Intralaryngeal arytenoidectomy. A report of six cases

Six cases of bilateral abductor palsy with stridor are presented. Following unilateral intralaryngeal arytenoidectomy, four had adequate airways and reasonable voices. Two required bilateral arytenoidectomy, one acquired an adequate airway at the expense of a weakened voice, and the other still requires a tracheostomy. There was only one minor complication. Decannulation and discharge from hospital were usually rapid.

BIPP allergy causing facial paralysis

The present case appears to be the first recorded in which BIPP sensitivity led to a delayed post-operative facial palsy.

Renal pseudotumours caused by xanthogranulomatous pyelonephritis

Five cases of xanthogranulomatous pyelonephritis are described. Wilms's tumour was suspected preoperatively in 2 of the cases and a renal tumour appeared to be confirmed at laparotomy in three. Pathological examination is diagnostic and the condition appears to be always unilateral. Nephrectomy is curative.

Gonadal function after combination chemotherapy for Hodgkin's disease in childhood

The effect of quadruple chemotherapy (mustine, vincristine, procarbazine, and prednisolone) on gonadal function was investigated in 15 males and 2 females treated for Hodgkin's disease during childhood. The 2 females have regular menstrual cycles with evidence of ovulation in one. Twelve of the males have shown normal progression of pubertal development since completing their treatment. Nine out of 10 late pubertal or adult subjects had small testes but only one developed gynaecomastia. All 4 prepubertal subjects had normal basal and peak gonadotrophin responses to luteinising hormone-releasing hormone. Nine of the 12 subjects studied during puberty or adulthood had either an increased basal serum follicle-stimulating hormone (FSH) level or an exaggerated FSH response to luteinising hormone-releasing hormone. Each of the 6 males who provided semen for analysis was azoospermic after an interval of between 2.4 and 8 (mean 5.3) years after completion of treatment. We conclude that severe testicular damage is common after treatment with mustine, vincristine, procarbazine, and prednisolone in childhood. The germinal epithelium is particularly vulnerable and the resultant azoospermia is likely to be irreversible. The Leydig cells are less susceptible to cytotoxic-induced damage. Pubertal development is normal and there is no indication for androgen replacement therapy.

Campylobacter enteritis associated with the consumption of free school milk

A large outbreak of campylobacter enteritis associated with the consumption of free school milk is described. The outbreak had an abrupt onset, and lasted for about 3 weeks; it involved mainly school children in the 2-4 and 5-7 year old age groups. During this period it was established from epidemiological and microbiological data that some 2500 children were infected. The source of the epidemic was almost certainly contaminated milk, although bacteriological proof could not be obtained. Biotyping of isolates was of considerable epidemiological value and showed the involvement of two distinct strains, one of which was dominant. Epidemiological evidence of limited person to person transmission of the infection was obtained; febrile convulsions as a prodromal sign of the illness was recognized for the first time. Strains of Campylobacter jejuni, and samples of patients' serum collected during this outbreak have enabled subsequent studies to be initiated on the serotyping of the responsible organism, on the serological response of patients infected with the organism, and on experimental infection of the bovine udder which demonstrated its potential as a source of C. jejuni in raw milk. A careful search of the literature suggests that this is the largest documented outbreak of campylobacter enteritis.

Haemoglobin and prognosis in childhood acute lymphoblastic leukaemia

Two hundred and nine children presenting consecutively with acute lymphoblastic leukaemia to a regional paediatric oncology unit were investigated to determine the prognostic significance of various factors at diagnosis. There was a strong positive correlation between the pretreatment haemoglobin level and the percentage of bone marrow blast cells in S phase of the cell cycle as assessed by flow cytometry. Patients with T- and B-cell leukaemia had significantly higher haemoglobin levels than non-B non-T patients. In patients with total white cell counts less than 20 X 10(9)/l, aged less than 13 years, and no mediastinal mass, there was no association of haemoglobin with length of first remission. However, among those with white blood counts greater than 20 +/- 10(9)/l there was a strong positive trend towards shorter remission with higher haemoglobin levels. Children with high white blood counts at diagnosis and low haemoglobin levels may have a better prognosis than predicted by the white blood count alone.

