Masako Tanimura

Spontaneous regression of localized neuroblastoma detected by mass screening.

PURPOSE To clarify whether and when neuroblastomas identified through screening do regress, and to ascertain how to treat them appropriately, we observed screened patients who had localized tumors, without any therapeutic intervention. PATIENTS AND METHODS The criteria for the observation program were as follows: disease stage I or II; tumor less than 5 cm in diameter; no invasion to the intraspinal canal or growth to the great vessels; urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) less than 50 microg/mg creatinine; and informed consent. Of 25 patients identified through screening for 6-month-old infants in Saitama Prefecture, Japan between April 1994 and March 1996, 11 patients who met the criteria and one other patient with stage III tumor were enrolled onto the program. They were examined by abdominal ultrasonography (US) and their urinary VMA and HVA levels were assessed approximately once per month. The observation periods ranged from 4 to 27 months. RESULTS The 11 tumors decreased in size, although one of these 11 tumors initially enlarged until the patient was 12 months of age and decreased in size thereafter. One other tumor slightly increased in size. Urinary VMA levels decreased in all patients. None of the tumors had completely disappeared by the last observation day. CONCLUSION Our results suggest that regression of screened neuroblastoma is not a rare phenomenon. At present, it seems reasonable to adopt a wait-and-see strategy, with careful observation, for selected stage I or II tumors identified in infants screened at 6 months of age.

Mass screening and age-specific incidence of neuroblastoma in Saitama Prefecture, Japan.

PURPOSE To provide the population-based incidence rate of neuroblastoma and to determine the effect of mass screening on the annual age-specific incidence of the tumor in Saitama Prefecture, Japan, from 1981 to 1992. METHODS Data on screened infants and patients detected by the screening were obtained from the records of the Prefectural Screening Center. Data on neuroblastomas in this area were obtained from the Childrens Cancer Registry of the Saitama Prefectural Government (Prefectural Registry) and from the Japan Childrens Cancer Registry (National Registry). Population data were obtained from the Prefectural Census. Mass screening for 6-month-old infants was performed by qualitative assessment of urinary vanillylmandelic acid (VMA) from June 1981 to September 1989 and by quantitative measurement of VMA/creatinine (Cre) and homovanillic acid (HVA)/Cre from October 1989 to December 1992. RESULTS Between 1981 and 1992, 199 cases of neuroblastoma, which include 74 cases detected by mass screening, were identified in Saitama Prefecture. The incidence rate for children under 15 years of age increased from 6.4/10(6) to 20.1/10(6), that for children 0 to 4 years of age increased from 17.0/10(6) to 64.1/10(6), and that for infants under 1 year of age increased from 27.9/10(6) to 260.4/10(6) during these 12 years. No significant reduction in the incidence rate was observed for children over 1 year of age. CONCLUSION The incidence rate for children under 15 years of age increased with mass screening. The rate for infants was sharply increased, with no corresponding decrease in the rate for children at older ages. These data suggest that there is a subset of neuroblastoma that can be detected by mass screening at 6 months of age but would not be diagnosed later clinically.

Marginal Decrease in Mortality and Marked Increase in Incidence as a Result of Neuroblastoma Screening at 6 Months of Age: Cohort Study in Seven Prefectures in Japan

