摘要:

To identify factors which might be associated with intellectual function following treatment for childhood acute lymphoblastic leukemia, 50 long-term survivors were studied using the Wechsler Intelligence Scale for Children-Revised. All patients were diagnosed between 1972 and 1974 and were treated on a single clinical trial protocol with identical induction and maintenance chemotherapy plus central nervous system prophylaxis that included cranial radiation.The mean full scale IQ score for the group was 95 (SEM 2.0), with mean verbal IQ of 94.4 and mean performance IQ of 96.9. Factors which were found to be closely associated with a lower IQ score included female sex (in both verbal IQ and full-scale IQ), longer duration of chemotherapy (in performance IQ), and younger age at the time of radiation (in both verbal IQ and full-scale IQ). The age at the time of radiation was found to be significantly correlated with discrepancy between verbal and performance IQ, with younger age being associated with verbal IQ scores higher than performance IQ scores. When analyses were performed within specific subgroups of patients defined by sex and age at the time of radiation, dose of cranial radiation, concomitant intratbecal methotrexate therapy, and duration of therapy were all found to be correlated with a lower level of intellectual function. These preliminary findings provide direction for future studies to help identify high-risk patients.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Thirty-two long-term survivors of childhood leukemia who were followed up at the University of Texas M. D. Anderson Hospital were evaluated with a battery of 17 neuropsychologic tests. These tests were selected to assess the development of cognitive skills and functions associated with brain impairment in children.Statistically significant differences were found between the group of children given CNS irradiation and the nonirradiated group on full-scale IQ and verbal IQ scores, mathematics skills, constructional skills, and memory for spatial material. Of particular interest was the absence of differences in language-based measures of verbal memory and the presence of group differences on measures of memory for spatial material. While the sample size was small, the findings delineate specific areas likely to be affected.These results indicate the need for caution when including cranial irradiation in CNS prophylaxis. When any CNS treatment is given, it seems appropriate that provisions be made for assessment and remediation of affected skills.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

We used cranial computed tomography (CT) to evaluate 51 leukemic patients with or without central nervous system (CNS) symptoms. Among 17 symptomatic patients, nine had gross abnormalities on CT scans; leukemic infiltrations, infections (CNS aspergillosis), hemorrhages, and therapy-related complications were all evident. One with a leukemic infiltration showed a peri-ventricular low density on the CT scans. The differential diagnosis of CT findings and the correlation between clinical and CT findings is described. The significance of a low-density area observed in an asymptomatic patient on long-term intrathecal methotrexate therapy for CNS leukemia is also discussed.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Childhood preleukemia, known as a rare condition, was evaluated in four of the authors' cases and in 24 cases from the literature. The required condition was evolution into overt acute leukemia. The children were 5 months to 15 years of age, and the preleukemia period ranged from 2 to 42 months. The symptoms and physical signs were nonspecific. Different kinds of cytopenia were found in the peripheral blood. Twelve children developed ALL and 16 developed AML. The analysis revealed that in childhood there exist two different types of preleukemia: pre-ALL and pre-AML. The age and sex distribution were different, as were the hematological changes. The marrow was usually hypoplastic in pre-ALL but hyperplastic in pre-AML. True hypoplasia in any of the three cell lines was more common in pre-ALL, whereas ineffective thrombopoiesis and normal or increased myelopoiesis were specific for pre-AML. Ineffective erythropoiesis was characteristic of both types. A typical chromosomal change in marrow, seen in pre-AML only, was a missing group C chromosome. The childhood pre-AML resembled adult preleukemia (also pre-AML) in many aspects, whereas the childhood pre-ALL seemed to be a different entity. It might be assumed that all preleukemic conditions do not evolve to overt malignancy. The incidence and true prognosis therefore remain unknown.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Acute ITP in children under 13 years of age is generally a benign, self-limited condition with spontaneous recovery occurring within a matter of days or weeks. Our analysis of platelet data indicate no advantage in terms of rate of recovery when steroids are used. In fact, the median of 3 weeks and mean of 3 1/2 weeks from onset to recovery in the nonsteroid-treated children were significantly better than the corresponding figures in the steroid-treated group. In addition, while reducing the risk of intracranial hemorrhage is generally given as the chief therapeutic rationale for using steroids, we have not seen a single case of ICH among 465 consecutive cases of acute ITP in children, the majority (93%) of whom did not receive steroids.On the other hand, adolescents, as adults, with ITP often have the autoimmune (chronic) form of the disease. In this group, corticosteroids may be of at least transient benefit and should be used.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Idiopathic thrombocytopenic purpura (ITP), an acquired hemorrhagic disorder, is characterized by the abrupt onset of thrombocytopenia despite normal megakaryo-cytic productivity. An accumulating body of evidence, including the recent demonstration of elevated levels of platelet-associated IgG, points to an immune etiology of acute childhood ITP. Although spontaneous recovery occurs in 80–90% of patients within 4 months of diagnosis, hemorrhagic complications may occur. Considerable evidence exists which suggests the efficacy of corticosteroid use in this disorder. Several clinical studies have shown that steroids may shorten the time to platelet count recovery, thus reducing the time at risk for hemorrhagic complications. The authors conclude with treatment recommendations for childhood ITP which include a brief course of prednisone.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Preliminary data from a prospective randomized study of the use of a short course of adrenocorticosteroids in 73 children with ITP demonstrates a significant advantage of moderate dose (60 mg/m2/day p.o. x 21 days) prednisolone therapy in decreasing the duration of severe thrombocytopenia in most patients. The period of risk for serious bleeding, as reflected in the Rumpel-Leede test, was also significantly reduced. The number of children who developed chronic thrombocytopenia, although small in both groups, appeared to be uninfluenced by steroid therapy. No side effects or serious complications were noted in this trial.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

IgG-SRK (identical with Sandoglobulin®) is a polyvalent IgG concentrate obtained by modified alcohol cryoprecipitation, including mild acidification at pH 4. This product was given in high doses intravenously for the treatment of six children with acute ITP, four children with intermittent ITP, and three children with severe chronic idiopathic thrombocytopenic purpura (ITP). An impressive initial response was observed in all patients, the extent of which may be of prognostic significance in acute ITP. Maintenance therapy was required in two of six patients with acute ITP, in three out of four patients with intermittent ITP, and in all of the patients with severe chronic ITP. In the cases of severe chronic ITP, the disease could not be adequately controlled over long periods of time, but bleeding episodes subsided or became considerably less frequent.Although little is known of the effects of IgG-SRK, possible mechanisms were discussed. It is emphasized that a new model has been discovered to study the interrelations between structure and function of human immunoglobulin molecules.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Chronic idiopathic thrombocytopenic purpura (ITP) in childhood exerts influence on the medical, social, and psychologic life of the child. Chronic platelet destruction takes place in the spleen and splenectomy results in complete and permanent recovery of normal platelet counts in most patients. Splenectomy is not without risks, however, and alternative methods of management have been sought. Chronic corticosteroid administration, immunosuppressive agents, infusions of fresh-frozen plasma, plasmapheresis, and high-dose intravenous gammaglobulin administration have all met with variable degrees of success. At the present time, there appears to be no completely satisfactory alternative to splenectomy in the management of the child with chronic ITP.

ISSN:0192-8562    

出版商:OVID    

年代:1984

数据来源: OVID