Efficacy of the "8 drugs in a day" protocol in brain tumors in children

In the present study, the "8 drugs in 1 day" regimen was tested in 54 children: 27 relapses (brain and/or spinal and/or meningeal sites), 10 refractory progressive diseases, 13 macroscopic residual tumors after partial excision and/or radiotherapy; in 4 cases, this regimen was prescribed as first line treatment. The response rate (complete and partial remission) was 46%. Results were very encouraging in medalloblastomas with a response rate of 76.5% whereas in brain stem gliomas it was only 23% and 33% in other astrocytomas. Immediate toxicity, mainly hematological, was very moderate. These results justify to propose this regimen as adjuvant chemotherapy, mostly in medulloblastomas and to plan other similar trials, using the most active drugs which seem presently to be alkylating and platinum-derived agents.     

Paroxysmal nocturnal hemoglobinuria and aplastic anemia

The case of a 14 year-old adolescent girl presenting with paroxysmal nocturnal hemoglobinuria (PNH) associated with aplastic anemia is reported. This disease, rare in children, is characterized by an acquired hemolytic anemia, with abnormal sensitivity to complement: PNH actually affects the bone marrow stem cell. This explains its possible association with any type of malignant blood disease and with aplastic anemia. When aplastic anemia is the first sign of the disease, diagnosis is delayed, due to the possible negative response of the specific Ham's test. Therefore, the proper complications of PNH, especially thromboses, may be misappreciated and poorly managed.     

Nursing workforce. Skirting the issue

A study of part-time nurses in three London trusts found that they were concentrated in lower grades and less likely to be involved in management than full-time nurses. While senior managers in the trusts were fully committed to flexible working, managers lower in the organisation felt that part-time working presented problems for continuity of care, and that part-time nurses were unwilling to work unsocial hours. A more strategic approach is needed to ensure that part-time nurses are employed most effectively at a time of acute nursing shortages.     

Serum dioxin concentrations and menstrual cycle characteristics

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a widespread industrial environmental contaminant. Animal studies suggest that TCDD exposure alters the estrus cycle. Twenty years after a 1976 industrial explosion in Seveso, Italy, the authors interviewed female residents to determine whether there was an association between TCDD exposure and current menstrual cycle characteristics. The authors analyzed serum samples collected soon after the explosion to quantify individual TCDD levels. Among women who were premenarcheal at the time of the explosion, a 10-fold increase in serum TCDD level was associated with a lengthening of the menstrual cycle by 0.93 days (95% confidence interval (CI): -0.01, 1.86) and a reduction in the odds of scanty menstrual flow (adjusted odds ratio = 0.33, 95% CI: 0.10, 1.06). However, among women who were postmenarcheal at the time of the explosion, TCDD was not associated with menstrual cycle length (adjusted beta = -0.03 days, 95% CI: -0.61, 0.54) or scantiness of flow (adjusted odds ratio = 1.36, 95% CI: 0.70, 2.64). In both menarche groups, TCDD levels were associated with decreased odds of having irregular cycles (adjusted odds ratio = 0.46, 95% CI: 0.23, 0.95) but were not related to days of flow (adjusted beta = 0.16 days, 95% CI: -0.08, 0.41). These results are consistent with effects of TCDD on ovarian function noted in some animal species and with greater sensitivity to TCDD during development.     

Features of large granular lymphocytes (LGL) expansion following allogeneic stem cell transplantation: a long-term analysis.

Large granular lymphocyte (LGL) proliferation typically follows a chronic course during which major features are cytopenia and immune abnormalities. Elevated numbers of LGL were reported in a few cases following allogeneic stem cell transplantation (allo-SCT). In this report, we present a retrospective analysis of LGL cases that occurred following allo-SCT in a cohort of 201 consecutive patients transplanted over a period of 7 years. Six cases were identified and LGL expansion occurred more frequently following a reduced fludarabine and anti-T lymphocyte globulin-based preparative regimen (4 cases/49), than after a conventional myeloablative regimen (2 cases/152). Expansion of LGL was seen between 3 and 15 months following allo-SCT. Hematopoiesis, with mild to severe cytopenia, was a favored target for LGL. Autoimmune manifestations including polyarthritis and hypergammaglobulinemia were also observed. LGL proliferation was observed in the context of chronic antigenic stimulation associated with recurrent viral infections especially CMV. Moreover, five out of these six high risk patients achieved a long-term complete remission concomitant or following LGL expansion. These data suggest that LGL might be a subset of effector lymphocytes which may participate to the graft-versus-tumor effect.