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The relation of breast feeding and other factors to the incidence of respiratory syncytial virus-associated lower respiratory tract illness (RSV-LRI) in the first year of life is examined. The study population is 1,179 healthy infants enrolled at birth between May 1980 and January 1984 into the Tucson Children's Respiratory Study, Tucson, Arizona. Each subject's data were assessed at each month of age during the first year of life, during those months when respiratory syncytial virus was isolated. A number of significant relations were observed, particularly between 1 and 3 months of age. At this age, the risk of having a RSV-LRI increased in association with less than 1-month or no breast feeding, with being male, and with increasing numbers of others sharing the child's bedroom. In multivariate analysis, only sex and the number of others sharing the room remained as significant direct effects. However, a significant interaction demonstrated that breast feeding has a protective role in relation to RSV-LRIs for those infants of mothers with a lower education level. The risk of having a RSV-LRI increases with combinations of risk factors. Being in day care was a significant risk factor in the 7- to 9-month age range. The RSV-LRI rate also varies by birth month. A separate case-control study assessed relations of RSV-LRIs with cord serum RSV antibody. Those with lower cord serum RSV antibody, who also have minimal breast feeding, were found to be especially at risk for RSV-LRIs in the first 5 months of life.

Summary: Morphometric analysis of the lungs and heart of a male infant who died at 33 months of age of bronchopulmonary dysplasia after prematurity and respiratory distress syndrome and its treatment is presented. Alveolar internal surface area was 8.4 m2compared to 15.3–27.8 for age-matched controls. The number of alveoli was 19 X 106(123.3–172.5 X 106for controls); however, the mean small airway diameter, 0.44 mm was normal, and small airway abnormalities were minimal. There was marked muscular hypertrophy of the right ventricle.Speculation: Severe neonatal lung injury, with persistent oxygen dependency throughout infancy might result in inhibition or marked slowing of lung growth. Because development of conducting airways is completed early during intrauterine life and because most alveolar development takes place postnatally, one might expect disturbances in alveolar growth to overshadow residual airway injury in survivors of bronchopulmonary dysplasia.

Postneonatal mortality due to respiratory illnesses is known to be inversely related to maternal age, but the possible role of young motherhood as a risk factor for respiratory morbidity in infants has not been thoroughly explored. The authors studied the incidence of lower respiratory tract illnesses during the first year of life, as ascertained by health plan pediatricians, in over 1,200 infants enrolled at birth between 1980 and 1984 in Tucson, Arizona. The incidence of wheezing lower respiratory tract illnesses increased significantly (p = 0.005) with decreasing maternal age, whereas the incidence of nonwheezing lower respiratory tract illness was independent of maternal age. A logistic regression was used to control for the effects of several known confounding factors. When compared with infants of mothers aged more than 30 years, adjusted odds ratios were 2.4 (95% confidence interval 1.8-3.1) for infants whose mothers were less than age 21 years (p < 0.0001), 1.8 (95% confidence interval 1.4-2.3) for infants whose mothers were aged 21-25 (p < 0.0001); and 1.4 (95% confidence interval 1.1-1.6) for infants whose mothers were aged 26-30 (p < 0.001). These results suggest that young motherhood is an important risk factor for wheezing lower respiratory tract illnesses during the first year of life. Both biological and social factors related to maternal age may explain these findings.

The Tucson Children's Respiratory Study, Tucson, Arizona, has been established as a long-term, longitudinal, prospective study of the risk factors for acute lower respiratory tract illnesses in early childhood and for chronic obstructive airways disease in later life. A total of 1,246 newborns were enrolled into the study between May 1980 and January 1984, representing 78% of eligible infants. Cord blood for immunologic studies, neonatal blood specimens for blood counts and differentials, and blood specimens at nine to 15 months of age for immunologic studies, blood counts, and differentials have been obtained on the majority of enrolled children. Pre-illness physiologic and more detailed immunologic studies have also been done on large subgroups of subjects. The majority of lower respiratory tract illnesses suffered by these children in the first three years of life have been assessed in detail for etiologic agents by means of culture and serologic techniques; 1,052 illnesses have been evaluated thus far. The type of illness and nature of etiologic agents are very similar to those reported in other epidemiologic studies. Thus, this group of enrolled infants and their family members constitute an appropriate population for the long-term study of risk factors for acute and chronic respiratory disorders.

