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The rate of enlargement of a descending thoracic aortic aneurysm is usually low, related to initial size and anatomical position. We report a case of an old, diabetic woman, with previous history of ischemic heart disease, admitted for a broncopneumia, in which a small descending thoracic aortic aneurysm was detected by a routine computed tomography (CT) scan. Because of the presence of comorbid condition, especially in the woman with an infectious respiratory disease, a closer follow-up by a 3-month CT scan was programmed. An impressive enlargement of the aneurysm, occurred in the next 2 months, caused patient's asphyxia and subsequent death. In patients with thoracic aortic aneurysm, mostly in females with comorbid condition, a closer CT scan control should be carried out, irrespective of the previous aneurysm size.

Background: IgM deficiency is a rare primary immunodeficiency. As few studies of selective IgM deficiency have been reported among the various other types of primary immunodeficiencies, the detailed pathogenesis of this disorder remains to be elucidated., Case Summary: We clinically analyzed a 37-year-old woman who presented with IgM and IgG4 deficiency and ectopic bronchial pneumonia, and investigated immunological functions. Occlusive pneumonia was repeatedly observed in the right S6 area, and bronchoscopy revealed a polyp in the right B6 orifice, which was later identified as a fibroepithelial polyp after transbronchial endoscopic polypectomy. Two months later, pneumonia involving the right inferior lobe developed. Systemic erythema and pigmentation with bleb formation were also observed on the skin, and were thought to be drug-induced exanthema following a biopsy. Serum levels of IgM and IgG4 were extremely low at 3.0mg/dl and less than 2.0mg/dl, respectively. Circulating CD20 positive B cells were mildly reduced and memory B cells were markedly decreased. The majority of B cells expressed IgM on their surface. There were no abnormalities in cell counts of neutrophils, T cells, NK cells and monocytes. Chemotaxins, bactericidal activity and phagocytosis of neutrophils were normal., Discussion: There have been no case reports of selective IgM deficiency with concurrent IgG4 deficiency, various dermal symptoms and a bronchial polyp, as demonstrated in our patient.

We present a case of severe optic neuropathy following linezolid treatment, which led to complete irreversible blindness, in a patient with progressive muscular dystrophy, treated with linezolid for 16 days for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Interruption of antibiotic therapy did not lead to remission of ocular symptoms. Administration of linezolid may lead to severe neuropathy even in the case of short-term treatment.

Three cases of children admitted to the Pediatric Intensive Medicine Unit in the months of February to March 2004 with the diagnosis of streptococcal toxic shock syndrome are presented. Two were under 2 years of age and the initial symptoms suggested viriasis. They evolved towards septic shock with early multiorganic failure and then death due to massive hemoptysis, ventricular fibrillation due to hyperkaliemia. Streptococcus pyogenes with serotypes M1T1 was isolated in all the cases and the patients had the clinical criteria of streptococcal toxic shock syndrome. Their course was unfavorable in spite of the resuscitation steps, early antibiotic treatment and artificial support of the different organic failures. We stress the rareness of the cases, early age, its appearance in a short period of time, its sudden onset and the null response to treatment initiated.

Background: In Germany, 2910 infants died in 2004; for many infants the reason was clear, especially prematurity or congenital abnormalities. However, 394 babies die every year suddenly and unexpectedly. The cause may be immediately clear, but is often not obvious., Aims: (1) To describe the causes of explained sudden unexpected death in infancy (SUDI) and (2) to compare risk factors for sudden infant death syndrome (SIDS) and explained SUDI., Methods: A 3-year population-based case-control study in Germany, 1998-2001., Results: 455 deaths, of which 51 (11.2%) were explained. Most of these deaths were due to respiratory or generalised infections. The risk factors for SIDS and explained SUDI were remarkably similar except for sleep position and breast feeding. Prone sleeping position is a major risk factor for SIDS (adjusted odds ratio (OR) 7.16, 95% confidence interval (CI) 3.85 to 13.31) but not for explained SUDI (adjusted OR 1.71, 95% CI 0.25 to 11.57). Not being breast fed in the first 2 weeks of life is a risk factor for SIDS (adjusted OR 2.37, 95% CI 1.46 to 3.84) but not for explained SUDI (adjusted OR 0.39, 95% CI 0.08 to 1.83)., Conclusions: Prone sleeping position is a unique risk factor for SIDS. Socioeconomic disadvantage and maternal smoking are risk factors for both SIDS and explained SUDI, and provide an opportunity for targeted intervention.

