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S Leikin

Publications and source records attributed to S Leikin.

At least 37 records · Page 2Linked to original sources
PubMed1993

The role of adolescents in decisions concerning their cancer therapy.

Because adolescents are codified as incompetents, their health care decision-making authority often is encroached upon. When a teenager develops a serious disease such as cancer, others are even more likely to appropriate decision-making authority than under normal circumstances. Adolescents can contribute to decisions concerning their treatment provided certain guidelines are used. These guidelines stem from bioethical concerns and our understanding of the development in cognitive ability related to decision-making. This article summarizes considerations relating to each of these two areas. Because the clinical stage of the malignancy also affects bioethical concerns, the adolescent's role in decision-making at the time of initial diagnosis and recurrence are discussed.

Adolescent↗
PubMed1993

Hydration forces.

Explore the source record for details and available documents.

Aluminum Silicates↗
PubMed1991

Lymphomatous presentation of childhood acute lymphoblastic leukemia. A subgroup at high risk of early treatment failure.

Multivariate analyses of the clinical course of 1537 children with acute lymphoblastic leukemia (ALL) identified a subgroup which experienced short remission duration and a high incidence of extramedullary relapse. The patients differed from other ALL patients by the presence at diagnosis of two or more of a constellation of clinical and laboratory features: organomegaly or mass disease, E-rosette positivity, hemoglobin level greater than 10 g/dl, leukocyte count greater than 50,000/microliters, male predominance, and older age. This type of presentation of ALL is referred to as the "lymphoma syndrome" (LS) since such patients exhibit a pattern of several clinical and laboratory features which were observed repeatedly but in differing combinations, and some of which clinically resemble lymphoma. A subsequent database from 2231 patients was analyzed. Patients with a mediastinal mass, massive splenomegaly, or massive adenopathy, alone or in combination, had a worse outcome when the patient also had either leukocytosis, E-rosette-positive lymphoblasts, or a normal or near normal hemoglobin (Hb) level at diagnosis. Similarly, the above three laboratory features alone or in combination did not predict less than 40% disease-free survival (DFS) unless they were accompanied by at least one of the clinical features of mass disease. When at least one clinical feature and at least one laboratory feature were present, the overall DFS was 36% 6 years after diagnosis versus 64% for all other patients. The association of these features with poor prognosis remained significant after adjusting for the level of leukocyte count at diagnosis, age at diagnosis, and sex of the patients. Patients with this recurrent syndrome of features do not represent a homogeneous biologic entity but they constitute a subgroup of patients with ALL having a high risk of treatment failure using current therapies, including failure to achieve remission, early relapse, and increased frequency of relapse in extramedullary sites. They deserve early recognition at diagnosis and selection of treatment strategies appropriate for very high risk ALL.

Adolescent↗
PubMed1989

When parents demand treatment.

In striving to provide quality medical care to the child and in serving as an educator and counselor to the family, the pediatrician can pursue several different decision making paths. The chosen path will depend on the pediatrician's medical knowledge and skill, but will also be influenced significantly by views of moral responsibility in medicine and attention to the emotional and social factors in the physician-patient encounter.

Ethics, Medical↗
PubMed1987

Children's Hospital ethics committees. A first estimate.

Special committees are being formed in hospitals to help deal with ethical problems presented by seriously ill infants and children. The functions of these multidisciplinary groups are to recommend policy and educate staff members about ethical matters and provide ethical consultation to parties involved in the care of these patients. This article provides a historical background of the formation of these committees and describes the development, constitution, and practices of the recently formed ethics committee of the Children's Hospital National Medical Center, Washington, DC. Ethical decision-making for the sick incompetent child requires determining his or her best interest. The committee's problems related to this determination and other questions are discussed to inform those working in pediatric health care and to help guide them in their future efforts in ethical decision making for minors.

Child↗
PubMed1985

Significance of X granules in histiocytosis X: an ultrastructural study.

