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A 3-year-old boy initially presented with purpura-like rashes and nephrotic syndrome, suspected to be IgA vasculitis nephritis (IgAVN). The suggestion of kidney biopsy was rejected. Although the patient responded well to glucocorticoids, they later developed recurrent proteinuria, refractory diarrhea, and subsequent metabolic acidosis. Kidney biopsy showed membranous nephropathy with positive semaphorin 3B expression, indicative of other kidney diseases rather than IgAVN. Although his kidney responded well to glucocorticoid combined with cyclosporine A treatment regimen, enteropathy and severe food allergy still progressed afterwards as evidenced by villous atrophy on gastrointestinal endoscopy examination. Whole exome sequencing identified a heterozygous missense variant in exon 11 of FOXP3: c.1121 T > G, confirming the diagnosis of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. The case expanded the phenotypic spectrum of IPEX syndrome, suggesting high phenotypic heterogeneity despite similar genotypes. It also put emphasis on the significance of kidney biopsy to differentiate IgA vasculitis nephropathy from other immune disorders. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate TFC by EC versus lung ultrasound (LUS) findings for diagnosing and follow-up of TTN in late preterm and term neonates. This prospective observational study was conducted on 80 neonates with gestational age ≥ 34 weeks. TTN group included 40 neonates diagnosed with TTN, and no lung disease (NLD) group included 40 neonates without respiratory distress. LUS and EC were performed within the first 24 h of life and repeated after 72 h. There was a statistically significant increase in TFC in TTN group on D1 [48.48 ± 4.86 (1 KOhm−1)] compared to NLD group [32.95 ± 4.59 (1 KOhm−1)], and then significant decrease in TFC in D3 [34.90 ± 4.42 (1 KOhm−1)] compared to D1 in the TTN group. There was a significant positive correlation between both TFC and LUS with Downes' score, TTN score, and duration of oxygen therapy in the TTN group. Conclusion: Both LUS and TFC by EC provide good bedside tools that could help to diagnose and monitor TTN. TFC showed a good correlation with LUS score and degree of respiratory distress. What is Known: • Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. • TTN is a diagnosis of exclusion, there are no specific clinical parameters or biomarker has been identified for TTN. What is New: • Thoracic fluid content (TFC) by electrical cardiometry is a new parameter to evaluate lung fluid volume and could help to diagnose and monitor TTN and correlates with lung ultrasound score. [ABSTRACT FROM AUTHOR]

Nasal continuous positive airway pressure (nCPAP) is one of the most commonly used non-invasive respiratory support modes in neonates with transient tachypnea of the newborn (TTN). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a non-invasive respiratory support mode that has been increasingly used in neonatal respiratory disorders. This prospective randomized controlled study compared the efficacy of nHFOV and nCPAP in reducing the duration of non-invasive respiratory support. Late preterm and term infants > 34 weeks' gestation were included in the study. The infants were randomly assigned to receive either nHFOV or nCPAP. Treatment was started with standard settings in both groups. Infants who met treatment failure criteria were switched to nasal intermittent mandatory ventilation for further positive-pressure support. A total of 60 infants were included in the study. Thirty of these infants were included in the nHFOV group and 30 were included in the nCPAP group. The median duration of non-invasive respiratory support was not significantly different between the two groups (21 h [IQR: 16–68] for nHFOV vs 15 h [IQR: 11–33] for nCPAP; p = 0.09). However, after adjusting for potential confounders, nHFOV was associated with a shorter duration of non-invasive respiratory support than nCPAP (adjusted mean difference: 16.3 h; 95% CI: 0.7 to 31.9; p = 0.04). nHFOV was well tolerated and did not increase the risk of complications. Conclusion: Our findings suggest that nHFOV is an effective and safe ventilation mode for late preterm and term neonates with TTN. Trial registry: Clinicaltrials.gov (NCT03006354). Date of registration: December 30, 2016. What is Known: • nHFOV is a ventilation model that has been increasingly used for the management of RDS. • TTN is one of the most common causes of neonatal respiratory distress. What is New: • nHFOV is associated with shorter duration of non-invasive respiratory support and duration of oxygen support. • nHFOV may be a safe and effective alternative to nCPAP for neonates with TTN. [ABSTRACT FROM AUTHOR]