We present the 1st autopsy findings of a child who had Johanson-Blizzard syndrome (JBS) and hypopituitarism. The patient died of acute bronchopneumonia at the age of 4 years. The autopsy revealed a small undescended pituitary that contained a glial hamartoma and a small rim of adenohypopysial cells, which were minimally reactive immunohistologically only for growth hormone. We review the literature with regard to other cases of JBS and hypopituitarism and pituitary function. The need for evaluating pituitary function in all patients with JBS is stressed. At the time of his death, our patient had no clinical evidence of pancreatic exocrine deficiency, and the histology of the pancreas revealed a normal number of acini; however, the acinar cells had an immature appearance. The microlobules were separated by loose fibrous tissue, and there was extensive periductal fibrosis. The spectrum of the pathognomic feature of congenital pancreatic exocrine insufficiency in JBS is discussed.

Gout is a metabolic disorder typically affecting the peripheral joints, more commonly in males. Spinal involvement is uncommon and is usually associated with hyperuricemia. We present the imaging findings of a case of spinal gout in a female patient with no previous history of hyperuricaemia, involving multiple spinal segments.

Objective: To evaluate the response to recombinant GH treatment and adverse events in children with Prader-Willi syndrome (PWS) from KIGS, the Pfizer International Growth Database., Patients: A total of 328 children (274 prepubertal, median age 6.0 years; 54 pubertal, median age 12.7 years) were treated for 1 year and 161 children were treated for 2 years with GH., Results: Height standard deviation score (SDS) increased significantly during treatment; the response was greater in prepubertal (-0.7 vs.-1.8 pretreatment) compared with pubertal children (-1.5 vs.-1.8). Predictors of first-year height velocity in multiple regression analysis were GH dose, body weight (positively correlated), height SDS minus mid-parental height SDS and chronological age (negatively correlated), together accounting for 39% of the variation in response to GH. Body mass index (BMI) SDS did not change significantly during 2 years of treatment. Of all the 675 GH-treated PWS patients in KIGS, there were five cases of sudden death (age range 3-15 years). Three were obese (weight for height > 200%) and causes of death included bronchopneumonia, respiratory insufficiency and sleep apnoea. Scoliosis was the most commonly reported adverse event (n = 24), four children developed hyperglycaemia and six had presumptive diabetes (type 2 in five, and one case of type 1)., Conclusions: Short-term growth improved in response to conventional doses of GH in children with PWS. Prior to commencement of GH, examination of the upper airways and sleep studies should be performed in PWS patients. GH should be used with caution in those with extreme obesity or disordered breathing and all patients should be closely monitored for adverse events.

