Subglottic hemangiomas in infants: treatment with intralesional corticosteroid injection and intubation.

Six children with a subglottic hemangioma were treated in the Sophia Children's Hospital in the period 1982-1987 by means of intralesional corticosteroid injection, followed by intubation. After treatment all children were symptomfree. In 3 patients this result was attained after 1 injection, in 2 after 3 injections. One patient needed 5 injections. The average duration of intubation was 19 days (7-36). Three months (1/2-7 1/2) after the onset of therapy all patients were free of symptoms. No serious complications were observed. No patient needed a tracheotomy. The average follow-up period was 3.3 years (1 1/2-5 1/2). The authors feel that not only the effect of intralesional corticosteroids, but also local gentle pressure by the tube is of therapeutic importance. The above-mentioned treatment of subglottic hemangioma in children is now the treatment of choice in our clinic.

Levamisole in the treatment of juvenile laryngeal papillomatosis.

Three patients are described who were treated with levamisole for juvenile laryngeal papillomatosis. In two patients no effect of levamisole was noted during a treatment period of 8-9 months. In the third patient a remission of the disease was noted some months after starting levamisole treatment. In view of our experience with the other two patients the remission may be due to the capricious natural course of the disease rather than to the effect of levamisole. Levamisole does not seem to be an effective drug for the treatment of extensive juvenile papillomatosis and according to the literature not a harmless drug.

Congenital nasal stenosis in neonates.

Sixteen newborn infants with respiratory problems due to bony nasal obstruction were studied. In 14 patients no surgery was needed. In two patients surgery became necessary after a few months. Congenital narrowing of the nasal passage was unknown until recently. The origin of the disorder is discussed.

Caustic injury of the oesophagus. Sixteen years experience, and introduction of a new model oesophageal stent.

Caustic ingestion can lead to oesophageal stenosis. We studied 251 patients, 205 of whom were children, in a sixteen-year period. Seventeen patients, of whom one was an adult, acquired deep burns in the oesophagus which had to be treated, to prevent the development of oesophageal strictures. These patients were treated with long-term stenting of the oesophagus with specially designed, silicone rubber stents, impregnated with silicone oil 20 cS, designed by one of us (R.N.P.B.) as the only treatment. Of all models, the twin-tube dilator was the most satisfactory. No corticosteroids were administered. Only one patient developed a mild stenosis. It is therefore our opinion that, when life-saving operations are not indicated, twin-tube stenting of the oesophagus is helpful in treating caustic lesions of the oesophagus and will prevent stricture formation. Corticosteroids were not given in this series, and should be abandoned in the treatment of caustic lesions.

Reconstruction of the ossicular chain with an autologous bone cylinder, produced with a hollow drill. Technique and application: a preliminary report.

An autologous bone cylinder is produced with a hollow drill. After modelling this bone cylinder, it is easy to reconstruct a stable ossicular chain in the middle ear.

Native starch in tablet formulations: properties on compaction.

Maize, potato, rice and tapioca (cassava) starch were evaluated with respect to their properties on direct compression. Rice starch showed much better compactibility as compared to maize, potato and tapioca starch. Moreover, its binding capacity proved to be almost insensitive to mixing with magnesium stearate. This in contrast to the dramatic decrease in crushing strength of potato starch tablets containing the lubricant. The compactibility of the starches was found to be strongly affected by the equilibrium moisture content of the starches, which is dependent on the relative humidity of the atmosphere under which the powders were stored. All starches showed adequate capacity for water uptake to act as a disintegrant. Rice starch exhibited worst flowability, caused by its fine particle size as compared to the other starches. Granulation of rice starch changed it into a potential filler-binder in tablets prepared by direct compression.