The effect of vitamin A status in children treated for cancer.

Chemotherapy for cancer can cause immunocompromise. The authors speculated that children with cancer and low vitamin A plasma levels were more susceptible to cancer treatment-related complications than children who are not vitamin A deficient. A cohort of 49 children with cancer were followed from diagnosis until death or for at least 5 years. Plasma retinol levels were determined at diagnosis. Complications of treatment were recorded. Children with low retinol levels at diagnosis tended to have more chance to develop febrile neutropenia (p = .052). Children with fever had lower mean vitamin A levels at diagnosis than those who did not suffer febrile episodes. In a childhood population with a high prevalence of vitamin A deficiency, routine vitamin A assessment and supplementation in children with cancer appears indicated.

Hemopure transfusion in a child with severe anemia.

A 23-month-old girl presented with heart failure from extremely severe sickle cell anemia. The family refused blood transfusion on religious grounds (Jehovah's Witness). Alternative options acceptable to this religion, such as iron, erythropoietin, or folic acid were rejected as useless in the particular situation of the child. The patient was transfused with Hemopure, a product that consists of polymerized bovine hemoglobin. This is the first case reported in the literature of a child transfused, in an emergency situation, with this product.

Improved outcome in South African children of mixed ethnicity treated for all.

A historical cohort study with an analytical component was conducted to determine whether risk-appropriate chemotherapy can improve survival in children of mixed ethnicity with ALL. Eighty-one coloured children treated for ALL in South Africa were divided into 2 groups: group A (n = 39), treated prior to 1992, and group B (n = 42), treated after 1992. A comparison was made of survival, treatment complications, and supportive measures. The two groups were comparable. The mean nadirs of the white cell count (p < .01), platelet count (p = .01), and hemoglobin value (p < .01) were significantly lower in group B. The survival rate of 37% in group A improved to 66% in group B (p = .025). The results show that a risk-adapted regimen increased survival in children of mixed ethnicity in the Western Cape, despite increased hematological toxicity and episodes of febrile neutropenia.

The Tygerberg Hospital Children's Tumour Registry 1983-1993.

This study records the disease profile and outcome of all 492 children with confirmed cancer below the age of 15 who were admitted to Tygerberg Hospital, South Africa, from 1983 to 1993. The black (48.3%), so-called coloured (30.3%) and caucasian (21.3%) children did not represent a confined geographical area. Leukaemia (22.8%), brain tumours (20.5%), lymphomas (15.2%), nephroblastomas (10%), neuroblastomas (8.5%) and retinoblastomas (5.7%) were the most common tumours. All children were treated with standard protocols and included in the Kaplan-Meier survival analyses. 14 patients were lost to follow-up. Projected survival in (acute lymphoblastic leukaemia) ALL was 63% in white children, but only 17% in black children. Survival was 65% in stage 1 and 2 Wilms' tumour, and exceeded 50% in medulloblastoma and astrocytoma. So-called African Burkitt's lymphoma occurred in all population groups. Overall, 5-year survival in Hodgkin's disease was 70%. Black and coloured children with neuroblastoma presented mainly with stage 3 and 4 disease. All 26 black and coloured children with retinoblastoma had a negative family history and advanced disease which needed enucleation.

Photocatalytic degradation of cyanobacterial microcystin toxins in water.

The microcystins are hepatotoxins produced by a number of cyanobacterial species (blue green algae) in fresh water systems. The increasing eutrophication of natural waters has led to an increase in the incidence of algal blooms and the consequent increased risk of microcystin contamination of water resources. The removal of microcystins LR, YR and YA from contaminated water was investigated using an experimental laboratory-scale photocatalytic 'falling film' reactor in which an oxygen purge, UV radiation and semiconductor titanium dioxide (TiO2) catalyst were used to oxidatively decompose the microcystin pollutants. Preliminary studies, using algal extracts spiked into distilled water, indicated that the microcystins were rapidly decomposed in this reactor. The decomposition followed first order reaction kinetics with half-lives of less than 5 min with the reactor operating in a closed-loop mode. Reaction rates were strongly dependent on the amount of TiO2 catalyst (O-5 g/l), but only marginally influenced by a change in gas purge from oxygen to compressed air. The use of lake water, rather than distilled water, showed that this process is feasible in natural waters, although increased levels of catalyst (up to 5 g/l) were required to achieve comparable decomposition rates.

