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The management of severe compound war injuries of the extremities in paediatric patients
500
INTERNATIONAL ABSTRACTS
and was bilateral in four. The omphalocele contents consisted of gastrointestinal tract only in nine patients and liver and gastrointestinal tract in six. All six patients with omphatoceles that included the liver had cephalad renal displacement. One patient with small bowel alone in the omphalocele had right kidney displacement. Clinicians should be aware of this variation to avoid confusion and further unnecessary evaluation.--George Holcomb, Jr Hypertension Induced by Occult Renal Tissue. S. Fernbach, E.
Holland, L Benuck, et aL J Urol 138:842-844, (October), 1987. Hypertension was noted in two children thought to have a solitary kidney after multiple radiologic studies. Aggressive diagnostic evaluation including selective renography with renin measurement, angiography, and cystoscopy allowed for detection of occult contralateral renal tissue. Surgical removal of this parenchyma resulted in a return to normal blood pressure.--George Hotcomb, :fr MUSCULOSKELETAL SYSTEM The Management of Severe Compound War Injuries of the Extremities in Paediatric Patients. 1,I. Bialik, J. Fishman, and H.
Stein. Z Kinderchir 42:57-59, (February), 1987. Twelve children suffering from severe multiple injuries following mine explosions and extensive crush to the locomotor system are described. An aggressive therapeutic approach included surgical debridement followed by soft tissue repair combined with external fixation and hyperbaric oxygen. Six limbs were salvaged. Eleven limbs had to be amputated. All children made a surprisingly quick functional recovery.-- Thomas A. Angerpoinmer Tuberculosis of the Spine: Results of Management of 300 Patients.
J.J. Adendorff, E J . Boeke, and C. Lazarus. J R Coil Surg (Ed) 32:152-155, (June), 1987. Three hundred cases of tuberculosis of spine seen in an 8-year period in a center in South Africa are reviewed. Ages ranged from 2 months to 85 years (108 were under 10 years). Ninety percent of cases involved thoracic and lumbar vertebrae as diagnosed radiologically. Approximately half the patients had some degree of spinal cord compression with neurologic signs. Back pains, gibhus, abscesses, and sinuses were common presenting features. All patients were given four antituberculous drugs--rifampicin, isoniazid, streptomycin, and pyrazinamide--for a minimum of 3 months. Apart from a few patients who were either too ill or refused operation, all with neurologic signs underwent anterior spinal decompression and fusion. Half with no neurologic signs had decompression and fusion. There was an overall mortality of 8.7%. Eightythree percent with moderate neurologic signs recovered; 40% with serious signs also did well. The authors recommend inpatient treatment with a combination of surgery and chemotherapy. In children, surgery is recommended only to relieve cord compression Or drain an abscess. Children respond well to chemotherapy alone.--W.G. Scobie The Importance of Orthotic Treatment in the Management of Fibrous Dysplasia of the Lower Limb. G.J.A. Siriwardena. J R Coil
Surg (Ed) 32:160-162, (June), 1987. Fibrous dysplasia of bone affecting the lower limb is associated with pain, deformity, and frequent fractures. The author reports his experience in three cases managed with an orthosis. In a 9-year-old child the tibia was involved; in two adults the femur. Fitting a well-designed orthosis allowed weight bearing with full functional use of the limb despite shortening and deformity found in the adults. All cases were symptom free at 12-years follow-up.--W.G. Scobie
NEOPLASMS M. Btute, P. Kelalis, K. Offord, et al. J Urot 138:968-978, (October), 1987.
Bilateral Wilms" T u m o r .
Despite institutional variation in the treatment of synchronous bilateral Wilms' tumor, a 76% overall 3-year survival rate has been achieved. A review of 145 patients with stage V disease (synchronous bilateral Wilms' tumor) registered with National Wilms' Tumor Studies II and III is reported. The majority of the patients (94, or 65%) underwent initial partial or complete tumor resection followed by chemotherapy with or without radiation, with a 3-year survival rate of 82%. However, survival of 45 patients who underwent initial biopsy, postoperative chemotherapy, and second-look surgery was 57% at 3 years, a result not significantly different statistically from the 82% figure. Only 38% of the patients had all tumor resected at one or more operations. Therefore, emphasis is being placed on chemotherapy as the predominant treatment modality for this disease. Unfavorable histology was found in 10% of the patients and six patients (4%) had discordant histology, that is unfavorable histology on one side with contralateral favorable histology. Better prognostic factors were patient age <3 years at diagnosis, lower stage of the most advanced lesions, favorable histology, and negative nodal involvement.--George Holcomb, Jr Relapse Associated Variables in Stage I Favorable Histology Wilms" T u m o r . D,A. Weeks, J.B. Beckwith, and D.W. Luckey.
