Sleep and respiration in children: time to wake up!

The interest in paediatric sleep disorders over the last few decades has had its main focus on the sudden infant death syndrome (SIDS) - healthy infants who go to sleep and never wake up again. Overall, this is the most dramatic form of paediatric sleep disordered breathing. By contrast, classical presentations of sleep disordered breathing in children, such as snoring and obstructive sleep apnoea as well as their clinical implications have been greatly neglected and underestimated in the past. In contrast to snoring in adults, snoring in children has so far generally been regarded as noisy breathing with no significant impact on the general health of children. This is also to a lesser extent true for obstructive sleep apnoea syndrome (OSAS). The sometimes dramatic complications of OSAS, such as cor pulmonale and developmental retardation have at least indicated that OSAS in children is important and may have a great impact on the general health of children. This has led to an increased interest from a clinical as well as a scientific point of view with some important findings, mainly that sleep disordered breathing in childhood varies from sleep disordered breathing in adulthood and that even mild to moderate disease has a huge impact on the general health of children, mainly on neurocognitive development.     

Pediatric erosive esophagitis maintenance: finally, some level 1 evidence!

In children, as in adults, gastroesophageal reflux disease (GERD), particularly erosive esophagitis, is now believed to be a chronic disease, probably requiring lifelong maintenance therapy. However, this assumption has not received adequate clinical testing, and the provocative article by Boccia et al. in this issue of the Journal challenges it. The strengths of this exceptional pediatric study lie in its prospective, controlled, randomized character, and in its relatively long duration of prospective follow-up. Weaknesses of the study include its limited power and lack of prior validation of outcome measures. The conclusions of the study are applicable only to children without chronic neurologic, respiratory, or congenital esophageal abnormalities, the children for whom chronic proton pump inhibitors (PPIs) are most often required. The study's provocative results might be explained by the fundamental lack of GERD chronicity in otherwise healthy children, combined with absence of the PPI dependence that can be produced when PPIs are used chronically for chronic disease.     

To aspirate or not!: The question may be not if,but when

• Current guidelines indicate that routine aspiration thrombectomy (AT) has a level III indication and AT is only indicated for “bail‐out” indications.
• “Bail‐out” situations are not well defined.
• The AT catheter may still be necessary and have other uses such as distal contrast or drug delivery.

     

T-cell reconstitution and expansion after hematopoietic stem cell transplantation: 'T' it up!

Adoptive immunotherapy is the isolation and infusion of antigen-specific or nonspecific lymphocytes. Adoptive therapy with T cells may have a role in replacing, repairing, or enhancing immune function damaged by cytotoxic therapies, and rapid lymphocyte recovery may improve outcome after autologous and allogeneic stem cell transplantation (SCT). Recently, a plethora of information on the basic mechanisms of T-cell biology and regulation of cellular immune responses has emerged, permitting the development of new forms of adoptive cell therapy. Efficient ex vivo culture method for T-cell subsets affords the possibility of adoptive transfer of T cells engineered with enhanced capacity for central memory, effector cytotoxicity, Th1, Th2, veto cell, and T regulatory functions. Studies show that homeostatic T-cell proliferation is important for effective adoptive immunotherapy and pretreatment with chemotherapy may enhance the effects of infused T cells. Replicative senescence, in part due to telomere erosion, likely limits successful adoptive immunotherapy, though it may be possible to maintain T-cell pools by enforced expression of telomerase. Clinical trials now demonstrate that it is possible to enhance immune reconstitution after SCT with cytokines or infusions of ex vivo costimulated expanded T cells. These data all support the premise that adoptive therapy can accelerate reconstitution of cellular immunity with enhanced antitumor effects following SCT.     

垂体脓肿7例临床分析及其诊断要点

目的分析垂体脓肿的临床表现、辅助检查、诊断及治疗特点。方法对1994年3月至2006年11月就诊于解放军总医院并经病理诊断确诊的7例垂体脓肿患者临床资料进行回顾性分析。结果7例垂体脓肿患者中原发性垂体脓肿4例,继发性垂体脓肿3例,其中合并垂体腺瘤、垂体囊肿、颅咽管瘤各1例。临床特征:发热者6例,视力下降或颞侧偏盲者5例;头痛伴食欲减退、恶心呕吐者4例。血常规检查白细胞升高者3例。内分泌检查:血浆泌乳素增高者4例,继发性甲状腺功能减退者3例,继发性肾上腺皮质功能减退者2例。影像学检查:MRI显像呈T1等信号或低信号,T2等信号或高信号,T1信号环形强化。术前经MRI及临床症状诊断2例,另5例均为术后病理证实。治疗:均行手术治疗,术后视神经功能障碍恢复不理想,其余症状均有改善,围手术期均予抗生素治疗。结论以发热、头痛、视力视野损害、部分及全垂体功能低下为首发症状的鞍区占位患者应高度怀疑垂体脓肿,早期诊断、及时手术和合理的抗生素治疗是改善垂体脓肿预后的关键。