Search

In a previous study of 22 severely growth-retarded children with inflammatory bowel disease (IBD), endocrinologic evaluation revealed hypogonadism and low growth hormone (HGH) levels. This was attributed to a secondary hypopituitarism. In order to assess this hypothesis, two individuals from this group and another similar child who was not so severely growth-retarded as to be included in the initial study were given HGH replacement in an acute trial and for a 6-month interval. No significant height increment could be attributed to the HGH administration although a definite anabolic response was present in each patient during the acute trial. It appears that the youngsters with IBD may have a relative end-organ resistance to the metabolic and growth-promoting effects of HGH and that their growth problems are not related to hypopituitarism.

A rapid, safe method of dilating tight esophageal strictures utilizing the Eder-Puestow dilators and the fiberoptic esophagoscope is described.

nary parenchyma or in the walls of the blood vessels. These findings, especially the plasmacytoid lymphocytes, are consistent with the pathologic diagnosis of Waldenstrom's macroglobu Iinem ia.' Shortly after the lung biopsy, the patient's hematocrit dropped from 35% to 28%, and she was also noted to have melena and guaiac-positive stools. Repeated upper gastrointestinal endoscopy was performed with the Olympus Model GFB-2 fiberscope. On this examination the body of the stomach was found to be extremely abnormal with hemorrhage, friability, adherent mucus, and nodularity. There were multiple areas of deep, irregular, poorly demarcated ulceration. The biopsy showed heavy infiltration of the stomach with lymphocytes, plasma cells and plasmacytoid lymphocytes (Figure 2). This mixed lymphoid infiltrate is consistent with Waldenstrom's disease.' The patient was treated for a month with 100 mg daily of oral cyclophosphamide, and repeated endoscopy with the Olympus Model GFB2 fiberscope revealed significant improvement. There were 3 to 4 superficial ulcerations in the distal body of the stomach. The mucosa through this area still appeared infiltrated. There was less friability of the mucosa than on the previous examination, but the endoscopic biopsy continued to show the presence of plasmacytoid lymphocytes.