bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiagent chemotherapy for children with metastatic neuroblastoma: A report from childrens cancer study group
Authors: Finklestein J. Z. , Klemperer M. R. , Evans A. , Bernstein I. , Leikin S. , McCreadie S. , Grosfeld J. , Hittle R. , Weiner J. , Sather H. , Hammond D.
Published: February 2007

During the past 10‐15 years there has not been a significant improvement in the overall survival of children with metastatic neuroblastoma. From 1971 through 1975, 104 eligible patients were entered on two clinical studies for newly diagnosed cases of stage IV neuroblastoma by the Childrens Cancer Study Group (CCSG). Patient data from both studies were evaluated for activity of cyclophosphamide, imidazole carboxamide, and vincristine and of these same agents plus adriamycin. Response was evaluated by serial measurements of tumor size. Eighty‐four patients experienced a complete or partial response. The life‐table estimate of median survival on both studies was 11–12 months for all patients and 13‐18 months for responders, unchanged from the results of previous CCSG studies. Long‐term survival, however, for patients on these studies demonstrates a significant increase compared with results reported from the three previous CCSG studies. Children less than 1 year or greater than 6 years of age at diagnosis showed a significantly improved survival pattern over the intermediate age group. It is suggested that there is a need to consider the induction response pattern and age at diagnosis when planning a maintenance program so that nonresponders can be identified early and considered for treatment with new agents or aggressive multimodal therapy.
Intraventricular versus intralumbar methotrexate for central‐nervous‐system leukemia: Prolonged remission with the ommaya reservoir
Authors: Bleyer W. Archie , Poplack David G.
Published: February 2007

Ten children had recurrence of central‐nervous‐system (CNS) leukemia despite monthly injections of methotrexate into their lumbar cerebrospinal fluid. Each child was then reinduced into remission and maintained with intraventricular methotrexate administered via an Ommaya reservoir and the length of this remission was compared with the duration of the child's previous intralumbar‐treated remission. Of eight evaluable patients, seven had longer CNS remissions with intraventricular therapy than with intralumbar therapy (P < 0.02). The median CNS remission duration in all patients was 475 days with intraventricular and 286 days with intralumbar therapy (P < 0.05). The rate of CNS relapse was reduced from 2.94 relapses per thousand days at risk during intralumbar therapy to 0.93 relapse per thousand days of intraventricular therapy. We conclude that intraventricular chemotherapy is significantly more effective against CNS leukemia than the same therapy given by lumbar puncture.
Evaluation of overall toxicity of high‐dosage methotrexate regimens
Authors: Perez Clara , Sutow Wataru W. , Wang Y. M. , Herson Jay
Published: February 2007

The occurrence of overall toxicity was analyzed for 43 patients with osteosarcoma who received 349 high‐dosage courses of methotrexate (HD‐MTX) with citrovorum factor (Leukovorin) „rescue”︁ (CF). The dosages of HD‐MTX ranged from 50 to 350 mg/kg. Overall toxicity was assessed on the basis of five manifestations of toxicity: stomatitis, dermatitis, myelosuppression, liver dysfunction, and kidney function abnormalities. The great majority (91.4%) of the infusions were well tolerated, but 8.6% were associated with moderate or severe toxicity. Stomatitis and serum glutamic‐oxaloacetic transaminase (SGOT) changes were the most frequent postinfusion findings. Three patients died from causes related to MTX toxicity. Dose, age, sex, and number of prior infusions were investigated by logistic regression analysis for prognostic effect on frequency of moderate to severe overall toxicity. Age and number of prior infusions had significant (P < 0.06) effects on overall toxicity. Patients older than 15 years with greater than 10 prior infusions constituted the „high risk”︁ group with a risk of moderate to severe toxicity 6.3 times that of the younger patients with fewer than 10 infusions.
An exploration of cancer staff attitudes and values
Authors: McKegney F. Patrick , Visco Gary , Yates Jerome , Hughes Judith
Published: February 2007

A multidisciplinary team involved in the care of patients with advanced cancer including physicians, nurses, social workers, physical therapists, nutritionists, clergymen, enterostomal therapists, biostatisticians and administrative personnel were studied over a period of eighteen months. A prospective study of staff attitudes and values about life, disease, and medical care which focused particularly on cancer, cancer treatment and patients with cancer was undertaken. Data were gathered from the staff by written responses to the following instruments: 1) Rokeach Value Survey and 2) a Personal Attitudes Towards Illness Questionnaire. This longitudinal prospective study demonstrated the reliability of scrutinizing individual and collective staff characteristics in a cancer care team. Although most team members had minimal previous contact with clinical research or with patients with advanced cancer, increased exposure did not result in changes in staff attitudes and values over the period of seventeen months.
Treatment of advanced head and neck cancer by means of radiation therapy plus chemotherapy — a randomised trial
Authors: Bezwoda Werner R. , de Moor Norah G. , Derman Denis P.
Published: February 2007

Fifty‐eight patients with advanced head and neck cancer were entered into a randomised trial comparing radical radiation therapy to the primary tumour and associated lymph node areas with a combination of radiation therapy plus chemotherapy. The distribution of tumour types and stages was similar in the two treatment groups. The response rates to radiation therapy alone (50% complete plus partial response) and to radiation therapy plus chemotherapy (60% complete plus partial response) were not significantly different. However, a significant difference in survival was found between the two groups. The median duration of survival for the patients treated by means of radiation therapy alone was 18 weeks; that for the combined therapy was 36 weeks. The combination of radical radiation therapy plus intermittent high‐dose chemotherapy was well tolerated and appears to be an approach that warrants further trial.
Relapse rates following cessation of chemotherapy during complete remission of acute lymphocytic leukemia
Authors: Baum E. , Sather H. , Nachman J. , Seinfeld J. , Krivit W. , Leikin S. , Miller D. , Joo P. , Hammond D. ,   A Report From Childrens Cancer Study Group
Published: February 2007