PURPOSE To determine the usefulness of 6-month screening for neuroblastoma. PATIENTS AND METHODS The cumulative incidence rates (IRs) and cumulative mortality rates (MRs) of neuroblastoma in children younger than 60 months of age were analyzed for control (n = 713,025), qualitative screening (Qual Screen, n = 1,142,519), and quantitative screening (Quan Screen, n = 550,331) cohorts, and for Screened and Unscreened subgroups within screening cohorts. RESULTS IRs (per 100,000) for infants aged 6 to 11 months were 1.12 in Control, 5.69 in Qual Screen (P <.0001), and 17.81 in Quan Screen (P <.0001); IRs for children aged 12 to 59 months were 7.29 in Control, 5.86 in Qual Screen (P =.28), and 6.36 in Quan Screen (P =.60). IRs for children aged 12 to 59 months in Unscreened or Screened subgroups remained at the same level. When patients diagnosed at younger than 6 months of age were excluded, the MR (per 100,000) under 60 months for Control was 4.21; those in Unscreened and Screened subgroups were 3.84 and 2.53 in Qual Screen (P =.30), and 3.20 and 1.97 in Quan Screen (P =.73), respectively; MRs between Control and Unscreened subgroups revealed no significant differences (P =.89 in Qual Screen, P =.85 in Quan Screen). CONCLUSION Six-month screening resulted in a marked increase in incidence for infants with no significant decrease in incidence for children older than 1 year of age. A decrease in mortality was observed, but it was not significant. The usefulness of screening is questionable, because the decrease of mortality should be balanced against the adverse effect of overdiagnosis and the psychological burden on parents and children.

Case‐control study of perinatal factors and hepatoblastoma in children with an extremely low birthweight

Abstract Background: There is a significant association between hepatoblastoma and low birthweight. A case‐control study was conducted to reveal risk factors for hepatoblastoma in children of extremely low birthweight (<1000 g).

Child abuse of one of a pair of twins in Japan

A nationwide survey in Japan on child abuse and neglect revealed that 10% of the victims were products of multiple births. None of the victims who were singletons had multiple-birth siblings, and only in a few cases were both twins abused. The findings indicated that one rather than both of a pair of twins was likely to be abused in Japan. Abuse of both twins was likely when there were serious parental or family problems, whereas abuse of one twin was associated with the childs medical problems or non-home care. There was no instance of abuse of a pair of twins when both were handicapped. Comparisons of the abused twin with the non-abused co-twin and examination of the abusers attitude to the victim suggested that the difference between twins in their development or in their response to parents increased the stress of child-rearing and encouraged favouritism, which resulted in abuse of only one twin. Comparison by parents of children with their siblings may be a common factor in general child abuse because it is a natural thing for parents to do.

Analysis of child abuse cases admitted in pediatric service in Japan I. Two types of abusive process in low birth‐weight infants

A very high rate (43.0%) of low birth‐weight (LBW) was shown in 331 abused/neglected cases reported from pediatric clinics of major hospitals in Japan.

Analysis of child abuse cases admitted in pediatric service in Japan II. Backgrounds of child abuse in non‐low birth‐weight infants

Child abuse of 126 non‐low birth‐weight (non‐LBW) cases reported front pediatric clinics of major hospitals in Japan in 1986 were examined. Compared to LBW infants abused childrens medical problems were few (25.4%) but the presence of step‐parents and a history of rearing outside the home were evident (41.3%).

Preliminary report : suspicion of hearing-loss at age 0-1 years by TV viewing attitude

To determine any difference of TV viewing attitude between normal and hearing-loss children, 14 normal and 8 sensory impaired infants/toddlers were observed separately in a playroom with a TV set showing a 12-min videotape. All children enjoyed TV and showed clear differences in TV viewing behavior between hearing-loss and auditory normal children. At the beginning of their favorite programs or changes in programs, normal infants/toddlers were quickly aware of the TV sound and turned toward the TV set, where as hearing-loss children remained unaware. Our observation proved the intact hearing of two clients who had not responded to regular infant auditory tests. Moreover, we surveyed 65 hearing-loss children. Only 21% of them began to watch TV at 0 year of age, 50% at 1 year. They did it apparently later than normal infants who began to watch TV mostly before 1 year of age in the Japanese general population. From fitting with a hearing aid, however, most of them began to enjoy TV, watch it longer, have their favorite programs (music, songs, etc.) and turn to face the TV whenever a favorite program began. This suggests hearing acuity is important to enjoy TV. Since TV is already familiar and attractive to most any children, it is a useful and sensitive tool for early detection of hearing-loss children at 6-18 months of age.