Gussie R. Higgins

Absence of neurotoxicity following massive intrathecal administration of methotrexate. Case report

A 4‐year‐old girl inadvertently received ten times the usual dose of methotrexate intrathecally. When the error was discovered, the patient was asymptomatic. Folinic acid was begun intramuscularly and continued until 48 hours after the accident. The absence of neurotoxicity is attributed to an insufficient concentration of methotrexate molecules in the spinal fluid and the lack of systemic toxicity to the administration of folinic acid. This case suggests that a higher dose of methotrexate may be given intrathecally without neurotoxicity and that systemic toxicity can be prevented by the administration of folinic acid.

Use of hypnosis for multiple symptoms in an adolescent girl with leukemia

An adolescent girl with chronic myelogenous leukemia was treated with hypnosis for several disease- and treatment-related problems during the last 4 months of her life. Data were collected before and after hypnosis on the nature and intensity of the patients acute pain and anxiety during bone marrow aspirations, chronic headache and backache, nausea and vomiting during chemotherapy, anorexia, and the discomfort associated with spiking temperatures. Comparisons of baseline and posthypnosis reports suggest that hypnosis was successfully used for acute and chronic pain, anxiety, unpleasant body sensations and, possibly, nausea and vomiting. The hypnotic techniques used, the limitations of hypnosis and clinical issues in this case are presented and discussed.

Acute Leukemia during the First Year of Life Presentation, Chemotherapy and Clinical Course

Acute leukemia in 32 infants diagnosed under one year of age was characterized by a higher than usual initial leukocyte count, a high incidence of skin infiltration and a variety of roentgenographic ab normalities. Sepsis and hemorrhage were the common causes of death. The prognosis for survival of children with acute leukemia under the age of one should improve with multiple drug therapy.

Vincristine, dactinomycin, and cyclophosphamide (VAC) chemotherapy for recurrent metastatic Wilms tumor in previously treated children

WILMS TUMOR CONSTITUTES the second most common solid tumor in the pediatric age group; about 450 cases of this malignancy are diagnosed annually in the United States. 1 The use of multimodal therapy in the management of Wilms tumor has become increasingly successful. Although survival for Wilms tumor is estimated to be in excess of 70%, ~ a the prognosis remains poor for patients who develop bilateral pulmonary or liver metastasis after initial therapy2- Most newly diagnosed children with Wilms tumor are presently treated according to the National Wilms Tumor Study. However, subsequent treatment of patients who fail on the national study protocol has not been uniform, and little information is available on the therapeutic response of patients with Wilms tumor who develop metastases. We are reporting the results obtained using vincristine, dactinomycin, and cyclophosphamide (VAC chemotherapy) in a group of previously treated patients with recurrent metastatic Wilms tumor at Childrens Hospital of Los Angeles. MATERIAL AND METHODS The characteristics of the ten patients treated with VAC chemotherapy are given in the Table. The median age at the time of diagnosis for this group of patients was 4 years, with seven patients older than 2 years. Histopathology of the tumor was reported as favorable in nine patients; one patient had the sarcomatous variant by the criteria of Beckwith and Palmer? Further classification of the favorable histology group demonstrated the tumor to be well differentiated in three patients, with tubular and/or glomeruloid structures easily recognized; three were clas

Functional Cellular Maturation in Cultures of Human Haematopoietic Cells

Summary. The capacity of cells grown in colonies derived from human haematopoietic cells to phagocytize bacteria and to reduce nitroblue tetrazolium (NBT) was studied as a measurement of functional maturation. Marrow cells from 12 non‐leukaemic patients, fivc patients with acute non‐lymphocytic leukacmia, and cells taken from a myeloblastic cell line established from a patient with acute myelo‐genous leukaemia (AML) were studied. Cells were cultured in soft agar with normal human leucocyte feeder layers as the source of stimulating factor. While the leukaemic marrows gave rise to fewer colonies than the non‐leukaemic marrows, colony formation by the AML cell line was extensive. In all instances colony formation was completely dependent upon the presence of the leucocyte feeder layers. Suspensions of pooled colonies contained 42% mature granulocytes in non‐leukaemic cultures and 41% in the leukaemic cultures. Granulocytes from these cultures showed active phagocytosis of Staphylococcus aureus and reduction of NBT. In cells taken directly from the liquid suspension culture of the AML cell line, no mature granulocytes nor phagocytosis were noted, whereas 35% and 26% of the cells removed from the colonies formed by these cells were classified as mature granulocytes, or demonstrated phagocytosis and NBT reduction respectively. These observations indicate that granulocytes in soft agar colonies derived from human haematopoietic cells are functionally mature, and that cells derivcd from a human AML cell line have the capacity to form colonies with normal maturation, if they are provided with an appropriate stimulating factor.

641 At AIRWAY OBSTRUCTION AND SUPERIOR VENA CAVA SYNDROME 041 SECONDARY TO NON-HODGKINS AND HODGKINS LYMPHOMA

Mediastinal compression causing airway obstruction (AWO) and superior vena cava (SVC) syndrome may be a presenting manifestation of childhood lymphoma. From 1967 through December 1977, 75 children with Non-Hodgkins Lymphoma (NHL) and 49 with Hodgkins Lymphoma (HL) were seen at our institution. Eighteen patients with NHL had primary mediastinal involvement, and of these 8 presented with moderate to severe AWO and/or signs of SVC syndrome. In 6 of these patients diagnosis was established in 3 by thoracotomy, 2 by cervical lymph node biopsy and 1 by thoracentesis. Two patients presented with severe AWO requiring corticosteroids for 2 days prior to the diagnostic surgical procedure. In 7 patients signs of AWO and/or SVC syndrome improved rapidly following initiation of corticosteroid and cyclophosphamide. Of the 49 patients with HL, 13 presented with mediastinal disease and of these only 4 had evidence of mediastinal compression, none severe. These 4 had diagnostic biopsy and staging laparotomy prior to treatment. In summary, severe AWO and/or SVC syndrome was more likely to occur in patients with NHL with mediastinal primary. General anesthesia may be hazardous in some patients, requiring a short course of corticosteroid therapy to alleviate the mediastinal compression prior to the diagnostic operative procedure.