The therapeutic benefit of maintenance chemotherapy beyond three years for children with acute lymphocytic leukemia (ALL) in continuous complete remission was evaluated by the investigators of Childrens Cancer Study Group (CCSG). Two hundred and twenty leukemic children in first remission for three years or longer and who had received at least three years of continuous chemotherapy were eligible. One hundred and one patients were randomized to either continue chemotherapy for an additional three years or to discontinue therapy, and 119 patients nonrandomly continued or discontinued therapy. The patients had received a variety of chemotherapy regimens. The study period extended from April 1970 until December 1977, with a median follow‐up time of 25 months. Relapses occurred in 15 randomized patients (15%). Randomized patients remaining on chemotherapy experienced a statistically significant lower relapse rate than patients randomized to discontinue therapy. Also among randomized patients, bone marrow relapse was signicantly more frequent in males than in females. Considering the total patient group, age and white blood count at diagnosis had no significance in predicting relapse. Of relapse events in males, 21% were isolated testicular relapses, identifying the testicle as a major risk site in males completing three years of continuous complete remission. This study demonstrates that continuing chemotherapy beyond three years results in a significant prolongation of remission in males, although the eventual survival outcome for later discontinuance of therapy will require longer follow‐up.
Histoplasmosis mimicking childhood non‐Hodgkin lymphoma
Authors: Brodeur Garrett M. , Wilber Richard B. , Melvin Susan L. , Murphy Sharon B.
Published: February 2007

Cell surface markers are becoming increasingly important in the diagnosis of malignant lymphoid diseases. We present a case of pulmonary histoplasmosis with a pleural effusion. The differential diagnosis included non‐Hodgkin lymphoma because the pleural fluid cells were cytologically identical to convoluted lymphoblasts; the cells also formed rosettes with sheep erythrocytes at 37°C, suggesting that they were malignant thymus‐derived lymphoblasts. Since cultures of pleural fluid were negative for bacteria and fungi, the correct diagnosis of histoplasmosis was made only after conventional histology identified Histoplasma capsulatum organisms in pleural nodules. Thus, until we have a better understanding of the significance of cell surface markers, we should continue to rely on conventional histology for the diagnosis of lymphomas.
Hypothalamic‐pituitary dysfunction following CNS prophylaxis in acute lymphocytic leukemia: Correlation with CT scan abnormalities
Authors: Oliff Allen , Bode Udo , Bercu Barry B. , Chiro Giovanni Di , Graves Versena , Poplack David G.
Published: February 2007

In an attempt to identify possible adverse effects of CNS prophylaxis (cranial radiation and intrathecal chemotherapy), we examined hypothalamic‐pituitary function in 23 patients with acute lymphocytic leukemia (ALL). Of 18 patients who had received both cranial radiation and intrathecal chemotherapy, nine had abnormally low growth hormone responses to insulin‐induced hypoglycemia (< 7.0 ng/ml). Seven of the nine patients with abnormally low growth hormone responses also mainfested ventricular dilatation on computed tomography (CT) brain scans, whereas only one of the nine patients with normal growth hormone responses demonstrated this CT scan finding (P = 0.015). The remaining patients, who had not received cranial radiation, had normal growth hormone responses and normal CT scans. There is a significant correlation between ventricular dilatation on CT and abnormally low peak growth hormone responses following CNS prophylaxis in ALL.
Primary Ewing's sarcoma of the sternum: A case report
Authors: Kedar Amos , Ghoorah Jaya , Thomas Patrick R. M. , Mindell Eugene R. , Tebbi Cameron K. , Freeman Arnold I.
Published: February 2007

A 12 1/2‐year‐old female presented with Ewing's sarcoma of the manubrium sterni which extended into the anterior mediastinum. At presentation there was no evidence of metastatic disease. Her initial treatment consisted of radiation therapy and chemotherapy. The residual tumor was subsequently resected and the sternal defect was repaired with Marlex mesh. Post‐operatively, she was maintained on chemotherapy consisting of BCNU, cyclophosphamide, and adriamycin. The adriamycin was discontinued after she developed sterile fibrinous pericarditis. She remains free of her disease two years after diagnosis. Although extremely rare, Ewing's does occur in the sternum and this area is amenable to wide local resection without severe functional disability.
Successful therapy of crystalcryoglobulinemia: A case report
Authors: Cummings F. J. , Park C. H. , Bogaars H. A. , Kalderon A. E. , Melnicoff I. , Kaplan S. R. , Diamond I. , Calabresi P.
Published: February 2007

Successful therapy for a case of multiple myeloma with a spontaneously crystallizing cryoglobulin of the IgG2‐kappa light chain variety was achieved, using both continuous‐flow cell centrifugation plasmapheresis to rapidly lower the M component and combination chemotherapy with phenylalanine mustard, prednisone, procarbazine, and vincristine to control the myeloma process. This resulted in resolution of incapacitating large and small necrotic cutaneous ulcerations of the extremities.

