bluuebunny/crossref_metadata_2025 huggingface dataset:
Testicular function following combination chemotherapy with Cis‐platin, vinblastine, and bleomycin
Authors: Johnson David H. , Hainsworth John D. , Linde Randolph B. , Greco F. Anthony
Published: February 2007

Recovery of the pituitary‐gonadal axis following treatment with vinblastine, bleomycin, cis‐platin ± doxorubicin (VBP ± A) is assessed retrospectively in 18 men with germinal neoplasms. One patient also received VP‐16‐213. In the first year after completing treatment all men demonstrated elevated follicle stimulating hormone (FSH) and luteinizing hormone (LH) values with concomitant azoospermia. Of the 11 men evaluated at least 24 months from completion of therapy, seven (64%) had recovery of both FSH and LH to normal or near normal levels. Spermatogenesis was present in five of six (83%) men providing semen samples and who were at least 2 years from stopping VBP. Five of seven (71%) men who were within 24 months of therapy were azoospermic. Regardless of the time of evaluation, most men (94%) had normal serum testosterone. Patients receiving maintenance vinblastine had more prolonged elevation of serum gonadotropins. We conclude that some men have evidence of recovery of fertility beginning two years after VBP ± A. In addition to germinal epithelium destruction, transient Leydig cell dysfunction occurs but is not accompanied by clinical findings of hypogonadism.
Hodgkin's disease presenting in epitrochlear nodes
Authors: Yu Anthony , Steinfeld Alan D.
Published: February 2007

Two cases of Hodgkin's Disease (HD) presenting in epitrochlear nodes are described, and compared to four similar cases gleaned from the literature. The nodular sclerosis type of HD was present in 5 of the 6 patients. Of the four patients staged with laparotomy, two had infradiaphragmatic disease. A treatment approach using radiation alone for patients with disease limited to the epitroclear region is presented, and anatomical considerations of the treatment technique are given.
Hypopyon in acute lymphoblastic leukemia
Authors: Smith W. Sean , Burke Miles J. , Wong K. Y.
Published: February 2007

A child with acute lymphoblastic leukemia had central nervous system relapse 23 months after diagnosis while in bone marrow remission. This was followed by leukemic involvement of the eye as the only site of relapse 7 months later. Leukemic cells layered out in the anterior chamber and cytologic examination was the only way to make a definitive diagnosis of leukemic hypopyon. Topical treatment is generally ineffective and radiotherapy is the treatment of choice. The prognosis with this complication depends on whether it occurs during therapy or after therapy has been discontinued.
Failure of bleomycin to improve the therapeutic effects of a combination of cyclophosphamide, doxorubicin, and cisplatin (CAP) in advanced sarcomas
Authors: Edmonson J. H. , Creagan E. T. , Kvols L. K. , Richardson R. L. , Rubin J. , Green S. J.
Published: February 2007

Fifty‐eight adults with unresectable metastatic sarcomas received monthly courses of bleomycin, cylcophosphamide, doxorubicin, and cisplatin (BCAP) in combination. Following four courses of BCAP, alternating monthly courses of vincristine, cyclophosphamide, dactinomycin and vincristine, doxorubicin, and dacarbazine were begun. Treatment was continued until disease progression or the achievement of disease resectability, with elimination of doxorubicin after a total dose of 520 mg/m2 had been received. Ten patients electively stopped treatment prematurely. One other patient was removed from treatment because of significant pulmonary toxicity. Of the 58 patients 20 (34%) achieved partial regression of disease including 10 of 18 with leiomyosarcoma, 2 of 8 with malignant fibrous histiocytomas, 3 of 8 with osteosarcoma, 3 of 7 with fibrosarcoma, 1 of 2 with epithelioid sarcoma, and 1 of 1 with mesenchymal chondrosarcoma. Median time to disease progression was 174 days and median survival was 341 days. The percentage of patients achieving disease regression on this study was nearly the same as the percentage achieving disease regression on study of CAP in advanced sarcomas.
Continuing medical education with a personalized monthly newsletter
Authors: Love Richard R. , Moorman Jeanne E.
Published: February 2007

The periodic newsletter is an approach to continuing medical education whose value is difficult to measure. A six‐page monthly newsletter covering cancer and ambulatory medicine topics has been developed in two departments of a university medical center to meet perceived educational needs of new regional primary care practitioners and to maintain a helping relationship between university based and practicing physicians. The newsletter is sent free of charge to requesting clinicians. Each issue of the newsletter is introduced by a personalized letter signed individually by the editor. A reader survey was conducted to evaluate the interest of recipients and the content, usefulness, and format of the newsletter. A usable response rate of 76% was achieved. The evaluation documented that most readers found the publication useful in their practices, remembered receiving issues specifically, kept issues themselves after circulation to colleagues, and read the cover letter. Compared with conference or formal journal instructional methods of continuing medical education, a newsletter may consistently reach a larger audience at a fraction of the cost.
Acute transformation of chronic lymphocytic leukemia
Authors: Jacobs Andrew D. , Schroff Robert W. , Gale Robert Peter
Published: February 2007

