[Validation of the combined SF36/MSQOL test of evaluation of quality of life in migraine patients in France]. / Validation de l'association SF36/MSQOL pour évaluer la qualité de vie des migraineux en France.

The impact of migraine on patients quality of life is great, even between attacks. The aim of this study was to assess the properties of a French language quality of life questionnaire, which associates the Medical Outcome Study Short Form (MOS SF 36) with the Migraine-Specific Quality of Life (MSQOL). Data were obtained from 110 consultant patients of neurology units located in three University hospitals in the center of France. The results indicated a good acceptability of the association of the two questionnaires with a 84p.cent response rate. The Principal Component Analysis showed no change in both SF-36 and MSQOL structures. It also suggested that the two questionnaires were complementary. The high values of the Cronbach alpha coefficients for each scale indicated a high level of internal consistency. The quality of life scores were correlated with external parameters such as frequency, intensity and length of migraine attacks, and social activity reduction due to these attacks. In conclusion, the association of the SF-36 with the MSQOL has the interest of associating generic and specific questionnaire, in a complementary way. This association has good psychometric properties, and can be used to evaluate migraineurs quality of life in French speaking countries.

[Cerebral computed tomography in acute childhood leukemias]. / Zerebrale Computertomographie bei akuten Leukämien im Kindesalter.

It is suggested that cranial computerized (axial) tomography permits a more complete neurologic work-up for all children with acute leukemia. It also permits a better knowledge of the frequency and varieties of cerebral complications in leukemia. Endocranial complications in acute leukemia are essentially infiltrative, hemorrhagic, infectious or iatrogenic. Cranial computerized tomography can demonstrate cerebral changes in meningeal leukemia, hemorrhages, calcifications, brain atrophy or leukencephalopathy. The preliminary results of cranial computerized tomography in childhood leukemia suggest that the iatrogenic main lesion of the brain due to combined radiation-chemotherapy is atrophy whereas that of the intrathecal cytostatic therapy is demyelination. Accurate diagnostics and control of possible cerebral complications in therapy of leukemia is essentially for appropriate therapeutic management. For that cranial computerized tomography may be the best method to a effective exploration of the brain.

[Diagnostic aspects in child abuse]. / Diagnostische Aspekte bei Kindesmisshandlung.

In connection with diagnostic and treatment of children the paediatrician may also be confronted with suspected by or certainly abused children. In those cases an evidence on necessary legal consequences will be useful. Anamnesis, examination and radiography have traditionally been used to assess the injuries of abused children. Sceletal scintigraphy should be the screening procedure of choice for children with bone injuries suspected or certainly having been abused. Cranial computer tomography is a recent method to detect intracranial lesions and cerebral late effects due to violence in abused children.

[Cystic fibrosis and pregnancy. Current results of a study (1980-1990)]. / Zystische Fibrose und Schwangerschaft. Neue Ergebnisse einer Studie (1980-1990).

This study is a recent collection of data on 19 women with cystic fibrosis who became pregnant between 1980 and 1990. The following data have been recorded:--age at diagnosis, progress of disease prior and during pregnancy, and during confinement. Satisfactory clinical score values and the fact that the mean age at diagnosis was 10.5 years indicated a less serious nature of the disease in the group studied. Pregnancy was complicated by pulmonary exacerbations and by poor weight gain in two thirds of cases. No maternal deaths during pregnancy and delivery were recorded. Abortions were induced in two pregnancies. More than one third of newborns were premature. It is noteworthy that of the 22 infants 16 were male. All of the children had negative sweat chloride tests. Eleven women could breast feed successfully. In twelve cases the mother's state of health deteriorated after pregnancy, and did not return to that before gravidity.

[Cessation of treatment in childhood acute lymphatic leukemia. Long-term observations after meningosis prevention with intrathecal gold colloid radioisotopes and methotrexate]. / Therapieabschluss bei akuter lymphatischer Leukämie im Kindesalter. Langzeitbeobachtungen nach Meningosispropylaxe mit intrathekalem 198Au-Kolloid und Methotrexat.