Physicochemical studies of the crystalcryoprotein demonstrated that cryoprecipitation was rapid and accompanied by the formation of needle‐shaped crystals, yet was completely reversible at 37°C. Cryocrit determinations varied depending upon relative centrifugal forces and temperature and did not always relate linearly to the amount of abnormal protein, thus making these alone unreliable in assessing response to therapy.
Estrogen receptor determination in percutaneous bone marrow biopsies of patients with metastatic breast cancer
Authors: Wortman James E. , Rundles R. Wayne , Moore Joseph O. , McCarty Kenneth S. , McCarty Kenneth S.
Published: February 2007

Estrogen receptor determination in metastatic breast cancer has been shown to be important in determining potential for response to endocrine therapy. One limitation to this procedure can be the availability of neoplastic material for receptor assay. This report describes Patients in whom estrogen receptor status was determined using malignant cells obtained through routine posterior iliac crest bone marrow biopsy. The ability to obtain receptor data from percutaneous bone marrow biopsy specimens has proved to be of importance in patients in whom other sites involved with tumor were not accessible.
Burkitt lymphoma in an American infant under one year of age, with electron microscopic examination of the tumor
Authors: Spruce Wayne E. , Kung Faith H. , Feldman Philip S.
Published: February 2007

Burkitt lymphoma in the United States has not been reported in a child under the age of one year. We report here a nine‐month‐old child who had facial involvement and a rapidly downhill course. This occurred despite an early response to combination chemotherapy and vigorous supportive measures. Electron microscopic examination of the tumor is also presented.
Quality of survival in histiocytosis X: A southwest oncology group study
Authors: Komp Diane M. , Mahdi Anas El , Starling Kenneth A. , Easley James , Vietti Teresa J. , Berry D. H. , George Stephen L.
Published: February 2007

Sixty children survived for five years after the diagnosis of histiocytosis X. Serious disabilities were seen in 50% of children whose disease involved soft tissue and bone. Late deaths from pulmonary failure were associated with opportunistic infections in two cases.

Future treatment approaches must weigh the risks of therapy‐related complications against the probability of significant disability if the disease continues for many years.
Hypopyon‐an early sign of leukaemic relapse
Authors: Lin H. P. , Chandran S. , Tan M. K. , Sinniah D.
Published: February 2007

A 5‐year‐old girl with ALL developed leukaemic hypopyon after 33 months of treatment. Bone marrow and CNS relapse developed 3 months later, which was successfully treated. Local radiotherapy did not prevent an ocular relapse 2 months later, and a second course of irradiation was successfully given. She developed a second bone marrow relapse and died about 9 months after hypopyon was first identified. It is postulated that hypopyon may be an early sign of leukaemic relapse.
Hepatitis B surface antigen in spinal fluid
Authors: Spiegel Robert J. , Tabor Edward , Pizzo Philip A. , Gerety Robert J.
Published: February 2007

Hepatitis B surface antigen (HBsAg) was detected in the cerebrospinal fluid (CSF) of five of nine leukemia patients with HBsAg‐positive sera. These five CSF samples were shown to be free of occult blood using a sensitive hemoglobin extraction technique. The presence of HBsAg in CSF was unrelated to cranial irradiation, prior lumbar punctures, or current chemotherapy. The findings indicate that many blood‐free CSF specimens from HBsAg‐positive patients, as well as all blood‐contaminated specimens, contain detectable HBsAg. This suggests that CSF from patients who are HBsAg‐positive should be handled with care, as it may be capable of trasmitting hepatitis B to health care personnel caring for these patients and laboratory personnel handling their specimens.
Thyroid function in pediatric patients after neck irradiation for Hodgkin disease
Authors: Green Daniel M. , Brecher Martin L. , Yakar Daniel , Blumenson Leslie E. , Lindsay Alan N. , Voorhess Mary L. , MacGillivray Margaret , Freeman Arnold I.
Published: February 2007

Thyroid function was evaluated in a consecutively treated group of children and adolescents with Hodgkin disease who received incidental radiation to the thyroid gland. Ten of 27 (36.7%) were found to have elevated concentrations of thyroid‐stimulating hormone (TSH).

Two groups of patients had an increased incidence of thyroid dysfunction — those who had not had a pretreatment lymphangiogram and those who were less than 13 years of age at the time of neck irradiation. The estimated percentage of patients who did not have a pretreatment lymphangiogram who will develop TSH elevation was 67.7% and of patients who were 13 years of age or less when irradiated, 64.8%. Thyroid dysfunction developed in 6/7 patients who had both of these risk factors present.
Osteonecrosis in patients with Hodgkin disease following combination chemotherapy
Authors: Albala Maurice M. , Steinfeld Alan D. , Khilnani Mansho T.
Published: February 2007

Three cases of osteonecrosis in patients receiving prednisone as part of multidrug chemotherapy for lymphoma are presented. These patients are discussed in the context of previously reported series. The etiology of steroid‐induced osteonecrosis and its radiologic manifestations are reviewed with regard to the need for biopsy to confirm the diagnosis. In light of this complication, the need for prednisone in lymphoma chemotherapy is considered.
Clinical, haematological, and radiological features of children presenting with lymphoblastic mediastinal masses
Authors: Mathew P. M. , Prangnell D. R. , Cole A. J. L. , Hill F. G. H. , Shah K. J. , Jones P. H. Morris , Martin J. , Palmer M. K. , Thompson E. N. , Eden O. B. , Mott M. G. , Mann J. R.
Published: February 2007

During 1968–1978, 68 children presented in six centres in the United Kingdom with lymphoblastic mediastinal masses. The disease was classified as acute lymphoblastic leukaemia (ALL) in 49 children whose bone marrow aspirates contained > 20% lymphoblasts, and as lymphoma (Sternberg lymphosarcoma — LS) in 19 with < 20% marrow infiltration. Males predominated in both groups, and children with ALL had more visceromegaly and lymphadenopathy, lower haemoglobin levels and platelet counts, and higher white cell counts. The most common chest x‐ray finding in both groups was a nonspecific anterior mediastinal mass, but the appearances varied considerably and could be classified into three categories, which are illustrated. Pleural effusions were present in 44%. Cell surface‐marker studies showed T cell characteristics in 14 of the 17 patients tested.

