[Breastfeeding after breast cancer: survey to hospital health professionals in Alsace]. / Allaitement après cancer du sein : enquête auprès des professionnels de santé hospitaliers en Alsace.

OBJECTIVES: For women treated for a breast cancer and wanting childbearing, the issues of breastfeeding and its oncological safety are controversial. Therefore the aim of our study was to establish a state of knowledge of health professionals on this subject. METHODS: Two hundred and fifty questionnaires were distributed to hospital health professionals, in five Units of Obstetrics and Gynecology in Alsace. The results of our study were expressed as the number of responses, and percentage. RESULTS: Analysis of the answers to this questionnaire demonstrated that health professionals have a good theoretical knowledge of the subject and that breastfeeding is not contraindicated. Indeed, in case of breastfeeding, 90% of the hospital health professionals thought that the risk of recurrence was unchanged or decreased and 81% of them answered that the overall survival was unchanged or increased. However, on a practical view, none of these health professionals followed a woman who breastfed after a breast cancer. DISCUSSION AND CONCLUSION: Breastfeeding after breast cancer does not worsen the prognosis and seems even to improve it. Furthermore, women breastfeeding after a breast cancer have an improved life quality and recommend it to other patients. However, few women breastfeed after breast cancer and this is due to often non-justified reasons coming from their health professionals. Their role should be more to pass clear information and bring their support to breastfeeding to help the women to face their fears as well as encountered difficulties which are not specific, but felt in a more intensive way.

[Skin reactions of the delayed type in cytostatically treated malignant neoplasms of childhood]. / Die Hautreaktion vom verzögerten Typ bei zytostatisch therapierten malignen Neubildungen im Kindesalter.

In 31 children with different cytostatic treated malignancies delayed cutaneous hypersensitivity (DCH) and their relationship to different peripheral white blood-cell counts was investigated. DCH was assessed by a multi-antigen-test device, which allows the simultaneous intracutaneous application of 7 standardized recall-antigen solutions. The grade of DCH reaction was measured by a "score", which reflects the sum of the diameters of all single positive reactions. The follow-up time was 3 years for each patient. At start of therapy 17 out of 31 children had pathologically decreased score values. In 16 out of these 17 children score values increased to normal during the cytostatic treatment. Patients with score values increasing from low to normal had a significant better outcome of their disease than patients with other score courses. A good correlation was found between an increase of score values and tumor-mass reduction. No positive correlation between the score and the peripheral white blood-cell counts could be evaluated, but a significant reciprocal correlation was found between the score and the peripheral absolute lymphocyte counts. Cytostatic drugs had no influence on the score. The results suggest, that the DCH can reveal immunological alterations, which are caused by the extent of tumor burden and by specific influences on the immune system and which are almost not influenced by the administration of cytostatic drugs.

[Active chickenpox vaccination of children with acute leukemia or other neoplastic diseases]. / Aktive Varizellenimpfung bei Kindern mit akuter Leukämie oder anderen neoplastischen Erkrankungen.

26 patients with acute leukemia and other malignancies susceptible to varicella were vaccinated during maintenance chemotherapy. Vaccination was done with OKA strain of live attenuated varicella vaccine developed by Takahashi 1974. All recipients showed no adverse clinical reactions. There was no spread of vaccine virus to others. Seroconversion was 94% in seronegative patients. In those having low antibody titers before vaccination in 56% booster effect was demonstrable. None of the seroconverted recipients contracted varicella in spite of documented contact exposure. Vaccine zoster was not observed. The results suggest that in immunocompromised children live varicella vaccination has a protective effect against varicella infection which has a described mortality rate up 7% in this patients.

Active immunization against varicella of children with acute leukaemia or other malignancies on maintenance chemotherapy.

Twenty-six patients with acute leukaemia and other malignancies susceptible to varicella were vaccinated with the Oka-strain live attenuated varicella vaccine during maintenance chemotherapy. All recipients showed no adverse clinical reactions. There was no spread of vaccine virus. Seroconversion was 94% in seronegative patients. Among those having low antibody titres before vaccination, a booster effect was demonstrable in 56%. None of the seroconverted recipients contracted varicella despite documented contact exposure. No case of herpes zoster occurred. The results suggest that, in immunocompromised children, live varicella vaccination has a protective effect against varicella infection which may result in a mortality rate of up to 7% in these patients.

[Comparative study of the prevalence of Epstein-Barr virus infections in Iran and Germany]. / Vergleichende Untersuchung der Durchseuchung mit Epstein-Barr-Virusinfektionen im Iran und in Deutschland.

