Pediatric cancers in the new millennium: dramatic progress, new challenges.

Over the past 50 years, great strides have been made in diagnosis, treatment, and survival of childhood cancer. In the 1960s the probability of survival for a child with cancer was less than 25%, whereas today it may exceed 80%. This dramatic change has occurred through significant and steady progress in our understanding of tumor biology, creation of specialized multidisciplinary care teams, incremental improvements in therapy, establishment of specialized centers with research infrastructure to conduct pivotal clinical studies, and the evolution of a cooperative group mechanism for clinical research.

Analysis of prognostic factors in ewing sarcoma family of tumors: review of St. Jude Children's Research Hospital studies.

Background: Advances in systemic and local therapies have improved outcomes for patients with the Ewing sarcoma family of tumors (ESFT). As new treatments are developed, a critical review of data from past treatment eras is needed to identify clinically relevant risk groups.

Methods: The authors reviewed the records of 220 patients with ESFT who were treated on protocols at St.

Significance of pleural effusion in neuroblastoma.

Background: Pleural effusion is uncommon at diagnosis of neuroblastoma in children. Because the presence of malignant cells in pleural fluid may significantly change the management and outcome of patients with neuroblastoma, we retrospectively analyzed a cohort of neuroblastoma patients who presented with pleural effusion at the time of diagnosis to determine the incidence, presentation, stage, treatment, and outcome of these patients.

Methods: We reviewed the presenting features of 295 patients with the diagnosis of neuroblastoma who received treatment at St.

Military rank and AIDS proportionate mortality in the Brazilian Navy.

This study describes AIDS mortality and occupational factors among servicemen in the Brazilian Navy. This is a proportional mortality study of 2,586 servicemen's death certificates (20-72 years of age) recorded from 1991 to 1995. Death certificates and occupational histories came from the Brazilian Navy Insurance System archives.

[Occupational accidents: social insurance costs and work days lost].

Objective: To estimate the proportion of occupational accident benefits granted within the total for health-related social security benefits, viewing the costs according to benefit type and the impact on productivity according to work days lost.

Methods: Records of benefit decisions from the National Benefits System of the National Social Security Institute for the State of Bahia in 2000 were utilized. Occupational accidents were defined in accordance with the clinical diagnoses of External Causes, Injuries and Poisoning (SS-00 to T99) of the International Classification of Diseases, 10th Revision, and with the benefit type, which distinguishes between occupational and non-occupational health problems.

Expanded genomewide scan implicates a novel locus at 3q28 among Caribbean hispanics with familial Alzheimer disease.

Objectives: To identify novel candidate regions for late-onset Alzheimer disease (LOAD) and to confirm linkage in previously identified chromosomal regions.

Design: Family-based linkage analysis.

Setting: Probands with familial LOAD identified in clinics in the Dominican Republic, Puerto Rico, and the United States.

Apolipoprotein E epsilon4 and age at onset of sporadic and familial Alzheimer disease in Caribbean Hispanics.

Background: The primary effect of the apolipoprotein E epsilon4 (APOE epsilon4) allele is on the age at onset of Alzheimer disease (AD).

Objective: To investigate whether the presence of the APOE epsilon4 allele can account for the earlier age at onset of familial AD (FAD) compared with sporadic AD (SAD).

Design: Population-based, case series ascertained in a prospective study of aging and dementia in Medicare recipients aged 65 years or older.

Pilot study to evaluate MYCN expression as a neuroblastoma cell marker to detect minimal residual disease by RT-PCR.

This pilot study was performed to determine whether MYCN expression warrants further investigation as a tumor marker to detect low levels of residual neuroblastoma (NB). Seven NB cell lines and 30 bone marrow (BM) samples from patients with high-risk NB were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) for MYCN expression, and for the established NB marker tyrosine hydroxylase. MYCN was expressed in all 7 NB cell lines, but not in normal peripheral blood, CD34 cells, or BM.

[Workers' health in Brazil: graduate research].

Objective: To study trends of dissertation and thesis production in workers' health in Brazil.

Methods: Observation units were dissertations and theses developed by Brazilian researchers in national and foreign graduate programs. Theses and dissertations were identified in previously compiled works, LILACS and Capes database.

Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors.

Purpose: To retrospectively assess whether computed tomographic (CT) findings can indicate the benign or malignant nature of pulmonary nodules in pediatric patients with malignant solid primary tumors.

Materials And Methods: With institutional review board approval, waived parental and patient consent, and HIPAA compliance, the authors determined the incidence of malignancy among 81 pulmonary nodules that were sampled at biopsy within 3 weeks after chest CT (January 1999 to September 2003) in 41 young patients with malignant solid tumors. Three radiologists independently and retrospectively reviewed these scans and the available previously obtained scans, classifying nodules as benign, malignant, or indeterminate on the basis of their number, unilateral versus bilateral distribution, size, margins (indistinct vs distinct), calcification, growth, and associated adenopathy.

Concomitant administration of vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide for high-risk sarcomas: the St. Jude Children's Research Hospital experience.

Background: Intensified chemotherapy may improve the outcome of patients with high-risk pediatric sarcomas. Vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide are highly effective against pediatric sarcomas. The authors investigated the feasibility of administering these agents concomitantly within a defined period.

