tdic(9;12): a nonrandom chromosome abnormality in childhood B-cell precursor acute lymphoblastic leukemia: a Pediatric Oncology Group Study

In a review of 432 children with newly diagnosed acute lymphoblastic leukemia (ALL), we identified a new nonrandom translocation, tdic(9;12)(p1?1;p1?2), in the leukemic marrow cells of eight patients. Seven had hypodiploid karyotypes that lacked chromosomes 9 and 12 and contained a der(12), tdic(9;12); the eighth had a pseudodiploid karyotype with two normal 9 chromosomes, one normal 12 and the der(12), tdic(9;12). Abnormalities involving chromosomes other than 9 and 12 were noted in four of the eight patients. All cells with the tdic(9;12) expressed both the common ALL antigen and HLA-DR. Cytoplasmic immunoglobulin, a marker of pre-B ALL, was detected in one case with the tdic(9;12) but was absent in the other seven. Our results suggest that the tdic(9;12)(p1?1;p1?2) rearrangement is specifically associated with leukemic B cell precursors.

Diminished lymphocyte and granulocyte gamma-glutamyltranspeptidase activity in acute lymphocytic leukemia and response to chemotherapy

gamma-Glutamyltranspeptidase (GGT) activity (per mg protein) in blood lymphoid cells of 27 children with acute lymphoblastic leukemia (ALL) (1.05 +/- 0.15) was significantly below that of controls (2.25 +/- 0.30), became normalized during chemotherapy-induced remission (2.47 +/- 0.26), and was low again (1.59 +/- 0.62) in relapsed subjects. Individual variations in the GGT activity of the blood lymphoid cell fraction (per mg protein) bore a significant inverse correlation to the number of white blood cells (WBC) as well as of blasts per ml blood. Blasts had minimal GGT activity; however, partial GGT deficiency was also exhibited by the microscopically normal circulatory lymphocytes of several patients prior to treatment and in relapsed subjects whose blood was still devoid of blasts. Significantly diminished GGT activity (per mg protein) was found in the blood granulocytes of ALL subjects. This deficit, restored during remission and present again at relapse, varied in magnitude but showed no statistically significant correlation to the different patients' degree of neutropenia. In about one-third of the newly diagnosed or relapsed pre-B ALL children, the circulatory granulocytes' GGT activity was only 10-20% of normal. The results suggest that 1) the presence or absence of this sign of functional maldifferentiation in granulocytes is a factor in the heterogeneity of disease manifestation among subjects with apparently the same type of ALL and that 2) measurement of GGT in the circulatory granulocytes, as well lymphocytes, may be useful for monitoring the efficacy of chemotherapy.

Lymphocyte thymidine kinase and treatment response in acute lymphocytic leukemia

The activity of thymidine kinase (TK) and the proportion of its isozymes (TK1/TK2) were studied in peripheral lymphoid cells of 37 children with acute lymphocytic leukemia (ALL). The high TK in 25 untreated subjects (31.5 +/- 8.9) decreased during chemotherapy-induced remission to uniformly low (5.3 +/- 0.4) normal values, and rose again during relapse to a mean of (24.8 +/- 8.1). The proportion of isozyme 1 followed the same pattern but TK was a more sensitive indicator of disease state. The lymphocyte fractions' TK (per mg protein) correlated with the number (per ml blood) of WBCs, blasts and lymphocytes. Although the higher TK of blasts than of apparently normal lymphocytes was confirmed in cases permitting clean physical separation, the lymphocyte fraction of several untreated subjects with minimal blast counts also exhibited elevated TK. Moreover, this elevation was also seen in relapsed cases even if their blood (unlike bone marrow) was devoid of blasts. The results indicate that quantification of TK can reveal a subpopulation of maldifferentiated lymphocytes which are microscopically normal and that it may provide an objective parameter of prognostic differences between ALL subjects with similar hematological characteristics.

Concurrence of von Willebrand's disease and hemophilia A: implications for carrier detection and prevalence

Five families with concurrent von Willebrand's disease (VWD) and classic hemophilia (hemophilia A) are described. Three were ascertained through women undergoing hemophilia carrier testing, one through an obligate carrier who also has VWD, and one through the affected father of a hemophiliac. The VWD probands exhibited Type I VWD with reduced Factor VIII-related antigen (VIIIR:Ag) and/or von Willebrand factor on more than one occasion, normal VIIIR:Ag on crossed immunoelectrophoresis, and mild symptoms. No male had both disorders, but two obligate hemophilia carriers also had VWD. Neither was detectable as a carrier by discriminant analysis. Four possible carriers of hemophilia had VWD and would also be classified as noncarriers statistically. These findings suggest that the presence of VWD may invalidate hemophilia carrier testing by conventional methods. The independent entry into the family of the two genes by mating of a hemophilia carrier and a VWD male is documented in two cases and probable in two. The observed frequency of such matings supports the hypothesis that VWD is a common disorder.

