Letter: Vasculitis as a complication of high-dose methotrexate in the treatment of acute leukemia.
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Biomedical subjects
Publications and source records attributed to A Shende.
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Twenty-five cases of hodgkin's Disease (15 males and 10 females) aged 5 to 17 years were studied from April 1970 to July 1976 (75 month period). Histology revealed that 2 had lymphocytic predominance, 12 had nodular sclerosis, and 11 had mixed cellularity. Pathologic staging revealed that 3 were IA, 1 IB, 5 IIA, 4IIB, 6IIIA, and 6 IIIB. Laparotomy altered the staging in 12 patients (9 were staging up and 3 down). All but 2 patients received extended field radiation, and 5 had recurrence of disease and were treated with combination chemotherapy. Twenty-three are alive without evidence of disease (21-75 months), and the 2 deaths were not due to Hodgkin's Disease but to hemobilia (postliver biopsy) and penumococcal septicemia, purpura fulminans, and disseminated intravascular coagulation (14 months postsplenectomy). Other complications included 2 patients with intestinal obstruction, 1 with postoperative subphrenic abscess, and 1 with streptococcal septicemia and polyarthritis. Nineteen patients received continuous penicillin prophylaxis postoperatively and the 2 with serious infections were amongst the 6 who had not received penicillin or whose penicillin had been discontinued at the time of infection. It is concluded that laparotomy and splenectomy in children is essential for accurate staging but carries significant risk, and continuous penicillin prophylaxis is recommended.
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Lanzkowsky, P., Shende, A., Aral, I., Saluja, G. (1975). Archives of Disease in Childhood, 50, 685. Organ irradiation and combination chemotherapy in treatment of acute lymphocytic leukaemia in children. A total of 30 consecutive children with acute lymphocytic leukaemia (ALL) were treated from June 1971 until December 1974. Remission was induced with the use of vincristine and prednisone. After induction of remission, cranial irradiation and intrathecal methotrexate were given. Then the liver, spleen, and kidney were irradiated and 6-mercaptopurine, cyclophosphamide, and methotrexate were administered during the maintenance phase. Pulsed doses of vincristine and prednisone were administered at 10- to 12-week intervals. The patients were subdivided into two groups based on their initial white blood cell (WBC) counts: a standard risk group with an initial WBC count of less than 25 000/mm3 (25 X 10(9)/1) and a high risk group with an initial WBC count greater than 25 000/mm3 (25 X 10(9)/1). Of the 30 children entered in this study one standard risk patient died in the induction phase before attaining remission. Analysis of the results is therefore based on the remaining 29 patients, 22 standard risk and 7 high risk patients, who attained complete remission. Survival rates in continuous remission were found to be 43% of the high risk group, 88% for the standard risk group, and 77% for the combined group. Analysis of the data indicates that this therapy is unsatisfactory in high risk ALL. The results to date of this therapy for standard risk are sufficiently encouraging to continue its use in this subgroup of patients.
Diabetes insipidus as the presenting manifestation of acute myeloblastic leukemia in a nine-year-old female is reported. In patients with recent onset of diabetes insipidus an underlying leukemic process should be excluded as an etiologic factor.
This study reports on 2,755 women seeking medical termination of pregnancy (MTP), and concurrent contraceptive acceptance, at a clinic in rural India from 1976 to 1987. The level of contraceptive acceptance among married women seeking MTP between 1976 and 1987 was 88.2 percent. Among married women seeking MTP in their first trimester of pregnancy, 43.4 percent accepted the IUD as a method of contraception and 41.8 percent accepted sterilization. By contrast, only 11.5 percent of women in their second trimester accepted the IUD, but 70.2 percent accepted sterilization. Seventy-two percent of the unmarried women and 43 percent of the married women seeking MTP were in their second trimester. Recommendations are made to: (1) combine contraceptive services and counseling with MTP whenever possible, (2) examine the consequences of policies that exclude unmarried women from contraceptive services, (3) investigate the reasons why so many women in this study sought MTP so late in pregnancy, and (4) obtain information on the determinants of contraceptive acceptance among women who seek MTP.