Maternal Dietary Risk Factors in Childhood Acute Lymphoblastic Leukemia (United States)

OBJECTIVE: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, and the second most common cause of mortality in children aged 1-14 years. Recent research has established that the disease can originate in utero, and thus maternal diet may be an important risk factor for ALL. METHODS: The Northern California Childhood Leukemia Study is a population-based case-control study of risk factors for childhood leukemia, including maternal diet. Cases (n = 138) and controls (n = 138) were matched on sex, date of birth, mother's race, Hispanicity, and county of residence at birth. Maternal dietary intake in the 12 months prior to pregnancy was obtained by a 76-item food frequency questionnaire. RESULTS: Consumption of the vegetables (OR = 0.53; 95% CI, 0.33-0.85; p = 0.008), protein sources (OR = 0.40; 95% CI, 0.18-0.90, p = 0.03), and fruits (OR = 0.71; 95% CI, 0.49-1.04; p = 0.08) food groups were inversely associated with ALL. Among nutrients, consumption of provitamin A carotenoids (OR = 0.65, 95% CI, 0.42-1.01; p = 0.05), and the antioxidant glutathione (OR = 0.42; 95% CI, 0.16-1.10; p = 0.08) were inversely associated with ALL. CONCLUSION: Maternal dietary factors, specifically the consumption of vegetables, fruits, protein sources and related nutrients, may play a role in the etiology of ALL. Dietary carotenoids and glutathione appear to be important contributors to this effect.     

A combined spinal-epidural technique for labor analgesia and symptomatic relief in two parturients with idiopathic intracranial hypertension

Idiopathic intracranial hypertension is a condition consisting of increased intracranial pressure of unknown etiology, predominantly affecting obese women of childbearing age. Symptomatic relief can be provided by lumbar puncture and withdrawal of cerebrospinal fluid, and the technique has been described in laboring women using an intrathecal catheter. We present two patients who achieved both labor analgesia and symptomatic relief via a combined spinal-epidural technique with small volume cerebrospinal fluid withdrawal. Both women complained of headache of at least a 5 on a 10-point pain scale at the time of labor induction. Between 5 and 6 mL of cerebrospinal fluid were withdrawn at the time of combined spinal-epidural insertion and pain relief was successfully achieved with patient-controlled epidural anesthesia. One patient proceeded to cesarean delivery for fetal indications under epidural anesthesia. Both women described significant improvement in headache symptoms that persisted until discharge from hospital, and neither developed new neurologic symptoms. A combined spinal-epidural technique with a small volume of cerebrospinal fluid withdrawal may provide labor analgesia and symptomatic relief in the parturient with idiopathic intracranial hypertension.     

Neurologic events after partial exchange transfusion for priapism in sickle cell disease

We describe six boys with homozygous sickle cell disease, aged 7 to 13 years, in whom acute, severe neurologic abnormalities developed 1 to 11 days after partial exchange transfusion was performed to treat priapism that was unresponsive to more conservative therapy. Hemoglobin levels were 10.5 to 13.4 gm/dl (mean 12.1 gm/dl), and hemoglobin S levels were 18% to 33% (mean 27%) before the onset of neurologic complications. Severe headache was the initial finding in five patients, four of whom had increased intracranial pressure and three of whom required tracheal intubation and hyperventilation. Four patients had seizures; three had focal neurologic deficits for more than 24 hours. Cerebral arteriography demonstrated vascular abnormalities, including irregularity, stenosis, and complete occlusion of vessels. Patients treated with regular erythrocyte transfusions had no recurrence of neurologic signs or symptoms when hemoglobin S levels were kept at 30% to 50%. The occurrence of serious neurologic complications after partial exchange transfusion in patients with homozygous sickle cell disease from three centers indicates the possibility of a causal relationship between the events. Early and thorough investigation of neurologic symptoms, especially severe headache, is warranted in this clinical setting.     

Dermal penetration of carbofuran in young and adult Fischer 344 rats

Dermal penetration of carbofuran was determined in young (33 d) and adult (82 d) female Fischer 344 rats employing in vivo and in vitro methods. In vivo dermal penetration at 120 h was 43% for young and 18% for adult rats. The half-time for carbofuran skin penetration (in vivo) was 128 h for the young and 400 h for the adults. The young to adult ratio of dermal penetration was greater than 1 at all time points (average 2.9) and had a maximum of 4.2 at 24 h. Cumulative urinary excretion approached about 95% of the absorbed dose in both the young and adult animals at 120 h. Whole-body retention was slightly higher in adults. Kidney showed the highest tissue-to-blood concentration ratio (4.6 in adult, 2.3 in young). The ratio for the carcass was 2.8 in the adult and 2.4 in the young. The urine/blood concentration ratio was high, 435 in the adult and 573 in the young. The feces/blood ratio was 44 in the adult and 65 in the young. Skin absorption by the in vitro continuous-flow system was 41% for the young and 11% for the adult at 72 h, compared to 36% and 13% by the in vivo method. The static in vitro method gave consistently lower skin penetration values of 12% for the young and 8.8% for the adult. Differences in the kinetics of retention and excretion were observed between the young and adult animals.     

Analysis of 5'' flanking regions of the gamma globin genes from major African haplotype backgrounds associated with sickle cell disease.

There are at least three major African haplotype backgrounds on which the beta s mutation arises. Sequence changes in the immediate 5' flanking area of the gamma-globin genes may account for differences in fetal hemoglobin expression among the three haplotypes. We determined the sequence from -350 to 10 bp 5' of the G gamma and A gamma fetal globin genes from one beta s-containing chromosome on each of the three major haplotype backgrounds. The Senegal chromosome had a T at -158 5' to the G gamma gene; the Benin (BEN) chromosome had an A to G change at -309 5' to the G gamma gene; and the Central African Republic (CAR) chromosome had a C to T change at -271 5' to the A gamma gene. Genomic DNA from patients with sickle cell disease was analyzed using the polymerase chain reaction and radiolabeled allele-specific oligonucleotide probes. The -309 G variant 5' to the G gamma gene is associated with BEN chromosomes, and the -271 T variant 5' to A gamma with CAR. The -309 change was also found on beta A-containing chromosomes, while the -271 change was not. The -309 change may have predated the beta s mutation on the BEN chromosome.