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Purpose:Optimal nutritional support in childhood cancer relies on the adequate provision of energy. This study investigated the impact of chemotherapy on resting energy expenditure (REE) during the first six months of treatment and the accuracy of predictive equations in calculating said requirements of newly diagnosed children with cancer.Methods:REE was measured at diagnosis utilising a validated bioelectrical impedance analysis (BIA) mobile unit and compared with three predictive equations (Schofield 1985, World Health Organization [WHO] 1985 and the Recommended Dietary Allowance [RDA] 1989). Agreement and accuracy of these equations were tested by determining bias and agreement rates and displayed using the Bland–Altman plot. Baseline values were plotted against monthly follow-up measurements over time. Statistical significance was 5% and a priori limits of agreement set between 90% and 110% of measured REE.Results:Forty-three newly diagnosed children with median age 4 years (IQR 2.0–7.6) were measured prior to chemotherapy initiation. Compared with measured REE (mean ± SD) 719.53 ± 206.29 kcal/day, all predictive equations significantly overestimated REE: WHO 1985 (889.75 ± 323.31 kcal/day; 23% overestimation), Schofield 1985 (899.62 ± 336.10 kcal/day; 25% overestimation) and RDA (1647.67 ± 481.06 kcal/day; 129% overestimation) (p < 0.001). Despite significant proportionate bias in all three equations (p < 0.001), the intra-class consistency coefficient showed good reliability for the Schofield 1985 (0.864) and WHO 1985 (0.849) equations. Though statistically significant (chi-square = 23.11, p < 0.003), the overall 1 kcal/kg (1.3%) increase for all cancer types at six months may not be clinically significant.Conclusion:Existing predictive equations are unable to calculate REE accurately at childhood cancer diagnosis, highlighting the need for future investigations into the development of cancer-specific equations.

Tuberculous meningitis (TBM), a swelling of cerebral membranes caused by infection with tubercule bacillus, is relatively rare in industrialized countries, but is widespread elsewhere and has a high mortality rate. Complications include raised intracranial pressure (ICP), which is due to hydrocephalus, or retention of fluid in the brain. In the absence of ways to curtail the incidence of TBM at present, focus has been on treating complications such as ICP. Various therapies have been useful in treating ICP. In the present study, the relative values of oral acetazolamide and furosemide (two drugs combined in treatment), intrathecal hyaluronidase (injection of an enzyme used to dissolve blockages that may contribute to fluid retention), and ventriculoperitoneal shunting (an artificial opening for drainage of fluid) were compared with respect to their ability to induce normal ICP. The subjects were 81 children with raised ICP due to TBM-related hydrocephalus, who were aged five months to eight years, assigned to one of four treatment groups. Group A, with 19 subjects, was a control group treated only for TBM. Group B included 19 children who received injections of hyaluronidase weekly for an average of six weeks, but for no less than four weeks. The 19 children in group C received acetazolamide and furosemide for a minimum of four weeks and an average of six weeks. In group D six children underwent shunting operations. These six children, however, were reassigned to one of the other three groups when the promising results obtained with drug therapy became apparent. Within the first month, 63 percent of the children had normal ICP. The best results were obtained in treatment group B (71 percent) and treatment group C (78 percent). In group A, 41 percent achieved normalized ICP. The average age of successfully treated children was 29 months compared with 41 months for those unsuccessfully treated. Seventy-two percent of those with stage II TBM were successfully treated compared with 40 percent of those with stage III TBM. Other clinical differences associated with patient outcome are discussed as well. The results illustrate the need for early diagnosis and drug therapy for TBM in young children. (Consumer Summary produced by Reliance Medical Information, Inc.)

The purpose of this study was to describe black adolescent women's moral concerns and emotional reactions to the voluntary termination of their pregnancies. Personal, semi-structured interviews were conducted with seven women (between the ages 16 and 19 years) who had legal, induced abortions, between one day and three months prior to the interview. A qualitative analysis of the results revealed that moral concerns were based on social, ecclesiastic and cultural values, as well as a sense of accountability towards the self. The women's emotional reactions predominantly involved the negative emotions of shame and embarrassment, as well as guilt and sadness linked to a sense of loss.

