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Ten patients were diagnosed with coronary artery fistula (CAF) between 1991 and 1998 in our department. The ages of patients ranged from 3 days to 12 years. Five patients were male and five patients were female. Nine patients had single CAF and 1 patient had dual CAFs. CAFs of 7 patients originated from the left coronary artery, and CAFs of 3 patients originated from the right coronary artery. CAFs of 7 patients terminated at the right ventricle, CAFs of 2 patients terminated at the right atrium, and the CAF of 1 patient terminated at the pulmonary artery. Four patients were diagnosed with CAF in the neonate period. All presented with congestive heart failure. Medical therapy was successful in treating congestive heart failure in 2 of these patients, but the other 2 needed operations. One patient presented with subacute bacterial endocarditis at 12 years of age requiring surgical intervention. One patient had a large left-to-right shunt that was surgically repaired. One patient with dual CAFs underwent coil embolization and the larger CAF achieved complete embolization, but the smaller CAF failed. Follow-up data revealed that 1 patient who received an operation died of sepsis due to recurrent bronchiolitis 6 months later. Nine patients were asymptomatic. Because complications including endocarditis may be encountered in later life, we suggest early closure with coil embolization.

Background Kawasaki disease is a vasculitis most commonly afflicting children

Pulmonary hemorrhage (PH) is an uncommon clinical manifestation of patients with systemic lupus erythematosus (SLE). In this report, we describe a 14-year-old male with PH as the sole clinical manifestation of his SLE. Kidney biopsy was performed and the report revealed lupus nephritis class IVb. He demonstrated a rapid clinical response to the therapy of intravenous pulse methylprednisolone. Awareness of the possibility of PH as a sole clinical presentation of SLE may aid in the diagnosis and early aggressive management of this condition.

Background: Hand-foot-mouth disease (HFMD) outbreaks in oung children in recent years. A significant increase in the numer of HFMD cases in China over the last 4y has made the public revention and therapy of this disease a critical issue. Enterovirus 1 (EV71) was the major causative agent of the HFMD outbreak nTianjin.Our objective is to analyze the clinical characteristics of cute flaccid paralysis (AFP) caused by EV71 HFMD. Methods: 10 cases HFMD (6 male, 4 female) complicated with FP were enrolled. The clinical manifestations were observed eanwhile the etiological results, spinal cordMRI findings, clinical lectroneurophysiology findings cerebrospinal fluid were colected. The recoveries of their impairment in limb extremitieswere ollowed up for 2 or 3 months. Results:AFP associatedwith enterovirus 71 infected HFMDwas articularly prevalent in children less than 2 years old, all of whom ad skin rash and fever. 70% of the cases had acute paralysis with ingle limb. Muscle power was initially improved in a week. All ases got obvious recovery in hospital and mild paralysis could ecover in 1 or 3 months. Findings of MRI and electroneurophysilogy were in highly accordance with clinical symptoms, both can rovide the basis of focal neurological signs. Being followedup for 2 r 3months, all children′smyodynamia of paralysis limbs gradually ecovered, 7 cases (70%) return to V grade. Conclusion: CNS involvement is the serious complication aused by EV71 infection and EV71 may be the great virus of nonolio enterovirus (NPEV). MRI and electroneurophysiology have mportant value to evaluate patients′ condition and prognosis. In cute stage, mortality and disability rate can be reduced effectively y all-around and actively intreatment. It is effective in clinical bservation by combined treatmentwith intravenous immue globlin (IVIG) and glucocorticoid.

Thirty-seven children (11 girls, 26 boys; aged 2.8 +/- 2.2 years) with Kawasaki disease (KD) were included in the study. The biventricular functions were evaluated by equilibrium multigated blood pooling ventriculography (EMBPV) and the severity of carditis was decided by Tc-hexamethylpropyleneamine oxime (HMPAO) labelled white blood cell (WBC) heart scans (Tc-WBC). The results showed that 43% (16/37) of the KD cases with the severe carditis by Tc-WBC had the worst left ventricular ejection fraction (LVEF) (55.4 +/- 15.6%) and right ventricular ejection fraction (RVEF) (43.7 +/- 12.2%) by EMBPV; 24% (9/37) of the cases with the mild carditis had the best LVEF (63.5% +/- 8.2%) and RVEF (53.7% +/- 11.2%); the remaining 32% (12/37) had moderately severe carditis and biventricular function (LVEF: 58.2 +/- 17.2% and RVEF: 46.9 +/- 19.5%). Because Tc-WBC cannot only detect the severity of carditis but also predict impairment of ventricular function accurately, the choice of Tc-WBC should be preferable for KD-a common inflammatory cardiovascular disease in children.

