SHORT-TERM FOLLOW-UP OF THE NUTRITIONAL STATUS OF CHILDREN UNDERGOING AUTOLOGOUS PERIPHERAL BLOOD STEM CELL TRANSPLANTATION

A prospective longitudinal study was conducted to analyze the evolution of the nutritional status of 34 children (12 girls and 22 boys), aged 1.5-15.8 years (median age 9.06), undergoing autologous peripheral blood stem cell transplantation (PBSCT). The nutritional status was evaluated at baseline, days + 1 and + 7, discharge, and day + 30 by dietary or parenteral intake, anthropometric and laboratory measurements, and nitrogen balance. At baseline, changes in anthropometric (53%) and biochemical measurements (83%) are frequent but mild. The mean caloric intake was normal. Children with normal values for the anthropometric parameters all had an intake > 80% (p < .01). No correlation was found between the anthropometric and biochemical parameters. During transplantation, significant changes (p < .001) were found for energy intake, albumin, transferrin, and nitrogen balance. Fibronectin, prealbumin, and retinol-binding protein showed only a few changes. All but prealbumin recovered on day + 30. No correlation was found between the nutritional status and toxicity or infection in children undergoing autologus PBSCT. The changes in the nutritional status observed at the start of transplantation correlated with the nutrional intake. Anthropometric and biochemical changes are complementary. The results may be ascribable to the fact that the patients in this series had mild malnutrition.     

THE COMPARISON OF ANTIBODY RESPONSE TO DIFFERENT HEPATITIS B VACCINES WITH AND WITHOUT pre-S2 ANTIGEN IN CHILDREN WITH CANCER

Children with cancer are at an increased risk of hepatitis B infection and chronic liver disease. Since hepatitis B vaccines containing pre-S2 antigen has been recently reported as being more efficient in providing immunization in healthy individuals, the authors compared antibody response to pre-S2-containing vaccine with no-pre-S2-containing hepatitis B vaccine, when given in double doses to 100 children receiving chemotherapy. Patients, aged 1 to 16 years with negative HBV serology, were vaccinated with 2 different types of HBV vaccines between 1997 and 1999. Group 1 received Gen Hevac B containing pre-S2 ( n = 41) in a dose of 20 &#119 g for patients younger than 10 years old and 40 &#119 g for older patients. Group 2 was vaccinated at the same dose with hepatitis B vaccines not containing pre-S2 antigen. All vaccinations were repeated at 0, 1, and 6 months. Serum samples were drawn for determination of anti-HBs titers at 1, 3, 6, and 8 months. After the third dose of vaccine, the seroconversion rate was 72% in group 1 and 62% in group 2. The anti-HBs levels were higher in the group receiving pre-S2-containing hepatitis B vaccine. However, the difference between groups was not statistically significant ( p > .05). The administration of pre-S2-containing hepatitis B vaccines may give a better seroconversion and higher antibody response to vaccination in children with cancer. But a further large-scale study is needed to confirm this finding.     

IMMUNOGENICITY OF HEPATITIS A VACCINE IN CHILDREN WITH CANCER

This study evaluated the immuned response of the hepatitis A vaccine in children with cancer who were receiving chemotherapy. Twenty-eight patients with lymphomas or solid tumors and who had negative serology for hepatitis A were enrolled. The median age was 4.7 years (range 2–16). The patients received 1440 IU hepatitis A vaccine at 0 and 6 months. Seroconversion rates at the first and seventh months were 60% (n = 17/28 patients) and 89% (n = 24/27 patients). No adverse effects were observed. The hepatitis A vaccine was found to be effective and safe in children with cancer.     

MVPP CHEMOTHERAPY COMBINED WITH RADIOTHERAPY IN THE TREATMENT OF HODGKIN'S DISEASE IN CHILDREN

ABSTRACT. Thirty-four children with Hodgkin's disease were treated during the years 1969–75. After radiotherapy, 7–15 cycles of MVPP were given within 24–53 months. In order to avoid chronic leukopenia, leukocyte counts were made frequently during chemotherapy, and the drug doses adjusted accordingly. A complete remission was obtained in 32 of the 34 children. Two patients died because of progressive disease. Twelve of the 32 survivors have been followed for at least 5 years, and a further 12 for at least 3 years. Three children are still on chemotherapy, whereas the remaining 29 being followed are in continued complete remission.     

