Immunodiagnosis of meningeal leukemia using the alkaline phosphatase procedure.

To optimalize the diagnosis of meningeal involvement in ALL we adapted the alkaline-phosphatase-anti-alkaline-phosphatase procedure (APAAP) to be used for cerebrospinal fluid (CSF) examination. The study was performed on 19 patients (9 children with leukemia) with CSF hypercellularity. 490 determinations with a panel of 12 monoclonal antibodies were performed. This method was convenient, cell morphology was preserved so that combined morphological and immunological characterization of specific cells was possible in mixed cell populations. The combined study of immunological and morphological criteria produced more accurate results than those based on morphological criteria alone. The APAAP technique is useful for small numbers of cells. The preservation of antigenic reactivity in frozen CSF smears may be of use in reevaluation studies.

[Acute renal insufficiency as the first symptom of malignant lymphoma in children]. / Ostra niewydolnosc nerek jako pierwsze ujawnienie nieziarniczego chloniaka zlosliwego u dzieci.

Acute renal insufficiency in children with malignant lymphoma may be the first symptom of illness. Intensive care with hemodialysis is the therapy of choice. It allows to eliminate the increased volume of liquid, toxins, continuing diagnostic and beginning chemotherapy. We present two children with NHL, who showed acute renal insufficiency. Intensive care with hemodialysis was required to treat renal failure before establishing diagnosis and during initial chemotherapy.

[Lateral cervical cyst in 13-year-old girl]. / Torbiel boczna szyi u 13-letniej dziewczynki.

We present a clinical description of a 13-year-old girl with lateral cervical cyst. We particularly emphasize the need for ultrasonographic examination during routine diagnostics of so-called cervical tumors.

[Acute lymphoblastic leukemia in children with Fanconi anemia]. / Ostra Bialaczka limfoblastyczna u dzieci z zespolem Fanconiego.

Fanconi anaemia (FA) is a rare autosomal recessive disorder. Manifestation of the disease is pleomorphic and may include many congenital malformations and marrow aplasia. Congenital disorders include: skeletal abnormalities, hypo- or hyperpigmentation of the skin, renal or heart anomalies and many others. FA is an invariably fatal disease owing to progressive marrow aplasia or the development of acute leukaemia or squamous cell carcinoma. We present two children with Fanconi anaemia who developed acute lymphoblastic leukaemia in the 4 and 12 year of life.

[Tumor lysis syndrome in the course of neoplastic disease of hematopoietic system in children]. / Zespól lizy guza w przebiegu chorób rozrostowych ukladu krwiotwórczego u dzieci.

Tumor lysis syndrome is characterized by hyperuricemia, hyperkalemia and hyperphosphatemia followed by hypocalcemia. Sometimes they are accompanied by hyperglycemia. It can lead to acute renal insufficiency, neurological and cardiological disorders. In the Clinic of Paediatric Haematology and Chemotherapy in Zabrze, in the period from Jan.01, 1990 to Dec.31, 1997, 305 children were treated due to neoplastic diseases of haematopoietic system: 169 with ALL, 34--ANLL, 48--NHL and 54--HD. Tumor lysis syndrome was found in 11 children, what was 3.6% of all patients. They included 3 children with ALL/1 from group SRG and 2 with HRG/, 2 with ANLL, 6 with NHL/2 with NB-NHL and 4 with B-NHL/. Tumor lysis syndrome did not occur in any patient with HD. Two symptoms of tumor lysis syndrome were found in 13 children (4.26%) including 3 with ALL (1 SRG and 2 HRG), 2 with ANLL and 8 NHL/3-NB-NHL and 5-B-NHL/. Diabetes occurred in two children with ALL. Acute renal insufficiency occurred in 6 children with ALL, 2 with ANLL and 8 with NHL. Two patients with B-NHL required dialysis. One renal insufficiency treated with hemodialyses was the first symptom of lymphoma. To prevent the consequences of tumor lysis syndrome hydration with alkalization, constant monitoring of the above mentioned biochemical parameters are necessary. Acute renal insufficiency, not responding to conservative treatment, should be immediately treated with hemodialyses and chemotherapy should be introduced under its 'shield'.

[Ultrasonographic evaluation of thyroid in patients cured from Hodgkin disease]. / Ocena ultrasonograficzna tarczycy pacjentów wyleczonych z choroby Hodgkina.