Background: Acoustic respiration rate (RRa) monitoring is a method of continuously measuring respiratory rate using a signal from an acoustic transducer placed over the airway. The purpose of the present study is to examine how the averaging time and respiratory pause time settings of an RRa monitor affect the detection time of sudden respiratory rate changes. Methods: A total of 40 healthy adult volunteers were included in the study. First, we measured the apnea detection time (apnea test) by dividing them into two groups (N = 20 each), one with a respiratory pause time setting of 20 s and the other with 40 s. Each group performed two apnea tests with an averaging time setting of 10 and 30 s. Next, we measured the tachypnea detection time (tachypnea test) for half of the subjects (N = 20) with two averaging time settings of 10 and 30 s. For each test, three measurements were taken, and the average of the three measurements was recorded. Results: There was no significant difference in the apnea detection time between the averaging time set at 10 and 30 s regardless of whether the respiratory pause time was set at 20 or 40 s. However, the apnea detection time was significantly shorter with the respiratory pause time of 20 s than 40 s, regardless of whether the averaging time was set at 10 or 30 s (p < 0.001). The tachypnea detection time was shorter with the averaging time of 10 s than 30 s (p < 0.001). Furthermore, the apnea detection time and tachypnea detection time were much longer than the actual settings. Conclusions: The results of the current study show that in the measurement of RRa, the apnea detection time is more affected by the respiratory pause time setting than the averaging time setting; however, the tachypnea detection time is significantly affected by the averaging time setting. [ABSTRACT FROM AUTHOR]

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare disorder that causes airway obstruction in newborns and children. Patients with CNPAS mainly present with nasal obstruction, respiratory distress, feeding difficulties, and/or failure to thrive. Here, we present the case of a 1-day old male baby born with tachypnea, nasal obstruction, and congestion. Clinical examination revealed subcostal retraction and nasal obstruction. Nasal examination revealed an inability to pass the neonatal scope bilaterally and narrowing of the nostrils. Imaging revealed an isolated narrowed pyriform aperture of 4.5 mm. The patient was treated conservatively, and he showed significant improvement. [ABSTRACT FROM AUTHOR]

Purpose: Fluid management is challenging in malaria patients given the risks associated with intravascular fluid depletion and iatrogenic fluid overload leading to pulmonary oedema. Given the limitations of the physical examination in guiding fluid therapy, we evaluated point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) and lungs as a novel tool to assess volume status and detect early oedema in malaria patients. Methods: To assess the correlation between IVC and lung ultrasound (LUS) indices and clinical signs of hypovolaemia and pulmonary oedema, respectively, concurrent clinical and sonographic examinations were performed in an observational study of 48 malaria patients and 62 healthy participants across age groups in Gabon. Results: IVC collapsibility index (CI) ≥ 50% on enrolment reflecting intravascular fluid depletion was associated with an increased number of clinical signs of hypovolaemia in severe and uncomplicated malaria. With exception of dry mucous membranes, IVC-CI correlated with most clinical signs of hypovolaemia, most notably sunken eyes (r = 0.35, p = 0.0001) and prolonged capillary refill (r = 0.35, p = 0.001). IVC-to-aorta ratio ≤ 0.8 was not associated with any clinical signs of hypovolaemia on enrolment. Among malaria patients, a B-pattern on enrolment reflecting interstitial fluid was associated with dyspnoea (p = 0.0003), crepitations and SpO2 ≤ 94% (both p < 0.0001), but not tachypnoea (p = 0.069). Severe malaria patients had increased IVC-CI (p < 0.0001) and more B-patterns (p = 0.004) on enrolment relative to uncomplicated malaria and controls. Conclusion: In malaria patients, POCUS of the IVC and lungs may improve the assessment of volume status and detect early oedema, which could help to manage fluids in these patients. [ABSTRACT FROM AUTHOR]

