Two-dimensional autoregressive analysis of carotid artery blood flow waveform in children with isolated atrial septal defect

BACKGROUND: The aim of the present study was to analyze the carotid artery blood flow waveform, using a two-dimensional autoregressive modeling approach and component analysis, and to determine the relation between cardiac contractility, peripheral and cerebral circulation and characteristic values of component activities of carotid artery blood flow waveform in patients with atrial septal defect (ASD), with or without congestive heart failure. METHODS AND RESULTS: We analyzed the carotid artery blood flow waveform of nine patients with ASD and 35 normal controls using a two-dimensional autoregressive modeling approach. The component of impulse response was divided into six groups according to the damping frequency: (i) group I, 0 Hz; (ii) group II, 1-5 Hz; (iii) group III, 5-8 Hz; (iv) group IV, 8-13 Hz; (v) group V, 13-17 Hz and (vi) group VI, > 17 Hz. The decrease of impulse response power-density in patients of groups I, II, III and IV and the prolongation of damping time for patients in groups I and II were particularly noticeable in two ASD patients, whose pulmonary to systemic blood flow ratio was more than 2.7 and whose left ventricular stroke volume was less than 33.1 mL/m2. The power-density of groups I and II varied with cardiac contractility and the power-density of groups III and IV varied with cerebral circulation. In contrast, the damping time of groups I and II changed with the reflection velocity from the position of arterial reflection against blood flow from left ventricle. CONCLUSIONS: These results may be influenced by the decrease in left ventricular stroke volume and velocity in arterial reflection.     

Multivariate autoregressive analysis of carotid artery blood flow waveform in an infant of a diabetic mother with cardiomyopathy

We analyzed the carotid artery blood flow waveform (CABFW) of an infant of a non-insulin dependent diabetic mother with hypertrophic cardiomyopathy (IDM cardiomyopathy) through multivariate autoregressive analysis and compared the developmental change of his CABFW with that of normal newborns. The total power was lower than normal newborns on the second and third day of life when his heart dysfunction was severe, and elevated on the fifth day of life when normal-heart function was recovered. The power of component 3 (C3), of which the damping frequency was 7–11 Hz, was slightly high on the second and third day of life and it decreased to the normal range on the fifth day of life by component analysis. In contrast, the power of C3 increased with decreasing resistance index of anterior cerebral artery (RI of ACA) which shows the cerebral vascular resistance of normal newborns. These results suggest that the carotid artery blood flow volume decreased by low cardiac output and the cerebral vascular resistance decreased to maintain the cerebral circulation, when the heart dysfunction was severe.     

Noninvasive assessment of artery wall properties in children aged 4-19 years

The vessel wall properties of the common carotid artery were noninvasively studied in 53 normotensive, presumed normal boys of various ages (4-19 yr) with the use of a multigate pulsed Doppler system. This device allows the on-line recording of velocity profiles and the relative changes in carotid artery diameter during the cardiac cycle. From the width of these profiles, the internal diameter of the carotid artery can be determined. With the use of internal carotid artery diameter, relative changes in carotid artery diameter during the cardiac cycle, and pulse pressure the pulse pressure, as measured in the brachial artery, the distensibility coefficient and the cross-sectional compliance were calculated. The children were allotted to three different age groups: group I (4-10 yr), group II (11-14 yr), and group III (15-19 yr). In the older children (group III) the systolic arterial pressure and the pulse pressure were significantly higher than in groups I and II. The carotid artery diameter was significantly larger and the distensibility coefficient was significantly smaller in group III than in groups I and II. The cross-sectional compliance was not significantly different in the age groups, which can be explained by the larger artery diameter in the older age group. The findings indicate that the carotid artery wall is less distensible in adolescents than in younger children. The subjects in group III showed similar carotid artery wall properties as the young adults (aged 20-34 yr) in a previous study. Therefore, it is likely that in adolescents the vascular system can be considered as mature as far as the arterial wall properties are concerned.     

Relationship between carotid intima-media thickness and arterial stiffness in children after Kawasaki disease.

