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Connatal tuberculosis is increasing in incidence and the mortality and morbidity of this disease remains high. We report a 27-week-old, 896 g female premature infant who had mild respiratory distress syndrome after birth. She developed signs of infection, progressive pneumonia and atelectasis which did not respond to mechanical ventilation and antibiotics. At 41 days of age, Mycobacterium tuberculosis was isolated from the non-bronchoscopic bronchoalveolar lavage. The isolate was sensitive to isoniazid, rifampin, streptomycin, and pyrazinamide . Miliary tuberculosis was subsequently diagnosed in her mother on a chest X-ray film and sputum cultures. The infant was treated successfully with anti-tuberculosis drugs. She had normal growth and development at the chronological age of 20 months old. Conclusion:Connatal tuberculosis should be considered in premature infants with symptoms of sepsis refractory to antibiotics. Most premature infants with connatal tuberculosis have lung involvement, and non-bronchoscopic bronchoalveolar lavage can be a useful procedure to establish the diagnosis.

Our objective was to review the clinical features and radiographic manifestations of chest wall lesions in a pediatric chest unit. Twenty-five patients (11 males and 14 females, aged 14 months to 15 years) were suspected of having a chest wall lesion on the basis of clinical examination and chest radiograph. A retrospective review of clinical characteristics and radiographic findings was performed in order to define the pathology and extent of lesions and outcomes of chest wall diseases in children. Thirty-six percent of pediatric patients studied for thoracic abnormalities had anatomical variations of the thoracic cage such as sternal titling, bifid ribs, and costal cartilage convexities. Tuberculous infections of the sternum and ribs were seen in 4 cases. Osteochondromas were seen in 4 patients, and were especially noted in patients with a history of familial exostosis. Other malignant thoracic wall tumors included in this study included chondrosarcoma (n=1), Ewing's sarcoma (n=1), and primitive neuroectodermal tumor (n=2). In conclusion, the protruding lesions arising from the chest wall demonstrate a wide range of normal, congenital variant, and pathologic lesions arising from the soft tissues and bony components. Those with life-threatening lesions (less likely located in the parasternal region) are more prone to have chest pains and dyspneic respirations; in most cases, plain chest radiographs tend to have a high rate of bony or pleural involvement as well as thoracic deformities. In an endemic area of tuberculosis, costal tuberculosis should be considered in undiagnosed bony lesions; a chest CT scan could be diagnostically useful.

OBJECTIVE: Our goal was to investigate the correlation between upper airway 3-dimensional computed tomography (3-D CT) measurements and polysomnography data of patients with sleep-disordered breathing (SDB). STUDY DESIGN AND SETTING: The 3-D CT scan measurements of the retropalatal space (RP), lateral and anteroposterior diameters of RP, retroglossal space, uvular thickness, and volume of upper airway were taken prospectively from 194 consecutive SDB patients. These were correlated with patients’ respective Respiratory Distress Index (RDI), snoring index, and lowest arterial oxygen saturation gathered from polysomnographic data. RESULTS: RP (r 0.27, P 0.0001) and lateral diameter (P 0.0073) were significantly correlated with RDI. Multivariate regression model (R 2 0.286) demonstrates RP (P 0.0036) and retroglossal space (P 0.027) to be predictive of RDI. No 3-D CT parameters correlated with snoring index and lowest arterial oxygen saturation attained statistical significant. CONCLUSION: The 3-D CT scan measurements can be valuable in evaluating upper airway patency in patients with SDB. The RP was the most relevant upper airway anatomic structure identified in these patients. SIGNIFICANCE: Modification of palatal surgery to increase the lateral dimension of the RP may be a breakthrough in increasing its success rate. (Otolaryngol Head Neck Surg 2003;129:336-42.) Sleep-disordered breathing (SDB) represents a continuum of sleep disorders that range from simple snoring to severe obstructive sleep apnea syndrome (OSAS). Recent advances in the treatment of SDB for patients with and without OSAS have created the demand for a valid tool that can be used to evaluate the upper airway patency of patients undergoing surgery. Symptoms of habitual snoring and excessive daytime sleepiness are common in the general population and have a poor predictive value in identifying patients with

Neonatal brain tumor is a rare clinical entity. The initial presentation in affected newborn infants is often subtle, nonspecific, and rarely includes focal neurologic signs. We report a 2-day-old male infant with congenital oligodendroglioma with initial manifestations of hyperbilirubinemia. Phototherapy was started immediately after admission. Because of a tense anterior fontanel and irritable crying, head ultrasonography, computed tomography, and magnetic resonance imaging were performed and revealed a heterogenous brain tumor in the left temporoparietal lobe. Craniotomy and tumor evacuation was performed, and WHO grade III anaplastic oligodendroglioma was confirmed by the pathologic studies. The patient was discharged 3 weeks later, and outpatient follow-up examination revealed a normally developed infant at 6 months of age. The cause of jaundice was thought to be secondary to tumor hemorrhage, which was not infrequent in neonatal brain tumor.