Acoustic respiratory rate (RRa) monitoring is a non-invasive method of monitoring respiratory rate in spontaneously breathing individuals. The aim of this report is to highlight the clinical utility of this monitoring system in post-thyroidectomy patients by presenting a case of respiratory compromise due to post-thyroidectomy hematoma, in which the alarm of the respiratory rate monitor alerted the nursing staff about the complication. A 61-year-old woman who uneventfully underwent right thyroid lobectomy for adenomatous goiter under general anesthesia with endotracheal intubation was being monitored postoperatively using the RRa monitoring system. The alarm of the monitor suddenly indicated tachypnea, with an increase in respiratory rate from 8 to 30 breaths/min over less than 3 min, although with normal oxygenation (SaO2 99%). Physical examination revealed the presence of a hematoma due to postoperative bleeding, which was emergently treated surgically under general anesthesia with awake videolaryngoscopy-assisted endotracheal intubation, with adequate preparations for emergency tracheostomy, if required. Videolaryngoscopy before the intubation revealed mild laryngopharyngeal edema and tracheal displacement, although awake endotracheal intubation could be easily performed with a metallic tube. Thereafter, after anesthesia induction, the hematoma was drained, hemostasis was achieved, and the wound was closed after surgical drain insertion. The patient was extubated postoperatively without any further respiratory events. The information on respiratory rate disorders provided by RRa monitoring, including the tachypnea alarm, can contribute to early detection of postoperative respiratory complications and to avoiding life-threatening situations following certain operations, such as thyroidectomy. [ABSTRACT FROM AUTHOR]

Background: Transient tachypnea of the newborn (TTN) is a common cause of early neonatal respiratory distress. It is due to delayed clearance of fetal lung fluid. Aim: To evaluate the effect of inhaled salbutamol, a beta-2 adrenergic agonist (β2AA), in management of TTN and to detect any side effects as a result of using it Methods: A total of 100 infants with TTN were randomly divided into two groups to receive either inhaled salbutamol (treatment group) or an equal volume of normal saline solution (placebo group) at the time of diagnosis. At enrollment (by the 6th hour), complete blood count, blood glucose, serum potassium (K+), arterial blood gasses, respiratory rate, heart rate, blood oxygen saturation (O2 Sat), fraction of inspired oxygen (FiO2), and TTN clinical score were determined for all patients. At 0.5, 1, and 4 h after drug administration, respiratory rate, heart rate, O2 Sat, FiO2, and the clinical TTN score were recorded. At 4 h after treatment, arterial blood gasses, serum K+, and blood glucose levels were measured again. The duration of total respiratory support and the duration of hospitalization were recorded as well. Results: No statistically significant differences existed between both groups in terms of gestational age, birth weight, gender, mode of delivery, Apgar score, or maternal risk factors. The duration of respiratory support and duration of hospitalization were significantly shorter in the treatment (salbutamol) group (P < 0.0005, P < 0.0002, respectively). In the treatment (salbutamol) group; the respiratory rate, FiO2 and TTN score were significantly lower after treatment (P < 0.0001, P < 0.0000, P < 0.0000, respectively). Also the PaO2 significantly increased (P < 0.0000) with significant improvement in PH (P < 0.0001) and significant reduction in PaCO2 (P < 0.03). However, there were no statistically significant differences in heart rates, serum K+, or glucose levels after treatment. Conclusion: Inhaled salbutamol, a β2AA, was effective in reducing the duration of respiratory support and hospitalization in TTN, with no detected side effects. [ABSTRACT FROM AUTHOR]