A patient with chronic lymphocytic leukemia had typical cell morphology and a characteristic clinical course for 7 years. He then developed progressive disease with a rapidly rising WBC which proved resistant to chemotherapy. The cells resembled lymphoblasts. Immunoperoxidase studies demonstrated identical immunoglobulin light and heavy chains on the surface of both mature lymphocytes and lymphoblasts. Using a recently described monoclonal antibody, B5, a “blast” antigen was demonstrated on the lymphoblast cell surface, but not on the mature lymphocytes. On the basis of morphological and immunological studies, we suggest that the patient's malignant clone transformed from chronic lymphocytic leukemia to acute lymphoblastic leukemia.
Involved field (IF) irradiation with or without chemotherapy in the management of children with Hodgkin's disease
Authors: Jereb Berta , Tan Charlotte , Bretsky Sara , He Shaoquin , Exelby Philip
Published: February 2007

The present policy at Memorial Sloan Kettering Cancer Center (MSKCC) of treating children with Hodgkin's disease [HD] is as follows: involved field (IF) irradiation only (3,600 rad) for Stages IA and IIA; IF irradiation (2,400 or 2,000 rad) combined with multidrug chemotherapy (MDP) protocol for all other stages. A somewhat higher recurrence rate is accepted for Stages IA and IIA in view of the good salvage rate for these recurrences and in view of side effects of more aggressive types of radiation treatment.

One hundred forty‐two patients with HD, 2‐19 years of age, were treated at MSKCC between 1970 and 1981; 98 of these were treated according to the present policy (SP group), and 44 (NP group) were treated differently. All SP patients underwent staging laparotomy. The follow‐up time was 12 to 146 months with a median of 65 months; two patients were lost to follow‐up.

For the SP group, all stages, 10‐year disease‐free survival is 77%, and 10‐year survival is 93%. By comparison, in the NP group 10‐year disease‐free survival is 64%, and 10‐year survival is 80%. The disease‐free survival of SP patients in Stages IA and IIA treated with IF radiation alone is 72%, and survival is 95%. The disease‐free survival of SP patients in advanced stages treated with combined radiation and chemotherapy is 87%; the salvage rate of recurrent disease in these stages is poor. The survival was apparently better (P = 0.07) in the SP group as compared to the NP group. All 6 patients of the SP group who died had a nodular sclerosing type of HD. None of the patients in the SP group have developed secondary malignancies, and no severe bone growth retardations or late effects to other organs were observed.

In our opinion, IF irradiation alone might at present be suitable treatment for children in Stages IA and IIA of Hodgkin's disease, and addition of IF radiation with low doses of MPD improves the survival of patients in advanced stages.
Recurrent testicular infiltrates following radiation therapy for lymphoid malignancy
Authors: Blatt Julie , Wollman Michael R. , Albo Vincent C. , Orlando Salvatore , Silverman Craig L.
Published: February 2007

From a group of 28 patients with biopsy‐proven testicular leukemia seen at our institution since 1979, we describe two boys with lymphoid malignancy who, subsequent to 1,800 rad and 2,400 rad testicular radiation, had second overt testicular relapses. This experience suggests that these patients need careful follow‐up physical examinations, that higher doses may be needed for prolonged local control, and that there may be a role for follow‐up testicular biopsies.
Retinoblastoma, eosinophilic granuloma, and malignant melanoma: A case report
Authors: Casson A. G. , Maroun F. B. , Arnold A. M. , Newman C. E.
Published: February 2007

The case history of a patient treated for unilateral hereditary retinoblastoma who subsequently developed malignant melanoma and eosinophilic granuloma is presented. Although the association between retinoblastoma and second malignancies including malignant melanoma is established, we have found no reports of third malignancies occurring in such individuals.
Racial variation in incidence of Wilms' tumor: Relationship to congenital anomalies
Authors: Kramer Shira , Meadows Anna T. , Jarrett Patricia
Published: February 2007

This is a study of the occurrence of Wilms' tumor and associated anomalies in all incident cases in the Greater Delaware Valley by race. The average annual incidence of Wilms' tumor in this population of 2 million children is significantly higher among nonwhites than whites. A significantly larger proportion of black cases has a Wilms' tumor‐associated condition including aniridia, genito‐urinary anomalies, the Beckwith‐Wiedemann Syndrome, and hemihypertrophy. For very young patients, there was a greater tendency for blacks to have bilateral tumors or a tumor‐associated anomaly, features characteristic of the hereditary form of Wilms' tumor. The excess risk of Wilms' tumor among blacks may be a result of a higher proportion having a hereditary predisposition or more common exposure to agents capable of inducing germinal mutations.
Phase II study of daunorubicin in previously untreated patients with advanced colorectal carcinoma
Authors: Harvey J. , Bonnem E. , Grady K. , Goodman A. , Schein P.
Published: February 2007

Fourteen patients with advanced measurable colorectal cancer were treated with daunorubicin hydrochloride (DNR). The drug was administered at a dose of 15 mg/m2 on day 1 through 3 and 8 through 10. After a 4‐day rest period DNR was given in weekly injections of 15 mg/m2. There were no partial or complete responses. This study failed to confirm the previously reported therapeutic activity of this agent in colorectal carcinoma, using an identical dose and schedule. We have initiated a phase I study of daunorubicin to identify a maximum tolerated dose using an every 3‐week schedule for future phase II trials in solid tumors.
Role of radionuclide imaging in the diagnosis of chondrosarcoma
Authors: McLean Richard G. , Choy Daniel , Höschl Radmil , Nayanar Vimala , Murray I. Provan C.
Published: February 2007

