SUMMARY A retrospective study was made of 9 patients with congenital lobar emphysema who presented over the past 13 years. The ages of the patients at diagnosis ranged from 2 weeks to 10 years. The earlier the presentation, the more severe were the symptoms. Two patients were misdiagnosed initially at the referring hospitals with near disastrous results. Pitfalls in diagnosis are outlined and the various investigative procedures discussed. A flow chart for the diagnostic approach is presented. Treatment was usually by lobectomy but 2 older children presenting late with mild symptoms were managed conservatively with satisfactory results.

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sumMARY Plasma alkaline phosphatase activity was measured in 349 infants aged between 5 and 10 days to establish a normal range for different gestational ages. Significant differences were observed between term and preterm infants, the highest values being associated with the shortest lengths of gestation. Plasma calcium, phosphate, and alkaline phosphatase activity were measured sequentially in 51 preterm infants < 1500 g at birth. A significant correlation was found between raised plasma alkaline phosphatase activity and radiological changes of osteoporosis, metaphyseal change, and periosteal reaction. Plasma alkaline phosphatase appears to be of value in screening for and monitoring rickets of prematurity.

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Duplex Doppler sonography and direct intracranial pressure (ICP) measurement were performed on 18 patients with infantile hydrocephalus. ICP was measured through a frontal reservoir or ventricular tap using a nondisplacement pressure transducer. The Pourcelot Resistive Index, RI = (peak systolic-end diastolic)/peak systolic velocity was obtained from pulsed-wave Doppler measurements of blood flow velocity in the anterior (ACA) and/or the middle cerebral (MCA) arteries. There was a statistically significant positive correlation between ICP and RIs in the MCA and ACA. Paired RI measurements in 7 patients with raised ICP decreased significantly from a mean of 0.90 pre-tap to 0.75 post-tap. Our results suggest that the RI provides a reliable measure of cerebrovascular resistance in hydrocephalus. Duplex Doppler ultrasonography thus is a useful noninvasive means of monitoring cerebrohaemodynamic change with simultaneous imaging of ventricular size in infantile hydrocephalus.

Radiological techniques such as real-time US with Doppler imaging and contrast-enhanced CT may establish the diagnosis of pulmonary sequestration by demonstrating the mass and its systemic vessel, thereby eliminating the need for more aggressive imaging procedures. Partial or total disappearance of these masses represents a further example of involutive pathology and suggests that not all cases of pulmonary sequestration should be surgically treated.

A retrospective study of 87 children presenting acutely with an "irritable hip" was undertaken to assess the role of arthrosonography of the hip joint. Arthrosonography detected 52 hip-joint effusions, of which 16 were aspirated and an effusion confirmed in 14 (88%). In 82 cases plain radiography was compared with arthrosonography for the detection of hip-joint effusions. Of 47 children with a positive ultrasound diagnosis, 28 (59%) showed abnormal findings on plain radiographs and, of 35 cases with negative ultrasound findings, 22 (63%) had a negative diagnosis by plain radiography. Patients with more severe clinical signs were more likely to have an ultrasonic diagnosis of an effusion (87%-100%) than those with mild clinical signs (25%). The ultrasonic measurement of the hip-joint capsule to femoral neck distance was 2.2 mm +/- 0.5 mm (mean +/- 1 SD) in normal hips and 6.3 mm +/- 1.5 mm in the joints with effusions. Our study suggests that arthrosonographically the normal capsular space is less than 3 mm and the difference between the two sides less than 2 mm. It is suggested that hip arthrosonography is a more accurate method for detecting hip-joint effusions than plain radiography; it may help select cases for hospital admission and should be performed before aspiration is attempted.