Central nervous system leukemia in children with acute nonlymphoblastic leukemia

Factors contributing to the development of central nervous system (CNS) leukemia, and the impact of leukemic involvement of this site on subsequent remission length, were determined in 184 children with acute nonlymphoblastic leukemia who had been treated in two successive clinical trials. Preventive CNS therapy in both studies consisted of intrathecal methotrexate (12 mg/m2) given monthly during the first six months of therapy and then every three months until all treatment was stopped. Children with CNS leukemia at diagnosis or relapse were given intrathecal chemotherapy weekly for four weeks and then monthly throughout the remainder of the treatment course. Those continuing in complete remission received 2,400 rad cranial irradiation plus five doses of intrathecal methotrexate before cessation of therapy. The 38 children (20.7%) with CNS leukemia at diagnosis were more likely to have an initial leukocyte count greater than or equal to 25 X 10(9)/L (P = .01) and age less than 2 years (P = .03). The presence of CNS leukemia at diagnosis did not adversely affect the remission induction rate (P = .13) or the length of complete remissions (P = .73). CNS relapse ended initial remissions in 11 patients only and did not preclude subsequent long-term survival, as four of these children are off therapy and in second complete remission for 33+ to 78+ months. Three features at diagnosis were predictive of CNS relapse: monocytic or myelomonocytic leukemia (P = .002); age less than 2 years (P = .0001); and leukocyte count greater than or equal to 25 X 10(9)/L (P = .012). By stepwise Cox regression analysis, each factor was found to have independent predictive value. Despite the apparent effectiveness of intrathecal methotrexate as preventive CNS treatment, our findings indicate that more effective prophylaxis is needed for patients with features predisposing to CNS relapse.     

An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

IntroductionIntercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity.MethodsThis was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013.ResultsA total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20–29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54).Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the ‘triangle of safety’ but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p<0.001). There was no mortality as a direct result of ICD insertion.ConclusionsICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation.     

Comparative assessment of validity and reliability of the Oral Impacts on Daily Performance (OIDP) frequency scale: a cross‐sectional survey among adolescents in Davanagere city,Karnataka, India

Abstract: Aim: To evaluate reliability and validity of an abbreviated version of the Oral Impact on Daily Performance (OIDP) questionnaire and to analyse the interrelationship between OIDP scores, socio‐demographic characteristics and oral health status among high school children in Davanagere city, Karnataka, India. Materials and methods: This cross‐sectional survey was conducted with 900 school children aged between 12 and 15. The subjects were randomly selected from six high schools. Selected subjects completed a survey instrument predesigned to measure subjective oral health indicators including the eight‐item OIDP frequency scores. The study participants were clinically examined for dental caries, and they completed a self‐administered questionnaire about demographic information and oral behaviours. Results: 44% of the students reported at least one oral impact in the previous 6 months. The reliability of the instrument was measured in terms of Cronbach’s alpha for the OIDP frequency. It was found to be 0.81. Eating was the most common performance affected (33%) followed by cleaning teeth (22%) and speaking (20%). The severity of impacts was low for relaxing and carrying out works. Conclusion: The OIDP frequency score has acceptable psychometric properties in the context of an oral health survey among high school children of Davanagere city, Karnataka, India.     

Clinical significance of low levels of myeloperoxidase positivity in childhood acute nonlymphoblastic leukemia

The clinical significance of a low percentage of myeloperoxidase- positive blast cells in childhood acute nonlymphoblastic leukemia was determined. Of 155 consecutive cases studied by cytochemical staining methods, 14 were characterized by 4% to 15% (median 6%) myeloperoxidase- positive blasts. All 14 cases showed reactivity to Sudan black B stain, and 7 had Auer rods. The morphological subtypes of leukemia were M1 (8 cases), M2 (3), M4 (1), and M5 (2). Immunological marker studies disclosed the lymphoid-associated T11 antigen on cells from 8 of the 11 cases tested. Other lymphoid-related findings in these 8 cases included the T3 antigen and E rosette formation in 1 case each. Among cases that were prospectively studied for the expression of lymphoid-associated markers, 6 of 8 with low levels of myeloperoxidase positivity compared with only 1 of 44 with higher levels (greater than 15%) possessed such features (P less than 0.001). We conclude that low levels of myeloperoxidase reactivity distinguish cases of acute leukemia in which the blast cells coexpress lymphoid (T11 antigen) and myeloid markers.     

Biplane stereoscopic magnification cerebral angiography

An angiographic system capable of simultaneous biplane stereoscopic magnification cerebral angiography was evaluated. Stereoscopic imaging improved the morphologic depiction of aneurysms and of arteriovenous malformations. In a series of 357 patients, procedure time was reduced because the initial biplane stereoscopic series was nearly always diagnostic, obviating the need for additional angiographic views.