Response to treatment and complications, such as central nervous system (CNS) and testicular relapse, were similar in ALL and LS, and were related to the size of the initial tumour load. Median remission lengths were 37 weeks for ALL and 89 weeks for LS patients. Leukaemic transformation occurred in 47% of LS children. Compared with the outcome in ALL children without mediastinal mass, the results of treatment were poor, regardless of the protocol used, and prophylactic therapy to the CNS reduced the frequency of, but did not eliminate, CNS disease.
Studies on the antidiuretic effect of cyclophosphamide: Vasopressin release and sodium excretion
Authors: Bode U. , Seif S. M. , Levine A. S.
Published: February 2007

To elucidate the mechanism of cyclophosphamide (CTX)‐induced antidiuresis, plasma and urine volume as well as serum electrolytes, creatinine, osmolality, and appropriate hormones were monitored serially during 19 courses of chemotherapy. In spite of plasma hypotonicity and urinary hypertonicity, the plasma vasopressin concentrations were unaltered. Intravenous isotonic hydration did not prevent water retention, but did not lead to plasma hypotonicity, and compensated for modest urinary sodium losses. Furosemide diuresis did not prevent the development of hyponatremia in patients receiving hypotonic hydration. The results indicate that the origin of this self‐limited syndrome is a direct effect of CTX on the renal tubule, permitting increased water reabsorption and sodium loss. The likelihood that water and salt imbalance will develop after CTX administration can be reduced by vigorous isotonic hydration, and pharmacological diuresis.
Failure of early intensive chemotherapy to improve prognosis in childhood acute lymphocytic leukemia
Authors: Camitta Bruce M. , Pinkel Donald , Thatcher L. G. , Casper James , Kun Larry E. , Lauer Stephen
Published: February 2007

The ability of intensive therapy, early in remission, to improve prognosis in childhood acute lymphocytic leukemia was tested in a randomized study. The intensive treatment included cyclophosphamide (200 mg/m2 IV weekly × 4) and Adriamycin (40 mg/m2 IV weeks 1 and 3). These drugs were not utilized during the induction or continuation phases of therapy. Treatment groups were similar with respect to patient age, sex, initial white cell count, and leukemic cell immunologic phenotype. Sixteen of 28 children who received the intensive phase of treatment relapsed, and one died in remission (pneumocystis pneumonia); 14/26 children who did not receive the intensive phase of treatment relapsed, and one died in remission (malignant histiocytosis). Times and sites of relapse were similar in both groups. Pneumocystis pneumonia (three cases) and herpes zoster (two cases) occurred only in children who received the intensive phase of treatment. In this study and in previously published reports, an early intensive phase of therapy did not improve prognosis in children with acute lymphocytic leukemia who also received three‐drug induction therapy, central nervous system prophylaxis, and continuation therapy with two or more agents.
Tumor regression of human retinoblastoma in the nude mouse following photoradiation therapy: A preliminary report
Authors: Benedict William F. , Lingua Robert W. , Doiron Daniel R. , Dawson Jo Ann , Murphree A. Linn
Published: February 2007

Retinoblastoma is the most common malignant intraocular neoplasm of childhood. Enucleation of both eyes is necessary in some advanced cases where radiotherapy and other modalities of treatment have failed. We present in this paper our initial observation that photoradiation therapy (the combination of the photosensitizing drug, hematoporphyrin derivative, and red light) produces marked tumor cytotoxicity in human retinoblastoma heterotransplanted into the anterior chamber of the nude mouse eye.
Gonadal function in pediatric patients following treatment for hodgkin disease
Authors: Green Daniel M. , Brecher Martin L. , Lindsay Allan N. , Yakar Daniel , Voorhess Mary L. , MacGillivray Margaret H. , Freeman Arnold I.
Published: February 2007

Gonadal function was assessed by determination of the serum levels of follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) in 24 children and adolescents 6—98 months after completion of treatment for Hodgkin disease that included pelvic irradiation and/or combination chemotherapy. Four of the five women and six of the nine men who received pelvic irradiation had elevations of serum FSH. Nine of these patients with an elevated FSH received combination chemotherapy in addition to pelvic irradiation. Five of seven males who received combination chemotherapy but no pelvic irradiation and were postpubertal at the time of evaluation had an elevated FSH level. Three of these five were prepubertal at the time of treatment. These results suggest that gonadal dysfunction occurred frequently among children and adolescents following treatment that included combination chemotherapy for Hodgkin disease.
The cytosine arabinoside (Ara‐C) syndrome
Authors: Castleberry R. P. , Crist William M. , Holbrook Tate , Malluh Ahmad , Gaddy Debra
Published: February 2007

Four patients with non‐Hodgkin lymphoma and two with acute lymphocytic leukemia (ages 4 years 4 months to 16 years 6 months) exhibited a unique reaction to intravenously administered cytosine arabinoside (Ara‐C) given alone as a part of the previously reported LSA2‐L2 treatment protocol. The syndrome was characterized by fever, myalgia, bone pain, and occasionally by chest pain, maculopapular rash, and conjunctivitis. Each of the eleven episodes of this syndrome occurred within 6–12 hours of drug infusion and always abated after cessation of Ara‐C. Prior to the reaction, patients had been on therapy for an average of 13.5 months during which they were exposed to 2298–5387 mg/m2 (mean of 3200 mg/m2) of Ara‐C.

