Progressive facial hemiatrophy. Report of a case associated with Ewing's sarcoma

A child with progressive facial hemiatrophy (PFHA) later had Ewing's sarcoma develop. During seizures presumably related to her PFHA, she suffered pathologic fractures on two occasions. The second of these might have been avoided had her condition been better understood.

Reversal of protein-energy malnutrition in children during treatment of advanced neoplastic disease

The effectiveness of enteral and parenteral feeding in supporting a satisfactory nutritional status and/or reversing protein-energy malnutrition was evaluated in 28 children, ages 1-19 (14 female) with advanced malignant disease (21 solid tumors, 7 leukemia-lymphoma). At the onset of treatment, 21 patients received intensive nutritional counseling (INC) and oral supplementation while seven received total parenteral nutrition (TPN). Sixteen of 21 patients who received INC had a decreased intake (x 48 +/- 24%) Recommended Dietary Allowances (RDA) for kilocalories and dramatic weight loss (x 16.4 +/- 12.4%). A total of 18 patients received TPN for a mean of 24 days (7-60); kcal averaged 90 +/- 26% RDA during weight gain. At onset of TPN, the mean serum albumin, transferrin and total lymphocyte counts were 3.06 +/- 0.38 g/dl, 175 +/- 62 mg/dl, and 1102 +/- 966/mm3 respectively, 15/18 children had subnormal anthropometric measurements and 17/18 patients were anergic to recall skin test antigens. TPN for less than 9-14 days neither repleted weight, skinfold reserves, nor serum albumin concentrations (greater than 3.2 g/dl) although an early increase (p less than .02) in transferrin concentration was observed. However, TPN for 28 days supported weight gain (3.27 kg, 16 +/- 6%), increased serum albumin (0.62 +/- 0.43 g/dl, p less than .001) and transferrin (62 +/- 42, p less than .002) to normal concentrations and reversed anergy in 7/11 patients retested. This study documents the severity of protein energy malnutrition which accompanies intense treatment of children with cancer and the nutritional and immunological benefits of a 28 day course of TPN.

[Primary and secondary perosteal reactions (author's transl)]

Radiological and histological comparative analysis of the morphological changes of periosteal reaction. A distinction is made between secondary periosteal reaction (so called periostitis ossificans or osseous periostosis), primary periosteal lesions (due to inflammation, trauma, fibrosis and neoplasia) and soft tissue lesions involving the adjacent periosteum. Secondary periosteal reactions are most frequent, indicating the need for search of its cause. Here biopsy of the periosteal reaction is often important for establishing an early diagnosis.

Systemic venous blood return via the portal vein

The patterns of collateral circulation which develop following obstruction of the inferior vena cava have been classically divided into three groups depending upon the level of obstruction, i.e., infrarenal, middle caval, and upper caval. The portal vein can play an active role at all three levels. Multiple potential routes to the portal vein are described and 6 cases are presented.

Ultrasound-guided percutaneous nephrostomy in the pediatric patient

Percutaneous nephrostomy drainage may be established rapidly using ultrasonic guidance in severely ill pediatric patients with obstructive uropathy. B-mode ultrasonography has proved to be rapid, accurate and free of irradiation hazards, making it applicable to children with little or no sedation.

Pleural effusion secondary to tumor regression

2 patients with metastatic cancer (Ewing's sarcoma and breast cancer) developed pleural effusions while undergoing systemic therapy for pulmonary metastases. Thoracenteses failed to reveal malignant cells and in both instances the characteristics of the fluids were those of transudates. The effusions developed in association with dissolution of pulmonary lesions and presumably represent a reactive process to tumor regression.

Metastatic Ewing sarcoma to the heart simulating adriamycin cardiotoxicity

A 20-year-old man with metastatic Ewing Sarcoma developed severe congestive heart failure. Because he had been treated with a large amount of Adriamycin, the diagnosis was initially thought to be Adriamycin cardiotoxicity. However, ante- and post-mortem studies revealed the presence of massive cardiac metastases. At post-mortem, there was no evidence of Adriamycin cardiotoxicity. This case emphasizes that cardiac metastases must be considered in the differential diagnosis of heart failure in patients treated with Adriamycin.

Ewing's tumour: uncommon presentation of an uncommon tumour

A case of Ewing's sarcoma presenting with high cervical cord compression is described and disseminated disease was present at the time of diagnosis. A combination of radiotherapy and chemotherapy did not result in a cure. The current treatment of Ewing's sarcoma is briefly reviewed.

Prolapse of the mitral valve is described in two patients with the Ebstein's anomaly of the tricuspid

Prolapse of the mitral valve is described in two patients with the Ebstein's anomaly of the tricuspid valve. This association has not been described previously. It is probable, however, that this association is not a rare one, but that clinical features of the prolapsing mitral valve are obscured by those resulting from the malformed tricuspid valve. Opportunity also was provided to study anatomically the mitral valve of a patient known to have a systolic click and a late systolic murmur (the Barlow syndrome). Although there have been several anatomic descriptions of floppy mitral valve at necropsy, they have been extremely rare in patients known to have the classic auscultatory features of the Barlow syndrome.

[Childhood facial paralysis due to tumours (author's transl)]

Facial nerve palsy due to malignant tumours is uncommon in childhood and adolescence. If present the malignancy may be primary or metastatic, and usually brain tumours, leukaemias, or lymphosarcomas are found. Rhabdomyosarcomas, parotid malignancies, Ewing's sarcomas, Wilms' tumours and neuroblastomas are rare. The nerve lesion may be due to direct tumour infiltration, external pressure on the nerve and secondary ischaemia. In disseminated malignancy the lesion is usually due to extending intraneural infiltration and all parts of the nerve may be affected. If facial nerve palsy coexists the prognosis in childhood malignancies is extremely poor.

Ewing's sarcoma as a cause of the syndrome of inappropriate secretion of antidiuretic hormone

A patient with Ewing's sarcoma presented with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (1). Plasma values for vasopressin were found to be over four times the normal values expected for the plasma osmolality. At postmortem examination, the arginine vasopressin concentration in the tumor tissue was ten times that of the plasma. These data suggest that Ewing's sarcoma may cause SIADH.

Ewing's sarcoma simulating vertebra plana

Five cases of vertebra plana have been reported, three with spontaneous regeneration and two caused by Ewing's sarcoma. It is emphasized that the diagnosis eosinophilic granuloma must rely on surgical biopsy.

Aneurysmal bone cyst secondary to other osseous lesions. Report of 57 cases

Fifty-seven aneurysmal bone cysts which were associated with or secondary to other lesions of bone are reported. The most common associations were with solitary or unicameral bone cyst, and with osteoclastoma. Other associated lesions included osteosarcoma, nonosteogenic fibroma, osteoblastoma, hemangioendothelioma, and hemangioma of bone. Five aneurysmal bone cysts were secondary to fracture or other bone trauma.

Malignant disease in children whose mothers had chickenpox, mumps, or rubella in pregnancy

To test the hypothesis that leukaemia may follow virus infection in pregnancy an analysis was made of deaths which occurred in a cohort of children born in 1951 and 1952 after pregnancies in which the mothers suffered virus infections-chickenpox or mumps at any stage of gestation or rubella in the first 18 weeks. All deaths which occurred between the children's second birthday and the end of 1971 were studied.Two deaths from leukaemia occurred among the children whose mothers suffered from chickenpox, a significant excess. There were no deaths from leukaemia among the other children, but the causes of the two deaths after maternal mumps-Ewing's tumour and Still's disease-are noted because of their rarity.