Analyses of prognostic factors in a retrospective review of 92 children with ependymoma: Italian Pediatric Neuro-oncology Group.

The principal aim of this report is to present the results of multivariate analyses conducted to identify clinical prognostic factors in 92 children aged < 16 years with ependymoma (EPD) retrospectively collected in seven Italian centres. They were treated over a 16-year period (1977-1993). Treatment modalities varied. Surgery and radiotherapy (RT) was the "gold standard" management method for the majority of these children. Only in the late 1980s did some of them receive chemotherapy (CT), mainly with vincristine, lomustine (CCNU) and prednisone. The median follow-up of the entire study population is 36 months (average 43 months; range 12 to 214 months). The 10-year overall (OS) and the progression-free survival (PFS) of the study population were 55.5% (CI 41.4-69.4%) and 34.7% (CI 21.4-47.8%), respectively. Age (< 5 years; > 5 years), sex, site (infratentorial vs. supratentorial), histology (anaplastic/malignant vs. non-anaplastic/non-malignant), type of resection (complete vs. incomplete); use and fields of RT, and of CT employed were entered in a multivariate regression model to test their impact on OS and PFS. On univariate analysis, radical surgery, the use of RT and age more than 5 years at the time of diagnosis achieved statistically significant values for predicting long-term OS and PFS. Histology reached marginal statistical significance but only for PFS. When those variables were entered in a multivariate analysis only radical resection (P = 0.00142 and 0.0001) resulted a significant factor for predicting long-term OS and PFS, while the use of RT reached a marginal statistical significance, but only for PFS (P = 0.05). Children who had the tumour completely resected did significantly better than all the others who had less than a complete resection, with a 10-year OS and PFS for the two groups of patients of 69.8% (CI 53-86.5%) and 57.2% (CI 40.3-75%) and of 32.5% (CI 8.5-57.6%) and 11.1% (0-24.4%), respectively. These findings suggest that, for childhood EPD, radical resection should be pursued as much as reasonably possible. Thus, it seems justified proposing for future trials, patient stratification by entity of surgical resection.

Use of cardiac troponin T rapid assay in the diagnosis of a myocardial injury secondary to electrical cardioversion.

BACKGROUND AND HYPOTHESIS: This study was carried out to determine whether cardiac troponin T test in rapid assay gives positive results in patients previously submitted to cardioversion or electrical defibrillation. METHODS: Forty patients with supraventricular tachyarrhythmias lasting no more than 2 days were treated with electrical cardioversion. The total creatine phosphokinase (CPK)-MB isoenzyme and troponin T in rapid assay were measured at baseline and at 6, 12, and 24 h thereafter. RESULTS: Total CPK baseline levels were normal in all cases; within 4 h, the serum CPK levels increased by 98%, at 6 h by 111.5%, at 12 h by 168%, and at 24 h by 225% (p > 0.01). The CPK-MB isoenzyme showed no percentage increase of total CPK higher than 5%, measured at 6, 12, and 24 h after the shock, independent of the number of attempts of cardioversion. The troponin T test was also negative in all cases at baseline and at 6, 12, and 24 h after cardioversion. CONCLUSION: We conclude that the absence of elevations in CPK-MB levels and cardiac troponin T levels matched clinical and electrocardiographic results showing absence of myocardial damage after electrical cardioversion.

[Evaluation of the anti-arrhythmia effect of intravenous flecainide in supraventricular tachyarrhythmias]. / Valoración antiarrítmica de la flecainida endovenosa en las taquiarritmias supraventriculares.

We studied the effects of intravenous flecainide acetate, given as a single dose of 2 mg/kg in no less than 15 minutes, on 31 patients with supraventricular tachyarrhythmias. Fourteen (87%) of the 16 patients with paroxysmal atrial fibrillation converted to sinus node rhythm. All 7 (100%) of the patients with paroxysmal supraventricular tachycardia converted to sinus node rhythm. Five (60%) of the 8 patients with paroxysmal atrial flutter converted to sinus node rhythm. The average time of conversion, after completion of drug administration, was 15 +/- 20 minutes. The QRS was prolonged an average of 82 to 91 milliseconds; in those cases who converted, the PR interval duration was 180 milliseconds average; QT was prolonged an average of 425-450 milliseconds. There were no changes in the JT interval, and we observed no hemodynamic untoward effects.

Acute myelogenous leukemia with translocation t(8;21): a cytogenetic study of seven cases.

Seven cases of acute nonlymphoblastic leukemia showing t(8;21)(q22;q22) at diagnosis are described. Involvement of a sex chromosome was found in all patients (in six cases as a loss, and in one as a Y duplication), thus, confirming the suggestion of a correlation between these two chromosomal abnormalities. The constitutional folic acid-sensitive fragile site fra(8)(q22) was not detected, in spite of careful analysis of over 300 metaphases of cells grown in folic acid-free medium. Morphologic diagnoses and clinical aspects are briefly discussed.