The high incidence of this syndrome (50% of our patients on the LSA2‐L2 regimen and 33% of those receiving Ara‐C) has not been previously reported. Considering the prolonged exposure to Ara‐C and our inability to document infections in the patients or pyrogens contaminating the drug lots, the most likely explanation for this syndrome is a hypersensitivity reaction to Ara‐C. Prevention of these symptoms with corticosteroids supports this contention and provides a reasonable alternative to discontinuing Ara‐C.
Hodgkin disease as the terminal malignancy in richter syndrome
Authors: Cosgriff Thomas M. , McCloskey Donald W.
Published: February 2007

A case of Richter syndrome in which autopsy revealed typical infiltrates of Hodgkin disease, including Reed—Sternberg cells, is reported. Previous reports of this association have met with skepticism. Clinical findings in patients with Hodgkin infiltrates do not differ from those with histiocytic lymphoma, except for the more frequent occurrence of a declining lymphocyte count. The present case is further evidence that Hodgkin disease does occur as a terminal malignancy in Richter syndrome.
Disseminated mycobacterium kansasii presenting with skin lesions in a patient with chronic lymphocytic leukemia
Authors: Tempero Margaret A. , Smith Philip W.
Published: February 2007

A patient with chronic lymphocytic leukemia developed skin lesions from which Mycobacterium kansasii was cultured. The organism was also recovered from sputum cultures. Twenty‐three additional cases of disseminated M kansasii infection are reviewed. This disease tends to occur in patients with altered immune response, and atypical histology of tissue specimens may delay diagnosis and treatment.
Radionuclide scanning in children with rhabdomyosarcoma
Authors: Weinblatt Mark E. , Miller John H.
Published: February 2007

Radionuclide scintigraphy was performed in 46 children with rhabdomyosarcoma. Of the 63 radiologically confirmed sites of bone disease, 76% were detected by 99mTc‐labeled phosphate uptake. All 15 sites of hepatic involvement and eight of the nine cranial sites of disease exhibited isotope accumulation. Gallium 67 scans showed 57% of the 43 proven sites of disease, including four previously unsuspected areas. Twelve false‐positive sites were obtained with gallium. Radionuclide scanning is a valuable aid in the diagnostic evaluation and management of childhood rhabdomyosarcoma.
Intrapleural therapy of malignant pleurisy in patients with neuroblastoma
Authors: Ha K. , Tawa A. , Ikeda T. , Tanaka J. , Okada A. , Yabuuchi H.
Published: February 2007

Three children with advanced neuroblastoma developed pleural effusion in the course of their disease. This unusual complication was successfully treated with intrapleural administration of a nonspecific “immunostimulatory” agent; cell wall skeleton of Nocardia rubra (N‐cws). The side effects of this procedure were mild and well tolerated even in infants in spite of their terminal stage. Intrapleural therapy in this study seemed to be useful for the treatment of pediatric malignant pleurisy.
Cyclical combination chemotherapy and thyroid function in patients with advanced hodgkin's disease
Authors: Sutcliffe S. B. , Chapman Ramona , Wrigley P. F. M.
Published: February 2007

Clinical and biochemical assessment of thyroid function was undertaken in patients with Hodgkin's disease at designated points following diagnosis. At diagnosis, two of 20 patients had either abnormally low routine thyroid indices, or elevated thyroid stimulating hormone (TSH) levels that were not due to iodine‐based investigations. Following lymphography, 76.5% of patients had TSH levels that remained elevated for a median period of 3 months. No detectable thyroid dysfunction was induced during chemotherapy. Fifty‐four patients were studied at a median time of 35 months after chemotherapy. One euthyroid patient had a nodular goitre, and one had abnormal thyroid indices. TSH levels were elevated in 44% of patients, although the median TSH level for the group was normal. Half the patients had abnormal TRH stimulation tests. Sixty patients were studied after irradiation and chemotherapy. Four patients had clinical thyroid dysfunction, and 10% of routine thyroid indices were abnormal. TSH levels were abnormal in 80%, with a markedly elevated median level. All thyroid releasing hormone stimulation tests were abnormal.
Childhood cancer in offspring of two wilms tumor survivors
Authors: Kantor Arlene F. , Li Frederick P. , Fraumeni Joseph F. , Curnen Mary G. Mccrea , Flannery John T.
Published: February 2007

A search was made for cancers among offspring and siblings of 149 Connecticut‐born children with Wilms tumor reported to the Connecticut Tumor Registry during 1935 to 1973. Nasopharyngeal rhabdomyosarcoma developed in the daughter of a man with unilateral Wilms tumor that also affected his sister. Hodgkin disease developed in the daughter of a woman who had unilateral Wilms tumor. One other patient had a sibling with Wilms tumor and three had a sibling with other cancers (two Hodgkin disease, one testicular seminoma). The survey suggests an excess risk of other forms of cancer among the progeny and siblings of Wilms tumor patients.
Low‐dose bleomycin lung
Authors: Wilson Kenneth S. , Worth Anne , Richards A. Gerald , Ford Hugh S.
Published: February 2007

