Bleeding complications in acute myeloblastic leukemia (author's transl)]

Bleeding is common in acute myeloblastic leukemia (AML). At the time of diagnosis, the danger of bleeding cannot be predicted by laboratory means. However, the following factors represent increased risks: Promyeloblastic leukemia, high blast count, low fibrinogen, low plasminogen. From coagulation studies performed at the time of bleeding complications, the pathomechanism leading to bleeding complications usually cannot be detected. The question whether impairment of production, consumption coagulopathy, or primary fibrinolysis causes the bleeding complications can only be answered by controlling frequently clinical and hemostatic criteria, which include the thrombocytic stystem as well as plasmatic coagulation and fibrinolysis. At the present time, the therapy of bleeding complications in AML is symptomatic. It consists of transfusion with thrombocytes or fresh whole blood, respectively. Coagulation factor concentrates should only be given in combination with Heparin to prevent the deterioration of consumption coagulopathy.     

Virusenteritis in childhood (author's transl)]

About 20% of infantile enteritis are caused by bacterial infections. The most cases of non bacterial infantile enteritis are supposed to be viral infections. Arguments for the existence of enterotropic viruses arised the first time in 1943. Since the middle of the fifties, various kinds of enteroviruses are known to be causative agents of infantile gastroenteritis. The same is true occasionally for some types of adenovirus. In 1973 the Norwalk-agent was discovered provocing enteritis mainly in adults. The most important progress was achieved by the discovery of Rotavirus. The viruses of this group nowadays are ment to be the most wide spread causes of enteritis in human beings and many mammalians. Rotavirus can be found in about 40--60% of acute infantile gastroenteritis in many parts of the world. Furthermore, in the last years of Coronavirus and Astrovirus were detected as causative agents of gastroenteritis in some domestic animals and probably in human beings too.     

Treatment and results of the first relapse of acute lymphatic leukemia in childhood (author's transl)]

In our experience the prognosis of hematological relapse in patients with acute lymphatic leukemia treated according to the Pinkel programme is very bad. It may be a little better for patients in whom relapse occurred after the end of therapy and who were submitted to intensified cytostatic treatment. The chances for achieving a second long-term remission, if the relapse is confined to the CNS, are also better. This is true particularly for those patients who in addition were given radiotherapy. In recurrence in the testes radiotherapy alone will not suffice and additional intensified cytosatic treatment should be considered.     

Myoclonic encephalopathy in childhood (author's transl)]

Two new cases of infantile myoclonic encephalopathy are reported and a survey of literature is given. The disease is characterized by generalised myoclonic jerks in all striated muscles, by cerebellar ataxia and by fast, jerking, mostly conjugated irregular eye movements (opsoclonus). The disease develops mostly during late infancy and early childhood. The pathogenesis is unknown, probably it is caused by immunological reactions to various agents. Treatment with ACTH or corticosteroids leads to rapid remission of the initial neurological symptoms, but it is suggested that therapy does not prevent frequent sequelae of psychomotor retardation and speech distubances. Remarkably, there is the high coincidence of infantile myoclonic encephalopathy and neuroblastoma. Therefore it is necessary to keep in mind the possibility of a causative neuroblastoma in all children with myoclonic encephalopathy and to control repeatly radiological findings and urin-excretion of catecholamines as well as their metabolic products.     

Cogans's syndrome in childhood (author's transl)]

A case--report is given of a patient with Cogan's syndrome in childhood. This syndrome consists of non-syphilitic interstitial keratitis and vestibuloauditory symptoms. Visual loss is rare but hearing loss is rapidly progressive. A relation to autoimmune diseases especially to panarteriitis nodosa has been suggested by a number of authors.     

Long-term second remission in acute leukemia of childhood (author's transl)

Report on a case of acute childhood leukemia, who presents with the following exceptional features: During complete remission early bilateral leukemic infiltrations of the testes, followed--after an intervall of several months--by a serve, general relapse with ascites. New induction therapy resulted in a second complete remission, persisting for the next 8 years with 6MP as well as after cessation of therapy until up to more than 17 years. Comparable courses are not as yet on record.     