Three-dimensional navigated laparoscopic ultrasonography: first experiences with a new minimally invasive diagnostic device.

BACKGROUND: A three-dimensional (3D) display of diagnostic imaging methods is technically feasible and increasingly important. However, the technical integration of laparoscopic ultrasound and 3D image reconstruction has not yet been realized. For this purpose, an electromagnetic navigation system was integrated into the tip of a conventional laparoscopic ultrasound probe. This first experience with a certified prototype of a navigated 3D laparoscopic ultrasound probe is reported. METHODS: Navigated 3D laparoscopic ultrasound was compared with the imaging data of 3D-navigated transcutaneous ultrasound and 3D computed tomography (CT) scan. The 3D CT scan served as the "gold standard." Clinical applicability, imaging quality, diagnostic potential, and accuracy in volumetric assessment of various well-defined hepatic lesions were analyzed. RESULTS: Navigated 3D laparoscopic ultrasound facilitates exact definition of tumor location and margins. As compared with the "gold standard" of the 3D CT scan, 3D laparoscopic ultrasound has a mild tendency to underestimate the volume of the region of interest (ROI) (D 3.1%). A comparison of 3D laparoscopy and transcutaneous 3D ultrasonography clearly demonstrated that the former is more accurate for volumetric assessment of the ROI. CONCLUSIONS: Three-dimensional laparoscopic ultrasound imaging with a navigated probe is technically feasible. The technique facilitates detailed ultrasound evaluation of laparoscopic procedures involving visual, in-depth, and volumetric perception of complex liver pathologies. Navigated 3D laparoscopic ultrasound may have the potential to improve the significance of laparoscopic ultrasonography, and additionally to become a valuable technology for planning and improving interventions guided by laparoscopic ultrasound.

Teratomas in infancy and childhood at Tygerberg Hospital, South Africa, 1973 to 1992.

OBJECTIVES: To document the childhood teratomas at Tygerberg Hospital and compare the profile with other African series. DESIGN: Retrospective review of the clinicopathologic features of 43 cases of childhood teratomas. Tumors were classified according to the World Health Organization criteria for germ cell tumors. SETTING: Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa. RESULTS: There were 26 mature, 15 immature, and 2 malignant teratomas. The most common sites were the ovaries and the sacrococcygeal region. Testicular teratomas were absent. The female-to-male ratio for black patients was 5.5:1. There was a peak age incidence in the first 4 years of life, with sacrococcygeal teratomas predominating. A second, smaller peak between 12 and 15 years was seen owing to ovarian teratomas. Immature teratomas presented at an earlier age than mature teratomas. The majority of ovarian teratomas occurred in patients of mixed race, whereas the extragonadal teratomas were distributed more evenly among the race groups. In black patients and patients of mixed race mature teratomas predominated, whereas in white patients immature teratomas were most common. CONCLUSIONS: The increased occurrence of teratomas among female patients, the large number of ovarian teratomas, the absence of testicular teratomas, and the low incidence of malignant teratomas correspond to the observations of other African series. Certain differences are apparent among the three race groups, namely, a high ratio of female-to-male patients in the black group, a predominance of ovarian teratomas in the mixed-race and black groups, and a predominance of extragonadal and immature teratomas in the white group.

Experience with high dose dexamethasone in the treatment of chronic symptomatic immune thrombocytopaenia.

OBJECTIVE: To evaluate the efficacy of high dose dexamethasone (HDD) as treatment for symptomatic chronic immune thrombocytopaenia (ITP). DESIGN: A non-randomised intervention study with final evaluation one year after treatment, comparing findings before and after intervention. SETTING: Tygerberg University Hospital, South Africa. PARTICIPANTS: A consecutive sample of six children with chronic (duration more than six months) ITP. The diagnosis of ITP was based on a platelet count of < 100 x 10(9)/1 together with appropriate clinical, laboratory and bone marrow findings. INTERVENTIONS: All children treated with dexamethasone 0.5 mg/kg/day intravenously for four days every 28 days for a total of six cycles. MAIN OUTCOME MEASURES: A rise in platelet count maintained for a least one year associated with the disappearance of symptoms due to thrombocytopaenia. RESULTS: Treatment was easy to administer and well tolerated with transient side effects in only two children. Three patients had a rise in platelet count of > 50 x 10(9)/1 during treatment and three had platelet counts of > 30 x 10(9)/1 after completion of therapy but only one at one month and one at six months after completion of the six courses respectively. None of the patients showed a sustained rise in platelet count during and after HDD treatment. CONCLUSION: HDD did not cause a significant sustained rise in the platelet count in children with chronic symptomatic ITP. If high dose prednisone and IVIG fail, a splenectomy should be considered in children over five years of age.