The presence and likelihood of an alternative diagnosis to pulmonary embolism is an important variable of the Wells' prediction rule for establishing clinical probability. We assessed whether evoking specific alternative diagnoses would reduce the probability of pulmonary embolism enough to forego further testing. We retrospectively studied a cohort of 965 consecutive patients admitted for suspicion of pulmonary embolism at three medical centers in Europe in whom the presence of an alternative diagnosis at least as likely as pulmonary embolism was recorded before diagnostic testing. We divided the patients into 15 categories of alternative diagnoses evoked. We then assessed the prevalence of pulmonary embolism in each diagnostic category and compared it to the prevalence of pulmonary embolism in a reference group (patients with no alternative diagnosis or a diagnosis less likely than pulmonary embolism). The prevalence of pulmonary embolism in the reference group was 48%. The presence of an alternative diagnosis as or more likely strongly reduced the probability of pulmonary embolism (OR 0.15, 95% CI: 0.1-0.2, p < 0.01). In almost every diagnostic category, the prevalence of pulmonary embolism was much lower than in the reference group with an odds ratio below or near 0.2. Bronchopneumonia (OR 0.4, 95% CI 0.2 to 0.7) and cancer (OR 0.6, 95% CI 0.3 to 1.5) reduced the likelihood of pulmonary embolism to a lower extent. Evoking an alternative diagnosis at least as likely as pulmonary embolism reduces the probability of the disease, but this effect is never large enough to allow ruling it out without further testing, especially when bronchopneumonia or cancer are the alternative diagnoses considered.

Recent clinical studies have emphasized the up-regulation (sensitization) of cough in pathological conditions of the airways. However there are also many situations where voluntary and reflex cough can be down-regulated. These include: (1) chemical stimulation of breathing by hypercapnia or hypoxia or both, establishing that cough sensitivity can be inversely related to drive to breathing; (2) voluntary inhibition of cough, probably similar in mechanism to the depression of cough that can be induced by hypnosis and other branches of alternative medicine; (3) the placebo effect of many antitussive treatments; (4) sleep; (5) general anaesthesia; (6) central nervous disorders such as coma, stroke, Parkinson's disease and several other conditions where the defect in the protective reflexes may lead to aspiration pneumonia; (7) increased activity in various afferent inputs from viscera in the thorax and abdomen; (8) a number of bronchopulmonary clinical disorders. The list is long, but regrettably the nervous mechanisms of these down-regulations have been little studied. In addition there are a number of situations, such as exercise, coitus, talking and singing which, while important to coughing humans, have been not investigated in relation to cough. Most of the studies have been with experimental animals, and their extension to human research is desirable. In view of the importance of cough and other defensive reflexes in maintaining human well-being, far more research is needed. The field is wide-open.

Background: Bronchitis obliterans is a severe and extremely rare complication of respiratory tract infections in children and is characterized by massive atelectasis and collapse of the affected lung. Of the rare cases reported in the literature all surviving children underwent surgical resection of the collapsed lung., Case Presentation: We report an infant with bronchitis obliterans that was treated conservatively. 5 years after the initial event, partial lung re-expansion was documented., Conclusion: This case therefore supports a conservative treatment whenever possible with pneumonectomy only as a last treatment option.

This study aimed to investigate whether Escherichia coli endotoxin (LPS) may predispose the lung to an infection with Pasteurella multocida type A (Pma) and to determine the LPS concentration needed to reproduce clinical signs of bronchopneumonia. Twenty-four hours before inoculating Pma or sterile growth medium, piglets were tracheally instilled with 10, 100 or 400 microg/kg LPS. Cough, body temperature, daily weight gain (DWG) bronchoalveolar lavage fluid (BALF) cells and volume of pneumonic lung were measured. Changes in breathing pattern (Penh) were assessed by whole body barometric plethysmography. No significant changes were observed in Pma-treated or in control animals. Each LPS doses induced DWG reduction while the higher generated a severe subacute interstitial pneumonia causing hyperthermia and an increase in Penh. The combination of the lower LPS doses with Pma produced an asymptomatic bronchopneumonia leading to DWG reduction, rise in Penh and an increase in BALF macrophages and neutrophils. With 400 microg/kg LPS, Pma worsened the inflammatory process as illustrated by cough, hyperthermia, major DWG reduction and by a greater Penh response. Lung lesions consisted of severe exudative bronchopneumonia. We concluded that LPS may negatively influence growth, predispose to persisting lung inflammatory process and promote Pma infection depending on the dose previously administered.