BACKGROUND: Evidence of premature atherosclerosis and systemic arterial stiffening in patients after Kawasaki disease is accumulating. AIM: To test the hypothesis that carotid intima-media thickness (IMT), a surrogate marker of atherosclerosis, is associated with systemic arterial stiffness in children after Kawasaki disease. METHODS: A cohort of 72 patients was studied, comprising 26 patients with Kawasaki disease and coronary aneurysms (group I), 24 patients with Kawasaki disease and normal coronary arteries (group II) and 22 healthy age-matched children (group III). The carotid IMT, carotid artery stiffness index, brachioradial pulse wave velocity (PWV), fasting total cholesterol, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol were determined and compared among the three groups. RESULTS: The carotid IMT was related to indices of arterial stiffness, and significant determinants of carotid IMT were identified by multivariate analysis. The mean (standard deviation (SD)) carotid IMT of both group I (0.41 (0.04) mm) and group II (0.39 (0.04) mm) was significantly greater than that of group III (0.36 (0.04) mm; p<0.001 and p = 0.008, respectively). For the entire cohort, carotid IMT correlated positively with LDL cholesterol (r = 0.31, p = 0.009), carotid artery stiffness index (r = 0.40, p = 0.001) and brachioradial PWV (r = 0.28, p = 0.016), but not with age, body mass index, systemic blood pressure, and HDL and total cholesterol. Multiple linear regression analysis identified carotid artery stiffness index (beta = 0.25, p = 0.028) and subject grouping (beta = -0.39, p = 0.001; model R(2) = 0.29) as significant correlates of carotid IMT. CONCLUSION: The increased carotid IMT in children after Kawasaki disease is associated with systemic arterial stiffening.     

Background patterns and sleep-wake cycles on amplitude-integrated electroencephalography in preterms younger than 30 weeks gestational age with peri-/intraventricular haemorrhage

AIM: The objective of this prospective study was to evaluate the influence of peri-/intraventricular haemorrhage (PIVH) grades I-IV on amplitude-integrated electroencephalographic (aEEG) activity in preterm infants<30 weeks gestational age (GA). METHODS: The aEEG tracings of the first 2 weeks of life of 56 preterm infants younger than 30 weeks GA (2 groups: group A=23-26 weeks GA, group B=27-29 weeks GA) born during a 4-year period with PIVH grades I-IV were assessed for the relative duration of four background aEEG activity patterns (continuous pattern, discontinuous high-voltage pattern, discontinuous low-voltage pattern and nearly isoelectric pattern), the presence of seizure activity and the appearance of sleep-wake cycles and compared to the tracings of 75 neurologically healthy preterms without PIVH. RESULTS: Analysis of aEEG background activity showed a decrease of continuous activity whereas discontinuous activity increased in both groups with larger haemorrhages (grades III and IV) and when compared to controls. Suspected seizure activity was more common with increasing degree of bleeding in group A (50% with PIVH I or II, 75% with PIVH III or IV) and when compared to controls and was the same with increasing degree of bleeding in group B (47% with PIVH I or II, 45% with PIVH III or IV). Sleep-wake cycles were less common with larger haemorrhages in both groups (group A: 41% with PIVH I or II, 25% with PIVH III or IV; group B: 52% with PIVH I or II, 9% with PIVH III or IV) and when compared to controls. CONCLUSIONS: The aEEG characteristics of severe PIVH consist in a combination of a more discontinuous background pattern, a lack of sleep-wake cycles and a higher likelihood of seizure activity when compared to age-matched controls.     

