Michael T. Gyepes

Sinus disease in children with respiratory allergy.

Sinus disease has been assumed to exist in children with respiratory tract allergy, although a systematic evaluation of the relationship of these two processes has never been reported. We have been impressed that sinus involvement often adds significantly to the morbidity rate of allergic disease; when controlled or eliminated, the allergic respiratory process appears easier to control. This study was ‘undertaken to: (1) better define the prevalence of sinus disease in allergic children, and (2) establish clinical and laboratory diagnostic criteria.

Gray-Scale Ultrasonography of the Normal Female Pelvis

The pelvis was evaluated with gray-scale ultrasound in 45 normal females, important aspects of instrumentation, changes in scanning techniques, and pitfalls in the identification of various normal anatomical structures are described, and normal ranges of uterine size and ovarian volume are reported.

Renovascular hypertension in children and adolescents.

Renovascular disease often leads to hypertension in children. The most frequent cause is fibromuscular dysplasia of focal type affecting main and peripheral arteries. Diastolic readings in excess of 110 mm Hg with normal serum creatinine and urinalysis are suggestive of renovascular disease. Excretory urography was positive in 65% of patients with unilateral disease. Radionuclide scans complement a positive excretory urogram but may be positive when the urogram is negative. Plasma renin activity was raised in the majority of patients; if the patient does not have peripheral branch stenosis, the renal vein renin ratio will lateralize in unilateral renal disease. The overall results of surgery are encouraging: 86% of surgical procedures alleviated hypertension in unilateral disease.

Transfemoral Selective Bilateral Pulmonary Arteriography with a Pulmonary-Artery-Seeking Catheter

Abstract A new, improved pulmonary-artery-seeking catheter is described. This catheter has a reversed secondary curve; when introduced from the right femoral vein, it passes readily from the right ventricle to the pulmonary artery with a minimum of manipulation. This catheter design has been successfully applied without complications in humans and dogs.

Pre and postoperative ventricular function in infants and children with right ventricular volume overload.

Hemodynamic and ventricular volume parameters were evaluated in 21 patients (24 studies) with total anomalous pulmonary venous return (TAPVR), 11 patients with secundum atrial septal defect (ASD), and eight patients who had complete correction of TAPVR or ASD. Right and left ventricular (RV and LV) volume parameters were calculated according to Simpsons rule and the area length methods, respectively. In infants with TAPVR, RV end-diastolic volume was larger than normal, but RV ejection fraction was significantly less than normal. LV end-diastolic volume and LV ejection fraction were all less than normal in infants with or without pulmonary hypertension, and the values did not correlate with the cardiorespiratory symptoms. In children with TAPVR or ASD, RV end-diastolic volume and output were higher than normal preoperatively and decreased to normal or near normal values postoperatively. The data suggest that pulmonary venous obstruction and/or RV failure are responsible for cardiorespiratory symptoms in infants with TAPVR and early surgical intervention is recommended in these patients.

Radiologic and histologic investigation of pulmonary oxygen toxicity in newborn guinea pigs.

The hypothesis that pulmonary oxygen toxicity is radiographically demonstrable was tested by serially radiographing 23 newborn guinea pigs maintained in a 96 to 100% oxygen environment at normal atmospheric pressure. All animals died in the increased-oxygen environment by six and one-half days. Nineteen showed characteristic radiologic progression of disease to death. Graded histologic changes in the lungs, particularly at the bronchiolar level, correlated strongly with the duration of 96 to 100% oxygen exposure (correlation coefficient, 0.90, P < 0.001). Duration of life in 96 to 100% oxygen was directly related to birth weight, but not to sex. Seventeen control newborn guinea pigs maintained in room air showed no radiologic evidence of disease and minimal histologic changes.

Tricuspid Atresia with Increased Pulmonary Blood Flow An Analysis of 13 Cases

The pathologic and clinical findings in 13 cases of tricuspid atresia and increased pulmonary blood flow encountered in UCLA Medical Center were reviewed. In seven, the great vessels were normally related (group I), and in six, the great vessels were transposed (group II). In all group II cases, aortic arch anomalies were encountered, a finding not duly emphasized in previous reports. Comparison of the two groups revealed significant clinical and laboratory differences. Group II patients typically presented with severe congestive heart failure and expired within the first 2 months of life. Group I patients usually presented with mild congestive heart failure which responded to therapy. Five of the latter demonstrated progressive change from increased to decreased pulmonary blood flow during their clinical course and eventually required palliative shunt procedures, four prior to the age of 2 years and one at 5 years of age.While the electrocardiogram demonstrated right atrial enlargement and left ventricular hypertrophy in both groups, the mean frontal plane axis was between −15° and −100° in group I and −75° and +75° in group II. QRS vector loops tended to be superiorly oriented in group I and inferiorly oriented in group II.Because the natural history and prognosis in these two groups differ significantly, diagnostic efforts should include determination of the relationship of the great vessels. When transposition of the great vessels is demonstrated, aortography should be performed because of the high incidence of aortic arch anomalies.

Aneurysm of the left atrium

Abstract Congenital left atrial aneurysm is a rare anomaly that has been reported only five times previously. The usual presenting features include an abnormal chest roentgenogram, an apical systolic murmur and supraventricular tachycardia. Even with cineangiocardiography the diagnosis is uncertain, and the lesion is commonly confused with cardiac tumor. Aneurysmectomy is the preferred treatment and has been successful in all patients undergoing operation. The presence of thrombi in the aneurysm necessitates circulatory assistance during excision.

Subpulmonic Obstruction in Complete (d) Transposition Produced by Redundant Tricuspid Tissue

Two cases are reported in which complete transposition of the great vessels was associated with an unusual form of subpulmonic obstruction. In each case, redundant tricuspid valvular tissue protruded through a ventricular septal defect into the left ventricular outflow tract, producing severe obstruction to the outflow of blood from the left ventricle.The clinical course suggested the presence of left ventricular outflow obstruction. Both patients demonstrated progressive clinical deterioration characterized by increasing cyanosis, respiratory distress, and decrease in intensity of the cardiac murmur. Serial laboratory determinations revealed increasing hemoglobin and decreasing systemic oxygen saturation. The clinical deterioration was relieved only temporarily by atrial balloon septostomy.The angiographic findings appear to be specific for this type of subpulmonic obstruction. In each case, a large asymmetric filling defect was demonstrated at the anterior border of the left ventricular outflow tract below the pulmonic valve.When the clinical and laboratory findings suggest pulmonary or subpulmonary obstruction, careful evaluation of the outflow tract is indicated. If diagnosed clinically, redundant tricuspid tissue could perhaps be resected during a definitive operation, thus relieving the outflow obstruction.

The effects of ganglionic blockade on tracheobronchial muscle in fetal and newborn lambs

Abstract Changes in diameters of the trachea and bronchi of fetal and newborn lambs were studied by cineroentgenograms and histological sections after administration of a ganglionic blocking agent. Mean increases in diameters of the trachea and left and right bronchi were 90 %, 69 % and 62 %, respectively, in the fetal lambs. In the newborn lambs, the mean increases in tracheal and left and right bronchial diameters (51 %, 38 % and 60 %, respectively) were considerably less than those observed in the fetal lambs. This suggests that after birth the enhanced activity of the sympathetic component of the autonomic nervous system under normal circumstances overcomes the parasympathetic dominance over the respiratory tract which is characteristic of fetal life.