegtmeyer Friedrich K. , Maacks Susanne , Wood W. Graham , Wiebicke Wolfram
Published: March 2007

Bacterial colonization of the tracheo‐bronchial tree is common and an established risk factor for infection in ventilated newborns. Elastase, a highly active proteinase, and lactoferrin, an iron‐binding protein and potential modulator of the inflammatory process, are both major constituents of either azurophilic or primary granules of neutrophilic granulocytes, released by activation of these cells during the inflammatory response. Since both elastase, complexed with its major inhibitor alpha1‐proteinase inhibitor (Eα1‐Pl), and lactoferrin (Lf) are indicators of granulocyte activation during bacterial infection, they may indicate infectious inflammation at the tracheobronchial site. To study whether these substances in a single suction probe may serve this purpose, we obtained 82 tracheo‐bronchial aspirates routinely from 16 ventilated newborns with a median gestational age of 31.5 (range, 25–39) weeks for laboratory analysis and bacterial cultures. Systemic inflammatory response by differential white blood cell count and C‐reactive protein (CRP) was monitored simultaneously. © 1992 Wiley‐Liss, Inc.

The median Eα1‐PI level was significantly elevated in culture‐positive aspirates (1,005 μg/L: range, < 30–29,240 μg/L) in contrast to culture‐negative samples (158 (μg/L; range, < 30‐1,408 μg/L). In addition to a diagnostic sensitivity of 77%, Eα‐PI offered a high specifity of 88%, a positive predictive value of 97%, and a negative predictive value of 73%. In contrast, median Lf concentration (10.6; range, 0.3–58.3 mg/L vs. 11.7; range, 1.6–158 mg/L) showed no correlation with culture results. Of the culture‐positive aspirates 36% corresponded with systemic signs of an acute inflammatory response, such as elevated l/T‐ratio and CRP. As confirmed by serial measurements in a representative preterm neonate we suggest that an elevated Eα‐PI concentration in tracheo‐bronchial aspirates is a helpful additional indicator of local inflammation before it is detectable by a systemic inflammatory response.
Pediatric asthma deaths in Victoria: The mild are at risk
Authors: Robertson Colin F. , Rubinfeld Abe R. , Bowes Glenn
Published: March 2007

Previous reviews of pediatric asthma mortality have mostly been from hospital‐based clinic populations and suggest that only those with severe asthma are most at risk. This report summarizes an investigation, by interviewer‐administered questionnaire, into the circumstances surrounding the death in all patients aged 20 years or less who died from asthma in the State of Victoria over a 3 year period from May 1, 1986. © 1992 Wiley‐Liss, Inc.

During this period, 51 deaths due to asthma were reported. Thirty‐three percent of these were judged to have a history of trivial or mild asthma, and 32% had no previous hospital admission for asthma. However, 36% were judged to have had severe asthma, 43% were taking regular inhaled beclomethasone or sodium cromoglycate, and 10% were taking regular oral steroids. Twenty‐two percent had a previous admission to an ICU. Death occurred outside hospital in 40 (78%) subjects. In the final attack 63% had sudden onset and collapse within minutes, 12% were found dead, and 25% had acute progression of an established attack. The investigators assessed 39% of the deaths to have had potentially preventable elements. The preventable factors included: inadequate assessment or therapy of prior asthma (68%), poor compliance with therapy (53%), and delay in seeking help (47%).

The majority of subjects in this survey could not be classified as “high risk.” Therefore, clinicians should ensure that all young patients with asthma are aware of optimal maintenance management, can recognize deteriorating asthma, and follow a clear individualized crisis plan.
Fine needle aspiration biopsy cytology as an adjunct in the diagnosis of childhood sarcoidosis
Authors: Wakely Paul E. , Silverman Jan F. , Holbrook C. Tate , Fairman R. Paul , Daeschner Charles W. , Joshi Vijay V.
Published: March 2007

Fine needle aspiration biopsy cytology performed in three children with sarcoidosis expedited clinical investigation and diagnosis of their disease. Each patient had a different clinical presentation; in two of them lymphoma was part of the initial differential diagnosis. Aspiration cytology in all cases revealed collections of epithelioid histiocytes, and multinucleate foreign body‐type giant cells, without accompanying necrosis or acute inflammation. A diagnosis of non‐caseating granulomas consistent with sarcoidosis was made in all aspirates. Special stains for identification of organisms performed on the smears of one case, and culture of aspirate material from one case were negative. Subsequent serum angiotensin converting enzyme levels in all patients were elevated. Chest x‐ray films in all patients showed mediastinal and hilar lymphadenopathy. One patient had an interstitial pulmonary infiltrate. All patients responded to steroid therapy. Fine needle aspiration biopsy can be a useful diagnostic tool in the evaluation of children with suspected sarcoidosis. © 1992 Wiley‐Liss, Inc.
Prolonged apnea and oxyhemoglobin desaturation in asymptomatic premature infants
Authors: Spear Michael L. , Stefano John L. , Spitzer Alan R.
Published: March 2007