The comparison of myocardial dysfunction in three forms of experimental septic shock

A rabbit model of septic shock was used to determine if myocardial dysfunction is a common component of shock due to diverse neonatal pathogens, and prostaglandins modulate septic myocardial dysfunction. The infusion of heat-killed Escherichia coli (group I), Haemophilus influenzae (group II), or Staphylococcus epidermidis (group III) produced significant decreases in the first derivative of left ventricular pressure with respect to time (p less than 0.05). Each organism also produced significant changes in mean arterial pressure, cardiac output, and heart rate, while pulmonary artery pressure was altered in groups I and III. Saline-infused control animals (group IV) exhibited no significant changes in any hemodynamic variable. Blood gas variables were not significantly changed in any group. These cardiovascular changes appeared dependent on arachidonic acid metabolism since indomethacin pretreatment prevented the cardiovascular changes induced by bacterial infusion. These results suggest that septic myocardial dysfunction is a common component of gram-negative and gram-positive septic shock, and that myocardial dysfunction is modulated by prostaglandin products.     

Head circumference, height, bone age and weight in 103 children with congenital hypothyroidism before and during thyroid hormone replacement

Head circumference, height, bone age and weight were studied in 103 children with congenital hypothyroidism before and up to 8 years of thyroid replacement therapy. The patients were divided into 4 groups according to the age at start of treatment: group I (diagnosed by neonatal screening): less than 2 weeks (n = 55); group II: 1-3 months (n = 7); group III: 4-12 months (n = 15); group IV: greater than 1 year of age (n = 26). Before treatment, group I showed a head circumference significantly larger than normal and a delay in bone maturation in the presence of normal length and weight. In the other groups length as well as bone age were significantly lower than normal, head circumference, in contrast, was normal (groups II and III) or even increased (group IV). During therapy, head circumference and bone age of group I became normal as were length and weight from the beginning. In the other groups, therapy led to a further increase of head size resulting in a mean head circumference significantly larger than normal during 8 years of observation in group IV. There was a catch-up of height, bone age and weight in groups II, III and IV; mean height of late treated children (group IV), however, remained significantly lower than normal even after 8 years of therapy. - Our study shows that congenital hypothyroidism is associated with increased head circumference, either absolutely or in relation to stature. Thyroid hormone therapy resulted in a normalization of head growth when treatment was initiated early, and in a further increase when treatment was started late. There was a catch-up of height, bone age and weight; complete normalization, however, occurred only in those children treated before one year of age.     

Prolonged seizures exacerbate perinatal hypoxic-ischemic brain damage

This study was undertaken to clarify whether seizures in the newborn cause damage to the healthy brain and, more specifically, to determine the extent to which seizures may contribute to the brain-damaging effects of hypoxia-ischemia (HI). Seizures were induced in 10-d-old rat pups with kainic acid (KA). Seizure duration was determined electrographically. HI was induced by common carotid artery ligation followed by exposure to 8% oxygen for either 15 or 30 min. Six groups of animals were assessed: 1) controls [neither KA nor HI (group I)]; 2) group II, KA alone; 3) group III, 15 min HI alone; 4) group IV,15 min HI plus KA; 5) group V, 30 min HI alone; and 6) group VI, 30 min HI plus KA. Animals were assessed neuropathologically at 3 (early) and 20 (late) d of recovery. KA injection without hypoxia resulted in continuous clinical and electrographic seizures lasting a mean of 282 min. No neuropathologic injury was seen in groups I (no HI or KA), II (KA alone), III (15 min HI alone), or IV (15 min HI and KA). Animals in group V (30 min HI alone) displayed brain damage with a mean score of 2.3 and 0.60 at 3 and 20 d of recovery, respectively. Animals in group VI (30 min HI and KA) had a mean score of 12.1 and 3.65 at 3 and 20 d of recovery, respectively. Compared with group V, the increased damage as a result of the seizure activity in group VI occurred exclusively in the hippocampus. Status epilepticus in the otherwise "healthy" neonatal brain does not cause neuropathologic injury. However, seizures superimposed on HI significantly exacerbate brain injury in a topographically specific manner.     