Bone involvement in childhood acute lymphoblastic leukaemia.

This retrospective study evaluated the prognostic significance of the radiological signs of bony involvement in children with acute lymphoblastic leukaemia (ALL). The skeletal surveys of 52 children with ALL were reviewed for evidence of leukaemic involvement. Radiolucent metaphyseal bands, osteolytic lesions and periosteal reaction were considered signs of leukaemic changes. Twenty eight children had evidence of skeletal involvement of whom 14 had changes at three or more areas. Known risk factors such as age < 2 years and > 10 years, mediastinal lymphadenopathy, splenomegaly > or = 5 cm below the costal margin, a white cell count of > or = 20 x 10(9)/l and leukaemic blast cells in the cerebrospinal fluid at diagnosis occurred with equal frequency in children with and without skeletal changes as well as those children with signs of involvement at > or = 3 sites. Event free survival (Kaplan Meier analysis) also did not differ in these three categories of children. We concluded that bone involvement in childhood ALL is not associated with other risk factors and does not predict outcome per se.

[Ultrasonic examination of the prostate, with rating apparatus for tumor recognition (author's transl)]. / Ultraschalluntersuchungen der Prostata mit Datengeräten zur Erkennung von Tumorerkrankungen.

UNLABELLED: The prostate was examined by ultrasonic waves to diagnose tumorous changes of the organ. We scanned directly from the abdominal wall through the full bladder (transvesical). The classification of the resulting B-pictures is based on patterns that are specific for normal, adenomatous, or cancerous tissue. The results show that adenomas and carcinomas are recognizable in 85% of the examined patients by ultrasonic waves and can be differentiated from normal prostate tissue. KEYWORDS: Ultrasonics, Prostate, Recognition of Tumors.

Lidocaine-prilocaine cream for local-anesthesia chalazion incision in children.

BACKGROUND: Chalazia are not uncommon in children. If conservative therapy for them fails, incision and drainage are necessary and usually require a general anesthetic, which increases costs and risks. PATIENTS AND METHODS: Five children (3 to 8 years old) had a eutectic mixture of lidocaine and prilocaine applied to the skin of the eyelid for 1 hour. Then local anesthetic was injected into the same site. RESULTS: The local anesthetic injection was painless, permitting successful incision and drainage in all cases. CONCLUSION: Lidocaine-prilocaine cream permits local anesthetic injection into the eyelids, facilitating office-based management of chalazia in children.

Mechanized keratomicropigmentation: corneal tattooing with the blepharopigmentor.

BACKGROUND AND OBJECTIVE: A mechanized micropigmentor with a triple prong tip was used to tattoo two corneas for cosmetically unacceptable blemishes. PATIENTS AND METHODS: Two adult patients with cosmetically disfiguring corneal blemishes in sightless eyes requested cosmetic improvement. With a mechanized micropigmentor, appropriate pigment was directly inoculated through the epithelium. RESULTS: After 2 and 3 years of follow-up, respectively, there have been no complications and there has been minimal fading. CONCLUSION: This mechanical device facilitates many more penetrations to introduce pigment, with a more uniform depth than can be achieved by freehand methods.

The use of central venous catheters in children receiving intensive oncotherapy in a developing country.

Fifty-three central venous access catheters were placed in 45 consecutive cancer patients younger than 13 years of age. Ten of the 16 children from a very poor socio-economic background were discharged and received their catheter care as outpatients. Catheters were left in situ for a mean period of 134 days and 159 days in the better and poor socio-economic groups respectively. In 19 cases catheters were removed before completion of chemotherapy. Reasons for early removal of catheters were technical factors in 9 patients, removal by the patient in 4 cases, blocked catheters or skin erosion at the exit site in 4 cases, and catheter sepsis in 2 patients. One febrile episode was recorded per 107 catheter days. Blood culture-proven sepsis occurred at a rate of 1.7 episodes per 1000 catheter days. There was no difference in the incidence of febrile episodes without obvious cause in patients from a good socio-economic background (1/100 catheter days) and in those from a socio-economically disadvantaged background (1/123 catheter days). The morbidity in patients from poor socio-economic circumstances who went home with long-term central venous access catheters in situ was acceptable.