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Longitudinal follow-up of pulmonary function after lobectomy in childhood-factors affecting lung growth
516
INTERNATIONAL
Quantitative Assessment of Intracranial Pressure by the Tympanic Membrane Displacement Audiometric Technique in Children With Shunted Hydrocephalus .... .. ..... ... ... .._............................................ 523
Neoplasms Abdominal Recurrence of Osteogenic Sarcoma . ... ... Hepatocellular Carcinoma in Children With Gardner’s Syndrome . .. ... .... ... ... .... .. ... .... ... ... ... .... .. ... .... .. Risk of Cancer Among Offspring of Childhood Cancer Survivors ... ... ... ... ... .... ... .... .. ... ... .... ... ... .. .... Unusual Presentation of Clear Cell Sarcoma of the Kidney .. ... ... ... ... ... ... .... ... ... .. .... ... .... ... .. .... ... ... ... .... .. Recombinant Human Erythropoietin in Children With Cancer ... ... ... .. .... ... .... .. .... .. .... ... ... ... ... ... ... .... .. GENERAL
Mild Hemophilia in Children: Prevalence, Treatment. L. Venkateswaran, J.A. Wilimas, Hematol/Oncol20:32-35, (January/February),
ABSTRACTS
Complications, and D. Jones, et al. J Pediatr 1998.
This report on 55 patients from St Jude’s indicates that mild hemophilia (35% of all patients) can escape clinical detection until trauma or surgery intervenes. This mild form may affect females, as it did in five patients in this review. Thirty-five of the 55 patients were identified from family history. Unusual bleeding after surgery or trauma should prompt a work-up for this possibility.-Michael P. Hirsh
523 THORAX
523 523 523 523
CONSIDERATIONS
Injuries and Deaths Due to Firearms in the Home. A.L. Kellerman, G. Somes, RP: Rivarn, et al. J Trauma 45:263-267, (August), 1998. The authors sought to determine the relative frequency with which guns in the home are used to injure or kill in self-defense, compared with the number of times these weapons are involved in an unintentional injury, suicide attempt, or criminal assault or homicide Three cities (Seattle, Memphis, and Galveston) were chosen for study. Of the 626 shootings in or around a residence, there were 438 assaults/ homicides (70%), 118 attempted or completed suicides (19%), and 54 unintentional shootings (9%). Only 13 shootings (2%) were an act of self-defense or legally justifiable. Handguns were used in nearly 90% of the shootings studied. For every time a gun in the home was used for self-defense or justifiable reasons, there were 4 unintentional shootings, 7 criminal assaults or homicides, and 11 attempted or completed suicides. These finding contradict advertisements that claim firearms provide effective home protection. In addition, measures to reduce home firearms and to promote safe and secure storage of firearms must be emphasized.-Steven Stylianos
Septicemia and Septic Shock in Pediatric Patients: 140 Consecutive Cases on a Pediatric Hematology-Oncology Service. A. Aledo, G. Heller; L. Ren, et al. J Pediatr Hematol/Oncol20:215-221, (May/June), 1998. This review of septic patients over a 12-month period at SloanKettering revealed several interesting observations: (1) When fever work-up showed bacteremia, the rate of development of septic shock was 19%. (2) The absolute neutrophil count (ANC) was >5OO/pL in 65% of these episodes. (3) Only 5 fungal infections were noted (4 with Candida). (4) The most common etiologic bacterium was coagulasenegative Staphylococcus. (5) 65% of patients in whom bacteremia developed had hematologic forms of cancer. (6) 46.9% of isolates contain Gram-positive cocci. (7) 40.6% were Gram-negative rods. (8) 83% of patients who required ICU admission for septic shock had Gram-negative rods. (9) There were 85.3% episodes of bacteremia per 1,000 admissions. (10) 95% of the patients had indwelling IV catheters. (11) All deaths (12%) were in patients with Gram-negative sepsis. (12) Current recommendation for antibiotic therapy is a B-lactam antibiotic combined with aminoglycosides. (13) Vancomycin is controversial for Gram-positive sepsis, but the authors do use it.-Michael P Hirsh