Seventy‐eight longitudinal four‐channel recordings of heart rate, thoracic impedance, nasal thermistry, and pulse oximetry were performed on 26 asymptomatic premature infants (gestational age, 29.9 ± 1.58 weeks; birth weight, 1,753 ± 226 grams; postconceptional age, 34.3 ± 2.0 weeks; postnatal age, 4.41 ± 2.40 weeks; all values mean ± SD). Tracings were scored for central and obstructive apnea, bradycardia, periodic breathing, apnea density, and prolonged apnea. The studies demonstrated 585 episodes (7.41/recording) of oxyhemoglobin desaturation with < 80% and 1,193 episodes (15.1/recording) desaturation with < 90%. Recordings had a mean of 16.1 episodes of central apnea, 3.04 episodes of obstructive apnea, and 2.34 episodes of bradycardia. Periodic breathing and short obstructive apneas correlated significantly with the total number of oxyhemoglobin desaturations of < 80% and 90%. Episodes of prolonged apnea were seen in 20 of 78 recordings. In the latter a significantly higher number of total desaturations < 90%), desaturations < 80% and 90% in association with apnea and with bradycardia, longer desaturations, desaturations during sleep, and isolated bradycardia were observed. Variations in heart rate, thoracic impedance, nasal air flow, and pulse oximetry are associated with episodes of oxyhemoglobin desaturation in asymptomatic premature infants. These infants, although asymptomatic, may be at risk for impaired tissue oxygenation. © 1992 Wiley‐Liss, Inc.
Gas exchange during exercise in diabetic children
Authors: Baraldi Eugenio , Monciotti Carla , Filippone Marco , Santuz Pierantonio , Magagnin Giampiero , Zanconato Stefania , Zacchello Franco
Published: March 2007

The purpose of this study was to evaluate the cardiorespiratory and metabolic response to exercise in 33 children, aged 9 to 15 years, affected by type I diabetes mellitus, in comparison with 47 age‐, sex‐, weight‐, and height‐matched healthy children. All diabetic children were on a mixed split‐dose insulin regimen, consisting of both regular and long‐acting insulin in the morning and evening. The last insulin injection was administered on average 6 hours before the test. The mean duration of diabetes mellitus was 5.0 ± 3.1 years. The metabolic control was evaluated on the basis of HbA1 levels (mean, 8.9 ± 1.8%). Pulmonary function tests and progressive exercise tests on the treadmill were performed. Gas exchange, ventilation, and heart rate (HR) were monitored during the tests. The O2 pulse (V/HR) was calculated. There was no difference in the baseline oxygen uptake (\documentclass{article}\pagestyle{empty}\begin{document}$ \mathop {\rm V}\limits^. $ \end\end{document}) between the diabetic children and the control group. \documentclass{article}\pagestyle{empty}\begin{document}$ \mathop {\rm V}\limits^. $ \end{document} peak was significantly lower (P < 0.01) in the diabetic adolescents (41.2 ± 5.9 mL/min/kg) compared to control subjects (46.3 ± 9.6 mL/min/kg) and it was achieved at an earlier (P < 0.01) time of run (7.5 ± 1.8 vs. 9.1 ± 2.8 min). Anaerobic threshold and minute ventilation were similar in the two groups. The O2 pulse throughout the test was significantly lower (ANOVA, P < 0.001) in the diabetic group compared to the controls. No differences were found in resting and post‐exercise spirometric values. In conclusion, our study shows that well‐controlled diabetic adolescents have a reduced working capacity. The lower O2 pulse reflects a reduced peripheral oxygen utilization that might suggest early microvascular disease. © 1992 Wiley‐Liss, Inc.
Clinical observations of nebulized flunisolide in infants and young children with asthma and bronchopulmonary dysplasia
Authors: König Peter , Shatley Miriam , Levine Clive , Mawhinney Thomas P.
Published: March 2007

Severe bronchopulmonary dysplasia (BPD) is frequently associated with asthma. The combination is often severe enough to necessitate corticosteroid therapy. There are no commercially available nebulizer solutions of corticosteroids for use in infants and young children. Seven infants and small children with very severe BPD and asthma aged 6–24 months, were treated with flunisolide, 187–250 μg q.i.d. in the form of nasal spray delivered by nebulizer. After treatment for 2.5–20 months, four patients showed clinical improvement, one initially improved but later deteriorated and died of cardiac failure, and two patients showed no improvement and died within 3 months. The number of days of hospitalization was significantly reduced from 8.4/month to 2.5/month (P < 0.05). No side‐effects were detected and it was felt that the three patients who died, did so as a consequence of very severe BPD and its cardiac consequences. The suspension remained stable for 80 min when mixed with normal saline, cromolyn sodium, albuterol, or acetylcysteine. It is concluded that nebulized flunisolide is a potentially useful treatment for infants and young children with asthma and BPD. © 1992 Wiley‐Liss, Inc.
Diet in infancy and bronchial hyperreactivity later in childhood
Authors: Pöysä L. , Pulkkinen A. , Korppi M. , Remes K. , Juntunen‐Backman K.
Published: March 2007

Sixty‐seven atopy‐prone children (atopic family group, AFG) and 52 children with no family history of atopy (NAFG) were followed for 10 years. During infancy, the mothers of the newborn AFG children were advised to adjust their infants' diet, with a view toward minimizing the risk of atopy, and not to keep pets. Pulmonary function tests, methacholine inhalation challenge (MIC), and skin prick tests (SPT) were done in order to evaluate the bronchial reactivity and skin reactivity in the two groups. A pathological result in MIC was found in 20 (30%) of the AFG children and in 10 (19%) of the NAFG children. Such results of MIC were more common in the children with positive SPT results than in those without (67% vs. 24%). In regard to the diet consumed in infancy, MIC was pathological in 23% of children with and in 36% without prophylactic diet in infancy. © 1992 Wiley‐Liss, Inc.

