In order to evaluate whether “Lung injury score (LIS)” and “criteria for Acute lung injury (ALI) and Acute respiratory distress syndrome (ARDS)” are adequate definitions for early diagnosis in children with ARDS, we performed clinical studies in ARDS group (n=7) and non-ARDS group (n=12). On study of LIS, the time to appear the alteration on each parameter differed and PaO₂/FiO₂ ratio reflected lung injury most sensitively. We compared arterial blood gas analysis between ARDS group and non-ARDS group before the diagnosis, PaO₂/FiO₂ ratio is significantly lower in ARDS group compared with it in non-ARDS group. There were no significant differences between groups in PaCO₂. Early phase of ARDS showed strong hypoxemia against mild hypoventilation supposed by normal level of PaCO₂. We concluded that we can use “LIS” as a final diagnosis and “criteria for ALI and ARDS” as an early diagnosis in children with ARDS. Further investigation on pediatric ARDS, considering the anatomical and physiological characteristics of children, is expected so that we can manage the better mechanical ventilation.

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We report a case of iatrogenic Cushing's syndrome. A ten-years old girl was referred to our hospital for assessment of her obesity (obesity index 47%). We knew that she had been using an inhalant containing dexamethasone (Stmerin D^®) every day since 2 years old for her bronchial asthma. Marked increase in body weight and decrease in heigth growth rate was obvious after 9 years old. She presented moon face, central obesity and hypertrichosis. The endocrinological examination revealed pituitary adrenal insufficiency. We made a diagnosis of iatrogenic Cushing's syndrome and chronic adrenal insufficiency due to regular inhalation of the inhalant containing dexamethasone for long period, which was only corticosteroid she had ever used. Recentry, wider application of inhalant corticosteroids are recommended for the treatment of bronchial asthma including children. However, this case alarms us about the possibility of the significant side effects of corticosteroid used through inhalation.

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A 9-months-old infant, having repeated cough and wheeze for 3 weeks, was admitted to our hospital suspected of croup or bronchitis. He suddenly developed a recoverable respiratory arrest on the 7th hospital day. The chest X-ray and CT scan performed after the arrest revealed a tumor in the mediastinum, which was diagnosed as Langerhans cell histiocytosis (LCH) by biopsy. LCH should be considered as a differrential diagnosis of the wheezy diseases, especially when the patient has progressive respiratory failure.

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