Changes in the atherogenic risk factor profile according to degree of weight loss

Background: The atherogenic risk factor profile in obese subjects is characterised by hypertension, reduced high density lipoprotein (HDL) cholesterol, increased low density lipoprotein (LDL) cholesterol and triglycerides, and insulin resistance. Aims: To examine the amount of weight reduction required to improve the atherogenic profile. Methods: Changes of systolic and diastolic blood pressure, HDL and LDL cholesterol, triglycerides, and insulin resistance, based on the HOMA model over a one year period were studied in obese children, who attended the intervention programme "Obeldicks". The children were divided into four groups according to the change in body mass index standard deviation score (SDS-BMI): group I, increase in SDS-BMI; group II, decrease in SDS-BMI <0.25; group III, decrease in SDS-BMI ⩾0.25–<0.5; group IV, decrease in SDS-BMI ⩾0.5. Results: A total of 130 children (mean age 10.7 years, range 4–15; mean SDS-BMI 2.5, range 2.0–4.0) were studied. The four groups did not differ in age, gender, or degree of overweight (SDS-BMI). An increasing SDS-BMI (group I: n = 20) was followed by a significant increase in insulin resistance (HOMA). Systolic and diastolic blood pressure, LDL cholesterol, triglycerides, and insulin resistance (HOMA) decreased significantly while HDL cholesterol increased significantly in group IV (n = 37). LDL cholesterol also decreased significantly in group III (n = 40); there was no significant change of the other parameters in groups I, II, and III. Conclusion: Over a time period of one year increasing weight in obese children leads to an increase in insulin resistance. Weight loss is associated with an improvement in the atherogenic profile and in insulin resistance, but only if the SDS-BMI decreases by at least 0.5 over a one year period.     

Changes in the atherogenic risk factor profile according to degree of weight loss.

BACKGROUND: The atherogenic risk factor profile in obese subjects is characterised by hypertension, reduced high density lipoprotein (HDL) cholesterol, increased low density lipoprotein (LDL) cholesterol and triglycerides, and insulin resistance. AIMS: To examine the amount of weight reduction required to improve the atherogenic profile. METHODS: Changes of systolic and diastolic blood pressure, HDL and LDL cholesterol, triglycerides, and insulin resistance, based on the HOMA model over a one year period were studied in obese children, who attended the intervention programme "Obeldicks". The children were divided into four groups according to the change in body mass index standard deviation score (SDS-BMI): group I, increase in SDS-BMI; group II, decrease in SDS-BMI <0.25; group III, decrease in SDS-BMI > or =0.25-<0.5; group IV, decrease in SDS-BMI > or =0.5. RESULTS: A total of 130 children (mean age 10.7 years, range 4-15; mean SDS-BMI 2.5, range 2.0-4.0) were studied. The four groups did not differ in age, gender, or degree of overweight (SDS-BMI). An increasing SDS-BMI (group I: n = 20) was followed by a significant increase in insulin resistance (HOMA). Systolic and diastolic blood pressure, LDL cholesterol, triglycerides, and insulin resistance (HOMA) decreased significantly while HDL cholesterol increased significantly in group IV (n = 37). LDL cholesterol also decreased significantly in group III (n = 40); there was no significant change of the other parameters in groups I, II, and III. CONCLUSION: Over a time period of one year increasing weight in obese children leads to an increase in insulin resistance. Weight loss is associated with an improvement in the atherogenic profile and in insulin resistance, but only if the SDS-BMI decreases by at least 0.5 over a one year period.     

