Immune thrombocytopenic purpura in childhood in Norway: a prospective, population-based registration.

A prospective, population-based registration of children with immune thrombocytopenic purpura (ITP) was performed in Norway in 1996 and 1997. Ninety-two cases were identified, indicating an incidence of 5.3 per 100,000 children under 15 years. The sex ratio (female/male) was 1.2/1. Fifty-six percent presented with cutaneous signs only. The lowest platelet count was < 20 x 10(9)/L in 91%. In spite of mild bleeding symptoms, medical treatment was given in 68%, in most cases (57/63) with intravenous immunoglobulin. A total of 41/44 patients with platelet counts of < or = 5 x 10(9)/L were treated, regardless of whether they had mucous bleedings or not. Eighteen percent had platelet counts < 150 x 10(9)/L at 6 months, and 9% at 12 months following diagnosis. One patient with therapy-resistant chronic ITP died 16 months after diagnosis from an anesthesia complication related to profound epistaxis. This study shows a relatively high incidence. As in other studies, there was a tendency to treat platelet counts rather than bleeding symptoms.

[Neurofibromatosis type 1 in childhood]. / Nevrofibromatose type 1 hos barn.

Neurofibromatosis 1 is one of the most common genetic disorders in man. Although almost every body system can be involved, it most frequently affects the skin, the nervous system and the skeleton. Major disease features are café-au-lait spots, axillary/inguinal freckling, neurofibromas and Lisch' nodules. The complications are quite variable, making it impossible to predict the clinical course in an individual patient. To summarize the problems associated with this disease we have quantified manifestations and complications in a group of 38 children with neurofibromatosis 1 who were seen at the University Hospital in Trondheim, Norway between 1987 and 1997. The results are based upon the medical records as well as clinical examination. A wide variety of initial symptoms was recorded, but the majority of the children had café-au-lait spots and axillary/inguinal freckling, two of the seven disease features included in the diagnostic criteria given by the National Institutes of Health. The most frequent complications were tumours, with highest incidence of optic pathway gliomas, disturbances of growth and puberty, delayed psychomotor development and learning disabilities. The risk of complications necessitates regular follow-up in a paediatric department. An annual assessment by an ophthalmologist is also recommended, as well as Visual Evoked Potentials/MRI as screening for optic glioma in children under ten years of age.

[Intracranial tumors in children (under 15 years)]. / Intrakraniale svulster hos barn (< 15 år).

Primary intracranial tumours develop in 30-35 Norwegian children each year. Of these tumours, astrocytomas are the most frequent, followed by medulloblastomas, oligoastrocytomas and ependymomas. In this article we give an overview of tumour classification, epidemiology, diagnosis, treatment and prognosis of intracranial tumours in children.

Immunoglobulin E in the feces of children and adolescents from some tropical and subtropical countries.

Eighteen of 27 individuals, aged from 6 months to 19 years (mean 5 years, 7 months), from countries in the tropics or the subtropics had either intestinal parasitic infestations or intestinal enteropathogenic bacterial infections or both. Fourteen of those with intestinal pathogens had detectable concentrations of IgE in their fecal extracts, ranging from less than 0.5 to 420 IU/ml extract (mean 33 IU/ml). This rate of occurrence was significantly higher than the number of IgE-positive fecal extracts in a group of 54 healthy nonallergic Norwegian children (p less than 0.001), but did not differ from that of a group of 40 allergic children (p greater than 0.20). The individuals with intestinal helminthic infection had the highest fecal IgE concentrations. Of the 9 individuals who did not have any demonstrable intestinal pathogen, low concentrations of IgE could be detected in feces from only 2, which did not differ from the rate in the healthy Norwegian controls. The concentrations of IgE in the feces of the subjects from tropical/subtropical regions correlated linearly with the corresponding serum concentrations of IgE (r = 0.69; p less than 0.001). The results indicate that the combined load of intestinal pathogens, including helminths, protozoa, and enteropathogenic bacteria, may stimulate IgE production in the gut.

[Neurofibromatosis and development of cancer in childhood]. / Neurofibromatose og kreftutvikling i barnealderen.