Cytostatic long-term treatment for about 36 months was administered to 18 children with acute lymphatic leukaemia who were in long-term remission (43-98 months). Prophylaxis of meningosis involved intrathecal 198Au colloid and methotrexate. Seven recurrences occurred during the long-term remissions: the bone marrow was involved six times, leukaemic meningosis occurred once. Five out of seven recurrences occurred within one year of cessation of treatment. There were no complications induced by intrathecal radio-gold, such as the apathy syndrome or leukoencephalopathy. Intrathecal methotrexate led to side effects before administration of radio-gold: encephalopathy twice, paraplegia once. Symptoms regressed completely in two children, one child with encephalopathy continues to have symptoms. All three children were given 198Au colloid intrathecally thereafter which was tolerated very well. 198Au colloid represents an alternative for prophylaxis of meningosis with 60Co telecobalt irradiation in leukaemias and non-Hodgkin lymphomas in childhood.

[Foreign body aspiration in childhood]. / Fremdkörperaspiration im Kindesalter.

Damage to the airways and lung parenchyma from aspiration is a common clinical problem with diagnostic and therapeutic challenges. The insult may be acute or chronic. The amount of concentration, chemical composition, and size of particles vary, and the lesion produced may be reversible or irreversible. Death may be immediate or late. Recovery may be complete, or crippling pulmonary disease may follow. In this review is reported on the aspiration of foreign bodies or liquids into the respiratory tract. Specialty: in infancy, esophageal foreign bodies may cause mainly respiratory symptoms. Adequate diagnosis and therapy are discussed.

[The cerebral sensitivity to "meningosis-prophylaxis" with 198Au radiogold according to EEG findings]. / Die zerebrale Verträglichkeit der "Meningosis-Prophylaxe" mit 198Au-Radiogold an Hand von EEG-Befunden

35 children (16 girls and 19 boys) at the age of 1 11/12 to 16 11/12 with acute leukaemia were injected intrathecally with 198Au-radiogold colloids (HOECHST-BEHRING) for "prophylaxis of meningosis". The colloid size of the isotope amounted to 5 or 30 nm, the applied activity lay between 1.4 and 3.12 mCi. According to a dosage estimation made with the help of LOEWINGERS formula 1 mCi of radiogold corresponds to approximately 1200 rad. Clinical observations, such as headaches, vomiting or fever up to 39 degrees C, could only be found in 6 children (17.1%) during the first 24 hours. All symptoms subsided quickly and without any sequels. Even retarded complications could not be detected. An electroencephalogram was made from all children before and after applying radiogold (1-8 d afterwards). After the injection of radiogold the majority of children had no change of findings in the electroencephalogram, 11 children even showed a tendency towards an improvement up to normalisation. Only 4 children had a deterioration of findings with unspecific disorders or appearances suspected of peak potential discharges. Simultaneously an accumulation of clinical complaints could be found. Judging from the clinical and electroencephalographic behaviour of our patients no absolute neurotoxity of radiogold could be ensured.

[Pregnancy and delivery in cystic fibrosis]. / Schwangerschaft und Geburt bei zystischer Fibrose.

The authors report about the course of pregnancy and delivery in two patients with cystic fibrosis. Epidemiology and clinical symptoms of cystic fibrosis, possible problems anticipated during pregnancy, delivery and puerperium in patients with cystic fibrosis, and questions concerning therapeutic abortion and contraceptive counseling are discussed. Important premises to the management of pregnancy and delivery in cystic fibrosis have to be: (1) adequate pre- and postpartal diagnosis and therapy of pulmonary and/or cardiac disease, (2) careful management of nutrition, control of pancreatic insufficiency and electrolyte balance, (3) exclusion of maternal diabetes mellitus, (4) sonographic measurements to supervise the development of the fetus, (5) adequate management of delivery, (6) monitoring of puerperium with regard to maternal cystic fibrosis, (7) exclusion of cystic fibrosis in the newborn.

