Lens implantation and diabetes mellitus.

In a series of 1,160 implant cases, 82 patients were diabetic. In this subgroup, lenses were implanted in 87 eyes, and a visual acuity of 6/12 (20/40) or better was obtained in 77 (88.6%) of the patients, which compared well with the nondiabetic control group of 1,078 cases.

The changing scene of intraocular implant lens surgery.

A review of lens implant surgery using different implant styles and both methods of cataract extraction revealed that there is little difference in the final visual acuity regardless of which implant or cataract technique is used. There appears to be a higher rate of cystoid macular edema with the intracapsular technique and a higher rate of corneal edema with the extracapsular technique. A modern attitude toward this technologic explosion insists more than ever on conventional points of view regarding patients' needs.

The role of chemotherapy in the treatment of Wilms' tumor.

The records of one hundred seventy-six patients with Wilm's tumor treated with transabdominal nephrectomy only or transabdominal nephrectomy, post-operative radiation therapy and several chemotherapy programs were reviewed. Three conclusions were reached: 1) The addition of postoperative radiation therapy and adjuvant chemotherapy has not improved the excellent, disease-free survival of patients with Stage I disease who were less than twenty-four months of age at diagnosis; 2) The addition of postoperative radiation therapy and adjuvant single agent chemotherapy has not improved the disease-free survival of patients with Stage II disease who were over twelve months of age at diagnosis; and 3) The use of combination chemotherapy with vincristine and actinomycin D has improved the disease-free survival of patients who present with Stage II disease.

Lung function in adolescents receiving high-dose methotrexate.

Methotrexate (MTX) has been implicated as a cause of interstitial pneumonitis and/or fibrosis, but the mechanism by which the drug causes these processes is not known. The purpose of this study was to determine whether patients receiving high-dose MTX developed a consistent decrease in pulmonary function, which would implicate a role for total dose of MTX received in the pathogenesis of the lung toxicity. Pulmonary function studies, including spirometry, plethysmography, and diffusing capacity at two levels of alveolar PO2, were performed in 38 adolescents treated for osteogenic sarcoma.

Offspring of patients treated for cancer in childhood.

Genetic effects of cancer in childhood were examined among offspring of patients enrolled in the tumor registries of the Sidney Farber Cancer Institute and the Kansas University Medical Center. For 146 patients, 84 women and 62 men, 293 pregnancies were reported after cessation of treatment of diverse neoplasms. The outcomes of 286 completed pregnancies were as follows: 242 live births (1 set of twins), 1 stillbirth, 25 spontaneous abortions, and 19 therapeutic abortions.

Parenteral feeding in the management of children with cancer.

Total parenteral nutrition TPN has been used to treat or prevent malnutrition in 65 children with a variety of solid tumors and leukemia in the past 7 years. TPN was used in 58 patients with gastrointestinal complications of surgery, chemotherapy, or radiation; in 2 patients for preoperative correction of malnutrition; and in 8 who were entered into a prospective study. During TPN, general nutrition and appearance improved in all patients.

Improved prognosis for patients with mediastinal lymphoblastic lymphoma.

Patients with diffuse lymphoblastic lymphoma (which includes convoluted lymphocytic lymphoma) with mediastinal involvement have predictable progression of disease to a leukemic phase that is cytologically indistinguishable from acute lymphoblastic leukemia (ALL). Therefore we treated 12 patients with diffuse lymphoblastic lymphoma involving the mediastinum with therapy that is effective in ALL. Treatment consisted of intermittent combination chemotherapy with adriamycin and preventive central nervous system therapy (craniocervical irradiation and intrathecal methotrexate).

Rhabdomyosarcoma of the head and neck: diagnosis and management.

Rhabdomyosarcoma represents the most common soft-tissue neoplasm of the head and neck found in children. The tumor is most commonly seen in Caucasian children under the age of 12, usually presenting as a painless mass. Distant metastases are frequently present, especially in regional lymph nodes, lung, and bone marrow.

Lens implantation, miosis, and glaucoma.