Myocardial imaging with 99Tcm-hexamethylpropylene amineoxime (HMPAO)-labelled white blood cells (Tc-WBC) was used to detect carditis and differentiate rheumatic fever (RF) and inactive rheumatic heart disease (IRHD). Ten cases of RF and 15 cases of IRHD were studied, and the results revealed 60% (6/10) of the cases of RF with carditis, but none of the cases (0/15) of IRHD with carditis. There was significant difference (P less than 0.05, by Fisher's test) between RF and IRHD. In our preliminary conclusion, Tc-WBC heart scanning may be a noninvasive method for evaluating the existence of carditis in cases of RHD and in the differentiation of RF and IRHD.

Experiments were conducted in 12 pentobarbital-anesthetized dogs with sinus denervation and vagotomy. The chest was opened, and the heart was replaced by a roller pump with two perfusion lines. The systemic and pulmonary circulations (SC and PC) were perfused with a constant and adjustable flow (Q). Venous outflows were directly driven by pumps without passing through a reservoir. In each closed circuit, the total blood volume remained constant because inflow and outflow were simultaneously and equally altered. In both SC and PC, arterial pressure (Pa), i.e., systemic arterial and pulmonary arterial pressures (SAP and PAP), was a positive function of Q, and venous pressure (Pv), i.e., right atrial and left atrial pressures (RAP and LAP), was a negative function of Q. The first series of experiments involved three equal step reductions in Q from baseline to zero flow. The venous-to-arterial compliance ratio (Cv/Ca) was calculated from delta Pa/delta Pv and vascular resistance (VR) from (Pa - Pv)/Q. The values of Cv/Ca in SC increased from 9.3 +/- 0.4 to 14.5 +/- 1.1 and 21.9 +/- 1.4 (P less than 0.001) in the three-step Q reduction. VR in the SC was not significantly dependent on Q. In the PC, the Cv/Ca was approximately 2.0 and VR was 0.16 mmHg.ml-1.min.kg, both values being independent of Q. Multiple-step reduction in Q for regression equations was carried out in 8 of the 12 dogs. We found that only the SAP was a linear function of Q (ml.min-1.kg-1): SAP = 18.458 + 0.953Q.(ABSTRACT TRUNCATED AT 250 WORDS)

Observations made by the ASPERA-3 experiment onboard the Mars Express spacecraft found within the martian magnetosphere beams of planetary ions. In the energy ( E / q )–time spectrograms these beams are often displayed as dispersive-like, ascending or descending (whether the spacecraft moves away or approach the planet) structures. A linear dependence between energy gained by the beam ions and the altitude from the planet suggests their acceleration in the electric field. The values of the electric field evaluated from ion energization occur close to the typical values of the interplanetary motional electric field. This suggests an effective penetration of the solar wind electric field deep into the martian magnetosphere or generation of large fields within the magnetosphere. Two different classes of events are found. At the nominal solar wind conditions, a ‘penetration’ occurs near the terminator. At the extreme solar wind conditions, the boundary of the induced magnetosphere moves to a more dense upper atmosphere that leads to a strong scavenging of planetary ions from the dayside regions.

Objectives: A major outbreak of enterovirus 71 (EV71) in Taiwan in 1998 caused many severe cases and 78 deaths. Our purpose was to find reliable markers and early indicators of fatal EV71 central nervous system (CNS) infection. Methods: From June 2000 to November 2001, 21 patients with hand foot mouth disease or herpangina with CNS infection were admitted to Kaohsiung Veterans General Hospital. All 21 had culture-confirmed EV71 infection or were EV71 IgM positive. Patients were divided into two groups: group I included the five fatalities at our institution and group II, the 16 surviving patients. Results: Of the 21 infants and children with EV71 infection with CNS involvement, MR imaging studies were completed on 17, and 15 showed hyperintensity in the posterior portions of brain stem. All patients received intravenous immunoglobulin (IVIG) 1 g/day for two days and supportive care. Five patients rapidly deteriorated owing to irreversible hypotension and died. The other 16 patients recovered completely without sequel. In group I patients, the decrease of cardiac ejection function is significant and laboratory findings showed lower platelet count ( P =0.0192). The mean of initial cTnI level for groups I and II was 10.6±11.6 and 0.48±0.55 ng/dl, respectively, higher in group I than in II ( P =0.0019). Conclusion: We hypothesized that like patients with severe burns, those with severe EV-71 CNS meningoencephalitis have varying degrees of non-ischemic cardiac injury, manifesting as leakage of cTnI from myocytes into the circulation. EV-71 CNS meningoencephalitis likely to die with an early myocardial involvement evidenced by reduced ejection fraction and release of cTnI. We conclude that fatal EV71 CNS infection quickly leads to death due to severe encephalopathy associated with cardiomyopathy.