Renal abscess is a rare disease in childhood and early diagnosis is essential to minimize the renal damages. Experiences gained from this 10-year study on patients with CT-proved diagnosis include the varied clinical presentations and use of sonographic-marked nephromegaly and focal mass as indications for further CT diagnosis.

Objective: We investigated the effect of intermittent cigarette smoke inhalation on the bone healing of tibial lengthening in rabbits. Methods: Twelve male rabbits were divided into two groups of six animals each. The first group underwent intermittent cigarette smoke inhalation, and the second group did not undergo intermittent cigarette smoke inhalation. Each animal's right tibia was lengthened 5 mm by using an uniplanar lengthening device. Bone mineral density (BMD) study was performed for all of the animals 1 day before operation and 3, 4, 5, and 6 weeks after operation. All of the animals were killed 6 weeks postoperatively for biomechanical testing. Results: By using the preoperative BMD as an internal control, we found that the BMD of the smoke-inhalation group was decreased significantly compared with the non-smoke-inhalation group. The mean %BMD at 3, 4, 5, and 6 weeks were 49.9%, 61.2%, 65.9%, and 71.0%, respectively, in the smoke-inhalation group, whereas the mean %BMD were 54.9%, 71.8%, 76.4%, and 82.0%, respectively, in the non-smoke-inhalation group (two-tailed t test, p > 0.05, p < 0.01, p < 0.01 and p < 0.01 at 3, 4, 5, and 6 weeks, respectively). By using the contralateral nonoperated tibia as internal control, we found that torsional strength of the smoke-inhalation group was decreased significantly compared with the non-smoke-inhalation group. The mean percentage of maximal torque was 63.8% in the smoke-inhalation group, whereas the mean percentage of maximal torque was 77.1% in the non-smoke-inhalation group (two tailed t test, p < 0.01). Conclusion: This study suggests that cigarette smoking delays the mineralization during the bone healing process of distraction osteogenesis and, thus, decreases the mechanical strength of the regenerating bone.

A 2-year-old boy presented with chronic wheezes and was refractory to medical treatment. A high carina with bilateral bronchial stenosis was erroneously diagnosed by bronchoscopic examination. Serial direct coronal computed tomographic scans showed a displaced right upper lobe tracheal bronchus associated with tracheal stenosis below the abnormal bronchus. A direct coronal computed tomographic scan of the tracheobronchial tree is a useful imaging technique for the delineation of airway configuration when the bronchoscope fails to pass beyond a stenotic region. A coronal computed tomographic scan may make invasive tracheobronchography unnecessary.

Background: We investigated the effect of hyperbaric oxygen (HBO) therapy on the early phase of tibial lengthening in our established rabbit model. Methods: Twenty-four male rabbits (six per group) underwent right tibial lengthening by 5 mm. Group 1 then underwent 2.5 atmospheres of absolute hyperbaric oxygenation for 2 hours daily for 6 weeks postoperatively; group 2, for early 5 weeks (weeks 1–5), group 3, for late 5 weeks (weeks 2–6), and group 4 had no HBO therapy. Bone mineral density (BMD) was measured before surgery and weekly thereafter from weeks 2 through 6. The mechanical strengths of the lengthened tibias were measured. Results: Significantly higher mean %BMDs were obtained for groups 1 and 2 than for groups 3 and 4. There was no difference in the mean %BMD between groups 1 and 2 (p > 0.05). The results were similar for mean percentage of maximal torque; group 1 had the maximum torque, followed sequentially by groups 2 though 4. Conclusion: The study results suggest that early and full-term administration of HBO therapy on tibial lengthening may achieve better benefits.

During the last decade, an increasing number of paediatric surgeons have chosen to perform a delayed oesophageal anastomosis for oesophageal atresia (OA) without tracheo-oesophageal fistula (TOF).The gap between the two oesophageal pouches is an important determinant in the surgical management of these patients. We describe a new method using spiral computed tomography (CT) to evaluate the gap between the proximal and distal oesophageal pouches. In our last four cases of OA without TOF, Stamm gastrostomy was performed soon after birth. At about 4 weeks of age, these patients underwent spiral CT with air inflation via the gastrostomy feeding tube with 3 mm slice thickness, pitch 1, and reconstruction interval every 1.5 mm. A three-dimensional reconstruction was done and measurements of the gap between the two segments were recorded. The procedure was repeated at monthly intervals until the optimal conditions for surgery were observed. All the babies thrived well on gastrostomy feeding. The gap distances were 2.4, 3.8, 4.2 and 5.9 cm respectively. Delayed primary oesophageal anastomosis was accomplished in three cases and gastric transposition was performed in another case at 12, 13, 14 and 16 weeks of age. The exact anatomical position the operation correlated well with the pre-operative three-dimensional CT results. Conclusion: this new technique is an easy and non-invasive method to assess the long gap in babies with oesophageal atresia without tracheo-oesophageal fistula. The radiological findings are also consistent with surgical anatomical situation during surgery suggesting that this investigation is useful in the pre-operative planning of oesophageal anastomosis or replacement.