PIP: The authors report on the course of pregnancy and delivery in 2 patients with cystic fibrosis. The epidemiology and clinical symptoms of cystic fibrosis, possible problems anticipated during pregnancy, delivery, and the puerperium in patients with cystic fibrosis, and questions concerning therapeutic abortion and contraceptive counseling are discussed. Important premises concerning the management of pregnancy and delivery in cystic fibrosis should be: adequate pre- and postpartum diagnosis and therapy of pulmonary and/or cardiac problems; careful management of nutrition, control of pancreatic insufficiency and electrolyte balance; exclusion of maternal diabetes mellitus; sonographic measurements to monitor the development of the fetus; adequate management of delivery; the monitoring of the puerperium with regard to maternal cystic fibrosis; and exclusion of cystic fibrosis in the newborn. (author's modified)

Meningosis prophylaxis with intrathecal 198Au-colloid and methotrexate in childhood acute lymphocytic leukemia.

Since 1972, telecobalt irradiation plus intrathecal methotrexate (ITMTX) has been successfully replaced in Jena by intrathecal colloidal radioactive gold (198Au) plus ITMTX for meningosis prophylaxis in leukemia. Seventy-three children with acute lymphocytic leukemia (ALL) were given 1.24-4.89 mCi (45.8-181 MBq) of colloidal 198Au IT after successful initiation of remission. During cytostatic therapy, the following relapses occurred: meningosis leucaemica, five patients (6.8%); bone-marrow relapse and the meningosis leucaemica, one patient; and bone-marrow relapse, 20 patients (27.4%). In 18 children, combination chemotherapy was terminated after two and a half or three years of treatment. After that time, one meningeal relapse and six bone-marrow relapses occurred. Within the first 24 hours after application of radioactive gold, headaches, vomiting, and fever occurred in less than 10% of the children. An apathy syndrome, leukecephalopathy, or severe infections, were not observed in a single case. Radioactive gold spreads in the subarachnoid space and is phagocytized by the arachnoidea. The tumoricide effect extends selectively over the space of distribution of the latent meningosis leucaemia. The cerebral parenchyma remains unaffected by radiation. Thus, radioactive gold may be preferable to telecobalt irradiation in preventing central nervous system leukemia.

[Lung-scintigraphy in the control of children with malignancies treated by radiochemotherapy (author's transl)]. / Lungenszintigraphie zur Uberwachung zytostatisch und radiologisch behandelter Kinder mit malignen Tumoren.

Cytostatics- and radiation-induced alterations of the parenchyma of the lung were investigated in 30 children with malignomas before, during and after therapy by means of lung perfusion scintigraphy. Before the tumour-therapy (2 children) lung-scintigrams were regular. 16 children (Hodgkin- and non Hodgkin-lymphoma, acute lymphocytic leukemia with mediastinal tumour, intrathoracal neuroblastoma and Ewing-sarcoma) received epidiaphragmatical radiation and cytostatics. All 35 lung-scintigrams of these patients (1-60 months after beginning of therapy) were abnormal. Within 6 months after radiation obstructions to perfusion could be demonstrated in ray-treated parenchyma of the lung only. Subsequent to 6 months after radiation, during cytostatics, disturbances of perfusion were diffusely spreading in the lung parenchyma. 12 children (acute lymphocytic leukemia, Histiocytosis X and osteogenic sarcoma) received cytostatics only. All 18 lung-scintigrams of these patients (1-55 months after beginning of therapy) were pathological. After cessation of therapy (radiochemotherapy or chemotherapy only) scintigraphically improvement of perfusion occurred in the majority of patients. Obviously the diffusely spreading obstructions to perfusion represent alterations during the early phase of their development induced by chemotherapy.

[Ocular symptoms and leukemia in childhood]. / Okuläre Symptomatik und Leukämie im Kindesalter.

Findings in a total of 200 children suffering from leukemia were evaluated. Ocular symptoms were found in 26% of the cases. Typically, fundus hemorrhages were found in the initial stage, leukemic infiltrates in the final stage and papilledema in the meningosis leucaemica stage. In patients with ophthalmologic changes the survival time was shorter than in patients with no ocular involvement. Ophthalmological "dispensaire" treatment is generally recommended.

Cranial computertomography in children with acute lymphatic leukemia (ALL) and non Hodgkin-lymphoma (NHL) after different methods of CNS-treatment.