Hodgkin's disease during remission of acute lymphoblastic leukemia (author's transl)]

1 1/2 years after diagnosis of acute lymphoblastic leukemia, Hodgkin's disease, stage IIA of cervical lymphnodes could be verified microscopically in a 7 year old girl in continuous complete remission (of leukemia) and was treated with regional irradiation and combination chemotherapy after exploratory laporotomy with splenectomy. The patient now is off therapy, healthy and without any signs of relapse of the two malignancies.     

Unusual skeletal changes in acute lymphoblastic leukemia in children (author's transl)]

During the early phase of their disease three children with acute lymphoblastic leukemia showed unusual skeletal changes radiologically. Mainly osteolysis in the lower jaw, opacity of the sinus, decreased hight of the vertebrae, and a unilateral necrosis of the head of the femur. These skeletal alterations are much more common in other diseases than in acute lymphoblastic leukemia.     

Relapse in acute lymphoblastic leukemia of childhood--treatment and results (author's transl)]

Twelve children with their first relapse of acute lymphoblastic leukemia who had the same initial therapy were treated on an out-patient basis. After 28 days all entered second remission. Medium remission duration was 11 months. At the end of the study seven patients were in continuous complete remission. Of the twelve children seven suffered bone marrow, two meningeal, two testicular relapses and one a combined bone marrow and meningeal relapse. Side effects were compatible with an out-patient treatment.     

The treatment of acute dehydration (author's transl)]

In infants and children acute dehydration is mainly caused by gastroenteritis with vomiting and diarrhoea, and by feeding failures. Since in the German speaking literature very different therapeutic regimens for rehydration are discussed the principles of oral and parenteral treatment are described. The rational therapy is based on the knowledge of physiology and pathophysiology of water and electrolyte metabolism. Therefore a few basic aspects are described, i.e. compartments of body fluids, turnover rates, the balance, types of dehydration, concentration of electrolytes in body fluids and their relevance to dehydration. Special problems exist in the treatment of hypertonic dehydration. In order to avoid cerebral edema the rehydration should not be attempted quickly with very hypotonic salt solutions, but should be performed with a 1/2--1/3 isotonic Ringer-lactate solution and early begin of potassium substitution over a period of 48 h.     

Subclavian steal syndrome in childhood (author's transl)]

The authors report on four children with subclavian steal associated with coarctation or interrupted aortic arch. All children showed a stenotic origin of the left subclavian; in addition three of them had an extreme hypoplasia of the proximal segment of this artery. Two children had typical symptoms of insufficiency of the vertebral and basilar circulation (headache, dizziness, syncopal attacks, vision and hearing disorders) since the age of 7 and 8 years, respectively. The clinical findings, such as reduced pulses and blood pressure of the respective arm, may suggest the provisional diagnosis. The principles of congenital subclavian steal are discussed.     

Diagnostik significance of cell membrane markers in childhood ALL (author's transl)]

Acute lymphoblastic leukemia (ALL) in childhood is not a homogeneous disease. By membrane phenotyping 6 groups of ALL in 66 children could be differentiated: Group I (38%) common ALL (anti-cALL+. Group II (32%) common ALL with T cell marker in addition (anti-cALL+, anti-T+). Group III (14%) T. cell ALL with E-rosette marker (anti T+, E+). Group IV (9%) T cell ALL without E-rosette marker (anti T+, E-). Group V (6%) undifferentiated ALL (anti-cALL-, anti-T). Group VI (1%) B cell typ (SmIg+). 19 or 20% of children in groups I and II opposed to 67 or 100% of children in groups III and IV had a white cell count at diagnosis of greater than 25,0 x 10(3)/mm(3) Mediastinal involvement was typical for groups III and IV. No significant difference was found so far for age or sex in the groups.     

