Biomedical subjects
Publications and source records attributed to U Bertram.
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The justification for a neuroblastoma screening program has been discussed controversially. The analysis of 701 patients of the German neuroblastoma trials NB 79, 82, and 85 provides additional information on this subject. The basis of our investigation was the good prognosis of stage I and II patients (92% survival 5-10 years after diagnosis) compared with 66% in stage III and 11% in metastatic disease. The correlation of age and stage (p less than 0.0001), a median progression time of 14.6 months (range 3.4-33.5 mo) from localized to metastatic disease as observed in 18 patients, the high incidence of asymptomatic diseases in stages I (49%) and II (30%) patients and the cost-benefit estimation arguments in favor of a screening program. The key problem for the lab part is the lower incidence of abnormal catecholamine metabolite excretion in stage I and II patients. The origin of 89% of metastatic disease from intraabdominal sites suggests that ultrasonography may be of additional value.
We describe the case of a 5 months old infant with an inflammatory fibroid polyp of the stomach. The girl presented with inflammatory symptoms and a tumor in the upper abdomen which was confirmed by sonography and computer-tomography. This very rare benign tumor has not yet been described in an infant.
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A malignant rhabdoid tumour (MRT) of the kidney was studied immunohistochemically using a large panel of monoclonal antibodies. All tumour cells were marked by a vimentin antibody. Variable amounts of the tumour cells were stained by antibodies specific for neurofilament proteins. Keratin, desmin and GFA, however, were not expressed. Antibodies reacting with lymphohaematopoietic antigens as well as with normal renal tissue and renal neoplasms, especially Wilms' tumours, (BA-1, BA-2, BA-3) and an antibody directed against Tamm-Horsfall protein failed to stain the tumour. These results, especially the expression of neurofilaments demonstrated for the first time in a MRT, point to a derivation of the demonstrated tumour from the neural crest. Analysis of the heterogeneous immunohistological marker expression and of the different primary sites of MRTs suggest that these highly malignant neoplasms are a histogenetically heterogeneous group, irrespective of their characteristic light microscopic appearance.
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Soft-tissue tumours and soft-tissue sarcomas are different in children and in adults, and therapy varies significantly according to histology, age and stage of disease. The most common soft-tissue sarcoma in children, rhabdomyosarcoma, can be cured in about 60% of cases by a combined therapy involving surgery, chemotherapy and radiotherapy. All children with soft-tissue sarcomas should be treated according to multi-center treatment protocols and should be referred to specialized oncology units. Modern diagnostic techniques and new treatment modalities will increase our knowledge and further raise the cure rate.
Cytomegalovirus (CMV) was isolated from the urine of babies from two consecutive pregnancies of a mother. The first baby had died of pneumonia at the age of six months, two years before the second confinement (twins of different sexes). The male twin was examined at the age of eight months on account of generalized lymphomas, pulmonary infiltrates and thrombopenia. He excreted CMV in the urine, and HIV antibodies were found in the serum. All members of the family (also the baby who died in 1983, from whom serum samples had been stored at -20 degrees C) finally proved to be carriers of antibodies against HIV. The parents and the female twin did not show any clinical symptoms indicating a HIV infection; however, CMV was also isolated from a urine sample from the mother.
In the years 1980-1985 72 children with acute lymphoblastic leukemia were diagnosed and treated by intensive combination chemotherapy (BFM protocols 79, 81, 83). Of these children 33 acquired a Hepatitis B-virus-carrier state with 1983 as the peak year of incidence. Both groups of patients, the infected and the uninfected ones, were comparable as to prognostic factors. All except 8 patients are off chemotherapy after a total duration of treatment of 1 1/2 or 2 years. Probability for event-free survival (life table analysis, maximum observation time 82 months, minimum 12 months) is equal (0.77 vs. 0.75) in both groups. With 3 exceptions, all HBV-infected patients still carry the HBs-antigen in the serum; 22 of the 30 living patients in the infected group developed anti-HBc.
In a 13-year-old boy--with haemophilia A, positive tests for HTLV-III antibodies, and lymphocytopenia--there occurred watery voluminous stools which persisted over many months. Cryptosporidia were demonstrated microscopically in the stool. Cryptosporidiosis should be considered in patients with acquired immune deficiency who have diarrhoea.
Eight patients undergoing antidepressant therapy with nortriptyline for 1--4 years were investigated. The period of the investigation was 7 weeks and included a 2-week placebo period, blind for the patients. Total saliva secretion measurement, the nortriptyline plasma level, and signs and symptoms of depression and side effects were obtained once a week during the study. The results of the investigation were: (1) long-term treatment with nortriptyline is followed by hyposecretion or xerostomia, (2) the reduction of the secretion is reversible, (3) re-establishment of treatment with dosage leading to the same serum level of nortriptyline is immediately followed by a drop in saliva secretion, and (4) the changes in salivary secretion are useful as an indicator of side effects. The practical importance of the investigation is discussed.
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Oral health and dental treatment needs were investigated in 560 elderly persons in the county of Vestsjaelland (West Zealand) in Denmark. Of the population aged 65 and above in three typical communities in the county, 10% were selected by random sampling and totaled 633 persons. Of these, 560 persons (88.5%) were interviewed and examined in their homes. The final sample population was representative of the total Danish population in relation to sex and socioeconomic status for this specific age group. Oral health was generally poor. In all, 68.2% of the population were edentulous (64.7 of the males, 70.7% of the females), while the dentate persons had an average of 12 teeth; 3.6% were totally edentulous and lacked dentures in both jaws, a further 5.5% were totally edentulous and lacked a denture in one jaw, and 83.4% had removable dentures. Only 3.4% of the dentate and 28.2% of the edentulous persons did not need any dental treatment. The total percentage of people needing treatment was 80. Prosthetic treatment was the main requirement, applying to 80% of the group. In contrast with this, only 25% of the interviewed subjects had a subjective need for treatment. Information and economic aids for dental treatment are obviously needed in the elderly Danish population.