Effective dose of L-asparaginase for induction of remission in previously treated children with acute lymphocytic leukemia: a report from Childrens Cancer Study Group.

L-Asparaginase, in the dose of greater than or equal to 6000 IU/sq m three times weekly, was demonstrated to be an effective agent in reinduction of remissions in childhood leukemia. Four hundred thirteen children with acute lymphocytic leukemia were treated with L-asparaginase. Doses i.m. ranged from 300 to 12,000 IU/sq m. None of the patients had received prior asparaginase therapy. 6-Mercaptopurine was given p.o. concurrently. All of the patients had experienced several previous relapses, and their disease was not responsive to 6-mercaptopurine. L-Asparaginase was found to be effective in reinducing remissions at the following rates: 9.5% for 300 IU/sq m; 35.1% for 3,000 IU/sq m; 53.5% for 6,000 IU/sq m; and 62.5% for 12,000 IU/sq m. The drug was given three times weekly for four weeks. Hypersensitivity reactions occurred in 6.5% of patients.

Detection of two anaerobic periodontopathogens in children by means of the BANA and ELISA assays.

The mouths of young children become colonized by a variety of bacteria, but there have been only a few studies that have sought the presence of periodontopathic species in this population. Almost all of these studies used culturing techniques rather than the newer detection methodologies for various periodontopathogens. Studies in adults have shown that Treponema denticola and Porphyromonas (Bacteroides) gingivalis can be detected in dental plaque by use of the BANA and ELISA diagnostic tests. In the present study, plaque samples from four subgingival sites in each of 157 children (aged from two to 18 years) were tested for BANA hydrolysis with a BANA reagent card, and for T. denticola and P. gingivalis with an ELISA assay. Anaerobic periodontopathogens hydrolyzing the BANA substrate were found to be present in at least one of four plaque samples in 88 children (56%). T. denticola and/or P. gingivalis were detected by ELISA in at least one plaque sample in each of 135 children (86%). This study shows that children are widely colonized by these micro-organisms. A higher proportion of Black children than Caucasian children was colonized by these BANA-positive organisms. Also, children having a parent with a documented history of periodontal disease were more likely to be BANA-positive than were children of parents with unknown periodontal status.

The treatment of medulloblastoma. Results of a prospective randomized trial of radiation therapy with and without CCNU, vincristine, and prednisone.

In a prospective randomized trial designed to study the effectiveness of adjuvant chemotherapy following standard surgical treatment and radiation therapy, 233 eligible patients with medulloblastoma were treated by members of the Children's Cancer Study Group and the Radiation Therapy Oncology Group. Eligible patients were randomly assigned to receive radiation therapy with or without adjuvant chemotherapy consisting of 1-(2-chloroethyl)-3-cyclohexyl-nitrosourea (CCNU), vincristine, and prednisone. The estimated 5-year event-free survival probability was 59% for patients treated with radiation therapy and chemotherapy and 50% for patients treated with radiation therapy alone, a difference which is not statistically significant. The 5-year survival probability was 65% for both groups. Although the treatment difference was not statistically significant when all patients were combined, in the small number of patients with more extensive tumors, event-free survival was better in the group receiving chemotherapy (48% vs. 0%, p = 0.006). In these latter patients the survival time is also significantly prolonged. Extent of disease (as measured by the M staging criteria described by Chang) and age at diagnosis were significantly associated with outcome; advanced disease and young age had a worse prognosis. The extent of tumor resection was not an independent prognostic factor. It is concluded that chemotherapy does not benefit patients with low-stage medulloblastoma, but may benefit those with more advanced stages of disease.

The relationship of various aspects of surgical management to outcome in childhood nonmetastatic osteosarcoma: a report from the Childrens Cancer Study Group.

Recently, much attention has been focused on the role of adjuvant chemotherapy in the treatment of osteosarcoma. Surgery, however, remains the primary modality for the ablation of this disease. In this report, we examine the relationship of various aspects of surgical management of osteosarcoma to prognosis for disease-free survival (DFS) in a randomized study of 234 pediatric patients. Attention is restricted to 166 patients with nonmetastatic disease confined to an extremity and who were randomized to receive one of two chemotherapeutic regimens. No advantage with respect to DFS was attributable to the various aspects of surgical management considered: interval from first symptoms to definitive surgery, surgical sequence, and type of surgery. Only two local recurrences were seen. One occurred in an above knee amputation stump and the other occurred in a patient receiving a tibial allograft. One of these patients died of pulmonary metastases within 6 months of recurrence; the other patient is alive without evidence of disease at last contact after resection of the recurrence followed by chemotherapy.

Brain tumors in children.

