No abstract

SummaryWe have studied the time of appearance of immunoglobulincontaining cells in the intestine of newborn infants. In 46 intestinal specimens from infants 2 hr to 6 months old, the numbers of immunoglobulin-containing cells were counted by the direct immunofluorescent or direct immunoperoxidase technique. MATERIALS AND METHODSA restudy was made of biopsy specimens taken for diagnostic purposes, 34 from the rectum and 3 from the transverse colon of PATIENTS 30 infants at the Children's Hospital, Helsinki in 1971-1977, and hi^^-^^^^^ biopsy specimens, 34 from the rectum and 3 from in addition, of autopsy material recently collected from the the transverse colon of 30 infants I day to 6 months old collected tines of 9 infants. Up to the age of 12 days, no immunoglobulin-in 1971-1977 at the Children's Hospital, Helsinki, were restudied. containing cells were seen. A small number (1 to 2) of IgM-Patients who had symptoms or signs suggestive of intestinal infeccontaining was wen in the lymph nodes the tion or malabsorption syndrome were excluded from the study. taken at the ages and l2 days. A Wcimen Fresh intestinal autopsy material was collected from a further 9 from a 1 2 -d a~e l d infant showed 24 and 60 IgM-containing infants who died of cardiac or respiratory failure; 4 of these were cells/mm2. In rectal specimens of infants less than 1 month old, born at term. A piece of upper jejunum was removed 2 to 8 hr the mean number of IgM-containing cells (26/mm2) was higher postmortem; 3 samples were taken in 1972 and 6 in 1978. The than that of IgA-containing cells (14/mm2)9 but older infants had earlier samples were processed for direct immunofluorescent study a significantly higher mean number of IgA-containing cells ( P < (15). and the 6 later ones were fixed in formalin and stained with 0.01). The mean number of IgM-containing cells was the same in peroxidase-conjugated antisera as described below. Measurements children 1 to 3 months (53 cells/mm2) and 3 to 6 months of age made in 1 1 patients (8 of the rectal biopsy group and 3 of the (59 cells/mm2), whereas the mean number of IgA-containing cells autopsy group) showed that serum immunoglobulins were normal. increased with age UP and 163 cells/mm2)-The Informed consent was obtained from the parents of all the infants youngest infant who had IgC-containing cells was 13 days old, before doing the autopsy, although positive staining of intercellular spaces in the lamina propria and of the capillary endothelium by anti-IgG serum was METHODS observed in all specimens. The mean number of IgG-containing cells was low (5 cells/mm2) in all age groups. Sparse IgE-containRectal biopsies had been taken 4 to 10 cm proximally of the ing cells (less than 12/mm2) were seen in 4 of the 46 specimens. In anal sphincter from infants suspected to have Hirschsprung's 5 patients, 2 or 3 consecutive specimens were available for the disease; the 3 biopsies from the colon were taken during transstudy; in these, the increase in the numbers of IgA-and IgM-versostomy. Specimens were fi...

SUmmARY Forty two children were admitted to this hospital between 1975 and 1980 with severe iron deficiency anaemia and 8 of them also had oedema caused by a low concentration of serum proteins. These 8 patients, aged 8-24 months, and 13 age matched controls were investigated. The patients had excessive faecal loss of 59FeCl or 51Cr-albumin, or both; their jejunal biopsy specimens showed little decrease in the ratio of villous height to crypt depth; and they had fewer intraepithelial lymphocytes and cells containing IgA than controls. They were all treated with an oral ferrous iron preparation and the oedema, hypoproteinaemia, and low haemoglobin concentrations rapidly resolved. These results show that immunologically mediated hypersensitivity is not implicated in iron deficiency anaemia associated with hypoproteinaemia.

In a multinational, population‐based study from the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), 2648 children below 15 y of age were diagnosed with acute lymphoblastic leukaemia (ALL) in the years 1981‐1996. The annual incidence was 3.9/100 000 children and was stable throughout the study period. The development from regional or national protocols to common Nordic treatment protocols for all risk groups was completed in 1992 through a successive intensification of therapy, based on multidrug chemotherapy including pulses of methotrexate in high doses and avoidance of cranial irradiation in most children. For children with non‐B‐cell ALL (n= 2602), the event‐free survival (p‐EFS) increased from 0.53 ± 0.02 (diagnosed 7/81‐6/86) to 0.67 ± 0.02 (7/86‐12/91) to 0.78 ± 0.02 (1/92‐12/96). The corresponding p‐EFS values at 5 y were 0.57, 0.70 and 0.78, respectively. The main improvements were seen in the group of children with non‐high risk leukaemia, with 5‐y p‐EFS values increasing from 0.60 to 0.76 and 0.85 for the three periods. In high‐risk patients, progress has been moderate, especially in children with high white blood cell values at diagnosis. During the last 5‐y period, only 10% of the patients received cranial irradiation in first remission while 90% of the patients received high doses of cytostatic infusions (methotrexate isolated or combined with cytarabinoside) and multiple intrathecal injections of methotrexate as CNS‐adjusted treatment without any indication of an increased CNS relapse rate.

In a retrospective analysis we evaluated the occurrence of infections in 59 children with acute lymphoblastic leukemia (ALL) during the entire duration of their anticancer chemotherapy. We recorded a total of 245 infection episodes, 118 (50%) being during neutropenia and 119 (50%) during nonneutropenia. The infections most commonly detected during neutropenia were fevers of undetermined origin (36%), clinically or microbiologically defined focal infections (33%), and bacteremias (28%). During nonneutropenia, upper respiratory tract infections (55%) were the most common. Patients needed hospitalization for infections for a total of 1951 days (i.e., a mean of 33 days per patient) and the mean number of infection episodes was 4.2 per patient. Recurrent fever developed in 21% of the children with bacteremia. Mortality caused by bacteremias was 10%. Infections during the chemotherapy of ALL were a significant cause of morbidity in children, but mortality was low.