Spontaneous Involution of Pulmonary Sequestration in Children: A Report of Two Cases and Review of the Literature. p. Garciu-PeAa, .I. Lucaya, G. Hendry. et al. Pediatr Radio1 281266.279, (April), 1998. Pulmonary sequestration is defined as a segment of lung parenchyma separated from the trachea-bronchial tree and receiving its blood supply from the aorta. Spontaneous involution of pulmonary sequestration is exceedingly rare, and the authors present two cases of pulmonary masses with systemic blood supply, diagnosed by ultrasonography and Doppler in one case, and with contrast-enhanced CT in the other. The mass disappeared after 6 years in the first case, and showed almost complete involution after 5 years in the second. The authors reviewed the literature and raise the question as to whether all pulmonary sequestrations in asymptomatic patients should be treated surgically.A.B. Mathur Longitudinal Follow-Up of Pulmonary Function After Lobectomy in Childhood-Factors Affecting Lung Growth. C. Nakajimu, C. Kijimoto, Z Yokoyama, et al. Pediatr Surg Int 13:341-345, (July). 1998. The authors evaluated 27 patients who had undergone pulmonary lobectomy because of pulmonary cystic disease (9 lung cysts, 6 bronchial atresias, 6 congenital cystic adenomatoid malformations [CCAM], and 6 intralobar pulmonary sequestrations). Lobectomy was performed at 1 month to 10 years 8 months of age. Four patients were excluded because of very low percent vital capacity. The remaining cases were evaluated with respect to disorder, age at surgery, and occurrence of preoperative infections. Pulmonary function was evaluated once or twice per year from 1 month to 13 years after operation. The percent vital capacity (%VC) decreased after lobectomy, but normal values were regained 1 year after the operation. The percent forced expiratory volume (%FEV) 1.0 increased after lobectomy and remained high for 10 years after surgery. Residual volume to total lung capacity (RV/TLC) increased after lobectomy, but had returned to normal after 1 to 2 years following surgery. The disorder for which the patient underwent operation did not influence correlated %VC or RV/TLC, but correlated %FEV 1.0 was higher after CCAM compared with bronchial atresia. Younger patients had higher correlated %VC and lower RViTLC values than older ones. Infection preoperatively decreased correlated %VC and increased RV/TLC values in comparison to noninfected cases. The authors conclude that VC after childhood lobectomy increases to higher values than expected with respect to the remaining lung volume within 2 years. Age over 4 years and preoperative infections are the main factors restricting pulmonary function.--Z Wester Lung Transplantation in Cystic Fibrosis. E.A. Rendina, I: De Giacomo, et al. Eur J Pediatr Surg 8:208-211, (August), The authors report on 13 children in performed for cystic fibrosis. Bilateral (BSLT) was performed successfully in pneumonia and sepsis, and 12 are alive
F Venuta, 1998.
whom lung transplantation was sequential lung transplantation all patients. One patient died of and well after follow-up of 1 to
INTERNATIONAL
Quantitative Assessment of Intracranial Pressure by the Tympanic Membrane Displacement Audiometric Technique in Children With Shunted Hydrocephalus .... .. ..... ... ... .._............................................ 523
Neoplasms Abdominal Recurrence of Osteogenic Sarcoma . ... ... Hepatocellular Carcinoma in Children With Gardner’s Syndrome . .. ... .... ... ... .... .. ... .... ... ... ... .... .. ... .... .. Risk of Cancer Among Offspring of Childhood Cancer Survivors ... ... ... ... ... .... ... .... .. ... ... .... ... ... .. .... Unusual Presentation of Clear Cell Sarcoma of the Kidney .. ... ... ... ... ... ... .... ... ... .. .... ... .... ... .. .... ... ... ... .... .. Recombinant Human Erythropoietin in Children With Cancer ... ... ... .. .... ... .... .. .... .. .... ... ... ... ... ... ... .... .. GENERAL
Mild Hemophilia in Children: Prevalence, Treatment. L. Venkateswaran, J.A. Wilimas, Hematol/Oncol20:32-35, (January/February),
ABSTRACTS
Complications, and D. Jones, et al. J Pediatr 1998.