A 67-year-old patient with metastatic renal cell cancer was treated with fractionated stereotactic radiotherapy to a hemorrhagic pons metastasis. He then developed multiple cystic brain lesions, suggestive of diffuse metastatic spread. However, further work-up revealed abscesses from bronchopneumonia. Diagnostic and therapeutic aspects as well as potential pitfalls in the management of patients with brain metastases are discussed.

Swyer-James-MacLeod Syndrome (SJMS) is considered to be a relatively uncommon and complex disease characterized by roentgenographic hyperlucency of one lung, lobe, or part of a lobe, due the pulmonary vascular structure and alveolar overdistension. It is sometimes associated with bronchiectasis. This syndrome seems to be an acquired disease that develops after viral bronchiolitis and/or viral pneumonia in early childhood. Microscopically, there is evidence of patchy bronchitis and bronchiolitis.SJMS is usually asymptomatic and discovered accidentally by chest radiography in a child with respiratory symptoms and should be differentiated from other causes of unilateral hyperlucency on chest radiography, such as those related to congenital bronchial and/or vascular abnormalities. Treatment includes early control of lung infections, as well as influenza and pneumococcal vaccination. Few reports of this syndrome in children have been published. We describe the case of a 12-year-old boy with unilateral hyperlucency of the lung and respiratory symptoms of acute pneumonia and discuss the main diagnostic features of this syndrome.

Objective: To evaluate the features, underlying causes, results of diagnostic testing, and treatment of pneumothorax in dairy cattle., Design: Retrospective study., Animals: 30 dairy cattle., Procedure: Medical records of all cattle with a diagnosis of pneumonia were reviewed. For cattle with pneumothorax, information was obtained pertaining to signalment, anamnesis, diagnosis, treatment, and outcome. Survival data were compared between cattle with pneumonia with or without pneumothorax., Results: Pneumothorax was associated with bronchopneumonia in 18 cattle, interstitial pneumonia in 7 cattle, pharyngeal or laryngeal trauma in 3 cattle, and neonatal respiratory distress in 2 calves. Bovine respiratory syncytial virus was the most commonly detected infectious agent. Eighteen of 30 (60%) cattle survived; 8 were euthanatized and 4 died. Survival rate was 81% for cattle with pneumonia without pneumothorax during the same time period. Pneumothorax was a significant risk factor for failure to survive to discharge from the hospital for cattle with underlying chronic bronchopneumonia., Conclusions and Clinical Relevance: Pneumothorax in dairy cattle appears to occur most commonly in association with chronic bronchopneumonia. Cattle of both sexes and all ages can be affected.

A 10-year-old Knabstrupper stallion was euthanatized because of severe dyspnea and exercise intolerance. Postmortem examination revealed diffuse severe alveolar emphysema and chronic fibrosing pleuritis of the caudal lung. Parts of both caudal lung lobes were covered with multiple raised firm gray to yellow plaques. Histologically, these areas consisted of circumscribed pleural fibroses and cysts of metaplastic keratinizing squamous epithelium. Immunohistochemistry revealed intense labeling for cytokeratins 5/6 and 10. In addition, caudal lung lobes were severely affected by a chronic partially obliterative bronchiolitis and peribronchiolitis with multifocal pleural involvement.

Aims: To analyse the lung pathology of severe acute respiratory syndrome (SARS) and correlate the findings with the time sequence of the disease., Methods and Results: Ten patients with a clinical diagnosis of SARS, and virological confirmation of SARS coronavirus infection were identified. Histology in most cases showed diffuse alveolar damage, from early to late phases, and the changes corresponded to the time sequence. Other variable features include multinucleated giant cells, pneumocytes with cytomegaly and variable amounts of inflammatory cells and foamy macrophages. One case showed superimposed bronchopneumonia. No viral inclusions were found. Coronavirus particles were identified in pneumocytes by electron microscopy., Conclusions: The predominant pathological process of SARS is diffuse alveolar damage and, in patients who die from the disease, there is evidence of organization and fibrosis. There are apparently no histological features specific for this disease, and the aetiological diagnosis depends on virological and ultrastructural studies.