42 children with acute lymphatic leukemia (ALL) or non-Hodgkin lymphoma (NHL) were subjected to cranial computer tomography (CT). 4 groups were formed according to CNS therapy. Group 1: 18 children in complete first remission after CNS prophylaxis with intrathecal 198 Au-colloid and methotrexate were examined between 3 1/2 and 7 1/3 years after beginning of therapy. 15 patients had normal computer tomograms, only 3 children had slight anomalies. The quantitative assessment of the computer tomograms yielded normal results for all 18 children. Group 2: 8 children were examined before CNS prophylaxis. 1 child had a connatal septum pellucidum cyst, 4 children had no anomalies and 3 children slight anomalies. The deviations from normal in groups 1 and 2 should be physiological variations. Group 3: 6 children were examined between 10 months and 8 1/4 years after termination of prophylactic CNS-irradiation (18-22.5 Gy) in combination with intrathecal methotrexate. Normal findings were obtained for 2 patients only. The other children had distinct cortical, subcortical or cerebellar atrophies and calcification of stem ganglia. Neurological complications had temporarily appeared in one child after skull irradiation. Group 4: A CT was made of 10 children during or after meningosis leukemia. The children who had received 198 Au-colloid for CNS prophylaxis yielded no pathological CT results. Distinct cortical, subcortical and cerebellar atrophies or calcification of stem ganglia were found in children after one or two CNS irradiations. These CT investigations confirm the results published by other authors, i.e. that owing to an irradiation--cytostatic therapy of the children's brains CNS lesions can be found in the CT. Their prognosis can only be determined by longterm observations. CNS prophylaxis by means of intrathecal 198 Au-colloid and methotrexate does not lead to any pathological CT anomalies.

[Lung scintigraphy after tumor therapy in childhood]. / Lungenszintigraphie nach Tumortherapie im Kindesalter.

Cytostatics- and radiation-induced alterations of the lung were investigated in 18 children after tumour-therapy by means of lung perfusion scintigraphy. 13 patients (Hodgkin- and non Hodgkin lymphoma, acute lymphocytic leukemia with mediastinal tumour, Ewing-sarcoma, and intrathoracal neuroblastoma) received epidiaphragmatical radiation and cytostatics. All 32 lung-scintigrams of these children 1-23 months after cessation of therapy were pathological. 5 patients (acute lymphocytic leukemia, Histiocytosis X) received cytostatics only. 1-6 months after cessation of therapy in these children 6 lung-scintigrams were pathological, one was normal. After cessation of tumour-treatment scintigraphical improvement of disturbed perfusion occurred in 9/18 patients only. In 6 children a deterioration of lung-perfusion was registered. Lung-scintigraphy is a method for testing pulmonary perfusion in diagnosis and therapy control in childhood malignancies. The results of this study indicate that prophylactic provisions against pulmonary damage during oncologic therapy are necessary.

["Prophylactic" intrathecal radiogold (198au) in leukaemia in children (author's transl)]. / Meningosis- "Prophylaxe" mit Radiogold (198Au) bei der Leukämie im Kindesalter

198Au radiogold-colloid (Behring) was injected as "prophylactic" therapy against central nervous system leukaemia in 26 children with acute leukaemia (22 acute lymphatic and 4 myeloid). During the period of observation (1.3. 1972 to 1.9.1975), 23 children remained free of central nervous system recurrences: 16 children are alive 3 to 39 1/2 months later, seven died after 4 1/2 to 29 1/2 months from the underlying disease. In one child CNS leukaemia developed after about five months, in another one during a second haematological recurrence, while the third one developed retrobulbar infiltration in the optic nerve. In general, 2 mCi 198Au gold-colloid was injected intrathecally via a lumbar puncture. The method was well tolerated.

[Pregnancy and labor in mucoviscidosis--results of a study in Germany]. / Schwangerschaft und Geburt bei Mukoviszidose--Resultate der Deutschland-Studie.