Inhaled steroids play a very important role in the prevention and treatment of asthma. Previous studies indicated that fluticasone propionate (FP) had low bioavailability and high local potency. However, the laboratory data in these studies were not obtained among Taiwan population. It is very important that native data should be established. Thus a 12-week research program was designed, involving 77 patients, 51 for FP group and 26 for beclomethasone dipropionate (BD) group. The objects were victims of moderate to severe asthma and their age ranged from 4 to 14 years old. An open, comparative and randomized method was adopted. Except for the 4-week-later daytime symptom score(P = 0.033, BD group was better), no other significant differences were found between the two groups in the symptom score improvement(P0.05). All the P-values for the daytimenight-time scores were lower than 0.001, which means obvious improvement after treatment in both groups. P-value for PEF improvement was 0.003 after 4 weeks (BD group was better) and 0.943 after 8 weeks; for FEV1 improvement, it was 0.005 after 4 weeks(BD group was better) and 0.252 after 8 weeks; and for FEV1/FVC improvements, it was 0.067 after 4 weeks and 0.097 after 8 weeks. There was no statistic significance in total eosinophil count (TEC), IgE, eosinophil cationic protein (ECP) serum level changes after 4 or 8 weeks. Adverse effects were all anticipated and no statistic significance showed up, either, between the two groups or in the cortisol levels (P0.05). In conclusion, native data indicated that the potency of 100 micrograms of FP was equal to that of 200 micrograms of BD and that few side effects were noted in FP group. It is recommended that this drug be introduced for clinical use.

Coagulase negative staphylococci are the commonest blood culture isolate from infants on neonatal intensive care units. The differentiation of contaminants from isolates representing true infection remains a significant clinical problem. Data from two neonatal intensive care units were collected prospectively in order to find those parameters, which best correlated with actual sepsis. Each case was assessed using clinical parameters to categorise infants into infection and contaminant groups. Logistic regression was then performed to find significant correlates. Three correlates were found, namely the presence of a long line (P = 0.001), abnormal white cell count (P = 0.037) and abnormal white cell morphology (P = 0.027). Abnormal white cell morphology was assessed by two experienced hematologists. More than half the isolates were probable contaminants and true infection may occur in the absence of a long line in this patient group.

Although mastoiditis can be a life threatening disease, clinicians often overlook it because it is uncommon. We reviewed the presentation and management of all children younger than 15 years of age with the discharge diagnosis of mastoiditis in our hospital from January 1994 through December 1999. Nineteen patients that fulfilled the case definition were included. The most common clinical presentation in this series was fever. More specific findings, such as otorrhea, postauricular pain, swelling, and redness of mastoid could be found in less than half of these patients. Only two patients had characteristic physical findings, and mastoiditis was diagnosed in only three patients upon admission. Plain radiographic evidence of mastoiditis was usually not apparent early in the course. In this series, the majority of patients were diagnosed by computed tomography (CT) scans. The present study demonstrates that mastoiditis most commonly presents without a clearly diagnostic set of physical examination and laboratory findings. Mastoiditis should be considered in patients with otitis media or with fever of unknown origin (FUO). The empirical antibiotic treatment should cover organisms commonly found in acute otitis media (AOM), including Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.

The wide spectrum of distal renal tubular acidosis (RTA) has been reported. Children with distal RTA can present with failure to thrive, gastrointestinal symptoms, nephrocalcinosis, and renal failure, etc. So far, secondary erythrocytosis in pediatric patients with distal RTA has not been reported. Here we report a case of distal RTA with failure to thrive and nephrocalcinosis accompanied by secondary erythrocytosis in a 3-year-old boy. He has been followed up for 2 years and is under treatment with NaHCO3 and potassium citrate. The treatment contributes to the improvement of metabolic acidosis and his growth. There is normal renal function and constant erythrocytosis during the follow-up period. Further studies are needed to clarify the relationship between erythrocytosis and distal RTA.

A 14-year-old boy gradually developed several subcutaneous masses over bilateral peri-auricular regions, neck, and both upper arms near the elbows over the past 2 years. The recent development of eyelid puffiness elicited his seeking medical attention. Hypereosinophilic syndrome was first considered due to the markedly elevated blood eosinophil count without other evidence of allergy or parasite infestation, but the absence of organ involvement made this diagnosis questionable. The histopathological investigation of the subcutaneous mass in the upper arm showed lymph node-like tissue with markedly reactive follicular hyperplasia and eosinophilic abscesses associated with granulomatous inflammation, thus leading to the final diagnosis of Kimura's disease. Oral prednisolone was prescribed successfully. This illness occurs mainly in young oriental males. We report this case to introduce it to pediatric clinicians as an important differential diagnostic entity in eosinophilia-associated diseases and reactive lymphadenopathy.

Pulse oximetry is noninvasive and widely used in the intensive care unit and during surgery. Complications associated with the use of pulse oximetry have been reported, including burns, pressure erosion, skin necrosis and digital sensory loss. The causes of these complications may be due to the incompatibilities between the probes and the monitors used from different companies, pressure duration for too long on a single skin site or overheating induced by a short circuit of the probe cable. We report a 940-g premature infant who had severe pulse oximetry-associated injury to the oximetry site. This may have been due to the infant's susceptibility to injury resulting from his critical condition, including low cardiac output, poor peripheral circulation and poor heat dissemination. Our experience shows that, when pulse oximetry is used, especially in critically ill, premature infants, frequent checking of the sensor and the site where the sensor is applied is required to avoid burn injury or pressure erosion of the skin.

Hemolysis occurred in a 2-year-old girl following partial coil occlusion of a moderate persistent ductus arteriosus. Spontaneous resolution of hemolysis occurred 2 months later, even though a small residual shunt persisted.

Multicystic dysplastic kidney (MCDK) is a common cause of abdominal mass in neonates. It is frequently associated with malformation of the contralateral kidney, such as ureteropelvic obstruction, etc. Because MCDK is usually functionless, it is important to evaluate the condition of the contralateral kidney. The presence of severe obstruction in the contralateral ureteropelvic junction is life-threatening and prompt treatment should be made to preserve the remaining renal function. We report on a neonate with left MCDK and contralateral ureteropelvic obstruction, presenting as anuria after birth, and also we review the literature.

Intracardiac tumors are rare in neonates. Most of these lesions are rhabdomyomas and they occur almost exclusively during infancy. Rhabdomyomas are commonly associated with tuberous sclerosis and often involve the brain, kidneys and pancreas; they are frequently multiple and originate most commonly from the ventricular septum. Surgical intervention is indicated for rhabdomyoma with either mechanical cardiac obstruction or dysrhythmias resulting in symptoms or sudden death. A newborn with diffuse rhabdomyomatosis over the right atrium, right ventricle and left ventricle of the heart complicated with congestive heart failure and intractable supraventricular tachycardia is reported herein. No tuberous sclerosis or other organ involvement was noted. The tumor was resected.

Cockayne syndrome (CS) is a rare autosomal recessive disorder characterized by growth retardation, senile-like appearance, loss of subcutaneous adipose tissue, photosensitive dermatitis, microcephaly, deafness, pigmentary degeneration of retina, disproportionately long limbs, skeletal malformations with knee contractures and neurologic abnormalities. This is a description of a three-year-old boy with typical features of Cockayne syndrome complicated with tetralogy of Fallot, pneumonia and hepato-splenomegaly. He had been suffering from frequent attacks of pneumonia and had been hospitalized for several times since birth. Tetralogy of Fallot was diagnosed under echocardiography study and he died suddenly in hospital during a mydriatic procedure in the Ophthalmologic Clinic.

Two-dimensional echocardiography had long been a standard diagnostic modality for congenital heart disease. Further attempts of three-dimensional reconstruction using two-dimensional echocardiographic images to visualize stereotypic structure of cardiac lesions have been successful only recently. So far only very few studies have been done to display three-dimensional anatomy of the heart through two-dimensional image acquisition because such complex procedures were involved.This study introduced a recently developed image acquisition and processing system for dynamic three-dimensional visualization of various congenital cardiac lesions. From December 1994 to April 1995, 35 cases were selected in the Echo Laboratory here from about 3000 Echo examinations completed. Each image was acquired on-line with specially designed high resolution image grazmber with EKG and respiratory gating technique. Off-line image processing using a window-architectured interactive software package includes construction of 2-D ehcocardiographic pixel to 3-D "voxel" with conversion of orthogonal to rotatory axial system, interpolation, extraction of region of interest, segmentation, shading and, finally, 3D rendering.Three-dimensional anatomy of various congenital cardiac defects was shown, including four cases with ventricular septal defects, two cases with atrial septal defects, and two cases with aortic stenosis. Dynamic reconstruction of a "beating heart" is recorded as vedio tape with video interface.The potential application of 3D display of the reconstruction from 2D echocardiographic images for the diagnosis of various congenital heart defects has been shown. The 3D display was able to improve the diagnostic ability of echocardiography, and clear-cut display of the various congenital cardiac defects and vavular stenosis could be demonstrated. Reinforcement of current techniques will expand future application of 3D display of conventional 2D images.

Cardiac myxoma especially of the right ventricle, is rare in children. A 12-year-old boy with right ventricle myxoma is reported. His heart murmur was found incidentally when he visited the Outpatient Department (OPD) because of upper respiratory infection symptoms. There was no exertional dyspnea, no palpitation, no syncope and no skin lesion. The echocardiogram revealed a heart tumor of about 4 x 3 cm in the right ventricle (RV) extending to the right atrium (RA). The tumor grew from the interventricular septum, resulting in an RV outlet and inlet obstruction. Magnetic resonance image (MRI) revealed a well-defined mass in the RV ventricle, with good enhancement after injecting a contrast medium. The patient received right atriotomy and total excision of the tumor with repairing of the interventricular septum base. Pathology revealed myxoma with gelatinous whitish color and central hemorrhage. At post-operative follow-up, the patient's condition was good.

