Reflections and Perspectives on Pediatric Psychology: Editor's Vale Dictum

Reviews major activities of the Editor and changes in the Journalof Pediatric Psychology (JPP) for issues published in 1993 through1997. Significant trends and accomplishments are reviewed, includingthe increased use of Special Issues and Special Sections tohighlight current pediatric psychological research. Articlespublished during the term are analyzed interms of article typeand population type Comarisons are made to earlier trends inJPP publication as reported by Roberts (1 992).     

Leukemia in Down Syndrome: A Review

The incidence of leukemia is higher in children with Down syndrome (DS) than in normals. In approximately 50% of cases the type of leukemia is acute megakaryoblastic leukemia (AMKL) and it occurs during the first 4 years of life. The leukemic cell also has features of erythroid progenitors and therefore appears to be a precursor cell with biphenotypic properties.     

Laboruntersuchungen als “eigene” Leistung im Sinne der GOÄ

Ohne Zusammenfassung     

Socioeconomic gradients in clinical stage at presentation and survival among breast cancer patients in the Stockholm area 1977-1997

A program to ensure an equivalent standard of care for all patients with breast cancer was initiated in the Stockholm area in the mid 1970s. As part of an evaluation of this program, social gradients in clinical stage at presentation and survival were analyzed among patients diagnosed during 1977 through 1997. The patients (n = 15,021) were selected from a database covering about 88% of all diagnosed breast cancer cases in the region. Putative associations were analyzed between clinical stage, survival and different socioeconomic indicators (level of education, income and occupation). There were significant social differences (p < 0.01) in distribution of clinical stage as well as in total and stage-specific survival. High income, more skilled work and a high level of education were all associated with clinically less advanced tumors and hence better survival. However, stage-specific survival differences were mostly generated by differences in nonbreast cancer mortality. The results indicate social inequalities regarding awareness of the disease and/or access to early detection. Social gradients in nonbreast cancer mortality were also found to influence observed survival. In contrast, we observed no significant social differences in stage-specific breast cancer mortality.     

Body size at birth modifies the effect of fat mass and obesity associated (FTO) rs9939609 polymorphism on adiposity in adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

The present study was intended to examine whether ponderal index (PI) at birth modifies the effect of the fat mass and obesity associated (FTO) rs9939609 polymorphism on adiposity in European adolescents. A total of 628 adolescents aged 14·4 (se 1·3) years (56·8 % female) were recruited. PI was calculated from parental reports of birth weight and length (kg/m3), and the BMI (kg/m2), body fat percentage and fat mass index (FMI, kg/m2) were calculated. The rs9939609 polymorphism was genotyped and physical activity assessed by accelerometry. Sex, duration of pregnancy, pubertal status, centre and physical activity were used as confounders in all the analyses. The minor A allele of the FTO rs9939609 was significantly associated with higher BMI, body fat percentage and FMI (all P < 0·05) but not with PI. Significant interactions between PI and the rs9939609 polymorphism in terms of body fat percentage (P = 0·002) and FMI (P = 0·017) were detected. However, this polymorphism was only significantly associated with higher BMI, body fat percentage and FMI (all P < 0·05) in adolescents in the lower PI tertile. Indeed, both body fat percentage and FMI were higher in those adolescents in the lower PI tertile carrying the A allele of the FTO rs9939609 polymorphism than in those with the TT genotype (25·0 (se 0·8) v. 22·1 (se 1·0) %, adjusted P = 0·030 and 5·6 (se 0·3) v. 4·6 (se 0·4) kg/m2, P = 0·031, respectively). Our findings suggest that those adolescents born with lower PI could be more vulnerable to the influence of the A risk allele of the FTO polymorphism on total adiposity content.     

Perioperative thyroid hormone kinetics in patients undergoing major oral and maxillofacial operations.

PURPOSE: The aim of this study was to investigate the perioperative response of serum thyroid hormones in patients who underwent extensive maxillofacial operations with desflurane (0.2 to 1.5 MAC) and remifentanil (0.05 to 0.3 microg/kg/min) anesthesia. MATERIALS AND METHODS: Serum thyroxine, total and free triiodothyronine, thyroid-stimulating hormone, interleukin-1beta and 6, TNF-alpha, free fatty acids, S100B protein, CRP, as well as amyloid A protein were measured in 13 patients subjected to extensive oral and maxillofacial operations. Samples were collected before anesthesia induction, at the end, and 6, 12, 24, and 72 hours after the end of surgery. Patients during the study fasted, and at the postoperative period received Ringer's saline or with 5% dextrose alternatively, at the rate of 0.5 to 1.5 mL/kg/hr. RESULTS: Thyroid hormones concentrations showed a significant decrease over time whereas their values recovered to the baseline 72 hours after surgery. Interleukin 1beta, 6, S100B protein, CRP, serum amyloid A protein, and free fatty acids showed a significant increase 6, 12, and 24 hours after the end of the operation as related to the basal value. No significant clinical complications were recorded over the study. CONCLUSION: Patients undergoing extensive oral and maxillofacial surgery exhibit marked decrease in serum thyroid hormones. Stress response, anesthesia, and perioperative fasting may be decisive factors eliciting this response. These metabolic derangements do not deteriorate the clinical outcome and subsequently may be an adaptive response for energy preservation in various organs.     

