摘要:

AbstractSeventy‐three patients under 18 years of age with a recurrent central nervous system tumor were randomized to receive combination chemotherapy with MOPP or OPP. Patients were stratified according to the tumor type into four major disease‐categories: (1) medulloblastoma, (2) astrocytoma and other glioma, (3) ependymoma, and (4) miscellaneous tumors to provide equal distribution of patients for each treatment within each disease category. Evaluation of response was based on computerized brain scan findings. Thirty‐five patients received MOPP and 38 received OPP treatment. There were three complete and six partial remissions among patients receiving MOPP and one complete and five partial remissions among patients receiving OPP. In addition, six patients on MOPP had stable disease for seven to 21 months. Only two patients on OPP had stable disease(6 and 36 months). Most of responses in both treatment regimens occurred in patients with medullo‐blastoma and astrocytoma. Median duration of remission was ninemonths for the MOPP and 11 months for the OPP. Two patients on MOPP regimen had fatal myelosuppression. Although the more toxic MOPP regimen produced more responses than OPP in children, differences in the duration of response or survival were not statistically significant (P=.79 and P = .84, respec

ISSN:0098-1532    

DOI:10.1002/mpo.2950120103

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractChildren with acute lymphocytic leukemia (ALL) who have a “lymphoma syndrome” (LySLk) defined by the presence of at least three of the following criteria: a) Hg>10 g/dl, b) lymph nodes>3 cm, c) spleen below umbilicus, d) liver below umbilicus, and e) mediastinal mass, appear to represent a subgroup of ALL. These children have a poor prognosis for survival when treated with standard chemotherapy for ALL. We performed a retrospective review of 21 patients at Children's Memorial Hospital with LySLk diagnosed from Jan 24, 1977 to July 8, 1981 and of the surface markers on their leukemic cells at diagnosis. Surface markers identified included E‐rosettes (E), surface immunoglobulin (SIg), and common ALL antigen (cALLA). Four patients were cALLA positive and E‐rosette negative; nine patients were E‐negative, cALLA negative; six patients were E positive, cALLA negative. In two patients E‐rosettes could not be accurately determined because of a low percentage of lymphoblasts in the samples studied. Follow‐up data on cALLA‐positive and cALLA‐negative patients revealed 4/4 cALLA‐positive patients with no evidence of disease (NED) at 22+ to 45+ months from diagnosis and 2/16 cALLA‐negative patients NED at 19 + and 57+ months. Thus it appears that the majority of children with LySLk have lymphoblasts which are cALLA negative. Patients who meet clinical criteria for LySLk but whose surface markers are E negative, cALLA positive may have a better prognosis and may represent a separate subgroup of patients with ALL and, therefore, should be given therapy appropriate for their prognostic classification by more standard criteria, such as white bloo

ISSN:0098-1532    

DOI:10.1002/mpo.2950120104

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractPatients with acute lymphoblastic leukemia who have a mediastinal mass at the time of diagnosis are said to have a poor prognosis. However, many factors which may not be independent contribute to the success of treatment. We compared the disease characteristics and results of therapy in children having large mediastinal masses and lymphoblastic leukemia without mediastinal mass. Patients with a mediastinal mass had less evidence of marrow failure but were burdened with considerably more leukemic cells as measured by peripheral blood white count and extent of lymphadenopathy. Since the presence of mediastinal mass was strongly associated with these and other poor prognostic characteristics, we used multivariate techniques to determine which characteristics were independently associated with an increased risk for relapse. White count, extent of lymphadenopathy, age, and sex were significant predictors of early relapse, but when controlled for these variables the presence of a mass did not predict prognosis.

ISSN:0098-1532    

DOI:10.1002/mpo.2950120105

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractTwenty‐two patients with advanced (FIGO stages III and IV) adenocarcinoma of the ovary were treated with 28‐day cycles of hexamethylmelamine, doxorubicin, andcis‐dichlorodiamine‐platinum (II) (HAC). After 45 months, there were 21 evaluable patients. The median survival was 16 months. Response was achieved in 82% (9/11) who had received no prior chemotheraphy, and in 50% (5/10) previously treated. HAC therapy was readily administered on an outpatient basis, with comparatively low major toxicities, primarily hematologic, neurologic, and gastrointestinal. These results indicate that HAC therapy is an effective regimen for patients with advanced ovarian carcinoma, regardless of their prior treatment