More and more infants with total anomalous pulmonary venous return (TAPVR) has been detected in this hospital (Taichung Veterans General Hospital) in recent years as new diagnostic methods have developed. Several of these methods have been compared to assess their influence on accuracy of diagnosis and the perceived incidence of TAPVR:A retrospective study was made of 36 patients, hospitalized with TAPVR between January, 1983 and June, 1993. All 36 had received 2D echo with color Doppler. Fifteen patients were diagnosed by cardiac catheterization. For the 21 patients who did not receive cardiac catheterization, diagnosis was proved in 16 by operation; in 3, by autopsy; another 2, by 2D echo with color Doppler and magnetic resonance imaging (MRI).Twenty-five patients were boys and 11, girls. Their ages ranged from 1 day to 6 years with a mean of 3.6 months. Twelve patients were supracardiac type (33%), 18 cardiac type (50%), 5 infracardiac type (14%); and only 1 was mixed (3%). Nine of the 11 girls (82%) were cardiac type, while only 9 (36%) of the 25 boys were cardiac type (P0.05). In 4 (80%) of 5 infracardiac-type patients the pulmonary venous returns were obstructed, while in only 8 (26%) of 31 non-infracardiac type patients was there evidence of obstruction (P = 0.06). The 11 patients who did not receive operations died. Operation mortality for isolated TAPVR was 0% (0/9) for the nonobstructed-nonrestrictive type patients, and was 50% (5/10) in the other two types (P0.05). Operation mortality in those younger than 30 days was 66.6% (2/3), and in those older than 30 days was 18.8% (3/16) (P = 0.15). Of 10 patients associated with complex heart diseases, 9 (90%) were common atrioventricular canal. Of the 18 patients diagnosed before July 1990, 15 patients received cardiac catheterization; of the 18 diagnosed after August 1990 (13 of whom were simple TAPVR), none had catheterizations. Eight patients received MRI which revealed good images of the pulmonary veins.Both echo with color Doppler and MRI are non-invasive tools which can make definite diagnoses of TAPVR: These new methods of diagnosis reveal that this disease is not so rare as was once thought. Cardiac catheterization adds little except risks and costs to diagnosis of simple TAPVR

Progress in early surgery and intensive care have enhanced survival for more individuals with serious cyanotic congenital heart disease (CHD). Parents are understandably concerned about patients' brain function. Therefore, a study was undertaken of brain magnetic resonance images (MRI) in infants and children with cyanotic CHD, stressing the correlation between clinical neurological examination and brain MRI findings.Sixteen infants and children with cyanotic CHD, 6 males and 10 females, were selected randomly from June 1991 to June 1993. Their ages ranged from 1 to 10 years, with a mean of 4.4 years. All patients underwent brain MRI and thorough clinical neurological examinations.Prominent and tortuous vessels over the Willis circle and basal ganglia were the most common brain MRI findings among patients with normal neurological examination (7/9), while ventriculomegaly (5/7) was the common findings for patients with abnormal neurological examination. Two patients who presented with low-grade fever and Babinski sign were found incidentally to have brain abscesses.It is not possible to make a conclusion from this preliminary report about the role which cyanotic CHD may play in the pathogenesis of brain insult, but the clinical neurological findings may provide guidance for the arrangement of brain MRI in infants and children with cyanotic CHD. Further larger scale, case-controlled study is needed to answer the controversial question whether cyanotic CHD per se causes brain insult.

Infective endocarditis occurs infrequently in the general pediatric population, but is often associated in patients with underlying heart disease. Even today it remains a serious threat leading to relevant mortality in all pediatric groups, in spite of better antibiotic treatment and prophylactic measures for endangered persons. This retrospective analysis reports experience here with infective endocarditis in children.The clinical and laboratory findings in 28 children with 30 episodes of infective endocarditis, from July 1984 to June 1993, were reviewed retrospectively.Twenty-one children (75 percent) had congenital heart disease, three (11 percent) had rheumatic heart disease and four (14 percent) had no underlying cardiac abnormality prior to presentation. Twenty-six (87 percent) of the 30 episodes had positive blood cultures. The most common organism isolated was streptococcus viridans (14 percent), followed by staphylococcus aureus (7 percent). Echocardiography identified vegetation in 21 of 28 (75 percent) patients. Twenty children were successfully treated medically. Four developed complications requiring surgery, of whom two died. A total of six children (21 percent) died of the disease or its complications. There were a high case fatality rate for children below the age of two years (75 percent), and children without an underlying cardiac abnormality (50 percent).It was concluded that patient survival is dependent on several factors which include early diagnosis, appropriate antimicrobial therapy and aggressive surgical intervention.

