Burgert, E. Omer

At the Mayo Clinic 711 children, ranging in age from birth to 15 years, were examined for the presence of spider nevi. The children were divided into three groups: normal controls, patients with chronic illness and patients with disease of the central nervous system. In the normal children, the incidence of spider nevi increased rapidly after 2 years of age to reach a plateau at about the time of puberty for both sexes. In children more than 13 years of age the incidence appeared to be decreasing, presumably toward the stated incidence of 12 to 15% in so-called normal adults. In normal children, spider nevi appeared to occur more frequently in pubertal females than in pubertal males. The incidence was increased in both sexes in patients more than 4 years of age with disease of the central nervous system. In patients with chronic illnesses, there was no significant increase in spider nevi, but the ratio of pubertal females to pubertal males was reversed. The anatomic distribution in all groups differed from that of adults, the dorsum of the hands and forearms being the sites of predilection in children. In view of the frequency of these lesions in childhood, it appears that the presence of spider nevi in otherwise healthy children is an insignificant stigma.

Three children with plasma cell granuloma of the lung had a syndrome characterized by digital clubbing, roentgenographic evidence of an intrapulmonary lesion with a diverse configuration, elevated erythrocyte sedimentation rate, elevated serum immunoglobulin levels, and thrombocytosis.

Abstract 1. Combinations of effective agents produce at least an additive increase in complete remission rates over that which can be achieved when the agents are used individually. 2. Patients who do not achieve complete remission with initial treatment have a significantly shorter survival. 3. Alternating MTX and 6-MP at 28-day intervals during remission does not prolong the duration of remission over that of combined concurrent 6-MP and MTX. 4. The administration of folic acid antagonists intrathecally at 28-day intervals during antimetabolite maintained remission did not prolong the duration of remission. Meningeal leukemia, however, occurred significantly less frequently in these patients. 5. The duration of combined 6-MP and MTX maintained remission is not greater than that of 6-MP maintained remission. 6. The toxicity of 6-MP and MTX in combination in patients in remission is additive. The above conclusions were drawn from this comparative study of combinations of chemotherapeutic agents in children with acute lymphocytic leukemia.