For MIC, using the new, Spira electro 2 dosimeter equipment, the sensitivity was 75% and specificity 97%, but the predictive value for diagnosing bronchial asthma was only 25%. The important advantage of our method is that the degree of bronchial reactivity can be estimated by responses to increasing provocative doses.

Our observations confirm that the new method is suitable for detecting bronchial asthma in clinical practice but it seems not to be optimal for epidemiological studies. We concluded that later bronchial hyperreactivity can not be diminished by avoiding home pets or providing a hypoallergenic diet during infancy.
Reproducibility of late phase pulmonary response to exercise and its relationship to bronchial hyperreactivity in children with chronic asthma
Authors: Boner A. L. , Vallone G. , Chiesa Mo M. , Spezia E. , Fambri Mid L. , Sette Yd L.
Published: March 2007

To determine the reproducibility of the delayed response to exercise and its effect on bronchial hyperreactivity, we had 26 asthmatic children perform treadmill exercise challenge on two occasions 1 week apart. Both challenges were preceded by 2 control days and 1 histamine challenge day, and were followed by another histamine challenge day. Peak expiratory flow rate (PEFR) was measured hourly for 12 hours on each control day and for 12 hours after each exercise or histamine challenge. During the first week, five patients showed a late reaction (PEFR change > 15%) after exercise, which was present in only two of them the following week. These two patients, however, also showed a spontaneous fall > 15% of PEFR from baseline during the other control study days. A similar pattern was seen in two other patients who had a late response during the second exercise challenge but not during the first. No significant change occurred in histamine PC‐20 FEV1 between before and after the exercise challenges. An apparent late asthmatic response after exercise challenge may represent a within‐day fluctuation in pulmonary mechanics that develops spontaneously in children with asthma. © 1992 Wiley‐Liss, Inc.
Validation of respiratory inductance plethysmography (“Respitrace”®) for the measurement of tidal breathing parameters in newborns
Authors: Stick S. M. , Ellis E. , Lesouëf P. N. , Sly P. D.
Published: March 2007

Introduction: The ratio of the time to reach peak (maximum) tidal expiratory flow (Tme) to total expiratory time (Te) is smaller in infants who later develop lower respiratory tract disease. In previous studies infants have been sedated and flow measured using a pneumotachograph with face‐mask. These methodological factors are known to affect tidal breathing, and the frequent need for sedation limits the use of the technique to relatively small studies. The aim of this study was to validate uncalibrated respiratory inductance plethysmography (Respitrace®) to measure Tme/Te in unsedated newborns.

Methods: Nineteen normal term infants were studied during quiet sleep. Agreement between Tme/Te measured directly using a pneumotachograph and with Respitrace was assessed in 15 infants. Repeatability of the Respitrace technique was assessed in 10 infants.

Results: The mean Tme/Te for the 19 infants using Respitrace was 0.46 (S.D. 0.14). The mean difference between Tme/Te obtained using Respitrace and that measured with a pneumotachograph was −0.014; 95% of Respitrace readings were between −0.042 and 0.070 of the pneumotachograph values. The mean difference between repeat Respitrace values was 0.02 with 95% of the second measurements within 0.066 of the first.

Conclusions: These results indicate that Respitrace can be used to determine Tme/Te accurately. © 1992 Wiley‐Liss, Inc.
Primary pulmonary tumors in childhood: A review of 31 years' experience and the literature
Authors: Cohen Marta C. , Kaschula R. O. C.
Published: March 2007

Primary pulmonary tumors are infrequent in childhood, therefore an accurate diagnosis and treatment is often delayed. We review the English language literature and report the clinical and pathological features of eight tumors arising in the lungs of pre‐adolescent children, accessioned between 1960 and 1991 in the pathology department of a children's hospital in South Africa. The ratio of pulmonary primary tumors to secondary neoplasms and to non‐neoplastic lesions of the lung examined during this period was 1:5:60. Over the last 31 years we received three plasma cell granulomas, two pleuro‐pulmonary blastomas, a mucoepidermoid carcinoma, an endobronchial fibrosarcoma, and a hemangioma. All patients presented with cough unresponsive to medical treatment. The incidence and spread of primary lung tumors in children was similar to that reported from other centers. Plasma cell granuloma is the most common primary tumor in the lungs of children. Agressive behavior is most frequently encountered with pleuro‐pulmonary blastoma and rhabdomyosarcoma, and because of their association with cystic lesions careful examination of lungs is required in such cases. Most other malignant neoplasms, such as muco‐epidermoid carcinoma and primary fibrosarcoma, are usually of a low grade of malignancy. A decreasing incidence of bronchogenic carcinoma seems to be reported during the first two decades of life. © 1992 Wiley‐Liss, Inc.
Assessment of exercise capacity in asthmatic children with various degrees of activity
Authors: Fink Gershon , Kaye Clive , Blau Hanna , Spitzer Shimon A.
Published: March 2007

