[The diagnosis and therapy of bilateral Wilm's tumour (author's transl)]. / Zur Diagnose und Therapie des bilateralen Wilms-Tumors.

The diagnosis and successful treatment in two patients with bilateral Wilms' tumour are described. In one patient the kidneys were affected simultaneously, the left kidney being duplex; in the second patient, the tumours occurred sequentially.

[Contribution to combined therapy of the Ewing-sarcoma (author's transl)]. / Beitrag zur Kombinationstherapie des Ewing-Sarkoms.

The techniques and results from the treatment of 15 own cases with Ewing-sarcoma having undergone different therapeutic schemes are reviewed with the help of universal literature. These tumors are shown to need individual treatment which has to be adapted to the present data in each case.

[Amitriptyline and imipramine poisoning]. / Intoxikation mit Amitriptylin und Imipramin.

Two cases of severe poisoning by tricyclic antidepressants (Amitriptylin, Imipramin) are reported. Both patients 3 and 11 years old children, developed a typical clinical picture with cardiovascular, neurological and atropine features. Beside a general supportive management, in one case physostigmin was used as antidote. Alternative treatments of enuresis in childhood are recommended.

[Myositis ossificans generalisata or calcinosis interstitialis universalis, a difficult differential diagnosis]. / Myositis ossificans generalisata bzw. Calcinosis interstitialis universalis, eine schwierige Differentialdiagnose.

Palpable indurations, calcified nodules, osseous plates and clasps in shoulder, upper arms, thighs and in the back and pelvis muscles are typical signs for several progressive diseases or are associates with some systemic diseases of youth. These changes imply greatly decreased range of motion of all limb joints and increasing retardation of growth and development and often lead to early death. Although often described, the etiology of these diseases is not known. We observed some years ago a particularly serious case, where the connective tissue of almost all the muscles of the skeleton, the subcutis and the ligaments of the limb joints were penetrated by amorphous calcifications and moreover ectopic ossifications were seen in the perirenal adipose tissue and in the interstitial adipose and connective tissue of the striped muscles. Ossifications and calcifications respectively are typical for different diseases, and therefore in our described case it was difficult to decide for a definitive diagnosis.

[Thrombocyte morphology and function during high-dose immunoglobulin therapy in acute and chronic idiopathic thrombocytopenic purpura. 1]. / Untersuchungen zur Thrombozytenmorphologie und -funktion unter hochdosierter Immunglobulin-Therapie bei akuter und chronischer idiopathisch thromobozytopenischer Purpura (ITP). 1. Mitteilung.

We examined the effectiveness of a high-dose Immunglobulin therapy in 8 patients with idiopathic thrombocytopenic purpura (ITP) and measured the number, the morphology and the function of Thrombocytes as well as thrombocyte dependent clotting parameters. 0.5 g/kg/B.W. 7s-Immunglobulin (7s-IgG) per treatment led to normal thrombocyte numbers in 7 out of 8 patients. The maximal thrombocyte-rise occurred on the 4th-10th day of treatment. Simultaneously bleeding time, thrombocyte-volume distribution frequency and Ristozetin-ADP and Collagen induced thrombocyte-aggregation normalized-indication as well as cause of the 7s-IgG-therapy are discussed.

[Clinico-pharmacological studies on the course of high-dose methotrexate therapy in childhood. A retrospective comparison of centers]. / Klinisch-pharmakologische Untersuchungen zum Verlauf der hochdosierten Methotrexat-Therapie im Kindesalter. Ein retrospektiver Zentrenvergleich.

In a retrospective study with comparison of two centres (Homburg and Munich) the response of 91 cycles of high-dose methotrexate treatment (4.2-13.6 g/m2 body-surface) was assessed in eight children with osteosarcoma and one with chondrosarcoma. Accompanying treatment (alkalization, infusion and leucovorin "rescue") was undertaken to reduce the methotrexate serum level 48 hours after infusion to below 0.4 mumol/l and thus avoid toxic effects. In the course of these treatment cycles there was a fall in urinary pH values below 7.0 in 59% (Homburg) and 75% (Munich) treatment cycles. On average there were lower methotrexate serum levels 24 and 48 hours after methotrexate administration among the Homburg patients than those in Munich. If urinary pH values fell to below 7.0, a decrease in leucocyte count below 2,000/mm3 was observed in 65% and 70%, respectively. The data indicate the need of carefully measuring urinary pH and methotrexate serum concentration during high-dosage methotrexate treatment and thus decrease the danger of bone-marrow damage.

