Thyroid dysfunction and neoplasia in children receiving neck irradiation for cancer

The reported relationship of radiation exposure and thyroid carcinoma stimulated this retrospective study of 298 patients treated at St. Jude Children's Hospital with radiation therapy to the neck for childhood cancer to identify patients who developed subsequent thyroid abnormalities. This series includes 153 patients with Hodgkin's disease, 95 with acute lymphocytic leukemia, 28 with lymphoepithelioma, and 22 with miscellaneous tumors. Inclusion in the study required 5 years of disease-free survival following therapy for their original tumor, which included thyroid irradiation. Follow-up has been 100%. Most patients also received chemotherapy. Seventeen patients were found to have decreased thyroid reserve with normal levels of free triiodothyroxine (T3) or free thyroxin, (T4) and an elevated level of thyroid-stimulating hormone (TSH). In nine patients hypothyroidism developed, with decreased T3 or T4 levels and an elevated level of TSH. One hyperthyroid patient was identified. Two patients had thyroiditis, and seven had thyroid neoplasms: (carcinoma in two, adenoma in two, colloid nodule in one, and undiagnosed nodules in two). This survey has demonstrated an increased incidence of thyroid dysfunction and thyroid neoplasia when compared to the general population. The importance of long-term follow-up for thyroid disease is emphasized in patients who have received thyroid irradiation. The possible role of subclinical hypothyroidism with TSH elevation coupled with radiation damage to the thyroid gland as a model for the development of neoplastic disease is discussed.

The role of surgical resection when combined with chemotherapy and radiation in the management of pelvic rhabdomyosarcoma

With the development of combined chemotherapy and radiation therapy for embryonal rhabdomyosarcoma, the role and extent of surgical resection of these pelvic tumors need to be defined. Thirty-six children with pelvic genitourinary rhabdomyosarcoma seen at St. Jude Children's were managed on protocols combining surgical resection and radiation, and chemotherapy. Ten children presented with cervical-vaginal tumors, which were managed with combined therapy; the surgical resection was histovaginectomy in eight and pelvic exenteration in one. Eight of the ten are free of disease from 1 to 14 years. Twelve children presented with bladder and prostate tumors, which were resected with segmental cystectomy in four cases, biopsy in five, and pelvic exenteration in three. All received combination therapy and six of the twelve are surviving free of disease from 6 months to 16 years. Fourteen children presented with paratesticular rhabdomyosarcoma. Chemotherapy was combined with radical orchiectomy in all cases. Retroperitoneal node dissection was done in nine and five had inguinal node dissection. Nine of the 14 are surviving NED from 2 to 16 years. One patient died, free of disease, with complications of combination therapy. The results of this review supports the approach of combining chemotherapy, radiation, and complete surgical resection.

Children's capacity to correct grammatical violations in sentences

Previous studies of children's knowledge of grammatical well-formedness have typically involved eliciting acceptability judgements from children. In the present study, children were expected to employ their tacit knowledge of the rules of grammar to correct sentences containing grammatical rule violations. Two groups of children (mean ages of 5;5 and 6;4) were presented with ungrammatical sentences resulting from either word-order changes or morpheme deletions. The results indicated that both groups of children performed well when presented with ungrammatical sentences containing morpheme deletions; but the performance of both groups was lower for the word-order violations, with the difference between the two types being greater for the 5-year-olds. It is argued that these results reflect differences in the extent to which the two types of rule violations rendered the original sentences meaningless.

Ventricular antiarrhythmic effects of beta-adrenergic blocking drugs: a review of mechanism and clinical studies

Beta-adrenergic blocking drugs are now commonly used in patients with ventricular arrhythmias. This review examines the possible mechanisms of their ventricular antiarrhythmic effect. Actions on the myocardial cell, as well as actions on the central and autonomic nervous system, are reviewed. Many clinical studies have attempted to show the efficacy of beta blockers in controlling ventricular arrhythmia and decreasing the incidence of sudden death after acute myocardial infarction. Although some of these clinical trials tended to show an impact on sudden death, the size of these trials or their design problems do not allow firm conclusions to be made. The Beta Blocker Heart Attack Trial (BHAT) is a placebo-controlled, double-blind, randomized trial of propranolol currently under way in the United States. Important additions to the previous trials include the addition of drug levels to ensure beta-blocking dosage, long-term electrocardiographic monitoring, and a study population of 4200 patients followed for an average of three years. These important design features will be of value in addressing some of the unanswered questions presented in this review.