A 1-year-old child with clinical features of monosomy 14 is reported. She has dysmorphic facial features including ocular colobomata, dolichocephaly and microcephaly, retinal pigmentation, severe seizures, fair curly hair and tapering fingers. There was severe mental retardation. This is the first reported case of severe mosaic monosomy 14, with up to 30% mosaicism. A recognizable facial gestalt is present in children with 14q deletions or partial monosomy 14, as well as susceptibility to infection, feeding difficulties, seizures and retinal pigmentation.

OF DEBATABLE INTEREST: Although the place of non-invasive ventilation (NIV) is indisputable in the management of acute respiratory failure during chronic obstructive pulmonary disease (COPD), where it significantly reduces the rate of intubation and complications and the number of days spent in intensive care, its interest is debated in the long term management of chronic obstructive respiratory failure (CORF). EFFICACY TO BE DEMONSTRATED: Although several short term studies confirm the efficacy of NIV on some physiological parameters and on the quality of sleep and quality of life in some patients, long term prospective studies are still too few and do not confirm these data on small series of patients and limited time. FOR CERTAIN CATEGORIES OF PATIENTS: It is legitimous to consider that sub-groups of patients respond to NIV, notably in cases of instable CORF non-controlled by medical treatments or by well-conducted kinesitherapy and oxygentherapy.

Nodular regenerative hyperplasia (NRH) of the liver is an infrequent entity that is usually diagnosed after the appearance of clinical signs of portal hypertension such as hepatomegaly, splenomegaly or upper gastrointestinal bleeding due to esophageal varices, which are the most frequently found clinical manifestations in NRH. Ascites is a less frequent finding and has always been described in association with other manifestations of portal hypertension. We describe a new case of NRH with atypical presentation in which ascites was the sole clinical manifestation.

Aims: The presence of ground glass hepatocytes in a liver biopsy may be related to different conditions, including fibrinogen storage disease. Three types of fibrinogen storage disease have been described, namely types I, II and III. Type I is an hereditary hypofibrinogenaemia genetically characterized by a mutant variant of the fibrinogen molecule designated as fibrinogen Brescia, consistent with a gamma284 Gly-->Arg mutation. Only rare cases of types II and III fibrinogen storage disease have been described. The purpose of the present paper is to describe two cases of fibrinogen storage disease without associated hypofibrinogenaemia, which appeared during acute infectious diseases., Methods and Results: Both patients were female, aged 77 and 73 years, who developed high transaminases during an infectious disease. In each case blood coagulation tests were within the normal range, and despite clinical and laboratory investigations no possible cause for liver disease could be found. Liver biopsies were performed; in both cases weakly eosinophilic cytoplasmic inclusions were observed. Using immunohistochemistry the inclusions were found to be due to fibrinogen accumulation. At ultrastructural level features corresponding to type II inclusions were observed. Molecular studies, performed in case 2, excluded the mutation typical of type I fibrinogen storage disease. Both patients also presented features of chronic hepatitis. In case 1, giant cell granulomas were additionally present. No close relatives of the patients presented any clinical or laboratory features of liver disease. In both patients altered liver function test values gradually, spontaneously, returned to within normal ranges after infectious disease was resolved., Conclusions: These cases suggest that, on rare occasions, hepatocytes may accumulate fibrinogen during an infectious disease.