The purpose of this study was to investigate the prevalence of attention deficit hyperactivity disorder (ADHD) in children who recovered from tuberculous meningitis (TBM) as part of an ongoing TBM research project. During this study, each TBM group subject underwent a thorough clinical-neurological examination, and a test battery which included the child behaviour check list (CBCL) Teacher's Report Form and Conners Rating Scale. The parents and teachers of each of the 21 TBM group and 21 control group subjects completed the above-mentioned questionnaires. All 21 TBM group subjects displayed symptoms of ADHD. The TBM group was significantly more hyperactive and unable to sustain attention than the control group. Furthermore, TBM group subjects were perceived as being significantly more unpopular, obsessive, compulsive and aggressive than the control group subjects. With regard to the frequency of externalizing behaviour, the TBM group subjects displayed significantly more externalizing behaviours as well as symptoms of attention deficit and hyperactivity. No significant differences between parents' and teachers' ratings were found. We conclude that ADHD is a common long-term complication of TBM.

The purpose of the present study was to determine the long‐term outcome of 76 children (40 females and 36 males) diagnosed and treated with modern antituberculosis drugs. The median age of the children on admission was 29.5 months and on follow‐up 9 years. Antituberculosis therapy consisted of daily isoniazid (20mg/kg), rifampicin (20mg/kg), ethionamide (20mg/kg), and pyrazinamide (40mg/kg) for 6 months. Twenty‐three children received daily prednisone (2–4mg/kg) for the first month of treatment. Raised intracranial pressure was actively monitored and treated. Patients with non‐communicating hydrocephalus received ventriculo‐peritoneal shunts shortly after admission while communicating hydrocephalus was treated with oral acetazolamide (100mg/kg/day) and furosemide (1mg/kg/day) in 3–4 divided doses. Communicating hydrocephalus that did not respond to this regimen within the first month of treatment also underwent ventriculo‐peritoneal shunting. Only 20% of children were functionally completely normal at follow‐up. Main areas of functional deficit were cognitive impairment (80%), poor scholastic progress (43%), and emotional disturbance (40%). Twenty‐five per cent of children had evidence of motor impairment, but all could walk and only 5 of 76 children (6% of total) were unable to run. One child was blind but no child had sensori‐neural deafness. It was concluded that these disabilities in children from mainly deprived socioeconomic backgrounds have serious implications for their future social, academic, and career prospects. A high index of suspicion of TBM in high tuberculosis incidence communities will help prevent the morbidity documented in this study.

A nine‐year‐old dog was presented with sudden‐onset ascites and a history of two previous syncopal episodes. Diagnostic tests pointed to a Budd‐Chiari‐like syndrome, with obstruction of the caudal vena cava between the liver and heart. The ascites was refractory to treatment and the dog was euthanased. On postmortem examination, a phaeochromocytoma of the left adrenal gland was present, with contiguous invasions into the caudal vena cava, extending cranially as far as the cavoatrial junction. To the authors' knowledge, this is the first reported case of a Budd‐Chiari‐like syndrome associated with a phaeochromocytoma in a dog.

The clinical course and serial cranial computerized tomographic (CT) findings of 202 children with tuberculous meningitis (TBM) admitted to Tygerberg Hospital between 1985 and 1994 were reviewed with regard to the incidence, CT appearance and clinical course of associated intracranial tuberculous granulomas. Thirty-four patients (16.85 per cent) had associated intracranial granulomas. Thirty-eight individual lesions were analysed and classified as meningeal, parenchymal or ependymal according to their central nervous system (CNS) location. Twenty-five patients had round to irregular, brain iso-, hypo- or hyperdense meningeal granulomas with variable degrees of enhancement and peri-lesional hypodensities. Four patients had diffusely enhancing, brain isodense, enplaque-like ependymal granulomas associated with the ventricular ependymal lining. Four patients with miliary tuberculosis and TBM showed multiple small diffusely enhancing, brain iso- or hyperdense parenchymal lesions and associated hypodensities on initial CT. Although granulomas in the meningeal and ependymal group had the propensity to paradoxically enlarge or appear on standard four-drug antituberculosis therapy, the majority resolved uneventfully. Rapid resolution of small parenchymal granulomas associated with miliary tuberculosis occurred in all cases. Most granulomas in this series were co-incidental, asymptomatic CT findings. In rare cases, the development or enlargement of a strategically located granuloma may result in complications.