Brain tumors are relatively common cancers among children, just as they are among adults. Unlike the tumors of adults, however, they have a predilection for the posterior fossa. The most common types of tumors among children are astrocytomas, ependymomas, and medulloblastomas. The definitive diagnosis of these lesions can usually be made with relative ease by CT scans of the brain. Treatment typically consists of the surgical removal of all or as much tumor as possible, followed by radiation therapy, and occasionally also by chemotherapy with one of the nitrosoureas combined with vincristine and/or other antitumor drugs. Recurrence-free survival may be expected for about half of the children past infancy who develop brain tumors. The substantial progress recently made in both the diagnosis and treatment of brain tumors in childhood has heightened, not diminished, the clinical responsibilities of primary care clinicians throughout the management of this disease. Since tumor-free survival so heavily depends upon an early diagnosis, a high index of suspicion must be maintained for commonplace non-specific symptomatology. The primary physician must pursue critical aspects of the medical history at the first suggestion of an atypical course. A skillful physical examination is then needed to detect subtle clinical signs that are indicators for the prompt performance of definitive diagnostic tests. Further, since there are now so many therapeutic modalities that can be brought into the comprehensive management of children with brain tumors, the primary clinician should maintain close contact with the patient not only to provide medical and psychological support, but also to monitor the clinical response or side effects of therapeutic agents and to serve as the patient advocate at times of great personal and family need.

Residents' evaluation of behavioural paediatrics instruction.

This study sought to explore the following questions: (1) Do residents perceive training focused on infancy and early childhood care issues as more clinically applicable than training focused on care of older children and adolescents? (2) Do residents at different training levels differ in their evaluation of behavioural paediatrics instruction? (3) What is the strength of the association between instructional style and clinical impact dimensions? and (4) Compared to the instruction provided by instructors from other medical and academic disciplines, do paediatric residents perceive differences in the teaching efficacy and clinical relevance of instruction provided by paediatricians? Data were drawn from 1341 residents' evaluations of 116 required behavioural paediatrics sessions over 3 years. The data demonstrated that house officers recognize the value of acquiring knowledge in behavioural paediatrics, regardless of the level of the house officers' training, or whether the focus concerned infants or older children. However, residents were more likely to perceive the presentations provided by paediatricians as providing instruction that was slightly more applicable to their practice needs than instruction that other faculty presented. The study results further demonstrated that the clarity and organization of instruction influences, but does not supercede, the residents' perception of the merit of instruction. The findings suggest that international recommendations for greater inclusion and acceptance of behavioural paediatric instruction can be achieved in programmes that, by requiring participation, confer equal status to behavioural paediatrics and traditional residency training. The results support residents' acceptance of a health team approach to behavioural paediatric instruction.(ABSTRACT TRUNCATED AT 250 WORDS)

A double-blind, placebo-controlled study of the efficacy of Lactinex in the prophylaxis of amoxicillin-induced diarrhea.

The disruption of the natural flora of the gastrointestinal tract (especially Lactobacillus acidophilus) may occur during antibiotic therapy. This may lead to diarrhea, dehydration, and electrolyte imbalances. It has been suggested that replacement of the lactobacilli with a commercially available product may prevent the diarrhea. The efficacy and safety of prophylactically administered Lactinex (culture of L. acidophilus and L. bulgaricus) was compared with placebo for the prevention of amoxicillin-induced diarrhea in pediatric patients. Lactinex or placebo was administered four times a day for ten days to coincide with the antibiotic therapy. The Lactobacillus preparation did not appear to consistently prevent diarrhea in this patient population. Patients' age, diet, and parental definition of diarrhea were factors that may have influenced the results.

The effectiveness of chemotherapy for treatment of high grade astrocytoma in children: results of a randomized trial. A report from the Childrens Cancer Study Group.

Fifty-eight patients with high-grade astrocytoma were treated by members of the Childrens Cancer Study Group in a prospective randomized trial designed to study the effectiveness of chemotherapy as an adjuvant to standard surgical treatment and radiotherapy. Following surgical therapy, patients were assigned randomly to radiotherapy with or without chemotherapy consisting of chloroethyl-cyclohexyl nitrosourea, vincristine, and prednisone. Treatment with chemotherapy prolonged survival and event-free survival. Five-year event-free survival was 46% for patients in the radiotherapy and chemotherapy group, and 18% for patients in the radiotherapy-alone group. Five-year survival was similarly improved. The differences in outcome due to treatment were statistically significant after correcting for imbalances in important prognostic factors (event-free survival, p = 0.026; survival, p = 0.067). The presence of mitoses or necrosis in the tumor specimen was associated with poorer outcome. Patients whose initial surgery was limited to biopsy, and patients with basal ganglia lesions, also had significantly worse outcome. Chemotherapy administered at the time of recurrence in a small number of patients did not produce any long-term survivors. This study is to our knowledge the only randomized trial to investigate effectiveness of chemotherapy in the treatment of high-grade astrocytoma in children.