The diagnosis of chondrosarcoma may be difficult if there is an atypical radiographic appearance or an inconclusive biopsy. Radionuclide bone scans of 13 patients with chondrosarcoma were reviewed to assess if a pattern of scan features could be recognised in association with this tumour. A combination, including increased blood pool activity, moderate intensity of uptake, patchy uptake with cortical predominance of activity, minimal distortion of bony outline, and a well‐defined scintigraphic margin, occurred regularly in the series. Recognition of this characteristic pattern of scintigraphic features in cases of suspected chondrosarcoma may assist in the diagnostic assessment.
Vindesine and high‐dose cisplatin in the treatment of advanced non‐small‐cell lung cancer
Authors: Fuks Joachim Z. , Patel Halesh , van Echo David A. , Hornedo Javier , Aisner Joseph
Published: February 2007

Seventeen patients with advanced non‐small‐cell lung cancer (NSCLC) were entered on a combination chemotherapy protocol including vindesine and high‐dose cisplatin. All patients had measurable disease and had not previously received chemotherapy. All patients entered were evaluable for toxicity and response. Tumor regression was limited to one complete and one partial response (response rate, 11.7%; 95% confidence limits, 0 to 27%). The complete and partial response lasted 260 + and 82 days, respectively. For the 15 nonresponding patients, the median time to disease progression was 76 days. Median survival was 141 days for the whole group. Significant toxic effects were vindesine‐related peripheral neuropathy and cisplatin‐in‐duced emesis. Myelosuppression was mild and manageable. The response for the vindesine‐cisplatin combination observed in our study is inferior to that seen in a previous vindesine‐cisplatin trial reported by others. Thus, the true value of this two‐drug regimen in the treatment of NSCLC remains to be established.
Benign metastatic islet cell tumour of the pancreas
Authors: Lewis M. A. , Lilleyman J. S. , Variend S.
Published: February 2007

A nine‐year‐old girl was fortuitously found to have a symptomless metastatic islet cell tumour (apudoma) of the head of the pancreas, the first to be described in a child. The tumour has not changed in size over 3 years and the patient has shown normal growth and development. Initial chemotherapy had no effect.
Simultaneous presentation of relapsing Hodgkin's disease and treatment‐related non‐Hodgkin's lymphoma
Authors: Perri Robert T. , Allen John I. , Oken Martin M. , Limas Catherine , Kay Neil E.
Published: February 2007

A 55‐year‐old white man was diagnosed in 1975 with Hodgkin's disease stage IIA, mixed cellularity. He was treated with 4,500 rads to an inverted‐Y field followed by six cycles of MOPP and remained in complete remission. In 1983 a right axillary lymph node biopsy showed recurrent Hodgkin's disease, mixed cellularity. While receiving his initial chemotherapy he developed persistent epigastric distress. Endoscopic gastric biopsy demonstrated a diffuse large‐cell non‐Hodgkin's lymphoma. Surface marker studies confirmed the separate identity of these two malignant lymphoproliferative processes. This represents the first reported simultaneous occurrence of relapsing Hodgkin's disease with treatmentrelated non‐Hodgkin's lymphoma.
Adjuvant therapy of cutaneous malignant melanoma: A critical review
Authors: Koh Howard K. , Sober Arthur J. , Harmon David C. , Lew Robert A. , Carey Robert W.
Published: February 2007

The emergence of revised definitions for the high‐risk patient with cutaneous malignant melanoma prompts us to re‐examine the current status of adjuvant therapy in this disease. We wish to address the question, “once a cutaneous melanoma is surgically removed and the patient is currently free of disease but at high risk for metastases, what can be done to prevent recurrence”?
Multicentric reticulohistiocytosis and cancer: A case report and review of the literature
Authors: Nunnink Johannes C. , Krusinski Paul A. , Yates Jerome W.
Published: February 2007

Multicentric reticulohistiocytosis (MR) is a syndrome characterized by papulonodular skin lesions, a debilitating polyarthritis, and characteristic histologic findings. It is a rare disorder with only 82 cases reported. Twenty‐eight percent had an associated neoplasm. Hematologic malignancies (four) and neoplasms arising from the breast (four), cervix (three), stomach (three), ovary (two), colon (two), lung (one), pleura (one), and from an unknown source (two) were all seen associated with MR. Eleven cases (including our own) were available for review. The papulonodular skin involvement was the initial manifestation (alone or concurrent with the polyarthritis) in 90% of our cases. The diagnosis of MR preceded that of the associated neoplasm in 73% of the cases. A case report is presented illustrating the relapse of MR before the clinical relapse of the associated tumor, and the response of both the tumor and MR to combination chemotherapy with cyclophosphamide, methotrexate, 5‐fluorouracil, and prednisone when prednisone and aspirin alone failed to relieve the symptoms of MR. Steroids were not beneficial in the patients reviewed. The best management of MR associated with a neoplasm is the best management of the primary neoplasm. Cytotoxic chemotherapy including cyclophosphamide should be considered if there is progression of the MR in order to control the symptoms of MR and prevent a progressive debilitating arthritis.
Salvage treatment for patient with multiple myeloma refractory to alkylating agents
Authors: Gomez German A. , Han Tin , Ozer Howard , Henderson Edward S.
Published: February 2007

Sixteen patients with multiple myeloma refractory to alkylating agents were treated with vincristine 0.25 mg/m2 i.v. on days 1 to 4 and prednisone 1 gm/m2 on days 1 and 3. Chemotherapy was repeated every 2 weeks. Of 15 evaluable patients, five achieved a partial response and four stable disease. Three patients with partial response and three with stable disease relapsed at 6, 7, and 16 and at 5, 9, and 10 months, respectively. The median survival for all patients was 10 1/2 months and it ranged from 1 to 21 + months. The median survival in responders was not reached at 13 months. Onset of antitumor effect was observed within the first 2 weeks. Symptomatic relief of bone pain was noted within 48 hours in responders and nonresponders. Improvement in bone marrow cellularity and decrease in plasma cell infiltration was documented in more than one‐half of the responders. Tolerance to the treatment was good. No hematologic or other significant toxicity was observed.
The use of chemotherapy for extraocular retinoblastoma
Authors: Pratt Charles B. , Crom Deborah B. , Howarth Cathryn
Published: February 2007

