Surfactant protein C gene (SFTPC) mutation-associated lung disease: high-resolution computed tomography (HRCT) findings and its relation to histological analysis

AIM OF THE STUDY

Determine high-resolution tomography (HRCT) scan characteristics in children with SFTPC mutation and correlate them to histological findings.

PATIENTS AND METHODS

This retrospective multicenter study included 15 children (7 females and 8 males) with SFTPC mutations. HRCT scans have been performed in all the children and lung biopsies in 8 children.

RESULTS

From all signs assessed on initial HRCT scans, ground-glass opacities (n =14, 93%) and lung cysts (n = 6, 40%) were predominant. Interlobular septal thickening (n = 1, 7%), air space consolidation (n = 1, 7%), paraseptal emphysema (n = 2, 13%), and pulmonary nodules (n = 1, 7%) were also found. Histological analysis revealed accumulation of macrophages in the alveolar lumen, type II pneumocyte hyperplasia, and alveolar septal thickening. Dilatation of the respiratory bronchiole and alveolar duct associated with muscular hyperplasia were also described. Interestingly, lung cysts on HRCT scans were associated with dilatation of terminal bronchioli and alveolar duct in lung biopsies.

CONCLUSION

In children with SFTPC mutations, HRCT scan finding was highly correlated to the histological findings and, as such, represent a useful tool to identify patients that may require SFTPC gene sequencing.

Impacts of the climate change on runoff and diffuse phosphorus load to Lake Balaton (Hungary)

The paper outlines a multi-component assessment of the impacts of the climate change on runoff and total phosphorus loads to the large shallow Lake Balaton in Hungary. Present hydrological cycle of the lake catchment has been examined using the rainfall-runoff model WetSpa. Particular phosphorus concentration in runoff was estimated on the basis of the simulated streamflow using an empirical power equation. Dissolved phosphorus concentrations were determined as a function of landuse and soil type of the corresponding sub-catchment. The model was calibrated and validated against daily observations manually at monitoring sites of sixteen inflowing streams around the lake. Runoff stemming from shoreline urban developments was calculated by the urban runoff simulation model SWMM. Phosphorus concentrations in urban runoff were calculated by an empirical relationship derived from field measurements. The model was henceforward run for climate change scenario analysis. Present weather data were modified by the climate change scenarios imported from the results of the CLIME project. The results indicate that the impact of the climate change on runoff and phosphorus load appears in the change of the distribution within a time period rather than in the total volume. However, due to the high uncertainties in climate models, the presented calculations are possible assumptions rather than established statements.

[Pneumocystis jiroveci pneumonia during prolonged corticosteroid therapy in an immunocompetent infant]

INTRODUCTION

Pneumocystis jiroveci (PJ) infection is rare in infants and is suggestive of primary or secondary immunodeficiency. We report on a case of severe PJ pneumonia in an immunocompetent infant after prolonged corticosteroid treatment.

CASE REPORT

A 5 1/2 month-old girl presented with hypoxemic respiratory distress. Her medical record was remarkable only for a bulky parotid haemangioma, which was treated with prolonged oral corticosteroid therapy. The chest X-ray showed a mixed alveolar-interstitial pattern, and bronchoalveolar lavage revealed the presence of PJ. A favourable outcome was obtained after three weeks of intravenous trimethoprim-sulfamethoxazole treatment.

CONCLUSION

PJ infection should be suspected in infants presenting with progressive respiratory distress associated with a mixed alveolar-interstitial pattern. Its potential seriousness justifies prophylactic therapy during prolonged immunosuppressive treatment (chemotherapy, corticosteroid treatment).

Design of best management practice applications for diffuse phosphorus pollution using interactive GIS

The paper presents a complex environmental engineering tool, which is appropriate to support decision making in watershed management. The PhosFate tool allows planning best management practices (BMPs) in catchments and simulating their possible impacts on immissions. The method has two parts: (a) a simple phosphorus (P) fate model to calculate diffuse P emissions and their surface transport, and (b) an interactive tool to design BMPs in small catchments. The fate model calculates diffuse P emissions via surface pathways. It is a conceptual, distributed parameter and long-term (annual) average model. The model also follows the fate of emitted P from each cell to the catchment outlets and calculates the field and in-stream retention. The fate model performed well in the Zala River catchment as a case study. Finally, an interactive design tool was developed to plan BMPs in the catchments and simulate their possible impacts on diffuse P fluxes. Different management scenarios were worked out and their effects evaluated and compared to each other. The results show that the approach is suitable to test BMP scenarios at small catchment scale.