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Two children presented with sleep disturbance due to enlarged 1;onsils and adenoids. One child died during induction of anaesthesia, and postmortem examination showed hypertrophy of the right ventricle and atrium. As a result a prospective survey was carried out of children undergoing tonsillectomy or adenoidectomy, or both. During a nine-month period an electrocardiogram was taken in 92 children. Three electrocardiograms (3-3%) showed evidence of right heart strain. The children with abnormal electrocardiograms had symptoms of sleep disturbance with apnoea, snoring, and daytime somnolence. These symptoms and the electrocardiographic changes were reversed by adenotonsillectomy.The prevalence of pulmonary hypertension in children with enlarged tonsils and adenoids is still underestimated. When signs and symptoms of sleep disturbance, particularly snoring, are present an electrocardiogram should be obtained and a cardiologist's opinion sought before embarking on routine surgery in view of the potentially fatal consequences.

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Can peak expiratory flow be measured accurately during a forced vital capacity manoeuvre? D. Wensley, D. Pickering, M. Silverman. #ERS Journals Ltd 2000. ABSTRACT: Spirometry and peak flow measurements traditionally depend on different forced expiratory manoeuvres and have usually been performed on separate, dedicated equipment. As spirometry becomes more widely used in primary care settings, the authors wished to determine whether there was a systematic difference between peak expiratory flow (PEF) derived from a short sharp exhalation (PEF manoeuvre) and from a full forced vital capacity (FVC) manoeuvre, using the same turbine spirometer (Microloop, Micro Medical, Kent, UK).Eighty children (38 with current asthma) aged 7±16 yrs were asked to perform 2 blocks of PEF and FVC manoeuvres, the order being randomly assigned.PEF obtained from a peak flow manoeuvre (PEFPF) was significantly greater than that from a forced vital capacity manoeuvre (PEFVC) in both healthy (group mean difference 20 L . min -1 ; p<0.001) and asthmatic children (group mean difference 9 L . min -1 ; p<0.004). For clinical purposes, a mean difference of about 3% for children with asthma is of no practical significance, and peak expiratory flow data can usefully be obtained during spirometric recordings. Eur Respir J 2000; 16: 673±676.

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