SELECTIVE SURGICAL INDICATION IN THE MANAGEMENT OF NEUTROPENIC CHILDREN PRESENTING WITH ACUTE ABDOMEN

As the treatment of pediatric malignancies improves and survival increases, the diagnosis of acute abdomen in these patients also becomes more common. Nevertheless, the management of this a condition is still controversial. The authors report their experience in treating 12 neutropenic children with acute abdomen. The charts of 12 neutropenic patients with a diagnosis of acute abdomen treated at Boldrini Children's Cancer Center in Campinas, Brazil, between 1991 and 1996, were reviewed. Therapeutic strategy included an initial period of bowel rest, general supportive measures, and broadspectrum antibiotics while waiting for the neutrophil count to rise. Three patients recovered completely without surgery, 8 under went late surgery without complications, and 1 died due to uncontrolled sepsis before surgery. The treatment of acute abdomen in neutropenic children remains controversial. As shown in the present series, an initial nonoperative approach with selective surgical indication appears to be safe and to yield good results. Supportive treatment, until the neutrophil count rises, followed by surgery, if necessary, appears to be a sound therapeutic approach for neutropenic children with acute abdomen.     

EVALUATION OF PERIPHERAL LYMPHADENOPATHY IN CHILDREN

The aim of this study was to evaluate children with lymphadenopathy and clinical approach to the suspicion of malignancy. The authors evaluated 457 patients with peripheral lymphadenopathy, less than 19 years of age, and referred to the Pediatric Oncology Department of Gazi University Medical School during the periods March 1996–April 2004. A total of 346 patients had benign disorders and 111 had malignant pathologies. Excisional biopsies were performed to 134 patients. A specific etiology could be found 39% in the benign group. Of the 457 patients, 218 were presented as acute, the rest as chronic lymphadenopathy. In the acute lymphadenopathy group, 98.2% of the patients had benign etiologies. The malignant disorders were mostly represented as chronic lymphadenopathy. Concerning the extension, 193 patients had localized lymphadenopathy and 264 had generalized lymphadenopaties. Cervical region was the most frequent site in both localized and generalized lymphadenopathy groups. Malignancies occurred as generalized lymphadenopathy. Supraclavicular area were involved only in the malignant group. Axillary involvement was predominant in BCG vaccine associated lymphadenitis and mycobacterium tuberculosis. All the lymph nodes less than 1 cm were due to benign causes. The malignant lesions were usually more than 3 cm in diameters. The following findings should alert the pediatrician for the probability of a malignant disorder: lymphadenopathy of more than 3 cm in size, of more than 4 weeks in duration, with supraclavicular involvement, and with abnormal laboratory and radiological findings.     

IV. EVALUATION OF DICHROMATIC EARPIECE DENSITOMETRY IN CHILDREN WITH LEFT-TO-RIGHT SHUNTS

Abstract: Earpiece densitometry was performed in 60 infants and children with left-to-right cardiovascular shunts. The method was found to possess a high diagnostic sensitivity with respect to identification of the left-to-right shunt. Earpiece densitometry was in this respect clearly superior to conventional method using oxygen saturation figures. Quantitation of pulmonary blood flow by both densitometric and oxygen content technique in a small number of patients indicates that the dye dilution technique gives values somewhat in excess of the Fick method. It is concluded that quantitation of the magnitude of the left-to-right shunt and pulmonary blood flow is disturbed by the fact that indicator material is recirculated before the ascending limb of the primary curve is fully inscribed.     

CLINICAL OUTCOME OF FEBRILE NEUTROPENIA IN CHILDREN WITH CANCER USING CEFTAZIDIME AND AMINOGLYCOSIDES

To determine treatment outcome using ceftazidime–aminoglycosides in febrile neutropenic children with cancer, the authors conducted a prospective cohort study in 216 episodes. Early and complete responses to antibiotics were 108/216 (50.0%) and 133/216 (61.6%) episodes, respectively. Death, a modification of antibiotic(s), and resistance to ceftazidime were 2/118 (1.7%), 73/216 (33.8%), and 4/216 (1.9%) episodes, respectively. Primary bacteremia and emerging bacteremia during treatment were 20/216 (9.3%) and 5/216 (2.3%) episodes. Ceftazidime–aminoglycosides was found to be a reasonable initial treatment of febrile neutropenia in the authors’ institution. Imipenem is considered in patients who have clinical sepsis and who fail to respond to initial treatment.     