Fifteen middle‐aged to older, overweight cats attending a first‐opinion clinic were investigated to rule out hyperadrenocorticism as a cause of their weight problem, using two different protocols for the adrenocortlcotropic hormone (ACTH) stimulation test. The cats received intravenous synthetic ACTH (tetracosactrin) at an initial dose of 125 μg; a second test was performed between two and three weeks later, using a dose of 250 vg intravenously. The mean basal serum cortisol concentration was 203 nmol/litre (range 81 to 354 nmol/litre). The highest mean serum cortisol concentration occurred at 60 minutes following the 125 μg dose and at 120 minutes following the 250 μg dose. There was, however, no statistically significant difference between these peak cortisol concentrations attained using either dose of tetracosactrin. A significantly higher mean serum cortisol concentration was attained after the higher dose at the 180 minutes time point, indicating a more prolonged response when compared with the lower dose. The cats were followed up for one year after the initial investigations and none were found to develop hyperadrenocorticism during this time.

Abstract: Intracranial pressure (ICP) was monitored in 218 consecutive children with hydrocephalus secondary to tuberculous meningitis (TBM). All children underwent cranial computerized tomographic (CT) scanning and continuous lumbar cerebrospinal (CSF) pressure monitoring on admission. Noncommunicating hydrocephalus (37 children), as determined by air encephalography, was treated by ventriculoperitoneal (VP) shunting and communicating hydrocephalus (181 children), by means of daily acetazolamide and frusemide. Response of ICP to treatment in the group with communicating hydrocephalus was assessed by means of repeated CSF pressure monitoring and CT scanning. One hundred and eighty-five of the 218 patients survived the 1st month of treatment. The aim of this study was the retrospective determination of (1) the relationship between ICP measurements and CT findings on admission and (2) the characteristics of the ICP recording which correlated best with the CT criteria of compensated hydrocephalus after the 1st month of treatment. No relationship was found between the level of baseline CSF pressure and the degree of hydrocephalus, as demonstrated by CT scanning, on admission. Seventy-five per cent of the patients with communicating hydrocephalus that survived the 1st month of treatment complied with the CT criteria for compensated hydrocephalus. All these patients had a baseline CSF pressure below 15 mmHg and absence of high-amplitude B waves on the pressure recording done at the end of the 1st month. In this study repeated lumbar CSF pressure monitoring proved to be an effective instrument to assess the response of communicating tuberculous hydrocephalus to medical treatment and also accurately predicted the timing of compensation of the hydrocephalus.

The clinical case records of 44 cats with distal aortic thromboembolism were reviewed. These detailed 49 separate episodes of thromboembolism. Of the 44 cats, 33 (75%) were neutered males, and 43 (98%) were domestic shorthairs. The mean age was 8.7 years (age range 2–16 years). Evidence of pre-existing heart disease had been noted in 23% of cases. Heart failure was a concurrent diagnosis in 51% of episodes and 36% of these cases survived their thromboembolic episodes. Overall, cats survived 39% of the episodes. Cats died during 28% of the episodes, while 33% of the episodes resulted in the cats being euthanased. The median survival time was 6 months. Seventeen per cent of cats on prophylactic aspirin therapy experienced an episode of re-embolisation. Forty-three per cent of episodes occurred in the spring.

MR imaging was performed on 27 children with stage II–III tuberculous meningitis for the specific purpose of examining the brainstem, as well as comparison with other CT features of the disease. In addition to defining the ischemic disturbances of basal ganglia and diencephalon more clearly, MR also demonstrates the frequent occurrence of parenchymal signal abnormalities in the brainstem and adjacent temporal lobes, which are invisible or uncertain on CT. Although the presence of brainstem abnormalities on MR correlated well with clinical findings of brainstem dysfunction, clinical staging on admission remains the best prognostic indicator in advanced TBM. We also review the MR features of basal exudation, hydrochephalus and tuberculoma.

