Background. Very young children with central nervous system malignant brain tumors have a poor prognosis. As compared with older children, survival is less likely, and those children who do survive frequently have severe impairment of growth and cognitive abilities, resulting partly from treatment with radiotherapy. Therefore, an intensive chemotherapeutic regimen was used to treat children younger than 2 years of age with a diagnosis of malignant astrocytomas. Patients and Methods. Thirty‐nine children younger than 24 months of age who were diagnosed with malignant astrocytoma were treated on a Childrens Cancer Group protocol with an eight‐drug chemotherapeutic regimen (vincristine, carmustine, procarbazine, hydroxyurea, cisplatin, cytosine arabinoside, prednisone, and dimethyl‐triazenoimidazole‐carboxamide) after surgery and postoperative staging. Radiation therapy was to be deferred until the completion of chemotherapy. Results. The objective response rate after two cycles of chemotherapy was 24%. Most patients did not receive radiotherapy.

The purpose of this paper was to define the histologic distrito the endemic (African) and sporadic forms of Burkitt lymbution, clinical features, and treatment response of childhood phoma, which differ in their clinical presentation, regional non-Hodgkin lymphoma (NHL) in northeastern Brazil. We incidence, association with Epstein-Barr virus, and biologic Patients and methodsThere was a striking predominance of the small noncleaved cell (Burkitt) subtype, which occurred in 92 of the 98 children and adolescents diagnosed with NHL. Subsequent analyses Between January 1980 and October 1987, a total of 98 chilfocused on these patients. The majority (n = 84) had advanced dren were diagnosed with non-Hodgkin lymphoma at the parental refusal/abandonment of therapy (10%). Epstein-BarrDiagnostic imaging studies were performed as indicated. virus (EBV) was detected in tumor cells from eight of the 11The pathologic diagnosis was established by histologic Of the 98 patients evaluated during the study period, 92 had small noncleaved cell histology. There were only five cases of lymphoblastic lymphoma and one of large cell histology. Having confirmed the predominance of Burkitt lymIntroduction phoma among the pediatric patients with NHL, we then focused on these 92 cases. Records were reviewed to evaluate The non-Hodgkin lymphomas of childhood are predominantly clinical and biological features, type of treatment, and outhigh-grade extranodal tumors that include the lymphoblastic, come. When sufficient paraffin-embedded tumor tissue was large cell, and small noncleaved cell subtypes. 1 The relative available, in situ RNA/RNA cytohybridization using plasmids frequency of these subtypes varies with geographic location.containing EBV-encoded small nuclear RNA was performed In the United States, the distribution is almost equal, 2 whereas at St Jude Children's Research Hospital to detect the presence small noncleaved cell tumors (Burkitt lymphoma) account for of Epstein-Barr virus DNA. 6 In these cases, the histologic diagthe majority of childhood NHLs in equatorial Africa. 3,4 In nosis was also reviewed and confirmed by a pediatric hematonortheastern Brazil -an area in which we have established a pathologist at St Jude (CWB). cooperative clinical program -anecdotal evidence suggests an increased overall incidence of lymphoma. However, to our knowledge, there have been no reports focusing on pediatric Hodgkin or non-Hodgkin lymphomas in this region. TreatmentWe noted an apparent predominance of the small noncleaved cell histology among children treated for NHL at a There were two distinct treatment periods. From 1980 to major pediatric cancer center in Recife, Brazil. In the present 1983, all consenting patients were treated with induction study, we evaluated the accuracy of this clinical impression chemotherapy similar to that used in the LSA 2 L 2 regimen and assessed long-term treatment outcome. We also sought to described by Wollner et al, 7 followed by maintenance therapy determine the relationship of the small noncleaved...

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To evaluate the impact of sleep deprivation (SD) on microbially induced alterations in sleep, we used gentle handling to deprive rabbits of sleep for 4 h before or after intravenous inoculation with Escherichia coli (EC). Sleep was monitored for the next 20 h. EC inoculation alone increased slow-wave sleep (SWS) time, delta-wave amplitude (DWA) during sleep and SWS bout length during the initial 2-4 h after inoculation. During the following 8-20 h, DWA during SWS was reduced relative to control values. SD alone increased SWS time and SWS bout length for 2 h after the end of the SD period. Rabbits subjected to SD for 4 h prior to EC inoculation demonstrated increases in SWS time, DWA during SWS and SWS bout length 2-4 h postinoculation. At some time points, these effects were greater in magnitude than those induced by either manipulation alone, but they were generally equivalent to the additive effects of the individual treatments. Rabbits subjected to SD after EC inoculation (i.e. during the period in which EC increases sleep) demonstrated increases in SWS time and DWA during SWS for only 2 h after the end of the SD period, suggesting that these animals maintained a sleep deficit as compared to rabbits inoculated with EC alone. SD alone elicited hyperthermia in rabbits, and EC-inoculated rabbits subjected to SD developed fevers greater than those induced by either treatment alone. Other clinical indices were not significantly affected by the combined treatments. These data indicate that the sleep changes that occur subsequent to bacterial inoculation are altered in sleep-deprived rabbits, but that SD does not exacerbate clinical illness in this model.