This paper reports the alterations in peripheral blood leukocyte phenotype in respiratory diseased calves affected with chlamydial and non-chlamydial co-infectious agent. The etiological contribution of chlamydial infectious agent in examined clinical cases of enzootic bronchopneumoniae syndrome was confirmed in affected calves serologically both by complement fixation test (CF) and enzyme immunoassay (EIA). Changes in leukocyte subpopulations in the blood of the calves were detected both with routine haematological methods and by FCM using specific monoclonal antibodies directed against CD14, CD45, CD2, CD4, CD8 and WC4 (a specific surface marker for bovine B-lymphocytes). The results obtained by flow cytometry analysis indicate that polymorfonuclear neutrophils (PMNLs) and T lymphocytes, especially CD8-positive cells, may play a significant role in cellular immune response against Chlamydophila psittaci (Chl. psittaci) co-infection in calves suffering from enzootic bronchopneumonia syndrome. A repercussion of this was a significant increase of the cell numbers in peripheral blood of the infected animals. Effective recruitment from a reserve marginal pool of these cells into blood vessels and activation of bone marrow proliferation are probably the reason for their high circulating number.

The presented research positively evaluates the vocality of the cough sound by estimating the global cough fundamental frequency or pitch. The fundamental frequency was determined by autocorrelation analysis on both the original time-signal and the linear predicted time-signal. The experimental cough database was registered in the free acoustical field on respectively three pathological and nine healthy non-smoking human subjects and on two pathological and two healthy Belgian Landrace piglets. For both species differences between pitch values for cough-sounds originating from subjects suffering from a respiratory infection and healthy subjects are put forward. The retrieved pitch-difference between respectively healthy and infected subjects indicates the existence of acoustically different cough-classes in accordance with a different cause or physical condition of the respiratory system.

Background: Patients with on-going HBV viral replication often present with clinical features of active chronic hepatitis. Until the recent introduction of nucleoside analogues, interferon-alpha was the only approved drug for these patients. One of the former drugs, lamivudine, has been shown in clinical trials in the US and Asia to effectively inhibit the viral polymerase of HBV. Our study was undertaken to assess the efficacy and safety of lamivudine therapy in Polish patients with chronic hepatitis B., Material/methods: Forty-five patients with chronic hepatitis B (HBeAg positive, anti-e negative, HBV-DNA positive by hybridization assay) were enrolled in the study. The patients received 100mg of lamivudine orally, once daily for 12 months. They returned for routine clinical and laboratory control every two weeks during the first months of treatment, and later at 3-month intervals while receiving lamivudine., Results: At the end of treatment, serum HBeAg was not detected in 21 patients (48.8%), and anti-HBe appeared in the serum of 19 patients. 37.2% of the patients in the study group showed sustained suppression of serum HBV DNA at the end of treatment. Lamivudine therapy was well tolerated, with the rate of occurrence of adverse events similar to that observed in other clinical studies., Conclusions: 12-month lamivudine therapy in this Polish population of patients with chronic hepatitis B induced a high rate of HBeAg seroconversion, accompanied by reduction of HBV-DNA and the normalization of alanine aminotransferase activities.

Background: Peripheral angioplasty is increasingly the first choice intervention in patients with peripheral vascular disease. The aim of the current study was to audit prospectively all major complications, especially the requirement for emergency surgical intervention., Patients and Methods: A prospective audit of outcome after peripheral angioplasty in 988 patients undergoing 1377 interventional procedures between 1 October 1995 and 30 September 1998 at which 1619 vessel segments were angioplastied., Results: Major medical morbidity (bronchopneumonia, stroke, renal failure, myocardial infarction) complicated 33/1377 procedures (2.4%). Emergency surgical intervention was required after 31/1377 procedures (2.3%) with the commonest aetiologies being acute limb ischaemia and haemorrhagic complications. The amputation rate following angioplasty was 0.6% and no patient presenting with claudication or graft complications underwent amputation. The amputation rate following angioplasty for critical limb ischaemia was 2.2%. Overall, the risk of death and/or major medical complication and/or requiring emergency surgical intervention was 3.5%. The rate of complications was no different for subintimal as opposed to transluminal angioplasties., Conclusions: Peripheral angioplasty is associated with a low risk of major medical and surgical complications.

