Browsing by Author "Hesseling, P. B."
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- ItemAn analysis of prognostic variables in acute lymphocytic leukaemia in a heterogenous South African population(1997) Wessels, G.; Hesseling, P. B.; Buurman, M.; Oud, C.; Nel, E. D.The records of all 96 children below the age of 15 years diagnosed with acute lymphoblastic leukaemia at Tygerberg Hospital in the Republic of South Africa between 1983 and 1995 were reviewed to determine risk factors which may predict poor outcome. Age < 2 and > 8 years, and white cell count > 20 x 109/l at diagnosis were significant predictors of poor outcome. Sex, FAB classification, immunophenotype, hepatomegaly, splenomegaly, BFM risk score, and the presence of mediastinal glands did not predict outcome. The presence of the established risk factors could not adequately explain the difference in 5-year event-free survival in the three ethnic groups which was 67 per cent in white, 17 per cent in black, and 38 per cent in children of mixed ethnic origin. In an attempt to improve survival in black children, our stratification of risk groups will in future be based on factors that include ethnicity, age and WCC ≤ 20 x 109/l at diagnosis. Pediatric oncology services in developing countries should adapt therapy to the risk factors of their local populations.
- ItemBurkitt's lymphoma : the prevalence of HIV/AIDS and the outcome of treatment(Health & Medical Publishing Group, 2018) Hesseling, P. B.; Kouya, F.; Katayi, E.; Mbah, G.; Wharin, P.The prevalence of HIV in Burkitt’s lymphoma (BL) patients and the outcome of treatment in Cameroon were unknown. Records of all patients diagnosed with BL at three Cameroon Baptist Convention hospitals were reviewed to ascertain the recorded HIV status and outcome of treatment. Of 979 patients diagnosed with BL, 717 were tested for HIV and 11 (1.5%) were HIV-positive. Three of eight patients treated with both cyclophosphamide (CPM)-based chemotherapy and antiretrovirals were alive at 62, 96 and 111 months, respectively. The HIV rate was comparable to that of 1% for the general population of children aged <15 years. Low-cost high-frequency CPM was the only available treatment option for BL and was associated with 37.5% long-term survival in a resource-limited setting.
- ItemBurkitt’s lymphoma patients in Northwest Cameroon have a lower incidence of sickle cell trait (Hb AS) than healthy controls(Health & Medical Publishing Group, 2016) Hesseling, P. B.; Jam, D. T.; Palmer, D. D.; Wharin, P.; Tuh, G. S.; Bardin, R.; Kidd, MContradictory findings have been reported from Africa with regard to the risk of developing Burkitt’s lymphoma (BL) in sickle cell trait (AS) carriers. Haemoglobin electrophoresis was performed in 78 BL patients in the Northwest region of Cameroon, and in 78 nearest-neighbour controls of the same age, sex and tribe from the same village. AS was confirmed in 4 of 78 (5.13%) BL patients and in 11 of 78 (14.10%) controls (χ2, p=0.052; Fisher’s exact, one-tailed, p=0.050). Sickle cell trait carriers had a marginal statistically reduced risk of developing BL.
- ItemThe effect of rooibos tea on the type I allergic reaction(Health & Medical Publishing Group, 1982) Hesseling, P. B.; Joubert, J. R.The hypothesis that Aspalathus linearis (rooibos tea) has anti-allergic properties was tested. The type I skin reaction was employed as a measurable criterion of allergic disease. Local application and the ingestion of rooibos tea failed to inhibit these reactions, and it is highly unlikely that this substance has any value in the treatment of this type of allergic disease.