Physical fitness in a group of 49 stable asthmatic children was determined by an incremental exercise test. Thirty‐one normal children served as a control group. The asthmatic children were divided into three groups. Group 1 was comprised of 16 children who actively participated in organized sports, Group 2 of 16 children who did not participate in organized sports but who engaged in free‐play, and Group 3 of 17 children with a sedentary life‐style who avoided even free‐play. The results of cardiopulmonary evaluation before and after maximal incremental exercise testing have shown that Groups 1 and 2 behaved like the control group and their physical fitness was similar. Group 3 whose life‐style was sedentary had poor physical fitness as compared to the other asthmatics and to the control group. This was the result of poor cardiovascular conditioning and was unrelated to the respiratory limitation. We conclude that poor physical fitness in asthmatic children is the result of a sedentary life‐style and can be potentially normalized. © 1993 Wiley‐Liss, Inc.
Elevated exoenzyme expression by Pseudomonas aeruginosa is correlated with exacerbations of lung disease in cystic fibrosis.
Authors: Grimwood K. , To M. , Semple R. A. , Sokol P. A. , Woods D. E.
Published: March 2007

Two studies were conducted to determine whether Pseudomonas aeruginosa exoenzyme expression was increased during pulmonary exacerbations of cystic fibrosis (CF) and if it was reduced by antibiotic therapy. The first study was retrospective comparing in vitro exoenzyme levels expressed by P. aeruginosa sputum isolates from seriously ill, hospitalized patients with CF to those from P. aeruginosa strains isolated from CF clinic patients who were in relatively better health. Exoenzyme values were significantly greater in P. aeruginosa strains isolated from ill, hospitalized patients than in clinic patients (P = 0.0001). In the prospective study, in vitro exoenzyme levels were measured from sputum p. aeruginosa isolates of 9 hospitalized patients with CF. Exoenzyme values were greatest in nonmucoid strains on admission (P < 0.0025), and P. aeruginosa exoenzyme expression decreased significantly during hospitalization (P < 0.0025). Deterioration in CF lung disease was accompanied by increased P. aeruginosa exoenzyme production, especially by nonmucoid strains. Antibiotic treatment during hospitalization resulted in mean improvement of % predicted forced expiratory volume in 1 sec (FEV1) from 39 to 53% (P = 0.002). Thus, antibiotics may improve pulmonary function in patients with CF by decreasing P. aeruginosa exoenzyme expression. © 1993 Wiley‐Liss, Inc.
Pulmonary follow‐up 2.5 years after a randomized, controlled, multiple dose bovine surfactant study of preterm newborn infants
Authors: Couser Robert J. , Ferrara T. Bruce , Wheeler William , McNamara John , Falde Brenda , Johnson Katie , Hoekstra Ronald E.
Published: March 2007

Forty‐seven preterm infants, who were previously enrolled in a prospective, randomized, blinded study at birth to assess the effects of multiple doses of exogenous bovine surfactant to prevent respiratory distress syndrome, underwent lung function evaluation and review of their medical histories at 21/2 years of age. During their initial hospitalization there were no differences between the 17 control infants and the 30 surfactant‐treated infants in the duration of ventilator or oxygen therapy and the incidence of bronchopulmonary dysplasia. At the follow‐up both groups were similar in chronological and corrected ages, weights, lengths, and sex ratios and there were no differences in the occurrence of allergy, asthma, bronchiolitis, eczema, pneumonia, and wheezing. In addition, there was no significant difference regarding the incidence of chest illnesses lasting either 3 or 7 days and in the total number of required rehospitalizations. Functional residual capacity (FRC), tidal volume (VT/kg), compliance (Crs/kg), resistance (R‐), and time constant of the respiratory system were not significantly different between the two groups at 21/2 years of age. We conclude that bovine surfactant, when given during the neonatal period, has little long‐term effect on lung function. Neonatal bovine surfactant therapy neither improves nor produces any adverse effects on the developing respiratory system. © 1993 Wiley‐Liss, Inc.
The effect of frequency and mean airway pressure on volume delivery during high‐frequency oscillation
Authors: Chan V. , Greenough A. , Milner A. D.
Published: March 2007