Pseudomembranous necrotizing bronchial aspergillosis. A variant of invasive aspergillosis in a patient with hemophilia and acquired immune deficiency syndrome

A 15-yr-old male hemophiliac developed the acquired immune deficiency syndrome (AIDS). His terminal illness was characterized by rapidly progressive respiratory failure with intermittent wheezing, nonresponsive to bronchodilator and steroid therapy. Postmortem examination revealed a pseudomembrane covering the mucosa of the lower trachea and bronchi of both lungs. This pseudomembrane was composed predominantly of fungal hyphae speciated as Aspergillus niger. There was widespread transmural necrotizing bronchitis and fungal invasion that extended to involve a narrow zone of peribronchial tissues. The intervening lung parenchyma was free of fungal disease. This unique form of bronchitis is a distinct variant of invasive aspergillosis and merits recognition because of its clinical and prognostic implications.

Patients' preferences for dentists' behaviors

Unlike previous studies that examined specialized populations or were completed some years ago, this survey collected information from a cross-section of patients who were currently receiving various kinds of dental treatment. Although the study disclosed that patients' preferences and perceptions of dentists' performance might vary within and between demographic groups, a more important finding was that, in general, most patients in all demographic groups held common beliefs about how they would like to be treated by their dentists. However, according to the reports of these patients, the dentists did not always behave in ways that were congruent with the patients' preferences. The study showed that patients are sensitive to dentists' behaviors. It should also be noted that dentists are sensitive to patients' behaviors and that dentist-patient relationships may be a source of stress for both patients and dentists. Nevertheless, the responsibility for setting the tone of these relationships rests primarily with the dentist rather than with the patient. Therefore, it is important for dentists to be aware of the needs and preferences of their patients so that they can act in ways that will make patients comfortable and dental treatment a positive experience. The potential that appears to be inherent in good, satisfying dentist-patient relationships for minimizing patient stress and making dentistry a less stressful profession has yet to be fully realized. Dentistry is a two-way street: whatever benefits the patient should in turn benefit the dentist as well.

Treatment of primary undifferentiated sarcoma of the liver with surgery and chemotherapy

Primary undifferentiated sarcoma of the liver is a rare tumor with survival reliant on total excision of the tumor. The authors report such a tumor, initially nonresectable, in a 7-year-old girl whose tumor was successfully excised following treatment with cisplatin and Adriamycin (doxorubicin). The light and electron microscopic details of this patient's tumor are presented.

Quantitative blood cultures in the evaluation of septicemia in children with Broviac catheters

We applied quantitative methods of analysis to all blood cultures drawn during the course of treatment in 28 children with Broviac catheters in a central vein. Thirty febrile episodes in 14 of these patients were evaluated. Samples of blood obtained from a peripheral vein and through the central catheter were cultured quantitatively on agar plates and nonquantitatively in standard broth media. Catheters were judged to be a source of septicemia nine times in seven children. In all nine positive catheter samples, the concentration of pathogens was 10 times as great as that observed in the peripheral venous sample. The blood drawn through the Broviac catheter contained greater than or equal to 2000 colony-forming units per milliliter in six cases. Quantitative cultures in two patients with septicemia not attributable to the catheter yielded low colony counts in the catheter sample. Cultures of blood samples drawn through the catheter when a child was well were not helpful in predicting subsequent septicemia. The technique of inoculating blood directly onto agar plates is easily performed and superior to standard broth cultures, because it detected pathogens within 16 hours and identified infections with multiple organisms.

Adolescents' questions about sex

Male and female Anglo, Hispanic and Native American adolescents from urban and rural areas were given a chance to ask anonymous questions about sex. These questions were then used as the bases for subsequent presentations on sex education. The most popular categories of questions were reproduction, sexuality, and contraception, followed by anatomy, venereal disease, pregnancy, abortion, vocabulary, hygiene, and other diseases. Younger adolescents asked significantly more questions in most categories than older ones. Girls asked significantly more total questions and ones concerning pregnancy, contraception, and anatomy than boys. Students attending rural schools asked more questions about venereal disease than those in urban schools, but no other main effects of urban-rural location were found. There were no ethnic differences found. The adolescents' questions ranged from sophisticated to poignantly ignorant, suggesting that the strategy of adapting sex education sessions to fit the concerns of the specific adolescents involved might be valuable.