A LONGITUDINAL STUDY OF CARDIAC FUNCTION IN CHILDREN WITH CANCER OVER 40 MONTHS

A previous study demonstrated impaired systolic function in 29% of patients treated with an thracycline as part of their therapy for malignant disease. A follow-up echocardiographic study was performed to determine whether there had been further deterioration of cardiac function. At least 40 months after the first study, those patients in whom abnormal systolic function had been detected and who had not received further anthracycline were studied by echocardiography using the same protocol as the initial study (group A). A second group of pediatric oncology patients who had not been given anthracycline but who had previously had cardiac assessment was selected as a control group (group N). The age and sex distributions of the two groups were comparable. Group A comprised 29 patients assessed on 2 occasions at mean times of 46 months and 89 months from the last dose of anthracycline. The mean dose of anthracycline received was 233 mg/m² (range 20-400). Nine of 16 patients and 4 of 5 patients who had abnormal ejection fraction (EF) and fractional shortening (FS) at first assessment had normal EF and FS at the second assessment. There were no significant changes in EF, FS, and left ventricular wall stress (LVWS) between the two examinations. In group N, 20 patients were assessed after a mean interval of 43 months. There were no significant changes in EF, FS, or LVWS between the two examinations. At the first but not the second examination there were significant differences in the left ventricular internal diameters, EF, FS, and LVWS between group A and group N. Mildly abnormal cardiac indices detected in children after cessation of treatment with anthracycline did not deteriorate in 3 to 4 years follow-up. A longer cardiac follow-up study is indicated to assess the late outcome.     

ACUTE POISONINGS OF CHILDREN IN OSLO

ABSTRACT. A one year prospective study of all children under 15 years of age presenting for acute poisoning in Oslo is reported. There were 181 admissions in 179 children, of which 97 (54 %) were boys, giving an annual incidence of 2.3 %. All children survived without sequelae. Most poisonings were accidental and only two suicidal attempts were recorded. Of all poisonings 68 per cent occurred between the age of 1 and 2 years. The dominating toxic agents were drugs (44 %), tobacco (22 %) and petroleum products (9 %). Most poisonings were mild and only 7 (4 %) classified as severe. Seventy-two per cent of all children were admitted within the second hour after the ingestion of the toxic agent. Therapy should therefore be directed towards emptying the stomach with emetics or gastric lavage, unless corrosives or petroleum products are ingested. Childhood poisonings still call for better preventive measures since the toxic agent was found inappropriately stored in 86 % of the accidental poisonings.     

血清SIL-2R在急性白血病病程中的变化

采用ＥＬＩＳＡＭ抗体夹心法检测４０例不同类型的急性白血病患者ＳＩＬ２Ｒ，并动态观察了在化疗过程中发生各种感染时ＳＩＬ－２Ｒ的变化，以及不同疗效转归患者的ＳＩＬ－２Ｒ的变化情况。结果发现：急性白血病ＳＩＬ－２Ｒ水平显著高于正常人（ｎ＝２５），高危组白血病ＳＩＬ－２Ｒ升高更为显著，在化疗过程中发生感染时ＳＩＬ－２Ｒ进一步升高，感染越严重升高越显著；不同疗效的患者ＳＩＬ－２Ｒ恢复程度不一致，完全缓解者已接近正常水平，部分缓解者虽然有所下降但与完全缓解者的下降有显著差别。这些结果提示ＳＩＬ－２Ｒ监测对判断急性白血病病情、了解预后，有一定临床价值。     

EVALUATION OF PROGNOSIS AND TREATMENT IN BELL'S PALSY IN CHILDREN

Nerve-excitability measurements performed early in the course of the disease are of a good prognostic value. The results show that when excitability is maintained unimpaired after 72 hours of the onset, there is a chance of 100% spontaneous cure. When the excitability is diminished by less than 50%, 90% recovery may occur, but when it is markedly diminished or absent the prognosis is bad. The schedule of treatment to be followed should be based on the result of nerve excitability measurement early in the course of the disease. Systemic vasodilators, as nicotinic acid early in the course of the disease has excellent effect as it cuts the vicious circle of arteriolar spasm without increasing pressure within the facial canal. It is advisable that early short wave therapy should be avoided as it may increase nerve compression through local vascular congestion in the vicinity of the nerve. Incidence of physiological block is higher in children with Bell's palsy than in corresponding adult patients who, as a result have a higher incidence of nerve degeneration and worse prognosis. The severity of paralysis does not indicate the degree of nerve lesion.     