The performance of a commercially available oscillator (SensorMedics 31 00) at different frequencies was assessed. A frequency response curve of a pneumotachcgraph system was constructed and this was used to measure the volume delivered by the oscillator to a lung model. The volume delivered by a constant diaphragm displacement was demonstrated to be inversely proportional to the frequency, but unaffected by increasing mean airway pressure from 15 to 25 cm H2O. The volume delivered during high frequency oscillation (HFO) was then asessed in 8 infants, median gestational age 29 weeks. The infants were studied at two frequencies, 10 and 15 Hz, both of which were used at two levels of mean airway pressure (MAP): 2 and 5 cm H2O above the MAP level previously used during conventional ventilation. The delivered volume was not significantly different at the two MAP levels, but was significantly greater at 10 than 15 H t at both MAP levels (P < 0.03); at MAP +2 cm H2O above baseline the reduction in delivered volume was from a median of 1.54 mL/kg (range, 0.88–3.12) at 10 Hz to 1.18 mL/kg (range, 0.6545) at 15 Hz. These results suggest that higher frequencies would require an increase in the oscillator displacement if effective gas exchange is to be maintained. © 1993 Wiley‐Liss, Inc.
Poor agreement between reported and recorded nocturnal cough in asthma
Authors: Falconer A. , Oldman C. , Helms P.
Published: March 2007

Reported presence or absence of night cough was compared with tape recorded cough in 15 children with perennial asthma (median age, 9 years; range, 7–14) who reported troublesome nocturnal symptoms. Measurements were made and diaries kept for 7 consecutive nights. Cough was reported on 66 of 105 (66%) and recorded on 93 (90%) available nights with poor overall agreement (Cohen's coefficient of assessment, kappa +0.30, range −0.17 to +l). The poor agreement between subjective and objective assessment of an important symptom of nocturnal asthma raises questions on the validity of symptom reporting and may in part explain the not infrequent disagreement between medical and patient assessment of disease severity. © 1993 Wiley‐Liss, Inc.
Postnatal expression of myosin lsoforms in the genioglossus and diaphragm muscles.
Authors: Brozanski Beverly S. , Daood Monica J. , Watchko Jon F. , Laframboise William A. , Guthrie Robert D.
Published: March 2007

We studied the expression of myosin heavy chain (MHC) and native myosin isoforms in the genioglossus (GG) and costal diaphragm (DIA) muscles of the rat during postnatal development using both denaturing and nondenaturing gel electrophoresis. Primary myotubes in both fast and slow muscles homogeneously express slow as well as embryonic myosin. Since the adult GG is comprised primarily of fast MHC isoforms, whereas the adult DIA is characterized by a mixture of MHC slow and fast isoforms, we hypothesized that the GG and DIA would be subject to different temporal patterns of MHC isoform expression during postnatal development. Native myosin and MHC gels demonstrated a persistence of neonatal MHC (MHC neo) on day 25 in the GG, whereas this isoform was not detected beyond day 21 in the DIA. The MHC phenotype in GG of the adult demonstrated a predominance of MHC 2× (35% ± 8) and MHC 28 (45% ± 10) with a smaller proportion of MHC 2A (19% ± 5). In contrast, the MHC phenotype in adult DIA was characterized by approximately equal proportions of MHC slow (25% ± 3), MHC 2A (34% ± 10), and MHC 2× (31% ± 12) with a small percentage of MHC 2B (9% ± 7). These data suggest that postnatal regulation of MHC expression in the GG and DIA is muscle specific. © 1993 Wiley‐Liss, Inc.
Fluid dynamics during initial aeration of mature fetal lung and effect of temperature
Authors: Scarpelli Emile M. , Antonio‐Santiago Maria T. , Clutario Bella C. , Mautone Alan J.
Published: March 2007

Air volume‐pressure (VP) curves were recorded simultaneously on pairs of mature rabbit fetuses from the same litter with one member of the pair at 37°C and the other at 22°C. lntrasaccular bubbles, formed primarily during inflation, were assessed for stability and surface tension (y). Average air flow rates (dV/dt) were calculated from the VP data. In separate experiments, liquid VP curves were recorded at 37° and 22°C: maximal liquid V was matched to maximal air V at 37° and 22° C, respectively. Fetal pulmonary liquid (FPL) viscosity (q) and density (p) were determined by standard methods. Both the effect of temperature on lung mechanics as reported previously, and the reliability of the rabbit model were confirmed in the paired fetuses. Analysis of fluid dynamics revealed that of the six parameters relevant to initial inflation‐deflation of FPL‐filled lungs, liquid p. distensibility (recoil), and γy were not altered significantly by temperature increase from 22° to 37°C. Enhanced lung mechanics at 37°C (including enhanced inflation at lower P, higher maximal V, increased production of intrasaccular bubbles, and higher V at end‐deflation) was primarily due to lowering of FPL η at the higher temperature which appears to have an effect by augmenting bulk liquid flow and liquid drainage. Lower ηl increases bulk flow through airways directly. Consequent recruitment and distention of these conducting units effectively increases radius (r) and further enhances flow. (The ultimate “brake” to airways flow at both temperatures is counter P from γ at air/liquid menisci.) Lower η also increases liquid drainage during the process of intrasaccular bubble production. This effect, along with temperature enhancement of surfactant solubility, increases the rate of bubble formation within peripheral units. © 1993 Wiley‐Liss, Inc.
High‐frequency jet ventilation in children with the adult respiratory distress syndrome complicated by pulmonary barotrauma
Authors: Smith David W. , Frankel Lorry R. , Derish Melinda T. , Moody Robert R. , Black Lehman E. , Chipps Bradley E. , Mathers Lawrence H.
Published: March 2007