Short- and long-term therapy of mild essential hypertension with timolol

The short and long-term antihypertensive action of timolol, a beta blocker, was assessed in 36 mild hypertensives in a 32-wk, double-blind, placebo-controlled study followed by an additional 96 wk of timolol in 17 responders. Diastolic blood pressure (DBP) and heart rate (HR) declined during the first phase from 103 to 93 mm Hg and from 73 to 61 bpm (P less than 0.01) but there was long-term timolol subjects (DBP 89 mm Hg at 32 wk and 88 mm Hg at 96 wk [NS] and HR 62 and 65 bpm [NS]). Although stimulated plasma renin activity in the entire group decreased from 1.08 to 0.28 ng/ml/hr (P less than 0.001), blood pressure reduction did not correlate with this decline (r = 0.29) or with serum timolol level (r = 0.29). In 20 patients who underwent treadmill was not altered. Thus, timolol is effective in reducing mild high blood pressure during short-term therapy and in maintaining this effect over the long term in responsive subjects. It is therefore potentially useful in chronic essential hypertension.

Normal computed tomograms of the brain in osteosarcoma patients treated with high-dose methotrexate

Eighteen patients with osteosarcoma, most of whom were adolescents, were examined for abnormalities of the brain by use of computed axial tomography. These studies were performed at 15-60 months (median 47 months) after the completion of adjuvant chemotherapy, which included high-dose methotrexate, cyclophosphamide, and Adriamycin. No abnormalities were found. The results of this study, together with the absence of brain lesions in published reports in children receiving high-dose methotrexate but no cranial irradiation, indicate that delayed neurotoxicity is not a major complication of this form of therapy in older children.

Kinetics and regulation of cell-free alkaline phosphatase synthesis

Regulation of alkaline phosphatase (EC 3.1.3.1) synthesis in a cell-free system from Escherichia coli has been observed. Synthesis from transducing phage deoxyribonucleic acid templates carrying phoA+ occurred in S30 fractions from wild-type or alkaline phosphatase-constitutive mutants. It did not occur in S30) fractions from alkaline phosphatase-negative mutants (phoB). The hybrid gene phoA-lacZ was also subject to phoB control, implying that phoA transcription is regulated. The yield of active alkaline phosphatase per phoA+ gene copy from cell-free synthesis was similar to that of beta-galactosidase. Alkaline phosphatase activity took longer to appear than beta-galactosidase activity. Synthesis of alkaline phosphatase subunits was not delayed, suggesting that a minimum number of subunits are synthesized before formation of active alkaline phosphatase occurs.

Stage-related combined modality treatment of retinoblastoma. Results of a prospective study

Forty-two consecutive patients with retinoblastoma were evaluated by a new staging system and combined modality therapy instituted according to stage. Nineteen patients had bilateral tumors and 23 had unilateral tumors. The staging system was effective in identifying subpopulations of patients and successfully predicted those at greater risk of recurrence or death. Thirty-nine of 42 patients survive (Median survival time, 42 months). Two of 4 children with tumor extension beyond the eye died while 37 of 38 children with tumor presumed confined to the eye survive. Toxicity of the chemotherapy was mild. Radiation therapy of intraocular tumor was associated with cataract formation but most children had satisfactory vision after extraction and the use of corrective lenses. Ophthalmologic findings did not always correlate with histologic extent of tumor and both should be used in planning and evaluating treatment. Recommendations are made on the role of chemotherapy and the need to reduce the morbidity of treatment.

