Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study

The aim of this cohort study was to assess the risk of developing cancer, specifically leukaemia, tumours of the central nervous system and lymphoma, before the age of 15 years in children previously exposed to computed tomography (CT) in Germany. Data for children with at least one CT between 1980 and 2010 were abstracted from 20 hospitals. Cancer cases occurring between 1980 and 2010 were identified by stochastic linkage with the German Childhood Cancer Registry (GCCR). For all cases and a sample of non-cases, radiology reports were reviewed to assess the underlying medical conditions at time of the CT. Cases were only included if diagnosis occurred at least 2 years after the first CT and no signs of cancer were recorded in the radiology reports. Standardised incidence ratios (SIR) using incidence rates from the general population were estimated. The cohort included information on 71,073 CT examinations in 44,584 children contributing 161,407 person-years at risk with 46 cases initially identified through linkage with the GCCR. Seven cases had to be excluded due to signs possibly suggestive of cancer at the time of first CT. Overall, more cancer cases were observed (O) than expected (E), but this was mainly driven by unexpected and possibly biased results for lymphomas. For leukaemia, the SIR (SIR = O/E) was 1.72 (95 % CI 0.89-3.01, O = 12), and for CNS tumours, the SIR was 1.35 (95 % CI 0.54-2.78, O = 7). Despite careful examination of the medical information, confounding by indication or reverse causation cannot be ruled out completely and may explain parts of the excess. Furthermore, the CT exposure may have been underestimated as only data from the participating clinics were available. This should be taken into account when interpreting risk estimates.

Ungewöhnliche Fingergelenkdestruktionen nach Radiosynoviorthese (RSO) und Cortisoninjektionstherapie bei Bouchard-Arthrose

Starting in 1998, a female patient suffering from activated Bouchard arthrosis was treated with intra-articular steroid injections into digits of both hands. In September 2001, an additional therapy with erbium-169 injections into the same joints was begun. The injections were continued until March 2003. No benefit was observed. Instead, severe destruction of the involved joints with articular necroses and marked periarticular calcifications had occurred. The course of events are documented by plain film examinations.

CONCLUSIONS

The indication for alternating steroid injections and radio-synovectomies in patients with activated Bouchard arthrosis has to be reconsidered. In vivo and in vitro experiments are necessary to evaluate the potential harms of this combination of therapies. A close clinical and radiological control of treatment outcome with reevaluation of the indication is necessary.

[Complicated malaria tropica in an infant]

We report on a five month-old infant from Cameroon, who was admitted because of febrile gastroenteritis after living in Germany for two weeks. Since the patient was somnolent, had a parasitaemia of Plasmodium falciparum of 230,000/microliter, a haemoglobin concentration of 5.3 g/dl and a thrombocytopenia, a complicated falciparum malaria was diagnosed. Treatment was started immediately with intravenous 20 mg quinine/kg bw as a loading dose, followed by 10 mg/kg bw every 12 hours, combined with intravenous clindamycin 10 mg/kg bw bd. Red blood cells were transfused once. The parasitaemia dropped to 2000 trophozoites/microliter within 48 hours. No asexual stages were detectable from the third day of treatment on. Weekly controls for the following four weeks remained negative. The mortality rate of complicated malaria is 50% in the first year of life, which can be reduced by early treatment. We present this case to draw attention to therapeutic options in infants.

Influence of low-dose aprotinin on the inflammatory reaction due to cardiopulmonary bypass in children

BACKGROUND

The serine protease inhibitor aprotinin inhibits trypsin, kallikrein, and plasmin and enhances the complement hemolytic activity of the first complement component C1. We tested whether low-dose aprotinin influences the inflammatory reaction related to cardiopulmonary bypass.

METHODS

In an open, randomized study, 25 children undergoing cardiac operations were investigated prospectively. The treated group comprised 11 patients receiving low-dose aprotinin (20,000 kIU/kg [2.8 mg/kg]), and the control group included 14 patients. Complement activation, cytokine production, and leukocyte stimulation were analyzed before, during, and after cardiopulmonary bypass.

RESULTS

In all children, significant C3 conversion and C5a generation, interleukin-6 synthesis, and myeloperoxidase, eosinophil cationic protein, and histamine liberation occurred in relation to cardiopulmonary bypass. This was not influenced by aprotinin treatment. In contrast, neutrophil kinetic studies at the end of cardiopulmonary bypass showed a significantly lower increase in the aprotinin as compared with the control group.

CONCLUSIONS

Our results suggest that low-dose aprotinin has little influence on the inflammatory reaction induced by cardiopulmonary bypass. Aprotinin affects neutrophil mobilization but not white blood cell degranulation related to cardiopulmonary bypass, and has no influence on complement activation and interleukin-6 synthesis.