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Palatal periosteal response to surgical trauma
ABSTRACTS
763
when closure was attempted through lateral wall movements toward the midline. The authors suggest and support the concept of nasendoscopy documenting connected speech in cleft palate individuals. They suggest that static observations, as well as X-rays, are not as productive as nasendoscopy.--/1. B. S o k o l Palatal Periostaal Response To Surgical Trauma. W. B.
Barro, R. A. Latham, and J. B. Mulliken. Plast Reconstr Surg 67:6-16, (January), 1981.
These two articles demonstrate very elegantly an experiment to ascertain whether the periosteum is capable of producing bone. The experiment shows that new bone accrues from the traumatized palatal surface, not from'the overlying periosteum, which becomes hyperplastic and thickened when surgically elevated. When the palatine bone is excised, the nasal and oral periosteum are slowly filled by new bone that develops from the respective margins. In experiments wherein rib periosteum has been transferred by microvascular anastomosis, new bone apparently forms from residual osteogenic residual mesenchymal cells with osteogenie potential present at the periosteal cortical interface, which is thus transplanted.--A. B. S o k o l Subglottic Stenosis in Newborn Intensive Care Unit Graduates. R. Jones,/1. Bodnar, Y. Roan, and D. Johnson. Am J
Dis Child 135:367-368, (April), 1981. Among 64 survivors of intubation and assisted ventilation in a neonatal intensive care unit, five infants with postintubation subglottic stenosis were identified in a follow-up clinic. The presence of lesions was not suspected until 3 wk to 3 me after discharge from initial hospitalization. The onset of strider often precipitated by respiratory illness most commonly led to the diagnosis. No correlation was found between the presence or the severity of laryngeal pathology, the gestational age of the infants, or the duration of intubation in this study. In spite of precautions taken for the intubation of neonates requiring assisted ventilation, subglottic stenosis may develop in these infants and should always be considered in newborn intensive care unit graduates when they manifest refractory or recurrent respiratory obstruction in the first year of life. Routine follow-up of all intubated neonates to detect subglottic stenosis is recommended.--J. J. Tepas THORAX Bacteriology of Tracheal Aspirates in Intubated Newborn.
1. Brook, IV. J. Martin, and S. M. Finegold. Chest 78:875877, (December), 1980.
Twenty-eight neonates varying in weight from 700 to 3600 g and in gestational ages from 26 to 42 wk had tracheal cultures taken while intubated for ventilatory support. Of the 52 cultures obtained, 20 were negative, and of the positive cultures 34 aerobes and 13 anaerobes were isolated. Of the five patients with perinatal pneumonia, three grew anaerobic organisms. Wright's stain of the aspirates revealed a significant increase in polymorphonuclear leucocytes in six patients with positive cultures. Five of these patients had pneumonia. The combination of tracheal aspirate culture and Wright's
stain should effectively define infectious and noninfectious conditions in seriously ill neonates.--Randall IV. Powell Invasive Aspargillosis With Massive Fatal Hamoptysis in Patients with Neoplastic Disease. M, H. Borkin, F. P.
/1rena, /1. E. Brown, and D. Armstrong. Chest 78:835-839, (December), 1980.
Two patients with invasive aspergillosis lung infections while immunosuppressed developed massive hemoptysis leading to respiratory insufficiency and death. One, a 7yr-old girl with leukemia, had antemortem diagnosis made and was being treated with amphotericin and rifampin when her fatal episode of hemoptysis occurred. The two cases represent the third and fourth cases of fatal hemoptysis due to aspergillosis in immunosuppressed patients. The authors recommend early surgical intervention, endobronchial tamponade, or bronchial artery embolization with the onset of hemoptysis when pulmonary aspergillosis has been documented or is suspected.--Randall W. Powell Actinomycosis: A Cause of Pulmonary and Mediastinal M a s s L e s i o n s in Children, S. M. Spinota, R. /t. Bell, and
F. IV. Henderson. Am J Dis Child 135:336-339, (April), 1981.
Two patients, aged 17 and 11 yr, with intrathoracic actinomycosis were encountered. One child was asymptomatic and had a slowly expanding lesion in the left upper lobe. The other child had a chronic illness with back pain, weight loss, amenorrhea, and a posterior mediastinal mass. Establishing the cause of these lesions and making the distinction between a neoplastic process and infection were particularly difficult and required open biopsy in both cases. lntrathoracic actinomycosis should be considered in the differential diagnosis of pulmonary and mediastinal mass lesions.--J. J. Tepas Annotation: Bronchopulmonary Dysplasia. A. D. Milner.
Arch Dis Child 55:661-663, (September), 1980. This annotation deals with the definition, etiology, prognosis, prevention, and treatment of bronchopulmonary dysplasia (BPD). The definition of BPD presents difficulty as the condition covers a spectrum from grade 1 to grade IV but the diagnostic features are probably a history of intermittent positive pressure ventilation, prolonged high oxygen concentration, clinical evidence of lung damage and x-ray changes of translucent cystic areas and dense bands of fibrosis. The precise relationship with hyaline membrane disease is not established, but high pressure ventilation and exposure to high oxygen concentrations appear to be causative factors. The prognosis for severe (grade IV) BPD is poor (up to 40% mortality) and, although survivors of BPD generally show radiologic improvement, damage to lung growth may predispose to later problems. Prevention of BPD depends on restricting inflation pressure and oxygen concentration to minimal levels compatible with adequate ventilation. Vitamin E (20 mg/kg/day i.m.) indomethacin and surgical closure of patent ductus arteriosus may protect against BPD and are undergoing clinical trials. Regular physiotherapy and broad spectrum antibiotics help to control repeated
763
when closure was attempted through lateral wall movements toward the midline. The authors suggest and support the concept of nasendoscopy documenting connected speech in cleft palate individuals. They suggest that static observations, as well as X-rays, are not as productive as nasendoscopy.--/1. B. S o k o l Palatal Periostaal Response To Surgical Trauma. W. B.