A patient with retroperitoneal diffuse histiocytic lymphoma treated with combination chemotherapy developed breathlessness and fever after receiving 30 units of bleomycin. At this stage pulmonary function tests were impaired and gallium scanning showed diffuse uptake in both lungs although a chest X‐ray film was normal. Bleomycin treatment was stopped but interstitial infiltrates appeared on subsequent chest X‐ray films. Open lung biopsy showed histologic changes of bleomycin toxicity. After treatment with prednisone, the patient felt well and was shown to have a normal gallium scan and normal respiratory function studies.
Unusual metastatic pattern in testicular malignant teratoma
Authors: Wassenaar Henk A. , Roos Raymund A. C. , Spaander Piet Jan , Van Oosterom Allan T.
Published: February 2007

A 25‐year‐old man presented with a malignant teratoma of the right testicle. After orchidectomy, the results of the surgical staging procedure were negative. Although pulmonary metastasis did not occur, massive bone marrow involvement with a bleeding tendency and hypercalcemic nephropathy developed. The response to chemotherapy was excellent, but after the attainment of a complete remission the patient developed carcinomatous leptomeningitis, which was confirmed at autopsy as cause of death.
Acute nonlymphocytic leukemia complicated by severe cytophagocytosis of formed blood elements by nonmalignant histiocytes: Cause of significant clinical morbidity
Authors: Theodorakis Michael E. , Zamkoff Kenneth W. , Davey Frederick R. , Ginsberg Sandra J. , Cass Diane L. , Gottlieb Arlan J.
Published: February 2007

A 52‐year‐old female presented with Philadelphia chromosome‐positive acute nonlymphocytic leukemia and a morphologically benign‐appearing histiocytosis with intramedullary cytophagocytosis of formed blood elements. No cause of the reactive histiocytosis could be found. Despite initial successful therapy of the acute nonlymphocytic leukemia with induction of a cytological remission, pancytopenia with marked cytophagocytosis persisted. Therapy aimed at reducing the degree of cytophagocytosis by the histiocytes, in the form of vinblastine‐treated platelets and, subsequently, prednisone, was instituted. There was no significant clinical response to either therapeutic maneuver. Cytophagocytosis persisted until leukemic relapse and death ensued.
The association of aniridia and wilms' tumor: Methods of surveillance and diagnosis
Authors: Palmer Nigel , Evans Audrey E.
Published: February 2007

The association between aniridia and Wilms' tumor (WT) is well known. The availability of data on a large number of WT patients entered on the first and second National Wilms' Tumor Studies provided the opportunity to review which examinations had been most effective in detecting the presence of WT in patients being followed with aniridia. The records of 1287 patients were available and 13 or 1% had known aniridia. The details of the prediagnostic studies were available in 9/13 patients. Those nine patients had been examined regularly by IVP at intervals of 3–12 months prior to the discovery of the WT, but in only one was the unsuspected WT detected by these means. In the remaining eight patients, the tumor was discovered by palpation in six and suspected because of hematuria in two. It is concluded that repeated IVP's are not a satisfactory method to diagnose a WT at an early stage and newer radiodiagnostic studies, such as ultrasonography, will probably prove more effective.
Intermittent combination chemotherapy with or without bacillus calmette‐guérin for treatment of acute lymphoblastic leukemia of childhood
Authors: Odom Lorrie Furman , Tubergen David G. , Githens John H. , Heideman Richard L. , Blake Marilyn A.
Published: February 2007

Seventy‐four children ranging in age from 6 months to 17.5 years with acute lymphoblastic leukemia newly diagnosed between 1976 and 1979 were entered on a study incorporating intermittent chemotherapy with or without the addition of bacillus Calmette‐Guérin (BCG). The chemotherapy program consisted of induction with vincristine, clexamethasone, and intrathecal methotrexate, intensification with adriamycin and asparaginase, central nervous system treatment with cranial irradiation and intrathecal methotrexate, and continuation treatment with 5‐day courses of combination chemotherapy administered every three weeks. The first phase of continuation therapy incorporated vincristine, adriamycin, 6‐mercaptopurine, and dexamethasone. In the second phase, oral methotrexate was substituted for the adriamycin in non‐T‐cell patients; in T‐cell patients, cytosine arabinoside or cyclophosphamide and methotrexate in alternating cycles were substituted for the adriamycin and asparaginase was added. Total duration of therapy was approximately 2.5 years. Connaught BCG was administered by Heaf gun on days 8 and 15 of each 3‐week cycle for the first 8 months of treatment in approximately one‐third of the patients. Actuarial disease‐free survival with a median follow‐up of 59 months shows no difference in outcome between the BCG and non‐BCG poor‐risk patients. However, there is an improvement in disease‐free survival of BCG‐treated good‐ and average‐risk girls (P = 0.04). While patients were actively receiving BCG there was also a trend toward the development of fewer significant infections than when patients were not receiving BCG (P = 0.85). Toxicities from BCG administration included satellite rashes, local tenderness, lymphadenopathy, secondary infection, and residual scars. Overall disease‐free survival by actuarial analysis is 60% at 6 years; for patients with disease‐tree survival of girls with good‐ and average‐risk prognostic features and also may have decreased the susceptibility to infection while it was being administered. However, the benefit does not appear sufficient to warrant its routine use, especially in view of the toxicities encountered.
Lack of prognostic value of T‐, B‐ and null‐lymphocytes in adult acute leukemia
Authors: Jehn U. , Wachholz K. , Kern D. , Hölzel D.
Published: February 2007