PROGNOSTIC VALUE OF DAY 14 BLAST PERCENTAGE AND THE ABSOLUTE BLAST INDEX IN BONE MARROW OF CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA

This study included all 690 children in Norway diagnosed as having acute lymphocytic leukemia (ALL) from July 1975 till the end of 1997. Relapses and deaths were monitored until the end of 2000. Neuroleukemia prophylaxis was intravenous methotrexate (MTX) infusions as intermediate-dose methotrexate (IDM) or high-dose methotrexate (HDM) combined with intrathecal MTX. From 1992, systemic therapy was considerably intensified, and, in addition, patients in a subgroup of the high-risk and very high-risk groups were given prophylactic cranial irradiation. The overall findings showed that MTX significantly reduced central nervous system (CNS)-related relapses, and, in general, reinforced systemic therapy reduced significantly non-CNS relapses and deaths. The overall crude survival was 75%. During the study period, the crude survival improved for patients on standard protocols from initially 65 to 90%. Forty patients (6%) developed isolated CNS relapse, 27 (4%) had combined CNS relapse, whereas 180 (26%) had non-CNS relapse. When IDM and HDM were compared, the cumulative risk for isolated CNS relapse was significantly lower with HDM, 12 and 5%, respectively. For any relapses that involved the CNS, the risk remained significantly lower for HDM, 8 versus 18%. Of the 40 patients with isolated CNS relapse, 23 survived (58%).     

ANALYSIS OF 136 FEBRILE NEUTROPENIC EPISODES IN CHILDREN WITH CANCER: Evaluation of Treatment Effectiveness and Cost

In this study, 136 febrile neutropenic episodes were overviewed retrospectively. Factors affecting treatment success and cost were analyzed. Twenty percent of the episodes were microbiologically documented and 51% of the bacterial isolates were gram negatives. The most commonly used empirical therapies in febrile episodes were the combination of two drugs (58.0%), monotherapy (14.8%), and antibiotics plus fluconazole (20.6%). In lymphoproliferative tumors duration of fever and discharge from the hospital were longer. Administration of the hematopoietic growth factors shortened neither the duration of neutropenia nor fever and hospitalization. Treatment costs were higher in lymphoproliferative tumors, in bacteremia, and in episodes where glycopeptides, antifungal drugs, and hematopoietic growth factors were used. In conclusion, duration of neutropenia was a significant independent predictive factor for duration of fever. In the lymphoproliferative tumors, duration of fever was longer and cost of treatment was more than in the solid tumors.     

MUTATIONS OF RETINOBLASTOMA GENE (Rb-1) AS A PROGNOSTIC FACTOR IN CHILDREN WITH ACUTE LEUKEMIA AND NEUROBLASTOMA

Rb-1 is a tumor suppressor gene encoding for a nuclear phosphoprotein acting as a cell cycle regulator, normally expressed in hematopoietic cells and more often inactivated by point mutations with predominance for exons 20-24. The aim of this study is to correlate the retinoblastoma-1 (Rb-1) gene mutations with the prognosis and progression of childhood acute leukemia and neuroblastoma. Bone marrow slides from 26 children with leukemia (18 acute lymphoblastic leukemia [ALL] and 8 acute myeloid leukemia [AML]) and 4 children with neuroblastoma were studied. Exons 20, 21, and 22 were amplified using the polymerase chain reaction technique. Single strand conformational polymorphism (SSCP) and heterodoublex analysis were performed to detect mutations. In ALL cases, two samples in exon 20 (11.11%), one in exon 21 (5.56%), and four in exon 22 (22.22%) had altered conformation. All but one of these cases were classified as high-risk leukemia patients who either relapsed or never achieved remission. Two of the AML cases who did not achieve remission and one of the neuroblastoma cases with concomitant bone marrow infiltration had altered conformation as well. The SSCP and heterodoublex analysis showed that all but one who did not belong to the high-risk group had the same altered conformation. These data suggest that Rb-1 gene could possibly be used as an independent prognostic factor for the acute leukemia of childhood and result in the intensification of chemotherapy. In solid tumors with bone marrow involvement it could play a role as a marker of aggressive disease.     

EVALUATION OF TWO SPIROMETERS AND TWO FLOWMETERS IN ASTHMATIC CHILDREN

ABSTRACT. The reliability of a Monaghan (M 403) spirometer and a Vitalograph spirometer was evaluated in 46 children with "subclinical" asthma. As in previous studies of healthy children the vital capacity (VC) and the forced expiratory volume in one second (FEV_1.0) were close to those of a Bernstein spirometer. The sensltivity of the spirometers and of two flowmeters (Wright's peak flow meter and Airflometer-Glaxo) was evaluated in the asthmatic children after inhalation of salbutamol and the changes after inhalation were compared to those obtained in a previous study of healthy children. The "simple" equipment gave substantial information about the degree of bronchial obstruction. It is concluded that the additional information obtained by using simple pulmonary function tests form a good basis for aggressive therapy.