Hemiparesis and ischemic changes of the white matter after intrathecal therapy for children with acute lymphocytic leukemia

Article Abstract:

An important advance in the treatment of acute lymphocytic leukemia in children was the recognition that the central nervous system served as a region in which leukemic cells could escape the effects of therapy. All successful treatment protocols now include therapy directed against the brain and spinal cord. One widely used method for attacking the leukemic cells hidden in the meninges covering the brain is the direct injection of chemotherapeutic drugs into the cerebrospinal fluid. Unfortunately, this treatment may produce a variety of acute and chronic neurological symptoms. The authors report the cases of three children who experienced serious but transient neurological symptoms after this direct injection of drugs, called intrathecal (IT) therapy. One child had received intrathecal injection of methotrexate, or IT MTX. The other two children received intrathecal injection of three drugs, methotrexate, hydrocortisone, and cytosine arabinoside. This triple intrathecal therapy is sometimes referred to as the TIT treatment. Ten to 14 days after the intrathecal therapy, the children developed hemiparesis, weakness on one side of the body. Two of the three children also developed severe dysarthria, difficulty in articulating speech. Electroencephalographic examination revealed no signs of epileptic activity. The symptoms observed were similar to the symptoms which might be expected in a stroke, and magnetic resonance imaging revealed lesions that were similar in appearance to stroke lesions. Fortunately, the recoveries achieved by these young patients were excellent; one patient recovered virtually completely, while the other two have recovered except for some minimal weakness. All patients are now long-term survivors of their leukemia. The mechanism by which IT MTX or TIT treatment might produce stroke-like lesions in the brain is not known. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Ischemia, Lymphocytic leukemia, Injections, Spinal, Spinal injections

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Typhlitis: an 18-year experience and postmortem review

Article Abstract:

Typhlitis is derived from the Greek word 'typhlon', meaning cecum, and is used to describe necrotizing colitis (inflammation of the colon resulting in tissue death), frequently localized in the cecum (a pouch in the large intestine). Although this condition was first recognized at autopsy, diagnoses are now sometimes made before the death of the patient. Over an 18-year period, 33 cases of typhlitis were identified during the autopsy of 170 patients with acute leukemia. The patients were between 10 months and 17 years old. Typhlitis was found in two patients with lymphoblastic leukemia, and two more cases were found in patients with aplastic anemia. The majority of cases were associated with bacterial infection, but fungal infection may also be a cause. The precise origin of typhlitis is uncertain; chemotherapeutic agents may directly affect the integrity of the bowel, or indirect effects may decrease the resistance of the patient to this infection. Patients with fever and decreased neutrophil (a type of white blood cell) counts are at greatest risk. The advent of ultrasonography and computerized tomography (CT) scan, an imaging technique, has made early diagnosis of typhlitis easier. Some cases may be managed medically by antibiotic administration and electrolyte and blood product support. Typhlitis can be life-threatening, and in cases where fever has persisted more than 72 hours, the possibility of fungal infection should be considered. Surgical management is also possible in patients not responding to antibiotics, but may be unwise for patients with an underlying disease process cannot be altered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Colitis

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The yield of routine chest radiography in children with cancer hospitalized for fever and neutropenia

Article Abstract:

Many children with cancer die from infections that occur during treatment. Chemotherapeutic drugs may cause neutropenia, a decrease in the number of circulating neutrophil white blood cells. Until the body can replace the protective neutrophils, it is more susceptible to a wide range of infections. Many symptoms of infection result from the immune response, rather than the infection itself. Therefore, an neutropenic cancer patient may not show the usual symptoms of infection and may not receive needed treatment. It has been suggested that all childhood cancer patients with neutropenia receive a chest X-ray if they develop a fever to detect pneumonia. However, it is not clear that this will actually improve the diagnosis and treatment of infections in childhood cancer patients. In a study of 131 consecutive admissions of children with cancer who also had neutropenia and fever, 128 received complete chest X-ray evaluation. Twenty-six of these had abnormal results. In 13 cases, the abnormality was due to a known cancerous disease. In only eight cases was pneumonia identified by chest X-ray, and in five of these cases the pneumonia was already suspected on the basis of clinical symptoms. Of the 128 children with neutropenia and fever, chest X-rays were necessary for the diagnosis in only three cases. These results cast doubt on the suggestion that childhood cancer patients with neutropenia and fever should receive routine chest X-rays. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Cancer in children, Childhood cancer, Pneumonia in children, Childhood pneumonia

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