ISSN:0098-1532    

DOI:10.1002/mpo.2950120106

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractTwenty‐nine evaluable patients with anthracycline‐resistant metastatic bone or soft tissue sarcomas were treated with chlorozotocin, 150 mg/m2every 6 weeks. Four patients (14%) achieved partial responses. The most severe toxicity was usually thrombocytopenia (which occurred in 31% of patients). Chlorozotocin has only minimal activity in drug‐resistant metastatic sar

ISSN:0098-1532    

DOI:10.1002/mpo.2950120107

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractSplenectomy for massive splenomegaly in thrombocytopenic patients refractory to platelet transfusions carries increased surgical risks. Blocking of the splenic artery may reduce the size of the organ, prolong the survival of transfused platelets, and reduce the surgical complications. We describe four cases of extreme splenomegaly and thrombocytopenia where successful splenectomy was carried out after angiographic embolization of the splenic artery in children with ju venile chronic myelogenous leukemia. Significant improvement was observed in platelet counts and in the survival of platelets after transfusions in three of the patients. There was a concomitant decrease in transfusion requirements. Isoimmunization prevented prolonged platelet survival in the fourth case. We recommend earlier splenectomy in these patients to reduce transfusion requirements and delay the onset of poor platelet survival after transfusions.

ISSN:0098-1532    

DOI:10.1002/mpo.2950120108

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractWe report a case of hypereosinophilic syndrome associated with acute lymphoblastic leukemia (L1 type, FAB classification) which showed an abnormal karyotype. An 8‐year‐old boy was admitted to our hospital with complaints of fever and cough that had persisted for 2 weeks. Peripheral blood examination revealed remarkable eosinophilia (120,000/mm3) and a few lymphoblasts. Bone marrow examination also revealed many mature eosinophils and 20% lymphoblasts that were PAS and peroxidase negative. A direct chromosome analysis of the bone marrow cells demonstrated that 12.5% of the spontaneously dividing cells had an abnormal karyotype of 46XY, t(5;14) (q31;q32). The chest radiogram showed interstitial pneumonia‐like densities, and the ECG had the pattern of a right bundle branch block. The therapy consisted of prednisolone, high dose of methylprednisolone, cyclophosphamide, and vincristine. This treatment failed to reduce the eosinophil count. On the 4th day after admission, the patient developed severe dyspnea, complete A‐V block, and died. At postmortem, dense infiltrations of eosinophils in various stages of maturation were noted in lungs an

ISSN:0098-1532    

DOI:10.1002/mpo.2950120109

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractIn order to evaluate the impact of a block in cancer medicine upon student interactions with cancer patients, a group of 32 students have been videotaped during interviews with simulated and genuine cancer patients before and after the block. The videotapes were scored and analyzed for frequencies and patterns of interactions by the method of Reciprocal Category Analysis. This disclosed significant decreases in purely factual questions by the students, with corresponding in creases in discussion of emotional aspects of illness, following the course. The temporal pattern of interaction also changed with less of a tendency to delay or avoid addressing emotional aspects of disease noted. In addition to demonstrating changes in student interactions with cancer patients following a didactic course, this study exemplifies an approach offering more direct assessment of physician‐patient interactions than has been practical using questionnaire

ISSN:0098-1532    

DOI:10.1002/mpo.2950120110

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractLife‐threatening medical conditions such as severe combined immunodeficiency disease, leukemia, severe aplastic anemia, radiation injury, burns, organ transplantation, and aggressive administration of chemotherapy often necessitate the isolation of the patient in a protected germ‐free environment for weeks or months. This treatment milieu has the effect of extensive psychological and physical isolation from family and staff. A review of the literature was undertaken to investigate the psychological implications of such treatment and to question the possibility that this isolation therapy might produce a unique type of psychological stress. Most authors agree that patients are able to withstand the emotional stress of germ‐free isolation and that behavioral changes relate more to the severity of the illness rather than to the isolation. However, there may be inherent stresses related to isolator therapy that can be alleviated by environmental manipulation. Case vignettes are included and patient management in such an environment is out

ISSN:0098-1532    

DOI:10.1002/mpo.2950120111

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractTransitional cell carcinoma of the nasal passages and sinuses is an uncommon tumor of the head and neck, for which the efficacy of chemotherapy has not been previously reported. A dramatic and complete tumor response to chemotherapy with cis‐platinum, methotrexate, and bleomycin is described in a patient with advanced proptosis due to extensive local recurrence of transitional cell carcinoma. Relevant literature on this rare histologic type of head and neck cancer has been reviewe

ISSN:0098-1532    

DOI:10.1002/mpo.2950120112

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY