[Brain metastases from Wilms' tumor without systemic involvement--a case report and review].

A 3-year-old boy presented with multiple brain metastases 21 months after the resection of stage II Wilms' tumor. Metastasis to other organs was not found. He was treated by total removal of a large metastatic tumor in the left temporal lobe and post-operative radiotherapy and chemotherapy. He has been in complete remission for 20 months after surgery. Cerebral metastasis from Wilms' tumor without systemic metastases is very rare. It is speculated that brain metastases occurred in this patient because most of the anticancer agents used in the primary treatment for Wilms' tumor were not able to cross the blood brain barrier.

Diffuse pleural rhabdomyosarcoma with persistent pleural effusion.

A unique case of embryonal rhabdomyosarcoma arising at the left pleura of a 7-year-old Japanese girl is reported. The present case was characterized by persistent pleural effusion, and the malignant cells incidentally found in it were the first diagnostic clue. The tumor showed a rare growth pattern involving diffuse thickening of the parietal pleura. Biopsy of the thickened parietal pleura upon thoracotomy revealed embryonal rhabdomyosarcoma largely composed of immature mesenchymal cells. Immunohistochemical demonstration of creatinine phosphokinase-MM was most helpful among several types of immunostain for the histopathological diagnosis. Ultrastructurally, thin filaments with primitive Z bands could be seen in some tumor cells. Intensive clinical examination revealed only diffuse thickening of the parietal pleura, which was reduced by chemotherapy. This is the first documented case of rhabdomyosarcoma arising at the pleura. Previous reports of rhabdomyosarcoma arising at unusual sites are reviewed and the histogenesis of this tumor is briefly discussed.

Vitamin K effect in low birth weight infants.

Factor II coagulant antigen (FII-AG), the protein induced by vitamin K absence or antagonist II (PIVKA-II), and coagulant activity (normotest) were measured in low birth weight infants. The factor II coagulant antigen and normotest levels in one-day-old babies were lower than those of full-term infants (P less than .005, P less than .01, respectively). Infants whose normotest levels were less than 30% at one day (group A) received vitamin K2, and the others whose normotest levels were greater than 30% at one day (group B) were not treated. At this time, the mean factor II coagulant antigen level was significantly lower in group A than in group B (P less than .05). During the first seven days of life, in 65.2% of the infants in group B the PIVKA-II level became positive, but this did not occur in any infant in group A. After vitamin K treatment, there was greater improvement in the normotest level in infants with positive PIVKA-II levels than in those with negative PIVKA-II levels. This observation indicates that the hypoprothrombinemia found in low birth weight infants at one day of age is attributable to reduced synthesis of factor II coagulant antigen in the liver at this stage, but the prophylactic administration of vitamin K seemed to be effective even in such infants, probably because of the increase in factor II coagulant antigen synthesis (P less than .001) during the first seven days of life.

Zinc balance in premature infants given the minimal dietary zinc requirement.

A zinc balance study was conducted on low birth weight infants (670 to 2420 g) fed unsupplemented human milk (the mother's or pooled) (group 1, n = 17) or human milk with zinc supplementation (group 2, n = 17). The mean zinc concentrations of the diets in groups 1 and 2 were 2.2 +/- 1.1 mg/L and 8.4 +/- 0.8 mg/L, respectively, and the mean copper concentration of the diets in both groups was 0.45 +/- 0.12 mg/L. The studies were performed 7 to 128 days after birth, which corresponded to 29 to 43 weeks postconceptional age. The turning point of zinc balance from negative to positive appeared to be greatly influenced by the postconceptional age, being approximately 36 weeks in both group 1 and group 2, rather than other factors such as the zinc intake and the postnatal age. The calculated minimal requirement of dietary zinc during the period from 36 to 40 weeks postconceptional age, for an adequate amount of zinc retention in infants (250 micrograms/kg/d), was 0.8 mg/kg/d. Zinc supplementation did not appear to interfere with copper retention.