We investigated whether -intermittent hyperbaric oxygen (HBO) therapy can mitigate the adverse effects of cigarette smoking on the bone healing of tibial lengthening by using a previously validated rabbit model.Eighteen male rabbits were randomly divided into three groups of six animals each. Group 1 (smoking plus HBO) went through intermittent cigarette smoke inhalation and hyperbaric oxygen therapy, group 2 (control) did not go through intermittent cigarette smoke inhalation or hyperbaric oxygen therapy and group 3 (smoking) went through intermittent cigarette smoke inhalation. Each animal's right tibia was lengthened 5 mm by using an uniplanar lengthening device. Bone mineral density (BMD) study was performed for all the animals at 1 day before operation and 3, 4, 5, and 6 weeks after operation. All of the animals were killed at 6 weeks postoperatively for biomechanical testing.By using the preoperative BMD as an internal control, we found that the BMD of group 1 (smoking plus HBO)and group 2 (control) was superior to that of group 3 (smoking). The mean %BMD at 3, 4, 5, and 6 weeks were 58.6%, 66.6%, 73.7%, and 83.8%, respectively, in group 1, whereas the mean %BMD were 52.0%, 64.3%, 70.1%, and 76.2%, respectively, in group 2, and the mean %BMD were 46.2%, 54.0%, 64.9%, and 69.4%, respectively, in group 3 (two-tailed t test, p0.05, p0.05, p0.05, and p0.05 at 3, 4, 5, and 6 week respectively between group 1 and group 2, p0.01,p0.01,p0.01, and p0.01 at 3, 4, 5, and 6 week, respectively, between group 1 and group 3 and p0.05, p0.05, p0.05, and p0.05 at 3, 4, 5, and 6 week respectively between group 2 and group 3). By using the contralateral nonoperated tibia as an internal control, we found that the torsional strength of group 1 (smoking plus HBO) and group 2 (control) was superior to that of group 3 (smoking). The mean percentage of maximum torque was 80.9% in group 1 (smoking plus HBO) and was 78.0% in group 2 (control), whereas the mean percentage of maximum torque was 59.6 % in group 3 (smoking) (two-tailed t test, p0.05 between groups land 3 and between groups 2 and 3, whereas p0.05 between groups 1 and 2).This study suggests that smoke inhalation delays the bone healing in tibial lengthening; however, HBO mitigates the delayed healing effect of smoke inhalation and, thus, helps the smoking animal in achieving an expeditious bone healing in tibial lengthening.

We investigated the effect of intermittent hyperbaric oxygen (HBO) therapy on the bone healing of tibial lengthening in rabbits. Twelve male rabbits were divided into two groups of six animals each. The first group went through 2.5 atmospheres absolute of hyperbaric oxygenation for 2 hours daily, and the second group did not go through hyperbaric oxygenation. Each animal's right tibia was lengthened 5 mm using an uniplanar lengthening device. Bone mineral density (BMD) study was performed for all of the animals at 1 day before operation and at 3, 4, 5, and 6 weeks after operation. All of the animals were killed at 6 weeks postoperatively for biomechanical testing. Using the preoperative BMD as an internal control, we found that the BMD of the HBO group was increased significantly compared with the non HBO group. The mean %BMD at 3, 4, 5, and 6 weeks were 69.5%, 80.1%, 87.8%, and 96.9%, respectively, in HBO group, whereas the mean %BMD were 51.6%, 67.7%, 70.5%, and 79.2%, respectively, in non-HBO group (two tailed t test, p < 0.01, p < 0.01, p < 0.01, and p < 0.01 at 3, 4, 5, and 6 weeks, respectively). Using the contralateral nonoperated tibia as an internal control, we found that torsional strength of lengthened tibia of the HBO group was increased significantly compared with the non-HBO group. The mean percent of maximal torque was 88.6% in HBO group at 6 weeks, whereas the mean percent of maximal torque was 76.0% in non-HBO group (two-tailed t test, p < 0.01). The results of this study suggest that the bone healing of tibial lengthening is enhanced by intermittent hyperbaric oxygen therapy.