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“Acquired” congenital diaphragmatic hernia following early onset group B streptococcal pneumonia
414 were found in four American but none of the Japanese patients. Confirmation of sarcoidosis was obtained by biopsy or positive Kveim test in all patients. Twelve Japanese and 20 American patients received corticosteroid treatment. Chest radiographs returned to normal in 38 of 43 Japanese and 37 of 40 American patients with or without treatment. The major difference in the two groups appears to be in the method of presentation.--Randall W. Powell Corticosteroids and Malnutrition: Aspergillus Lung Abscess Asthmatic Child. J. R. Morion, L. S. Mihalas, P. Leung, and D. J. Strieder. Chest 78:667 669, (October), 1980. in a n
A 16-yr-old female with severe asthma developed increasing dyspnea that became continuous, incapacitating, and poorly responsive to all medications. Corticosteroid therapy resulted in Cushingoid facies that led to depression and refusal to eat, which in turn required admission. Three months later a chest radiograph revealed a l-cm cavity in the left upper lobe with sputum cultures growing Aspergillus fumigatus. Multiple immunologic tests revealed no response to the infection and quite poor overall immune competence. Amphotericin B therapy was started and surgical resection of the abscess was performed and the patient recovered. Reduction in steroid dosage resulted in improvement of her depression and appetite. Steroids and malnutrition both depress delayed cutaneous hypersensitivity, lymphocyte rosette formation and response to phytohemagglutinin stimulation. Steroids also reduce granulocyte migration, impair phagocytosis, and increase the catabolism and decrease the synthesis of immunoglobulins. In this patient the combination of steroid and malnutrition probably led to this opportunistic fungal infection, a very rare occurrence in asthma patients on steroids. Randall W. Powell Pulmonary Hemorrhage Secondary to Chest Tube Placement for Pneumothorax in Neonates. A, L. Jung, S. D.
Minton, and Y. Roan. Clin Pediatr 19:624-627, (September), 1980.
Two neonates developed serious intrapleural bleeding following chest tube placement for pneumothorax. Both infants died and in one, a postmortem examination revealed a laceration of the intercostal artery and vein and a lung laceration with hematoma. The authors discuss means of preventing this unusual complication.--Randall W. Powell "Acquired" Congenital Diaphragmatic Hernia Following Early Onset Group B StreptOcoccal Pneumonia. G. P.
Giacoia and S. Jegathesen. Clin Pediatr 19:662-664, (October), 1980.
A male newborn developed pulmonary infiltrates and resiratory insufficiency by age 12 hr. Cultures grew out group B strep and after an initial stormy course he was weaned from the ventilator. At age 13 days, the infant required ventilatory support and his radiograph revealed opacification of both lung fields and a right pleural effusion. The next day after weaning from the ventilator, acute respiratory insufficiency developed and the chest radiograph revealed a right diaphragmatic hernia that was repaired. In this case the use of positive pressure ventilation and abnor-
ABSTRACTS mal lung compliance may have led to the delayed herniation. In an editorial comment, reference is made to 12 similar cases of delayed presentation of right diaphragmatic hernias following group B strep neonatal pneumonia. A neonate with strep pneumonia who suddenly deteriorates may have an associated diaphragmatic hernia.--Randall W. Powell Tolazoline in the Postoperative Period of Diaphragmatic H e r n i a . L. Lassaletta, Z. Ros, A. Queizan, M. Benavent, R. Cabrera, E. Jaureguizar, and A. Martinez. Ann Esp Pediatr 13:651-656, 1980.
From 1969 to 1979, 51 neonates with diaphragmatic hernia were operated on at La Paz Children's Hospital. Fifteen died, 2 during the operation. All of them were operated before the 14th hr of life; their mean weight was 2800 g. The mean postoperative survival time was 75 hr. Only 11 received autopsy; all of whom had severe hypoplastic lungs and patent ductus arteriosus. Another group of 27 autopsies were studied, including either dead born or neonates who died before surgery. All had unilateral or bilateral hypoplastic lungs and 12 had patent ductus arteriosus. The authors focus their interest in the treatment of the rightto-left shunting developed in the postoperative period. They describe two newborns (2400 and 2800 g) that underwent surgery at 8 and 4 hr of life. Both had a left diaphragmatic hernia that was repaired uneventfully. A clear deterioration at 20 and 48 hr was followed by right temporal catheterization for preductal blood gases and an umbilical catheterization for postductal blood gases. Once a diaphragmatic shunt was diagnosed, Tolazoline (Priscoline) was perfused at a constant rate of 1 m g / k g / 2 4 hr with occasional bolus doses if required (2 mg/kg). In both patients there was a clear response to Tolazoline administration, and they were discharged on the 12th and 13th postoperative day. They conclude that the study of pre- and postductal gases is an optimal way of controling right-to-left shunt using vasodilators of the pulmonary artery such as Tolazoline. They have had no complications in either patient.--E, de Jaureguizar
HEART AND GREAT VESSELS Potassium-Induced Cardioplegia in Patients Undergoing Correction of Congenital Heart Defects. F. A. Crawford Jr.,
