Long-term leukemia survivors (46) underwent cardiac evaluation, including physical examination, ECG, exercise testing, and echocardiography. They were 2-17 years old at diagnosis and 5-23 years old after treatment. Thirty-four survivors received anthracyclines (AC) (mean 203 mg/m2), 12 of them had also alkylating agents (AA) and 12 had no AC. Exercise tolerance was bellow predicted values in 21 (48%) survivors and 21 survivors had ECG abnormalities, which were more frequent in those treated with AC. Concomitant AC with AA was correlated with prolonged isovolumic relaxation time (IVRT) and influenced significantly the volume of left atrium (p = .02). Sixteen (52%) survivors had IVRT > or = 90 ms. There were no significant differences in other parameters of diastolic or systolic function. Despite the lack of clinical symptoms in the survivors treated with lower doses of AC, subtile abnormalities in myocardial function were found, mainly manifest as abnormal diastolic function. Prolonged IVRT may be a sensitive indicator for early detection of AC cardiotoxicity.

Adolescent↗

PubMedDate not supplied

Hepatoblastoma in fine needle aspirates.

OBJECTIVE: To analyze cytomorphologic characteristics of hepatoblastoma (HB) and evaluate the feasibility of recognizing its histologic subtypes in smears. STUDY DESIGN: Fine needle aspirates from 14 primary and 1 metastatic HB were reexamined. The diagnosis of HB was confirmed by tissue examination (10 cases) and by clinical and laboratory findings alone (5 cases). RESULTS: In 12 samples, neoplastic cells resembled immature hepatocytes but were smaller and had a higher nuclear/cytoplasmic ratio. In nine of these smears the cells were rather uniform, while the other three presented with moderate pleomorphism. The cells were arranged in three-dimensional clusters, loose sheets, cords, rosettelike structures and occasional pseudopapillae and were dispersed. CONCLUSION: With knowledge of the cellular features and architectural patterns of HB, a reliable diagnosis could be obtained in 12/15 cases without the use of special techniques. In the remaining three aspirates the tumor cell population partly or entirely differed from normal hepatocytes, requiring ancillary techniques for proper diagnosis. On reexamination of the 10 cases with tissue diagnoses, 4/6 mixed HBs could be correctly subtyped, whereas the distinction between embryonal and fetal cells in four cases of epithelial HB seemed questionable.

Biopsy, Needle↗

PubMedDate not supplied

Half-body irradiation in the treatment of multiple myeloma: a report of nine cases.

We report the results of treatment of 9 patients with advanced multiple myeloma (MM) using half-body irradiation. Six nonresponders to chemotherapy received it as consolidation therapy after the plateau phase of MM had been observed, and 4 patients received it as salvage therapy of refractory or relapsing MM. One of the patients received it twice, first as consolidation and later during the course of her disease also as salvage therapy. Objective response was obtained in 1 of 6 patients who received half-body irradiation as consolidation therapy and in 3 of 4 patients who received it as salvage therapy. Responders to half-body irradiation generally achieved a longer relapse-free interval. Treatment with half-body irradiation was especially effective in combination with human leukocyte interferon as salvage therapy in 2 of the patients with refractory MM, leading to a relapse-free interval of more than 27 months in one of them. Symptomatic relief was observed in 5 of 6 patients. All had transient post-irradiation pancytopenia, with pneumonitis, nausea and vomiting observed in those who had the upper half of the body irradiated first. It is thus our opinion that halfbody irradiation should not be used as consolidation therapy in nonresponders to chemotherapy, because it causes undue toxicity to heavily pretreated patients. Its role in the treatment of refractory or relapsing MM in combination with human leukocyte interferon should be fully evaluated.

Adult↗

PubMedDate not supplied

Endodermal sinus tumor of the pineal region: case report.

A 13-year-old boy presented with symptoms and signs of a posterior 3rd ventricle tumor associated with raised levels of serum and cerebrospinal alpha-fetoprotein. The patient underwent subtotal resection of the tumor followed by craniospinal radiation. Histopathological examination revealed a pure endodermal sinus tumor. Endodermal sinus tumors represent a rare type of germ cell tumor, only 13 intracranial cases having been reported in the literature.

