Surgically treatable causes of neonatal respiratory distress.
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Thirty chronic hashish smokers (mean age-20 years) with respiratory symptoms and six control subjects who were nonhashish smokers were evaluated by history, physical examination, bronchoscopy, and bronchial biopsy. Twenty-three (23) of 23 (100 percent) patients who smoked hashish plus cigarettes had one or more histopathologic abnormalities of basal cell hyperplasia, atypical cells, or squamous cell metaplasia. Only one of seven (28.6 percent) hashish smokers who smoked cigarettes, one of three (33.3 percent) cigarette smokers who smoked no hashish, and zero of three (0 percent) nonsmokers showed one or more of the same histopathologic lesions (p less than .05). Hashish smoking when combined with cigarette smoking appeared to have more deleterious pulmonary effects than either hashish or cigarettes smoked alone, and the abnormal histopathologic lesions found in these smokers are identical to those frequently associated with later development of emphysema and carcinoma of the lung.
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This paper reports the associated malformations and the clinical findings that were observed in 417 cytogenetically confirmed Down Syndrome patients. Among them congenital heart defects have occurred more frequently [75; 17.98%] than osteoarticular malformations [23; 5.52]; eye anomalies [22; 5.27%]; and gastroenterological malformations [n 16; 3.84%]. With regard to prognosis and treatment appropriate counselling has been given to Down Syndrome patients and their families.
The anesthesiologist uses a wide spectrum of drugs, including inhalational general anesthetics, barbiturates, benzodiazepines, narcotics analgesics and their antagonists, and neuromuscular blocking drugs. All of these drugs in sufficient dose impair the ventilatory response to chemical stimuli, and may cause inadequate gas exchange. The effect of depression of ventilatory control depends on the magnitude of depression and the coexistence of functional abnormalities in the respiratory system. The functional abnormalities are the result of preexistent pulmonary disease or other disease processes that impair respiratory function, the anticipated effects of major surgery (e.g., pulmonary resection), and the complications of anesthesia and surgery. From a functional viewpoint, the mechanisms of the effects of these disease processes on ventilatory control are: (1) interference with the neurophysiological control of automatic ventilation; (2) impairment of peripheral or central chemoreceptor function; (3) impairment of respiratory muscle function; (4) increase in the mechanical load to breathing as a result of increased resistance or decreased compliance of the respiratory system; and (5) increase in the ventilatory requirements as a result of ventilation/blood flow maldistribution, metabolic acidosis, or increased metabolic rate. As a result of current trends in the use of multiple drugs and controlled ventilation during anesthesia, the patient is at greatest risk during the early postoperative period in the recovery room. In addition to the functional abnormalities described above, the probability of impaired gas exchange and respiratory failure is increased as a result of impaired metabolism and elimination of drugs as a result of hepatic and renal insufficiency, and acute changes in acidbase status, which alter the ionization and distribution of drugs.
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Many disorders of the fetal thorax and abdomen can be evaluated using ultrasound. Even when a definitive diagnosis cannot be made prenatally, sonography can provide valuable clinical information regarding the nature and location of the abnormality, associated anomalies, and the presence of secondary complications. An awareness of these disorders and their sonographic appearance is important to impact upon obstetrical management and overall prognosis.
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