Osteoarticular infection and occult bacteremia are the 2 invasive infectious pathologies most frequently associated in childhood with Kingella kingae. We report a series of 11 patients in whom osteomyelitis predominates over septic arthritis, which is the reverse of other series, probably as a consequence of inoculation of samples during surgery on agar media, used in combination with or as an alternative to inoculation into blood culture bottles. Although K. kingae infections usually follow a benign clinical course, we noted 2 patients with mild orthopedic sequelae.

The disk diffusion (DD) method remains the most popular manual technique for antibiotic susceptibility testing (AST) in clinical microbiology laboratories. This is because of its simplicity, reproducibility, and limited cost compared to (automated) microdilution systems, which are usually less sensitive at detecting certain important mechanisms of resistance. Here, we evaluate the PREVI® Isola automated seeder system using a new protocol for spreading bacterial suspensions (eight deposits of calibrated inocula of bacteria, followed by two rounds of rotation) in comparison with manual DD reference testing on a large series of clinical and reference strains. The average time required for seeding one agar plate for DD with this new protocol was 51 s per plate, i.e., 70 agar plates/h. Reproducibility and repeatability was assessed on three reference and three randomly chosen clinical strains, as usually requested by the European Committee on Antimicrobial Susceptibility Testing (EUCAST), and was excellent compared to the manual method. The standard deviations of zones of growth inhibition showed no statistical discrimination. The correlation between the two methods, assessed using 294 clinical isolates and a panel of six antibiotics (n = 3,528 zones of growth inhibition measured), was excellent, with a correlation coefficient of 0.977. The new PREVI® Isola protocol adapted for DD had a sensitivity of 99 % and a specificity of 100 % compared to the manual technique for interpreting DD as recommended by the EUCAST.

This therapeutic protocol achieved good oncologic and orthopaedic results. We observed a significant treatment-related toxicity.

Nine children with calcified intervertebral discs are described. Seven were boys and 2 were girls. The average age at diagnosis was 8.6 years (range 5 to 14 years). Follow up was from 2 to 10 years. Only one child gave a history of trauma. In all twelve discs were involved with more than one disc being affected in 2 children; there were 7 in the cervical spine, 4 in the thoracic and one in the lumbar spine. Every child with cervical calcification had an acute onset with pain and limited movement, and disappeared during the following months. The calcified discs in the thoracic and lumbar regions did not cause symptoms and did not change. Calcification of cervical discs is self-limiting and has an excellent prognosis.

INTRODUCTIONEwing sarcoma family of tumors (ESFT) is the second most common bone malignancy in children, accounting for approximately 40% of all bone cancers [1]. ESFT is characterized by a specific balanced chromosomal translocation which fuses the amino-terminal domain of the EWSR1 gene or, in rare cases, the TLS/FUS gene, to the DNA-binding domain of one of five ETS genes [2]. The transcripts resulting from these fusion genes can be detected using the reverse transcriptase-polymerase chain reaction (RT-PCR) technique. RT-PCR provides a higher sensitivity than conventional cytological analysis to detect tumor cells in bone marrow (BM) and peripheral blood (PB). Previous studies have reported that among patients with local-regional ESFT, RT-PCR positivity of BM correlates with a high risk of adverse outcome and significantly poorer disease-free survival rates [3]. Thus, RT-PCR analysis of BM might be useful to classify localized and metastatic patients at diagnosis.Treatment of ESFT has improved over the last two decades with reported durable remissions in 50-70% of non-metastatic patients [4]. In 1995, the group at MSKCC published the P6 protocol showing a successful induction of remission in patients with localregional disease and good initial responses with dose-intensive and short-term chemotherapy in patients with distant metastases [5]. A subsequent and extended outcome data on 68 patients (44 localized) with ESFT treated with the P6 protocol showed a 4-year EFS and OS for patients with localized disease of 82% and 89%, respectively. Patients with detectable metastatic disease at diagnosis had a significantly worse prognosis, with a 4-year EFS rate of 12% and OS rate of 17.8% [6].In 1998, the MSKCC group reported a cumulative incidence of therapy related acute myelogenous leukemias (t-AML) and myelodysplastic syndromes (MDS) at 40 months of 8% in survivors of the P6 protocol [7]. The latest report from the MSKCC group [6] details three patients experiencing secondary MDS/t-AML out of 44 non-metastatic patients, which makes a 7% incidence in the population with longest overall survival. This and other experiences suggested that repetitive use of high-dose alkylating agents given with topoisomerase-II inhibitors is strongly leukemogenic, even with modest cumulative doses of each drug. The two well-described kinds of t-AML/MDS occurred, namely, those associated with topoisomerase-II inhibitors and marked by early emergence of t-AML with translocations of the MLL gene at chromosome band 11q23, and those associated with alkylating agents and marked by an MDS, whole or partial deletions of chromosomes 5 or 7, and a latency period of 2-8 years [8,9].In 2001, we modified the original P6 (hereby mP6) protocol by: (1) reducing the number of chemotherapy cycles down to five, three CDV and two IE, in order to decrease the risk of secondary tumors; (2) using higher doses of ifosfamide (2.8 g/m 2 /day instead of 1.8 g) post-surgery in cases with poor histological response; and (3) using dexrazoxane before doxorubicin t...