A rapid, reliable silver impregnation method is described for nervous tissue fixed in formol-saline, Bouin or Sum. Sections are impregnated for 10-15 minutes at room temperature or 37 C in a solution containing 0.5 g Protargol-S, 0.005-0.01 g allantoin, 1 ml of 1% Cu[NO2]2, 1 ml of 1% AgNO3. and 1-2 drops of 30% H2O2 in 100 ml distilled water. Thereafter the dons arc reduced in a hydroquinone-formalin solution. This is followed by gold toning and subsequent reduction and mounting. Alternatively. following the first reduction, the silver image can be intensified by placing sections in a silver-allantoin bath which is followed by reduction and mounting. This method is very reliable and selective, making it suitable for general routine and research use.

The phase-contrast techniques used in counting asbestos fibres are difficult to apply to glass fibres because of the low contrast of the phase image. To overcome this difficulty filters were treated and examined in different ways. The most satisfactory proved to be low-temperature ashing of sectors attached to glass slides by acetone vapour followed by microscopical examination using simple Köhler illumination. This technique yielded Counts approximately twice those obtained from standard phase-contrast evaluation.

Concentrations of interferon γ (IFN-γ) in the lumbar cerebrospinal fluid (CSF) of 30 children (mean age, 27 months) being treated for stage III (16 children) and stage II (14 children) tuberculous meningitis (TBM) were determined by ELISA. Nine children with stage III TBM and six with stage II TBM received prednisone (4 mg/kg). Concentrations of IFN-γ in 73 CSF specimens (18 from the first week of therapy, 20 from the second, 19 from the third, and 16 from the fourth) were determined. The mean concentrations were 780 pg/mL in the first week of therapy and 554 pg/mL, 529 pg/mL, and 269 pg/mL in the second, third, and fourth weeks, respectively. Tumor necrosis factor α (TNF-α) and interleukin-1β (IL-1β) concentrations in 56 specimens from 23 of these same children were determined by ELISA. The mean CSF TNF-α concentration in 12 specimens obtained during the first week of therapy was 17 pg/mL, and the mean was 11 pg/mL during each of the subsequent weeks (14 specimens were evaluated in the second week and 15 specimens in the third and fourth weeks of therapy). Mean IL-1β concentrations in these same groups of specimens were 52 pg/mL, 43 pg/mL, 42 pg/mL, and 18 pg/mL. No correlation could be shown between cytokine concentration and stage of disease, and no differences existed between those who did and those who did not receive prednisone. A significant decline in IL-1β concentrations was shown during the 4-week period, but none in TNF-α or IFN-γ concentrations was noted. Persistently high CSF IFN-γ concentrations in cases of TBM (as in cases of aseptic meningitis but not bacterial meningitis) at the time of diagnosis suggest an immune response fundamentally different from that in bacterial meningitis.

The role of socioeconomic factors for the risk of developing tuberculosis (TB) is unclear. Differences and similarities between cases and controls on various socioeconomic factors were determined. Some 84 black TB patients on ambulatory treatment and 84 disease-free controls living in the same urban area (South Africa) and matched for age and sex were studied. Variables measured: demographic details, general living conditions, household ownership of luxury items, and weekly consumption of four proteins (meat, fish, chicken and cheese). Three socioeconomic indices were constructed from the above variables. No significant differences were found between cases and controls on most of the variables. Overall significant differences were found on the pattern of language groups (chi-square; p = 0.031), employment groups (chi-square; p = 0.029) and meat (chi-square; p = 0.012) and chicken consumption (chi-square; p = 0.034). A tendency was observed for more employed cases than controls to have a primary school education. However, no conclusive evidence was found on the association between socioeconomic factors and risk of developing TB. The development of a more appropriate socioeconomic measure for developing countries is a necessary step for further research.