Long-term prognosis in patients cured from Hodgkin's disease (HD), diagnosed in childhood has dramatically improved. This is why, early detection and elimination of treatment side-effects has become essential. The study aimed at thyroid morphology evaluation in 46 patients remaining in complete remission more than five years after completion of treatment for HD. Thyroid morphology was assessed by palpation and ultrasonography. Control group consisted of 43 age- and sex-matched healthy people. 17.4% of patients after HD treatment had abnormal thyroid morphology on physical examination (gland enlargement, increased consistency or presence of nodules). Thyroid volume in this group was significantly decreased comparing to control group (p < 0.005). 32.6% of patients had heterogenic echogenicity. Ultrasonography revealed pathological lesions in 21.7% of examined individuals. Single hypoechogenic lesions in 5 patients, multiple hypoechogenic in 4 patients and multiple hypo- and hyperechogenic in 1 existed. High frequency of pathological thyroid lesions in thyroid of patients cured from HD emphasizes the need for systematic ultrasonographic thyroid evaluation.

[The problem of blood transfusion ++ in Jehova's Witnesses' children with oncological disease]. / Problem przetaczania krwi w chorobach nowotworowych ukladu krwiotwórczego u dzieci wyznawców swiadków Jehowy.

We present 2 cases of Jehovah's Witnesses' children suffering from oncological diseases (non-Hodgkin Lymphoma and Acute Lymphoblastic Leukaemia). During their treatment we used erythropoietin and no blood products were transfused.

[Does residual mediastinal mass in children with completed treatment of Hodgkin's disease affect the incidence of relapses?]. / Czy resztkowy guz sródpiersia przetrwaly po zakonczeniu leczenia choroby Hodgkina u dzieci ma wplyw na czestosc wystepowania wznów?

Four hundred and four children with Hodgkin's disease (stage I-IV) were treated in seven cooperating centers of Polish Paediatric Leukaemia/Lymphoma Study Group between 1988 and 1996. Mediastinal masses and/or hilar involvement were found in 261 (65%) patients. Remission was obtained in 256 (98%) of this group. In 31 (12%) children residual mediastinal/hilar masses were found after completing the treatment. For this reason in 13 cases the number of chemotherapy courses and/or the dose of radiation therapy were increased. In two cases thoracotomy or thoracoscopy were performed, and in one case gallium scan was performed. In none of these patients active disease was found. Relapses occurred in 4 (12.9%) from the group of 31 children with residual mediastinal/hilar involvement 8-15 months after cessation of the therapy. Twenty seven children have been in first remission for 5-113 months (median, 34). In 225 patients with a complete resolution of their mediastinal/hilar masses, relapses occurred in 13 (5.7%) cases. Patients with residual mediastinal mass should be carefully evaluated before making a decision to complete their treatment, including CT scan, MRI, and gallium scan. In doubtful cases histopathological verification should be done.

[Evaluation of cochlear function by means of otoacoustic emission in children treated with cytostatic drugs in the course of bone marrow proliferative diseases]. / Ocena funkcji slimaka za pomoca otoemisji akustycznej u dzieci leczonych cytostatykami w przebiegu chorób rozrostowych ukladu krwiotwórczego.

The aim of study was cochlear function estimation by means otoacoustic emission in children treated by leukaemia cytostatic drugs in course of the bone marrow proliferative diseases. The children after treatment of acute lymphoblastic leukemia or nongranulomatic malignant lymphoma according to BFM programme were examined in this study. Audiologic examination of children included tonal audiometry, tympanometry and otoacoustic emission as well. The results were compared to the findings of control group consisted of healthy children have never suffered from ear diseases and have never used ototoxic drugs. No significant differences in tonal audiometry and TEOAE were observed. Aggressive treatment of leukaemia does not result in hearing loss.

[Non-Hodgkin gastric lymphoma in a 14-year-old boy]. / Nieziarniczy chloniak zlosliwy zoladka u 14-letniego chlopca.

Lymphomas of the gastrointestinal tract in children are localized most often in the ileocoecal region. We described a rare case of gastric lymphoma in 14-year-old boy.

[T-cell acute lymphoblastic leukemia E(-) with antigen Ia expression]. / T-komórkowa ostra bialaczka limfoblastyczna E(-) z ekspresja antygenu Ia.

A case is presented of a rare T-phenotype acute lymphoblastic leukaemia. The blast cells were negative in the rosette test and demonstrated expression of the Ia antigen.

[Extramedullary (bone) relapse 16 months after allo bmt in a 7-year-old girl treated for acute lymphoblastic leukaemia from the second year of life]. / Pozaszpikowa (kostna) wznowa u 7-letniej dziewczynki leczonej od drugiego roku zycia z powodu ostrej bialaczki limfoblastycznej--W 16. Miesiacu po allo bmt.

7-year-old girl treated for acute lymphoblastic leukaemia since June 1995 after marrow relapse (June 1997) presented with painful oedema of the upper part of left hip and limping, 16 months after allogeneic bone marrow transplantation (BMT). Bone marrow examination excluded medullary relapse. Histopathological investigation of periosteum and bone scrapings revealed massive leukemic infiltration. Radiotherapy resulted in local arrest of the malignant process. However, bone marrow relapse was diagnosed in the child two months later with subsequent death after one month.