The relationships of age, sex, ethnicity, and weight to stereotypes of obesity and self perception

In order to assess the relationships of stereotypes of obesity and of self perceptions to age, sex, ethnicity and weight, 447 adults and children varying in sex, ethnic background and weight rated 12 line drawings of people who varied in age, sex and weight, as well as giving self ratings on similar scales. The normal weight stimuli, compared with the fat oe thin ones, were more wanted as friends and were seen as happier, having more friends, being smarter, and better looking but less lonely and mean. The thin stimulus figures were seen as having more friends, being better looking, smarter and meaner than the fat ones. These trends held for both the sexes, all ages, all ethnic groups, and children of all weights. Names or nicknames assigned to the stimuli also reflected stereotypes: Fat nicknames were given primarily to the fat stimuli; Thin and Height-related ones were given to the thin stimuli; and the average stimuli received more Neutral/Normal and Clearly Positive and fewer Other/Ambiguous and Clearly Negative names. Self evaluations suggested that fifth graders and American Indians were lowest in self concept on some scales, consistent with other research. Overweight subjects were generally similar to average and underweight ones in self ratings, contrary to expectation. Apparently these subjects did not perceive themselves as negatively as previous research and their ratings of the obese stimuli might have caused us to expect.

Eating habits, restraint, knowledge and attitudes toward obesity

A questionnaire was administered to 53 male and 169 female Australian university students in order to determine their attitudes toward obesity, knowledge about obesity, abnormal or unhealthy eating habits and scores on Herman's Revised Restraint Scale. Additional variables measured were the subject's own degree of overweight; overweight friends, relatives and dates; sex, age and age of onset of obesity, for those calling themselves overweight. Generally negative attitudes toward obesity were reported, as assessed by weights viewed as potentially attractive for males and females, rating scale evaluations of obesity and feelings about being overweight oneself. These attitude measures were significantly intercorrelated. Knowledge of current information about obesity was at the level of chance. Restraint and eating habits were significantly intercorrelated and also related to self-perceived overweight and number of overweight relatives. Other results suggested that overweight is both more common in females than males and viewed more seriously by them.

Beliefs about obesity: effects of age, ethnicity, sex and weight

To find out if subjects' knowledge of the complex nature of obesity increases with age, 447 nursery school, first grade, fifth grade, and adult subjects were asked if they knew anyone fat and, if so, who; what the causes of obesity are; and whose fault it is if someone is fat. Older subjects were increasingly likely to know people who were fat and to give complex causal explanations for obesity; moreover, adults were less likely than children to see the fat individual as responsible for his obesity. Female subjects were more likely than males to know someone fat and to give complex explanations of obesity. Anglo, Hispanic, Native American and black subjects did not differ on any measure. Children who were underweight, of average weight or overweight also did not differ in knowledge or beliefs. The results suggest that, although accuracy of knowledge increases with age, education about obesity at all age levels may be needed to reduce incorrect beliefs and accompanying negative attitudes toward obesity.

Psychosocial effects of gastric reduction surgery for obesity

A sample of 44 patients who had undergone gastric reduction surgery for severe obesity responded to a questionnaire asking about psychosocial changes after the surgery and about their reactions to the weight loss and to previous weight reduction methods. Subjects reported substantial weight losses accompanied by reduced food intake and normalization of eating patterns; increases in physical and social activities; more positive relationships with others, including sexual functioning; and more positive self-perceptions in a number of areas. All were glad that they had had the operation and saw it as more successful than other methods of weight control. In light of the social pressures encouraging people to lose weight and the general lack of success of nonsurgical weight reduction methods, it is likely that this procedure will be increasingly widely used, although its long-term effects have not been studied.

Marrow transplantation for juvenile osteopetrosis

Two children with the juvenile form of osteopetrosis were treated with marrow transplants from their HLA identical siblings. Following transplantation each child exhibited extensive bone reabsorption with a marked augmentation of osteoclastic function attributable to donor osteoclasts, including remodeling of bone with expansion of intramedullary hematopoiesis and correction of associated abnormalities of thymic factor and natural killer cells. Osteopetrosis ultimately recurred in one patient in whom engraftment of donor hematopoietic elements was not achieved. Our studies indicate that marrow transplantation will correct osteopetrosis but that permanent reconstitution necessitates sustained engraftment of marrow precursors of cells with osteoclastic activity.