Case reportAt the age of 4 yrs the male child suffered from a Wilms-tumour of the right kidney treated by polychemotherapy (SIOP No. 9 for stage 1 using actinomycin and vincristin) and surgical removal. A year later, abdominal pain occurred and a local relapse of the Wilms-tumour was diagnosed. Further diagnostics revealed infiltration into the liver, diaphragm, and the thoracic wall. In addition, three lung metastases were found. The child received polychemotherapy again (according to protocol SIOP 93/01 for stage 4 using adriamycin, etoposide, carboplatin, ifosphamide) and radiotherapy of the lung, abdomen (15 Gray) and of the tumour site (35 Gray). The tumour could be resected. All follow-ups during the next 6 yrs showed remission and the child was healthy.At the age of 11 yrs, he presented with fever and cough. The chest radiograph showed an opacity of the left upper field ( fig. 1). Under the suspicion of pneumonia, antibiotic treatment was started. Due to bronchial obstruction, the child received low-dose inhaled steroids and b-adrenergic agents. Nonetheless, he still suffered from bronchial obstruction and intermittent fever. Pulmonary function measurement revealed a mixed restrictive and obstructive ventilation disorder (forced vital capacity 52%, forced expiratory volume in one second 49% and flow at 25% vital capacity 13% predicted). Computed tomography (CT) scan of the thorax (including radioopaque material) was performed ( fig. 2).For further diagnosis flexible bronchoscopy was performed, revealing a ball-shaped, soft, solid tumour deriving from the left upper lobe bronchus and bulging into the ostium of the left main bronchus ( fig. 3). In order to obtain a thorough diagnosis of the tumour, thoracic surgical intervention was performed. The histology of the tumour revealed typical findings ( fig. 4).
Intermittent pressure within the limits of physiological stress and strain stimulates the growth plates of a healthy bone (Pauwels), whereas a constant pathological strong pressure does inhibit the enchondral longitudinal growth (Hueter-Volkmann). An active change of direction of growth is induced if the pressure is exerted excentrically: growth deformities. In the presence of a diseased weak bone asymmetrical pressure leads to passive bending of bone: weight bearing deformities. An attempt is made to support these distinctions by experimental and clinical observations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.