All children who underwent flexible bronchoscopy in the respiratory unit at Paediatric Institute, Hospital Kuala Lumpur from June 1997 to June 2002 were reviewed. A hundred and ten children underwent the procedure under sedation or general anaesthesia. The median age of these children was eight months. (Q1 3, Q3 30) The commonest indication for performing flexible bronchoscopy was for chronic stridor (50 cases) followed by persistent or recurrent changes such as lung infiltrates, atelectasis and consolidation on the chest radiographs (22). Laryngomalacia was found to be the commonest cause of stridor in 29 children. Two patients were diagnosed with pulmonary tuberculosis. With regard to safety, three procedures were abandoned due to recurrent desaturation below 85%. One of these patients had severe laryngospasm that required ventilation for 48 hours but recovered fully. Two neonates developed pneumonia requiring antibiotics following bronchoscopy. No patients developed pneumothorax or bleeding following the procedure. Bronchoscopy is a safe procedure when performed by well-trained personnel. Since it is an invasive procedure the benefits must outweigh the risks before it is performed.
Bronchoscopy/*statistics & numerical data ; Hospitals, Pediatric/*statistics & numerical data ; Malaysia ; Respiratory Tract Diseases/*pathology ; Respiratory Tract Diseases/*surgery

Bronchoscopy ; Child ; Congenital Abnormalities ; pathology ; Humans ; Respiratory Tract Diseases ; complications ; pathology

OBJECTIVEThe study is to investigate the associations between visibility, major air pollutants and daily counts of hospital admission in Shanghai, China.

METHODSDaily data on hospital admission, visibility, and air pollution during 2005-2008 were obtained from the Shanghai Insurance Bureau (SHIB), Shanghai Meteorological Bureau, and Shanghai Environmental Monitoring Center, respectively. The generalized additive model (GAM) with penalized splines was used to examine the associations between daily visibility and hospital admission.

RESULTSAmong various pollutants, PM(2.5) showed strongest correlation with visibility. Decreased visibility was significantly associated with increased risk of hospital admission in Shanghai. An inter-quartile range decrease in the 2-day (L01) moving average of visibility corresponded to 3.66% (95%CI: 1.02%, 6.31%), 4.06% (95%CI: 0.84%, 7.27%), and 4.32% (95%CI: 1.67%, 6.97%) increase of total, cardiovascular, and respiratory hospitalizations, respectively.

CONCLUSIONOur analyses provide the first piece of evidence in China, demonstrating that decreased visibility has an effect on hospital admission, and this finding strengthens the rationale for further limiting air pollution levels in Shanghai.

Air Pollutants ; chemistry ; Cardiovascular Diseases ; epidemiology ; pathology ; China ; epidemiology ; Hospitalization ; Humans ; Particulate Matter ; chemistry ; Respiratory Tract Diseases ; epidemiology ; pathology ; Risk Factors ; Weather

A not pregnant 4-year-old Jersey cow was presented with the sudden appearance of respiratory noise, nasal discharge and moderate respiratory difficulty. Upon physical examination a snoring-like noise, extended head and neck position, exaggerated abdominal effort, bilateral nasal discharge and left prescapular lymph node enlargement were noted. Sub-occlusion of the initial portion of the respiratory tract was suspected. Radiographic and endoscopic examinations revealed a pedunculate mass on the dorsal aspect of the rhinopharynx, which was removed with endoscopically assisted electrosurgery. Histologic examination revealed a chronic pyogranulomatous inflammation with eosinophilic club-like bodies surrounding small colonies of rod-shaped bacteria. Results of histochemical staining were consistent with Actinobacillus-like bacteria and a diagnosis of respiratory actinobacillosis was reached. Surgery and antibiotic therapy were resolutive, as demonstated by an endoscopic check at the second month after surgery, even without the association of the traditional iodine cure, which is regarded as the treatment of choice for actinobacillosis.
Actinobacillosis/*diagnosis/drug therapy/microbiology/surgery ; Actinobacillus/physiology ; Animals ; Cattle ; Cattle Diseases/*diagnosis/drug therapy/pathology/surgery ; Female ; Respiratory Tract Infections/drug therapy/pathology/surgery/*veterinary ; Treatment Outcome