T. Y. Barnes, and B. J. Heath. Chest 78:316-320, (August), 1980.
Sixty consecutive patients ranging in age from 4 wk to 18 yr (median 5.79 yr) undergoing correction of cardiac defects requiring aortic cross-clamping, had topical myocardial hypothermia and cold potassium-induced cardioplegia. Defects corrected included VSD (32), tetralogy of Fallot (16), A-V canal defects (6), transposition (1), double-outlet RV (1), aortic valvotomy (3), and aortic valve replacement (1) with three patients dying. The authors feel this technique promotes myocardial preservation and greatly improves surgical exposure. Spontaneous defibrillation occurred in 45 patients (75%) and only 11 required inotropic support. The mean immediate post-operative cardiac index was normal (2.85 liters/rain/m2). This technique, widely applied in adult cardiac surgery, seems to be applicable to the correction of congenital cardiac defects also.--Randall W. Powell
A 16-yr-old female with severe asthma developed increasing dyspnea that became continuous, incapacitating, and poorly responsive to all medications. Corticosteroid therapy resulted in Cushingoid facies that led to depression and refusal to eat, which in turn required admission. Three months later a chest radiograph revealed a l-cm cavity in the left upper lobe with sputum cultures growing Aspergillus fumigatus. Multiple immunologic tests revealed no response to the infection and quite poor overall immune competence. Amphotericin B therapy was started and surgical resection of the abscess was performed and the patient recovered. Reduction in steroid dosage resulted in improvement of her depression and appetite. Steroids and malnutrition both depress delayed cutaneous hypersensitivity, lymphocyte rosette formation and response to phytohemagglutinin stimulation. Steroids also reduce granulocyte migration, impair phagocytosis, and increase the catabolism and decrease the synthesis of immunoglobulins. In this patient the combination of steroid and malnutrition probably led to this opportunistic fungal infection, a very rare occurrence in asthma patients on steroids. Randall W. Powell Pulmonary Hemorrhage Secondary to Chest Tube Placement for Pneumothorax in Neonates. A, L. Jung, S. D.
Minton, and Y. Roan. Clin Pediatr 19:624-627, (September), 1980.
Two neonates developed serious intrapleural bleeding following chest tube placement for pneumothorax. Both infants died and in one, a postmortem examination revealed a laceration of the intercostal artery and vein and a lung laceration with hematoma. The authors discuss means of preventing this unusual complication.--Randall W. Powell "Acquired" Congenital Diaphragmatic Hernia Following Early Onset Group B StreptOcoccal Pneumonia. G. P.
Giacoia and S. Jegathesen. Clin Pediatr 19:662-664, (October), 1980.
A male newborn developed pulmonary infiltrates and resiratory insufficiency by age 12 hr. Cultures grew out group B strep and after an initial stormy course he was weaned from the ventilator. At age 13 days, the infant required ventilatory support and his radiograph revealed opacification of both lung fields and a right pleural effusion. The next day after weaning from the ventilator, acute respiratory insufficiency developed and the chest radiograph revealed a right diaphragmatic hernia that was repaired. In this case the use of positive pressure ventilation and abnor-
ABSTRACTS mal lung compliance may have led to the delayed herniation. In an editorial comment, reference is made to 12 similar cases of delayed presentation of right diaphragmatic hernias following group B strep neonatal pneumonia. A neonate with strep pneumonia who suddenly deteriorates may have an associated diaphragmatic hernia.--Randall W. Powell Tolazoline in the Postoperative Period of Diaphragmatic H e r n i a . L. Lassaletta, Z. Ros, A. Queizan, M. Benavent, R. Cabrera, E. Jaureguizar, and A. Martinez. Ann Esp Pediatr 13:651-656, 1980.
From 1969 to 1979, 51 neonates with diaphragmatic hernia were operated on at La Paz Children's Hospital. Fifteen died, 2 during the operation. All of them were operated before the 14th hr of life; their mean weight was 2800 g. The mean postoperative survival time was 75 hr. Only 11 received autopsy; all of whom had severe hypoplastic lungs and patent ductus arteriosus. Another group of 27 autopsies were studied, including either dead born or neonates who died before surgery. All had unilateral or bilateral hypoplastic lungs and 12 had patent ductus arteriosus. The authors focus their interest in the treatment of the rightto-left shunting developed in the postoperative period. They describe two newborns (2400 and 2800 g) that underwent surgery at 8 and 4 hr of life. Both had a left diaphragmatic hernia that was repaired uneventfully. A clear deterioration at 20 and 48 hr was followed by right temporal catheterization for preductal blood gases and an umbilical catheterization for postductal blood gases. Once a diaphragmatic shunt was diagnosed, Tolazoline (Priscoline) was perfused at a constant rate of 1 m g / k g / 2 4 hr with occasional bolus doses if required (2 mg/kg). In both patients there was a clear response to Tolazoline administration, and they were discharged on the 12th and 13th postoperative day. They conclude that the study of pre- and postductal gases is an optimal way of controling right-to-left shunt using vasodilators of the pulmonary artery such as Tolazoline. They have had no complications in either patient.--E, de Jaureguizar
HEART AND GREAT VESSELS Potassium-Induced Cardioplegia in Patients Undergoing Correction of Congenital Heart Defects. F. A. Crawford Jr.,
T. Y. Barnes, and B. J. Heath. Chest 78:316-320, (August), 1980.
Sixty consecutive patients ranging in age from 4 wk to 18 yr (median 5.79 yr) undergoing correction of cardiac defects requiring aortic cross-clamping, had topical myocardial hypothermia and cold potassium-induced cardioplegia. Defects corrected included VSD (32), tetralogy of Fallot (16), A-V canal defects (6), transposition (1), double-outlet RV (1), aortic valvotomy (3), and aortic valve replacement (1) with three patients dying. The authors feel this technique promotes myocardial preservation and greatly improves surgical exposure. Spontaneous defibrillation occurred in 45 patients (75%) and only 11 required inotropic support. The mean immediate post-operative cardiac index was normal (2.85 liters/rain/m2). This technique, widely applied in adult cardiac surgery, seems to be applicable to the correction of congenital cardiac defects also.--Randall W. Powell