Thirty-one pregnancies in 27 women suffering from mucoviscidosis have been studied in Germany, in the period from 1980 to 1991. This analysis is the largest collection of data to date relating to pregnancy and birth with mucoviscidosis after the American-Canadian study of 1980. The German study demonstrated that only women with few weak symptoms became pregnant: typically the pregnant women's mucoviscidosis was diagnosed at an average age of 9.2 years, and 96.5% of the women had a satisfactory pregravid Shwachman-Kulczicki-Score. Only minor complications were observed in these pregnancies, in particular pulmonary exacerbations (in 18 pregnancies) and an insufficient weight gain (average of 7.2 kg). Abortions were induced in five pregnancies and no spontaneous were observed. There were of maternal deaths during pregnancy or childbirth. More than one quarter of the newborns were premature. All the children had normal sweat chloride test results. 21 women could breast-feed successfully. In fifteen cases the mother's state of health deteriorated after pregnancy however only to a minor (ten cases) or moderate degree (four cases). It is noteworthy that of the twenty six infants twenty one were male. In this study we obtained the unexpected result that unaffected heterocygous children of women with mucoviscidosis are mainly male.

[Nonspecific killer cells in premature and mature neonates and infants]. / Unspezifische Killerzellen bei unreifen und reifen Neugeborenen und Säuglingen.

K (killer) and natural killer (NK) cells were investigated in peripheral blood of 76 children, preterm small for date babies (n = 8), preterm babies (n = 15), fullterm small for date babies (n = 6) fullterm babies (n = 7) and infants up to 12 months age (n = 40). The K and NK cell activity of human leukocytes was analysed as compared with those cells of the K 562 cell line and murine cells covered by xenologous antibodies in Graffi erythroblast leukemia by means of the 51Cr release test. K cell activities were significantly lower in preterm small for date babies to infants with 1-12 months of age. In our results it is shown that NK capacity of preterm or term newborns and infants up to 6 months age does not differ significantly from each other. Children who are 6-12 months old will have significantly higher NK cell activities. It can be concluded that K cell activities are fully developed during pregnancy and NK cell activities later when the children are between 6 and 12 months of age.

[Spontaneous lymphocyte-mediated cytotoxicity and antibody-dependent cell cytotoxicity of human effector cells]. / Spontane lymphozytenvermittelte Zytotoxizität und antikörperabhängige zelluläre Zytotoxizität menschlicher Effektorzellen.

Antigen dependent cellular cytotoxity (ADCC) and non-killer cell activities of haematological healthy donors were investigated in the 51Cr release test. Attempts of cell fraction reveal that lymphocytes are active as killer and non-killer cells. Granulocytes were efficient effector cells of antigen dependent cellular cytotoxity (ADCC), however, they had no natural-killer activity. In testing leukocyte fractions of 11 donors, killer cell would only be found in the non-T-fraction. In contrast to that, three types could be observed in the distribution on non-killer cells: Distribution on T-lymphocyte fraction (27.3%), distribution on non-T-lymphocyte fraction (9.1%) and approximately equal distribution on T- and non-T-lymphocyte fraction 63.7%). Without any treatment patients with acute lymphocytic leukemia showed an antigen dependent cellular cytotoxity and non-killer activity only in exceptional cases. Normal activities were reached in remission, with chemotherapy having a depressive effect on non-killer activity.

[Human nonspecific killer cells]. / Unspezifische Killerzellen des Menschen.

The NK and K-cell activity of human leukocytes was investigated as compared with those cells of the K 562 cell line and murine cells covered by xenoantibodies in Graffi erythroblast leukaemia by means of the 51Cr release test. NK and K-cells could be identified in the blood and bone-marrow. However, they could not be identified in the thymus, lymph-nodes, and tonsils. Attempts of cell fraction with the blood of healthy donors revealed that the K-cells must be attributed to non-T-lymphocytes. NK-cells may be found in the fraction of non-T-lymphocytes as well as in that of T-lymphocytes. Killer cell activity tests in children with acute leukaemia resulted in leukaemia cells having NK and K-cell activity only in very rare cases. ALL patients in remission had strongly lowered NK-cell values under chemotherapy. In comparison to that, chemotherapy had no influence on K-cell activity. On the one hand, NK-cell activities were induced in mixed cultures of allogenous lymphocytes of the blood and, on the other hand, in cells of lymph-nodes. Attempts of fractionation, investigations for determining the influence of chemotherapy and attempts of inducing killer cell activity in vitro lead to the conclusion that NK and K-cells may be regarded as similar cell populations, being, however, not identical.