Antibiotic sequential therapy for febrile neutropenia in pediatric patients with malignancy.

Children suffering malignant diseases can experience phases of bone marrow depression during intensive chemotherapy. The influence of antibiotic sequence therapy on the course of diseases was examined in 41 pediatric patients with malignant diseases. Inclusion criteria were neutropenia (ANC < 500/microL), rectal body temperature over 38.5 degrees C, and increased C-reactive protein (CRP, cutoff > 5.0 mg/L). The first stage of therapy comprised the following antibiotics: piperacillin, teicoplanin, and gentamicin. In stage 2 imipenem, teicoplanin, and tobramycin were administered. Fluconazole was the antifungal drug of choice in stages 1 and 2. In the first level of antibiotic therapy 68% of the patients showed a positive reaction. The C-reactive protein was a sensitive parameter, which significantly decreased with 3 days of therapy. A total of 72% of the bacteriological smears were sterile. All patients survived the septic phase.

Relationships of cytokine (GM-CSF) serum concentration to blood cell count and the inflammatory parameters in children with malignant diseases.

This study examined both the endogenous and exogenous (therapy-related) pharmacokinetics of the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) in neutropenic children with solid and systemic malignancies. The daily endogenous GM-CSF serum concentration before application was 29 pg/mL. During the 10 days of examination, the concentration rose to an average value of 1351 pg/mL 8 h after application. A significant stimulation of the neutrophils, monocytes, and eosinophils in peripheral blood was documented. No significant correlation between the GM-CSF concentration and peripheral blood cell counts could be documented. Paraclinically, there was no evidence for functional disturbance of either the liver or the kidneys, i.e., under the cytokine therapy. The therapy was well tolerated by all the children involved in the study.

[Titanium implant as an alternative possibility in fusion of the cervical vertebrae--initial clinical experiences]. / Das Titan-Implantat als alternative Fusionsmöglichkeit im HWS-Bereich--erste klinische Erfahrungen.

We report on our experience with the use of titanium for disc replacement in the cervical spine. In 52 patients a total of 55 titanium grafts were implanted. Follow-up examinations were available in 48 patients with an observation time of 14 month on average. Results of clinical-neurological examinations were excellent or good in 37 patients (77%), moderate in 9 cases (19%), while two patients (4%) showed poor outcome. Radiological follow-up examinations showed a correct position in 47 of the 48 patients. Incorrect position as observed in 1 case made operative revision necessary. According to our results, titanium grafts seem to be a useful alternative method as compared to conventional techniques of fusion. Essential advantages are simple handling, biocompatibility of the material as well as the solid bond achieved by the special qualities of the graft with respect to surface and form. Availability of different graft sizes allows tailored fusion.

[Case observations on the significance of early pregnancy factor as a tumor marker]. / Kasuistische Betrachtungen zur Bedeutung des Early Pregnancy Factor (EPF) als Tumormarker.

At three patients who have been operated on because of completely different tumours (trophoblast tumour, endodermalsinus tumour of the right ovary and rhabdomyosarcoma as well as adrenal cortex carcinoma) pre-operatively the Early Pregnancy Factor (EPF) could in each case be shown in the serum with the help of the rosette inhibition test. In two cases the EPF already intra-operatively disappeared from the serum. In the third case it could be found until the second day after operation. Since that patient suffered from two histogenetically non-related malignant tumours it was not possible to trace whether the adrenal cortex carcinoma or the rhabdomyosarcoma have been the reason for the EPF-synthesis. The already intra-operative disappearance and the also during further post-operative controls unsuccessful proof of EPF in serum can indicate an opportunity for the early assessment of efficiency of the surgical treatment of tumours which develop EPF or which induce the EPF-synthesis.

[The effect of combined ALL therapy in childhood on body growth]. / Zum Einfluss der komplexen ALL-Therapie im Kindesalter auf das Körperwachstum.

Female ALL long-term survivors who received cranial telecobalt radiation under the conditions of Therapy Study III of the Study Group on "Paediatric Haematology/Oncology" showed a significant reduction in adult height. On completion of therapy a drop in growth can already be observed in female ALL patients. This limitation on growth can probably be attributed to a disturbance in the hypothalamus-hypophysis system and to reduced GH secretion as a result of radiation.

[Fibrous hamartoma in the infant]. / Das fibröse Hamartom des Kleinkindes.

