Logan, George B.

Follow-up letters were received from 336 asthmatic patients who had been examined at the Mayo Clinic 17 to 27 years previously. There was a ratio of two male patients to one female. The age of onset of asthma was less than 5 years in 65% of patients. Forty-eight per cent of patients reported that they had wheezing at the time of follow-up. There was essentially no difference between those who had an early onset of asthma and those who had a later onset. Of patients who had had associated eczema, 54% reported wheezing in the preceding year in contrast to 42% of those who had had no associated allergic disease. Of the group having had allergic rhinitis, 48% reported wheezing at the time of follow-up; this also was the average for the total group. When patients were divided into groups according to present age, a tendency was revealed for male patients to improve with age. This was not true of female patients.

To the Editor.— Diseases of the gallbladder and bile ducts, while uncommon among infants and children, still occur with sufficient frequency that they must be remembered by all pediatric clinicians. One of the problems in this regard is that of terminology. If stones are present in the gallbladder or ducts there is no problem, though one has to know that pigmented and nonpigmented (usually cholesterol) stones are both found in children. Cholelithiasis, with or without cholecystitis, is the proper diagnosis.

An infant with Hodgkin's disease and thymic alymphoplasia is described. The infant died at 5 months of age after an illness clinically characterized by frequent respiratory infections, erythematous rash, oral thrush, and hepatosplenomegaly. The peripheral blood showed severe anemia and lymphopenia; IgG level was very low, and there was no mitosis of peripheral lymphocytes after stimulation with phytohemagglutinin. Autopsy revealed Pneumocystis carinii pneumonia, thymic alymphoplasia, and Hodgkin's lymphoma in lymph nodes, liver, spleen, and lungs. A reovirus type 3 was isolated from the lungs. The association of diseases as rare as Hodgkin's disease and thymic alymphoplasia suggests a relationship between them. This may consist of either an abnormal susceptibility to oncogenic virus or an inability to destroy mutant cells in an infant with congenital immunologic-deficiency syndrome.

The records in 40 cases of congenital atresia of the extrahepatic biliary tract, proved at surgical exploration or necropsy or both, were studied at the Mayo Clinic with reference to clinical and pathologic aspects. Histologic examination of the liver was carried out in 21 of these cases; the muscular injections of vitamin K; each of these patients died during hospitalization.

What disease states are occasionally associ ated with hypogarathyraidisna? Is there any explanation for the association of moniliasis or steatorrhea in the syndrome re ported ? Is there a familial incidence of the syndrome of hypoparathyroidism, Addison's disease and moniliasis?