Among the 114 children with retinoblas‐toma seen at St. Jude Children's Research Hospital 1962–1984, 11 have received treatment with chemotherapy for measurable extraocular disease which was present at diagnosis (seven patients) or developed later during the subsequent course of their disease (four patients). Metastatic disease involved the brain and spinal fluid of four persons, the orbit of five, the bone marrow of five, lymph nodes of four, and soft tissues of three individuals at the time of their treatments. Single agents or combinations were used. Two patients with orbital extension of primary retinoblastoma developed complete responses following chemotherapy and subsequently received orbital irradiation, and have had long‐term disease‐free survival. Additional responses developed in patients who received vincristine, cyclophosphamide, adriamycin, cisplatin, VM‐26, and ifosfamide, singly or in combination. With future identification of effective chemotherapy, new studies may be focused upon patients with localized disease to reduce radiation dosage or the need for immediate surgical resection of all involved eyes.
Combination chemotherapy with mitomycin‐C, cisplatin, and vinblastine in the treatment of non‐small‐cell lung cancer
Authors: Niell Harvey B. , Griffin John P.
Published: February 2007

The drug combination of mitomycin‐C, cis‐platin, and vinblastine was administered to 30 patients with stage III non‐small‐cell lung cancer. All patients had a performance status of 50% or greater, had evaluable disease, and had not received previous chemotherapy. The overall response rate was 37% with responses seen in 7 of 18 (39%) squamous cell and 3 of 11 (27%) patients with adenocarcinoma of the lung. Mean survival was greater by 2 months in those patients with an objective response to chemotherapy (8.1 vs 5.5). Drug‐associated gastrointestinal toxicity was the most common side effect observed. This three‐drug combination appears to be an active regimen in the treatment of non‐small‐cell broncho‐genie carcinoma; however, altered dosage schedules should be examined in order to decrease drug‐related toxicity.
Chemotherapy‐associated Raynaud's phenomenon in a two‐year‐old girl
Authors: McGuire Warren A. , Passo Murray H. , Weetman Robert M.
Published: February 2007

Raynaud's phenomenon occurred in a 2‐year‐old girl 17 months after starting multi‐agent chemotherapy for an endodermal sinus tumor of the vagina. Symptoms began 2 months after receiving her final dose of bleo‐mycin, and gradually resolved over a 6‐month period despite continuing vinblastine. Chemotherapy‐associated Raynaud's phenomenon appears to be unusual in young children, although mild episodes of vasospasm may not be reported by children or their parents. Specific questions regarding symptoms of Raynaud's phenomenon should be asked of all children receiving vinblastine and bleomycin therapy.
Natural history of histiocytosis X: A pediatric oncology group study
Authors: Berry D. H. , Gresik Mary V. , Humphrey G. Bennett , Starling Kenneth , Vietti Teresa , Boyett James , Marcus Robert
Published: February 2007

The best therapy for patients with histiocytosis X with disease involvement other than isolated bone lesions but without organ dysfunction is unclear. This retrospective study was undertaken to define the natural history of this group of patients.

In 25 of the 92 studied patients, there was no progression of the disease after diagnosis. In 53 surviving patients, the disease either continuously progressed (40) or recurred intermittently (13), The onset of last disease activity was 24 months or less for 55% of these children. A fatal outcome occurred in 14 children. All of these children developed organ dysfunction and 11/14 died during or before the second year of disease. These three different outcomes could not be predicted from the parameters evaluated; however, the disease that never abated but was continuously active was associated with a suboptimal outcome, and the development of organ dysfunction was a grave prognostic sign.
Education in cancer prevention for primary care clinicians
Authors: Love Richard R. , Stone Howard L. , Hughes Barbara
Published: February 2007

In response to increased public interest in cancer prevention and rapidly escalating health care costs, the National Cancer Institute supported the development of cancer prevention courses for health professionals. A multidisciplinary group of physicians, behavioral scientists, and educators developed, field‐tested, revised, and evaluated a 12‐module, 24‐classroom‐hour clinical preventive oncology course for primary care physicians. A rationale for education in cancer prevention is presented, the new clinical discipline of preventive oncology is defined, and contributory disciplines are identified. A curriculum based upon detailed learning objectives is described, short‐term evaluation data are presented, and a methodology for incorporating a didactic course into a residency program is suggested. The positive reception given to this course by residents warrants optimism concerning application of a biopsychosocial or self‐regulative model rather than the traditional biomedical one to clinical medicine and its teaching.
Legionnaires' disease in patients with cancer
Authors: Nunnink Johannes C. , Gallagher James G. , Yates Jerome W.
Published: February 2007