Extracorporeal shockwave lithotripsy (SWL) is often marketed as a non-invasive and absolutely safe out-patient treatment, and hence many non-trained medical professionals in India have acquired this technology. Presented here is a patient who developed a life-threatening renal and peri-renal hematoma after receiving 4500 shockwaves for a renal calculus. The treating physician, a non-allopathic doctor, carried out SWL despite the patient's uncontrolled hypertension and anticoagulant drugs. The large expanding hematoma needed emergency nephrectomy. The patient died in the next 48 h due to persistent bleeding and disseminated intravascular coagulation. This case brings to light that proper training is needed even for such seemingly "risk-free" treatments. Also, legislations and regulations are needed to monitor sales of such vital equipment to non-qualified professionals. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the agreement between integrated management of childhood illness (IMCI) and final diagnosis in patients presenting with cough at the second and third level health institutions.Methods: This cross-sectional study included 373 children aged 2-60 mo who presented with cough at the pediatric emergency and outpatient clinics in the Department of Pediatrics. After clinical examination of children, body temperature, respiratory rate, saturation, presence or absence of the chest indrawing, rales, wheezing and laryngeal stridor were recorded. Cases were categorized according to IMCI algorithm regarding the severity using the color code, such as red (urgent treatment), yellow (treatment in the hospital), or green (treatment at home). Final diagnosis after physical examination, laboratory analysis and chest X-ray was compared with the IMCI algorithm.Results: Study agreement between IMCI classification and final diagnosis was 74.3% with kappa value 0.55 (moderate agreement). Similar agreement values were detected in both the second and third level health institutions. Health condition and gender did not affect agreement value. Agreement were found to be high in patients <24 mo of age (ĸ = 0.67), presence of fever and cough (ĸ = 0.54), tachypnea (ĸ = 0.93), chest indrawing (ĸ = 1.00) and oxygen saturation of <94%(ĸ = 0.90).Conclusions: Adding saturation level to the IMCI algorithmic diagnosis may increase agreement between IMCI classification and final diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To determine whether antenatal corticosteroids administration prior to an elective cesarean section (ECS) at 34-37 weeks gestation is associated with improved neonatal outcome.Materials and Methods: A case control study of women with singleton pregnancies who underwent ECS between 34 and 37 weeks of gestation including two groups: (1) study group in which patients were treated with betamethasone prior to ECS (n = 58) and (2) control group matched for gestational age at delivery in which patients did not receive betamethasone (n = 107). Neonatal measures including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), oxygen requirement, admission to the special care unit, hypoglycemia, hyperbilirubinemia and length of hospitalization were determined in both groups. Composite respiratory morbidity was defined as the presence of either RDS, TTN, mechanical ventilation or oxygen requirement.Results: There was no significant difference in the rate of composite respiratory morbidity nor its components between patients with and without betamethasone treatment (25.9 vs. 25.2%, respectively, p = 0.9).Conclusion: Antenatal treatment with corticosteroids prior to ECS at 34-37 weeks of gestation did not result in significant reduction in neonatal respiratory morbidity in our cohort of patients. [ABSTRACT FROM AUTHOR]

Objectives: To compare the performance of respiratory rate and other clinical signs against pulse oximetry for predicting hypoxia in children with Severe pneumonia/Very severe disease as per Integrated Management of Neonatal and Childhood Illness (IMNCI) classification. Design: Cross-sectional study. Setting: Pediatric emergency department of a tertiary-care hospital in Delhi, India. Subjects: 112 hospitalized children (2 mo - 5 y) with Severe pneumonia/Very severe disease as per IMNCI classification. Methods: Respiratory rate was recorded at enrolment, along with other clinical signs and symptoms. Oxygen saturation (SpO) was measured by a pulse oximeter. Clinical predictors of hypoxia (SpO <90%) and their combinations (index test) were evaluated for their sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of hypoxia, against pulse oximetry (reference test). Results: Hypoxia was present in 57 (50.9%) children. Presence of tachypnea, head nodding, irritability, inability to drink/ breastfeed, vomiting, and altered sensorium was significantly associated with hypoxia ( P<0.05). Multiple logistic regression revealed that age-specific tachypnea (RR≥70/min for 2-12 mo, and RR ≥60/min for ≥12 mo), head nodding, and inability to drink/breastfeed were independent predictors for hypoxia with sensitivity of 70.2%, 50.9% and 75.4%, respectively; and specificity of 88.9%, 96.4%, and 90.9%, respectively. When all three predictors were used in conjunction, the sensitivity increased to 91.2% and specificity was 81.8%. Conclusions: No single clinical sign can perform as well as pulse oximetry for predicting hypoxia in children with severe pneumonia. In settings where pulse oximetry is not available, combination of signs, age-specific tachypnea, head nodding, and inability to drink/breastfeeding has acceptable sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic test performance of Point of care ultrasonography (PoC-USG) for identifying the etiology of respiratory distress (RD) in neonates when combination of radiological and clinical criteria is considered as the gold standard.Methods: A neonate was included in the study if he/she had RD and underwent x-ray chest and ultrasound within 4 h of admission and the age was less than 24 h. The neonates admitted with non-respiratory illness were chosen as controls. A trained neonatologist took trans-thoracic and trans-abdominal views and a radiologist, as per the defined criteria, did the interpretation.Results: During the study period, 63 neonates with RD and 31 control neonates were enrolled. Overall from the clinical-radiological findings, the final diagnosis was respiratory distress syndrome (RDS), transient tachypnea of newborn (TTNB) and pneumonia in 29, 33 and one infants respectively. The ultrasound diagnosis of respiratory distress was RDS in 30 infants and TTNB in 33 infants. Pneumonia was not a diagnosis in any of the infants on PoC-USG. The sensitivity and specificity of USG in the diagnosis of respiratory distress were 98.4% and 100% respectively. One infant with diagnosis of pneumonia on chest x-ray was interpreted as RDS on USG.Conclusions: PoC-USG can be used to diagnose different etiologies of RD in neonates. [ABSTRACT FROM AUTHOR]

