Monatsschr Kinderh
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An eleven month old infant girl presented with a two-month history of inspiratory stridor. Analysis of her symptoms indicated airway obstruction located in the middle of the trachea; a barium esophagogram revealed an esophageal foreign body with tracheal compression. By endoscopy, a chestnut shell was extracted from the esophagus. In infancy, esophageal foreign bodies may cause mainly respiratory symptoms.
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A congenital subclavian steal syndrome may be caused by coarctation or interruption of the aortic isthmus or by isolation of a subclavian artery. We describe a patient with D-transposition of the great arteries, a left aortic arch, and isolation of the right subclavian artery which originated from the right pulmonary artery via a right ductus arteriosus. ⋯ We recommend routine cerebral doppler sonography for all infants with congenital heart disease and unilaterally weak brachial pulses. Since the long term outcome of the congenital subclavian steal syndrome is uncertain the aberrant subclavian artery should be reimplanted at the time of corrective cardiac surgery.
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Since virus isolation consumes a lot of work and time, and virus specific antibodies are not detectable before several days after the onset of illness we developed an enzyme immunoassay (ELISA) for the detection of influenza A and influenza B virus antigen in nasopharyngeal specimens (NPS). This test permits antigen detection within four hours. This ELISA was tested with 119 NPS from children, most of these between 1-12 years old. ⋯ The failure to detect antigen could not be solely due to low antigen concentration in the NPS because in 5 materials high concentrations of infectious virus were shown in cell culture. The test allows the rapid diagnosis of influenza virus infections with high efficacy also for laboratories without the facility to perform tissue culture. For accelerating the diagnosis by isolation of viruses in cell cultures, ELISA is useful as cell culture confirmation test, because influenza virus antigen is detectable before a cytopathogenic effect appears.
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Toxic shock syndrome, caused by an exotoxin of staphylococcus aureus is very rare in children. On admission, beside the shock, abdominal problems as vomiting, diarrhoea and a developing adynamic ileus were outstanding in our patient. Not before additional symptoms as staphylococcal pneumonia with bacteriemia occurred and later desquamation of palms and feet, diagnosis of toxic shock syndrome could be confirmed.
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Serial pulmonary function tests were performed in 13 preterm infants with severe RDS and 16 premature neonates with healthy lungs (8 intubated because of hypovention after birth, 8 were breathing spontaneously). Airflow was measured by a pneumotachograph, pressure changes were determined by airway pressure in ventilated infants or esophageal pressure in spontaneously breathing neonates. Pulmonary mechanics were calculated by a computerized system (PEDS/Medical Associated Services, Hatfield, Pennsylvania). ⋯ In the course of the disease, improvement in gas exchange preceded increase of compliance. Intraindividual comparisons in the acute and recovery phase of RDS and in infants with normal lungs showed higher values for compliance and lower values for airway pressure and resistance during spontaneous breaths. The differences between dynamic compliance of the respiratory system measured during mechanical ventilation, and dynamic lung compliance recorded during spontaneous breaths are due to influences of the respirator on the infant's lung.