Clinical, haematological, and radiological features of children presenting with lymphoblastic mediastinal masses

During 1968-1978, 68 children presented in six centres in the United Kingdom with lymphoblastic mediastinal masses. The disease was classified as acute lymphoblastic leukaemia (ALL) in 49 children whose bone marrow aspirates contained > 20% lymphoblasts, and as lymphoma (Sternberg lymphosarcoma - LS) in 19 with < 20% marrow infiltration. Male predominated in both groups, and children with ALL had more visceromegaly and lymphadenopathy, lower haemoglobin levels and platelet counts, and higher white cell counts. The most common chest x-ray finding in both groups was a nonspecific anterior mediastinal mass, but the appearances varied considerably and could be classified into three categories, which are illustrated. Pleural effusions were present in 44%. Cell surface-marker studies showed T cell characteristics in 14 of the 17 patients tested. Response to treatment and complications, such as central nervous system (CNS) and testicular relapse, were similar in ALL and LS, and were related to the size of the initial tumour load. Median remission lengths were 37 weeks for ALL and 89 weeks for LS patients. Leukaemic transformation occurred in 47% of LS children. Compared with the outcome in ALL children without mediastinal mass, the results of treatment were poor, regardless of the protocol used, and prophylactic therapy to the CNS reduced the frequency of, but did not eliminate, CNS disease.

Fire-setting on an adolescent inpatient unit: an analysis

A one time series of fire-setting episodes on an inpatient adolescent service are analyzed from a systems standpoint for the purpose of primary prevention. This paper documents that fire-setting behavior can occur in individuals with no prior history of fire-setting and that losses to the hospital system proper can be psychologically coupled to losses felt by an individual. Specific recommendations are offered based on both case history analysis of the protagonists and the psychosocial determinants of the hospital system. A selective literature review compares this experience with others.

An isolated case of Legionnaires' disease

A single sporadic case of Legionnaires' disease which showed some unusual features is described from a young male who had never been out of the United Kingdom. The relevant literature is briefly reviewed.

Nephroblastoma: treatment during 1970-3 and the effect on survival of inclusion in the first MRC trial

In 1970-3 313 children were diagnosed as having nephroblastoma in Great Britain. From the start of the first Medical Research Council nephroblastoma study in October 1970 until the end of 1973, 98 children (57% of all eligible children) were included in the trial. Of the 313 children, 288 (92%) had a nephrectomy, 248 (79%) received a course of radiotherapy, and 267 (85%) were given at least four days' chemotherapy. The three-year survival rate was 58%; the rate among children in the trial (77%) was significantly better than that among children who were eligible for the trial but not included (58%). Children who had nephrectomies at specialised children's and teaching hospitals had a higher survival rate than those treated elsewhere. All children with nephroblastoma should be treated according to well-defined protocols which take into account the age of the child and the stage of the tumour and include a full course of maintenance chemotherapy.

Normal growth despite abnormalities of growth hormone secretion in children treated for acute leukemia

We have studied the relationship between abnormalities of the growth hormone-somatomedin axis and growth in 26 children previously treated for acute lymphatic leukemia. Each child had previously received cranial irradiation, was in complete clinical and hematologic remission, and off all drugs. The mean standing height SDS of the 26 children was significantly less than normal. There was no significant difference between the mean standing height SDS, height velocity SDS, somatomedin activities, and degree of bone age retardation between the 17 children who received the higher dose of cranial irradiation (Group 1) and the nine who had the lower dose of cranial irradiation (Group II). Furthermore, there was no significant reduction in mean height velocity SDS, somatomedin activity, or bone age in either group when compared to normal age-matched controls. The peak GH responses to both insulin hypoglycemia and an arginine test were significantly lowered in Groups I and II when compared to a control group of children. We conclude that only a minority of children, who previously received cranial irradiation for ALL were clinically GH deficient and, therefore, likely to benefit from GH therapy despite the finding that the majority of these children had reduced GH responses to pharmacologic stimuli.

Laser surgery for malignant melanoma and superficial malignancies

This study describes 18 months' experience with the CO2 laser in the treatment of malignant melanoma and other superficial malignancies. In 110 patients, a general assessment was made of the advantages commonly claimed for the laser. In addition, a comparison between laser and scalpel surgery was made by means of a small retrospective study. Results from 39 patients undergoing wide excision and graft for primary malignant melanoma in association with axillary lymph node dissection indicated that the laser offered no specific advantages over the scalpel for this particular type of operation. The laser was shown to have specific advantages in the treatment of extensive superficial malignancy, in locally recurrent tumours, and in malignancy of soft tissues. In these situations it did minimize blood loss and achieve satisfactory extirpation of the lesion.

Relevance of circulating immune complexes in childhood acute lymphoblastic leukaemia

Circulating immune complexes have been measured using the (125I)C1q binding test in 216 sera from 135 children with acute lymphoblastic leukaemia. Increased circulating immune complexes were detectable in 10.7% of the sera and 10.4% of the children. There was no correlation between the presence of circulating immune complexes and prognosis, but a strong correlation with a history of recent infection.