Palliative radiotherapy in children with neuroblastoma

Limited information is available regarding the efficacy of external beam radiation therapy in the palliation of metastatic disease from neuroblastoma. From 1960 to 2000, 29 children with 53 metastatic sites received palliative radiotherapy. There were 26 soft tissue (group I), 19 bone (group II), 5 brain (group III), and 3 hepatic (group IV) treated sites. Median radiotherapy doses for groups I, II, III, and IV sites were 2000, 2000, 2400, and 450 cGy, respectively. For group I sites, complete response was complete disappearance of mass, partial response was > or =50% resolution of mass, no response was <50% resolution or < or =25% progression of mass, and progressive disease was >25% progression of mass. For group II sites, complete response was complete pain relief without medication, partial response was > or =50% pain relief with or without medication, no response was <50% change in pain with medication, and progressive disease was increase in pain and/or medication. Median survival was 2.5 months after palliative radiotherapy. For group I sites, complete response was seen in 1 (4%) while partial response was documented in 19 (73%). Duration of response was until death in 18 responders (90%); 2 patients relapsed with an increasing soft tissue mass at 5 months and 1 year after palliative radiotherapy. For group II sites, complete response was seen in 8 (42%) while partial response was documented in 7 (37%). Duration of response was until death in 14 responders (93%); 1 patient had relapse of pain 1 year after palliative radiotherapy. For the 5 group III children, the median survival was 2.5 months with a range of 2 days to 13 months. Four children had neurological improvement after cranial radiotherapy; one patient progressed and died secondary to neurological compromise 2 days after radiotherapy. For the 3 group IV sites, 2 had improvement in respiratory status after radiotherapy, whereas 1 progressed despite doxorubicin, cyclophosphamide, and radiation. The only patient who survived had a stage IV-S neuroblastoma with liver metastases and is alive 13 years after hepatic irradiation. Radiotherapy is an effective treatment for palliation of symptomatic metastatic disease in children with neuroblastoma.     

Detection of pulmonary arterial morphology in tetralogy of Fallot with pulmonary atresia by computed tomography: 12 years of experience

Our aim was to evaluate the feasibility of using computed tomography (CT) to define the pulmonary artery anatomy in patients with tetralogy of Fallot and pulmonary atresia (TOF-PA). We retrospectively reviewed 110 patients with TOF-PA between 1995 and 2008. Those who received cardiac catheterization and surgery within 3 months of their CT examinations were enrolled. Based on Dr. Somerville's classification, the pulmonary arterial pattern was determined, including identifiable pulmonary trunk (type I), the presence of both left and right pulmonary arteries without trunk (II), only left or right pulmonary artery present (III), and absent intrapericardial pulmonary arteries (IV). The accuracy of both imaging modalities was evaluated with operation findings as the golden standard. The effective radiation doses and adverse events were also recorded. In the 64 eligible patients (median age, 23 months), CT and catheterization demonstrated accurate pulmonary arterial morphology in 60 (60/64) and 53 (53/64) TOF-PA patients, respectively. Thirty-two of 35 type I patients were correctly identified by CT, whereas 26 were correctly identified by catheterization (p?=?0.03). Of the 20 type II TOF-PA patients, 19 were diagnosed by CT, whereas 18 were diagnosed by catheterization. CT and catheterization both successfully defined six type III and three type IV patients. The median calculated radiation doses caused by CT and catheterization were 4.5 and 5.6 mSv, respectively (p?>?0.05). CONCLUSIONS: For patients with TOF-PA, CT could accurately delineate pulmonary arterial morphology with the same level of accuracy as cardiac catheterization. Therefore, CT can be considered a reasonable diagnostic alternative for such patients.     

CARDIOVASCULAR DIMENSIONS

Measurements have been made of the dimensions of the cardiovascular system, i.e. , the heart volume in the prone position, the blood volume and the total amount of haemoglobin (THb). The following results are obtained:
1. The blood volume is probably significantly lower (10 per cent) than that predicted from the body weight in group I and highly significantly lower in group II (21 per cent) and group III + IV (24 per cent). The mean value in adult patients in group III + IV is only 62.3 ml/kg of body weight.
2. The THb is approximately normal in group I, whereas it is significantly lower (–14 per cent) than the value predicted from the body weight in group II and highly significantly lower (–17 per cent) in group III + IV.
3. In Friedreich's ataxia, both inactivity and muscular atrophy contribute to a reduction in vascular volume, with a resulting decrease in blood volume and THb.
4. The decrease in blood volume and THb is approximately the same in group II as in group III + IV. It is concluded that the wheel-chair cases approach minimum values for maintenance of an adequate circulation.
5. The heart volume in relation to THb is probably significantly increased in group II and significantly in group III + IV. In two wheel-chair cases a considerable enlargement was recorded.     