During exercise, tidal volume initially contributes to ventilatory responses more than respiratory frequency, and respiratory frequency then increases rapidly while tidal volume stabilizes. Dyspnea intensity is also known to increase in a threshold-like manner. We tested the possibility that the threshold of tachypneic breathing is equal to that of dyspnea perception during cycle ergometer exercise ( n = 27). Dyspnea intensity was scored by a visual analog scale. Thresholds were expressed as values of pulmonary O uptake at each breakpoint. Dyspnea intensity and respiratory frequency started increasing rapidly once the intensity of stimuli exceeded a threshold level. The thresholds for dyspnea intensity and for occurrence of tachypnea were significantly correlated. An intraclass correlation coefficient of 0.71 and narrow limits of agreement on the Bland-Altman plot indicated a good agreement between these thresholds. These results suggest that the start of tachypneic breathing coincides with the threshold for dyspnea intensity during cycle ergometer exercise. [ABSTRACT FROM AUTHOR]

We report the case of a 50-year-old obese man (115 kg body mass at 1.77 m height), who started taking 2,4-dinitrophenol (DNP) for weight reduction 44 days before his death. After 43 days of taking DNP, the man showed signs of intoxication with nausea, vomiting, and attacks of sweating. After admission to a hospital where the man concealed his DNP intake, sinus tachycardia, tachypnea, and general unrest were noted. The patient died 9 h after the onset of those symptoms. Upon autopsy, a yellowing of palms and soles was striking. The initially uncertain cause of death could only be clarified by the forensic toxicological examinations and subsequent police investigations. Finally, the man had a total intake of 12.3 g of DNP in 44 days which is relatively high compared to other lethal DNP intoxications. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of oral antibiotics in underfive children with pneumonia and chest indrawing. Methods: We included controlled clinical trials (randomized or quasi randomized) that compared the efficacy of oral antibiotics versus parenteral antibiotics for treatment of community- acquired pneumonia with chest-indrawing (severe pneumonia as defined by the World Health Organization's guidelines) in children below 60 months of age. Data were extracted and managed using RevMan software. Main outcome variables were: treatment failure rate, relapse rate, death rate, need for hospitalization, and severe adverse effects. Results: We identified four randomized controlled trials involving 4400 children who were diagnosed to have severe pneumonia but were feeding well and not hypoxic. Baseline characteristics of children in the two treatment arms (oral and parenteral antibiotics) were similar. In two studies, oral antibiotics were administered on an ambulatory basis, while in two, oral antibiotics were used in hospitalized children. Failure rate in children receiving oral antibiotics was 13% (288/2208) while that in children receiving parenteral antibiotics was 13.8% (302/2183) (OR 0.93; 95% CI 0.78, 1.11). Failure rates were not affected by the type of oral antibiotic, or presence of wheeze. Relapse rates, hospitalization or serious adverse events were similar in the two groups. Conclusion: Children with tachypnea with chest-indrawing without signs/symptoms of very severe pneumonia may be treated with oral antibiotics. [ABSTRACT FROM AUTHOR]

The article presents a case study of a healthy 3-year-old girl who was exposed to chlorine gas while sitting near swimming pool. Paramedics contacted Poison Control Center (PCC) on their way to hospital with patient. X-ray and tests revealed cough, tachypnea, wheezes and acute bronchitis and further tests revealed pulmonary edema but nebulizer with sodium bicarbonate and albuterol was given alongside corticosteroids that made the patient normal.

