[Validation of the combined SF36/MSQOL test of evaluation of quality of life in migraine patients in France]

The impact of migraine on patients quality of life is great, even between attacks. The aim of this study was to assess the properties of a French language quality of life questionnaire, which associates the Medical Outcome Study Short Form (MOS SF 36) with the Migraine-Specific Quality of Life (MSQOL). Data were obtained from 110 consultant patients of neurology units located in three University hospitals in the center of France. The results indicated a good acceptability of the association of the two questionnaires with a 84p.cent response rate. The Principal Component Analysis showed no change in both SF-36 and MSQOL structures. It also suggested that the two questionnaires were complementary. The high values of the Cronbach alpha coefficients for each scale indicated a high level of internal consistency. The quality of life scores were correlated with external parameters such as frequency, intensity and length of migraine attacks, and social activity reduction due to these attacks. In conclusion, the association of the SF-36 with the MSQOL has the interest of associating generic and specific questionnaire, in a complementary way. This association has good psychometric properties, and can be used to evaluate migraineurs quality of life in French speaking countries.

Morphological Investigations on Carbon-Black Particles by Atomic Force Microscopy

The atomic force microscope (AFM) can profile surfaces similar to the scanning tunneling microscope (STM) at resolutions down to the atomic level. To investigate carbon-black particles and subsequently styrene-butadiene-rubber, filled with carbon black, a STM was modified to run as an AFM. An optical detection system is used to measure the deflection of the cantilever. Atomic resolution was achieved by forces in the order of 5·10−8 N on mica with the AFM. Structural investigations of carbon-black particles of different dimensions with the AFM agree with the data of the manufacturer. The model of the microstructure of such particles, built up of 1–3 nm large, tilted domains of graphite structures, could be confirmed. This surface roughness is probably an important parameter for the strengthening mechanism of carbon black in elastomers.

[Foreign body aspiration in childhood]

Damage to the airways and lung parenchyma from aspiration is a common clinical problem with diagnostic and therapeutic challenges. The insult may be acute or chronic. The amount of concentration, chemical composition, and size of particles vary, and the lesion produced may be reversible or irreversible. Death may be immediate or late. Recovery may be complete, or crippling pulmonary disease may follow. In this review is reported on the aspiration of foreign bodies or liquids into the respiratory tract. Specialty: in infancy, esophageal foreign bodies may cause mainly respiratory symptoms. Adequate diagnosis and therapy are discussed.

[Cystic fibrosis and pregnancy. Current results of a study (1980-1990)]

This study is a recent collection of data on 19 women with cystic fibrosis who became pregnant between 1980 and 1990. The following data have been recorded:--age at diagnosis, progress of disease prior and during pregnancy, and during confinement. Satisfactory clinical score values and the fact that the mean age at diagnosis was 10.5 years indicated a less serious nature of the disease in the group studied. Pregnancy was complicated by pulmonary exacerbations and by poor weight gain in two thirds of cases. No maternal deaths during pregnancy and delivery were recorded. Abortions were induced in two pregnancies. More than one third of newborns were premature. It is noteworthy that of the 22 infants 16 were male. All of the children had negative sweat chloride tests. Eleven women could breast feed successfully. In twelve cases the mother's state of health deteriorated after pregnancy, and did not return to that before gravidity.

[Diagnostic aspects in child abuse]

In connection with diagnostic and treatment of children the paediatrician may also be confronted with suspected by or certainly abused children. In those cases an evidence on necessary legal consequences will be useful. Anamnesis, examination and radiography have traditionally been used to assess the injuries of abused children. Sceletal scintigraphy should be the screening procedure of choice for children with bone injuries suspected or certainly having been abused. Cranial computer tomography is a recent method to detect intracranial lesions and cerebral late effects due to violence in abused children.

[Lung scintigraphy after tumor therapy in childhood]

Cytostatics- and radiation-induced alterations of the lung were investigated in 18 children after tumour-therapy by means of lung perfusion scintigraphy. 13 patients (Hodgkin- and non Hodgkin lymphoma, acute lymphocytic leukemia with mediastinal tumour, Ewing-sarcoma, and intrathoracal neuroblastoma) received epidiaphragmatical radiation and cytostatics. All 32 lung-scintigrams of these children 1-23 months after cessation of therapy were pathological. 5 patients (acute lymphocytic leukemia, Histiocytosis X) received cytostatics only. 1-6 months after cessation of therapy in these children 6 lung-scintigrams were pathological, one was normal. After cessation of tumour-treatment scintigraphical improvement of disturbed perfusion occurred in 9/18 patients only. In 6 children a deterioration of lung-perfusion was registered. Lung-scintigraphy is a method for testing pulmonary perfusion in diagnosis and therapy control in childhood malignancies. The results of this study indicate that prophylactic provisions against pulmonary damage during oncologic therapy are necessary.

[Ocular symptoms and leukemia in childhood]

Findings in a total of 200 children suffering from leukemia were evaluated. Ocular symptoms were found in 26% of the cases. Typically, fundus hemorrhages were found in the initial stage, leukemic infiltrates in the final stage and papilledema in the meningosis leucaemica stage. In patients with ophthalmologic changes the survival time was shorter than in patients with no ocular involvement. Ophthalmological "dispensaire" treatment is generally recommended.