Histiocytosis X is characterized by the presence of cytoplasmic rod structures called Langerhans' cell granules or X granules (XG). It has been speculated that histiocytosis X is a Langerhans' cell disorder. This ultrastructural study was performed to quantitate the number of XG containing histiocytes in the histiocytosis X lesions. Twenty-four specimens from 22 patients with histiocytosis X were studied: 4 from skin, 5 from lymph node, 11 from bone, 2 from lung, 1 from gingiva, and 1 from cheek. The majority of the histiocytes in histiocytosis X lesions do not contain X granules. The majority of the histiocytes in histiocytosis X lesions do not contain X granules. The percentage of histiocytes with XG in a lesion has no relation to the age of the patient or the organ from which it was obtained, except for skin, where they were quite numerous. The relative percent-age of histiocytes with granules does not correlate significantly with the prognosis of these patients.

Adolescent↗
PubMed1984

Results in children with local and regional neuroblastoma managed with and without vincristine, cyclophosphamide, and imidazolecarboxamide. A report from the Children's Cancer Study Group.

Members of children's cancer study group designed Study CCG 351 to determine whether three drug chemotherapy improved the survival experience of children with localized neuroblastoma. Patients in stages I-III were treated with surgical removal of the primary tumor and those in stages II and III received radiation therapy to the tumor bed and chemotherapy. Treatment included cyclophosphamide, imidazolecarboxamide, and vincristine given in 5-day pulses each month for 12 courses. The results were compared to those from a previous study, CCG 011, for localized neuroblastoma, in which children were randomized between a treatment regimen that included cyclophosphamide and one with no chemotherapy. There were 133 evaluable patients, subdivided as follows: stages I-26, stages II-74, and stages III-33. The 3-year life-table survival rates by stage of 96, 89 and 50% were not significantly different from the patients in CCG 011 similarly staged who received either no chemotherapy or oral CPM. These data suggest that multiagent chemotherapy, as prescribed, did not improve the outlook for children with locally advanced but nonmetastatic neuroblastoma. The staging criteria employed showed a modest difference in outcome between patients in stages I and II, but a significant poorer survival for stage III as compared to either stage I or II.

Aminoimidazole Carboxamide↗
PubMed1981

Prognostic importance of morphology (FAB classification) in childhood acute lymphoblastic leukaemia (ALL).

The French-American-British (FAB) classification has been proposed as a useful and uniform method of defining morphologic subsets of acute leukaemias. As part of a prospective study designed to identify subsets of children with high risk of early relapse (CCG 141), submitted bone marrow slides from 765 of 883 patients entered on study were reviewed by two morphologists blinded as to prognostic factors and treatment regimen. L1, L2 and L3 acute lymphoblastic leukaemia (ALL) comprised 85.1%, 14.1% and 0.8%, respectively, of the total population. Children with greater than 25% L2 lymphoblasts had a significantly higher relapse rate and significantly poorer survival. Results of this study indicate that as a single variable, lymphoblast morphology is a very significant predictor of survival, haematologic remission, and complete continuous remission. Multivariate analyses show that lymphoblast morphology is again significant in determining duration of survival (P = 0.048), and is of borderline statistical significance (P = 0.089) in predicting length of complete continuous remission. The FAB classification, with minor modifications, is reproducible, useful, and prognostic in childhood ALL.

Adult↗
PubMed1981

Immunologic evaluation in the prognosis of acute lymphoblastic leukemia. A report from Childrens Cancer Study Group.

Eight-hundred ninety-five previously untreated acute lymphoblastic leukemia (ALL) patients were entered on a protocol designed to provide results of selected immunologic tests. At diagnosis, delayed hypersensitivity tests with four antigens (tetanus, diptheria, candida, and SKSD), immunoglobulin levels, tests for serum inhibition to phytohemagglutinin-stimulated lymphocyte blastogenesis, and HLA-A, B, and C typing were performed. Although delayed lymphocyte blastogenesis have been reported previously to be abnormal in ALL, we did not find them to be associated with disease outcome. Thirty percent of the patients had reduced levels of one or more immunoglobulins. The frequency of remission was less in those patients with decreased IgG and IgA. IgA and IgM showed prognostic importance in remission duration, and all three fractions appeared to have prognostic significance for survival duration. Although none of the HLA types appeared to be associated with significantly increased or decreased success in remission induction, patients with antigens A28 or B12 and patients bearing lymphocyte A11/B35 had shorter remissions. our results indicate that the immunologic factors studied, hypogammaglobulinemia and certain HLA antigens may be related to disease control and outcome in ALL.

Adolescent↗