We examined the changes in pulmonary function values in 27 patients who underwent a lobectomy due to cystic lung disease and compared the results regarding such factors as disease type, age at operation, and preoperative infections. Percent vital capacity (%VC) decreased immediately after lobectomy, but recovered to normal values within 2 postoperative years and remained within or above the normal range. The ratio of residual volume to total lung capacity (RV/TLC) rose temporally with the increase in %VC, but then remained normal after 2 postoperative years. There was no difference in %VC and RV/TLC between diseases, while bronchial atresia showed a significantly lower correlation with percent of forced expiratory volume at 1 s. The older group operated upon at over 4 years of age and the group that had infections before operation showed relatively low %VC and high RV/TLC. Some patients demonstrated extremely low %VC along with funnel chest deformities. Our study suggests that overinflation of the remaining lung compensates VC in the early period after lobectomy while subsequently alveolar multiplication occurs. Factors affecting compensatory lung growth were considered to be operation later than 4 years of age, preoperative infection, and a thoracic deformity.
We recommend the use of this new set of prediction equations together with suggested cut-off values, for assessment of spirometry in Japanese children and adolescents.
Hepatopulmonary syndrome (HPS) (hypoxaemia due to intrapulmonary vasodilation and a right-to-left shunt associated with liver disease) resolves after liver transplantation. The authors describe a case of spontaneous resolution of HPS prior to liver transplantation. This patient was diagnosed with HPS associated with extra-hepatic biliary atresia when she was 10 years old. She exhibited digital clubbing, facial vascular dilation, cyanosis, and suffered from dyspnoea during exercise. The patient's PaO(2) at rest was 53.8 mm Hg in room air and a Technetium-99m macro-aggregated albumin lung perfusion scan demonstrated a right-to-left shunt. Although her symptoms and laboratory data supported a diagnosis of HPS, she nevertheless showed spontaneous resolution within 2 years. When she was 14 years old, pulmonary hypertension was evident upon examination of her echocardiogram. HPS may be improved or masked by an accidental overlap with pulmonary hypertension in the terminal stage of liver disease.
A 1-year-old boy was referred for evaluation of persistent cough and wheezing. His respiratory symptoms had gradually increased over the prior 3 months, and he had experienced multiple episodes of pneumonia and/or atelectasis mainly in the left lung. Physical examination showed decreased breath sounds on the left side. Chest radiograph showed hyperinflation of the left lung (Figure 1). Computed tomography of the chest demonstrated a well-demarcated, intraluminal tracheal mass that originated from the posterior wall of the tracheal bifurcation that nearly occluded the left main bronchus (Figures 2 and 3; Figure 3 available at www. jpeds.com). He was scheduled for elective surgery, but he developed respiratory failure. Emergent endoscopic laser resection of the tumor was performed (Figure 4; available at www.jpeds.com). Histologic examination revealed a benign fibrous histiocytoma. He underwent endoscopic laser resections 3 times over the next 3 months due to difficulty in completely resecting the tumor. There is no recurrence on further follow-up. Persistent cough, a commonly encountered clinical condition, may be caused by a variety of conditions, such as congenital anomalies, infection, asthma, aspiration, environmental, and psychological causes. 1 Following detailed history and physical examination, chest radiograph is the first diagnostic test for evaluation and may lead to specific diagnoses or help determine subsequent diagnostic tests. This patient had a benign fibrous histiocytoma of the trachea. Primary tracheal tumors are rare but can also present with persistent cough and, in fact, a majority of previously reported cases were initially misdiagnosed as asthma or recurrent pneumonia. 2 Among these rare tumors, benign tumors account for two-thirds. Benign tumors include hemangioma, granular cell tumor, and benign fibrous tumor. Malignant tumors include malignant fibrous tumor. 2 Bronchoscopy and biopsy allow for a definitive diagnosis. Treatment includes endoscopic excision 3 or partial tracheal resection. 4 Hemangiomas may be treated with propranolol. 5 Although primary tracheal tumor is rare, it has a risk of lifethreatening airway obstruction. n
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.