A 4‐year experience with Legionella pneumophila (LD) diagnosed in 36 patients with cancer was reviewed. Cancer patients represented 24% of the total population of patients acquiring LD during that time. Hematologic neoplasms (42%) and lung cancer (22%) accounted for the majority of afflicted patients. Nosocomial infections occurred in 42% of the patients evaluated. Several risk factors were assessed, and only neutropenia, and previous steroid therapy played a causal role (p < .05) when assessed in a retrospective case control fashion. Overall mortality in oncology patients with LD (53%) was high and underscores the need rapidly to diagnose and treat this entity. This mortality decreased after 1977 when an effective antibiotic was utilized. Mixed infections also played a major role in outcome and occurred in 31% of the 36 patients studied. The mortality in these cancer patients was 73%, and this emphasizes the need to exclude and treat concomitant bacterial or fungal infections.
Successful chemotherapeutic decompression of epidural malignant germ cell tumor
Authors: Gale Gordon B. , O'Connor Dennis M. , Chu Jen‐Yih , Tantana Supranee , Weber Thomas R.
Published: February 2007

A patient with a sacrococcygeal malignant germ cell tumor developed epidural spinal cord compression syndrome 32 days after surgical resection of tumor. Rapid resolution of symptoms was observed after chemotherapy with vinblastine, bleomycin, and cisplatinum. There was no radiation therapy or laminectomy for spinal compression. The patient had an excellent neurological recovery without any sequelae from spinal compression. Chemotherapy alone is an excellent approach to the management of epidural compression by malignant germ tumor.
The clinical significance of blast cell morphology in childhood lymphoblastic leukaemia
Authors: Lilleyman J. S. , Hann I. M. , Stevens R. F.
Published: February 2007

The morphological classification of ALL based on the FAB co‐operative group's criteria is capable of identifying 10–15% of children with L2 disease who, given similar treatment, will fare less well than the 85–90% with the L1 variant. The significant features defining L2 morphology are a low cellular nuclear: cytoplasmic ratio and the presence of nucleoli.

Children with L2 disease do not have higher leucocyte counts but are older, have “common” ALL less frequently, and more often have well‐preserved marrow function at diagnosis. Their poor outlook is manifest not only by their higher relapse rate but also by a higher proportion failing to remit in the first instance. L2 morphology does not necessarily “breed true” and can arise in a small proportion of patients with previous L1 disease at the time of relapse.

Other striking morphological features of lymphoblasts, including azurophil granules, vacuoles and “hand mirror” cells, have yet to have their significance defined, though the latter feature may be an unfavourable finding.
Procarbazine‐induced interstitial pneumonitis with a normal chest X‐ray: A case report
Authors: Garbes Isosceles D. , Henderson Edward S. , Gomez German A. , Bakshi Suraj P. , Parthasarathy K. L. , Castillo Nieva B.
Published: February 2007

Pulmonary toxicity due to cytotoxic drugs is well described in the literature. This is most commonly described in association with bleomycin, busulfan, and methotrexate. This report presents a case of interstitial pneumonitis with a normal chest x‐ray that is most certainly due to procarbazine. In addition, the role of gallium‐67 citrate scintigraphy in early diagnosis is discussed. This is especially important since discontinuation of the drug before radiographic manifestations of pulmonary toxicity become evident may prevent permanent pulmonary injury and its sequelae.
Factors associated with psychological distress in cancer patients
Authors: Cassileth Barrie R. , Lusk Edward J. , Brown Lorraine L , Cross Patricia A. , Walsh William P. , Hurwitz Shelley
Published: February 2007

We studied the mental health of 1,278 patients with cancer and 645 family members of patients with cancer to delineate clinical and demographic characteristics associated with poor psychological status. For both patients and their matched relatives, there was a direct relationship between poorer mental health scores and younger age. Highly significant age differences emerged as well for subscale scores of anxiety, depression, and general positive affect in patients, and for depression, emotional ties, and loss of control in relatives. Treatment status, performance status, and sex also contributed significantly to mental health scores. Patients at greatest risk for psychological problems are young, female, receiving palliative or active treatment as opposed to follow‐up care, and symptomatic or not fully ambulatory. Clinicians should be alert to the potential for psychological problems among patients in these categories.
The staging of childhood acute lymphoblastic leukemia: Strategies of the childrens cancer study group and a three‐dimensional technic of multivariate analysis
Authors: Bleyer W. Archie , Sather Harland , Coccia Peter , Lukens John , Siegel Stuart , Hammond G. Denman
Published: February 2007

In childhood acute lymphoblastic leukemia, univariate analyses have identified more than thirty clinical and laboratory prognostic factors. Multivariate analysis is used to sort out the most independent and predictive of these factors, but the methods used are mathematically and conceptually complex.

In this report, we depict the interactions between multiple variables graphically using 3‐dimensional data displays. This approach helps conceptualize the multivariate process and provides an alternative method. We applied the method to the 2,987 children in the CCC‐160 series of studies, and specifically to the “high‐risk” subgroups: initial white cell count (WBC) greater than >50,000/μl; white count > 50,000/μl in conjunction with a mediastinal mass; age at diagnosis less than 1 year; and, central nervous system (CNS) leukemia at diagnosis. Analyzed in this fashion, T‐cell immunophenotype, the presence of a large mediastinal mass, CNS leukemia, and the lymphomatous pattern lose their prognostic value when outcome is stratified by age and WBC. The 3‐dimensional method confirms the mathematical analyses and provides graphic evidence for the conclusions.
Streptococcus bovis bacteremia and underlying gastrointestinal neoplasms
Authors: Friedman Eitan , Elian Dan , Eisenstein Zemach
Published: February 2007

Two patients are described in whom Streptococcus bovis bacteremia was the only clue to the presence of a colonic neoplasm. A third patient had the rare association of gastric carcinoma and Streptococcus bovis bacteremia that followed an operation for the carcinoma. The need for both complete gastrointestinal survey in patients with Streptococcus bovis bacteremia and administration of appropriate antibiotic prophylaxis during surgical manipulation is emphasized.
Hepatocellular carcinoma in thalassemia major
Authors: Borgna‐Pignatti Caterina , De Stefano Piero , Sessa Fausto , Avato Franco
Published: February 2007

The occurrence of hepatocellular carcinoma in a 22‐year‐old man with thalassemia major is reported. As a result of transfusional hemochromatosis, this patient had already developed diabetes, hypogonadism, heart failure, and the sicca syndrome; he was serum and tissue HBsAg negative. Liver iron concentration measured postmortem was found to be 50 times normal.