Therapy of childhood acute lymphoblastic leukemia. Treatment results 1971-75 in 78 patients (author's transl)]

From December 1971 until July 1973 44 children with ALL have been treated according to branch A of the randomised DAL study series of June 3rd 1972 (1/71), which is a slight modification of study VII of Memphis. Afterwards until July 1975 34 patients received a somewhat intensified initial therapy (11/73). The results of 1/71 with a 3-year-remission rate of 39% and an expected 5-year-remission rate of 32% are comparable to those of study VII. The results of 11/73 with an expected 3-year-remission rate of 54% seems clearly superior and unterline the importance of an intensive initial therapy, like it is introduced now in a still more aggressive manner in our running protocol III/75. Therapy mortality was found to be about 5% and seemed to be dependant on the staff's experience. Cytosin-arabinoside orally proved effective as a prophylactic measure during incubation as well as a therapeutic agent in manifest varicalla/zoster infections.     

Winter sport injuries in childhood (author's transl)]

3374 accidents occurring on the field of sport during the years 1975--1977 accounted for 19% of all accidents dealt with at the Institute of Kinderchirurgie in Graz. 51% of the accidents were caused by the typical winter sports: skiing, tobogganing, ice-skating and ski-jumping with skiing accounting for 75% of the accidents. The fracture localization typical of the different kinds of winter sport is dealt with in detail. The correct size and safety of the equipment were found to be particularly important in the prevention of such accidents in childhood.     

Concordant leukemia in identical twins (author's transl)]

We report female monozygous twins who developed acute lymphoblastic leukemia at the age of 5 1/2 years. The diagnosis in the first twin was made after pallor, lethargy, and petechiae developed. The diagnosis in the second twin was made two days later when a whole blood count was taken. The lymphoblasts of both patients showed with the exception of the PAS-reaction identical morphological, cytochemical, and immunological results. The PAS-reaction was positive in 55% of the lymphoblasts in one twin, negativ in the lymphoblasts of the other twin. Both patients are in continuous complete remission 14 months after diagnosis. The risk of leukemia is high in the other monozygous twin when one of the twins has already developed leukemia. In the literature it is estimated to be 1 : 5. The diagnosis after the second year of life is rarely made at the same time. There is only one previous report of this occuring in a case of acute myeloblastic leukemia in 4 1/2 year old monozygous twins.     

Immunological aspects of acute lymphoblastic leukemia (ALL) in children (author's transl)]

The prognostic significance of the immunological classification of ALL in children is described. While the prognosis of patients with the most frequent O- or common-ALL (frequency 70-85%) is comparatively good, prognosis of patients with T-ALL, which is most probably identical with acid phosphatase positive ALL,and with the rare B-ALL is worse. The therapeutic implications of the immunological classification is discussed.     

Incidence of ampicillin rashes in childhood (author's transl)]

In a retrospective clinical trial 6056 pediatric medical records were analysed concerning the incidence of ampicillin rashes. Out of this population 1482 children of different agegroups were treated with ampicillin for various diagnoses. 44 rashes had developed in patients, equivalent to an overall incidence of rashes attributable to ampicillin of 2.9%. 907 newborns, in the age of 0 until 30 days, did not show any exanthema; elder babies, aged 31 until to 365 days, showed an incidence of rashes associated with ampicillin therapy in 4.06%. Children of the age-groups 1 to 4, and 5 to 15 years had developed skin reactions in 9.9% and 8.8%, respectively. If the large group of newborn babies is not taken in account, the average incidence of ampicillin rashes increases from 2.9% to 7.6%. Eruption of exanthema after start of ampicillin therapy occured changed between the 1st and 21st day, usually after 4 and 5 or 7 to 12 days. The mostly morbilliform rashes vanished in the average after 2 to 4 days. In the beginning of or during exanthema the number of eosinophile leucocytes was increased in 30% of patients. In 93% the ampicillin therapy was ended after skin reactions were noticed; the rashes of children, who were treated further with ampicillin, did not show any difference to those exanthema of children, whose therapy was stopped.     

Bone marrow transplantation in a case of acute lymphoblastic leukemia (author's transl)]

In a 6-year-old girl with acute lymphoblastic leukemia, pericardial effusion and mediastinal mass remission lasted for 7 wks. only in spite of intensive chemotherapy. Bone marrow transplantation for a HL-A-identical, MLC-negative sister was attempted after antipleukemic therapy (Cytosin-arabinoside, BCNU, Cyclophosphamide) and total body irradiation, After uneventful course of engraftment complete remission was achieved for 5 1/2 months.