Interstitial lung disease (ILD) is defined as a rare, heterogeneous group of parenchymal lung conditions that develop primarily because of underlying developmental or genetic disorders. Affected infants typically present with clinical syndromes characterized by dyspnea, tachypnea, crackles and hypoxemia. Until recently, the understanding of ILD in infants has been limited largely owing to a lack of evidence-based information of underlying pathogenesis, natural history, imaging findings and histopathological features. However, ILD in infants is now better understood and managed because of (1) advances in imaging methods that result in rapid and accurate detection, (2) improved thoracoscopic techniques for lung biopsy, (3) a consensus regarding the pathological criteria for these particular lung conditions and (4) a new classification system based on the underlying etiology of ILD. This article reviews the new classification system, imaging technique, clinical presentation and imaging findings of ILD in infants. Specialized knowledge of this new classification system in conjunction with recognition of characteristic imaging findings of ILD in infants has great potential for early and accurate diagnosis, which in turn can lead to optimal patient management. [ABSTRACT FROM AUTHOR]

The authors reflect on the acute respiratory distress syndrome (ARDS). They mention its recognition since World War II which occur in patients suffering from refractory anoxemia, respiratory distress with tachypnea and bilateral pulmonary infiltrates. An overview of advancement in its treatment and the systemic inflammatory response known as biotrauma is also presented.

For human exercise at intensities greater than ~70 to 85% of maximal levels of exertion, ventilation ( V E) increases proportionately to core temperature ( T C) following distinct T C thresholds. This suggested T C in humans could be a modulator of exercise-induced ventilation. This study tested the reproducibility of relationships between oesophageal temperature ( T oes), ventilation and its components during incremental exercise. On two nonconsecutive days, at an ambient temperature of 22.1±0.3°C and RH of 45±5%, seven untrained adult males of normal physique pedaled on a seated cycle ergometer in an incremental exercise protocol from rest to the point of exhaustion. In each exercise session, ventilatory equivalents for oxygen consumption $$(V_{\text{E}} \cdot {V_{\text{O}_{\text{2}}}} ^{ - 1}) $$ and carbon dioxide production $$(V_{\text{E}} \cdot {V_{\text{CO}_{\text{2}}}} ^{ - 1}) $$ plus the components of V E, tidal volume ( V T) and frequency of respiration (ƒ), were expressed as a function of T oes. Results indicated the reproducibility criteria of Bland and Altman were met for the relationships between T oes and both $$V_{\text{E}} \cdot {V_{\text{O}_{\text{2}}}} ^{ - 1} $$ and $$V_{\text{E}} \cdot {V_{\text{CO}_{\text{2}}}} ^{ - 1} $$ as well as for relationships between T oes and each of V T and f. Intraclass correlation coefficients ( R) for between-trial T oes thresholds for $$V_{\text{E}} \cdot {V_{\text{O}_{\text{2}}}} ^{ - 1} $$ ( R=0.91, P<0.05) and $$V_{\text{E}} \cdot {V_{\text{CO}_{\text{2}}}} ^{ - 1} $$ ( R=0.88, P<0.05) were also high and significant. In both trials, after T oes increased by ~0.3°C, V T demonstrated a distinct plateau point at a reproducible T oes ( R=0.93, P<0.05) and ƒ demonstrated a distinct and reproducible T oes threshold ( R=0.84, P<0.05). In conclusion, the results illustrate that for humans, ventilation has a significant and reproducible relationship with core temperature during incremental exercise. [ABSTRACT FROM AUTHOR]