- ItemFollow-up of a suspected excess of brain tumours among Namibian children(Health and Medical Publishing Group (HMPG), 2005-10) Preston-Martin, S.; Wessels, G.; Hecht, S.; Hesseling, P. B.To the Editor: The aim of this follow-up study was to further investigate a suggested excess of childhood brain tumours (CBT) among Herero children in Namibia from 1983 to 1988. Incidence rates of primary brain tumours among Herero children were found to be 4 times higher than rates among Namibian children in any of the 10 other tribal groups or among children of European origin. The causes of CBTs remain largely unknown. The only established causes are ionizing radiation and predisposing inherited syndromes. A particularly compelling hypothesis is that exposure during gestation to N-nitroso compounds (NOCs) may lead to the development of CBT. This hypothesis was suggested by experimental work in which 100% production of nervous system (NS) tumours in rat offspring resulted from transplacental exposure to the neurocarcinogen ethylnitrosourea (ENU) or to low levels of the precursor compounds sodium nitrite and ethyl urea added to the food and drinking water of pregnant rats
- ItemGaucher's disease in the Cape Coloured population of the RSA, including a family with 5 affected siblings(Health & Medical Publishing Group, 1987) Swart, A. L.; Hesseling, P. B.; Hayden, M. R.Nine Cape Coloured children from four families with severe non-neuropathic Gaucher's disease are documented. The diagnosis was confirmed histologically in the bone marrow, spleen and liver, and by serum acid phosphatase and leucocyte β-glucosidase assays. This represents a minimum prevalence for Gaucher's disease of 1 in 247,350 in this population and an approximate genetic carrier rate of 1 in 230 for the abnormal gene. A family with 5 affected siblings is recorded. The severe early clinical expression documented in these coloured patients is similar to that described in the Afrikaner population and differs from the less severe expression of Gaucher's disease in the South African Ashkenazi Jewish population. Gaucher's disease in the Cape Coloured population presents with a precocious onset, causes severe complications and progresses rapidly.
- ItemHaemophilia patients aged 0-18 years in the Western Cape(Health & Medical Publishing Group, 2003) Hazewinkel, M. H.; Hoogerwerf, J. J.; Hesseling, P. B.; Hartley, P.; MacLean, P. E.; Peters, M.; Wessels, G.Objectives. To record the number of haemophiliacs aged 0 - 18 years in the Western Cape (WC), what event led to the diagnosis, the level of clotting factor, treatment, functional status of their joints and impact of the disease on the family. Design. A prospective study of patients registered with the South African National Haemophilia Registry and new patients, utilising the patients' paediatricians, hospital records, patient and guardian interviews, physical examination and provincial nurse haemophilia co-ordinators. Setting. Haemophilia care centres, at the three WC academic hospitals, regional hospitals and homes of patients. Two elective medical students, MHH and JJH, collected the information. Subjects. All boys with confirmed haemophilia A or B in the WC. Outcome measures. Events that led to diagnosis, degree of haemophilia, use of clotting factor, functional status, and effect on family. Results. Of 78 patients (59 haemophilia A, 19 haemophilia B) identified, 49 could be studied. Forty-three per cent had severe, 29% moderate and 22% mild disease (6% unknown). Family history was present in 49%, but led to diagnosis in only 12%. The most common first symptoms were subcutaneous and mucosal bleeding. Delay in diagnosis varied from 0 to 9 months. Twenty-nine per cent of guardians were suspected of child abuse. RSA produced clotting factor was used 'on demand' in 73% of patients, for periodic prophylaxis in 20% and as continuous prophylaxis in 7%. Joints were functionally restricted in 43% of patients. The majority of guardians (59%) said the disease had a major impact on the family. Conclusions. The diagnosis of haemophilia in children with a positive family history was often delayed. Haemophilia causes significant morbidity in our patients and their families.
- ItemHemoglobin M(Iwate) in Cape Town : a report of 2 cases(Health & Medical Publishing Group, 1979) Hesseling, P. B.Two siblings had suffered from cyanosis since birth owing to the presence of Hb M(Iwate). The diagnosis was confirmed by electrophoresis, spectroscopy and peptide analysis. The benign nature of this unusual condition is stressed.
- ItemIncidence and frequency rates of childhood cancer in Namibia(Health & Medical Publishing Group, 1997) Wessels, G.; Hesseling, P. B.Objective. To estimate the extent of paediatric malignancy in an African country and to compare these findings with paediatric cancer rates in other countries. Design. A retrospective descriptive study which calculated incidence and frequency rates from the data obtained from a 6-year survey of childhood cancer in Namibia. Setting. Children from the general community who were referred by primary care physicians or clinics and diagnosed in peripheral district hospitals or a tertiary care institution. Patients. A total of 163 children less than 15 years of age diagnosed with any malignant neoplasm, intracranial tumour or histiocytosis between 1983 and 1988. Intervention. None. Main outcome measures. The minimum overall incidence of childhood cancer recorded in Namibia was lower than the rates usually reported by economically privileged countries. The rates of certain malignancies corresponded to the rates recorded in other African countries. Results. The overall incidence of childhood cancer was 55.5 per million. Tumours of the central nervous system occurred most commonly (18%), followed by renal tumours (14%), leukaemia (12%) and lymphoma (11.5%). The 5.8 per million incidence rate of retinoblastoma was similar to the rates recorded in other African countries but higher than in the UK or the USA. The incidence rates per million children for renal tumours, malignant bone tumours and soft-tissue sarcomas were 7.4, 4.8 and 5.2, respectively, which correspond with the rates in Western Europe and the USA. The incidence rate of CNS tumours was only 9.3 per million. Both leukaemia (6.5 per million) and lymphoma (6.3 per million) had rates far lower than those recorded in central Africa or developed Western countries. Conclusion. The incidence pattern of childhood cancer in Namibia demonstrates features of both the patterns described as typical for Africa and those described for industrialised countries.
