Pediatric Annals

A PEDIATRICIAN'S VIEW

Milton I Levine, MD

Abstract

One of the greatest joys in the practice of pediatrics is the opportunity to watch children grow and develop from the moment they are born on through infancy, childhood, and adolescence. This opportunity differs in large part from hospital pediatrics, in which the focus is on the abnormalities of childhood, whether they result from trauma, infection, congenital defect, glandular dysfunction, blood dyscrasias, tumors, nephritis, nephrosis, and the like.

The practicing pediatrician, for his or her part, is dedicated to protecting and guiding the child through the years of growth and development. The practicing pediatrician cares for the whole child, not only physically but emotionally as well. He or she treats the child's illnesses and traumas and becomes an important part of the child's life and often serves as a guidance counselor for the parents as well.

There was a time, as many of us still remember, when deaths of children were not infrequent. Each year every pediatrician was faced with the possibility of deaths among his or her patients from numerous uncontrollable diseases. Poliomyelitis, scarlet fever, nephrosis, empyema, blood stream infections, erysipelas, appendicitis, and tuberculosis were some of the more common dangers. The practicing pediatrician had many moments of anxiety and many moments of distress.

Today most of these threats have disappeared due largely to a combination of preventive vaccines, antibiotic therapy, and medical and surgical advances.

But still a few life-threatening conditions remain, and of those still encountered by the modern pediatrician, none is more pernicious than cancer. Fortunately, it is comparatively rare during infancy and childhood, but all pediatricians with active practices meet with the condition from time to time.

But cancer today, as we all know, has a much better prognosis than only a few years ago. This is due to a combination of treatment by surgery, steroids, x-ray therapy, and chemotherapy. And since children under treatment and in remission are home so much of the time, the role of the child's pediatrician has greatly increased. He or she must understand fully not only the signs and symptoms of the disease but also the complications that at times are related to the treatment.

It is to give the practicing pediatrician a better understanding of the modern approach to cancer that this and the following issue of Pediatric Annals are presented.

Dr. Carl Pochedly, author of the volume, The Child with Leukemia, and coeditor of the book, Major Problems in Childhood Cancer, is the guest editor of these two issues. Dr. Pochedly has brought together an eminent group of contributors from authorities in the field.

Dr. Joseph H. Burchenal of the Memorial Sloan-Kettering Cancer Center in New York City presents an overview of the advances made in the treatment of childhood cancer in the past 30 years.

Drs. Donald J. Fernbach and Kenneth A. Starling of the Baylor College of Medicine, Houston, Tex., follow with an article on acute leukemia, in which they point out how much longer and with less morbidity affected children are living under modern methods of therapy. A suggested treatment regimen is detailed. The wealth of these authors' experience is demonstrated by a study of 1,024 children with acute leukemia followed by the Southwest Cancer Chemotherapy Group.

In the next article, "Lymphosarcoma," Dr. André D. Lascari of the Southern Illinois University School of Medicine notes that although this condition has always been one of the most dangerous cancers in children, the combination of radiotherapy and chemotherapy has resulted in increased survival. The section of the article on differential diagnosis and the section defining the anatomic stages of the disease are of special importance to…

One of the greatest joys in the practice of pediatrics is the opportunity to watch children grow and develop from the moment they are born on through infancy, childhood, and adolescence. This opportunity differs in large part from hospital pediatrics, in which the focus is on the abnormalities of childhood, whether they result from trauma, infection, congenital defect, glandular dysfunction, blood dyscrasias, tumors, nephritis, nephrosis, and the like.

The practicing pediatrician, for his or her part, is dedicated to protecting and guiding the child through the years of growth and development. The practicing pediatrician cares for the whole child, not only physically but emotionally as well. He or she treats the child's illnesses and traumas and becomes an important part of the child's life and often serves as a guidance counselor for the parents as well.

