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Biomedical subjects

J R Farwell

Publications and source records attributed to J R Farwell.

At least 19 recordsLinked to original sources
PubMed1990

Phenobarbital for febrile seizures--effects on intelligence and on seizure recurrence.

Phenobarbital is widely used in the treatment of children with febrile seizures, although there is concern about possible behavioral and cognitive side effects. In 217 children between 8 and 36 months of age who had had at least one febrile seizure and were at heightened risk of further seizures, we compared the intelligence quotients (IQs) of a group randomly assigned to daily doses of phenobarbital (4 to 5 mg per kilogram of body weight per day) with the IQs of a group randomly assigned to placebo. After two years, the mean IQ was 7.03 [corrected] points lower in the group assigned to phenobarbital than in the placebo group (95 percent confidence interval, -11.52 to -2.5, P = 0.0068 [corrected]). Six months later, after the medication had been tapered and discontinued, the mean IQ was 5.2 points lower in the group assigned to phenobarbital (95 percent confidence interval, -10.5 to 0.04, P = 0.052). The proportion of children remaining free of subsequent seizures did not differ significantly between the treatment groups. We conclude that phenobarbital depresses cognitive performance in children treated for febrile seizures and that this disadvantage, which may outlast the administration of the drug by several months, is not offset by the benefit of seizure prevention.

Child, Preschool↗
PubMed1990

Risk of febrile seizures in childhood in relation to prenatal maternal cigarette smoking and alcohol intake.

The case-control study of febrile seizures in childhood described here, comprising 472 case-control pairs in western Washington, was designed to investigate the importance of prenatal exposures as risk factors for febrile seizures and to determine the degree to which two clinical subtypes of febrile seizures (simple and complex) have different risk factors. Maternal cigarette smoking and alcohol intake during pregnancy were associated with the risk of a febrile seizure in the child. Prenatal maternal cigarette smoking was associated with a twofold increase in the risk of a simple febrile seizure (95% confidence interval 1.2-3.4), and a strong dose-response relation was found. This association could not be explained by maternal demographic variables, maternal alcohol intake, child's birth weight, or childhood medical history variables. Prenatal maternal alcohol intake was associated with a twofold increase in the risk of a complex febrile seizure (95% confidence interval 1.3-3.8), and a strong dose-response relation was present. This association could not be explained by maternal age, race, education, or cigarette smoking. These results suggest that curtailment of smoking and alcohol consumption during pregnancy, a measure already widely prescribed during pregnancy, may also be an effective means of preventing childhood febrile seizures.

Alcohol Drinking↗
PubMed1989

Pinealomas and germinomas in children.

A series of 34 pinealomas and intracranial germinomas in childhood (age less than 20), from two tumor registries, is analyzed. Male to female ratio was 2:1. Median age was 12 years. Visual complaints and endocrine disturbances were the most common presenting symptoms. Papilledema, visual field deficits, and oculomotor abnormalities were the principal findings at diagnosis. Cumulative probability of survival (CPS) of the entire series at one year was 0.65, at two years 0.54, and at five years 0.54. Best survival was with treatment by operation and radiation: CPS at one year was 0.82, at two years 0.82, and at five years still 0.82. Survival was similar with pineal region tumors and with suprasellar tumors. Most long-term survivors, particularly with suprasellar germinomas, had permanent hormonal deficits requiring replacement therapy.

Adolescent↗
PubMed1987

Adult occurrence of medulloblastoma.

We analyze a series of 44 medulloblastomas in patients aged 20 and older, listed in the Connecticut Tumor Registry. Average age was 34.1 years. Incidence was 0.058 per 100,000 per year. Headache and ataxia were the most frequent presenting complaints. Findings at diagnosis most often were papilloedema, cranial nerve palsies, and cerebellar dysfunction. Treatments included operation (15%), radiation (7%), and operation plus radiation (60%). Probability of survival at one year was 0.62; at five years, 0.26. Survival with operation and radiation was superior to survival with other courses of treatment. Extracranial metastases to the spinal cord, the bones, and the pleura occurred in 27% of cases. For the first two years from diagnosis, survival in this series was significantly better than survival in the contemporary series of children with medulloblastoma. At five years and ten years, survival in adults and children was comparable.