High‐frequency jet ventilation (HFJV) was used in 29 children with severe ARDS complicated by pulmonary barotrauma (PST). Treatment with HFJV was begun when PBT was progressing over a 24‐h period while receiving conventional ventilation (CV). The mean (±SD) age was 0.95 ± 1.21 years (range, 0.03‐4 years). The most common diagnosis was viral pneumonia (n = 17); other diagnoses included aspiration pneumonitis (n = 4), bacterial pneumonia (n = 3), multiple trauma (n = 2), and near‐drowning (n = 3). The Bunnell Life‐Pulse ventilator was used at a rate of 240/min or 300/min, with inspiratory time of 0.02 sec. Twenty children survived (69%). Survivors and nonsurvivors had equal disease severity prior to HFJV as assessed by ventilator settings, alveolar‐to‐arterial oxygen tension gradient, oxygenation index, and blood gas values. Survivors had spent significantly less time on conventional ventilation prior to HFJV than nonsurvivors, with a mean (±SD) of 3.7 ± 2.1 days vs 9.6 5 4.5 days, respectively (P < 0.05). Survivors underwent an average of 4.4 ± 3.9 days of HFJV, which supported adequate gas exchange with lower airway pressures, and produced resolution or significant improvement in airleak on chest radiograph. In conclusion, we speculate that the application of HFJV early in the course of severe hypoxemic respiratory failure complicated by airleak, allows the reduction of airway pressures, thereby minimizing pulmonary barotrauma and allowing the lung to recover from the underlying insult. Further controlled evaluation of HFJV in this high risk group of patients is warranted. © 1993 Wiley‐Liss, Inc.
Acute lower respiratory infection in Argentinian children: A 40 month clinical and epidemiological study
Authors: Murtagh Patricia , Cerqueiro Cristina , Halac Alicia , Avila Maria , Salomón Horacio , Weissenbacher Mercedes
Published: March 2007

In a total of 1, 003 children (805 inpatients and 198 outpatients) with acute lower respiratory infections (ALRI), clinical, social, and environmental data were analyzed. The major clinical entities were bronchiolitis, pneumonia, bronchitis, and laryngitis. The first two of these predominated in inpatients; pneumonia and bronchitis were more common in older children, while bronchiolitis was observed in infants. Respiratory rates of >50/min. were more common in younger children and in cases with bronchiolitis and bronchitis. Retractions showed markedly less age‐dependent variations and were present in all severe cases with different clinical diagnoses. Retractions alone or associated with cyanosis were the best indicators for severity of ALRI. Among outpatients, fever and wheezing were more common; inpatients were younger, more frequently malnourished, and from a lower socioeconomic level; family history of chronic bronchitis, crowding, and parental smoking also prevailed in this group. Family asthma and exposure to domestic aerosols was more common among outpatients. Prematurity rate (17 and 15%) of all ALRI cases was twice that of the general pediatric population and a significant difference existed between in‐ and outpatients under 6 months of age when perinatal respiratory pathologies predominated among inpatients. It is suggested to consider the need for assessing personal, family, and environmental risk factors in addition to clinical signs and symptoms when severe cases of ALRI are evaluated. Pediatr Pulmonol. 1993; 16: 1–8. © 1993 Wiley‐Liss, Inc.
New associations of primary ciliary dyskinesia syndrome
Authors: Engesaeth V. Gemou , Warner J. O. , Bush A.
Published: March 2007

Ten of 32 patients with primary ciliary dyskinesia syndrome (PCDS) also had other conditions. Five esophageal problems, 4 congenital heart disease, 2 scoliosis, and 4 miscellaneous and probably coincidental conditions were discovered. Additionally, a patient in this series, who has a normal heart, had a brother who died after surgery for complex congenital heart disease. In retrospect, he too probably had PCDS. The association of severe esophageal and cardiac disease with primary ciliary dyskinesia has not been described before. The diagnosis of PCDS may carry more implications than previously recognized. Pediatr Pulmonol. 1993; 16:9–12. © Wiley‐Liss, Inc.
Lung function in children and adolescents with tetralogy of Fallot after intracardiac repair
Authors: Zapletal Alois , Samanek Milan , Hruda Jaroslav , Hucin Bohuslav
Published: March 2007