Effect of megestrol acetate on uroflow rates in patients with benign prostatic hypertrophy: double-blind study

Sixty-one patients with benign prostatic hypertrophy (BPH) and decreased maximum and mean urine flow rates were randomly assigned to megestrol (Megace, 120 mg./day) or placebo therapy. The patients were studied over a five-month period with maximal and mean urine flow rates every two weeks. The patients on megestrol demonstrated significant increases in maximum and mean urine flow rates from the sixth through the twentieth weeks compared with their own control baseline values; the placebo-treated patients showed no significant changes in mean flow rates at any time point over the twenty weeks in comparison with their own baseline control values; maximum flow rates in placebo-treated patients did demonstrate statistically significant increases above their own control baseline values at eight, twelve, eighteen, and twenty weeks. Megestrol-treated patients, in comparison with the placebo group, showed statistically significant increases in maximum flow rate at fourteen, sixteen, and twenty weeks after therapy, and statistically significant increases in mean flow rate over the placebo patients at ten, twelve, fourteen, and twenty weeks. Clinical symptoms improved in 78 per cent of the megestrol-treated patients and 57 per cent of the placebo-treated patients. The side effects of megestrol were minimal except for loss of libido in 70 per cent of patients.

Successful chemoprophylaxis for Pneumocystis carinii pneumonitis

In a randomized, double-blind, placebocontrolled study to evaluate the efficacy of trimethoprim-sulfamethoxazole for the prevention of Pneumocystis carinii pneumonia, we studied 160 patients with cancer who were at high risk for this pneumonia over a two-year period. Seventeen of the 80 patients receiving a placebo acquired P. carinii pneumonitis, whereas none of the 80 given 150 mg of trimethoprim and 750 mg of sulfamethoxazole per square meter per day had the infection P less than 0.01). Bacterial sepsis, pneumonia other than that caused by P. carinii, acute otitis media, upper-respiratory-tract infections, sinusitis and cellulitis occurred less frequently in recipients of the drug than in the placebo group (P less than 0.01 in each case). Oral candidiasis was the only adverse effect ecountered from trimethoprim-sulfamethoxazole administration. The study shows the combination to be highly effective in the prevention of P. carinii pneumonitis.

Epipodophyllotoxin VM-26 in the treatment of childhood neuroblastoma

Thirteen children with disseminated neuroblastoma that had become refractory to conventional chemotherapy were treated with the epipodophyllotoxin VM-26. Three patients developed partial responses (greater than 50% reductions in tumors and in the proportion of tumor cells in bone marrow). Acute nonhematologic toxicity after treatment was minimal. Hematologic toxicity was observed but could not be assessed accurately since most patients had abnormal hematopoiesis due to extensive tumor involvement of bone marrow. These results demonstrate that VM-26, as a single agent, can produce measurable tumor responses in children with neuroblastoma.

Complementation test between alkaline phosphatase regulatory mutations phoB and phoRc in Escherichia coli

A phoRc and a phoB mutation belong to the same complementation group suggesting that there is a single positive control gene for alkaline phosphatase synthesis.

Adjuvant multiple drug chemotherapy for osteosarcoma of the extremity

Results of treatment for osteosarcoma of the extremity have been poor with metastases usually causing death within 2 years following diagnosis. Because of the great risk of development of metastases, 20 patients have received adjuvant chemotherapy with Adriamycin, cyclophosphamide and high-dose methotrexate-leucovorin rescue for up to 12 months following amputation for osteosarcoma. Sixteen of these patients are surviving; 11 are free of evident tumor from 6 to 34 months following amputation. Five patients were found to have pulmonary metastases while receiving chemotherapy and three patients developed metastases following completion of chemotherapy. One patient died following her third treatment with high-dose methotrexate-leucorovin rescue. Other toxicity included nausea, vomiting, mucosal ulcerations, infections, hematologic abnormalities, changes in kidney and liver functions tests, and minor coagulation abnormalities. The natural history of osteosarcoma may have been modified by the use of these agents for periods exceeding the median time to predicted detection of pulmonary metastases. Microscopic metastases of some patients were eradicated by this adjuvant chemotherapy. For patients who developed metastases, these metastases were delayed in their time of detection and in their number at the time of detection.