Meningosis prophylaxis with intrathecal 198Au-colloid and methotrexate in childhood acute lymphocytic leukemia

Since 1972, telecobalt irradiation plus intrathecal methotrexate (ITMTX) has been successfully replaced in Jena by intrathecal colloidal radioactive gold (198Au) plus ITMTX for meningosis prophylaxis in leukemia. Seventy-three children with acute lymphocytic leukemia (ALL) were given 1.24-4.89 mCi (45.8-181 MBq) of colloidal 198Au IT after successful initiation of remission. During cytostatic therapy, the following relapses occurred: meningosis leucaemica, five patients (6.8%); bone-marrow relapse and the meningosis leucaemica, one patient; and bone-marrow relapse, 20 patients (27.4%). In 18 children, combination chemotherapy was terminated after two and a half or three years of treatment. After that time, one meningeal relapse and six bone-marrow relapses occurred. Within the first 24 hours after application of radioactive gold, headaches, vomiting, and fever occurred in less than 10% of the children. An apathy syndrome, leukecephalopathy, or severe infections, were not observed in a single case. Radioactive gold spreads in the subarachnoid space and is phagocytized by the arachnoidea. The tumoricide effect extends selectively over the space of distribution of the latent meningosis leucaemia. The cerebral parenchyma remains unaffected by radiation. Thus, radioactive gold may be preferable to telecobalt irradiation in preventing central nervous system leukemia.

[Lung-scintigraphy in the control of children with malignancies treated by radiochemotherapy (author's transl)]

Cytostatics- and radiation-induced alterations of the parenchyma of the lung were investigated in 30 children with malignomas before, during and after therapy by means of lung perfusion scintigraphy. Before the tumour-therapy (2 children) lung-scintigrams were regular. 16 children (Hodgkin- and non Hodgkin-lymphoma, acute lymphocytic leukemia with mediastinal tumour, intrathoracal neuroblastoma and Ewing-sarcoma) received epidiaphragmatical radiation and cytostatics. All 35 lung-scintigrams of these patients (1-60 months after beginning of therapy) were abnormal. Within 6 months after radiation obstructions to perfusion could be demonstrated in ray-treated parenchyma of the lung only. Subsequent to 6 months after radiation, during cytostatics, disturbances of perfusion were diffusely spreading in the lung parenchyma. 12 children (acute lymphocytic leukemia, Histiocytosis X and osteogenic sarcoma) received cytostatics only. All 18 lung-scintigrams of these patients (1-55 months after beginning of therapy) were pathological. After cessation of therapy (radiochemotherapy or chemotherapy only) scintigraphically improvement of perfusion occurred in the majority of patients. Obviously the diffusely spreading obstructions to perfusion represent alterations during the early phase of their development induced by chemotherapy.

[Cessation of treatment in childhood acute lymphatic leukemia. Long-term observations after meningosis prevention with intrathecal gold colloid radioisotopes and methotrexate]

Cytostatic long-term treatment for about 36 months was administered to 18 children with acute lymphatic leukaemia who were in long-term remission (43-98 months). Prophylaxis of meningosis involved intrathecal 198Au colloid and methotrexate. Seven recurrences occurred during the long-term remissions: the bone marrow was involved six times, leukaemic meningosis occurred once. Five out of seven recurrences occurred within one year of cessation of treatment. There were no complications induced by intrathecal radio-gold, such as the apathy syndrome or leukoencephalopathy. Intrathecal methotrexate led to side effects before administration of radio-gold: encephalopathy twice, paraplegia once. Symptoms regressed completely in two children, one child with encephalopathy continues to have symptoms. All three children were given 198Au colloid intrathecally thereafter which was tolerated very well. 198Au colloid represents an alternative for prophylaxis of meningosis with 60Co telecobalt irradiation in leukaemias and non-Hodgkin lymphomas in childhood.

[Cerebral computed tomography in acute childhood leukemias]

It is suggested that cranial computerized (axial) tomography permits a more complete neurologic work-up for all children with acute leukemia. It also permits a better knowledge of the frequency and varieties of cerebral complications in leukemia. Endocranial complications in acute leukemia are essentially infiltrative, hemorrhagic, infectious or iatrogenic. Cranial computerized tomography can demonstrate cerebral changes in meningeal leukemia, hemorrhages, calcifications, brain atrophy or leukencephalopathy. The preliminary results of cranial computerized tomography in childhood leukemia suggest that the iatrogenic main lesion of the brain due to combined radiation-chemotherapy is atrophy whereas that of the intrathecal cytostatic therapy is demyelination. Accurate diagnostics and control of possible cerebral complications in therapy of leukemia is essentially for appropriate therapeutic management. For that cranial computerized tomography may be the best method to a effective exploration of the brain.

["Prophylactic" intrathecal radiogold (198au) in leukaemia in children (author's transl)]

198Au radiogold-colloid (Behring) was injected as "prophylactic" therapy against central nervous system leukaemia in 26 children with acute leukaemia (22 acute lymphatic and 4 myeloid). During the period of observation (1.3. 1972 to 1.9.1975), 23 children remained free of central nervous system recurrences: 16 children are alive 3 to 39 1/2 months later, seven died after 4 1/2 to 29 1/2 months from the underlying disease. In one child CNS leukaemia developed after about five months, in another one during a second haematological recurrence, while the third one developed retrobulbar infiltration in the optic nerve. In general, 2 mCi 198Au gold-colloid was injected intrathecally via a lumbar puncture. The method was well tolerated.