Respiratory distress due to either medical or surgical causes occurs commonly in neonates. It is the most common cause of admission to a neonatal surgical intensive care facility in a tertiary care hospital. The distress can be caused by a variety of clinical conditions; common conditions treated in medical intensive care units are transient tachypnea of the new born, respiratory distress syndrome, pulmonary air leak and pneumothorax. In surgical causes of respiratory distress in neonates the underlying mechanisms include airway obstruction, pulmonary collapse or displacement and parenchymal disease or insufficiency; the common causes are congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, congenital lobar emphysema and esophageal atresia with or without tracheo-esophageal fistula. Obstructive lesions of the new born airway include choanal atresia, macroglossis, Pierre-Robin syndrome, lymphangioma, teratoma or other mediastinal masses, cysts, subglottic stenosis and laryngo tracheomalacia. Imaging plays a very major role in the pre-operative diagnosis of these conditions and proper pre-operative resuscitation helps in improving the results of surgery dramatically. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate whether the changes in breathing pattern that frequently occur towards the end of exhaustive exercise (i.e., increased breathing frequency, fb, with or without decreased tidal volume) may be caused by the respiratory work itself rather than by leg muscle work. Eight healthy, trained subjects performed the following three sessions in random order: (A) two sequential cycling endurance tests at 78% peak O2 consumption (VO2peak) to exhaustion (A1, A2); (B) isolated, isocapnic hyperpnea (B1) at a minute ventilation (VE) and an exercise duration similar to that attained during a preliminary cycling endurance test at 78% VO2peak, followed by a cycling endurance test at 78% VO2peak (B2); (C) isolated, isocapnic hyperpnea (C1) at a VE at least 20% higher than that of the preliminary cycling test and the same exercise duration as the preliminary cycling test, followed by a cycling endurance test at 78% VO2peak (C2). Neither of the two isocapnic hyperventilation tasks (B1 or C1) affected either the breathing pattern or the endurance times of the subsequent cycling tests. Only cycling test A2 was significantly shorter [mean (SD) 26.5 (8.3) min] than tests A1 [41.0 (9.0) min], B2 [41.9 (6.0) min], and C2 [42.0 (7.5) min]. In addition, compared to test A1, only the breathing pattern of test A2 was significantly different [i.e., VE: +10.5 (7.6) l min-1, and fb: +12.1 (8.5) breaths min-1], in contrast to the breathing patterns of cycling tests B2 [VE: -2.5 (6.2) l min-1, fb: +0.2 (3.6) breaths min-1] and C2 [VE: -3.0 (7.0) l min-1, fb: +0.6 (6.1) breaths min-1]. In summary, these results suggest that the changes in breathing pattern that occur towards the end of an exhaustive exercise test are a result of changes in the leg muscles rather than in the respiratory muscles themselves. [ABSTRACT FROM AUTHOR]

The first patient with strangulated hiatus hernia due to pyloric stenosis is reported. A 70-year-old male patient presented as an emergency with severe left-sided chest pain, tachycardia, tachypnea, dysphagia, and nausea but no vomiting. The diagnosis of strangulated hiatus hernia due to pyloric stenosis was suspected, because a CT scan done 24 h following a barium meal showed much retained barium in both infra- and supradiaphragmatic parts of the stomach. Recognition of this condition is important since absence of pneumoperitoneum should not delay the diagnosis. In this complication, the perforation is likely to be at the hiatus, not the fundus as occurs in other causes of strangulation. A gastric drainage procedure should be an essential part of treatment. [ABSTRACT FROM AUTHOR]

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We present a 7.8-month-old girl with recurrent pneumonia, growth retardation, and tachypnea. Computed tomography revealed a particularly unusual esophageal lung, in association with pulmonary vascular anomalies of right pulmonary veins atresia and right pulmonary artery hypoplasia. [ABSTRACT FROM AUTHOR]

Transcutaneous electrical sensory stimulation (TESS) devices are approved for use in Japan, but their safety when used through the neck skin for dysphagia rehabilitation has not been reported. This study aimed to verify the safety of TESS use through the neck skin. Twenty patients (mean age 86.5 ± 5.1 years) with aspiration pneumonia undergoing dysphagia rehabilitation were included in this retrospective observational and matched control study. We compared vital signs in 10 subjects who underwent swallowing rehabilitation with the TESS device, and matched control patients over 7 days. The results were the following: tachycardia, 0.60 ± 1.07 vs. 0.70 ± 0.67 days; high blood pressure, 0.40 ± 0.70 vs. 0.50 ± 1.08 days; low blood pressure, 0.40 ± 0.70 vs. 0.10 ± 0.32 days; low oxygen saturation, 0.60 ± 1.58 vs. 0.50 ± 1.08 days, p = 0.870; oxygen administration, 0.80 ± 2.20 vs. 1.20 ± 2.15 days; tachypnea, 0.50 ± 0.71 vs. 0.50 ± 0.53 days; elevated body temperature, 2.00 ± 1.41 vs. 1.60 ± 1.96 days. There were no significant differences in clinical stability between the TESS and control groups of patients with aspiration pneumonia. TESS through the neck appears safe as an intervention in dysphagia rehabilitation. [ABSTRACT FROM AUTHOR]