Whole-body hyperthermia and chemotherapy for treatment of patients with advanced, refractory malignancies.
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Biomedical subjects
Publications and source records attributed to J J Hutter.
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Serial echocardiographic studies were performed on 48 children who received chemotherapy with doxorubicin hydrochloride (Adriamycin). For the group as a whole, no correlation could be made between the cumulative dose of doxorubicin administered and left ventricular systolic function as measured by the fractional shortening of the left ventricle (delta s). Two asymptomatic patients, however, demonstrated depressed delta s and abnormal results from radionuclide studies at cumulative doxorubicin doses of less than 430 mg/sq m. Differentiation of the echoderived curve of left ventricular minor axis dimension indicated that these two patients had abnormalities in both diastolic and systolic function. Good correlation was demonstrated between echocardiographic and radionuclide studies in eight patients, including the two with depressed function. Inherent variability limits the sensitivity of echocardiographic functional studies, but serial studies are helpful in the evaluation of cardiac function in children who receive doxorubicin.
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This report describes an 11-7/12-year-old girl with leiomyosarcoma of the stomach metastatic to liver who was treated with surgical resection and combination chemotherapy, which included adriamycin. She remains well 52 months after diagnosis and 27 months after cessation of chemotherapy. The favorable course of this patient suggests that aggressive adjuvant chemotherapy should be considered for patients with leiomyosarcoma who have poor prognostic features.
The diagnosis and treatment of cancer in adolescents produce changes in their activities, relationships, and concerns. This case study explores these changes and formulates an approach to help such adolescents live meaningfully as they experience their illness.
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A 22-month-old girl developed a rapidly fatal erythrophagocytic syndrome associated with evidence of acute EB viral infection. The association of hemophagocytic syndromes with viral, bacterial, and parasitic infections is discussed. All cases diagnosed as histiocytic medullary reticulosis should include attempts to detect possible association with infectious agents in addition to the assessment of host response.
Two children who presented initially with a lymphoid malignancy were noted to develop recurrences with myeloid features late in the course of their disease. In both cases, evidence of lymphoid differentiation was present in the myelogenous cells that were Ph1 chromosome negative. The first patient had acute myelogenous leukemia and developed a recurrence with morphologic features of acute myelogenous leukemia. Terminal transferase was present in the myelogenous blasts. The second patient initially had a diffuse lymphoblastic non-Hodgkin lymphoma. During the course of her illness she developed a myeloproliferative disorder characterized by basophilic meningitis, splenomegaly, and hypereosinophilia. Lymphocyte T-cell (E-rosette) markers were present on the eosinophils. These observations lend further support to the hypothesis of varying lymphoid and myeloid differentiation in certain cases of leukemia.
Children with neuroblastoma whose opsomyoclonus recurs or persists after initial surgery should be carefully evaluated for tumor. If no tumor is detectable, therapy with ACTH should be considered in patients whose symptomatology is severe enough to compromise normal development.
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Spontaneous mitoses in the blood of 67 patients with acute leukemia were enumerated and their identity determined by cytogenetic methods. Most patients were children with acute lymphoblastic leukemia. Simultaneous 16- to 20-hour cultures of blood leukocytes (Bu) and of bone marrow (BM) cells were performed without phytohemagglutinin (PHA). Blood leukocytes were also cultured with PHA for 72 hours (BPHA). Mitoses in Bu cultures were counted, and karyotypic analysis performed on cells from the three culture types. In 21 control subjects, Bu cultures usually yielded no mitoses. Relapse and remission patients both displayed significantly more Bu mitoses than the controls. The karyotypes of Bu, BPHA, and BM mitoses in remission patients were normal. Fifty percent of relapse patients displayed cytogenetically abnormal leukemia cell lines; the percentage of their abnormal karyotypes was significantly higher in BM cells than in Bu or BPHA cells. The majority of the mitotic cells in Bu cultures from both relapse and remission patients appear to be of a nonleukemic origin. The number of mitoses could not be correlated with type of leukemia, hematologic parameters, or prognosis.
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Cultures of bone-marrow cells incubated for 5 h at 4 degrees had cells in metaphase with elongated chromosomes which were easily Giemsa banded. Colcemid was not necessary for metaphase arrest at this temperature. This technique made possible routine karyotyping of patients with leukemia and other hematological diseases in which the detection of aberrations was otherwise difficult.
A growing literature supports the concept that some cases of neuroblastoma are hereditary. To this we add the first known case, to our knowledge, of neuroblastoma in a parent and child. Various factors, such as the remarkable tendency for this tumor to regress spontaneously, as well as its frequent fatal outcome, have reduced the number of observed familial cases. It is important that siblings and progeny of patients with neuroblastoma be examined to detect possible subclinical neuroblastoma.
Neutrophil (PMN) bactericidal activity, phagocytosis, and nitroblue tetrazolium (NBT) reduction were evaluated in 18 children with untreated or relapsing acute leukemia and 20 children in hematologic remission. Half of the patients in relapse demonstrated abnormal PMN bactericidal activity, while remission patients had essentially normal PMN bactericidal activity. Phagocytosis of Staphylococcus aureus was normal in relapse and remission subjects. NBT reduction by PMN's of leukemic patients was significantly lower than that of controls, but there was no correlation between decreased NBT-reductase activity and decreased bactericidal power. Six patients in remission had received intensive chemotherapy for more than 4 years, and all demonstrated normal PMN functions. Among relapse patients with abnormal PMN bactericidal activity 63% eventually developed severe bacterial infections. By comparison, 20% of the relapse patients with normal PMN bactericidal activity subsequently developed severe infections. The PMN dysfunction observed in relapse patients suggests that abnormal PMN bactericidal activity may contribute the increased susceptibility to bacterial infections during leukemic relapse.
Serial determinations of the absolute granulocyte and platelet counts were performed in 40 infants with severe neonatal necrotizing enterocolitis. Fourteen of the 38 infants had absolute granulocyte counts less than 1,500 nm3, the mean absolute granulocyte count was significantly lower in the group of infants who died during the acute episode of NEC as compared to that of the infants who survived. Thrity-five of 40 infants had nadir platelet counts less than 150,000/nm3, clinical bleeding occurred in 12 of the thrombocytopenic infants. Fourteen thrombocytopenic infants were evaluated for disseminated intravascular coagulation by additional coagulation studies; six were noted to have laboratory evidence of DIC. We conclude that (1) a low absolute granulocyte count in severe NEC is associated with a poor prognosis and (2) thrombocytopenia is a significant problem in severe NEC and may occur with or without evidence of fulminant intravascular coagulation.
A child with Ph1-negative juvenile chronic myelogenous leukemia (CML) is presented. The only chromosomal abnormality in hematopoietic tissues consisted of an absent Y chromosome. While a missing Y chromosome in adult patients with CML may be associated with a better prognosis, the clinical course in our patient was as malignant as that usually observed in other children with Ph1-negative juvenile CML.