J. Carlos Maggi

Association of lipid-laden alveolar macrophages and gastroesophageal reflux in children

The association of lipid-laden alveolar macrophages (LLAM) and gastroesophageal reflux (GER) was investigated prospectively in 115 patients in two groups. Group 1 included 74 children with chronic respiratory tract disorders and documented GER by prolonged esophageal pH monitoring, barium esophagram, and esophagoscopy; group 2 included 41 children with chronic respiratory tract disorders without GER. LLAM were present in 63 (85%) and eight (19%) children from groups 1 and 2, respectively (P less than 0.0001). Thus a strong association between the presence of LLAM and GER in children with chronic respiratory tract disorders was established. We suggest that LLAM from bronchial lavage may be a useful marker for tracheal aspiration in children with GER in whom chronic lung disease may subsequently develop.

Severe Clonidine Overdose in Children Requiring Critical Care

Hospital, Long Beach, and The Departments of Pediatrics at the University of California, Irvine, California. Correspondence to: J. Carlos Maggi, MD, Children’s Lung Center and Pediatric Intensive Care Unit, Miller Children’s Hospital Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90801-1428. Received for publication August 1985, revised October 1985, and accepted May 1986. CLONIDINE (CATAPRES) is used extensively in the management of adult hypertension. Major toxic effects of clonidine include respiratory depression, hypotension, hypothermia, bradycardia, and decreased cardiac output.2-6 Few massive ingestions have been reported in children.3,4,6,7 We report two toddlers (twin sisters) who accidentally ingested massive doses of clonidine, sustained respiratory and hemodynamic failures, and required critical care support. Their management is discussed after review of the literature.

Intracranial Pressure Monitoring by Subarachnoid Bolt in Comatose Children

The safety of intracranial pressure (ICP) monitoring by the subarachnoid bolt was studied in 124 comatose children with global (103 patients) and focal (21 patients) cerebral lesions. None of the children developed cerebral hematoma, diffuse bleeding, epileptical focus, or local or systemic infection. Based on our experience, we advocate the use of the subarachnoid bolt for the purpose of ICP monitoring as a simple and safe modality.

Pediatric fiberoptic bronchoscopy as adjunctive therapy in acute asthma with respiratory failure.

Status asthmaticus respiratory failure is associated with thickened mucus secretions necessitating aggressive pulmonary clearance. The role of bronchoscopy in pediatric mechanically ventilated asthmatic patients has not been published.

Endobronchial Tuberculosis Presenting as Respiratory Failure in an Infant

can cause ventricular tachycardia and fibrillation, seizures, and vasoconstriction with hypertension as well as nausea, vomiting, and diarrhea. Our patient on presentation demonstrated vomiting with loose stools. Although he had been exposed in utero, no evidence of neurologic dysfunction was documented on his delivery physical. A developmental exam after recovery and before discharge was appropriate for a 5-month-old infant. Cravey reported two infants de-