We studied lung function in 41 patients, aged 6–27 years, 1–5 years after intracardiac surgical repair (ICR) of tetralogy of Fallot (TOF) and about 5 years after the establishment of the Pediatric Cardiac Center in Prague. The measurements included vital capacity (VC). total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), forced expiratory flows (FEF), specific airway conductance (SGaw), lung recoil pressure (Pst), and specific static lung compliance (S1st). Single or mutiple abnormal lung function parameters were found in 83% of patients. Lung function was not related to shunting operations prior to ICR, hemoglobin concentration, and hematocrit, and had no specific pattern. Pst at 100% TLC and 90% TLC declined with increasing age at ICR and at lung function testing, while SC, rose, as did the ratio FRC/TLC. Fifteen patients were studied before and after surgery. Single or multiple lung function tests were abnormal in 93% before and in 84% after ICR. After ICR the ratios FRC/TLC and also RV/TLC, FEF at 25% VC, and FEF at 60% TLC were less frequently abnormal, while Pst at 100% TLC and at 90% TLC, as well as SGaw and TLC, were more frequently abnormal after ICR. The results indicated a regression of smaller airway obstruction and lung hyperinflation after ICR. The evolution of abnormally compliant (emphysematous) lungs with growth of the patients might be a sign of permanent sequelae of early lung damage from abnormal pulmonary hemodynamics. Pediatr Pulmonol. 1993; 16:23–30. © 1993 Wiley‐Liss, Inc.
Resistive and elastic unloading to assist spontaneous breathing does not change functional residual capacity
Authors: Schulze Andreas , Schaller Peter , Töpfer Andreas , Kirpalani Haresh
Published: March 2007

Resistive and/or elastic unloading (a negative ventilator impedance, otherwise termed proportional assist ventilation) may be a useful means to assist spontaneous breathing. This only applies if the ventilator accurately provides pressure changes at the airway opening (Pao) proportional to the instantaneous flow and/or volume signal of spontaneous breathing and no significant phase lag. We designed such an infant ventilator, which controls the Pao, by a negative feedback loop, and superimposes a second positive feedback circuit to generate unloading. To test this mode and the ventilator's accuracy in performing the synchronized pressure changes, we examined the functional residual capacity (FRC). We hypothesized that unloading by itself would not alter FRC because Pao, should return to a preset baseline at end‐expiration, and furthermore, that FRC could be actively altered by changing the baseline. Five anesthetized, tracheotomized, spontaneously breathing rabbits [respiratory system compliance 22.4 ± 4.6 mL/kPa (mean ± SEM)] were exposed to end‐expiratory Pao, levels of 0, 0.2, 0.4, and 0.6 kPa. At each of these levels a period of regular continuous positive airway pressure (CPAP) was alternated with a period of unloading (−40 mL/kPa ventilator compliance combined with −3 kPa/Us ventilator resistance). FRC measured by a sulfur hexafluoride washout technique was virtually identical on CPAP and during unloading at equal end‐expiratory Pao, (difference, 1.41% ± 0.95%), but FRC increased upon elevation of the end‐expiratory Pao, by 29.4 2 3.6 mL/kPa on CPAP and 30.2 ± 3.2 at unloading (difference NS). We conclude that FRC is not destabilized by unloading, but that during unloading, as during CPAP, it depends on the end‐expiratory Pao. Pediatr Pulmonol. 1993; 16:170–176. © 1993 Wiley‐Liss, Inc.
International comparison of asthma prevalence in children: Australia, Switzerland, Chile
Authors: Robertson Colin F. , Bishop Janet , Sennhauser Felix H. , Mallol Javier
Published: March 2007

The aim of the study was to determine if the prevalence of symptoms suggestive of asthma in school‐age children was similar in three countries with differing language and culture. To answer this question, we used the same instrument, translated appropriately, for schoolchildren in Melbourne, Australia, St. Gallen, Switzerland, and La Serena, Chile. A three page respiratory symptoms questionnaire was issued to schools for distribution to children for completion by parents and return to the school. Three age groups were selected for study, based on the average age of the school grade. Grades were used with average ages of 7, 12, and 15 years, respectively. A total of 26,628 questionnaires were issued to parents (Australia, 10,981; Switzerland, 4.464; Chile, 11,163). The response rates for each country were 89% for Australia, 97.5% for Switzerland, and 71% for Chile.

The prevalence of wheezing in the last 12 months for 7 year olds was 23.1% in Melbourne, 7.4% in St. Gallen, and 26.5% in La Serena; for 12 year olds it was 20.9% in Melbourne, 6.0% in St. Gallen, and 21.l% in La Serena; for 15 year olds it was 18.6% in Melbourne, 4.5% in St. Gallen, and 17.7% in La Serene. A history of wheezing was more common in boys than girls at age 7 in Melbourne and St. Gallen, but not La Serena. This difference was less at age 12 and was not seen at age 15. Among those who had reported wheezing in the last 12 months, bronchodilator use was reported by 83% (1,611/1,948) from Melbourne, 46% (1 18/259) from St. Gallen, and 47% (538/1,140) from La Serena.

The prevalence of respiratory symptoms reported from Switzerland was much lower than that for Australia or Chile. Now that a difference in the prevalence of asthma symptoms has been demonstrated, it may be desirable to compare environmental factors between countries with different prevalence rates. Pediatr Pulmonol. 1993; 16:219–226. © 1993 Wiley‐Liss, Inc.
Bone turnover in asthmatic children treated with oral prednisolone or inhaled budesonide
Authors: Wolthers Ole D. , Riis Bente Juel , Pedersen Søsren
Published: March 2007