Multiply transfused patients are at risk of developing hepatocellular carcinoma. Serial measurements of serum alpha‐fetoprotein should permit early detection of the tumor and reduce mortality. Preventive measures include early immunisation against hepatitis B virus and prevention of iron accumulation by intensive use of desferrioxamine. Treatment of hemochromatosis‐associated hypogonadism with androgens should be considered with caution.
Extraneural metastases from medulloblastoma: Long‐term survival after sequentially scheduled chemotherapy and radiotherapy
Authors: Mahoney Donald H. , Steuber C. Philip , Sandbach John F. , Fernbach Donald J.
Published: February 2007

Extraneural relapse of medulloblastoma is an uncommon event which has typically been associated with a fatal outcome. We present a case of a 2 1/2‐year‐old male who developed extensive bone marrow and bone metastases 19 months after diagnosis and treatment of a medulloblastoma. This patient was successfully treated with a sequentially scheduled combination of vincristine, cyclophosphamide, and doxorubicin and remained free of disease for more than 5 years from the time of relapse.
Squamous cell carcinoma of the thymus: A case report of rapid response to cyclophosphamide, doxorubicin, cisplatin, and prednisone
Authors: Umsawasdi Theera , Chong Clayton , Weedn Victor W. , McKenna Robert J. , Barkley H. Thomas , Chiuten Delia F.
Published: February 2007

A woman with unresectable squamous cell carcinoma of the thymus was treated with combination chemotherapy consisting of cyclophosphamide, adriamycin, cisplatin, and prednisone. Rapid tumor response and hyper‐uricemia occurred within 10 days after the first course of chemotherapy. Mediastinal irradiation was given after two courses of chemotherapy. Chemotherapy was continued until the total dose of adriamycin reached 450 mg/m2. The patient is alive and well in remission more than 111 weeks after therapy was begun and more than 63 weeks after treatment was discontinued. Further study of this chemotherapeutic regimen in squamous cell carcinoma of the thymus is needed. Monitoring of serum uric acid levels may be required.
Prolonged echo viral meningitis in a cancer patient with normal serum immunoglobulins
Authors: Watanabe Masayo , Cho Cheng T. , Trueworthy Robert C. , Saving Kay L.
Published: February 2007

This is a report of prolonged meningitis caused by echovirus type 20 in a patient with rhabdomyosarcoma. It represents one of the few documented cases of delayed clearance of echovirus in the cerebrospinal fluid in a patient with normal serum immunoglobulins. The case illustrates the prolonged clinical course of echoviral meningitis in a patient receiving cytotoxic drug therapy, and it suggests that factor(s) other than humoral antibodies may be involved in the elimination of echovirus from the central nervous system.
Radiation myelopathy: A review
Authors: Goldwein Joel W.
Published: February 2007

Radiation myelopathy is a serious potential complication associated with radiation therapy to the spinal cord. Its exact cause is unknown. It represents a spectrum of syndromes, the most common of which are acute transient radiation myelopathy and chronic progressive radiation myelitis. A review of the literature indicates that cord damage is related to a number of controllable factors including dose fraction size, treatment time, total dose, length of cord irradiated, technical and clerical errors. Other less well understood factors that appear to contribute to the risk such as combined chemoradiotherapy effects and hyperthermia should also be recognized. A better awareness and understanding of these factors should ultimately lead to safer and more effective treatments.
Radioimmunodetection of neuroblastoma with antineuroblastoma monoclonal antibody
Authors: Etoh Takao , Takahashi Hideyo , Ohnuma Naomi , Maie Masahiko , Tanabe Masahiro , Kuriyama Yutaka
Published: February 2007

The Antineuroblastoma monoclonal antibody CNM‐5 was submitted to preclinical studies and then used for tumor imaging with following results.

1. CNM‐5 is an antibody which belongs to the IgM fraction and has a molecular weight of 900 kilodaltons. Its protein concentration was found to be 17.99 mg/dl.

2. The 131l‐labeled antibody was injected into nude mice transplanted with human neuroblastoma, and imaging was performed by a gamma camera. Accumulation of 131l in the tumor was relatively clearly seen.

Various organs were removed and examined for 131l uptake. Radioactivity was easily detected in the tumor, suggesting that CNM‐5 is effective for use in imaging diagnosis of neuroblastoma.
Metaiodobenzylguanidine (MIBG) labeled with 123I/131I in neuroblastoma diagnosis and follow‐up treatment with a review of the diagnostic results of the international workshop of pediatric oncology held in Rome, september 1986
Authors: Feine U. , Müller‐Schauenburg W. , Treuner J. , Klingebiel T H.
Published: February 2007

Our experience in scintigraphic diagnosis using 123l/131l‐metaiodobenzylguanidme (MIBG) on 37 children with neuroblastomas stage III‐IV is reported and discussed, together with the results obtained by other authors on MIBG diagnosis at the International Workshop of Pediatric Oncology held in Rome in September 1986.

