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Treatment of parapneumonic effusion in children remains controversial in the literature and in clinical practice. The aim of this study was to determine whether mutual consensus exists in the diagnosis and treatment of parapneumonic effusion in Central European countries. A questionnaire was sent to all directors of pediatric respiratory units in four adjacent Central European countries (Austria, France, Germany, Switzerland). The response rate was 61.8%. Responses reflected acceptable agreement regarding initial diagnostic procedures, as most centers performed chest X-ray and biological exams, followed by ultrasound, thoracocentesis, or computed tomography. However, antibiotic regimens were very heterogeneous, and the survey revealed complete lack of agreement on the indications and effusion volume threshold for invasive procedures, such as fibrinolytic instillation and thoracoscopy. In conclusion, apart from initial diagnostic procedures, this study showed a lack of mutual consensus among the four countries regarding the management of pediatric parapneumonic effusion. Multicenter prospective trials are clearly needed to acquire more evidence on the management of childhood parapneumonic effusion, enabling the development of evidence-based algorithms that could help to avoid unnecessary examinations with potential long-term side effects, such as radiation exposure at a young age., (© 2015 Wiley Periodicals, Inc.)

Apparently minor chest trauma may result in localized pulmonary contusion. Complications of the contusion, particularly infection, may be delayed. The association between the infection and initial injury may not be appreciated due to the time frame between the injury and clinical presentation. We report two cases of low-moderate impact pulmonary trauma resulting in focal pulmonary contusion, complicated by infection., ((c) 2006 Wiley-Liss, Inc.)

Background: A flexible bronchoscope typically gets its designated size from the diameter of the distal tip but this is not the maximum diameter of the insertion tube., Aim: The aim of this study was to determine the size and site of the maximum diameter of flexible bronchoscope insertion tubes and to compare standard bronchofiberscopes with newer bronchovideoscopes., Methods: We assessed 10 bronchoscopes ranging from 2.2 to 4.9 mm external diameter (Olympus, Tokyo, Japan) using an electronic digital caliper. Investigators were blinded to the type and model of each scope. The median, minimum and maximum diameters of the bronchoscopes were calculated and the measured diameters were compared with the stated diameters of the distal tip and insertion tube., Results: The maximum and median measured diameters were wider than the stated diameter of the distal tip in all the scopes. The maximum discrepancy between the measured and stated diameters ranged from 0.19 mm (6.7%) to 0.66 mm (22.2%) with a mean of 0.41 mm (14.0%). There was no difference between bronchofiberscopes and bronchovideoscopes., Conclusion: The maximum diameter of the distal tip and insertion tube of pediatric sized flexible bronchoscopes is significantly greater than the manufacturer's specifications. This may impact on the choice of bronchoscope selected for procedures in children.

The first cystic fibrosis (CF) scoring system was published in 1958. Since then, many other scoring systems were developed. Clinical parameters, details about statistical evaluations, and recent strategic uses of scores were identified. Several similar scores aiming to assess chronic illness severity (Shwachman-Kulczycki score and a modification, Cooperman, Berneze-score and the NIH score) have not been evaluated and are out of date, given the changing natural history of CF. Of the current scoring systems, the modified Shwachman score by Doershuk is perhaps most reliable for describing follow-up studies. Scores designed for acute changes and short-term evaluation were also developed. The modified Huang score may be useful in the prognostic evaluation of patients with end-stage disease. It could also be used for discrimination of adult patients with differing disease severity and for longitudinal evaluation. Scores assessing pulmonary exacerbations could help provide consensus among clinicians regarding the need for intervention. Most of these scores require further evaluation. Although scores could provide an objective measure of disease severity, progression, need for and response to interventions, including value in selecting patients for lung transplantation and as an outcome measure for research studies, no scoring system can fulfill all these objectives. Nevertheless, there is a need for the development of a modern day longitudinal score that is sensitive, valid and reproducible, to reflect the milder disease status of patients.

Abdominal pain is common in individuals with cystic fibrosis (CF). We report on a 17-year old boy with CF and two recognized intussusceptions: the first colonic intussusception was presumed due to distal intestinal obstruction syndrome, and the second enteric one due to polypoid lesions containing heterotopic gastric mucosa. The presentation, pathology, management, and a literature review of intussusception in CF are discussed., (2005 Wiley-Liss, Inc.)