Biochemical markers of bone turnover were studied in prepubertal school children with asthma in two randomized double‐blind crossover trials with run‐in, treatment, and wash‐out periods of 2 weeks. One group (n = 11) was treated with 2.5 and 5.0 mg prednisolone, the other (n = 14) with 200 and 800 μg inhaled budesonide per day. Serum osteocalcin, serum total alkaline phosphatase, fasting urinary excretion of hydroxyproline and calcium, serum 25‐hydroxyvitamin D, and 1,25 dihydroxyvitamin D were assessed. A dose‐related reduction of serum osteocalcin (Page's test for trend: P = 0.04; z = −2.3) and of the fasting urinary hydroxypro1ine:creatinine ratio (Page's test for trend: P = 0.05; z = −2.0) was found in the children who were treated with prednisolone. Inhaled budesonide was not associated with statistically significant effects on any of the biochemical markers. Short‐term treatment with low daily doses of prednisolone may cause a suppression of bone turnover in children with asthma. To reduce the risk of adverse effects on bone turnover, doses of inhaled budesonide up to 800 μg daily may be preferable to low doses of prednisolone. Bone turnover remains to be evaluated during long‐term treatment. Pediatr Pulmonol. 1993; 16:341–346. © 1993 Wiley‐Liss, Inc.
Evolution of pulmonary function during an acute exacerbation in hospitalized patients with cystic fibrosis
Authors: Gozal David , Bailey Sandra L. , Keens Thomas G.
Published: March 2007

Few objective criteria have been validated for serial clinical monitoring in patients with cystic fibrosis (CF) during pulmonary exacerbations. While pulmonary function tests (PFT) are often used to monitor clinical improvement, it is not known which test correlates most closely with clinical improvement. To answer this, we measured routine PFT in 58 patients with CF before, during, and at discharge after 2–3 week hospital admission in 71 episodes of pulmonary exacerbation. Patients with CF were discharged based on clinical, radiological, and laboratory criteria. In general, all PFTs improved at midadmission and improved further by discharge, at which time forced expiratory volume in 1 second (FEV1), forced expiratory flow between 25% and 75% of forced vital capacity (FEF25–75), vital capacity (VC), maximal voluntary ventilation (MVV), and oxygen saturation by pulse oximetry (SPO2) increased. The residual volume to total capacity ratio (RV/TLC) and the slope of phase 3 in the single breath N, washout curve (SP3 N2) decreased. The change in SP3 N2 was significantly greater than in any other PIT (P < 0.01 vs. VC and FEV1; P < 0.02 vs. RV and P < 0.001 vs. SPO2). A calculated optimal cut‐off value for SP3 N2 improvement was significantly more sensitive in identifying patient improvement at discharge than any other pulmonary function test (P = 0.005). We speculate that clinical improvement in patients with CF is closely linked to improved distribution of ventilation. Pediatr Pulmonol. 1993; 16:347–353. © 1993 Wiley‐Liss, Inc.
Correlation between specific IgG subclass antibodies to Pseudomonas aeruginosa and opsonic activity in serum from patients with cystic fibrosis
Authors: Pressler Tacjana , Jensen Elsebeth T. , Espersen Frank , Pedersen Svend S. , Høiby Niels , Koch Christian
Published: March 2007

Heat‐stable opsonins from sera of patients with cystic fibrosis (CF) non‐CF patients with chronic Pseudornonas aeruginosa infection, healthy children, and adults were investigated for their ability to promote phagocytosis of 35S‐labeled P. aeruginosa by human polymorphonuclear neutrophils. Healthy children had significantly lower levels of opsonic activity than adults. Sera from patients with CF without chronic P. aeruginosa lung infection showed significantly higher levels of opsonic activity compared to healthy children. Sera from patients with CF in the early stage of chronic infection had similar opsonic activity as non‐CF patients with chronic infection. Sera from patients with CF in the late stage of chronic infection had higher opsonic activity than other infected patients, but not different from adult controls. An inverse correlation was found between levels of specific antibodies to P. aeruginosa and opsonic activity in the group of patients in a late stage of infection. An inverse correlation was also found between levels of IgG1 and lgG3 to P. aeruginosa St‐Ag and opsonic activity during the late stage of infection. Infection with P. aeruginosa in CF did not induce significantly increased opsonic activity. It seems that antibodies to P. aeruginosa may have inhibitory opsonic activity. Pediatr Pulmonol. 1994; 17:31–40. © 1994 Wiley‐Liss, Inc.
The “horseshoe” lung: Six new cases
Authors: Dupuis Claude , Remy Jacques , Rémy‐Jardin Martine , Coulomb Max , Brèviere Georges‐Marie , Laden Seima Ben
Published: March 2007

Six cases of horseshoe lung have been found in a group of 147 scimitar syndrome cases collected in a cooperative multicenter study. These cases were associated either with the severe infantile or with the benign adult form of the scimitar syndrome. The aim of this paper is to describe the clinical and imaging signs as well as the prognosis of 6 new cases of horseshoe lung in association with scimitar syndrome. The authors conclude (1) that the diagnosis of horseshoe lung may be strongly suspected on standard chest radiographs and confirmed by thoracic CT scan; (2) that the prognosis of scimitar syndrome does not seem to be worse when associated with horseshoe lung. Pediatr Pulmonol. 1994; 17:124–130. © 1994 Wiley‐Liss, Inc.