PURPOSE: Infants with acute lymphoblastic leukemia (ALL) often enter remission; however, they have a high rate of relapse. To prevent relapse, infants' tolerance of and benefits from early intensive rotating drug pairs as part of therapy were studied. METHODS: After prednisone, vincristine, asparaginase, and daunorubicin induction, 12 intensive treatments (ABACABACABAC) were administered in 30 weeks: A, intermediate dose methotrexate (MTX) and intermediate dose mercaptopurine (MP); B, cytosine arabinoside (Ara-C) and daunorubicin (DNR); C, Ara-C and teniposide (VM-26). Triple intrathecal chemotherapy (Ara-C, MTX, and hydrocortisone) was administered for central nervous system prophylaxis. Continuation therapy consisted of weekly MTX and daily MP for a total of 130 weeks of continuous complete remission. RESULTS: Thirty-three infants (1 year old or younger) with newly diagnosed ALL were treated. Two infants did not respond to induction, 1 died from sepsis during continuation, 1 received a bone marrow transplant, and 24 relapsed. Median time to relapse was 39 weeks. The event-free survival rate at 5 years was 17% (standard error +/- 7.7%). The most significant toxicities occurred during intensification and included fever-neutropenia and bacterial sepsis. CONCLUSION: Although early intensive rotating therapy is tolerable, the relapse-free survival rate remains poor for infants treated with the schedule on this protocol.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Kinematics and kinetics of the hip, knee, and ankle of children with clubfoot after posteromedial release.

Clubfoot is a bony deformity characterized by inversion, adduction, and equinus that often require surgical intervention. This study assessed the gait kinetics and kinematics of children with unilateral and those with bilateral clubfoot, comparing them with age-and gender-matched normal (control) children. Patient satisfaction also was examined using a questionnaire, and muscle strength was evaluated at the ankle and knee. In evaluating the kinematics, it was important to note that deviations occurred at the ankle of children with clubfoot. Differences in kinematics and kinetics at the hip and knee between normal children and those with clubfoot resulted from lack of motion at the ankle. Furthermore, the strength of ankle plantarflexors was weak, which reduced plantarflexion during push-off. This restricted motion may have been caused by residual bony deformities and muscle tightness resulting from the original condition that contributed to muscle stiffness during gait.

Adolescent↗

PubMedDate not supplied

Ankle and first metatarsophalangeal joint dorsiflexion in children with clubfoot.

It has been hypothesised that the stiffness of the plantar aponeurosis after clubfoot surgery affects push-off. Because the first metatarsophalangeal (MTP) joint motion relies on the plantar aponeurosis, it was important to determine whether there was a lack of first MTP joint motion in children with clubfoot that also affected push-off. By examining the motion of the first MTP joint using a motion analysis system and passive motion techniques, then correlating these with gait characteristics, the authors found that the first MTP joint was not affected in children with clubfoot. The authors found that a motion analysis system could be used to determine range of motion accurately.

Analysis of Variance↗