Utility of virtual bronchoscopy for diagnosis of tracheal lesions in children was evaluated by comparing the images from a case of congenital tracheal stenosis due to complete cartilaginous ring with those by fiberoptic bronchoscopy.Results suggested that virtual bronchoscopy has diagnostic values comparable to those of fiberoptic bronchoscopy and is potentially useful at facilities that are not equipped with fiberoptic bronchoscopy.However, further studies are needed to fully establish its utility for diagnosing tracheal lesions with respiration-associated changes, such as tracheomalasia. We recommend that the institutions, where fiberoptic bronchoscopy is available, should perform virtual bronchoscopy in parallel to investigate its utility.

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The purpose of this article is to evaluate the usefulness of polysomnography for a diagnosis of pediatric sleep disorder and the efficacy of treatment by adenotonsillectomy or continuous positive airway pressure with a nasal mask (nasal CPAP).Forty one children were enrolled in this study. Their chief complaints involved snoring and apnea during sleep.All of them underwent the nocturnal polysomnography in the hospital.For the evaluation of obstructive sleep apnea syndrome, we used two indices, apnea hypopnea index (AHI) and a total of time during which O₂ saturation falls below 95% by pulse oximetry (<95% desaturation time).Thirty six subjects were diagnosed adenotonsillar hypertrophy and 13 subjects had adenotonsillectomy.Twenty one subjects were kept under observation without surgical treatment.Four subjects were obese.Two of them were diagnosed obstructive sleep apnea syndrome and were treated with nasal CPAP.It is demonstrated that both the surgical intervention and nCPAP vastly improved clinical manifestations and the result of nocturnal polysomnography also revealed the efficacy of these interventions.

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We report an 11-year-old girl with myasthenic crisis, who was initially diagnosed as respiratory distress due to status asthmatics.There were several points which confused us to lead the final diagnosis;glucocorticoid was effective;ptosis was not obvious;fatigability of muscles and diurnal symptom fluctuation was not noticed.In contrast, there were some findings which were not compatible with asthma exacerbation ;she had no wheezing and her respiratory distress did not apparently respond to bronchodilators.Finally bulbar palsy was found, and the diagnosis of myasthenia gravis (MG) was confirmed by a positive anticholinesterase test, specific findings of electromyography, and a positive anti-acetylcholine receptor antibody.When a patient with respiratory distress has facial weakness and dysphagia, MG should be considered.

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The early diagnosis of airway foreign body is very important.This paper reported 3 children with peanuts aspiration;a girl aged 20-month, two boys aged 14-and 27-month.In each case, it took 20, 50, and 21 days to make correct diagnosis, respectively.The symptoms had appeared immediately after aspiration in case 1 and 3, but 2 weeks later in case 2.The episode of aspiration was recognized by the first physicians in case 1 and 2, but not in case 3.Previous diagnosis was first asthma exacerbation, acute pneumonia, and common cold, respectively.Partial effectiveness of the treatment (corticosteroid in case 1, and antibiotics in case 2) and symptomless period (in case 2) might explain the delayed diagnosis.Lung perfusion scintigraphy might be helpful for the diagnosis of suspicious airway foreign body cases, because it demonstrated definitive laterality in our all subjects.Unfortunately, it is still not generally known about foreign body aspiration by general physicians and caregivers.To prevent aspiration, we should appeal the need of warning labels on packages of the causative foods.

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A newborn male infant is reported to show the clinical course of tracheoesophageal fistula (TEF) following neonatal toxic shock syndrome-like exanthematous disease (NTED).Necrotizing tracheobronchitis (NTB) is caused by mechanical and/or chemical stimuli such as high concentration oxygen, jet ventilation and endotracheal tube itself, and occurs around the tracheal bifurcation.In contrast, our patient had TEF in the midtrachea, thus, other factors may have played a role in its formation. Case: A male infant, born at 37-week-gestation with uneventful pregnancy and delivery, was admitted to our hospital due to respiratory distress.At six hours of age, endotracheal intubation was performed smoothly.NTED developed at four days of age, and resolved with using antibiotics, catecholamines and anti-DIC agents.When recurrent atelectasis in various bilateral lobes and abdominal distention suddenly appeared at 13 days of age, fiberoptic bronchoscopy and esophagoscopy revealed TEF spreading 2.5cm in length in the midtrachea.He died at 24 days of age despite surgical reconstruction. Although autopsy findings indicated that this fistula was result of NTB, it was located more cranially than those of“traditional”NTB.Other factors such as toxic shock syndrome toxin 1, which causes NTED as a superantigen, may have influenced.

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Unilateral lung agenesis is extremely rare and have various complications.The onset and clinical course in this disease is quite variable.An 8-month-old boy with severe stridor and wheeze was referred to our hospital to stabilize respiratory failure.He was diagnosed as right lung agenesis with tracheal stenosis.In this case, respiratory management was extremely difficult, but physiotherapy, especially positioning, was very effective.To evaluate precise mechanism, bronchofiberscopy and lung function test were very useful
We speculated that factors leading to serious conditions in this desease are;1) right lung agenesis, 2) compression of trachea by more than 2 blood vessels, 3) complication of tracheal malacia or trachealstenosis, and 4) onset within early infancy.

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