There was a time, as many of us still remember, when deaths of children were not infrequent. Each year every pediatrician was faced with the possibility of deaths among his or her patients from numerous uncontrollable diseases. Poliomyelitis, scarlet fever, nephrosis, empyema, blood stream infections, erysipelas, appendicitis, and tuberculosis were some of the more common dangers. The practicing pediatrician had many moments of anxiety and many moments of distress.

Today most of these threats have disappeared due largely to a combination of preventive vaccines, antibiotic therapy, and medical and surgical advances.

But still a few life-threatening conditions remain, and of those still encountered by the modern pediatrician, none is more pernicious than cancer. Fortunately, it is comparatively rare during infancy and childhood, but all pediatricians with active practices meet with the condition from time to time.

But cancer today, as we all know, has a much better prognosis than only a few years ago. This is due to a combination of treatment by surgery, steroids, x-ray therapy, and chemotherapy. And since children under treatment and in remission are home so much of the time, the role of the child's pediatrician has greatly increased. He or she must understand fully not only the signs and symptoms of the disease but also the complications that at times are related to the treatment.

It is to give the practicing pediatrician a better understanding of the modern approach to cancer that this and the following issue of Pediatric Annals are presented.

Dr. Carl Pochedly, author of the volume, The Child with Leukemia, and coeditor of the book, Major Problems in Childhood Cancer, is the guest editor of these two issues. Dr. Pochedly has brought together an eminent group of contributors from authorities in the field.

Dr. Joseph H. Burchenal of the Memorial Sloan-Kettering Cancer Center in New York City presents an overview of the advances made in the treatment of childhood cancer in the past 30 years.

Drs. Donald J. Fernbach and Kenneth A. Starling of the Baylor College of Medicine, Houston, Tex., follow with an article on acute leukemia, in which they point out how much longer and with less morbidity affected children are living under modern methods of therapy. A suggested treatment regimen is detailed. The wealth of these authors' experience is demonstrated by a study of 1,024 children with acute leukemia followed by the Southwest Cancer Chemotherapy Group.

In the next article, "Lymphosarcoma," Dr. André D. Lascari of the Southern Illinois University School of Medicine notes that although this condition has always been one of the most dangerous cancers in children, the combination of radiotherapy and chemotherapy has resulted in increased survival. The section of the article on differential diagnosis and the section defining the anatomic stages of the disease are of special importance to all pediatricians who suspect the condition in any of their patients.

In the contribution on Wilms' tumor by Dr. Darieen R. Powars of the University of Southern California School of Medicine that follows, the author differentiates between the true Wilms' tumor and the benign mesoblastic nephroma so frequently mistaken for it. This differentiation is most important, Dr. Powars points out, because intense radiation of an infant or young child may have very serious after effects. Under current methods of management, as presented in the article, Wilms' tumor now has the best prognosis for long-term survival of any of the major malignant disorders of childhood.

The subject of neuroblastoma is covered by Dr. Lawrence Helson of the Memorial Sloan-Kettering Cancer Center. In this important article Dr. Helson emphasizes that early diagnosis in the first two years of life (before disssemination) is indispensable for a good prognosis. This places a most important responsibility on the shoulders of the child's pediatrician, for once the neuroblastoma is disseminated the results of treatment are poor.

The final article, "Infection in Childhood Cancer," by Drs. Robert R. Chilcote and Robert L. Baehner of Indiana University School of Medicine is a further contribution of. great importance to the practicing pediatrician if he or she is to aid in the care of children during their treatment for cancer. As the authors point out, mild infections may become life-threatening infections during periods of therapeutic immunosuppression or myelosuppression with severe granulocytopenia. The portions of the article relating to clinical management of such infections and the general prophylactic procedures are of extreme importance to the pediatrician if he or she is to work closely with the oncologist or hematologist in the care of the child with cancer.

The next issue of Pediatric Annals, also under the guest editorship of Dr. Pochedly, will cover rhabdomyosarcoma, brain tumors, retinoblastoma, Hodgkin's disease, and immunotherapy.

10.3928/0090-4481-19740501-03

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