352 persons from Iran and 469 persons from West-Germany were tested for EBV-antibodies using an immunofluorescence assay. In Iran the virus infection starts early in infancy and attains higher antibody values as compared with age related German population. In the age group of 1-5 years 70% of the Iranians are antibody positive in contrast to only 56% of the Germans in the same age group. The high prevalence of EBV-antibodies is due to unfavourable hygienic facilities as well as to regional overpopulation.

[A method of modernized milk formula preparation in children's hospitals]. / Ein Weg zur modernen Milchküche in der Kinderklinik.

Nurses on the ward prepare the milk formula just before feeding by the nurse on the ward. Bottles and nipples are cleaned mechanically by dishwashers using alkaline cleaner for bottles, or a mild-alkaline cleaner (WA 725 S) and an antiseptic (Septo DA) for nipples. The nipples are sealed into plastic bags immediately after cleaning using sterile equipment. No further sterilisation is necessary as frequent bacterial culturing has shown. This procedure is safe, easy, and saves cost and time.

[A rapid method for the determination of virus-specific IgM antibodies]. / Eine Schnellmethode zur Bestimmung virusspezifischer IgM-Antikörper.

A newly developed ion exchange chromatography is reported; it is a simple and quick method to separate a highly purified IgM fraction from blood serum. The immunofluorescence test was used to demonstrate that these fractions contain only virus-specific IgM antibodies, but no demonstrable IgG antibodies, which can often block the specific IgM reactivity by competitive inhibition. The specificity of the reaction was tested on sera from 145 persons: the IgM test was always positive in clinically proven viral infections; the reaction was negative in all patients whose infection had occurred some time in the past. A series of suspected virus infections could be verified by the demonstration of specific IgM antibodies.

[Infections in children with leukaemia or malignant tumour treated with cytostatic agents: long-term study of 200 cases (author's transl)]. / Virusinfektionen bei zytostatisch behandelten Leukämie-und Tumorpatienten. Langzeituntersuchungen an 200 Patienten.

All children with leukaemia or malignant tumour receiving cytostatic agents were followed by virological tests over three years. Serological tests or virus isolation in 200 children demonstrated 238 instances of viral infection. Only those of the herpes group led to severe symptoms which, however, responded to treatment. The course of infections induced by respiratory viruses was no different from that in children not receiving immunosuppressive agents. It was possible, by using a "virus risk register", to give early protection to infected children by the appropriate prophylactic means. In addition to the virus infections there were seven cases of Pneumocystis carinii pneumonia which ended fatally in two. Since the prophylactic use of cotrimoxazole there have been no further cases.

[A specific IgM test for the diagnosis of Epstein-Barr virus infections (author's transl)]. / Die Diagnose von Epstein-Barr-Virus-Infektionen mit dem IgM-Immunfluoreszenztest.

IgM antibodies specific for Epstein-Barr virus (EBV) were measured in 302 patients with high IgG antibody titers to study whether EBV was the cause of disease in children having one or more symptoms of classical infectious mononucleosis. IgM antibodies specific for EBV were found in all patients with the defined clinical picture of infectious mononucleosis. In addition the majority of cases with clinical suspicion of the disease had also specific IgM titers. Besides infectious mononucleosis EBV can also be the cause of other diseases like hepatitis, and lymphadenitis: we found IgM antibodies specific for EBV in 48% of patients with nonbacterial lymphadenitis and in 64% of patients with hepatitis not due to hepatitis A or B virus. In contrast to observations by others we were able to show heterophile antibodies in cases with incomplete features of infectious mononucleosis. IgM antibodies to EBV were found in 4 out of 85 controls only. We conclude that untypical features of infectious mononucleosis can be caused by EBV also. Therefore the determination of specific IgM antibodies to EBV can be helpful in the diagnosis of uncharacteristic EBV infections.

[Distribution of cytomegalovirus in children and adults in the Munich area (author's transl)]. / Verbreitung des Zytomegalie-Virus bei Kindern und Erwachsenen im Raum München.

In a regional contamination study 798 healthy persons from the Munich area were examined for cytomegalovirus antibodies. The highest proportion of antibodies (60%) was found in neonates in the first days of life. At the age of 6 to 24 months, only 10% of the children were still seropositive. At this time the maternal antibodies were no longer important. In late adult life, 57% of those examined possessed antibodies against the virus. An attempt was also made to isolate the cytomegalovirus from the urine of 157 healthy persons. This isolation was only possible in three apparently healthy infants aged from 3 to 12 months.