- ItemIncidence of acute lymphoblastic leukaemia in white and coloured children in the Western Cape(Health & Medical Publishing Group, 2004) Hesseling, P. B.; Hartley, P.; Zietsman, L.; Van Lill, S.; Preston-Martin, S.; Wessels, G.Objectives. To record the age-specific incidence rate (ASIR) for diagnosed acute lymphoblastic leukaemia (ALL) in coloured and white children aged 0-12 years in the Western Cape (WC). Design. A retrospective population-based study using the 1991 population census to calculate the mean annual childhood population and the ASIR for ALL in the 0-4, 5-9 and 10-12-year age groups in rural and Cape Town metropolitan areas for the period 1983-1999. Odds ratios were calculated using EpiInfo 2000. Setting. Registry records of the paediatric cancer units at Tygerberg and Red Cross War Memorial Children's hospitals where all children with ALL in the WC were initially treated. Subjects. All white and coloured children aged 0-12 years diagnosed as having ALL from 1983-1999. Outcome measures. The ASIR by age and ethnic group in rural and metropolitan patients in the WC. Results. The estimated annual childhood population in 1991 was 709 151 with 80.4% coloured and 19.6% white children, of whom 60% were resident in the Cape Town metropolitan area and 40% in the rural area of the WC. Of 246 children with ALL diagnosed in the period 1983 - 1999, 144 were male and 102 female. The ASIR in coloured children aged 0 - 4 years was 17.1/106 in the rural and 30.5/106 in the metropolitan area, compared with 55.7/106 and 56.2/106 respectively in white children. In the 5-9-year age group the ASIR in coloured children was 10.0/106 in the rural and 16.6/106 in the metropolitan area compared with 27.6/106 and 26.7/106 respectively in white children. The 10-12-year age group had comparable incidence rates in both populations and geographical areas. Only one case occurred within a 20 km radius of the Koeberg nuclear reactor. Conclusions. White children have an ASIR for ALL comparable to rates of diagnosis in the USA, while only half as many coloured children aged 0-9 years were diagnosed in both the rural and metropolitan areas. This contrast may indicate significant underdiagnosis of ALL in coloured children over the period in question. The change in health policy since 1994, which has improved access to primary health care, may improve the rate of diagnosis among coloured and black children.
- ItemKaposi’s sarcoma : good outcome with doxorubicin, bleomycin and vincristine sulphate (ABV) chemotherapy and highly active antiretroviral therapy(Health & Medical Publishing Group, 2017) Hesseling, P. B.; Katayi, E.; Wharin, P.; Bardin, R.; Kouya, F.; Palmer, D.; Glenn, M.; Kruger, MarianaThere is little published information on effective treatment of Kaposi’s sarcoma (KS) in children in low-income countries. We prospectively treated 12 patients with an institutional review board-approved protocol consisting of four monthly courses of doxorubicin (Adriamycin), bleomycin and vincristine sulphate (ABV), with highly active antiretroviral therapy (HAART) plus co-trimoxazole prophylaxis for those who were HIV-positive, with additional vincristine if remission was not achieved after 4 months. Maintenance HAART plus co-trimoxazole was given to all HIV-positive patients. A fine-needle aspirate and CD4+ count were done if possible, and staging was performed according to Mitsuyasu. Eight of ten HIV-positive patients with stage III - IVB disease, and both HIV-negative patients with stage I disease, were in remission after 473 - 1 490 (mean 939) days. One patient died after absconding during treatment, and one died from neutropenia-related pulmonary infection. ABV with or without HAART is an effective treatment option for children with KS.
- ItemLeucocyte ultrastructure and folate metabolism in Down's syndrome(Health & Medical Publishing Group, 1977) Gericke, G. S.; Hesseling, P. B.; Brink, S.; Tiedt, F. C.Electron microscopic and hematologic investigation of peripheral blood showed a higher percentage of leukemia like nuclear ultrastructural abnormalities in the leucocytes of 30 individuals with Down's syndrome (mean 6,3%) than in normal controls (mean <1%). Most of these aberrations consisted of nuclear membrane abnormalities. Red cell folate values were very low in the group with Down's syndrome. Although mean serum folate and vitamin B12 levels were normal in this group, these individuals displayed increasing macrocytosis and decreasing serum folate levels with age. The whole group with Down's syndrome showed an increased mean corpuscular volume (MCV). The percentage of ultrastructural abnormalities did not correlate with folate levels when they were analysed individually. The existence of nuclear membrane abnormalities and folate deficiency, both of which may be associated with increased chromosome breakage, may be partly responsible for the increased leukemia risk in patients with Down's syndrome.
