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Chordoma presenting as a posterior mediastinal mass. A choristoma
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ABSTRACTS
THORAX
Management of Crushing Chest Injuries in Children. J. L. Levy, Jr. Southern Med. J. 85:1040-1044 (September), 1972.
The author has evaluated 51 children under 12 yr of age who sustained blunt chest trauma. He emphasizes the importance of institution of a good airway immediately upon the child’s arrival in the emergency room. The rapid placement of an endotracheal tube is preferred to a tracheostomy, which often results in loss of valuable time. The diagnosis of hypovolemia is critical. Evaluation of early injuries is necessary. Since 1960, mechanical ventilators have been used for all children with continuing respiratory distress at Tulane University School of Medicine. In most instances, these are needed for flail chest, pulmonary contusions, atelectasis, or “wetlung” syndrome. A volume-cycled ventilator is preferred to the pressure-cycled ventilator for children. It was found that a Bournes respirator is most effective up to the age of 3 yr, whereas the Emerson or Engstrom is best for older children. Hourly blood-gas determinations are indicated until the patient’s condition is stabilized. Ultrasonic nebulizers to decrease the viscosity of secretions have been found effective. Frequent bronchoscopy is helpful when indicated. The author concludes that the morbidity and mortality rates are directly proportional to the effectiveness of early therapy. He also emphasizes that the relationship between clinical respiratory distress and x-ray findings of the chest are not always comparable. Several of the children exhibited severe respiratory distress with derangement of blood gases associated with respiratory alkalosis, even though the chest x-ray was normal.-George Holcomb, 7r. Hemothorax In Idiopathic Thrombocytopenic Purpura (ITP). V. L. Fromke and W. R. Schmidt. J. Thorac. Cardiovasc. Surg. 63:962-967 (June), 1972. Spontaneous hemothorax secondary to idiopathic thrombocytopenic purpure is rare. Treatment in this 6%yr-old man was by thoracentesis, corticoids, and splenectomy. Twenty-four references are included. -Thomas M. Holder
Spontaneous Pneumothorax and Pneumomediastinum as Complications of Sarcoma. J. F. Laucius, H. S. Brodovsky, and C. D. Howe. J. Thorac. Cardiovasc. Surg. 64:467-461 (September), 1972.
The case reports of three teen-age patients with sarcoma and pulmonary metastases who developed spontaneous pneumothorax (two) and spontaneous pneumomediastinum (one) are presented. Two of the patients had osteogenic sarcoma and one had rhabdomyosarcoma. All three were known to have pulmonary metastases prior to the onset of pneumothorax or pneumomediastinum.-Thomas M. Holder Chordoma Presenting as a Posterior Mediastinal Mass. A Choristoma. R. L. Clemons, R. Ii. Blank, J. 13. Hutcheson, and E. H. Ruffolo. J. Thorac. Cardiovasc. Surg. 63:922-924 (June), 1972.
This is a case report of a l4-yr-old girl treated by excision. No follow-up is presented.-Thomas M. Holder Pulmonary Fibroplasia in Newborn Babies Treated With Oxygen and Artificial Ventilation. C. K. Banerjee, D. J. Girling, and J. S. Wigglesworth. Arch. Dis. Child. 47: 509-518. (August), 1972.
This retrospective study of 81 infants dying between 1965 and 1970 attempts to correlate pulmonary fibroplasia with the percentage of oxygen in the inspired “air” and with prolonged artificial ventilation. All infants developing pulmonary fibroplasia had been treated in over 60% of oxygen for at least 46 hr. Eight patients are also recorded who did not have fibroplasia although they had over 60% oxygen for more than 46 hr. The findings suggest a definite relationship between the pulmonary fibroplasia and high tensions of inspired oxygen for a prolonged period. No clear relationship between pulmonary fibroplasia and mechanical ventilation is indicated by analysis of this series of infants. Histologic change in the lungs are discussed and illustrated.-D. G. Young Pulmonary Resection in Cystic Fibrosis. Margaret B. Mearns, D. J. Hodson, A. D. M. Jackson, E. M. Haworth, F. Holmes Sellers, M. Sturridge, N. E. France, and
ABSTRACTS
THORAX
Management of Crushing Chest Injuries in Children. J. L. Levy, Jr. Southern Med. J. 85:1040-1044 (September), 1972.
