Esophagitis: a frequent consequence of gastroesophageal reflux in infancy

A control group of infants was evaluated to determine criteria for the diagnosis of histologic esophagitis. Based on our observations, histologic esophagitis was defined as four or more intraepithelial neutrophils or one eosinophil per high power field or both. Esophageal biopsy specimens from 33 consecutive infants younger than 2 years who had been examined for clinically significant gastroesophageal reflux (GER) were reviewed for histologic esophagitis. Endoscopy had been performed in each patient, and 4.1 +/- 1.1 (mean +/- SD) biopsy specimens had been obtained above the distal 20% of the esophagus. Twenty (61%) infants had histologic esophagitis, including 15 with intraepithelial eosinophils alone, one with intraepithelial neutrophils alone, and four with both. Older infants (7 to 24 months) with histologic esophagitis were more likely to have moderate to severe inflammation than were infants younger than 7 months of age (P = 0.01). Endoscopic evidence for gross esophagitis was found in six (18%) infants; of these, five had abnormal biopsies, including four with moderate to severe inflammation. Among the 27 infants with a grossly normal esophagus, 14 (52%) had histologic esophagitis, including nine (33%) with moderate to severe inflammation. We conclude that in infants with clinically significant GER: (1) esophagitis is common, (2) histologic esophagitis frequently occurs in the absence of gross endoscopic findings, (3) the likelihood of moderate to severe inflammation increases after 6 months of age, and (4) intraepithelial eosinophils are a sensitive marker for acute inflammation in association with GER.     

Isolated extramedullary relapse of acute myelogenous leukemia in a tooth

We report a case of isolated extramedullary relapse of acute myelogenous leukemia in a tooth following bone marrow transplantation. The patient was a 4-yr-old child who developed gingival swelling and bleeding while in bone marrow remission. Crush artifact prevented definitive diagnosis of leukemic relapse in a biopsy of the gingival soft tissue, but decalcification of the tooth showed an unequivocal leukemic infiltrate in the dental pulp. Decalcification and sectioning of extracted teeth are recommended when equivocal findings are present in the gingival soft tissue or when there is a history of lymphoreticular malignancy.     

Irradiation alone or in combination with surgery in stage IB and IIA carcinoma of the uterine cervix: A nonrandomized comparison.

This is a report of a nonrandomized comparison of treatment results of 244 patients with stage IB carcinoma of the uterine cervix treated by radiation alone and 92 treated with preoperative radiation and surgery and 77 patients with stage IIA treated by radiation alone and 24 treated with a combination of radiation and surgery. The techniques of irradiation and types of operation are described in detail. The five-year tumor free actuarial survival for the patients with stage IB treated either with irradiation alone or combined with surgery was approximately 85% and the ten-year survival, 78%. For stage IIA the tumor free actuarial five-year survival without tumor was 73% and for ten years, 60%. In the 244 patients treated with radiation alone, there were ten central failures (4%) usually combined with distant metastasis. Further, 16 of these patients (6.5%) developed parametrial recurrence, in all but one instance associated with distant metastasis. In the 92 patients with stage IB treated with combined therapy, there were three local recurrences (3.8%), two of them combined with parametrial failures and six parametrial recurrences (6.5%), all of them concomitant with distant metastasis. Of the 77 patients with stage IIA treated by irradiation alone, there was one central recurrence alone and five local and parametrial recurrences, all of them associated with periaortic nodes or distant metastasis. Four additional patients had parametrial recurrences only concurrent with distant metastasis. Of the 24 patients treated with irradiation and surgery, there were two parametrial recurrences combined with distant metastasis (8.2%). There was no significant difference in the survival or recurrence rate of the patients treated with either method. In the group treated with combined therapy, patients with stage IB who showed evidence of microscopic residual tumor after irradiation had a failure rate of approximately 42% (8/18) in contrast to only 8.6% (6/70) in those with negative specimens. In stage IIA there were three failures in eight patients with residual tumor in the specimen in contrast to only two of 16 with negative specimens (12.5%). Major complications were comparable in both groups (radiation alone approximately 8.7% and irradiation combined with surgery approximately 14%), the difference is not statistically significant. The most frequent minor complication in patients treated with radiation alone was vaginal fibrosis (30 patients--9%) or vaginal vault necrosis (10 patients--3%).     

Rhabdomyolysis-induced acute renal failure associated with legionnaires' disease

Legionnaires' disease (LD) is a systemic infectious disease primarily involving the lungs. Rhabdomyolysis, with subsequent acute renal failure, is an infrequently recognized entity associated with high mortality rates in LD patients. As in the case presented herein, initial respiratory signs and symptoms may not be prominent. Early diagnosis and appropriate treatment can be life-saving.     

Hyperadrenalism in childhood and adolescence.

