James C. H. Simmons

Brain tumors in the very young child: Postoperative chemotherapy in combined-modality treatment

Twelve consecutively diagnosed children with brain tumors, ages 7 to 27 months, were treated by a combined‐modality approach featuring aggressive surgical resection followed by chemotherapy and delayed irradiation. Patients received multiple clinical neurologic examinations and psychological evaluations, as well as diagnostic imaging studies, to monitor the efficacy of chemotherapy and toxic effects of therapy. Six of the eight children with residual tumor evident postoperatively on computed tomography scans had objective responses to chemotherapy. The efficacy of chemotherapy was further demonstrated by the lack of disease progression for 7 months or longer in eight children, seven of whom remain free of tumor 19 to 57 months (median, 28 months) from the date of diagnosis. The neurologic status of ten patients improved during treatment. Developmental progress was normal in two, low average in three, and frankly deficient in four of ten children formally evaluated. These results indicate that postoperative chemotherapy, added to a regimen of surgical resection and delayed irradiation, prolong survival with only minimal short term neurotoxicity in the majority of very young children with malignant brain tumors.

Initial management of athletic injuries to the head and neck

Abstract Over half of the fatal injuries sustained by athletes result from trauma to the head and neck. Any significant reduction in the mortality rate following athletic injuries to the head must begin with the team or family physician. Only through the physicians acute awareness of his responsibility in the detection of the symptoms and signs which suggest impending disaster, and the institution of emergency treatment when indicated, can these fatalities be avoided. In injuries to the cervical spine with damage to the spinal cord or nerve root, the primary responsibility of the team or local physician is the prevention of additional neurologic damage. The precautions regarding movement and transportation of these patients must be rigidly enforced by the physician who institutes the initial management of these injured athletes. The period of time which should elapse following specific injuries prior to resumption of athletic competition and the injuries which constitute definite contraindication to contact sport activity are discussed.

Glioblastoma in Children

Both morphologic and clinical features of 72 consecutive cases of brain tumors, collected over 9 years at Le Bonheur Childrens Medical Center, were reviewed. We identified 11 cases as glioblastoma, representing 16% of all intracranial neoplasm and 26% of glial tumors. The patients ranged in age from 1 to 15 years with the median age of 10 years. There were 4 females and 7 males; 2 blacks and 9 whites. The median survival was 9 months. The tumor was observed in both cerebrum and cerebellum. Sexual predominance was not appreciable, although there was male excess. The tumor was significantly more frequent in whites than blacks (p less than 0.05). Similar racial predominance was noted in the other, more common brain tumors in children such as astrocytoma and medulloblastoma.

1183 MICROBIOLOGIC AND CLINICAL CHARACTERIZATION OF COAGULASE-NBGATIVE STAPHYLOCOCCI FROM CEREBROSPINAL FLUID SHUNTS

Recent studies have suggested that bacterial adherence to smooth surfaces may be important in the pathogenesis of medical device infections with coagulase-negative staphylococci (CNS). We collected and characterized 84 strains of CNS (51 pathogens and 33 contaminants) cultured from cerebrospinal fluid (CSF) shunts of pediatric patients. Species distribution was similar for both pathogens and contaminants except that 20% of the pathogens and none of the contaminants were phospnatase-negative Staphylococcus epidermidis (p<.01). Neither species nor antibiotic susceptibility correlated with clinical outcome. All patients treated with total shunt removal were cured while only 33% of the patients treated with antibiotics alone were cured. As an index of bacterial adherence, we measured the optical density (OD) of stained bacterial films adherent to tissue culture plates. Pathogenic CNS were more adherent than CSF contaminants (mean OD .510 vs .307 p<.05). Furthermore, 5/6 (83%) of infections due to non-adherent organisms were cured with antibiotics alone compared to 17/43 (40%) of infections due to adherent organisms (p<.05). These results suggest that adherence to CSF shunts is important in the pathogenesis of CSF shunt infections.