Cefixime allows greater dose escalation of oral irinotecan: a phase I study in pediatric patients with refractory solid tumors.

Purpose: Irinotecan is active against a variety of malignancies; however, severe diarrhea limits its usefulness. In our phase I study, the intravenous formulation of irinotecan was administered orally daily for 5 days for 2 consecutive weeks (repeated every 21 days) to children with refractory solid tumors. Our objectives were to determine the maximum-tolerated dose (MTD), dose-limiting toxicity, and pharmacokinetics of oral irinotecan and to evaluate whether coadministration of cefixime (8 mg/kg/d beginning 5 days before irinotecan and continuing throughout the course) ameliorates irinotecan-induced diarrhea.

Nontraditional work factors in farmworker adolescent populations: implications for health research and interventions.

Agriculture has been documented to be one of the most hazardous work environments for both adults and children. Adolescents may be especially vulnerable to adverse health effects from agricultural exposures due to the rapid growth and development experienced during those years. Separating the occupational, economic, and social issues in this population is difficult.

The impact of early resection of primary neuroblastoma on the survival of children older than 1 year of age with stage 4 disease: the St. Jude Children's Research Hospital Experience.

Background: It remains unclear whether primary tumor resection benefits patients with metastatic neuroblastoma. The authors assessed the impact of extent and timing of resection on outcome in these patients.

Methods: The authors reviewed the records of 124 patients > 1 year of age at diagnosis of International Neuroblastoma Staging System Stage 4 neuroblastoma.

Adolescent students who work: gender differences in school performances and self-perceived health.

In a prospective cohort study, the hypotheses that adolescent students who work have poorer school performances, more sick days, and poor self-perceived health were examined. From a one-stage random cluster area sampling of 2512 households in Bahia, Brazil, 888 students 10-21 years of age were asked to answer questionnaires. School dropouts were more common among working students independently of gender.

Periodontal health and oral mucosal lesions as related to occupational exposure to acid mists.

Objectives: The association between exposure to acid mists and periodontal changes and oral mucosal lesions was measured using data from an Oral Health Promotion Program in a large metal plant. The role of sociodemographic factors, lifestyle, and oral health behavior in relation to these outcomes was also examined.

Methods: This is a cross-sectional study of 665 active male workers who volunteered to participate in the oral health program.

Development and validation of limited sampling models for topotecan lactone pharmacokinetic studies in children.

Purpose: To develop and validate a pharmacokinetic limited sampling model (LSM) for intravenous and oral topotecan pharmacokinetic studies in children.

Methods: Topotecan lactone concentration-time data from five trials were used to develop and validate LSM for intravenous and oral topotecan. Based on full sampling from one intravenous study (30 patients; 195 studies), a LSM for intravenous topotecan was determined using a modification of the D-optimality algorithm.

Phase I study of the combination of topotecan and irinotecan in children with refractory solid tumors.

Purpose: We have shown in xenograft studies that the antitumor activities of topotecan and irinotecan are highly schedule- and dose-dependent, with a high frequency of response at low, protracted dose schedules. Preclinical and clinical data suggest that topotecan and irinotecan have different antitumor activities and mechanisms of resistance, and non-overlapping toxicities, providing a rationale for their combination. Combining both agents may increase the amount of camptothecin delivered to the tumor, without additive toxicity.

[Reliability of reported data from adolescent and their mothers in a health survey].

Objective: To estimate the reliability of data obtained from questionnaires applied to adolescents and their mothers in a health survey.

Methods: Data from population-based survey conducted with a one-stage random cluster area sampling of residents in the urban area of Salvador, Brazil, were assessed. The study sample comprised 82 pairs of adolescent workers aged 10 to 14 years and their mothers.

Percutaneous biopsy of pediatric solid tumors.

Background: The objective of the current study was to determine the diagnostic accuracy of percutaneous biopsy of pediatric solid tumors, a procedure that is less invasive than open biopsy.

Methods: The authors conducted a retrospective analysis of clinical data related to 202 percutaneous core-needle biopsies of solid tumors at St. Jude Children's Research Hospital over 5.

Improved response in high-risk neuroblastoma with protracted topotecan administration using a pharmacokinetically guided dosing approach.

Purpose: To estimate the response rate and toxicity associated with intravenous topotecan when it is administered on a protracted schedule according to a pharmacokinetically guided dosing approach to treat childhood high-risk neuroblastoma.

Patients And Methods: In this prospective phase II trial, topotecan was administered intravenously daily for 5 days for each of 2 consecutive weeks for two cycles. On the basis of topotecan systemic clearance, doses were individualized to attain a single-day topotecan lactone area under the plasma concentration-time curve (AUC) of 80 to 120 ng/mL .

Joint effects of smoking, noise exposure and age on hearing loss.

Background: Smoking has been shown to have adverse effects on hearing, but it's unclear whether smoking interacts with known causes of hearing loss such as noise exposure and ageing.

Aims: To examine the hypothesis that smoking, noise and age jointly affect hearing acuity.

Methods: This cross-sectional study was carried out in 535 male adult workers of a metal processing factory.