Abnormalities, Multiple ; Bronchial Diseases ; complications ; Bronchoscopy ; Child ; Child, Preschool ; Female ; Foreign Bodies ; complications ; Humans ; Infant ; Lung ; diagnostic imaging ; pathology ; Male ; Radiography ; Respiratory System Abnormalities ; complications ; Respiratory Tract Diseases ; etiology ; pathology

OBJECTIVETo study the pathology, imaging and clinical features of a child with trisomy 21 syndrome associated interstitial lung disease.

METHODData of a case with trisomy 21 syndrome associated interstitial lung disease confirmed by lung imaging and pathology were collected, analyzed and the related reports in literature were reviewed.

RESULTThe patient was a one year and 7 months old boy who suffered from severe pneumonia and recurrent infection during his hospital stay. When his disease was stable, he did not have shortness of breath and cyanosis, but a chest computed tomography (CT) showed ground-glass opacity, regional emphysema, band-like change in lung parenchyma, which indicated interstitial lung diseases. Unequal air inflation in bilateral lungs and diffuse over-distension of peripheral air spaces in lung surface were seen through thoracoscope. Pathological examination indicated that alveolar, alveolar ducts and alveolar sac were enlarged, alveolar septa was expanded. There were two reports in lung pathology of trisomy 21 syndrome, alveolar growth abnormalities was seen in 86%-88% cases. The multiple subpleural cysts in chest CT was characteristic. Clinically, trisomy 21 syndrome had high morbidity of respiratory tract infection and progress to respiratory failure frequently. Prolonged postoperative desaturation was constant which required long duration of respiratory support.

CONCLUSIONTrisomy 21 syndrome associated alveolar growth abnormalities were confirmed, which manifest as alveolar simplification in pathology and interstitial lung diseases in imaging. The risk of respiratory failure in these cases caused by infection and surgery should be considered.

Cysts ; pathology ; Down Syndrome ; complications ; Humans ; Infant ; Lung ; pathology ; Lung Diseases, Interstitial ; diagnosis ; etiology ; Male ; Postoperative Period ; Pulmonary Alveoli ; pathology ; Respiratory Insufficiency ; Respiratory Tract Infections ; Tomography, X-Ray Computed

The upper chest wall does not grow properly in children with spinal muscular atrophy (SMA) with paradoxical breathing. This suggests that long-term inability to take a deep breath in developing children may result in underdevelopment of the upper chest wall. In addition, a rapid and paradoxical breathing pattern is frequently observed in children with severe cerebral palsy (CP), which often corresponds to the underdevelopment of the upper chest wall. The present study is designed to evaluate the ratio of the upper to lower chest wall in children with severe spastic quadriplegic CP, compared with normal children. We compared normal children with children that had spastic quadriplegic CP who did not have kyphosis or scoliosis. Test subjects were matched in terms of age, height, and weight. The diameters of upper chest (D(apex)) and of lower chest (D(base)) were measured on the anteroposterior (AP) view of a chest X-ray and the D(apex) to D(base) ratio was calculated. In selected cases the forced vital capacity (FVC) was measured using a Wright Respirometer. The D(apex) to D(base) ratio was significantly lower in the CP group than in the control group (p < 0.001). The ratio increased linearly with age (p < 0.001) in both CP (R = 0.372) and control groups (R = 0.477). The FVC/preFVC showed significant correlation with the D(apex) to D(base) ratio (R = 0.542, p < 0.01). The results of this study suggest a deviation of optimal chest wall structure in children with spastic quadriplegic CP.
X-Rays ; Vital Capacity ; Time Factors ; Thoracic Wall ; Thoracic Cavity ; Respiratory Tract Diseases/*pathology/physiopathology ; *Respiration ; Quadriplegia/*pathology ; Muscle Spasticity/*pathology ; Male ; Lung/pathology ; Humans ; Forced Expiratory Volume ; Female ; Child, Preschool ; Child ; Cerebral Palsy/*pathology ; Case-Control Studies

