Letters to the Editor

PEDIATRICS ◽  
1968 ◽  
Vol 42 (1) ◽  
pp. 210-211
Author(s):  
Gerhard Nellhaus
Keyword(s):  
General Hospital ◽  
Head Circumference ◽  
Additional Data ◽  
Massachusetts General Hospital ◽  
Letters To The Editor ◽  
Normal Intelligence ◽  
Children's Hospital ◽  
Children’S Hospital

The finding of Drs. Cloutier and Stickler that 3 of 15 children (20%) with idiopathic hypopituitarism and normal intelligence had head circumference measurements of less than -2 S.D. was most interesting. Since my own experience with hypopituitary dwarfs was limited, additional data was obtained from Dr. Thomas Aceto, Jr., of the Children's Hospital of Buffalo, Sew York, and Dr. John D. Crawford of the Children's Service of the Massachusetts General Hospital, Boston, Massachusetts.

Flaws in Study of Management of Children with Febrile Illness

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 866-867
Author(s):  
JOURNAL CLUB
Keyword(s):  
General Practitioner ◽  
General Hospital ◽  
General Practitioners ◽  
Family Physician ◽  
Journal Club ◽  
Febrile Illness ◽  
Emergency Rooms ◽  
Children's Hospital ◽  
Children’S Hospital

To the Editor.— Our residency's journal club recently reviewed your October issue and the article on management of febrile illness.1 We found it to be misleading and inconclusive for the following reasons. First, the study presented itself as a comparison of the management of fever in children by pediatricians and "general practitioners." Based on introductory statements the term "general practitioner" implies family physician, but this is not clearly stated. As the article progresses, we find the data collected are based on experience in emergency rooms at a children's hospital v a "general" hospital, each staffed by residents or interns.

Stanford V chemotherapy and involved field radiotherapy for children and adolescents with unfavorable risk Hodgkin lymphoma: Results of a multi-institutional prospective clinical trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9502-9502 ◽  
Author(s):  
Monika Metzger ◽  
Amy Billett ◽  
Alison M. Friedmann ◽  
Matthew J. Krasin ◽  
Scott C. Howard ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Children And Adolescents ◽  
Hodgkin Lymphoma ◽  
Low Dose ◽  
Massachusetts General Hospital ◽  
Children's Hospital ◽  
Significant Difference ◽  
Children’S Hospital ◽  
Involved Field ◽  
Involved Field Radiotherapy

9502 Background: To evaluate the efficacy of 12 weeks of Stanford V chemotherapy (prednisone, vinblastine, doxorubicine, nitrogen mustard, etoposide, vincristine, and bleomycin) without routine growth factor support plus response-adapted low-dose, involved-field radiotherapy (IFRT) in children and adolescents with unfavorable risk Hodgkin lymphoma (HL). Methods: Multi-institutional (St. Jude Children’s Research Hospital, Stanford University, Children’s Hospital Boston, Massachusetts General Hospital and Maine Children’s Hospital) clinical trial. One hundred forty-one patients with clinical stages IIB (n=43), IIIB (n=19), IVA (n=27), and IVB (n=52) HL were treated with 12 weeks of Stanford V chemotherapy and low dose IFRT between June 2002 and May 2011. Involved nodal sites in complete remission (CR, defined as > 75% shrinkage of the original tumor and PET negative) after 8 weeks of Stanford V received 15 Gy IFRT; those sites that achieved only partial response received 25.5 Gy IFRT after completion of all 12 weeks of chemotherapy. Results: With a median follow-up of 4.6 years, the 3-year overall and event-free survival (EFS) are 97% (SE=2%) and 79% (SE=4%) respectively. There was no significant difference in EFS by stage (IIB vs. IIIB vs. IV; P=0.84). Ten patients developed progessive disease and 18 relapsed, while 5 have died (1 after relapse in an accident and 4 of refractory disease). Most common toxicities were grade 3 hematologic with 234 episodes of neutropenia in 101 patients (72%) and 85 episodes of anemia in 52 patients (37%); Fever and neutropenia occurred 13 times in 12 patients (9%). Conclusions: Risk-adapted, combined-modality therapy using 12 weeks of Stanford V chemotherapy plus IFRT is well tolerated in this population with manageable acute toxicities. Overall survival is comparable to other more intense chemotherapy regimens. Future high-risk front line therapies may consider a Stanford V backbone with targeted intensification and further tailoring of radiation therapy.

