Brain tumours in children. A plea for an interdisciplinary working group.

A considerable number of high risk brain tumours require an interdisciplinary approach with surgery, radiation and chemotherapy rather than one single therapeutic regimen. Children with a medulloblastoma must be subdivided into four different risk groups depending on the size of the tumour, on the age of the child and on cerebral spinal fluid cytology findings. The treatment protocol for ependymomas depends on the location of the tumour and on histological grading.

[Are stomach polyps an indicator of colonic carcinoma and colonic polyps an indicator of stomach carcinoma?].

Over a period of six years a total of 407 patients with polyps of the gastrointestinal tract were examined by gastroscopy and coloscopy and the findings analysed retrospectively. Among patients with colon polyps 10.5% were found also to have polypoid gastric lesions, among those with adenoma of the colon the prevalence was 11.

[Prognosis and quality of life following tumors in the pineal region in childhood].

At the department of neurosurgery and pediatrics of the University Hospital of Hamburg 18 children with pineal region tumors were treated by surgical removal and craniospinal axis radiation. Total or nearly total removal was achieved in 13 cases. In case of astrocytoma and pineocytoma no further treatment was performed.

Pineal region tumours of childhood.

In Germany, the relative frequency of pineal region tumours seems to be much higher than hitherto assumed. At the University Hospital Hamburg, from 1980-1985 17 children with pineal region tumours were encountered amongst 102 children with CNS tumours. Two-cell-type germinoma is the most frequent pineal region tumour.

Vitamin B12 and brain development.

This is a report of a 1 1/2-year-old male with megaloblastic anaemia and a progressive neurological disorder clinically resembling leucodystrophy. The child was exclusively breast fed and his mother had been a strict vegetarian for more than 4 years before the child was born. After Vitamin B12 therapy the anaemia disappeared and the neurological condition dramatically improved.

[Home monitoring of apnea in children at increased risk for sudden infant death (SIDS)].

Since 1981, 96 infants considered at increased risk of SIDS underwent home monitoring for prolonged sleep apnea: 23 infants after a near miss for SIDS event, 28 siblings of a SIDS victim and 45 infants with a variety of perinatal risk factors. For a total of 65 infants the course of home monitor surveillance was completed by September 1984 with a duration ranging from 6 to 15 month: 26% (4/15) of the near miss for SIDS group, 23% (3/13) of the SIDS siblings and 13% (5/37) of the perinatal risk cases developed more than one prolonged apneic episode with additional symptoms requiring vigorous intervention by parents. Two infants of the perinatal risk group became SIDS victims: despite an apnea alarm after 15 seconds the parents were unable to resuscitate their infant in one case, the other died from SIDS about 4 month after monitoring was discontinued because of an uneventful course and normal polygraphic sleep recordings The large number of prolonged apneas requiring intervention and the two SIDS cases (3% of the total study group) indicate a considerably increased risk of prolonged life-threatening sleep apnea and SIDS in the population monitored.

Sleep apnoea profile in preterm infants recovering from respiratory distress syndrome.

Polygraphic recordings were made on 10 preterm infants recovering from respiratory distress syndrome and 12 healthy preterm control infants at 40, 52, and 64 weeks' conceptual age to study the influence of respiratory distress syndrome on the development of the sleep apnoea profile. Two significant differences were found: infants with respiratory distress syndrome not only had a lower incidence of non-obstructive apnoea and periodic breathing at 40 weeks but also a persistently higher incidence of obstructive and mixed apnoea at 52 and 64 weeks' conceptual age; the latter finding being related to non-rapid eye movement sleep only. While the lower incidence of both types of apnoea at 40 weeks suggests an advanced maturation of respiratory drive, the persistence of obstructive and mixed apnoea related to non-rapid eye movement sleep may reflect the impact of respiratory distress syndrome on airway structures.

Infant sleep apnea profile: preterm vs. term infants.

By means of polygraphic sleep recording, the sleep apnea profile with respect to the number and duration of inactive, obstructive and mixed apneic episodes as well as periodic breathing has been investigated in infants born preterm at 40, 52 and 64 weeks conceptional age and compared to that of term infants. At 40 weeks preterm infants showed significantly more apnea and periodic breathing compared to term infants. The difference was essentially due to obstructive and mixed apnea in non-REM sleep.

Clinical course of GM2 gangliosidoses. A correlative attempt.

The clinical course of the early onset gangliosidoses can be explained on the basis of the developmental time course of different brain structures and functional systems. In particular, the maturation of the four basic motor control systems--spinal cord, brain stem and cerebellum, basal ganglia, cerebral cortex--determines the appearance of certain motor deficits. In late onset GM2 gangliosidoses, however, regional preference of the storage process has to be assumed in order to explain certain characteristic features of the disorder.

Neuronal control of neonatal respiration - sleep apnea and the sudden infant death syndrome.

During the last decade evidence has been accumulated that there might be a continuum from normally occurring short spells of apnea during sleep to life threatening long lasting respiratory pauses with marked bradycardia or even cardiac arrest from which, however, the infant could be resuscitated - the so-called Near Miss for Sudden Infant Death Event - and finally, to the Sudden Infant Death Syndrome (SIDS). There are still many missing links between these three phenomena and it seems likely that the connection between all three is not a straight matter in degree of immature dysfunction of cardiorespiratory control mechanisms. However, no other concept has shead so much light on SIDS and - most probably - no other concept with its consequence of continuous home monitoring has already salvaged so many babies as research into the different sleep apnea syndromes during infancy.

Rectal biopsy findings in infantile neuroaxonal dystrophy.

A 21-month-old boy with a family history of parental consanguinity and two siblings having died of a progressive neurological disorder was investigated for a neurometabolic disease because of recent loss of gait and lack of intellectual progress. While a lysosomal disease could not be verified, his clinical findings were compatible with infantile neuroaxonal dystrophy, the diagnosis of which was electron microscopically established by demonstrating typical enlarged axonal terminals in rectal biopsy tissue.

The etiology of neurosensory hearing defects in preterm infants.

We retrospectively investigated the influence of gestational age, perinatal risk, and the duration of incubator care periods in 193 surviving preterm infants with a gestational age between 28 and 36 weeks raised in our intensive care nursery incubators from 1965--1967. 24 (12.4%) of the children showed definite neurosensory hearing defects, which were particularly encountered in the high frequencies.

The ontogeny of sensory perception in preterm infants.

The extra- vs intrauterine development of both visual and auditory cortical evoked response patterns was compared at 33, 37 and 40 weeks conceptional age. The maturation of visual cortical evoked responses is retarded in infants at 37 and 40 weeks conceptional age when born with a gestational age of less than 32 weeks, which thus implies a long extrauterine life span. The maturation of the auditory cortical evoked responses is not influenced by premature exposure to the extrauterine environment.