Esophageal strictures in children: treatment by serial balloon catheter dilatation

Grüntzig balloon catheters were used to dilate ten esophageal strictures in eight infants and children. Five infants who had anastomotic strictures following esophageal atresia repair gained complete resolution of their strictures, usually after one or two dilatations. Three older children who had strictures following esophageal re-operation or reconstruction required longer courses of dilatations to achieve consistent esophageal patency. The technique failed in two chronic strictures of two and one-half and nine years' duration. Balloon catheter dilatation, begun in the early postoperative period, is a safe, effective method for dilating esophageal strictures.     

The severity of immune neutropenia correlates with the maturational specificity of antineutrophil antibodies

Sera from 15 patients with antineutrophil antibodies against peripheral blood neutrophils were incubated with normal bone marrow, and the reaction with marrow precursors was determined. Serum from controls did not deposit IgG on either peripheral blood or marrow myeloid cells. Serum from patients with moderate immune neutropenia with myeloid hyperplasia deposited IgG on neutrophils, bands and metamyelocytes, but not on earlier precursors. Serum from one patient with severe neutropenia and myeloid hypoplasia deposited IgG on myelocytes and promyelocytes as well as more mature cells. Serum from a patient with antineutrophil antibodies which impaired chemotaxis but who did not have neutropenia deposited IgG only on neutrophils and occasional bands. Immune neutropenia may become increasingly severe as antibodies become directed against earlier precursors.     

Assessment of residual posttreatment masses in Hodgkin's disease and the need for biopsy in children

Background

In children with Hodgkin's disease (HD), a significant residual mass may remain after definitive treatment. It may be composed of necrotic/fibrous tissue or resistant HD. Various imaging modalities are available to assess this mass, including chest x-ray (CXR), computed tomographic (CT) scan, and gallium scan. Our aim was to determine the sensitivity and specificity of each modality for residual HD.

Methods

Two hundred fifty-six children with HD during 1985 to 2003 were retrospectively reviewed.

Results

Twenty-six patients with HD had residual masses at end of therapy, deemed to be of concern for residual disease. These children had 16 abnormal CXRs, 18 abnormal CT scans, and 9 abnormal gallium scans; all patients underwent biopsy. Ten (38%) showed resistant HD and 16 (62%) had fibrotic and necrotic tissue. The sensitivity and specificity of each imaging modality were 60% and 38% for CXR, 67% and 8% for CT scan, and 71% and 71% for gallium scan, respectively.

Conclusions

These imaging modalities were not sufficiently sensitive or specific to predict which residual masses may be harboring resistant HD. Hence, the need for surgical biopsy will remain important in the assessment of these masses. FDG-PET scan, which was not available to these children, is a modality that may improve this assessment.     

Functional study of lipids of PNH red cell membranes: susceptibility of liposomes to reactive lysis

Lipids extracted with chloroform-methanol from red blood cell membranes of 7 PNH and 13 control subjects were used for the preparation of liposomes, which were then examined with the reactive lysis test. PNH liposomes lysed to a higher extent than control liposomes as indicated by the higher dilution of the limiting complement reagent that was necessary to lyse 50% of the PNH liposomes. A similar finding was also observed with liposomes made of lipids from AET-treated red cells. The enhanced reactive lysis can be attributed to the polar lipid fraction, as indicated by the increased lysis of hybrid liposomes prepared from this polar lipids extracted from PNH erythrocyte membrane and lipids extracted from normal erythrocyte membrane. The increased susceptibility to reactive lysis does not seem to be specific of PNH liposomes, since it was also observed with liposomes prepared from lipids of red cells from beta-thalassemia major and autoimmune hemolytic disease.