In our own investigation, 49 examinations were undertaken with 123l‐MIBG and 66 with 131l‐MIBG partly under therapy conditions with high‐activity doses of 131I‐MIBG. There were 29 neuroblastomas, 3 ganglioneuromas, and 3 ganglioneuroblastomas.

The localization of all primary tumors was over 90%; for neuroblastomas with a high level of catecholamine excretion, over 95%. The specificity was about 100%.

The sensitivity with respect to tumor relapse and all localization of metastasis and bone‐marrow tumor infiltration in the followup‐phase approaches was 70% during or after therapy. What emerges from the experience of most investigators is that 123l‐MIBG is the agent best suited to detect tumor relapse and metastasis, especially in the bone marrow. MIBG examinations are of great value in follow‐up studies for detecting tumor relapse and bone marrow infiltrations, especially before the onset of clinical symptoms and other indications.
Radionuclide therapy of neural crest tumors
Authors: Voǔte P. A. , Hoefnagel C. A. , De Kraker J. , Evans A. E. , Hayes A. , Green A.
Published: February 2007

The potential concentration of I 131‐Metaiodo‐benzylguanidine (MIBG) in pheochromocytoma, and the successful application in diagnosis and therapy of pheochromocytoma, has led to its use in therapy in other tumours derived from the neural crest. In neuroblastoma, the concentration of MIBG is as reliable as it is in pheochromocytoma. 18 patients with a neuroblastoma were treated, leading to two complete remissions, seven partial remissions, two no change, and two progressive disease; one patient was lost for follow‐up.

Six adults were treated, three with a carcinoid, two malignant pheochromocytoma and one medullary thyroid carcinoma. Although follow‐up is still short, preliminary results of therapeutic use of I 131‐MIBG indicate that this treatment modality may be effective.
Treatment of neuroblastoma with 131I‐metaiodobenzylguanidine
Authors: Troncone L. , Riccardi R. , Montemaggi P. , Rufini V. , Lasorella A. , Mastrangelo R.
Published: February 2007

Seven patients with neuroblastoma (six children and one adult) were treated with therapeutic doses of high specific activity 131l metaiodobenzylguanidine 131l‐MIBG). Six patients were in stage IV and unresponsive to conventional treatment. One patient, in stage III, was treated at diagnosis, an approach never previously reported.

Single doses of 131l‐MIBG varying from 70 to 184 mCi split into two parts were administered by slow i.v. infusion (4 to 3 hours) at 2‐to 4‐day intervals. The following results were obtained in the six evaluable patients: two patients showed transient stabilization of the disease; three had an objective response, with shrinking of the primary tumor and/or regression of the metastatic lesions. Of these three patients, two suffered relapses at 2 and 7 months, respectively, from the first course of MIBG. The third patient, in whom the residual disease almost completely disappeared following MIBG therapy, is still alive in complete remission after autologous bone marrow transplantation with a follow‐up of 14 months. The single patient treated at diagnosis showed a dramatic response to a relatively low dosage of MIBG, with histologically proved disappearance of the tumor mass.

Our data indicate that MIBG may be useful in the treatment of neuroblastoma unresponsive to conventional chemotherapy. The complete response observed in the patient treated at diagnosis suggests that the full potentiallty of MIBG therapy should be explored in untreated patients.
High‐dose melphalan, vincristine, and total‐body irradiation with autologous bone marrow transplantation in children with relapsed neuroblastoma: A phase II study
Authors: Pinkerton C. R. , Philip T. , Biron P. , Frapazz D. , Phillipe N. , Zucker J. M. , Bernard J. L. , Philip I. , Kemshead J. , Favrot M.
Published: February 2007

Seven children with neuroblastoma who had relapsed on or after conventional therapy (3 originally stage IV, 3 stage III, 1 stage II) were entered on a study of “massive therapy” with purged autologous bone marrow rescue. In 5 patients attempts were made to reinduce remission with alternative chemotherapy, and a partial or complete response was achieved in 3. The massive therapy regimen comprised melphalan, vincristine, and total‐body irradiation. Of 6 patients with measurable disease, all showed objective response to high‐dose therapy (5 partial, 1 complete remission), but the median duration of remission was only 5 months (range 1/2 to 10). One patient remains disease‐free at 18 months post graft. This patient was the only one treated in second complete remission. These data confirm the high response rate achieved by high‐dose melphalan, total‐body irradiation regimens, but it appears unlikely that a single high‐dose chemoradiotherapy procedure will cure patients after relapse, particularly if they are unresponsive to conventional salvage regimens. Such protocols may, however, have a role as consolidation in first remission. The use of double‐autograft procedures is an alternative that warrants further investigation in patients with relapsed neuroblastoma.
Long‐term sequelae of cancer treatment on the central nervous system in childhood
Authors: Packer Roger J. , Meadows Anna T. , Rorke Lucy B. , Goldwein Joel L. , D'Angio Giulio
Published: February 2007