As many as fourteen children with teratodermoid tumours of the mediastinum were examined and treated at the department of surgery of developmental abnormalities of the Institute of Pediatrics, Obstetrics and Gynecology. Intrathoracal compression of the respiratory tracts caused by a ripe teratodermoid tumour was identified in 7 patients, by an unripe tumour--teratoblastoma--in one patient. Some specificities of intrathoracal compression of the respiratory tracts have been studied together with complications thereof.

To determine parameters of distinctive value in polycythemia rubra vera (PV) versus secondary polycythemias (SP), a clinicopathological study was performed on 199 patients. These presented with a borderline to marked elevation of the hemoglobin level (> 18 g/dl in men and > 16 g/dl in women). Evaluations of clinical features and bone marrow histopathology were carried out independently. According to the results derived from laboratory data and representative pretreatment trephine biopsies, three groups of patients emerged: group I presenting with the concordant clinical and morphological findings of early to manifest PV (136 patients), group II consisting of 55 patients with the congruent signs and symptoms of SP mostly caused by various chronic bronchopulmonal disorders, and finally eight patients (group III) with divergent findings. Between group I and II patients (PV versus SP), a number of clinical parameters proved to be significantly different. With the exception, of the red cell mass, platelet count, leukocyte alkaline phosphatase, LDH, spleen size, and the erythropoietin level had a significantly discriminating impact. Morphological features of distinctive value consisted of a set of specific lesions. Contrasting SP with an only borderline to slight increase in cellularity associated with a moderate enlargement of the erythroblastic islets, PV was always characterized by a significant increase in hematopoiesis, revealing a trilinear proliferation (panmyelosis). Megakaryopoiesis was strikingly different in PV as compared to SP by displaying clustering and a pleomorphous appearance. i.e., very small and giant megakaryocytes with staghorn-like nuclei were neighboring each other. Moreover, conspicuous alterations of the interstitial compartment were recognizable in SP. These consisted of deposits of cell debris in histiocytic reticular cells, iron-laden macrophages, and a plasmacytosis, implying an inflammatory reaction. These changes were only very rarely observed in PV, as opposed to a minimal to slight increase in reticulin fibers in about 12% of patients. In conclusion, a more elaborate evaluation of bone marrow features resulted in a set of diagnostic criteria with discriminating capacity that should be considered in prospective clinical trials.

Administration of oxygen via a tube held close to the nose prevented hypoxemia during breastfeeding in 15 of 20 infants with bronchopneumonia.

A 6-year-old male tapir was admitted because it had been anorexic for 1 day. On admission, the tapir weighed 160 kg. Its rectal temperature was 32.4 degrees C, its heart rate was 120 beats per minute, and its respiratory rate was 12 breaths per minute. The elasticity of the skin was diminished. Haematological evaluation upon admission revealed a haematocrit of 0.63 L.L-1., 6.0 G.L-1 leucocytes with 40 per cent band neutrophils. The concentrations of urea nitrogen and creatinine in plasma were raised (18.9 mmol L-1. and 475 mumol L-1., respectively). Severe combined acidosis was apparent; the venous pH was 6.965, the bicarbonate concentration was 13.7 mmol.L-1., and the venous pCO2 was 8.6 kPa. No strongyle eggs were isolated from faeces by flotation, but a faecal sample yielded a positive culture for Pseudomonas aeruginosa. Urinalysis revealed proteinuria and the presence of leucocytes and renal epithelial cells. Treatment with fluids, TMP/S (17.5 and 3.5 mg/kg body weight, twice a day, respectively), and clenbuterol (0.56 microgram/kg body weight, twice a day) intravenously was unsuccessful and the tapir died 4 days after hospitalization. At necropsy, peritonitis due to a colon infarct as well as chronic bronchopneumonia and renal tubulonecrosis were found. The antibiotic susceptibility of the bacteria isolated (Streptoc. sp., E. coli, and K. pneumoniae) from the tapir post-mortem was assessed.