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nosis and let them know that they do not have an increased risk of recurrence. We thank Donna McDonald-McGinn, MS, for assistance with and referral of patient 1; James J. Kirk, DO, for referral of patient 2; Kathleen E. Richkind, PhD, and Robert C. Miller, PhD, for fibroblast cytogenetie analysis on patients 1 and 3, respectively; and Fikru Bekele for technical assistance with patient 2.

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7. 8. 9. 10.

REFERENCES 1. Butler N, Claireaux AE. Congenital diaphragmatic hernia as a cause of perinatal mortality. Lancet 1962;1:659-63. 2. Cunniff C, Jones KL, Jones h|C. Patterns of malformation in children with congenital diaphragmatic defects. J PEOIATR 1990;116:258-61. 3. Pallister PD, Meisner LF, Elejalde RE, et al. The Pallister mosaic syndrome. Birth Defects 1977;13(3B):103-10. 4. Killian W, Teschler-Nicola M. Case report 72: mental retardation, unusual facial appearance, abnormal hair. Syndrome Identification 1981;7(1):6-7. 5. Wenger SL, Boone LY, Steele MW. Mosaicism in Pallister i(12p) syndrome. Am J Med Genet 1990;35:523-5. 6. Speleman F, Leroy JG, Van Roy N, et al. Pallister-Killian

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syndrome: characterization of the isochromosome 12p by fluorescent in situ hybridization. Am J Med Genet 1991 ;41:381-7. Schinzel A. Tetrasomy 12p (Pallister-Killian syndrome). J Med Genet 1991;28:122-5. Wyatt PR. Pallister-Killian syndrome: an update of a clinical case [Letter]. Am J Med Genet 1988;29:229. Pauli RM, Zeier RA, Sekhon GS. Mosaic isochromosome 12p [Letter]. Am J Med Genet 1987;27:291-4. Warburton D, Anyane-Yeboa K, Francke U. Mosaic trisomy 12p: four new cases, and confirmation of the chromosomal origin of the supernumerary chromosome in one of the original Pallister-mosaic syndrome cases. Am J Med Genet 1987;27: 275-83. Young ID, Duckett DP, O'Reilly KM. Lethal presentation of mosaic tetrasomy 12p (Pallister-Killian) syndrome. Ann Genet 1989;32(1):62-4. Bresson JL, Arbez-Gindre F, Peltie J, Gouget A. PallisterKillian-mosaic tetrasomy 12p syndrome: another prenatally diagnosed case. Prenat Diagn 1991;11:271-5. McLeod DR, Wesselman LR, Hoar DI. Pallister-Killian syndrome: additional manifestations of cleft palate and sacral appendage. J Med Genet 1991;28:541-3. Priest JH, Ust JM, Fernhoff PM. Tissue specificity and stability of mosaicism in Pallister-Killian +i(12p) syndrome: relevance for prenatal diagnosis. Am J Med Genet 1991;42:820-4.

Bilateral fiberoptic bronchoalveolar lavage in acute unilateral lobar pneumonia J o n a t h a n . G r i g g , MRCP(UK). Carine v a n d e n Borre, MD. Anne Malfroot, MD. Denis Pierard, MD. Deyun W a n g , MD. a n d Isi Dab, MD From the Departments of Pediatric Pulmonology and Cystic Fibrosis. Microbiology, and Otorhinolaryngology. Academisch Klnderziekenhuis. Vrije Universiteit Brussel, Brussels.Belgium Bilateral cultures of bronchoalveolar l a v a g e fluid were obtained from eight children with unilateral lobar pneumonia. In four patients bacterial pathogens were not isolated from l a v a g e of the radiologlcally normal side but were subsequently cultured from the consolidated segment. This pattern helped to exclude contamination by oropharyngeal flora of bronchoalveolar l a v a g e fluid. Bilateral bronchoalveolar l a v a g e may help in the interpretation of lower respiratory tract cultures obtained by fiberoptic bronchoscopy. (J PEDIAIR4993; 122:606-8)

Supported by grants from the Nuffield Foundation, Allen and Hanbury, Ltd. (United Kingdom), and the Ministry of the Flemish Community in Belgium (Ministerie van de Vlaamse Gemeenschap). Submitted for publication May 5, 1992; accepted Jan. 4, 1993. Reprint requests: Isi Dab, hiD, Department of Pediatric Pulmonology and Cystic Fibrosis, Academisch Kinderzienkenhuis, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. Copyright 9 1993 by Mosby-Year Book, Inc. 0022-3476/93/$1.00+.10 9/22/45339

Blood culture results in acute childhood pneumonia are frequently negative, so determining the causative organism is often difficult. 1 The availability of broad-spectrum antibiotics allows treatment without a microbiologic diagnosis, but this approach may be inadequate in the presence of immunosuppression or multiply resistant organisms. In adults with pneumonia, lavage fluid obtained from the consolidated lobe at bronchoscopy often contains the causative or

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Table. Pathogens isolated from NP aspirate and BALF BALF from lung Patient No.

NP lavage

1 2

S. pneumoniae H. influenzae (+)

3

B-Hemolytic streptococcus (group A)

No pathogen No pathogen /~-Hemolyticstreptococcus (group A)

S. pneumoniae

4

RSV No pathogen S. pneumoniae H. influenzae (-)