Fibrous hamartoma is a rare example of juvenile fibromatoses. We report a case of an 11 month old infancy with presenting of clinical picture, morphological findings and therapy. Biological behaviour, differential diagnosis and pathogenetic connections to other fibromatoses were discussed.

[Current aspects of the sudden infant death syndrome]. / Aktuelle Aspekte zum Syndrom des plötzlichen Kindestodes (SIDS).

SIDS is the most frequent cause of death in infancy outside the neonatal period. The pathogenesis of the disease is not clearly understood. Risk factors associated with SIDS can be defined. At present, the hypothesis of apnoea plays a major role in the pathogenesis. Findings show a central nervous dysfunction with an interruption of brain stem regulation of respiratory and cardiac function. In an emergency, the physician must carry out appropriate measures. Prophylaxis is possible in infants at risk. The active involvement of parents plays a decisive role in the prophylaxis of SIDS.

[Primary bronchial tumor in childhood--a case report]. / Primärer Bronchialtumor im Kindesalter--Fallbericht.

Primary bronchial tumors are a rarity in childhood. According to the WHO-classification of 1981 Bronchial Carcinoid tumors and Mucoepidermoid carcinoms are listed as the most frequent histological types of the malignoma group and will be not longer associated with attributed benign tumors. In the literature especially the prognostic important early diagnosis and the difficulty of histological differentiation ist emphasized. In this paper is described a 12-year old girl suffering from a bronchial tumor. Throughout the 3 months of disease the diagnosis had been establisted by endoscopy. Surgically the resection of right middle and lower lobe was necessary. 7 years after bilobectomia the patient is without trouble of problems. The classification of the tumor ist problematic within the frame of in the WHO-classification and was discussed.

[Long-term survival following acute lymphoblastic leukemia (ALL) in childhood]. / Langzeitüberlebende nach akuter lymphoblastischer Leukose (ALL) des Kindesalters.

48 patients with ALL (3%) treated according to two different protocols survived 5 years or longer. The mean survival time was 13.0 +/- 5.0 years, but 29 patients lived 16.5 +/- 3.0 years. Only 18 patients (38%) were 16.9 +/- 3.0 years in them 1. CCR, the longest remission time amounted to more than 25 years. Of the patients relapsed 9 are 8.4 +/- 2.8 years in 2. CR. Late relapses after 5 years were observed in seven cases the last in the 9th year of disease. After 5 years the survival rate in both protocols was not different. As a late sequelae, there was one patient with intrahepatic block and portal hypertension and one with encephalopathy and imbecility. All patients were able to leave their professional examination, 5 patients married and 6 healthy children were born.

[Intrathecal methotrexate--overdosing in pediatric lymphoblastic leukemia]. / Intrathekale Methotrexat--Uberdosierung bei kindlicher lymphoblastischer Leukose.

Intrathecal methotrexate-overdosage in the meningosis therapy leads to CNS damages dependent on dose. It was given a own case report and a literature review with clinical symptoms and the therapy in this complication. Neuropathologic findings included demyelinisation und necrosis of the white matter.

Experience in surgical treatment of pulmonary and bronchial tumours in childhood.

From the patient material of three paediatric surgical centres and the patient material of the paediatric surgical hospitals of Zurich, Switzerland and Leipzig, GDR, 24 cases of lung and bronchial tumours are reported. The aim of this review is to show a spectrum of the cases observed in our region. The most frequent of these very rare tumours was pulmonary blastoma, followed by endobronchial adenoma in its different variants. Since only the latter can be endoscopically diagnosed, endoscopy should be carried out as early as possible when the diagnosis is not clear. Cystic lung disease seems to be particularly frequently associated with pulmonary blastomas. Uncertainties in diagnosis and therapy owing to the rareness of these diseases cause further problems.

[Intrathecal radiogold prophylaxis and the cerebrospinal fluid findings in children with acute lymphoblastic leukemia]. / Intrathekale Radiogoldprophylaxe und Liquorbefunde bei Kindern mit akuter lymphoblastischer Leukose.

Intrathecal radiogold application represents an alternative to the prophylaxis of meningosis in childhood acute lymphoblastic leukemia. Its compatibility is good, there are rarely any clinical side-effects. In addition to inconstant phagocytosis, changes of the protein value and its fractions could be identified in the cerebrospinal fluid. The cumulative rates of remission and survival are less marked in these groups of patients than in those who received a prophylactic skull irradiation.