In a series of 1,079 patients, average age 76.3 years, 48 eyes required an iridoplasty for chronic miosis and, of these, visual acuity was 6/12 (20/40) or better postoperatively in 89.6% (43).

Dislocation of Binkhorst four-loop lens implant.

A consecutive series of 1,093 Binkhorst four-loop lens implantations was used to examine the problem of dislocation of implants used in intracapsular cataract extractions; emphasis of the study was on the need for suture fixation. Transiridectomy suture fixation was used in 497 procedures, no suture was used in 403 procedures, and a simple iris suture technique was used in 193 procedures. Although the transiridectomy suture fixation procedure had the lowest percentage of dislocations, the iris suture technique is considered safer.

The role of radiation therapy in the treatment of pediatric non-Hodgkin's lymphomas.

Between 1971 and 1976, 64 patients less than 18 years of age with non-Hodgkin's lymphoma were treated at Boston's Children's Hospital Medical Center-Joint Center for Radiation Therapy. A multimodality approach was used, consisting of radiation therapy (3500--4500 rad), surgery, and chemotherapy. Since 1973, all patients have received a regimen initially comprising Adriamycin, Prednisone, 6-Mercaptopurine, Vincristine, and L-Asparaginase.

Wilms' tumor--model of a curable pediatric malignant solid tumor.

Wilms' tumor is the model of the treatment of a pediatric solid tumor. Initially it appeared that multi-modality therapy, consisting of transabodominal nephrectomy, post-operative radiation therapy to the tumor bed and adjuvant, single agent chemotherapy provided the highest likelihood of disease-free survival. The identification of important prognostic factors, such as histology, tumor weight, lymph node involvement and age at diagnosis has led to a re-examination of the treatment of Wilms' tumor.

The role of radiation therapy in the treatment of soft tissue sarcomas of childhood.

The treatment of soft tissue sarcomas in children at the Joint Center for Radiation Therapy, Children's Hospital Medical Center, and the Sidney Farber Cancer Institute from 1970 to 1976 has been reviewed. Twenty-seven patients were diagnosed with rhabdomyosarcoma, and twenty patients were diagnosed with soft tissue sarcomas of other histologies. An aggressive, combined modality therapeutic approach was applied in the treatment of all patients with emphasis placed on conservation of function.

The course of five-year survivors of cancer in childhood.

A follow-up study was made of two independent series of 1,807 and 425 children who were alive five years after diagnosis of a malignant neoplasm. Over the subsequent 20 years (5 to 24 years after initial diagnosis), actuarial survival rates for the cohorts were 83% and 79%, respectively, compared to 97% for matched control subjects in the general population (P less than 0.01).

Pars plana vitrectomy as a primary treatment for acute bacterial endophthalmitis.

We successfully treated six patients with culture-proven acute bacterial endophthalmitis by a combination of emergency pars plana vitrectomy and the instillation of intravitreal antibiotics. All six patients regained satisfactory vision.

Esophagitis due to adriamycin and radiation therapy for childhood malignancy.

Esophagitis occurred in seven patients receiving mediastinal radiation and chemotherapy including adriamycin for non-Hodgkin's lymphoma, osteogenic sarcoma, and acute lymphocytic leukemia. Radiation doses were 500-2500 rad, below the reported esophageal tolerance dose. With subsequent adriamycin, recall esophagitis occurred in three of five patients at risk, two of whom developed strictures.

The management of testicular tumors in children.

Of 43 testicular tumors in children seen at the Children's Hospital Medical Center and Sidney Farber Cancer Institute 33 were malignant. These tumors occurred primarily in young children. Any solid scrotal mass in an infant must be considered malignant until proved otherwise.

Serial studies of cardiac function in patients receiving adriamycin.

A total of 283 adult and pediatric patients treated with drug combinations which include adriamycin (ADM) had at least one cardiac evaluation; 103 patients had two or more serial studies after a baseline evaluation. Changes in systolic time intervals, echocardiographically determined ejection fractions, and electrocardiographic voltage correlated with increasing cumulative ADM dosage. However, the incidence of congestive heart failure among these patients was less than 2%.