Adult↗
PubMed1985

Astrocytomas in childhood: a population-based study.

A population-based study of astrocytomas occurring in children is reported. A population-based study eliminates referral bias and the bias of a series based on the experience of a given medical center or a particular surgeon. In a 42-year period, 179 such cases were diagnosed. The average age at diagnosis was 8.9 years. Over one-half of the astrocytic tumors were located in the cerebellum. A peak in the number of astrocytomas was noted between 1965 and 1970. Cumulative probability of survival of children with intracranial astrocytomas at 6 months and at 1, 2, and 5 years was 0.824, 0.752, 0.732, and 0.667; by 10 years and 20 years the cumulative probability of survival had fallen to 0.607 and 0.538. The shortest survival was observed with brainstem tumors, with an average survival of 19 months. Longer survivals were noted with tumors of the cerebral hemispheres: 0.779, 0.748, 0.678 and 0.628 at 1, 2, 5, and 10 years, respectively. The longest survivals were in those children with cerebellar astrocytomas: at 1 year they had an 0.837 probability of survival and at 20 years, 0.675.

Adolescent↗
PubMed1978

Intracranial neoplasms in infants.

Fifty-four primary intracranial neoplasms occurred in infants (18 months of age or younger) in Connecticut during a 40-year period, 1935 to 1974. Thirty percent were medulloblastomas and 16% were ependymal neoplasms. An equal number of males and females were affected. Forty percent were located in the cerebellum, 37% in the cerebral hemispheres, and 17% in the brain stem. The most common symptom was vomiting. Abnormally large head circumference was the most common physical finding. Average survival was 43 months. Survival relative to histopathologic type and location of the neoplasm is discussed. Eighteen patients survived longer than one year and the level of neurological function of these longer survivors is presented.

Astrocytoma↗
PubMed1978

Oligodendrogliomas in children.

Oligodendrogliomas are quite uncommon in children. In a 41-year period (1935 to 1975) in Connecticut, 12 histologically verified cases of oligodendrogliomas were noted in persons less than 20 years of age, constituting between 1% and 2% of all primary intracranial neoplasms in Connecticut children. Eleven of the neoplasms occurred in the cerebral hemispheres; these cases of cerebral oligodendrogliomas were reviewed and analyzed.

Adolescent↗
PubMed1977

A method for characterizing subgroups and related survivals in cancer patients. Application to brain tumors.

It has long been known that if the probability of dying of a given cancer remains constant over time, the logarithmic plot of survival of a group of patients with that cancer will be a straight line. More frequently, however, the probability of dying varies with time and the logarithmic survival plot is a curve. We believe that in some cases a population of patients with one type of neoplasm may be composed of several subgroups, each of which has a simple predictable course with a rectilinear survival plot. This article describes a method for partitioning such survival plots and identifying and characterizing the subgroups and applies the method to a group of patients with brain tumors. The value of being able to identify these subgroups and their relative proportions, the observations that can be made with this analysis regarding the nature of the various subgroups of brain tumors, and the implications of changes in the half-lives as well as the proportions of the subgroups with time are discussed.

Astrocytoma↗
PubMed1977

Central nervous system tumors in children.

Of 488 central nervous system neoplasms occurring in children over a 39-year period, 467 were intracranial and 21 were intraspinal. The most common intracranial neoplasms were astrocytoma (28%), medulloblastoma (25%), ependymal neoplasm (9%), craniopharyngioma (9%), and glioblastoma multiforme (9%). The median age at diagnosis was 6 years with a male-to-female ratio of 1.3:1. Overall mean survival was 53.4 months and varied greatly relative to the type of tumor and the location. Of the intraspinal neoplasms the most frequently noted were the astrocytoma (47%) and the ependymal neoplasma (24%). The median age at diagnosis was 10 years with a male-to-female ratio of 1:1. The average survival from diagnosis (54.1 months) was comparable to that of intracranial neoplasms. Detailed analyses of each histological type of tumor relative to age at diagnosis, sex, anatomical location and survival from diagnosis are reported for both intracranial and intraspinal neoplasms.

Adolescent↗
PubMed1977

Intraspinal neoplasms in children.

