THE OCCURRENCE OF TWO VASCULAR RINGS IN THE SAME INFANT

A fatal case of an infant with a combination of two vascular rings is described. One ring consisted of a right-sided aortic arch, aberrant left subclavian artery and persistent ductus arteriosus, the other of an anomalous left pulmonary artery branched off from the right pulmonary artery. The importance of a properly performed roentgen examination of the oesophagus is stressed.     

CLINICAL APPLICATIONS OF ECHOCARDIOGRAPHY IN INFANTS AND CHILDREN II. Estimation of Aortic Root Diameter and Left A trial Size: A Comparison between Echocardiegraphy and Angiocardiography

During a period of 18 months, a comparison was made between echocardiography and angiocardiography in every patient submitted to heart catheterization and angiocardiography. This paper deals with comparisons between an aortic root dimension measured on an echocardiogram and the aortic root diameter measured on the angiocardiogram, and between a left atrial dimension measured on an echocardiogram and the sagittal left atrial diameter measured on the angiocardiogram. This study could be made in 89% of the 166 patients with respect to the aortic root and in 87% of the 91 patients with respect to the left atrial dimension. The failure to obtain measurements in some of the patients (9 and lo%, respectively for the two comparisons) was generally due to an abnormal position of the aorta (transposition of the great arteries, double outlet right ventricle or truncus arteriosus communis) while in a few remaining cases no satisfactory echocardiogram could be obtained. A very good correlation (r = 0.98) was found between the aortic root dimension as measured by echocardiography and the aortic root diameter as measured by angiocardiography. A good correlation (r=0.93) was also found between the left atrial dimension as measured by echocardiography and the left atrial sagittal diameter as measured by angiocardiography. Examination of the outflow vessel in truncus arteriosus communis by echocardiography gave echocardiograms which could contribute to the diagnosis of truncus arteriosus communis. The conclusion of this investigation is that the echocardiographic examination as described here can serve as a useful, non-invasive, semi-quantitative method for the estimation of the aortic root diameter and the left atrial size.     

Blood flow velocity in the femoral artery 1–3 years after catheterization. A prospective study in neonates and children

During the period 1987–1989 femoral artery cannulations were performed in 95 patients of whom 74 were neonates. Catheter sizes were 24 G (n= 28), 22 G (n= 54) and 20 G (n= 13). Median indwelling time was 3 days (range: 1–13 days). Catheter removal was due to perfusion related symptoms in 12 cases, malfunction in 16 cases and because they were no longer needed in 67 cases. One to three years after the catheterization event the systolic peak flow velocity in the femoral artery was analysed with a Doppler sonography system in 28 neonates and in 6 older children. Measurements were performed where the external iliac artery ascends from the pelvic fossa (proximal site) and in the common femoral artery which was considered to be the site for catheter introduction (puncture site). In the neonatal group (n= 28), there was a significant increase in the peak flow velocity at the puncture site in the catheterized leg (P < 0.05), as well as a signficant increase in the quota of the puncture and proximal site values in the catheterized leg (P < 0.05). In the catheterized leg, the peak flow velocity at the puncture site correlated positively with the length of the indwelling time (r= 0.467, P < 0.01). It is concluded that the use of the femoral artery for intra-arterial monitoring in neonates and children is clinically a safe method. The findings of peak systolic velocity may indicate damage to the vessel and/or adjacent vessel tissue present 1–3 years after the catheterization event.     

PULMONARY MECHANICS, CHEST X-RAY AND LUNG DISEASE AFTER MECHANICAL VENTILATION IN LOW BIRTH WEIGHT INFANTS

Abstract. Lindroth, M., Jonson, B., Svenningsen, N. W. and Mortensson, W. (Neonatal Unit, Department of Paediatrics, University Hospital, Lund, Sweden). Pulmonary mechanics, chest X-ray and lung disease after mechanical ventilation in low birth weight infants. Acta Paediatr Scand, 69:761, 1980.—Pulmonary mechanics, chest X-ray and the incidence of clinical lung disease were studied in 41 low birth weight infants treated with intermittent positive pressure ventilation (IPPV) in the neonatal period. Shortly after IPPV most patients, irrespective of X-ray findings, had signs of lung damage reflected in low dynamic compliance or high pulmonary resistance. Both parameters, however, had a strong tendency towards normalization during the first year of life. Overdistention on chest X-ray was common at 6–12 months of age. Pneumonia and bronchitis were common during the first two years of life but subsided later on. Development of BPD or later respiratory disease were not correlated to treatment with high inspired oxygen concentrations but commonest in patients with hyaline membrane disease. The combined findings of pulmonary mechanics and chest X-ray shortly after IPPV were correlated to later clinical lung disease.     