Hyperadrenalism in childhood and adolescence has unique features that influence diagnosis and management. We reviewed our experience with 18 patients, ranging in age from 18 months to 18 years. Nine had bilateral adrenal hyperplasia, eight had adrenal neoplasms, and one had micronodular hyperplasia. Patients with congenital adrenal hyperplasia and hyperaldosteronism were excluded. Six patients with Cushing's disease diagnosed in earlier years were treated by total adrenalectomy and recently two patients underwent transsphenoidal removal of pituitary tumors. Bilateral adrenalectomy was carried out in one patient with micronodular hyperplasia and in a second because of elevated adrenocorticotrophic hormone (ACTH) levels from an undefined source. Eight patients had adrenal neoplasms, including five adenomas and three carcinomas. We found no reliable criteria to differentiate before surgery between adrenal adenomas and adrenal carcinomas. The most recognizable characteristic of malignancy was tumor size, specifically weight greater than 75 gms. Of the three patients with adrenal carcinoma, one expired 20 months after adrenalectomy and 8 months after receiving palliative partial hepatectomy for liver metastasis. Two patients are well with normal growth and development at 11 and 20 years following adrenalectomy. With the exception of one patient who died 6 years after surgery from a glioblastoma multiforme, all patients with adrenal adenomas are well. Eight patients underwent bilateral adrenalectomy for hypercortisolism. Five of the six who have reached their adult stature are significantly stunted. Four of six patients with Cushing's disease, treated by total adrenalectomy, have developed Nelson's syndrome at 2, 6, 10, and 12 years after surgery. Of the two patients undergoing transsphenoidal surgery, one had recurrent disease at 2 years and was treated by pituitary irradiation with recovery. The patients undergoing adrenalectomy for micronodular hyperplasia and ectopic ACTH are well at 2 and 4 years, respectively. Cushing's disease in children and adolescents is best treated by transsphenoidal removal of the pituitary adenoma. Adrenalectomy, once the most accepted approach, plays a secondary role and is indicated primarily in micronodular adrenal hyperplasia, in patients with ectopic ACTH production of an undefined source, and in recurrent Cushing's disease following prior pituitary irradiation. The high incidence of Nelson's syndrome in children treated by adrenalectomy mandates that patients at risk be monitored lifelong for the progression of a pituitary tumor.(ABSTRACT TRUNCATED AT 400 WORDS)     

The effect of some contrast agents in the lung: an experimental study in the rat and dog

Radiographic and histologic studies were carried out in rats and dogs after the instillation of Barosperse, Hypaque-35%, metrizamide, MP10013 (a nonionic iodine-containing agent), and isotonic saline into the lungs of these animals. In addition, blood gases were examined using these agents in dogs. Given aspiration of larger quantities of the contrast agents, the nonionic iodine-containing agents (metrizamide and MP10013) were better tolerated and evoked less pulmonary response than either Hypaque-35% or Barosperse.     

Effects of glow-discharge and surfactant treatments on the wettability of vinyl polysiloxane impression materials

STATEMENT OF PROBLEM: Although surfactant-modified vinyl polysiloxane (VPS) is described as hydrophilic by manufacturers, interaction with dental gypsum is relatively poor. PURPOSE: The purpose of this study was to compare and evaluate the wettability of surfactant-modified VPS after different surface treatments. MATERIAL AND METHODS: Eighty-four impression-material specimens (20 x 10 x 1 mm) were prepared from 3 different brands of VPS (Aquasil, Panasil Contact Plus, and Accuflex). Four groups (n = 7) of specimens were established according to the surface treatment method used: no treatment, topical application of 2 different surface wettability agents (Silwet Copolymer L-77 or Delar surfactant), or coating with an acrylic acid plasma in a glow-discharge reactor. Plasma treatment specimens were coated with acrylic acid in a glow-discharge system at a radio frequency of 13.56 MHz with 20-W discharge power and 5 minutes of exposure time. Wettability was measured using the contact-angle method. Values were recorded after the drop contacted the surface at 0.6 second, 30.7 seconds, and 210.8 seconds. Contact-angle mean values were compared using 3-way analysis of variance with repeated measures on 1 factor, followed by a post hoc Duncan test (alpha=.05). RESULTS: As the sphericity assumption was not satisfied, the Greenhouse-Geisser correction was used for contact-angle values. Glow-discharge treatment proved to be effective for increasing the surface energy of the VPS compared to controls at all time points studied (P <.0001). At 0.6 second, Silwet significantly decreased the contact-angle values for Aquasil and for Panasil Contact Plus (P <.0001). Delar treatment, at this time point, significantly increased the contact-angle values of GC (P <.0001) and decreased the contact-angle values of Aquasil (P <.0001). At 30.7 seconds, Silwet significantly increased the wettability of Aquasil and Panasil Contact Plus ( P <.0001) but did not significantly increase the wettability of GC. Delar treatment, at 30.7 seconds, increased the contact-angle values of GC (P <.0001), whereas contact-angle values of Aquasil significantly decreased (P <.0001). At 210.8 seconds, all surface-modification methods used were effective in increasing the wettability of VPS tested over untreated controls (P <.0001). CONCLUSION: Wettability of VPS-based impression materials can be increased by coating the surface with acrylic acid in a glow-discharge reactor. The change in wettability achieved by the application of topical surfactants resulted in variations among surfactant-VPS combinations.