Cancer 60:1204-12 t 2, (September), 1987. Having analyzed, in detail, the patients with unfavorable histology entered in the National Wilms' Tumor Studies (NWTS), the group of pathologists associated with this study have now turned to the other end of the spectrum, ie, the most favorable forms of Wilms' tumor, stage I, favorable histology. In this group they have found a number of pathologic features that predict relaspse. These include (1) invasion of the tumor capsule, (2) the presence of an "inflammatory pseudocapsule," (3) renal sinus invasion, and (4) tumor in intrarenal vessels. All patients in stage I with favorable histology that relapsed in NWTS-3 had one or more of these features. This was confirmed by review of the cases in NWTS-I including those that relapsed after single agent therapy. Thus, it is apparent that additional "microsubstaging" is possible and may lead to protocol modifications and improved therapy for patients in favorable, as well as unfavorable, histologic forms of Wilms' tumor.--Daniel M. Hays Simultaneous Occurrence of Wilms" Tumor and Multiple Hamarto-
a 15-Year-Old Girl. H. Lindner and U. WillnOw, Z Kinderchir 42:123-125, (April), 1987. m a s in
The observation of multiple adenofibroleiomyomatous hamartomas of the lung in a 15-year-old girl 7 years after treatment of a W~lms' tumor is presented, The girl underwent right-sided nephrectomy for a Wilms' tumor in 1975. Under irradiation with a total dose of 34 Gy and chemotherapy for 2 years, she remained free of recurrence or metastases. However, chest x-ray done in 1982 showed three round foci in the right lung. Histologic examination of the excised tumors revealed adenoflbroleiomyomatous hamartomas of the lung without evidence of malignancy, Two years later, the girl is in excellent condition. The simultaneous Occurrence fo Wiims' tumor and benign or malignant tumors points to genetic factors in the development of both tumors,nThomas A, Angerpointner Renal Metastases From Neuroblast0ma, D. Filiatraidt, C. Hoyoux, P. Benoit, et al. Pediatr Radiol 17:137-138, (February), 1987.
Neuroblastoma is one Of the pediatric cancers that has the most unpredictable evolution. It can metastasize to almost any organ, but
INTERNATIONAL ABSTRACTS
and was bilateral in four. The omphalocele contents consisted of gastrointestinal tract only in nine patients and liver and gastrointestinal tract in six. All six patients with omphatoceles that included the liver had cephalad renal displacement. One patient with small bowel alone in the omphalocele had right kidney displacement. Clinicians should be aware of this variation to avoid confusion and further unnecessary evaluation.--George Holcomb, Jr Hypertension Induced by Occult Renal Tissue. S. Fernbach, E.
Holland, L Benuck, et aL J Urol 138:842-844, (October), 1987. Hypertension was noted in two children thought to have a solitary kidney after multiple radiologic studies. Aggressive diagnostic evaluation including selective renography with renin measurement, angiography, and cystoscopy allowed for detection of occult contralateral renal tissue. Surgical removal of this parenchyma resulted in a return to normal blood pressure.--George Hotcomb, :fr MUSCULOSKELETAL SYSTEM The Management of Severe Compound War Injuries of the Extremities in Paediatric Patients. 1,I. Bialik, J. Fishman, and H.
Stein. Z Kinderchir 42:57-59, (February), 1987. Twelve children suffering from severe multiple injuries following mine explosions and extensive crush to the locomotor system are described. An aggressive therapeutic approach included surgical debridement followed by soft tissue repair combined with external fixation and hyperbaric oxygen. Six limbs were salvaged. Eleven limbs had to be amputated. All children made a surprisingly quick functional recovery.-- Thomas A. Angerpoinmer Tuberculosis of the Spine: Results of Management of 300 Patients.
