Assessment of intellectual development after surgery for craniofacial dysostosis.

A 2-year-old girl with Crouzon's disease underwent three craniectomies. At age 4, she began a series of psychological tests to monitor her intellectual and academic functioning. Eight years after surgery, her intellectual functioning was comparable to that of her unaffected sister and far superior to that of her affected cousins, who were from similar home environments. Although the exact contributions of early identification and surgical intervention to the patient's intellectual and academic achievement could not be ascertained, these results suggest that some patients who receive early surgical treatment for Crouzon's disease may maintain a consistent rate of intellectual and academic development.

Emotional reactions of children to isolation in a cancer hospital.

Emotional reactions of 123 hospitalized children and their mothers were evaluated during standard isolation with limited visitation and during peninsula isolation with visitation only through glass partitions. Self-report surveys and behavioral observations by nurses indicated that (1) patients and parents in both isolation facilities had overall high levels of hospital-related anxiety and depression which varied with the patient's chronologic age; and (2) parents of preschool children had more negative opinions toward peninsula isolation than did parents of older children. These results confirm the need for psychologically supportive programs for the families of children being treated for catastrophic diseases.

Effects of central-nervous-system irradiation on neuropsychologic functioning of children with acute lymphocytic leukemia.

Two neuropsychologic studies were performed to determine the long-term effects of "prophylactic" cranial or craniospinal irradiation on the psychologic and neurologic functions of children with acute lymphocytic leukemia. In a prospective study, 34 patients with leukemia who received either craniospinal irradiation or cranial irradiation combined with intrathecal methotrexate were evaluated by standardized neurologic and psychologic examinations before and after irradiation. Their performance was compared with that of 27 controls who received irradiation to parts of the body other than the cranium. In a retrospective study, 11 patients with leukemia receiving prophylactic craniospinal irradiation and 12 controls with the disease not receiving such therapy were followed from the second year after either irradiation or the initial hematologic remission. Eighteen months after irradiation in the prospective study and four years after irradiation in the retrospective study, no noteworthy neurologic or psychologic differences were found between subjects and controls.