The distribution of T‐, B‐ and null‐lymphocytes was studied in the peripheral blood of 38 adult patients with acute nonlymphocytic leukemia (ANLL) and 15 with acute lymphocytic leukemia (ALL) at first diagnosis, during induction treatment, and in remission. Thirteen ANLL and 9 ALL patients were followed until relapse and during reinduction therapy. T‐ and B‐cells were detected by specific membrane marker. The pre‐ and posttreatment pattern of lymphocyte subpopulations was analyzed to determine their prognostic significance for remission incidence, remission duration, and survival. It was observed that in both types of leukemia, T‐cells are more affected by the leukemic process and cytostatic drugs than B‐cells. Nonresponding patients possibly have a reduced potential for recruiting precursor T‐ and B‐cells. At first diagnosis, no significant correlation was found between pre‐ or posttreatment variables and prognosis. At relapse, ANLL patients had a longer second remission when a high proportion of B‐cells was found; ALL patients with a high lymphocyte count before and after treatment, experienced longer survival.
Effect of total parenteral nutrition on marrow recovery during induction therapy for acute nonlymphocytic leukemia in childhood
Authors: Hays Daniel M. , Merritt Russell J. , White Leslie , Ashley Judith , Siegel Stuart E.
Published: February 2007

Ten well‐nourished children with acute non‐lymphocytic leukemia (ANLL) were randomly assigned to groups that received (a) total parenteral nutrition (TPN) throughout the period of induction therapy or (b) standard nutritional support. Body mass and skin hypersensitivity reactions were better maintained in experimental patients. Patients on TPN had higher total white blood counts, absolute granulocyte counts, and platelet counts than did control patients during the course. No difference was apparent in the frequency of febrile episodes, or other aspects of the patients' courses. This preliminary report suggests that intensive nutritional support may accelerate the recovery of normal marrow function during induction therapy for ANLL.
High dose systemic methotrexate‐associated acute neurologic dysfunction
Authors: Packer Roger J. , Grossman Robert I. , Belasco Jean Bello
Published: February 2007

Two patients treated with high dose methotrexate with citrovorum rescue (HDMTX‐CF) for osteogenic sarcoma developed the acute onset of neurologic deficits. Prior to the onset of symptoms, one child suffered brief episodes of altered consciousness. Both patients developed hemiparesis and then steadily improved over 72 hours. Laboratory evaluations disclosed normal coagulation parameters and nontoxic serum methotrexate levels at onset of symptoms. Computed tomography in one child disclosed a large low absorption abnormality. This patient represents the first reported case of positive radiologic findings associated with this syndrome. The two patients recovered completely and received further HDMTX‐CF without sequelae. This condition may result from transient demyelination or embolic cerebrovascular disease.
Bone marrow involvement in histiocytosis X
Authors: McClain K. , Ramsay N. K. C. , Robison L. , Sundberg R. D. , Nesbit M.
Published: February 2007

Twenty‐eight patients with histiocytosis × (HX) who had bone marrow aspirates and/or trephine biopsies taken at diagnosis were studied. Five of the 28 patients (18%) had bone marrow specimens with clusters of benign histiocytes characteristic of histiocytosis X. Several statistically significant clinical and laboratory differences were found between those patients with postive marrows versus those with uninvolved bone marrows. Presence of HX in the bone marrow was more frequently associated with fever (P < 0.01), splenomegaly (P < 0.01), rash (P = 0.04), diabetes insipidus (P = 0.09), and platelet counts less than 175 × 109/L (P = 0.01). Two of the five patients with bone marrow involvement died, whereas there were no deaths due to HX in the other 23 patients. From this review, it is suggested that bone marrow involvement at diagnosis may be associated with more extensive and potentially fatal disease. HX of the marrow was more easily diagnosed from trephine biopsy sections than aspiration smears.
Case report: Nasopharyngeal rhabdomyosarcoma and gorlin's naevoid basal cell carcinoma syndrome
Authors: Beddis I. R. , Mott M. G. , Bullimore J.
Published: February 2007

A 4‐year‐old girl presented with a nasopharyngeal rhabdomyosarcoma and had the characteristic features of the naevoid basal cell carcinoma syndrome. She was treated with a modified standard combination of chemotherapy and radiotherapy. However, radiotherapy had to be interrupted because of severe radiation recall.
Treatment of spinal cord compression: A retrospective analysis
Authors: Loeffler Jay S. , Glicksman Arvin S. , Tefft Melvin , Gelch Melvyn
Published: February 2007

Epidural spinal cord compression from metastatic disease is a common neurological complication of cancer. The incidence is probably increasing owing to continual advancements in the treatment of cancer that have led to prolongation of life and a greater probability of secondary involvement of the spinal cord.

A problem often encountered by the oncologist treating patients with epidural spinal cord compression is the recurrence of compression by metastatic tumor both in and out of the original treatment field. Radiotherapists are often presented with the difficult task of trying to determine the optimal dose/time fractionation with the hope of improving the therapeutic ratio.

We have examined the charts of 80 patients treated at the Rhode Island Hospital during the last five years (1975‐1980) with myelographic evidence of cord compression in order to determine 1) the recurrence rate of cord compression by metastatic tumor after radiotherapy treatment both in and out of the original treatment field; 2) the influence of various dose/fractionation schedules on the disease‐free interval; 3) the percentage of recurrence out of the treatment field that might represent “skipped lesions” at the original time of diagnosis.

