Background. There is no gold standard test for diagnosis of gastroesophageal reflux disease (GERD) associated infantile wheezing. Objectives. To evaluate the value of bronchoalveolar lavage (BAL) pepsin assay in diagnosis of GERD in wheezy infants. Methods. Fifty-two wheezy infants were evaluated for GERD using esophageal combined impedance-pH (MII-pH) monitoring, esophagogastroduodenoscopy with esophageal biopsies, and BAL pepsin. Tracheobronchial aspirates from 10 healthy infants planned for surgery without history of respiratory problems were examined for pepsin. Results. Wheezy infants with silent reflux and wheezy infants with typical GERD symptoms but normal MII-pH had significantly higher BAL pepsin compared to healthy control (45.3 ± 8.6 and 42.8 ± 8 versus 29 ± 2.6, P < 0.0001 and P = 0.011, resp.). BAL pepsin had sensitivity (61.7%, 72 %, and 70%) and specificity (55.5%, 52.9%, and 53%) to diagnose GERD associated infantile wheeze compared to abnormal MII-pH, reflux esophagitis, and lipid laden macrophage index, respectively. Conclusion. A stepwise approach for assessment of GERD in wheezy infants is advised. In those with silent reflux, a trial of antireflux therapy is warranted with no need for further pepsin assay. But when combined MII-pH is negative despite the presence of typical GERD symptoms, pepsin assay will be needed to rule out GERD related aspiration.

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Inflammatory pseudotumors of the lung are a group of non-neoplastic tumors, which are mainly of parenchymal origin and rarely endobronchial. We report a case of a 9-year-old girl who presented with left-sided tension pneumothorax and subcutaneous emphysema. After emergency management, chest computed tomography revealed an ill-defined left lung mass. Rigid bronchoscopy revealed a mass occluding the left main bronchus at the origin of the left upper lobe bronchus. Initially, the mass was thought to be a foreign body granuloma. Few weeks later, the child presented with recurrence of the same clinical, radiologic, and bronchoscopic outcomes. Histologic examination after the repeat bronchoscopic excision revealed the lesion to be consistent with inflammatory pseudotumor. Left upper lobectomy was performed with a complete resolution of symptoms and no recurrence was observed during the 2 years of follow-up. To the best of our knowledge, this is the first reported case of inflammatory pseudotumor presenting with tension pneumothorax.

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Aim:The aim of this study was to evaluate the effect of asthma on dentoalveolar morphology in the developing child. Methods: This study was conducted on 50 asthmatic Egyptian children and 50 non-asthmatic Egyptian children. Each child's dental casts of the maxilla and mandible were analyzed. The upper and lower intercanine width, the upper and lower intermolar width (UIMW-LIMW), the upper and lower arch length, and the palatal depth were determined. Results: Children with asthma demonstrated higher mean values in more than one of the parameters measured when compared with the mean values of non-asthmatic children for both genders. In general, the UIMW of asthmatic children had lower mean values when compared with the mean value of non-asthmatic children, except when compared regarding gender. A Student t-test noted a significant difference in UIMW and LIMW in male children. Conclusion: Asthma has an effect on upper and lower dental arch dimensions in both genders. Key words:Asthma, dentoalveolar morphology, children Dr. Salwa Mohamad Awad is Professor and Chairman of Pediatric Dentistry, Faculty of Dentistry, Mansoura University, Egypt. She got her BS, MS and PhD from Faculty of Dentistry, Mansoura University, Egypt. She participated in many scientific researches supervision, in the committees of arbitration and discussion of researches, and also in workshops and international scientific conferences. She conducted many local and international scientific researches and got many courses of development faculty administration. Besides, she acts as director of quality unit at college, and internal auditor and evaluator of quality assurance and accreditation.Dr. Fathi Abdulraqep Qasem is Master of Pediatric Dentistry, Faculty of Dentistry, Dhamar University, Yemen. He got his BS from Faculty of Dentistry, Dhamar University, Yemen, and MS from Faculty of Dentistry, Mansoura University, Egypt. He is manager of dental clinic of the training hospital of the Faculty of Dentistry, Dhamar University, Yemen. He participates in many workshops and international scientific conferences.

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We report the case of a 6-year-old boy who presented with a 2-month history of stridor and respiratory difficulty, preceded 1 month earlier by dry cough. The evaluation before admission revealed glottic narrowing due to diffuse inflammatory changes. On examination, the patient was seen to have biphasic stridor and respiratory distress with diminished breath sounds throughout both lung fields. Laryngoscopy revealed multiple polyps and granulation tissue causing marked laryngeal narrowing. No foreign body was detected in the larynx. Elective tracheostomy was performed before proceeding to bronchoscopy. The latter procedure revealed a foreign body in the left main bronchus. One week after the foreign body extraction, repeat bronchoscopy revealed nearly total disappearance of polyps and granulation tissues. The tracheostomy tube was removed and the patient recovered uneventfully. To our knowledge, this is the first reported case of stridor caused by a migrating laryngeal foreign body. A thorough endobronchial examination should be carried out in patients with unexplained laryngeal polyps and granulation tissue.

Background: Foreign body aspiration in pediatrics is usually managed by rigid bronchoscopy, which is associated with plenty of adverse events. Objective: We tried to compare the effect of nebulized saline, lidocaine or combined lidocaine with epinephrine on postoperative respiratory complications. Patients and methods: This prospective study included 90 children, who were divided into three groups according to the nebulized solution; NS group (normal saline 0.9%), L group (lidocaine 1% 4 mg.kg -1 ) and LA group [4 mg.kg -1 lidocaine 1% and adrenaline (1:1000) 3 mg). Our primary outcome was the incidence of post-operative respiratory complications, while the secondary ones included hemodynamic changes and the incidence of intraoperative cough or desaturation. Results: All pre-procedural data were insignificant among the three groups. The LA group expressed higher heart rates, while the L group showed a significant reduction when compared to NS group. Propofol consumption showed a significant decline in two studied groups compared to the NS group. Intraoperative cough was higher in NS group in comparison to L and LA groups. Although, intraoperative desaturation per case along with post-operative sedation showed no significant difference among the three groups, post-operative cough frequency attacks and severity were higher in NS group when compared to L and LA group and when L group were compared to LA group. Postoperative stridor was insignificant among the three groups. Conclusion: Nebulized lidocaine/adrenaline combination is appropriate option to achieve proper intraoperative sedation and upper airway conditions with reduction of post-operative negative respiratory outcomes together with minor hemodynamic changes.