Conference at The Mount Sinai Hospital of New York

Conference at The Mount Sinai Hospital of New York

MCCOIG ET AL ficacy [abstract 614]. In: Program and abstracts of the 8th Conference on Retroviruses and Opportunistic Infections (Chicago). Alexandri...

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MCCOIG ET AL

ficacy [abstract 614]. In: Program and abstracts of the 8th Conference on Retroviruses and Opportunistic Infections (Chicago). Alexandria (VA): Foundation for Retrovirology and Human Health; 2001. p. 228.

THE JOURNAL OF PEDIATRICS JULY 2002 30. Di Stefano M, Monno L, Fiore JR, Buccoliero G, Appice A, Perulli LM, et al. Neurological disorders during HIV-1 infection correlate with viral load in cerebrospinal fluid but not with virus phenotype. AIDS 1998;12:737-43.

31. Lanier ER, Sturge G, McClernon D, Brown S, Halman M, Sacktor N, et al. HIV-1 RNA reverse transcriptase sequence in plasma and CSF of patients with AIDS dementia complex treated with abacavir. AIDS 2001;15:747-51.

50 Years Ago in The Journal of Pediatrics CONFERENCE AT THE MOUNT SINAI HOSPITAL OF NEW YORK Hodes HL, Karelitz SJ. J Pediatr 1952;40:781-95 Hodes and Karelitz present 2 cases of congenital central nervous system (CNS) tumors. The first is that of a 10-week-old girl with left facial paralysis and vomiting. In addition to the history and physical examination, the work-up included skull radiographs, electroencephalogram, and subdural and lumbar punctures. Finally, a ventriculogram revealed massive dilatation of the lateral ventricles and nonvisualization of the third and fourth ventricles. This was thought to be consistent with a posterior fossa mass. Postmortem examination confirmed the presence of a “neuroepithelioma” involving the left side of the pons and the left cerebellar hemisphere. The second case is that of an 8-day-old girl with failure to move her lower extremities. The work-up included a myelogram, which revealed complete blockage of caudal flow at the level of the 11th dorsal vertebra. A laminectomy with removal of much of the tumor was followed by radiotherapy (a total of 2000 r in daily doses of 50 r and 75 r). The tumor was thought to have most of the characteristics of a neuroblastoma. To say “We’ve come a long way in the area of neuro-oncology over the past five decades” is an understatement. Advances in almost every aspect of diagnosis and therapy have marked this progress. The ready availability of imaging studies, such as computed tomography and magnetic resonance imaging, allows us to make a more rapid and precise diagnosis. New anesthetic agents and both anesthetic and surgical techniques have enabled pediatric neurosurgeons to attempt more aggressive resections. Recently, intraoperative magnetic resonance imaging has allowed for curative resections of tumors previously considered inoperable. As was noted in the article, the classification of brain tumors varied significantly among neuropathologists. Although not totally uniform today, the pathologic classification of brain tumors has been greatly enhanced by an improved understanding of the histogenesis through immunohistochemistry, cytogenetics, and molecular diagnostics. Radiation techniques and delivery methods have undergone continual refinement to render maximum benefit with the least morbidity. Similarly, chemotherapeutic agents have become available that have application to CNS tumors. All of these advances have resulted in major improvements in the prognosis for children with CNS tumors. Fifty years ago, it was stated that in a large series of more than 400 brain tumors in children, only 13% of the children lived longer than 5 years and most had astrocytomas. Medulloblastomas usually resulted in death. Today, the cure rate for low-grade astrocytomas and medulloblastomas is more than 90% and 80%, respectively. John J. Buchino, MD Chief of Pathology Kosair Children’s Hospital Louisville, KY 40232 9/37/125397 doi:10.1067/mpd.2002.125397

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