Neurofibromatosis takes two major forms; classical or peripheral neurofibromatosis as described by von Recklinghausen, which accounts for more than 90% of the cases, and central or bilateral acoustic neurofibromatosis. The diagnosis is often postponed until adulthood, since the classical signs gradually appear during childhood and adolescence. It is a relatively common autosomal dominant disorder affecting about one in 3,000. At least 20% of patients will develop one or more complications associated with neurofibromatosis. One of the complications is the development of malignancies. Four children at our hospital developed different forms of malignant tumours arising from neurofibromatosis. We recommend that all patients suffering from this disease are evaluated in detail after the diagnosis has been confirmed and are followed up every six to 12 months. In this way complications may be discovered early and the necessary steps taken.

Structural chromosome aberrations in lymphocytes from children previously treated for Wilms' tumor or Hodgkin's disease.

Nineteen children treated for Wilms' tumor (thirteen cases) or Hodgkin's disease (six cases) with cytostatic agents and/or radiotherapy were studied cytogenetically on lymphocytes cultivated from blood samples drawn after at least 1 year of complete remission after end of therapy. A reference group of children was matched for age, sex, and residence. The frequencies of sister chromatid exchange (5.4 versus 5.6 SCE/cell), and chromosome damage type gaps (6.6 versus 7.1%) and breaks (1.9 versus 1.9%) were not different in the two groups, but exchange type aberrations were more frequent in the patients (0.9 versus 0.06%). Fifty karyotypes were analyzed in all but two cases of Hodgkin's disease. The overall frequency of stable (3.1 versus 3.8%) and unstable (1.7 versus 1.4%) structural chromosome changes such as translocations, deletions, chromatid exchanges, and dicentrics were not different in the patient and the control groups. If the chromosome data reflect a general cancer risk, this risk cannot be considerably higher among the cancer-treated children.

Thyroid function in children after cytostatic treatment for acute leukemia.

Sixty-one children were examined for thyroid dysfunction as an adverse late effect after cessation of antileukemic treatment. The aim of the study was to contribute to clarifying which types of therapy can cause this endocrine disorder. Our treatment protocols do not include cranial irradiation as CNS prophylaxis, but we give relatively intensive intrathecal methotrexate treatment. The results indicate that this cytostatic regimen alone does not cause thyroid dysfunction as an adverse late effect.

BK virus infection in children with cancer: serological response studied by haemagglutination inhibition, neutralization, and IgG- and IgM-class specific ELISA tests.

We recently developed enzyme-linked immunosorbent assays (ELISAs) for the detection of anti-BK virus IgG- and IgM-antibodies, and also a convenient and rapid serum neutralization test. Complemented by a traditional haemagglutination inhibition test (HAI) these methods were used to investigate the longitudinal response to BKV infection in sequentially taken sera from 29 children under treatment for cancer. In separate experiments it was shown that the results were not at any extent influenced by antibodies against other polyomaviruses. At the time of diagnosis the prevalence of specific IgG- and IgM-antibodies and the geometric mean IgG levels were not significantly different for the patients compared with a group of healthy children. The primary infections seemed to occur at the same age for the two groups of children. Seven of the patients had a primary infection with BKV. The results indicate that the host response in moderately immunosuppressed children during primary infection is the same as expected for healthy individuals with the development of specific IgG, HAI, and NT antibodies, and, usually, production of BKV-IgM for several months. The results indicated that whether specific IgM was demonstrated in the first sample or appeared later during a reactivation episode, this parameter was correlated with profound immunosuppression. Significant titre changes, detectable IgM antibodies and/or seroconversions were demonstrated in 69% (20/29) of the cancer patients. Such indications of recent viral activity was recorded in 42% (8/19) of children with meningococcal infections. The observation periods for the two groups of patients are, however, not directly comparable.

Similarities between IgE in human feces and a chymotrypsin-digest of an IgE myeloma protein.

