A lifelong non-smoker who was the victim of a massive accidental exposure to anhydrous ammonia gas was followed up for 10 years. In the acute phase the patient presented with severe tracheobronchitis and respiratory failure, caused by very severe burns of the respiratory mucosa. After some improvement he was left with severe and fixed airways obstruction. Isotope studies of mucociliary clearance, computed tomography, and bronchography showed mild bronchiectasis. It is concluded that acute exposure to high concentrations of ammonia may lead to acute respiratory injury but also to long term impairment of respiratory function. (Thorax 1992;47:755-757)
Studies of American Burkitt's lymphoma in 12 children showed a high incidence of abdominal involvement, including ileocecal masses with intussusception, retroperitoneal extension, and diffuse bowel involvement. Pleural effusions were common, and 2 patients had pulmonary nodules. Three patients had diffuse renal involvement. The mandibles and other bones were not affected in any of the 9 patients tested. The first 2 patients survived 0.5 to 8.5 months; the last 2 were treated much more aggressively and were still free of disease at the time this paper was written, 14 and 16 months after treatment, respectively. Hopefully, early recognition of the clinical and roentgenographic features of American Burkitt's lymphoma will contribute to improved survival.
A full-term newborn infant had the onset of respiratory distress immediately after birth. She required supplemental oxygen from birth, and had pulmonary alveolar proteinosis (PAP) documented by open lung biopsies at 6 and at 12 weeks of age. Light and electron microscopy showed dense, PAS-positive granular, homogeneous material within the alveolar spaces, diagnostic of PAP. No Pneumocystic carinii organisms were demonstrated on silver staining, and bacterial and viral cultures were negative. The infant died of progressive respiratory insufficiency at 1 yr or age. Pulmonary alveolar proteinosis should considered a rare cause of chronic respiratory distress in the newborn infant.
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