Reye's Syndrome—Study

PEDIATRICS ◽  
1974 ◽  
Vol 54 (3) ◽  
pp. 388-388
Author(s):  
Jerome S. Haller
Keyword(s):  
General Hospital ◽  
Yale University ◽  
Reye's Syndrome ◽  
Children's Hospital ◽  
Centre Hospitalier ◽  
School Of Medicine ◽  
Centre Hospitalier Universitaire ◽  
Emory University ◽  
Children’S Hospital

Because of the variety of therapies employed in Reye's syndrome, Dr. Peter Huttenlocher of Yale University School of Medicine and I have drawn up a protocol designed to evaluate the effectiveness of frequently used regimens. The study has been devised on a multi-hospital basis with the following hospitals already participating: Harbor General Hospital (Dr. Marvin Weil); Children's Hospital of Buffalo (Dr. M. Cohen); Emory University School of Medicine (Dr. J. Schwartz); Children's Hospital of Michigan (Dr. J. Finnegan); and Centre Hospitalier Universitaire, Université de Sherbrooke, Sherbrooke, Quebec (Dr. B. Lemieux).

Predictors of mortality in children with myelomeningocele and symptomatic Chiari type II malformation

2018 ◽  
Vol 21 (6) ◽  
pp. 587-596 ◽  
Author(s):  
Michael M. McDowell ◽  
Jason E. Blatt ◽  
Christopher P. Deibert ◽  
Nathan T. Zwagerman ◽  
Zachary J. Tempel ◽  
...  
Keyword(s):  
Head Circumference ◽  
Medical Intervention ◽  
Type Ii ◽  
Central Apnea ◽  
Children's Hospital ◽  
Poor Outcome ◽  
Postoperative Changes ◽  
Children’S Hospital ◽  
Poor Outcomes ◽  
Symptoms And Signs

OBJECTIVEChiari malformation type II (CM-II) in myelomeningocele is associated with a significant rate of mortality and poor outcome. Death is frequently heralded by the onset or progression of neurological symptoms. The authors sought to identify predictors of poor outcome and mortality within the myelomeningocele population at Children’s Hospital of Pittsburgh.METHODSA retrospective chart and radiology review was performed on all infants who underwent primary closure of a myelomeningocele defect at Children’s Hospital of Pittsburgh between the years of 1995 and 2015. Preoperative symptoms and signs leading to CM-II decompression, as well as operative details and postoperative changes in these symptoms and signs, were investigated in detail and correlated to outcome. Poor outcome was defined as death, stridor, or ventilator dependence. Deceased patients were separately assessed within this subgroup.RESULTSThirty-two (21%) of 153 patients were found to have symptomatic CM-II. Of the 32 patients meeting inclusion criteria, 12 (38%) had poor outcomes. Eight patients (25%) died since initial presentation; 5 of these patients (16% of the overall cohort) died within the 1st year of life and 3 (9%) died during adolescence. Seven (88%) of the 8 patients who died had central apnea on presentation (p = 0.001) and 7 (44%) of the 16 patients who developed symptoms in the first 3 months of life died, compared with 1 (6.3%) of 16 who developed symptoms later in childhood (p = 0.04). The median Apgar score at 1 minute was 4.5 for patients who died and 8 for surviving patients (p = 0.006). The median diameter of the myelomeningocele defect was 5.75 cm for patients who died and 5 for those who survived (p = 0.01). The anatomical level of defect trended toward higher levels in patients who died, with 4 patients in that group having an anatomical level at L-2 or higher compared with 5 of the surviving patients (p = 0.001). The median initial head circumference for the 5 patients dying in the 1st year of life was 41.5 cm, versus 34 cm for all other patients (p = 0.01).CONCLUSIONSCM-II in spina bifida is associated with a significant mortality rate even when surgical intervention is performed. Death is more frequent in symptomatic patients presenting prior to 1 year of age. Late deaths are associated with symptom progression despite aggressive surgical and medical intervention. In this patient cohort, death was more likely in patients with symptomatic presentation during the first 3 months of life, low Apgar scores, large myelomeningocele defects, early central apnea, and large head circumference at birth.

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