Twenty-nine primary intraspinal neoplasms in children observed between 1936 and 1975 in Connecticut are reviewed. Most of them were gliomas: 45 per cent astrocytoma, 24 per cent ependymal neoplasm, 10 per cent glioblastoma multiforme and 7 per cent glioma. Symptoms, physical findings and therapy are reviewed.

Age Factors↗
PubMed1976

Glioblastoma multiforme in children.

Of 488 children with central nervous system neoplasms, 43 (8.8%) had glioblastomas, 22 of which were in the cerebral hemispheres, 16 in the brain stem, two in the cerebellum, and three in the spinal cord. The male to female ratio was 3:2. Glioblastoma multiforme of the cerebral hemispheres occurred at a mean age of 12.7 years, and the frontal lobe was the most commonly involved. Main presenting symptoms included headache (85%), nausea or vomiting (65%), and seizures (35%). Papilledema (45%) was the most common physical finding. The longest survivals were achieved by a combination of operation and radiation (22 months). Brain stem glioblastomas occurred at a mean age of 6.7 years, with the pons as the most frequent site. Nausea or vomiting (50%) and headache (36%) were the main presenting symptoms; the major physical findings were ataxia (43%), cranial nerve palsies (28%), and paresis (28%). The length of survival was greatest with radiation alone (10.5 months). The period of survival of children with glioblastoma multiforme was significantly increased with steroid therapy. Glioblastoma multiforme behaves similarly in children and adults. Intracranial glioblastomas have a more rapidly fatal course than that of other similarly situated gliomas in childhood.

Adolescent↗
PubMed1976

Ependymomas and ependymoblastomas in children.

The authors analyze histologically verified cases of ependymoma and ependymoblastoma (malignant ependymoma) occurring in children in Connecticut from 1935 to 1973. Of the 488 central nervous system tumors diagnosed in that period, 44 (9%) of the 467 intracranial neoplasms and five (24%) of the 21 intraspinal tumors were of ependymal origin. An increase in the incidence of ependymomas was noted since the mid-1950's. The mean ages at diagnosis of ependymomas and ependymoblastomas were 5.6 and 5.0 years respectively. The male to female ratio was 0.6:1 for ependymomas and 1.7:1 for ependymoblastomas. Epencymomas were found above and below the tentorium with similar frequency; however, viturally all of the epencymoblastomas occurred supratentorially. Presenting symptoms and physical findings were reviewed. A significant difference (p less than 0.05) was noted in the seizure rates of supratentorial ependymomas (9%) and ependymoblastomas (38%). A significantly increased survival (p less than 0.05) was associated with supratentorial ependymal neoplasms relative to infratentorial from 42 months following diagnosis onward. Contrary tp the reports of no clinical difference between ependymomas and ependymoblastomas, children with supratentorial ependymomas were noted to have a significantly longer survival (p less than 0.05) than those with similarly situated ependymoblastomas, with the difference noted from 18 months following diagnosis onward. The children treated by operation and irradiation had a significantly greater survival (p less than 0.05) than those treated by other methods; furthermore, with this treatment, longer survivals were noted in the ependymoma patients as compared to those with epencymoblastomas. This difference became significant (p less than 0.05) at 27 months after diagnosis. Operative mortality decreased from 40% to 17% in the last decade of the study as compared to the previous decade. Steroid therapy may have contributed to this decreased operative mortality, but it had no statistically significant effect on length of survival. The clinical course of intracranial ependymal neoplasms in adults and children was compared and appeared to be essentially the same.

Adolescent↗
PubMed1976

Intracranial neoplasms in children: a comparison of North America, Europe, Africa, and Asia.

Series of intracranial neoplasms in childrem from four continents (North America, Europe, Africa, and Asia) are presented and their histopathological distributions are compared. Findings include a proportion of craniopharyngiomas in Japan and Africa about double that of other areas, with a relative deficit of medulloblastomas. Pinealomas also occurred approximately three times as often in Japan and Africa as elsewhere. A incidence of ependymomas in India double that of other parts of the world was noted. Astrocytomas were the most frequently occurring neoplasms in all series except the Japanese. Possible interpretations of the differences among the series, as well as proposals for further investigation, are discussed.

Africa↗