Long-Term Results in Childhood Rhabdomyosarcoma: A Retrospective Study in Italy

This paper reviews a series of 70 consecutive children with rhabdomyosarcoma (RMS) diagnosed during 1971-1978 and treated in five Italian institutions. Thirteen were classified as group I, 12 as group II, 37 as group III, and 8 as group IV according to the Intergroup RMS Study staging system. Survival was influenced by tumor extension at diagnosis, primary site, and response to therapy. The 5-year-survival rate was 92% for group I patients, 67% for group II, 44% for group HI, and 0% for group IV. Thirty-four children had all therapy stopped after 12-32 months of complete remission, 7 had late recurrences, and 3 died from disease. Musculoskeletal sequelae were diagnosed in 11 children, short stature in 3, corneal opacity in 2, and cardiac failure in 1.     

Short, middle and long-term outcome of major peri-intraventricular hemorrhages

Within 4 years 10 months (1981-1985), the Port-Royal Neonatal Intensive Care Unit admitted 2,400 neonates, one third with a birthweight below 1,501 g; 4,631 cranial ultrasound studies were performed in 1,488 of those neonates, mostly less than 1,501 g, detecting 392 consecutive peri-intraventricular hemorrhages (PIVH), of which 130 were major forms (from unilateral grade III to bilateral grade IV PIVH). Overall survival rates were 91% in grade I, 85% in grade II, 42% in grade III, 26% in grade IV; survival rate was significantly lower in bilateral than in unilateral grade II and III PIVH. In major PIVH, deaths occurred early (58% in the first week after birth). Post-hemorrhagic dilatation was constant but mostly regressive; true active hydrocephalus appeared in 1 unilateral grade III PIVH and 8 bilateral grade III PIVH, with ventriculo-peritoneal shunt in the second month of life in 5 infants (2 died), and 4 deaths (surgery not feasible). The neurological and developmental outcome of 42 of 46 survivors (4 losts to follow-up) was evaluated beyond one year of age in 12 unilateral grade III PIVH (10 normal children, 1 minor sequela, 1 moderate sequela), 16 bilateral grade III PIVH (7 normal children, 3 minor sequelae, 1 moderate sequela, 5 major sequelae), 13 unilateral grade IV PIVH (8 normal children, 1 minor sequela, 3 moderate sequelae, 1 major sequela), 1 bilateral grade IV PIVH (major sequela). A persistent major dilatation after 6-9 months of age bore an ominous prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hemorrhagic and hypoxic-ischemic intracranial lesions in neonates diagnosed by realtime sonography: incidence and short-term outcome

887 neonates at risk, referred to our neonatal unit underwent serial cranial ultrasound examinations and neurological follow-up over a period of 2 years. Our study focused on the prognosis of hemorrhagic and hypoxic-ischemic intracranial lesions. 194 patients with hemorrhages (subependymal hemorrhages [SEH] I degree-IV degrees according to Papile, hemorrhages of the choroid plexus [CPH], primarily intraparenchymal hemorrhages [PIH]) and/or hypoxic-ischemic lesions (infarcts of the major intracranial arteries and lesions of the periventricular white matter) were neurologically followed-up 12 to 24 months postnatally. A group of 266 patients with normal ultrasound scans out of the same population was equally followed-up and served as a control group. At the age of 12 months a preliminary neurodevelopmental diagnosis was made and the patients were divided into 3 groups. Group N (normal) had a normal neuromotor outcome, group S (suspect) showed minor neurological abnormalities without evidence of cerebral palsy and/or a developmental quotient between 80 and 90. Group A (abnormal) included patients with any degree of cerebral palsy (CP) and/or a development quotient below 80. A normal neurological outcome was seen in 88.3% of patients without intracranial lesion and in a comparable proportion of patients with SEH I degree (88.9%), SEH II degrees (84.8%) and CPH (81.3%). Patients with SEH III degrees developed normally in 72.7%, whereas only 25% of patients with SEH IV degrees and PIH were neurological normal at 12 months of age. For detailed statistical evaluation only preterm neonates (birthweight below 2500 grms) with and without hemorrhagic lesions were compared. Concerning the neurological short-term outcome our analysis revealed no statistically significant difference between patients with SEH I degrees, II degrees, III degrees, CPH and the control group. SEH IV degrees and PIH showed a unfavourable outcome. Only 2/8 surviving patients had a normal development, but small numbers of patients made a statistical analysis impossible. Two children with infarcts of the middle cerebral artery developed spastic hemiplegia of the contralateral body side. One child with an infarct of the posterior cerebral artery developed normally until the age of 1 year, but could not be followed-up further. Patients with periventricular lesions showed a normal neuromotor development in 88.9% and 75% when they had solitary periventricular cysts or wedge-shaped periventricular lesions, whereas none of 9 children who suffered from extensive cystic periventricular leucomalacia was neurologically normal at the age of 1 year.(ABSTRACT TRUNCATED AT 400 WORDS)     