Severe Neonatal Respiratory Distress Syndrome Treated with the Isolated Phospholipid Fraction of Natural Surfactant

Ten newborn infants (795–1680 g) with severe respiratory distress syndrome (RDS) were treated with the isolated phospholipid fraction of bovine or porcine surfactant, which was administered via the airways (dose 200 mg/kg), at a median age of 10.5 h. Before receiving surfactant, all the infants were on artificial ventilation (FiO₂ 0.6–1.0). Within 2 h after surfactant replacement, the arterial-to-alveolar P_O2 ratio increased from 0.1 to 0.35. There was a concomitant improvement in lung aeration on the chest roentgenograms and a significant reduction in the right-to-left shunt. Four patients died of cerebral hemorrhage; two of them also had a patent ductus arteriosus. One surviving infant developed bronchopulmonary dysplasia, and another succumbed 8 months later to the sudden infant death syndrome. No antibodies against surfactant were detected in the sera of the survivors. Since our results show a significant improvement in lung function after replacement therapy, the efficacy of this new surfactant preparation should be further tested in randomized clinical trials.     

INFANTILE PERIARTERITIS NODOSA OR MUCOCUTANEOUS LYMPH NODE SYNDROME A report on four cases and diagnostic considerations

Abstract Ahlström, H., Lundström, N.-R., Mortensson, W., Östberg, G. and Lantorp, K. (Department of Paediatrics and Radiology, University Hospital, Lund, the Department of Pathology, General Hospital, Malmö and the Department of Infectious Disease, County Hospital, Jönköping, Sweden). Infantile periarteritis nodosa or mucocutaneous lymph node syndrom. A report on four cases and diagnostic considerations. Acta Paediatr Scand, 66: 193, 1977.—Coronary artery aneurysm in childhood is a rare disease and has in most cases been ascribed to infantile periarteritis nodosa (IPN). In recent years a mucocutaneous lymph node syndrom (MLNS) has been found almost exclusively in Japan first described by Kawasaki 1967; this disease frequently involves the coronary arteries and myocardium. Four cases with coronary aneurysms are presented from Sweden and seem to be the first described from Scandinavia. Three of these patients died a sudden death with cardiac arrest. Since MLNS and IPN have identical clinical and pathological features, we suggest that MLNS and IPN constitute a pathologic entity and that to separate them on a clinical or histological basis is nonsensical. The risk of coronary aneurysm and possible sudden death must be considered in patients with uncharacteristic symptoms including prolonged fever, conjunctivitis, exanthema, lesions in the oral mucosa, elevated sedimentation rate, and leukocytosis.     

OMENTAL AND MESENTERIC CYSTS IN CHILDREN

ABSTRACT. Six children with omental or mesenteric cysts are reported. The cysts usually gave rise to an uncharacteristic clinical picture and deceptive findings, which lead to misconception of the nature of the lesions. The primary step to correct diagnosis is to include the disease among the differential possibilities; ultrasonography may offer conclusive information.     

CLINICAL APPLICATIONS OF ECHOCARDIOGRAPHY IN INFANTS AND CHILDREN: III. Estimation of Left and Right Ventricular Size: a Compurison between Echocardiography and Angiocardiography

Abstract. Lundström, N.-R. and Mortensson, W. (Departments of Pediatrics and Radiology, University of Lund, Sweden). Clinical applications of echocardiography in infants and children. III. Estimation of left and right ventricular size: a comparison between echocardiography and angiocardiography. Acta Paediat Scand, 63:257, 1974.–Intracardiac distances can be measured by echocardiography, which is a non-invasive technique. The aim of the present study was to investigate if the size of the left and right ventricle could be estimated by echocardiography. This was accomplished by a comparison with angiocardiography. The left ventricular internal dimension measured by echocardiography was compared with the long axis of the left ventricle measured on an angiocardiogram in 60 patients. A comparison between a right ventricular dimension measured by echocardiography and the size of the right ventricle evaluated from an angiocardiogram was made in 84 patients. A fairly good positive correlation was found between the left ventricular internal dimension measured by echocardiography and the long axis of the left ventricle measured on the angiocardiogram (r=0.93). As regards right ventricular size, it was found that echocardiography could separate a right ventricle of normal size from a clearly enlarged right ventricle. The conclusion of this investigation is that the echocardiographic examination can serve as a useful, non-invasive, semiquantitative method for the evaluation of left and right ventricular sizes in infants and children.