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  Česky / Czech version Endoskopie, 2006, 15, č. 3, s. 58–60.
 
Benign stenosis of oesophagus of mycotic aetiology with the primary diagnosis of acute lymfoblastic leukaemia in young patients 
Svobodová D.1, Klvaňa P.2, Slaný J.1, Blažek B.1, Čuřík R.3 

1Klinika dětského lékařství FNsP Ostrava, přednosta: doc. MUDr. Jaroslav Slaný, CSc. 2Interní klinika FNsP Ostrava, přednosta: doc. MUDr. Arnošt Martínek, CSc. 3Ústav patologie FNsP Ostrava, přednosta: MUDr. Romuald Čuřík
 


Summary:

       The present study discusses two cases of benign oesophagus stenosis of mycotic aetiology in two young girls treated for acute lymphoblastic leukaemia. Both of them have undergone an intensive treatment by cytostatics following BFM ALL IC 2002 protocol, i.e. in an immunodeficient condition, both infected by Candida Albicans on different scales (positive cultivation from the throat, urine, vomit, and stool in the 3-year-old, systemic candidosis affecting the spleen, liver and lungs in the 2-yearold), accompanied by the positive ELISA anti-gene from the serum. Consequently, an oesophagus stenosis has been diagnosed (a filiform stenosis at 15 cm from the incisors in the 2-year-old: Th 5-6, 8 mm at 20 cm from the incisors in the 3-year-old;). The condition is successfully controlled by means of gradual dilatations up to 14–16 mm followed by possible peroral reception of minced and mushy food. The endoscopic intervention is here complicated by the children’s primary disease, by repeated occurrences of febrile neutropenia, and blocks of chemotherapy during which invasive operations must be avoided. The timing of individual dilatations is thus extremely difficult, they must be carried out very carefully due to the danger of perforation and in general anaesthesia with respect to the young patients (in the cases presented the patient-friendly anaesthetics included isofluran as an inhalant anaesthetic and propofol – a phenol derivative with an ultrashort effect as an intravenous anaesthetic, the shortest one as far as oxidative stress is considered).

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