Our results show 1) that 9 patients (11.3%) experienced recurrence within the original treatment field; 2) that 21 (26.3%) experienced recurrence within the spinal canal, but out of the original treatment field; 3) that 9 of the 21 (42%) cases of recurrence out of the original treatment field occurred within 1 week and thus were determined to be “>Our results show 1) that 9 patients (11.3%) experienced recurrence within the original treatment field; 2) that 21 (26.3%) experienced recurrence within the spinal canal, but out of the original treatment field; 3) that 9 of the 21 (42%) cases of recurrence out of the original treatment field occurred within 1 week and thus were determined to be” at the time of diagnosis; and 4) that there appears to be a dose‐response relationship for those patients treated successfully without recurrences who did not have presenting symptoms of complete paraplegia.
Hypereosinophilic syndrome in acute lymphoblastic leukemia with a chromosome translocation [t(5q;14q)]
Authors: Tono‐oka Tatsuhito , Sato Yoshiko , Matsumoto Takahide , Ueno Norihiro , Ohkawa Masato , Shikano Takaaki , Takeda Takeo
Published: February 2007

We report a case of hypereosinophilic syndrome associated with acute lymphoblastic leukemia (L1 type, FAB classification) which showed an abnormal karyotype. An 8‐year‐old boy was admitted to our hospital with complaints of fever and cough that had persisted for 2 weeks. Peripheral blood examination revealed remarkable eosinophilia (120,000/mm3) and a few lymphoblasts. Bone marrow examination also revealed many mature eosinophils and 20% lymphoblasts that were PAS and peroxidase negative. A direct chromosome analysis of the bone marrow cells demonstrated that 12.5% of the spontaneously dividing cells had an abnormal karyotype of 46XY, t(5;14) (q31;q32). The chest radiogram showed interstitial pneumonia‐like densities, and the ECG had the pattern of a right bundle branch block. The therapy consisted of prednisolone, high dose of methylprednisolone, cyclophosphamide, and vincristine. This treatment failed to reduce the eosinophil count. On the 4th day after admission, the patient developed severe dyspnea, complete A‐V block, and died. At postmortem, dense infiltrations of eosinophils in various stages of maturation were noted in lungs and liver.
Medical student interactions with cancer patients: Evaluation with videotaped interviews
Authors: Terasaki Melanie R. T. , Morgan Clifford O. , Elias Laurence
Published: February 2007

In order to evaluate the impact of a block in cancer medicine upon student interactions with cancer patients, a group of 32 students have been videotaped during interviews with simulated and genuine cancer patients before and after the block. The videotapes were scored and analyzed for frequencies and patterns of interactions by the method of Reciprocal Category Analysis. This disclosed significant decreases in purely factual questions by the students, with corresponding in creases in discussion of emotional aspects of illness, following the course. The temporal pattern of interaction also changed with less of a tendency to delay or avoid addressing emotional aspects of disease noted. In addition to demonstrating changes in student interactions with cancer patients following a didactic course, this study exemplifies an approach offering more direct assessment of physician‐patient interactions than has been practical using questionnaires.
Serum LDH values in childhood acute leukemias and non‐Hodgkin's lymphoma
Authors: Suarez Carlos R. , Andreeff Michael , Miller Denis R.
Published: February 2007

Serum lactate dehydrogenase activity (LDH) was examined in 66 children with acute lymphoblastic leukemia (ALL), 26 with acute non‐lymphocytic leukemia (ANLL), and 116 with non‐Hodgkin's lymphoma (NHL). The mean serum LDH value for the ALL and ANLL groups was not significantly different: 970 ± 105 units/L (mean ± standard error of the mean) and 817 ± 161 units/L, respectively. The difference between the LDH values in patients with ALL (970 ± 105 units/L) and NHL (551 ± 51 units/L) was significant (P = .001). In 32% of the patients with ALL and 23% of the patients with ANLL, serum LDH values were above 1000 units/L, whereas only 13% of the cases with NHL had values above 1000 units/L. In patients with ALL the LDH levels were correlated with white blood cell counts at the time of diagnosis. In NHL, there was no difference in serum LDH levels among the various histologic subtypes. Values of LDH in stage IV NHL and in ALL were similar.
Cisplatinum‐induced renal salt wasting
Authors: Kurtzberg Joanne , Dennis Vincent W. , Kinney Thomas R.
Published: February 2007

We report two patients who developed high urinary excretion of sodium chloride after receiving cisplatinum. One patient became symptomatically hyponatremic during intravenous administration of hypotonic fluid. The second patient developed orthostatic hypotension. Urine sodium and chloride concentrations exceeded 130 mmol/liter despite hyponatremia or volume depletion. There was no evidence of adrenal cortical impairment and no improvement with fludrocortisone. We propose that cisplatinum may inhibit solute transport by the thick ascending limb of Henle, causing clinically significant, previously unreported toxicity in patients receiving chronic cisplatinum antitumor therapy.
Effective chemotherapy for metastatic malignant sacrococcygeal tumour
Authors: Beddis I. R. , Noblett Helen , Mott M. G.
Published: February 2007

Two children with disseminated malignant sacrococcygeal tumour were treated with six courses of vinblastine, cis‐platinum, and bleomycin. Both had exploratory operations after four courses of treatment and no histological evidence of malignant disease was found. The two children have remained free of disease with normal α‐fetoprotein levels for 30 months and 18 months, respectively.