Conventional methods to assess cardiac contractility have been focused on the mechanical properties of the myocardium. Many of these have suffered from theoretical and practical drawbacks. In this study, we have attempted to evaluate the left ventricular contractile status using the thermodynamic principle and compared these indices with the conventional index (dP/dt). A total of 8 mongrel dogs were anesthetized and artificially ventilated. A Millar catheter with high-fidelity multiple sensors was inserted into the aorta to record the simultaneous changes in aortic flow and pressure waves. Cardiac inotropy was increased by graded doses (2-32 micrograms/kg/min) of dobutamine. Angiotensin injection (100-300 micrograms) to achieve a blood pressure elevation of 30 mmHg was employed for afterload augmentation. Preload was increased by rapid infusion of 6% dextran solution (20 ml/kg). Several thermodynamic parameters were calculated at steady state during the control period and after drug interventions. These included power-averaged rate of power density generation (ARPD), peak ejection rate of change of power (PREP), energy-averaged power density (APD) and frequency-normalized ARPD (FARPD). PREP and APD were unchanged by afterload increment while FARPD, ARPD and dP/dt decreased significantly with an increase in afterload, ARPD was highly sensitive to an increased preload (p0.001), and PREP was also changed significantly by an increase in preload. dP/dt was boarderlinely affected by Dextran infusion (p = 0.05), and APD was independent of preload (P0.05). Inotropic stimulation increased ARPD, PREP, APD, FARPD and dP/dt by 139.0 +/- 48.0%, 98.0 +/- 51.4%, 74.0 +/- 49.7%, 60.0 +/- 30.4% and 44.6 +/- 10.4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

During endotracheal intubation, checking the position of endotracheal tube is important in order to avoid accidental esophageal intubation. Exhaled CO2 pressures of 50 emergent intubation attempts were recorded in our pediatric intensive unit to evaluate the efficacy of capnography in the early detection of esophageal intubation. Adjustment of the tube position was performed when indicated. In successful endotracheal intubation, the end-tidal CO2 pressures (PetCO2) ranged from 10 mmHg to 80 mmHg with typical respiratory phasic waveforms. In cases of inadvertent esophageal intubation, the PetCO2 values were less than 5 mmHg and revealed no typical respiratory pattern. It was also observed that PetCO2 decreased during one lung intubation or when the tip of endotracheal tube was pulled above the glottis. Capnographic monitoring end-tidal CO2 pressure continuously may be a reliable, time-saving tool for the detection of inadvertent esophageal intubation and the evaluation of proper positioning of the endotracheal tube.

This report is on three double aortic arch cases. They were diagnosed in our department between 1982 and 1992. The first case was complicated by dilated cardiomyopathy whose diagnosis was delayed due to a lack of clinical experience. Corrective surgery relieved the airway obstruction and his breathing improved postoperatively. The patient finally died of heart failure due to concurrent progressive dilated cardiomyopathy one and half years later. The second and third cases were diagnosed on the day of admission by a barium esophagogram and echocardiogram. MRI (Magnetic resonance image) of the cardiovascular system on these two patients revealed no other associated abnormalities. No angiography was done on the third case. They underwent surgery with excellent results. In any infant younger than 3 months with dyspnea and dysphagia, double aortic arch should be suspected. The esophagogram can show extrinsic compression. An echocardiogram can reveal two aortic arches. Both procedures can be performed easily and safely at the bedside. We recommend that these to be considered as routine examinations in such patients.

Cellulitis of extremities due to Haemophilus influenzae is rare in children. Only 60 cases of Haemophilus influenzae cellulitis of the extremities have been reported. It usually affects young children between the ages of six and 24 months. The lesion often presents with a red-to-bluish-purple discoloration overlying the involved area. High fever and leukocytosis are commonly found. Culture of needle aspirate and blood with appropriate media is necessary for diagnosis. Early diagnosis is especially important because of associated bacteremia and the subsequent possibility of life-threatening complications such as meningitis. We reported a 8-month-old female infant with Haemophilus influenzae type b cellulitis over the right hand. She was admitted due to high fever and painful swelling of the right hand. Edematous right hand with dusky erythematous skin over the dorsum and swelling of the palm with limitation of range of motion were noted on admission. Smear of needle aspirate revealed gram negative bacilli and beta-lactamase(-) Haemophilus influenzae type b was cultivated in the blood culture. She was successfully treated with ampicillin and discharged with stable condition.