Lower respiratory tract illnesses occurring during the first year of life in 1,179 healthy infants enrolled in the Children's Respiratory Study, Tucson, Arizona, are described. The children, who use the pediatricians of a health maintenance organization, were enrolled into the study between May 1980 and January 1984. Data were collected on signs, symptoms, and diagnosis for each illness; nasopharyngeal and throat swabs were collected at the acute visit for viral, chlamydial, and mycoplasmal cultures. The cumulative incidence of illness in the first year of life was 32.88 per 100 children. Of the 348 initial lower respiratory tract illnesses occurring in these infants, 60% were diagnosed as bronchiolitis. At least one infecting agent was identified in 66% of the specimens collected at the time of the first illness. Respiratory syncytial virus was the most common isolate; 12 other agents were also identified. There was a strong (p less than 0.0001) relation between agent identified, symptoms reported, and diagnosis; bronchiolitis was predominantly associated with respiratory syncytial virus and croup with parainfluenza viruses. Sex and ethnicity were unrelated to illness experience or to characteristics of the first illness. Lower respiratory tract illness occurrence in the Children's Respiratory Study appears to be similar to patterns observed elsewhere, suggesting that diagnoses (and infecting agents) have changed little over the past decades.

COCCIDIOIDAL GRANULOMA CONFINED TO THE TONGUE. PRESENTED BY DR. HARRY E. ALDERSON. A. J. L., a married man aged 39, a truck driver residing in Watsonville, Calif., had macroglossia of enormous proportions of six months' duration on April 14, 1936. There were two irregular superficial ulcers near the right border of the tongue, where the disease had its onset.The patient bit his tongue in November 1935, and it has never healed. The swelling has gradually increased, and the tongue now almost fills his mouth. This swelling is fairly uniform and firm, but the borders are deeply indented by pressure of the teeth. The base of the tongue is free, but the surface in front of it shows deep-seated but slightly elevated irregular and poorly defined hard nodules.There was never any interference with breathing, but the patient has great difficulty in eating and talking. The cervical nodes and submaxillary

Lupus Erythematosus Showing Features of Sarcoid, Resistant to Gold Sodium Thiosulfate But Responding to Bismuth Subsalicylate. Presented by Dr. Charles Albert Shumate for Dr. Harry E. Alderson.This patient was presented at the meeting of this society in December 1934 with the diagnosis of lupus erythematosus resistant to therapy with a gold, but responding to treatment with a bismuth preparation (Arch. Dermat. & Syph. 32:311 [Aug.] 1935). At that time there was discussion as to whether the disorder was syphilis, sarcoid or lupus erythematosus. Serologic tests were negative; the history was irrelevant; the results of biopsy suggested lupus erythematosus. The treatment had consisted of nine intravenous injections of 5 mg. of gold sodium thiosulfate at weekly intervals, and during the period of treatment the eruption on the face became steadily worse. Injections of gold sodium thiosulfate were discontinued, and eight injections of 2 cc. of bismuth subsalicylate

Lupus Erythematosus Resistant to Therapy with a Gold, but Responding to Treatment with a Bismuth, Preparation. Presented by Dr. A. E. Ingels.This patient was presented at the December meeting of the San Francisco Dermatological Society (Arch. Dermat. & Syph.32:311 [Aug.] 1935). At that time there was some discussion as to whether the condition was syphilis, sarcoid or lupus erythematosus.Examination of the tissue showed lupus erythematosus disseminatus with features of sarcoid. The histopathologic report is as follows: "Specimens were fixed in dilute solution of formaldehyde U. S. P. (1:10), were stained with hematoxylin and eosin, Van Gieson's stain and Becker's stain. There is a normal amount of keratosis and no parakeratosis. Plugging of the hair follicles is present in a moderate degree. Plugging of sweat ducts is present. The epidermis proper is thinned to only three or four layers of cells in places. The basal cell layer