Inhibition of anastomotic intimal hyperplasia by a synthetic nonsulphated heparin-mimicking compound

Despite extensive research in the design of endovascular catheters and advanced surgical techniques, stenosis recurs in a large percentage of patients undergoing angioplasty or anastomosis. Hence, neointimal hyperplasia, caused by migration and proliferation of vascular smooth muscle cells (SMC), remains a significant limitation to the relief of obstructive-occlusive vascular disease. It has been previously demonstrated that heparin displaces active basic fibroblast growth factor (bFGF) from the lumenal surface of blood vessels. Sequestration of the displaced bFGF by injured areas of the vessel wall is inhibited in the presence of a synthetic nonsulphated heparin-mimicking polyanionic compound (RG-13577). This compound also induces a phenotype transformation of coronary SMC into a metabolically active hypertropic status that could promote repair processes after balloon angioplasty while inhibiting cell proliferation. In this paper, the result of a continuous administration of compound RG-13577 both in the rat carotid catheter injury model and in a newly developed rat model of surgical arterial vascular injury (anastomosis) is reported: it causes a profound inhibition of intimal hyperplasia in both models. A combined treatment with heparin/heparan sulphate mimetics and halofuginone, a potent inhibitor of collagen synthesis, extracellular matrix deposition and SMC proliferation, is expected to inhibit restenosis through inhibition of both signals/activities induced by soluble molecules (ie, heparin-binding growth factors) and components of the extracellular matrix (ie, type I collagen).     

Linac-integrated kV-cone beam CT: technical features and first applications.

One of the most prominent imaging techniques in image-guided radiotherapy (IGRT) is the acquisition of cone beam computed tomographies (CBCTs) at the linac with the patient in treatment position. CBCTs provide accurate 3-dimensional (3D) knowledge about the patient's anatomy for every treatment fraction and are therefore well suited for all adaptive corrections of errors related to interfractional uncertainties of the treatment process. In this paper, we first describe the technical development and implementation of this new imaging technique at our linac, i.e., the hardware components and their operating parameters are discussed in detail for a standard image acquisition of CBCTs. Then, an extension of this approach for the acquisition of complete images for extended field of views--the "shifted detector" technique--is presented followed by a first investigation of how CBCTs can be reliably used for adaptive dose calculations. Finally, a first clinical application, the process of automatic patient positioning based on CBCT images, is discussed. From our investigations, we conclude that the technical development of linac-integrated CBCTs bears an enormous potential for the correction of interfractional treatment errors. However, image quality and reconstruction speed of the images leave room for improvement. The development of clinical strategies for the optimal application of this new image modality in a clinical environment is one the major tasks for the future.     

(14)C-lidocaine disposition in serum and tissues of normal and liver diseased rats.

PURPOSE: This study was designed to investigate the disposition of (14)C-lidocaine in serum and tissues in rats with liver dysfunction. MATERIALS AND METHODS: Eighteen male rats were randomly divided into 2 groups. Group A was considered as control while group B underwent liver damage by administrating CCl(4) 0.4 mg/kg twice a week for 6 weeks. Both groups received 5 doses of 2.5 mg/kg lidocaine mixture (labeled (14)C-lidocaine and nonlabeled). The rats were killed 2 hours after the last dose. Total lidocaine levels ((14)C-lidocaine and (14)C-lidocaine metabolite concentrations) as well as the percent of total lidocaine-bound fractions in tissues were measured. RESULTS: (14)C-lidocaine concentrations were significantly increased in the serum (9.4+/-0.4 microg/mL), heart (7.8+/-2 microg/gL), and mandible (0.97+/-0.01 microg/g) in diseased rats as compared with normal rats (serum, 5.3+/-1.7 microg/mL; heart, 4.2+/-0.9 microg/g; mandible, 0.68+/-0.02 microg/g, respectively). (14)C-lidocaine bound fractions in the mandible and heart did not show any significant differences between the 2 groups. Instead, (14)C-lidocaine bound fractions in serum were significantly reduced in diseased animals as opposed to normal ones. CONCLUSION: We concluded that liver dysfunction can modify (14)C-lidocaine concentrations in the serum and tissues without altering the lidocaine binding properties in the mandible and heart.