Neuropsychologic functioning of survivors of childhood medulloblastoma randomized to receive conventional or reduced-dose craniospinal irradiation: a Pediatric Oncology Group study

PURPOSE: The purpose of this study was to test the hypothesis that survivors of medulloblastoma who were younger at diagnosis and those who received standard-dose cranial irradiation (SRT) of 36 Gy would have a lower performance on standardized tests of cognitive function and achievement than children who were older and those treated with reduced-dose cranial irradiation (RRT) of 23.4 Gy. PATIENTS AND METHODS: Eligible patients had been treated on Pediatric Oncology Group (POG) study 8631 for low-risk medulloblastoma that randomized patients to receive RRT or SRT after surgical resection. Those who were alive and free of progressive disease 6.1 to 9.9 years from completion of treatment were eligible for this study. Of the 35 eligible patients, 22 patients (13 SRT, nine RRT) participated in a battery of tests that included intellectual and academic development as well as ratings of health-related quality of life. RESULTS: Patients were stratified by treatment group (SRT v RRT) and into younger (Y) and older (O) groups by the median age at diagnosis (8.85 years), which resulted in four groups that we hypothesized would show neuropsychologic test scores in the following order: Y/SRT less than Y/RRT less than O/SRT less than O/RRT. Evidence to support the hypothesized ordering of groups in terms of neuropsychologic toxicity was obtained with regard to Performance Intelligence Quotient (IQ), Full Scale IQ, Attention, Reading, and Arithmetic. CONCLUSION: Children treated for medulloblastoma experienced less severe neuropsychologic toxicity when treated with 23.4 Gy instead of 36 Gy cranial irradiation. Older children experienced less toxicity than children who were younger at the time of irradiation.     

Comparison of outcome of stroke patients--cerebral ischaemic versus cerebral haemorrhagic from the standpoint of a physiatrist

Thirty patients having hemiplegia arising out of stroke were considered for the study. There were 15 patients each of cerebral infarction and cerebral haemorrhage. The patients were evaluated initially and 6-8 weeks after the first visit for neuromuscular function and activity of daily living following the schedule of Feldman et al and Barthel index respectively. After determining neuromuscular function the patients were graded as 'not impaired', 'mild to moderately impaired' and 'moderate to severely impaired' taking into account of muscular function, spasticity and disabling contracture. In determining activity of daily living the patients were divided into 'A' to 'E' categories depending on the score (0 to 100) they obtained on assessment. The patients were put to standard physiotherapeutic measures in addition to standard medical therapy. At the end of the study it was found that haemorrhagic stroke patients showed better improvement both in neuromuscular function and activity of daily living.     

Surat''94: was it melioidosis?--interesting observations from the first case of imported melioidosis in India

With regard to HIV/AIDS, this editorial claims that attitude problems, communication difficulties, issues of confidentiality in connection with the prevention of disease spread, absence of uniformity in the management of patients, and lack of counseling skills all contribute to dilemmas in AIDS care. First, the author claims that, since attitude affects the way we communicate and reflects on every area of life, health care givers should change their negative attitudes in order to serve each patient with love and compassion. Next, the issue of confidentiality is addressed. The author writes that tracing of contacts is difficult when an HIV-infected individual is given his/her full right to confidentiality. Next, it is suggested that the management of HIV/AIDS patients should be made uniform by putting one person in charge in the hospital setting. Finally, the author concludes that all health workers ought to have basic counseling skills, as this is one of the most important aspects of care.     

Painful trigeminal neuropathy: clinical and pharmacological observations

A 74-year-old woman had a 5-year history of constant burning pain and numbness of the central face of subacute onset. The central region of the face, oral cavity, and nose lacked all sensation. Corneal reflexes and the jaw jerk were absent. Blood tests, rectal biopsy, neurodiagnostic studies, and surgical exploration of the trigeminal nerve were normal. Blink reflexes were absent. Facial nerve motor latencies and EMG of the facial and masseter muscles were normal. Responses to the thermoregulatory sweat test, intradermal histamine, and simulated diving were present. Oral administration of 500 mg L-dopa aggravated her pain and produced transient hypalgesia in the C2 through C6 dermatomes. Infraorbital nerve biopsy demonstrated loss of large myelinated fibers. In conclusion: (1) Only the central region of the face is exclusively supplied by the trigeminal nerves. (2) Somato-autonomic reflexes coupled with electrophysiological studies localized the lesion to the large fibers. (3) Large fiber loss and central brain stem reorganization may explain the burning pain. (4) Dopamine may modulate trigeminal nociception.     

Detection of ras gene mutations in pancreatic juice and peripheral blood of patients with pancreatic adenocarcinoma

Pancreatic adenocarcinomas are known to have a high incidence of K-ras gene mutations. Differential diagnosis of pancreatic cancer and chronic pancreatitis sometimes presents a clinical dilemma. We recently developed a highly sensitive and specific polymerase chain reaction capable of detecting 3-30 copies of mutant K-ras genes harboring codon 12 single base changes in the presence of 300,000 normal copies. Mutant ras genes were detected in DNA purified from pancreatic juice from all 6 cases of pancreatic adenocarcinoma and 1 case of intraductal papillary neoplasms of the pancreas. In 2 of 6 other cases with pancreatic adenocarcinoma, circulating metastatic cells were detected in DNA purified from peripheral blood. Activated ras genes were not found in pancreatic juice of three control cases (chronic pancreatitis and choledocholithiasis) or in the peripheral blood of two patients with insulinomas. Notable conclusions of this study are that there can be significant levels of shed tumor cells in peripheral blood and an even higher number in pancreatic juice. In addition, two different K-ras mutations were found in some patients.