An 8-year-old girl who had experienced intermittent cough and fever over a 3 year period, was admitted after experiencing a recurrence for one month. One year ago the patient experienced a recurrent oral mucosal ulcer. Physical examination showed vitiligo in the skin of the upper right back. Routine blood tests and immune function tests performed in other hospitals had shown normal results. Multiple lung CT scans showed pulmonary infection. The patient had recurrent fever and cough and persistent presence of some lesions after anti-infective therapy. The antitubercular therapy was ineffective. Routine blood tests after admission showed agranulocytosis. Gene detection was performed and she was diagnosed with dyskeratosis congenita caused by homozygous mutation in RTEL1. Patients with dyskeratosis congenita with RTEL1 gene mutation tend to develop pulmonary complications. Since RTEL1 gene sequence is highly variable with many mutation sites and patterns and can be inherited via autosomal dominant or recessive inheritance, this disease often has various clinical manifestations, which may lead to missed diagnosis or misdiagnosis. For children with unexplained recurrent pulmonary infection, examinations of the oral cavity, skin, and nails and toes should be taken and routine blood tests should be performed to exclude dyskeratosis congenita. There are no specific therapies for dyskeratosis congenita at present, and when bone marrow failure and pulmonary failure occur, hematopoietic stem cell transplantation and lung transplantation are the only therapies. Androgen and its derivatives are effective in some patients. Drugs targeting the telomere may be promising for patients with dyskeratosis congenita.
Child ; Dyskeratosis Congenita ; complications ; therapy ; Female ; Humans ; Mouth Diseases ; etiology ; Mouth Mucosa ; pathology ; Recurrence ; Respiratory Tract Infections ; etiology ; Telomere ; drug effects ; Ulcer ; etiology

OBJECTIVE: To analyze the significance of forensic autopsy in medical tangle. METHODS: Ninety autopsy cases of medical legal dispute were retrospectively analyzed from the database of our department from 2001 to 2008. All cases were analyzed and classified based on age, sex, cause of death, clinic diagnosis and forensic diagnosis. RESULTS: The age ranged from 1 day to 72 years, and the ratios of male to female is 1:1. The most common healthcare facilities involved were county hospitals (30 cases, 33.33%). The coincidence rate between clinical diagnoses and pathological diagnoses was 33.33%. CONCLUSION The forensic autopsy is valuable to solve or even avoid the occurrence of medical legal dispute.
Adult ; Aged ; Autopsy ; Cardiovascular Diseases/pathology* ; Cause of Death ; Child ; Child, Preschool ; Female ; Forensic Pathology ; Humans ; Infant ; Infant, Newborn ; Male ; Malpractice/legislation & jurisprudence* ; Middle Aged ; Respiratory Tract Diseases/pathology* ; Young Adult

Good's syndrome is extremely rare. This adult-onset condition is characterized by a thymoma with immunodeficiency, low B- and T-cell counts, and hypo-gammaglobulinemia. The initial clinical presentation is either a mass-lesion thymoma or a recurrent infection. Patients with Good's syndrome are very susceptible to infections; common respiratory and opportunistic infections can be life-threatening. There are no reports of granulomatous lung disease in patients with Good's syndrome, although it has been observed in patients with common variable immunodeficiency, of which Good's syndrome is a subset. We describe a 53-year-old male thymoma patient who presented with respiratory symptoms caused by granulomatous lung disease and an opportunistic infection. He died of uncontrolled fungal infection despite repeated intravenous immunoglobulin and supportive care. Clinicians should look for evidence of immunologic dysfunction in thymoma patients presenting with severe recurrent infections, especially opportunistic infections.
Fatal Outcome ; Granuloma, Respiratory Tract/diagnosis/*etiology/therapy ; Humans ; Immunologic Deficiency Syndromes/*complications/immunology/pathology ; Lung Diseases/diagnosis/*etiology/therapy ; Male ; Middle Aged ; Thymoma/*complications/immunology/pathology ; Thymus Neoplasms/*complications/immunology/pathology