Immunoglobulin E (IgE) in human feces was characterized by radioimmunoassays with different specificities of the second antibodies, and by immunoprecipitation techniques. The fecal IgE was compared with an intact IgE myeloma protein and with Fc'' fragments of the IgE molecules, obtained after prolonged chymotrypsin-digestion of the IgE myeloma protein. The experiments showed that both the fecal IgE and Fc'' fragments shared the D epsilon 1 antigenic determinants while the intact IgE had both D epsilon 1 and D epsilon 2 determinants. They also shared thermal stability at 56 degrees C as compared to intact IgE. Fecal IgE and Fc'' fragments both showed rapid anodal migration in an electric field, different to that of intact IgE. A tandem crossed immunoelectrophoresis technique provided signs of immunological identity between the precipitates of fecal IgE and those of the Fc'' fragments. It is therefore likely that most, if not all, IgE in human feces consists of Fc" fragments.

High-dose methotrexate therapy (6-8 g/m2) in childhood malignancies: clinical tolerability and pharmacokinetics.

Five children, ages 2.5 to 12 years (mean 6.2 years), with acute lymphoblastic leukemia or non-Hodgkin's lymphoma were given 22 courses of high-dose methotrexate (HD-MTX) therapy (6-8 g/m2/24 h). No serious clinical complications were encountered, but stomatitis occurred after three (14%) of the courses. First-phase elimination half-lives (t1/2(alpha)) of MTX and 7-hydroxy-methotrexate (7-OH-MTX) after 21 infusions were 2.7 +/- 0.4 h and 6.5 +/- 1.8 h (mean +/- SD). In one course (4.5%) there was delayed systemic MTX elimination, with first-phase elimination half-lives (t1/2(alpha] for MTX and 7-OH-MTX of 4.2 and 9.9 h, respectively, and second-phase elimination half-lives (t1/2(beta)) of 43 and 58 h. Significant decreases in white blood cell count, increases in serum creatinine, and increases in alanine aminotransferase and/or aspartate aminotransferase during the first 2-6 days were present in five (23%), three (14%), and six (27%) of the courses, respectively. The regimen was tolerated well by the children.

Lactoferrin and C-reactive protein in response to cytostatic drugs with emphasis on methotrexate.

In this study plasma concentrations of lactoferrin (LF) and C-reactive protein (CRP) are examined in 9 children with different kinds of cancer but without any intercurrent infections. New, sensitive enzyme-linked immunosorbent assay for LF and CRP are described. The samples are drawn before, during, and after the cytotoxic drugs are given. The cytotoxic courses include cis-platinum, vincristine, adriamycin, cytarabine, and methotrexate (6 g/m2/24 h and 33.6 g/m2/24 h). During the infusion of methotrexate 33.6 g/m2 the concentrations of LF are increased, only a small increase of CRP is observed, and for the other groups there is no changes of both parameters.

Methotrexate infusions in poor prognosis acute lymphoblastic leukemia: II. High-dose methotrexate (HDM) in acute lymphoblastic leukemia in childhood: a pilot study from April 1981.

The pilot study using HDM in all cases of ALL in childhood had been run for 4 1/2 years as of September 1985. Fourteen (23%) of all 62 diagnosed cases of ALL had WBC above 50 X 10(9)/L, all 14 achieved CR. Three of them were below one year of age, two also had WBC above 400 X 10(9)/L, the third infant had B-cell-leukemia. The remaining 11 children received our new HDM protocol (Fig. 1), one of them had relapsed (BM) as of September 1985.

Methotrexate infusions in poor prognosis acute lymphoblastic leukemia in children: I. The Norwegian methotrexate study in acute lymphoblastic leukemia in childhood, August 1975-December 1980.

One hundred fifty-three children with ALL were diagnosed in Norway in the period August 1975-December 1980. One hundred thirty-two of them received 3 infusions of methotrexate as consolidation therapy combined with methotrexate intrathecally as CNS prophylaxis. Eleven (44%) of the total 25 methotrexate cases with WBC above 50 X 10(9)/L were in CCR after 4 1/2-10 years. Two more cases had discontinued therapy, while in second remission. The event-free survival of all diagnosed 32 children in Norway with WBC above 50 X 10(9)/L was 37%. Seven infants below the age of 1 year are included in the 32 cases.