A 10-year-8-month-old girl with the Pickwickian syndrome was presented. In this case, asthmatic bronchitis preceded the development of the Pickwickian syndrome. There was no mental retardation. Pulmonary function tests revealed a pattern of hypoventilation: reduc tion in tidal volume, inspiratory capacity, maximum breathing capacity and timed vital capacity, and increase in functional residual capacity, residual volume and the residual volume/total lung capacity ratio. Further, forced expiratory volume for one second/forced vital capacity, maximal midexpiratory flow, the air velocity index and the expiratory check valve index were also found to be reduced, suggesting the existence of airway obstruction. From the clincial symptoms, course and pulmonary function tests of our case, it was assumed that in our case, bronchial obstruction due to asthmatic bronchitis, in combination with malfunction of the respiratory muscles due to obesity, played an important role in the development of the syndrome.
A male patient kat present , 8 years of age) with autoimmune hemolytic anemia of `warm type' was under our observation since 3 years and 6 months of age, when he was first admitted to our hospital. The patient was treated by splenectomy and long-term steroid medication for 2 years and 3 months. However, because a complete remission could not be attained, the patient was thymectomized as a last resort at the age of 5 years and 1 month. Apparently, thymectomy was effective in reducing the steroid dosage (1.25 mg 4 successive days a week to 0.75mg 3 successive days a week), in improving the clinical symptoms and in abolishing the necessities of blood transfusions. autoimmune hemolytic anemia; thymectomy
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