Exclusion of fetal ventriculomegaly with a single measurement: the width of the lateral ventricular atrium

The ventricular atria in 100 healthy fetuses with gestational ages ranging from 14 to 38 menstrual weeks were evaluated and compared with those of 38 fetuses in whom ventriculomegaly had been diagnosed in utero. Axial sonograms of the brain through the atrium of the lateral ventricle demonstrated that the normal atrial diameter remained relatively constant throughout the gestational age range observed. The atrium had a mean diameter of 7.6 +/- 0.6 mm (standard deviation [SD]). Measurement of this structure can be quickly performed, is reproducible with low intra- and interobserver variation, and permits ventriculomegaly to be excluded. Atrial diameters exceeding 10 mm (above 4 SDs) suggest ventriculomegaly, with a low false-positive rate.     

Results of treatment of malignant germ cell tumors in 93 children: a report from the Childrens Cancer Study Group.

We report treatment results in 93 children entered on study from 1978 to 1984 with malignant germ cell tumors (MGCTs), excluding dysgerminoma and tumors of the testis or brain. The estimated 4-year survival and event-free survival (EFS) for all 93 patients were 54% and 49%, respectively. For 30 children with ovarian tumors, the estimated 4-year survival was 67% and EFS was 63%. For 63 children with nongonadal tumors, survival and EFS were 48% and 42%, respectively. The comparison of EFS between ovarian and nongonadal tumors was significant at P = .03. The treatment plan included a second-look surgical procedure after 18 weeks of chemotherapy. Over half of 36 patients evaluated as having a residual mass present immediately before second-look surgery had no malignant tumor after review of surgical specimens. Age greater than 11 years at diagnosis, incomplete removal of tumor at first surgery, and more than one structure or organ involved at diagnosis increased the risk for adverse event. The histologic subtype of the primary tumor was not related to outcome. Diagnosis was verified by independent pathologic review, and treatment was uniform. Seventeen percent of all registered patients (21 of 127) were excluded because of ineligible pathologic diagnoses; sixty percent (13 of 21) were immature teratomas.     

Ultrasound versus excretory urography in evaluating acute flank pain

To determine the role of ultrasound (US) in patients with acute flank pain and suspected acute urinary tract obstruction, a prospective study was performed on 20 patients comparing US with emergency excretory urography. US was not as sensitive as excretory urography for diagnosing hydronephrosis, for detecting ureteral or renal calcification, or for diagnosing forniceal rupture. Although US is an effective screening modality for hydronephrosis in patients with chronic renal obstruction, it is not useful for evaluating patients with acute flank pain in whom acute obstruction may be present. In this group of patients, excretory urography remains the examination of choice.     

Biliary endoprostheses. Insertion using a combined peroral-transhepatic method

The transhepatic placement of adequately sized endoprostheses for the palliation of malignant biliary obstruction is painful and requires large hepatic parenchymal tracks. Endoscopically placed biliary stents are smaller, but may not be adequate for long-term patency. The authors have used a combined peroral-transhepatic approach successfully to pull large endoprostheses through the alimentary track and into the biliary tree.     

Therapy of acute myelogenous leukemia in patients over the age of 50: a randomized Southeastern Cancer Study Group trial

In a randomized trial, 299 evaluable patients with acute myelogenous leukemia, age greater than or equal to 51, were initially randomized to cytosine arabinoside, 100 mg/m2/day, by continuous intravenous infusion for seven days, plus either daunorubicin 45 mg/m2/day x 3 (DA), or m-AMSA 200 mg/m2/day x 3 days (MA). Complete remission (CR) rates were not significantly different, 47% for DA and 42% for MA. Toxicities were similar except that severe hepatic toxicity, serum bilirubin greater than or equal to 7 mg/dl, was more frequent in patients receiving MA (10%) than in patients receiving DA (4%), p less than 0.05. Deaths during induction were significantly more frequent in patients receiving MA (38%) than in patients receiving DA (25%), p = 0.018. Patients achieving a CR received thioguanine, cytosine arabinoside, and daunorubicin (TAD) for three cycles as consolidation. Among evaluable patients, 82/102 (80%) stayed in CR during these three cycles. Patients were then randomized to either no maintenance or to DA every 13 weeks x 4 cycles, at a dose slightly lower than used for induction. Remission duration was similar for the two maintenance programs, 10.7 months for no maintenance and 8.5 months for DA. The percentage of patients evaluable for maintenance achieving three year relapse-free survival was similar for the two maintenance programs, 28% for no maintenance and 21% for DA. However, overall survival was significantly greater (40 vs 12 months, p = 0.007) for patients receiving no maintenance therapy, due to greater survival after recurrence in these patients. At each phase of the study there were substantial numbers of non-evaluable cases, often due to incomplete evaluation of remission status. Of the 379 patients initially entered into the trial, 35% obtained a complete remission. Of all the patients who achieved a complete remission, 61% were both evaluable and in remission upon completion of the maintenance phase. Of these patients who completed the maintenance phase in remission, 15% were relapse free survivors three years following initiation of maintenance therapy. Overall, only 3.2% of patients who entered the trial (35% x 61% x 15%) were continuous relapse-free survivors three years into the maintenance phase.     

Dual-photon Gd-153 absorptiometry of bone

Dual-photon absorptiometry with gadolinium 153 was used to measure the mineral content of lumbar vertebrae in cadavers, excised vertebrae with marrow, and dry, marrow-free vertebrae. The error introduced by the surrounding soft tissue of cadavers was 3%, and the error in determining mineral mass or density in excised vertebrae was about 5%. The correlation coefficient between the results of Gd-153 and corrected iodine 125 (single-photon) absorptiometry on 24 femoral necks was 0.99, and the predictive error was 3.7%. Dual-photon absorptiometry accurately indicates bone mass and bone density and is only slightly affected by either surrounding tissue or fat changes in bone marrow.     

A fluorescence-based assay for monitoring helicase activity.

A continuous fluorescence-based assay is described for measuring helicase-mediated unwinding of duplex DNA. The assay utilizes an oligonucleotide substrate containing the fluorescent adenine analog, 2-aminopurine, at regular intervals. 2-Aminopurine forms a Watson-Crick-type base pair with thymine and does not distort normal B-form DNA. Fluorescence of the 2-aminopurines within this oligonucleotide is quenched 2-fold upon its hybridization to a complementary strand. Unwinding of this substrate by the T4 dda helicase restores the fluorescence of the 2-aminopurines and is easily followed using stopped-flow or steady-state fluorescence spectroscopy. The flourescence-based assay provides rate data comparable to that obtained from conventional discontinuous assays using labeled substrates and additionally furnishes a means for following a single turnover. This assay should prove useful for defining the mechanism by which helicases unwind duplex DNA.     

An adolescent psychiatric unit for difficult medical patients

While the combined psychiatric and medical treatment of patients is highly desirable, such treatment of more complex medical patients in a psychiatric milieu has been difficult to accomplish. This paper describes the creation of and experience with a psychiatric unit for adolescents with both difficult medical and psychiatric problems. Useful aspects of the structure of such a unit are discussed, and case examples are presented.A version of this paper was presented at the Annual Meeting of the American Association of Psychiatric Services for Children, Feb., 1991, Miami, Florida.