This report on 55 patients from St Jude’s indicates that mild hemophilia (35% of all patients) can escape clinical detection until trauma or surgery intervenes. This mild form may affect females, as it did in five patients in this review. Thirty-five of the 55 patients were identified from family history. Unusual bleeding after surgery or trauma should prompt a work-up for this possibility.-Michael P. Hirsh
523 THORAX
523 523 523 523
CONSIDERATIONS
Injuries and Deaths Due to Firearms in the Home. A.L. Kellerman, G. Somes, RP: Rivarn, et al. J Trauma 45:263-267, (August), 1998. The authors sought to determine the relative frequency with which guns in the home are used to injure or kill in self-defense, compared with the number of times these weapons are involved in an unintentional injury, suicide attempt, or criminal assault or homicide Three cities (Seattle, Memphis, and Galveston) were chosen for study. Of the 626 shootings in or around a residence, there were 438 assaults/ homicides (70%), 118 attempted or completed suicides (19%), and 54 unintentional shootings (9%). Only 13 shootings (2%) were an act of self-defense or legally justifiable. Handguns were used in nearly 90% of the shootings studied. For every time a gun in the home was used for self-defense or justifiable reasons, there were 4 unintentional shootings, 7 criminal assaults or homicides, and 11 attempted or completed suicides. These finding contradict advertisements that claim firearms provide effective home protection. In addition, measures to reduce home firearms and to promote safe and secure storage of firearms must be emphasized.-Steven Stylianos
Septicemia and Septic Shock in Pediatric Patients: 140 Consecutive Cases on a Pediatric Hematology-Oncology Service. A. Aledo, G. Heller; L. Ren, et al. J Pediatr Hematol/Oncol20:215-221, (May/June), 1998. This review of septic patients over a 12-month period at SloanKettering revealed several interesting observations: (1) When fever work-up showed bacteremia, the rate of development of septic shock was 19%. (2) The absolute neutrophil count (ANC) was >5OO/pL in 65% of these episodes. (3) Only 5 fungal infections were noted (4 with Candida). (4) The most common etiologic bacterium was coagulasenegative Staphylococcus. (5) 65% of patients in whom bacteremia developed had hematologic forms of cancer. (6) 46.9% of isolates contain Gram-positive cocci. (7) 40.6% were Gram-negative rods. (8) 83% of patients who required ICU admission for septic shock had Gram-negative rods. (9) There were 85.3% episodes of bacteremia per 1,000 admissions. (10) 95% of the patients had indwelling IV catheters. (11) All deaths (12%) were in patients with Gram-negative sepsis. (12) Current recommendation for antibiotic therapy is a B-lactam antibiotic combined with aminoglycosides. (13) Vancomycin is controversial for Gram-positive sepsis, but the authors do use it.-Michael P Hirsh
Spontaneous Involution of Pulmonary Sequestration in Children: A Report of Two Cases and Review of the Literature. p. Garciu-PeAa, .I. Lucaya, G. Hendry. et al. Pediatr Radio1 281266.279, (April), 1998. Pulmonary sequestration is defined as a segment of lung parenchyma separated from the trachea-bronchial tree and receiving its blood supply from the aorta. Spontaneous involution of pulmonary sequestration is exceedingly rare, and the authors present two cases of pulmonary masses with systemic blood supply, diagnosed by ultrasonography and Doppler in one case, and with contrast-enhanced CT in the other. The mass disappeared after 6 years in the first case, and showed almost complete involution after 5 years in the second. The authors reviewed the literature and raise the question as to whether all pulmonary sequestrations in asymptomatic patients should be treated surgically.A.B. Mathur Longitudinal Follow-Up of Pulmonary Function After Lobectomy in Childhood-Factors Affecting Lung Growth. C. Nakajimu, C. Kijimoto, Z Yokoyama, et al. Pediatr Surg Int 13:341-345, (July). 1998. The authors evaluated 27 patients who had undergone pulmonary lobectomy because of pulmonary cystic disease (9 lung cysts, 6 bronchial atresias, 6 congenital cystic adenomatoid malformations [CCAM], and 6 intralobar pulmonary sequestrations). Lobectomy was performed at 1 month to 10 years 8 months of age. Four patients were excluded because of very low percent vital capacity. The remaining cases were evaluated with respect to disorder, age at surgery, and occurrence of preoperative infections. Pulmonary function was evaluated once or twice per year from 1 month to 13 years after operation. The percent vital capacity (%VC) decreased after lobectomy, but normal values were regained 1 year after the operation. The percent forced expiratory volume (%FEV) 1.0 increased after lobectomy and remained high for 10 years after surgery. Residual volume to total lung capacity (RV/TLC) increased after lobectomy, but had returned to normal after 1 to 2 years following surgery. The disorder for which the patient underwent operation did not influence correlated %VC or RV/TLC, but correlated %FEV 1.0 was higher after CCAM compared with bronchial atresia. Younger patients had higher correlated %VC and lower RViTLC values than older ones. Infection preoperatively decreased correlated %VC and increased RV/TLC values in comparison to noninfected cases. The authors conclude that VC after childhood lobectomy increases to higher values than expected with respect to the remaining lung volume within 2 years. Age over 4 years and preoperative infections are the main factors restricting pulmonary function.--Z Wester Lung Transplantation in Cystic Fibrosis. E.A. Rendina, I: De Giacomo, et al. Eur J Pediatr Surg 8:208-211, (August), The authors report on 13 children in performed for cystic fibrosis. Bilateral (BSLT) was performed successfully in pneumonia and sepsis, and 12 are alive
F Venuta, 1998.
whom lung transplantation was sequential lung transplantation all patients. One patient died of and well after follow-up of 1 to