Sixty-eight infants with clinical evidence of a large ventricular septal defect (VSD), refractory to conventional medical treatment, underwent surgical closure within the first 12 months of life from August 1987 to June 1991. There were 43 males and 25 females. The ages of the patients ranged from two to 12 months, with a mean age of 6.6 months. The mean body weight of the patients was 5.4 kg (range, 2.3-10 kg). Surgery was performed because of intractable heart failure in 27 infants (39.7%), failure to thrive in 40 (58.8%), repeated pneumonia in 43 (63.2%) and prolonged endotracheal intubation in nine (13.2%). There were 21 patients with a supracristal VSD (30.9%) and 47 patients with perimembranous VSD (69.1%). Nine patients (13.2%) had preoperative cardiac catheterization. Transatrial repair of perimembranous VSDs and transpulmonary repair of supracristal VSDs was used exclusively without ventriculotomy. Surgically induced heart blocks did not occur in any of the patients. Only two patients (2.9%) died during the early postoperative period. Diagnosis in most cases was confirmed by the present advanced integrated color Doppler echocardiographic technology which is widely used by pediatric cardiologists. There was no need to perform cardiac catheterization in most patients with VSDs. The morbidity and mortality were very low. We strongly suggest that for infants with a large VSD, primary repair should be the procedure of choice.

A case of a 3-month-old male infant with severe LV dysfunction and a complete double aortic arch (both arches patient) is reported. The right dominant aortic arch runs retroesophageally to the right and joins with the left smaller arch to form the descending thoracic aorta on the right side while the ligamentum arteriosum was located in its normal position (the left side). Through a left thoracotomy, the smaller left arch and the ligamentum were divided to relieve the obstruction of the trachea from compression of the vascular ring. Postoperative convalescence was good. Further follow up of this patient after 9 months showed that there was neither any respiratory failure nor any heart failure sign present, though severe LV dysfunction persisted.

Myocardial imaging with 99Tcm-HMPAO-labelled white blood cells (WBC) and 67Ga citrate was used to detect myocarditis in the acute phase of Kawasaki disease among 22 infants and children; 18 cases of myocarditis were detected by 99Tcm-HMPAO-labelled WBC heart scans, but only one case was detected by 67Ga citrate heart scans. In conclusion, 99Tcm-HMPAO-labelled WBC scanning provides a more sensitive method than 67Ga citrate scanning in the detection of myocarditis in Kawasaki disease.

Central venous catheters are commonly used in neonatal and pediatric intensive care. Sonographic catheter localization is a technique without any known detrimental side effect. The positioning of silastic central venous catheters in two different diameters used in critical newborns and children was examined by sonography in this study. The sonographic findings were compared with the corresponding radiographic results. Even the very thin catheters could be easily detected due to their strong echoes. Results of forty catheter positions, including malpositions, demonstrate accuracy and practicability of this technique. Sonography may become an alternative examination to reduce the frequency of control radiography.

Aortic flow measurement with Doppler echocardiography has become a non-invasive technique in clinical practice. In the present animal study, we evaluated the flow-derived parameters such as peak velocity (PV) and its maximal acceleration (MA) as indices of ventricular contractility independent of the loading status. Eight pentobarbital-anesthetized cats were maintained with artificial ventilation. The chest was opened to place an electromagnetic flow probe around the ascending aorta for recording pulsatile aortic flow. PV and MA were measured from the flow tracing and on-line electronic differentiation. Intravenous infusions of dobutamine (DT), angiotensin II (AII) and dextran (DN) were used to alter the cardiac inotropism, afterload and preload, respectively. At a steady state (approximately 5 min after infusion), DT increased the PV from 56 +/- 9 to 78 +/- 14 cm/sec (p less than 0.05) and MA from 1302 +/- 108 to 1699 +/- 117 cm/sec2 (p less than 0.05). In response to AII infusion, PV was slightly reduced (60 +/- 7 to 55 +/- 6 cm/sec, p less than 0.05) while MA was also reduced mildly but significantly (1219 +/- 109 to 1099 +/- 109 cm/sec2, p less than 0.05). Dextran infusion produced a marked increase in PV (48 +/- 7 to 82 +/- 13 cm/sec, p less than 0.05) while the increase was slightly less for MA (1089 +/- 95 to 1604 +/- 109 cm/sec2). The results indicated that inotropic stimulation markedly increased both PV and MA. PV and MA responded slightly but significantly to afterload alterations. (8.3% vs 9.8%, respectively). Both PV and MA increased markedly to the preload increment.(ABSTRACT TRUNCATED AT 250 WORDS)