J.J. Adendorff, E J . Boeke, and C. Lazarus. J R Coil Surg (Ed) 32:152-155, (June), 1987. Three hundred cases of tuberculosis of spine seen in an 8-year period in a center in South Africa are reviewed. Ages ranged from 2 months to 85 years (108 were under 10 years). Ninety percent of cases involved thoracic and lumbar vertebrae as diagnosed radiologically. Approximately half the patients had some degree of spinal cord compression with neurologic signs. Back pains, gibhus, abscesses, and sinuses were common presenting features. All patients were given four antituberculous drugs--rifampicin, isoniazid, streptomycin, and pyrazinamide--for a minimum of 3 months. Apart from a few patients who were either too ill or refused operation, all with neurologic signs underwent anterior spinal decompression and fusion. Half with no neurologic signs had decompression and fusion. There was an overall mortality of 8.7%. Eightythree percent with moderate neurologic signs recovered; 40% with serious signs also did well. The authors recommend inpatient treatment with a combination of surgery and chemotherapy. In children, surgery is recommended only to relieve cord compression Or drain an abscess. Children respond well to chemotherapy alone.--W.G. Scobie The Importance of Orthotic Treatment in the Management of Fibrous Dysplasia of the Lower Limb. G.J.A. Siriwardena. J R Coil
Surg (Ed) 32:160-162, (June), 1987. Fibrous dysplasia of bone affecting the lower limb is associated with pain, deformity, and frequent fractures. The author reports his experience in three cases managed with an orthosis. In a 9-year-old child the tibia was involved; in two adults the femur. Fitting a well-designed orthosis allowed weight bearing with full functional use of the limb despite shortening and deformity found in the adults. All cases were symptom free at 12-years follow-up.--W.G. Scobie
NEOPLASMS M. Btute, P. Kelalis, K. Offord, et al. J Urot 138:968-978, (October), 1987.
Bilateral Wilms" T u m o r .
Despite institutional variation in the treatment of synchronous bilateral Wilms' tumor, a 76% overall 3-year survival rate has been achieved. A review of 145 patients with stage V disease (synchronous bilateral Wilms' tumor) registered with National Wilms' Tumor Studies II and III is reported. The majority of the patients (94, or 65%) underwent initial partial or complete tumor resection followed by chemotherapy with or without radiation, with a 3-year survival rate of 82%. However, survival of 45 patients who underwent initial biopsy, postoperative chemotherapy, and second-look surgery was 57% at 3 years, a result not significantly different statistically from the 82% figure. Only 38% of the patients had all tumor resected at one or more operations. Therefore, emphasis is being placed on chemotherapy as the predominant treatment modality for this disease. Unfavorable histology was found in 10% of the patients and six patients (4%) had discordant histology, that is unfavorable histology on one side with contralateral favorable histology. Better prognostic factors were patient age <3 years at diagnosis, lower stage of the most advanced lesions, favorable histology, and negative nodal involvement.--George Holcomb, Jr Relapse Associated Variables in Stage I Favorable Histology Wilms" T u m o r . D,A. Weeks, J.B. Beckwith, and D.W. Luckey.
Cancer 60:1204-12 t 2, (September), 1987. Having analyzed, in detail, the patients with unfavorable histology entered in the National Wilms' Tumor Studies (NWTS), the group of pathologists associated with this study have now turned to the other end of the spectrum, ie, the most favorable forms of Wilms' tumor, stage I, favorable histology. In this group they have found a number of pathologic features that predict relaspse. These include (1) invasion of the tumor capsule, (2) the presence of an "inflammatory pseudocapsule," (3) renal sinus invasion, and (4) tumor in intrarenal vessels. All patients in stage I with favorable histology that relapsed in NWTS-3 had one or more of these features. This was confirmed by review of the cases in NWTS-I including those that relapsed after single agent therapy. Thus, it is apparent that additional "microsubstaging" is possible and may lead to protocol modifications and improved therapy for patients in favorable, as well as unfavorable, histologic forms of Wilms' tumor.--Daniel M. Hays Simultaneous Occurrence of Wilms" Tumor and Multiple Hamarto-
a 15-Year-Old Girl. H. Lindner and U. WillnOw, Z Kinderchir 42:123-125, (April), 1987. m a s in
The observation of multiple adenofibroleiomyomatous hamartomas of the lung in a 15-year-old girl 7 years after treatment of a W~lms' tumor is presented, The girl underwent right-sided nephrectomy for a Wilms' tumor in 1975. Under irradiation with a total dose of 34 Gy and chemotherapy for 2 years, she remained free of recurrence or metastases. However, chest x-ray done in 1982 showed three round foci in the right lung. Histologic examination of the excised tumors revealed adenoflbroleiomyomatous hamartomas of the lung without evidence of malignancy, Two years later, the girl is in excellent condition. The simultaneous Occurrence fo Wiims' tumor and benign or malignant tumors points to genetic factors in the development of both tumors,nThomas A, Angerpointner Renal Metastases From Neuroblast0ma, D. Filiatraidt, C. Hoyoux, P. Benoit, et al. Pediatr Radiol 17:137-138, (February), 1987.
Neuroblastoma is one Of the pediatric cancers that has the most unpredictable evolution. It can metastasize to almost any organ, but