Thrombotic complications during induction chemotherapy of acute childhood lymphoblastic leukemia.

The incidence of thrombosis during induction chemotherapy of acute childhood lymphoblastic leukemia (ALL) patients was 6 found to be in 105 (5.7%). There were 4 cerebral infarctions, 1 superior vena cava (SVC) obstruction and 1 deep vein thrombosis. Among these, 2 of them died. A prospective study was further conducted of the change in coagulation and anticoagulation factors during 6 weeks of induction chemotherapy. It was found that the activated partial thromboplastin time (aPTT) was within normal range in all cases throughout 6 weeks, while prothrombin time (PT) and thrombin time (TT) were slightly prolonged, especially during the first 3 weeks of this phase. The natural anticoagulant panels which included protein C (PC), protein S (PS) and antithrombin III (AT III) and also fibrinogen level, were lower during the first 3 weeks and reached its nadir during the second and third week. The lower level of natural anticoagulants might be an important predisposing factor for the occurrence of thrombosis in these patients.

Prevalence of migraine and headache among school children in Bangkok.

To determine the prevalence and risk factors of migraine and headache among school children in Bangkok. Methods: We carried out a community-based questionnaire survey, using the IHS diagnostic criteria, in 10 schools in Bangkok. The sensitivity and specificity of the questionnaire used in this study were 47.05% and 94.12% respectively. Two groups of school children, first and seventh grade students, were selected in order to determine the influence of age on the prevalence of migraine. The questionnaire also contained questions regarding risk factors such as family history of migraine, travelling time between school and home, mode of communication, school hours, and sleep duration at night. Results: The response rates were 23.48% for the first grade students, and 100% for the seventh grade students. The prevalence of migraine in the 821 first grade students that responded was 0.37%, with 0.6% in boys and 0.3% in girls. From the total of 3,547 seventh grade students that were studied, there were 169 children (4.77%) who met the criteria of migraine by IHS, 58 males (3.11%) and 111 females (6.6%). Risk factors that increased the occurrence migraine were a positive family history of migraine, female sex, stress due to travelling time to school of more than 2 hours, and less sleeping time. Conclusion: The prevalence of migraine of both age groups in this study was lower than studies from western countries. This could be due to a racial difference as well as the low sensitivity of the questionnaire. Besides the positive family history of migraine and less sleep duration at night, stress due to long hours of travelling between school and home was also an important triggering factor of migraine of school children in Bangkok.

Treatments of severe aplastic anemia in children.

We carried out a retrospective analysis of the outcome of treatment in patients with severe aplastic anemia who attended the Department of Pediatrics, Siriraj Hospital, during 1972- 1998. There were 31 patients, 17 boys and 14 girls, by Camitta’s criteria for severe aplastic anemia. All of them were idiopathic. Twenty patients were treated conventionally with steroid and androgen compounds, 5 with immunosuppressive therapy and 6 with bone marrow transplantation. In the conventional treatment group, after 1 year to 19 years of follow up, 64.7% achieved complete response, 11.8% achieved partial response and 23.5% died. The response rate in the immunosuppressive therapy group was only 40% after 3 months to 2 years of follow up. In the bone marrow transplantation group, bone marrow engraftment was achieved in all cases (means 29.8, range 19 - 42 days), and the patients yielded the highest complete response rate (100%). However, 1 case relapsed after complete response for 1 year, but he was successfully cured after second transplantation. The overall survival rate and cure rate were also 100% after 1 year and a half to 10 years of follow up. Bone marrow transplantation, when compared to other treatments, resulted in the highest response or cure rate with the shortest treatment duration. The only disadvantages of bone marrow transplantation are the high cost and the limited availability of HLA compatible donors.