Treatment of trilateral retinoblastoma with vincristine and cyclophosphamide

Current therapy for patients with trilateral retinoblastoma, consisting primarily of surgical intervention and radiotherapy, has resulted in no long-term survivors. The use of adjuvant chemotherapy has not improved this outcome. After observing a tumor response to cyclophosphamide in a patient with suprasellar retinoblastoma, we treated a subsequent patient with trilateral retinoblastoma with both vincristine and cyclophosphamide. Objective tumor regression resulted. Although the tumor ultimately progressed in both patients, these findings suggest that vincristine and cyclophosphamide are active in patients with intracranial (trilateral) retinoblastoma.

Axenfeld-Rieger syndrome. A spectrum of developmental disorders

The clinical and histopathologic features of Axenfeld's anomaly and Rieger's anomaly and syndrome are reviewed, and recent findings regarding the pathogenesis of this spectrum of developmental disorders are discussed. Based on these observations, it has been suggested that a developmental arrest, in the third trimester of gestation, of tissues derived from the neural crest cells accounts for the ocular and most of the nonocular abnormalities in this group of disorders. Since previous collective terms, such as mesodermal dysgenesis and anterior chamber cleavage syndrome, are not consistent with these new observations, the alternative name, Axenfeld-Rieger syndrome, has been proposed. The differential diagnosis of the syndrome includes two additional spectra of disorders: the iridocorneal endothelial syndrome and the posterior polymorphous dystrophies. The most serious ocular problem in Axenfeld-Rieger syndrome is the associated glaucoma, which occurs in a high percentage of patients and is typically difficult to control. Recent observations regarding the mechanism of the glaucoma, as reviewed in this paper, provide guidance in the management of this aspect of Axenfeld-Rieger syndrome.

Treatment of intestinal cryptosporidiosis with spiramycin

Nine male patients with the acquired immunodeficiency syndrome and one female patient who had an allogeneic bone marrow transplant for acute myeloblastic leukemia in relapse developed severe debilitating diarrhea. Cryptosporidium species were found in the stools of all patients. After receiving treatment with spiramycin for 1 week, five patients had complete resolution of the diarrhea and four patients had symptomatic improvement. One patient responded gradually and the diarrhea resolved after 30 days of treatment with spiramycin.

Dyskinetic strabismus as a sign of cerebral palsy

We found dyskinetic strabismus in 66 patients with cerebral palsy. The most striking feature of dyskinetic strabismus is the fluctuation from esotropia to exotropia under the same accommodative conditions with a slow tonic deviation similar to a vergence movement. With increasing age, exodeviation becomes more prevalent. Dyskinetic strabismus is seen exclusively in cerebral palsy patients. Many of these patients have an athetoid component to their disorder. The association of dyskinetic strabismus with athetosis and upward gaze palsy suggests that the basal ganglia may be the site of the malfunction. The strabismus responds poorly to surgery and the associated athetosis is important in the diagnosis and treatment of cerebral palsy.

SOME REACTIONS INVOLVED IN THE PHOTOBROMINATION OF SIMPLE ALCOHOLS AND KETONES IN THE VAPOR PHASE

The vapor phase brominations of methanol, ethanol, formaldehyde, and acetaldehyde are all photosensitive. The products have been identified and mechanisms postulated to explain their formation. The vapor phase reactions between formaldehyde and HBr, acetaldehyde and HBr, acetaldehyde and acetyl bromide, and ethanol and acetyl bromide have also been studied.

ANESTHESIA FOR CRIPPLED CHILDREN

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