Cortisol and cytokine responses after surgery in different age groups of pediatric patients

We investigated the cortisol and cytokine responses to surgical stress in the different age groups of pediatric patients. This study included 19 neonates (0-6 days old, group I), 19 infants (1-11 months old, group II), and 20 pre-school children (1-5 years old, group III), undergoing major thoracic and abdominal surgery. We obtained blood samples preoperatively and 0, 3, 6, 12, and 24 h postoperatively to measure the plasma levels of C-reactive protein (CRP), cortisol, interleukin (IL)-6, and IL-10. The plasma CRP level in each group reached a peak value on postoperative day 2; however, the peak value was significantly lower in group I than in groups II or III (I vs II, III; p=0.0134, p=0.0017, respectively). The plasma cortisol level in each group reached a peak value just after surgery; however, the peak value was also significantly lower in group I than in groups II or III (I vs II, III; p<0.001, p=0.0104, respectively). The plasma IL-6 level in each group reached a peak level hours postoperatively; however, the peak values in groups I and II were higher than in group III (I, II vs III; p=0.003, p=0.0458, respectively). The plasma IL-10 level in each group reached a peak value just after surgery and did not differ among the three groups. The endocrine and cytokine responses to the surgical stress vary among the different age groups of pediatric patients.     

OFF-LABEL USE OF GRANULOCYTE COLONY-STIMULATING FACTOR IN NONCONGENITAL NEUTROPENIA: Retrospective Data from the Italian Neutropenia Registry

This paper reviews a series of 70 consecutive children with rhabdomyosarcoma (RMS) diagnosed during 1971-1978 and treated in five Italian institutions. Thirteen were classified as group I, 12 as group II, 37 as group III, and 8 as group IV according to the Intergroup RMS Study staging system. Survival was influenced by tumor extension at diagnosis, primary site, and response to therapy. The 5-year-survival rate was 92% for group I patients, 67% for group II, 44% for group HI, and 0% for group IV. Thirty-four children had all therapy stopped after 12-32 months of complete remission, 7 had late recurrences, and 3 died from disease. Musculoskeletal sequelae were diagnosed in 11 children, short stature in 3, corneal opacity in 2, and cardiac failure in 1.     

Evaluation of different induction regimens in children with acute lymphocytic leukemia

Four induction regimens-prednisolone and 6- mercaptopurine (group I), prednisolone and vincristine (group II), prednisolone, vincristine & asparaginase (group III) and prednisolone, vincristine and adriamycin followed by cyclophosphamide and 1-asparaginase (group IV)- have been evaluated. Successful induction remission was achieved in 16 (69.6%) in group I, 23 (92.0%) in group II, 36 (94.7%) in group III, 31 (96.8%) in group IV. Relapses were seen in 10 (62.5%), 10 (73.8%), 25 (69.4%) and 9 (29.0%) in the four groups respectively. Relapses seen in group IV were infrequent as compared to children of group I, II & III. Adverse risk factors were similar in all the four groups. Ninety four children (61.3%) had one or more poor prognostic factors at diagnosis. Three of 43(7%) children with no poor prognostic factors died during induction therapy as compared to 18 of 94 (19.1%) children associated, with poor prognostic factors at diagnosis. Higher mortality was seen under two years of age.