Testicular endocrine function and cyclophosphamide in prepubertal and pubertal patients.

Testicular function was examined by means of HCG-stimulation tests in 6 prepubertal or pubertal patients with leukemia or malignant tumours during cytostatic therapy and in 5 patients with nephrotic syndrome after discontinuation of treatment. The results of urinary testosterone assays suggest no damaging effect of cyclophosphamide on Leydig cell function.

[Intensive combined drug therapy and beta-interferon in the treatment of children with metastasizing neuroblastoma: GPO-NB 79/82 study]. / Intensive Kombinationschemotherapie und beta-Interferon zur Behandlung von Kindern mit metastasiertem Neuroblastom: Studie GPO-NB 79/82.

From June 1979 to June 1982 72 children with metastatic neuroblastoma older than 1 year of age at diagnosis were treated according to the protocol NB 79 of the German Society for Paediatric Oncology. The chemotherapy included three cycles of adriamycine, cyclophosphamide, vincristine, dacarbazine and five cycles of adriamycine and cyclophosphamide. 34 patients were randomized for additional beta-Interferon (Fiblaferon) treatment (10(5) U/kg daily for 3 weeks followed by 3 times a week for 21 weeks). 38 patients were not treated with Fiblaferon. The response rate was 96% including 35% complete and 61% partial remissions. Preoperative chemotherapy improved remarkably the resectability of the primary tumor without enhancing complication rates. The cumulative proportion surviving was 21% for the interferon group and 6% for the patients not treated with interferon. The cumulative recurrence free survival rate, however, was 5% for both groups. The median survival time was 19 months and the median recurrence free survival time 10 months. A serious side effect of chemotherapy was bone marrow depression (73%) resulting in 1 week delay of drug administration per cycle. The median of administered drug dosages was 87-100% of the recommended dosages. Side effects of beta-Interferon commonly decreased with time and were fever reactions (55%), shaking chills (29%), cardiovascular reactions (16%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute myelogenous leukemia in children: results of the cooperative BFM-78 therapy study after 3 3/4 years]. / Akute myeloische Leukämie bei Kindern: Ergebnisse der kooperativen Therapiestudie BFM-78 nach 3 3/4 Jahren.

Between December, 1978, and October, 1982, 151 children with acute myelogenous leukemia from 30 pediatric clinics entered the cooperative study. The treatment consisted of a 10-week intensive induction therapy and a subsequent maintenance therapy, which is terminated for children in complete continuous remission after 2 years. The induction treatment during the first 4 weeks consisted of a combination of prednisone, 6-thioguanine (TG), vincristine, adriamycin (ADR) and cytosine-arabinoside (ARA-C). In the following 4 weeks i.v. cyclophosphamide, i.th. methotrexate and prophylactic cranial irradiation were administered in addition to TG, ARA-C and ADR. 119 of the 151 patients (79%) achieved complete remission. 13 children (9%) died of early hemorrhages, 2 of them before onset of therapy. 5 patients died initially of other complications, another 6 after remission has been achieved. 13 children did not respond or responded poorly to the induction therapy. So far, 40 relapses occurred, mainly in the bone marrow. In 6 relapses the central nervous system was involved. The probability for a continuous complete remission for the total group is 0.41 +/- 0.05 (life table analysis) and for the total group 0.56 +/- 0.06 after 45 months. The corresponding probability for survival after 46 months are 0.43 +/- 0.06 for the remission group. The risk for occurrence of early fatal hemorrhages was higher in children with acute monocytic leukemia than in the other morphological subtypes. An initial leukocyte count of more than 100,000/microliters was found significantly more often in patients who did not achieve remission (early deaths and nonresponders) than in children of the remission group. So far, no factors could be identified which influence the risk for relapse. The present results of the study allow the conclusion, that with the applied treatment strategy it is possible to achieve not only in a high portion of children with AML remission but also to improve the chances for long-time remission and perhaps cure.