- ItemLeukaemogenesis in Down's syndrome(Health & Medical Publishing Group, 1977) Gericke, G. S.; Hesseling, P. B.; Brink, S.; Becker, W. B.Due to the fixed karotype and documented malignancy risk in patients with Down's syndrome, recently described aetiological factors can be assigned to their proper places in a conceptual framework for leukaemogenesis in these individuals. This is a more profitable approach than those in which various types of karyotypic patterns are matched to different malignancies. It seems that viruses may play a special role, but they need interaction with other factors, most of which are present in Down's syndrome. A unifying concept which may be helpful in establishing research priorities is presented.
- ItemOnyalai - therapeutic effects of vincristine sulphate : a prospective randomized trial(Health & Medical Publishing Group, 1986-08) Hesseling, P. B.; Girdle-Brown, B.; Smith, J.Twenty out of 40 patients with onyalai admitted to Rundu State Hospital, Kavango, SWA/Namibia, were randomized to receive a vincristine sulphate bolus of 1,5 mg/m2 or an equivalent volume of normal saline intravenously on days 8 and 15 when haemorrhage or a platelet count of less than 50 x 109/l persisted for more than 1 week after admission. All patients were observed in hospital for at least 21 days. Five out of 10 patients who received vincristine achieved a platelet count in excess of 100 x 109/l on day 21 and only 2 out of 10 patients who received placebo achieved a similar rise in the platelet count. Two patients, neither of whom was treated with vincristine, died of cerebral haemorrhage.
- ItemPlatelet antibodies in immune thrombocytopenic purpura and onyalai(HMPG, 1981) Brink, S.; Hesseling, P. B.; Amadhila, S.; Visser, H. S.A prospective study was undertaken to assess the nature, incidence and natural history of platelet antibodies in patients with immune throbocytopenic purpura (ITP) and patients with onyalai, using an immunofluorescent technique. Twelve patients under 14 years old and 11 patients 14 - 75 years old with ITP, and 24 patients with onyalai were studied. Alternate younger patients were treated with corticosteroids. Ten of the 12 children with ITP had IgG platelet antibodies in their serum, which disappeared as the platelet count recovered. Steroid therapy did not change the course of the disease or the antibody response. Of the 24 patients with onyalai, 23 had IgG antibodies and 18 had IgM antibodies, which were still present after 14 days and unrelated to the rise in platelet count. Steroid therapy did not affect the platelet count or the antibody titre. The difference in immune response of ITP and onyalai points to a difference in aetiology. The clinical presence of IgM antibodies in onyalai fits the hypothesis that a toxin, possibly acting as a hapten, is responsible for this form of thrombocytopenia.
- ItemPleuropericardial effusions in children with non-Hodgkin's lymphoma. A report of 2 cases(Health & Medical Publishing Group, 1987-12) Schraader, E. B.; Hesseling, P. B.Two children with non-Hodgkin's lymphoma (NHL) who presented with pleuropericardial effusions are reported on. Pericardial effusions are very unusual in children with mediastinal nodal NHL. In the first patient, who presented with a pleural effusion and pericardial tamponade, the diagnosis of NHL was obscured by a false-positive report of acid-fast bacilli in the pleural fluid. The second patient presented with a pleural effusion and a pericardial effusion with superior vena cava obstruction. Rapid filling of the serous cavities was a striking feature in both cases. Cytological and biochemical investigation of the pleural fluid and pleural biopsy are of limited diagnostic value. Pleuropericardial effusions in NHL are reviewed. The patients have been in disease-free remission for 18 and 16 months respectively.