Increasing numbers of children with cancer, including those with acute lymphocytic leukemia and medulloblastoma, are experiencing long‐term disease control. As survival increases, so does the recognition that the treatment used to prolong survival may have significant detrimental effects on the central nervous system (CNS). Because of the slow replication rate of most constituents of the CNS, these effects tend to be delayed. Radiotherapy, and to a lesser extent, chemotherapy (primarily methotrexate) have been implicated in the causation of such sequelae. The pathogenesis of CNS damage is only partially understood and evidence suggests that direct effects on intracranial endothelial cells and brain white matter and immunologic mechanism play a role. A spectrum of clinical syndromes may occur, including radionecrosis, necrotizing leukoencephalopathy, mineralizing microangiopathy with dystrophic calcification, cerebellar sclerosis and spinal cord dysfunction. The two most common forms of sequelae are neuropsychological and neuroendocrinologic damage. The frequency, degree of and etiology of neurocognitive dysfunction is less than completely elucidated. Radiotherapy has been implicated as the major cause of damage, but the relationship between radiotherapy and the type of damage caused and the volume and dose of radiotherapy and degree of cognitive damage is unclear. Cognitive deficits are progressive in nature. Younger children are more likely to suffer the severest damage; but no patient of any age is free of risk of damage. Growth hormone impairment is the most common form of neuroendocrinologic dysfunction. There is increasing evidence that children with cancer who are long‐term survivors are at increased risk for the development of secondary CNS tumors; possibly due, in part, to previous treatment. Much work needs to be done to characterize the sequelae which may occur, develop means of earlier detection, investigate ways to ameliorate sequelae and devise less toxic treatment.
Unusual skin rash following withdrawal of oral 6‐mercaptopurine in children with leukemia
Authors: Kirk Judy A. , Rogers Maureen , Menser Margaret A. , Bergin Mary , Dalla‐Pozza Luciano , Stevens Michael M.
Published: February 2007

Sixteen episodes of a distinctive, papular rash occurred in eight patients following withdrawal of 6‐mercaptopurine (6MP) and methotrexate (MTX) used as maintenance therapy for acute lymphoblastic leukemia (ALL). The rash also developed in one of the eight patients when only 6MP was discontinued. The eruption occurred mainly on the face, and in this site resembled the perioral dermatitis seen following withdrawal of topical fluorinated steroids. The rash generally began within 3 weeks of stopping 6MP and lasted 3 to 4 weeks. It failed to improve with the use of topical corticosteroid. We conclude that this rash is caused by the withdrawal of oral 6MP.
Hematologic and clinical features of patients with chromosome 5 monosomy or deletion (5q)
Authors: Brusamolino Ercole , Orlandi Ester , Morra Enrica , Bernasconi Paolo , Pagnucco Guido , Colombo Anna , Lazzarino Mario , Bernasconi Carlo
Published: February 2007

This paper analyzes the hematologic features and outcome of 13 patients with chromosome 5 abnormalities (monosomy 5 or deletion of 5q), either isolated or with additional anomalies. Among four patients with isolated del (5q), two had a stable refractory macrocytic anemia with thrombocytosis (5q‐syndrome). All nine patients with complex karyotypes had acute leukemia or refractory anemia with excess of blasts in acute transformation; two cases were TdT‐positive, with a lymphoid or a mixed phenotype. In seven patients, preleukemia preceded overt leukemia, and in six, a prior therapeutic, or occupational exposure to mutagens/carcinogens had occurred. Additional chromosome 7 abnormalities were seen in four cases. The median survival of patients with complex karyotypes was 19 months from the time of diagnosis of the hematologic disorder and 5 months from the time of identification of the chromosome 5 abnormality. Pathogenetic implications of the chromosome 5 monosomy or del (5q) through a proto‐oncogene activation and the putative hemopoietic stem cell involvement in a clonal disease are discussed.
Fine‐needle aspiration biopsy in children: Experience in 70 cases
Authors: Verdeguer Amparo , Castel Victoria , Torres Vicente , Olagüe Ramon , Ferris Josep , Esquembre Carlos , Vallcanera Amparo , Muro M. Dolores
Published: February 2007

Results of 70 fine‐needle aspiration biopsies (FNAB) were evaluated retrospectively in 61 pediatric patients. Over a period of 9 months all mass lesions suspected being malignant were aspirated. Twelve of the 70 aspirations were performed in children having known tumours, in order to exclude recurrence or metastasis. The others were carried out to obtain a diagnosis. Satisfactory specimens were obtained from 58 (83%). There were 21 benign diagnoses, 36 malignant diagnoses, and 1 with suspected malignancy. Correlation of histologic and cytologic diagnoses was possible in 45 cases. The diagnostic sensitivity and specificity were 95% and 80%, respectively. We have found FNAB more accurate in the diagnosis of malignancies than in benign lesions. The results suggest that this is a useful technique for obtaining a first diagnosis of malignancy, as well as for excluding recurrence or metastatic disease.
Heterogeneity of immunological patterns in Langerhan's histiocytosis and response to crude calf thymic extract in 11 patients
Authors: Ceci Adriana , De Terlizzi Marino , Tbma Maria Grazia , Calculli Giovanni , Caputo Ruggero , Castello Manuel , Indolfi Paolo , Rosati Domenico
Published: February 2007

Response to treatment with daily intramuscularly administered crude calf thymic extract (Suppressin) in 11 patients with Langerhan's histiocytosis (L.H.) is reported.

In ten patients, T‐lymphocytic subsets were studied before starting immunotherapy: OKT3 positive and OKT4 positive cells were reduced in four patients; OKT8 positive cells were reduced in two patients; three patients were normal. After immunotherapy, one patient entered complete remission, four patients had stationary disease, and six had marked clinical progression.

Subsequently eight patients underwent conventional chemotherapy, and only three entered complete remission.

This study has demonstrated the heterogeneity of immunological patterns in L.H. and justifies the necessity for investigations on the immunoregulatory mechanism of L.H.