Adolescent↗

PubMedDate not supplied

Two unusual recurrences of intracranial germinoma.

Two recurrent cases of intracranial suprasellar germinoma, with relapses at 55 and 16 months, respectively, after the end of primary therapy strongly effective against pure germinoma, are presented. Human chorionic gonadotropin beta subunit was elevated in the cerebrospinal fluid and in the serum in both patients at the time of recurrence but not before. This and resulting treatment failures suggest that there were also other, more resistant elements within the primary tumor, which have not been identified in biopsy specimens. The problem of adequate diagnosis and its impact on patients' survival are discussed.

Antineoplastic Agents↗

PubMedDate not supplied

Pediatric oncology in Slovenia.

Slovenia, a new country and formerly a part of Yugoslavia, has had its Childrens Hospital in Ljubljana since 1865. This became a part of the University Hospital in 1945, and in the early 1960s the Department of Pediatric Hematology-Oncology was established. The Oncological Institute of Slovenia was established in 1938 and has developed into a modern facility for comprehensive cancer care, research, and teaching. In close cooperation, established in the 1960s, a team from these two institutions takes care of the approximately 60 children per year who develop cancer in Slovenia. Consisting of pediatricians, radiation oncologists, pathologists, cytologists, surgeons, and other ad hoc specialists, the team meets at least twice weekly to plan treatment, follow the patients, discuss the results, and teach. All patients are subject to regular follow-up indefinitely. A separate team has been formed to study the late effects of cancer treatment on survivors, who by now are mostly adults.

Academies and Institutes↗

PubMedDate not supplied

Leukemic hypopyon.

A seven-year-old girl was successfully treated for acute lymphoblastic leukemia. Despite clinical remission she developed a monocular hypopyon which was treated successfully with topical and subtenons steroids. When the hypopyon reappeared, a diagnostic paracentesis revealed leukemic cells and a normal aqueous lactate dehydrogenase. Leukemic ocular infiltration may clinically mimic both neoplastic and inflammatory ocular conditions. The combination of paracentesis and lactate dehydrogenase assay greatly aid in the correct diagnosis.

Anterior Chamber↗

PubMedDate not supplied

Leukemic ophthalmopathy detected by ultrasound.

Contact A- and B- scan ultrasonography was performed on 40 patients with acute lymphocytic leukemia at initial diagnosis, during therapy, during remission, and in patients with recurrences. This technique simply and consistently reveals tumor in the choroid, despite the fact that leukemic involvement may cause only 1-2 mm of choroidal thickening. Leukemic involvement may be diffuse or localized, detected with or without visual symptoms, and can be monitored repeatedly. Leukemic involvement of the choroid is difficult to see ophthalmoscopically, but easy to detect with contact ultrasound.

Choroid Neoplasms↗

PubMedDate not supplied

Intrapleural application of natural IFN alpha in breast cancer patients with pleural carcinomatosis. Monitoring of immunotherapy by assaying serum interferon levels.

For resistant local recurrence, e.g. in breast cancer, or metastatic spread, local infiltration of IFN may be an interesting new approach. The aim of this study was to find out if intrapleurally administered interferon, in breast cancer patients with pleural carcinomatosis, can cause measurable serum concentrations and how soon after administration. Serum IFN concentrations were compared with those in the pleural fluid, and correlated with the presence of malignant cells in the pleural fluid. To uncover possible rhythmicity of serum interferon levels and its relationship to the timing of therapy, natural leukocyte interferon was administered intrapleurally at 10 a.m. Data on pharmacokinetics were obtained from blood samples drawn at -2, 0, 2, 8, 14, 22 and 46 h during the course of treatment. In contrast to our previous observations in healthy volunteers, levels of serum IFN before therapy had no circadian rhythmicity. Daily pharmacokinetic profile of individual patients on interferon therapy has shown that serum IFN peaks 8 h after intrapleurally administered IFN alpha. The peak depended on frequency and number of applied doses. During treatment with IFN alpha, malignant cells degenerated and finally disappeared from pleural fluid. At the same time reactive cells appeared. This effect is rather uniformly observed, but varies in degree. The number of patients is too small, however, to permit conclusions in regard to correlation of this clinical effect and the levels of serum IFN alpha.

Adult↗