Barro, R. A. Latham, and J. B. Mulliken. Plast Reconstr Surg 67:6-16, (January), 1981.
These two articles demonstrate very elegantly an experiment to ascertain whether the periosteum is capable of producing bone. The experiment shows that new bone accrues from the traumatized palatal surface, not from'the overlying periosteum, which becomes hyperplastic and thickened when surgically elevated. When the palatine bone is excised, the nasal and oral periosteum are slowly filled by new bone that develops from the respective margins. In experiments wherein rib periosteum has been transferred by microvascular anastomosis, new bone apparently forms from residual osteogenic residual mesenchymal cells with osteogenie potential present at the periosteal cortical interface, which is thus transplanted.--A. B. S o k o l Subglottic Stenosis in Newborn Intensive Care Unit Graduates. R. Jones,/1. Bodnar, Y. Roan, and D. Johnson. Am J
Dis Child 135:367-368, (April), 1981. Among 64 survivors of intubation and assisted ventilation in a neonatal intensive care unit, five infants with postintubation subglottic stenosis were identified in a follow-up clinic. The presence of lesions was not suspected until 3 wk to 3 me after discharge from initial hospitalization. The onset of strider often precipitated by respiratory illness most commonly led to the diagnosis. No correlation was found between the presence or the severity of laryngeal pathology, the gestational age of the infants, or the duration of intubation in this study. In spite of precautions taken for the intubation of neonates requiring assisted ventilation, subglottic stenosis may develop in these infants and should always be considered in newborn intensive care unit graduates when they manifest refractory or recurrent respiratory obstruction in the first year of life. Routine follow-up of all intubated neonates to detect subglottic stenosis is recommended.--J. J. Tepas THORAX Bacteriology of Tracheal Aspirates in Intubated Newborn.
1. Brook, IV. J. Martin, and S. M. Finegold. Chest 78:875877, (December), 1980.
Twenty-eight neonates varying in weight from 700 to 3600 g and in gestational ages from 26 to 42 wk had tracheal cultures taken while intubated for ventilatory support. Of the 52 cultures obtained, 20 were negative, and of the positive cultures 34 aerobes and 13 anaerobes were isolated. Of the five patients with perinatal pneumonia, three grew anaerobic organisms. Wright's stain of the aspirates revealed a significant increase in polymorphonuclear leucocytes in six patients with positive cultures. Five of these patients had pneumonia. The combination of tracheal aspirate culture and Wright's
stain should effectively define infectious and noninfectious conditions in seriously ill neonates.--Randall IV. Powell Invasive Aspargillosis With Massive Fatal Hamoptysis in Patients with Neoplastic Disease. M, H. Borkin, F. P.
/1rena, /1. E. Brown, and D. Armstrong. Chest 78:835-839, (December), 1980.
Two patients with invasive aspergillosis lung infections while immunosuppressed developed massive hemoptysis leading to respiratory insufficiency and death. One, a 7yr-old girl with leukemia, had antemortem diagnosis made and was being treated with amphotericin and rifampin when her fatal episode of hemoptysis occurred. The two cases represent the third and fourth cases of fatal hemoptysis due to aspergillosis in immunosuppressed patients. The authors recommend early surgical intervention, endobronchial tamponade, or bronchial artery embolization with the onset of hemoptysis when pulmonary aspergillosis has been documented or is suspected.--Randall W. Powell Actinomycosis: A Cause of Pulmonary and Mediastinal M a s s L e s i o n s in Children, S. M. Spinota, R. /t. Bell, and
F. IV. Henderson. Am J Dis Child 135:336-339, (April), 1981.
Two patients, aged 17 and 11 yr, with intrathoracic actinomycosis were encountered. One child was asymptomatic and had a slowly expanding lesion in the left upper lobe. The other child had a chronic illness with back pain, weight loss, amenorrhea, and a posterior mediastinal mass. Establishing the cause of these lesions and making the distinction between a neoplastic process and infection were particularly difficult and required open biopsy in both cases. lntrathoracic actinomycosis should be considered in the differential diagnosis of pulmonary and mediastinal mass lesions.--J. J. Tepas Annotation: Bronchopulmonary Dysplasia. A. D. Milner.
Arch Dis Child 55:661-663, (September), 1980. This annotation deals with the definition, etiology, prognosis, prevention, and treatment of bronchopulmonary dysplasia (BPD). The definition of BPD presents difficulty as the condition covers a spectrum from grade 1 to grade IV but the diagnostic features are probably a history of intermittent positive pressure ventilation, prolonged high oxygen concentration, clinical evidence of lung damage and x-ray changes of translucent cystic areas and dense bands of fibrosis. The precise relationship with hyaline membrane disease is not established, but high pressure ventilation and exposure to high oxygen concentrations appear to be causative factors. The prognosis for severe (grade IV) BPD is poor (up to 40% mortality) and, although survivors of BPD generally show radiologic improvement, damage to lung growth may predispose to later problems. Prevention of BPD depends on restricting inflation pressure and oxygen concentration to minimal levels compatible with adequate ventilation. Vitamin E (20 mg/kg/day i.m.) indomethacin and surgical closure of patent ductus arteriosus may protect against BPD and are undergoing clinical trials. Regular physiotherapy and broad spectrum antibiotics help to control repeated