- ItemA prospective study of long-term use of amikacin in a paediatrics department : indications, administration, side-effects, bacterial isolates and resistance(Health & Medical Publishing Group, 1990) Hesseling, P. B.; Mouton, W. L.; Henning, P. A.; Kirsten, G. F.; Spruyt, L. L.; Schraader, E. B.; Wessels, G.; Grassman, R.Amikacin (Amikin; B-M) was used as the only aminoglycoside for 18 months in a paediatric department within a general hospital because of high levels of resistance of Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter cloacae isolates to tobramycin, gentamicin and netilmicin. Between 1 February 1987 and 31 July 1988, 816 children were treated with a slow intravenous injection at a standardised dose adjusted for weight and age. Respiratory disease was present in 35,8% of 537 neonates, 56,4% of 190 infants and 70,9% of 89 older children. Escherichia coli (65 isolates), Klebsiella species (59 isolates), Enterobacter species (26 isolates) and P. aeruginosa (22 isolates) constituted the most common Gram-negative pathogens. The positive blood culture yield was 7,8%. Satisfactory median peak and trough serum amikacin levels were achieved. No significant renal side-effects were noted. Severe bilateral hearing loss in 1 low-birthweight infant resulted from inadvertent overdosage. At the end of this 18-month surveillance period 97,7% of E. coli, 98,6% of K. pneumoniae, 96,3% of E. cloacae, and 98,0% of P. aeruginosa isolates remained sensitive to amikacin, while resistance of K. pneumoniae to tobramycin, netilmicin and gentamicin decreased significantly (P < 0,003, P < 0,001 and P < 0,007 respectively; chi-square test).
- ItemThe 'Road to Health' card in a paediatric outpatient department(Health & Medical Publishing Group, 1987) Donald, P. R.; Hesseling, P. B.The use of the 'Road to Health' card was assessed in the Paediatric Outpatient Department of Tygerberg Hospital over three annual week-long surveys. Of 621 children seen, 344 (55%) were accompanied by a card which in 231 cases (67%) was still in its original polythene bag. Mass was recorded on a mean of 6 occasions, perinatal data were noted on 80% of cards, but the passing of milestones was noted on only 25% of cards. Episodes of illness were recorded on only 40% of cards.
- ItemSerum immunoglobulin and complement values in onyalai : comparison with black, San and white inhabitants of Kavango, SWA/Namibia(Health & Medical Publishing Group, 1986-08) Hesseling, P. B.; Cooper, R. C.; Girdle-Brown, B.The hypothesis that onyalai results from a polyclonal immune response and that complement activation occurs in its active phase was investigated. Serum immunoglobulins IgA, IgG and IgM and complement fractions C3 and C4 were measured in 21 black onyalai patients and 44 of their close relatives, 37 healthy black schoolchildren, 42 Barakwenga San, 10 Kung San and 18 whites in Kavango. An additional 4 patients with onyalai were investigated after splenectomy. Total complement level, circulating immune complexes and antinuclear antibodies were measured in an additional 6 patients with acute onyalai. The results did not support the hypothesis.
- ItemThe Cameroon 2008 burkitt lymphoma protocol: Improved event-free survival with treatment adapted to disease stage and the response to induction therapy(2012) Hesseling, P. B.; Njume, E.; Kouya, F.; Katayi, T.; Wharin, P.; Tamannai, M.; Achu, P.; Kidd, M.; McCormick, P.Treatment of endemic Burkitt lymphoma (BL) with cyclophosphamide (CPM) and intrathecal methotrexate (IT MTX) can cure 50% of patients. In this study, induction therapy with CPM and IT MTX was followed by consolidation chemotherapy adapted for stage, clinical response, and abdominal ultrasound findings. One hundred and twenty-nine consecutive patients with BL, 77 male and 52 female with a median age of 7.9 years, were treated in mission hospitals in Cameroon. The diagnosis rested on fine-needle aspirate (79%), biopsy, bone marrow, cerebrospinal fluid, abdominal ultrasound, and clinical examination. Six percent had St Jude stage I, 13% stage II, 72% stage III, and 12% stage IV disease. The abdomen (76%) and face (50%) were mainly involved. Induction chemotherapy was CPM 40 mg/kg and IT MTX 12.5 mg and IT hydrocortisone 12.5 mg on days 1, 8, and 15. Stage I and II patients received CPM 60 mg/kg on day 29, and stage III patients CPM 60 mg/kg on days 29 and 43 if in remission on day 28. Stage IV patients and patients not in remission received CPM 60 mg/kg on days 29, 43, and 57 and 1.0 g/m 2 MTX intravenous (IV) and vincristine 1.5 mg/m 2 IV on day 29. Event-free survival (EFS) at mean 365 days was 61% (n = 79) and 100% in stage I, 85% in stage II, 60% in stage III, and 27% in stage IV patients. Deaths (n = 24) were disease or treatment related and 26 patients relapsed (mean 135 days). Risk-adapted treatment achieved 61% 1-year EFS. © 2012 Informa Healthcare USA, Inc.