The author has evaluated 51 children under 12 yr of age who sustained blunt chest trauma. He emphasizes the importance of institution of a good airway immediately upon the child’s arrival in the emergency room. The rapid placement of an endotracheal tube is preferred to a tracheostomy, which often results in loss of valuable time. The diagnosis of hypovolemia is critical. Evaluation of early injuries is necessary. Since 1960, mechanical ventilators have been used for all children with continuing respiratory distress at Tulane University School of Medicine. In most instances, these are needed for flail chest, pulmonary contusions, atelectasis, or “wetlung” syndrome. A volume-cycled ventilator is preferred to the pressure-cycled ventilator for children. It was found that a Bournes respirator is most effective up to the age of 3 yr, whereas the Emerson or Engstrom is best for older children. Hourly blood-gas determinations are indicated until the patient’s condition is stabilized. Ultrasonic nebulizers to decrease the viscosity of secretions have been found effective. Frequent bronchoscopy is helpful when indicated. The author concludes that the morbidity and mortality rates are directly proportional to the effectiveness of early therapy. He also emphasizes that the relationship between clinical respiratory distress and x-ray findings of the chest are not always comparable. Several of the children exhibited severe respiratory distress with derangement of blood gases associated with respiratory alkalosis, even though the chest x-ray was normal.-George Holcomb, 7r. Hemothorax In Idiopathic Thrombocytopenic Purpura (ITP). V. L. Fromke and W. R. Schmidt. J. Thorac. Cardiovasc. Surg. 63:962-967 (June), 1972. Spontaneous hemothorax secondary to idiopathic thrombocytopenic purpure is rare. Treatment in this 6%yr-old man was by thoracentesis, corticoids, and splenectomy. Twenty-four references are included. -Thomas M. Holder
Spontaneous Pneumothorax and Pneumomediastinum as Complications of Sarcoma. J. F. Laucius, H. S. Brodovsky, and C. D. Howe. J. Thorac. Cardiovasc. Surg. 64:467-461 (September), 1972.
The case reports of three teen-age patients with sarcoma and pulmonary metastases who developed spontaneous pneumothorax (two) and spontaneous pneumomediastinum (one) are presented. Two of the patients had osteogenic sarcoma and one had rhabdomyosarcoma. All three were known to have pulmonary metastases prior to the onset of pneumothorax or pneumomediastinum.-Thomas M. Holder Chordoma Presenting as a Posterior Mediastinal Mass. A Choristoma. R. L. Clemons, R. Ii. Blank, J. 13. Hutcheson, and E. H. Ruffolo. J. Thorac. Cardiovasc. Surg. 63:922-924 (June), 1972.
This is a case report of a l4-yr-old girl treated by excision. No follow-up is presented.-Thomas M. Holder Pulmonary Fibroplasia in Newborn Babies Treated With Oxygen and Artificial Ventilation. C. K. Banerjee, D. J. Girling, and J. S. Wigglesworth. Arch. Dis. Child. 47: 509-518. (August), 1972.
This retrospective study of 81 infants dying between 1965 and 1970 attempts to correlate pulmonary fibroplasia with the percentage of oxygen in the inspired “air” and with prolonged artificial ventilation. All infants developing pulmonary fibroplasia had been treated in over 60% of oxygen for at least 46 hr. Eight patients are also recorded who did not have fibroplasia although they had over 60% oxygen for more than 46 hr. The findings suggest a definite relationship between the pulmonary fibroplasia and high tensions of inspired oxygen for a prolonged period. No clear relationship between pulmonary fibroplasia and mechanical ventilation is indicated by analysis of this series of infants. Histologic change in the lungs are discussed and illustrated.-D. G. Young Pulmonary Resection in Cystic Fibrosis. Margaret B. Mearns, D. J. Hodson, A. D. M. Jackson, E. M. Haworth, F. Holmes Sellers, M. Sturridge, N. E. France, and