Endoscopic removal of a swallowed ball bearing from stomach of a 4-year-old child.

substances from impacted neutrophils in the lungs. Since poly-acrylonitrile membrane dialysers also activate complement but do not cause appreciable leucopenia,; it is more likely that the mechanism implicated in our patient was pulmonary leucostasis. There are several other unexplained complications of dialysis which might be related to complement activation or leucostasis or both. They include arthralgia, abdominal discomfort, migraine, and ascites. Trials of polyacrylonitrile membrane (avoiding neutropenia) or poly-carbonate membrane (avoiding complement activation) would seem worthwhile in these conditions. Osmotic fragility of erythrocytes in Duchenne muscular dystrophy Duchenne muscular dystrophy is an X-linked recessive disorder affecting young boys. It is one of the more severe forms of muscular dystrophy and is transmitted by healthy female carriers. Onset is usually at 3-5 years and affected individuals become chairbound by the end of the first decade. Death occurs in the late teens or early twenties from cardiac failure or pneumonia. The basic defect in this disorder is as yet unknown but several recent studies'"' have suggested that there may be a generalised membrane abnormality affecting erythrocytes as well as muscle. Fisher et a14 have reported an increase in the osmotic fragility in cases of what they refer to as "pseudo-hypertrophic muscular dystrophy." We report here our findings in a series of 10 patients with confirmed Duchenne muscular dystrophy and four definite carriers. (A definite carrier is defined as the mother of an affected boy with another affected male relative. The four carriers studied here had serum creatinine kinase levels of 83, 132, 213, and 344 IU/l (normal upper limit 85 IU/1).) Patients, methods, and results Heparinised samples of venous blood were obtained from patients (aged 1-18), their unaffected brothers (aged 1-16), and female carriers (aged 23-56) when the families attended the muscular dystrophy clinic in the department. Control samples were obtained from young boys (aged 4-15) before ortho-Per cent lysis (mean ± SD) itn male controls, boys with Duchenne muscular dystrophy (DMD), their unaffected brothers, female controls, and definite carriers Sodium Male DMD Female Definite chloride controls patients Brothers controls carriers concentration (n = 10) (n = 10) (n = 5) (n = 36) (n = 4) paedic operations for disorders unrelated to neuromuscular abnormalities and healthy women volunteers (aged 17-67). The amount of lysis at various concentrations of sodium chloridc was determined bv the method of Dacie and Lewis.5 The concentrations of sodium chloride resulting in 50'>, lysis of each sample …