Immunotherapy of osteosarcoma patients with virus-modified tumor cells

Twelve patients 11-20 years of age with recurrent osteosarcoma were immunized with either autologous or allogeneic tumor cells infected with influenza virus, strain B/Michigan or A/Port Chalmers. Six patients received only the vaccine, and the remaining six patients continued to receive methotrexate chemotherapy. The main objectives of this study were to determine if immunizations were toxic, if antibodies developed to the influenza virus antigen component of the vaccine, if this vaccine increased tumor-specific cellular and humoral immunity, and if the increase in immune response could be correlated with clinical course and prognosis. In all 12 cases, toxicity was negligible, and immunizations boosted antibody titers to both tumor cell and influenza virus antigens. However, in four of the six patients with advanced disease who received immunotherapy only, the vaccine did not stimulate mixed lymphocytes nor did it increase cell-mediated immunity. By contrast, five of six patients with minimal disease who continued methotrexate therapy developed cellular and humoral immunity in response to both allogeneic and autologous tumor cells. Although no clear-cut relationship between responses to the tumor cell vaccine and clinical course and prognosis could be demonstrated, three of the six patients with minimal disease have survived for 7-8 months after the first vaccination, without progression of disease. This study demonstrates that plasma membrane preparations derived from different lines of virus-infected osteosarcoma tumor cells will elicit an antibody response in patients with drug-resistant progressive osteogenic sarcoma.

Genetic analysis of regulatory mutants of alkaline phosphatase of E. coli

A fine structure map of the phoR region of E. coli, mutations of which affect the rate of alkaline phosphatase synthesis, was constructed by Hfr X F- crosses. Mutations causing three different phenotypes (previously reported as phoRa, phoRb, phoRc (Garen and Echols 1962a,b) are clustered in three closely linked genetic loci. PhoR mutants of all three types, including the phoRb type not previously tested, are recessive to wild-type phoR+. In addition, phoRa and phoRc complement each other, while phoRa and phoRb do not. Our results support the hypothesis of Morris et al. (1974) that phoRc mutants represent a cistron (phoB) different from phoR.

4'-demethylepipodophyllotoxin 9-(4,6-o-2-thenylidene-beta-D-glucopyranoside) (NSC-122819; VM-26) and 4'-demethylepipodophyllotoxin 9-(4.6-0-ethylidene-beta-D-glucopyranoside) (NSC-141540; VP-16-213) in childhood cancer: preliminary observations

We evaluated the responses of 39 children with cancer who, after failure to respond to conventional chemotherapeutic agents, received either or both of two epipodophyllotoxins: 4'-demethylepipodophyllotoxin 9-(4,6-o-2-thenylidene-beta-D-glucopyranoside) (NSC-122819) and 4'-demethylepipodophyllotoxin 9-(4,6-o-ethylidene-beta-D-glucopyranoside) (NSC-141540). Seventeen patients has acute lymphocytic leukemia (ALL). 12 had acute nonlymphocytic leukemia (ANLL), and ten had solid tumors. Initially, the patients in each disease category were randomized to receive 50 mg/m2/dose of NSC-122819 intravenously (iv) twice weekly or 75 mg/m2/dose iv of NSC-141540 twice weekly for 4 weeks. Drug dosages and schedules of administration were adjusted during the course of the study. Although objective responses were not detected in the heterogeneous group of solid tumor patients, definite clinical responses were obtained in nine of the 29 patients with acute leukemia. The responses to the two epipodophyllotoxins were noted in patients with ALL as well as in patients with ANLL. Toxic side-effects included nausea, vomiting, diarrhea, fever, alopecia, leukopenia, and thrombocytopenia. These results, the first reported with both NSC-122819 and NSC-141540 in childhood cancer, indicate that the epipodophyllotoxins are well tolerated and may be effective against acute leukemia.