Non-Hodgkin's lymphomas of the nose and paranasal sinuses in the pediatric population.

Paranasal and nasal neoplasms often elude early diagnosis in the pediatric population. This report examines 3 cases of nasal and paranasal sinus lymphomas out of 29 lymphomas and lymphoproliferative disorders seen from 1983 to 1990. Diagnostic delays are common. The development of orbital signs and symptoms often leads to diagnosis. Computed tomography and magnetic resonance imaging are important in delineating the extent of disease and allow appropriate staging. Transnasal biopsy yields the definitive diagnosis, with low associated morbidity. Aggressive chemotherapy and irradiation prolongs survival; with this regimen all of our patients have remained alive, although 1 has residual disease. B-cell lymphomas are more common than T-cell varieties in children. One patient demonstrated B-cell immunodeficiency and preleukemia prior to developing primary paranasal sinus non-Hodgkin's lymphoma; this case reiterates the systemic nature of lymphoma, Key differences between children and adults in the manifestations of nasal and sinus lymphomas are emphasized.

Sleep abnormalities in patients with severe cerebral palsy.

The all-night polysomnographic findings of nine patients with spastic quadriparesis (mean age 36.7 months) were analysed retrospectively and compared with those of nine age-matched controls (mean age 37.4 months). The cerebral palsy group had significantly more respiratory disturbances per hour of sleep, with five of nine being diagnosed as having obstructive sleep apnea. They also had fewer changes in body position during the night. Interictal epileptiform discharges averaged 23.3 per cent of the total arousals in the cerebral palsy group. Obstructive apnea, decreased ability to change body position, and interictal epileptiform discharges are prevalent in the sleep of patients with severe cerebral palsy, and contribute towards its disruption.

Extraluminal esophageal coin erosion in children. Case report and review.

Coins are often reported as the most commonly ingested foreign body (FB) in children. They are felt to be benign FBs since they usually pass through the gastrointestinal tract without incident. However, when these objects become impacted within the esophageal lumen, they can perforate the esophagus and migrate extraluminally. Symptoms of the perforation itself are frequently absent, but the potential vascular and suppurative complications may be devastating. We present the 10th reported case of complete extraluminal migration of an esophageal coin, and the only case which was treated without an open surgical procedure. Because of the potential complications, we recommend aggressive surgical intervention as soon as the diagnosis is made.

Papillary adenocarcinoma in ectopic thyroid.

A single case of papillary adenocarcinoma of median ectopic thyroid is presented. There have been 96 other similar cases reported in the English literature. Since the tumor rarely involves the cervical lymphatics or thyroid gland in the absence of a palpable mass, local excision with the Sistrunk procedure is the recommended therapy. Suppression doses of thyroid hormone may be of benefit.