Both 2-D echocardiography and angiocardiography were performed preoperatively in 40 children with isolated ventricular septal defect (VSD). The diagnosis of VSD was confirmed and the size of VSD was measured during operation within on month of the study. There were 27 males and 13 females (age: 10mos-9 yrs). The VSD was classified into perimembranous type (24), supracristal type (14), and AV canal type (2) by surgery. The maximal VSD areas were calculated by 1/4 pi De2 (De = maximal defect diameter measured by 2D echo). The maximal shunt flow areas were measured by color Doppler echocardiography from frame by frame search of the video tape. The maximal shunt flow area was corrected by the body surface area to be the maximal shunt flow area index. A left ventriculogram (LVG) was performed from 4-chamber and left lateral views to measure the maximal diameter of the defect. The maximal defect area of VSD on angiocardiogram was also calculated by 1/4 pi Da2 (Da = maximal defect diameter measured by angiocardiography). The VSD areas measured by different methods were compared by the linear regression analysis. We found that: (1) there is good correlation of the maximal defect diameter and the area of ventricular septal defect by 2-DE and LVG (r = 0.80, p less than 0.0001 v.s. r = 0.78, p less than 0.0001). (2) the ventricular septal defect area by 2-DE had a better correlation with the surgical measurement than that by LVG (r = 0.93, p less than 0.0001, v.s. r = 0.80, p less than 0.0001). (3) the size of ventricular septal defect measured by two-dimensional echocardiography has a better correlation with the MSFAI than the LVG did (r = 0.81, p less than 0.0001, v.s. r = 0.64, p less than 0.0001). Therefore, by measuring the maximal defect diameter, maximal defect area and maximal shunt flow area index, the echocardiography can provide an accurate and non-invasive assessment of isolated VSD in children.

To evaluate the efficacy of two-dimensional Doppler echocardiography in assessing the severity of isolated ventricular septal defect, 31 children were studied within 24 hours of cardiac catheterization. The shunt flow area at peak systole (PSFA), diastole (DFA) and end-diastole (EDFA) and maximal shunt flow area (MSFA) were measured with frame-by-frame technique and corrected with body surface area and heart rate. The Qp/Qs ratio was calculated by the Fick's principle. Simultaneous pressures at peak systole (PSP), diastole (DP) and end-diastole (EDP) were recorded in the left (LV) and right ventricle (RV). The Qp/Qs ratio was correlated well with MFA (p = 0.05), MFA/BSA (p less than 0.001), PSFA/BSA (p less than 0.001), MFA/HR (p less than 0.05), MFA/BSA, HR (p less than 0.001), PSFA/BSA and HR (p,0.001). The PSP gradient between LV and RV was inversely correlated with MFA/BSA and PSFA/BSA (p less than 0.05) and HR (p less than 0.05). Two-dimensional Doppler echocardiography can provide a useful information of hemodynamic changes in children with isolated ventricular septal defect.

Twenty-two infants of isolated ventricular septal defect with congestive heart failure were fed with lower-sodium content formula-Lonalac (Mead-Johnson) to study the clinical response of treatment for congestive heart failure. There were no significant changes of intake, urinary output, serum sodium, potassium and osmolality before, 2 days and 6 days after Lonalac feeding. The low sodium content formula may feed the infants with congestive heart failure in addition to the traditional anticongestive therapy.

The presence of a luteinizing hormone inhibitor in the urine of albino rats was demonstrated. This inhibitor is a heat-stable, non-dialyzable, acid-precipitable and celiteabsorptive substance.

A study was made to observe the influence of pinealectomy on the excretion of a gonadotropin inhibitor in the urine of male rats. Ovulation induced with PMS and HCG was not inhibited in mice which received a heated extract prepared from the urine of pinealectomized rats, whereas ovulation was inhibited in mice given a heated extract from the urine of intact and of sham-operated rats. Ovulation was also partially inhibited in mice receiving a heated extract from the urine of hypophysectomized rats. These observations suggest that the pineal may be the secreting organ of a gonadotropin inhibitor and that the pituitary may be involved in the secretion of the inhibitor in rats. (Endocrinology 88: 816, 1971)

Die dunklen Pinealzellen waren nach Hypophysektomie betrachtlich vermehrt, wahrend die Vesikeln in den sympathischen Nervenendigungen vermindert waren. Auch nach Ovariektomie waren die dunklen Pinealzellen in geringerem Ausmass vermehrt, ohne dass die Vesikeln vermindert waren. Die osmiophile Granula war sehr sparlich.

Campylobacter jejuni has been recently recognized as a frequent cause of diarrheal disease in infants and children. To assess its importance as an enteric pathogen in this area, in our pediatric laboratory, campylobacter jejuni was isolated by selective culture from 35 out of 623 (5.6%) patients with a history of acute diarrhea between March 1981 to December 1981. The peak incidence was in the summer (from May to August), age ranged from 10 days to 8 years, with the high incidence in the very young children. The sex ratio of male to female was four : one. In general, Campylobacter enteritis is not a severe disease and not associated with dehydration. The most common signs were feverfrequent diarrhea. Most of the children recovered spontaneously on conservative management. The antibiograms for 30 strains showed that the Aminoglycosides, Chloramphenicol, Ampicillin, Erythromycin were the most effective drugs. Resistance to erythromycin was found in 13.4% of our series. This study shows campylobacter is the common cause of bacterial diarrhea in Taiwan.