The characteristics of childhood ALL in SA are similar to those observed in developed countries. Future prospective studies utilizing unified national protocols are needed to further improve the outcome of our patients.

BACKGROUND AND OBJECTIVEBecause of the need for more comprehensive information on the least toxic and most effective forms of therapy for children with acute lymphoblastic leukemia (ALL), we reviewed our experience in the treatment of children with ALL at King Faisal Specialist Hospital and Research Centre (KFSH&RC) and King Fahad National Center for Children’s Cancer and Research (KFNCCC&R) over a period of 18 years with a focus on patient characteristics and outcome.METHODSDuring the period of 1981 to 1998, records of children with ALL were retrospectively reviewed with respect to clinical presentation, laboratory findings, risk factors, stratification, therapy and outcome. The protocols used in treatment included 4 local protocols (KFSH 81, 84, 87 and 90), and subsequently, Children’s Cancer Group (CCG) protocols, and these were grouped as Era 1 (1981–1992) and Era 2 (1993–1998).RESULTSOf 509 children with ALL treated during this period, 316 were treated using local protocols and 193 using CCG protocols. Drugs used in Era 1 included a 4-drug induction using etoposid (VP-16) instead of L-asparaginase. Consolidation was based on high dose methotrexate (MTX) 1g/m2 and maintenance was based on oral mercaptopurine (6-MP) and MTX with periodic pulses using intravenous teniposide (VM-26), Ara-C, L-asparaginase, adriamycin, prednisone, VP-16 and cyclophosphamide. International protocols were introduced in Era 2, which was also marked by intensification of early treatment, a wider selection of cytoreductive agents, and the alternating use of non-cross-resistant pairs of drugs during the post-remission period. The end-of-induction remission rate improved from 90% in Era 1 to 95% in Era 2, which was of borderline statistical significance (P=.049). The 5-year event-free survival (EFS) improved from 30.6% in Era 1 to 64.2% in Era 2 (P<.001). Improvement in outcome was achieved without any significant increase in morbidity or mortality, due to improvement in both systemic therapy and supportive care. The most important independent prognostic factors were intensity of therapy, poor risk category assignment and CNS disease at diagnosis.CONCLUSIONOutcome in children with ALL has improved because of intensification of treatment protocols and better supportive care.

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Adolescent idiopathic scoliosis is a common disorder of unknown etiology. The lack of symptoms delays its detection, sometimes beyond the remedial range. In this study, consent forms were distributed to elementary schoolgirls between 11-13 years, at random, in the city of Riyadh. Out of 1,147 girls screened, 40 girls were positive on screening. In the clinic, nine girls were found to have no scoliosis, one had old poliomyelitis and one had lumbar lipoma. The remaining 29 girls had idiopathic scoliosis, giving a prevalence of 2.5%. However, the Cobb's angle was more than five degrees in nine girls only, reducing the prevalence of significant curves to 0.78%. The study was acceptable to all parties involved. We feel studies that address the issues of female screeners, transportation problems, and cost-effectiveness are needed prior to embarking on larger scale programs.A Abo-Bakr, A Al-Mazyiad, M Al-Hussein, R Al-Sudairy, M Krimli, PJ Patel, Adolescent Idiopathic Scoliosis Screening of Schoolgirls. 1992; 12(6): 555-557 Adolescent idiopathic scoliosis (AIS) is a common disorder of unknown etiology. It is a worldwide problem with similar prevalence in different parts of the world. This disorder lends itself to an easy and a reasonably accurate screening method. Physical examination has proved to be a successful screening tool with minimal cost [1][2][3][4][5][6][7][8][9]. Its progression can be halted by appropriate intervention. For these reasons, school screening programs for AIS have already been established in different parts of the world and are now a common practice in North America [1][2][3][4][5][6][7][8]. This study was designed to determine the prevalence of this disorder in schoolgirls who constitute the population of highest risk. Material and MethodsApproval to carry out the study was obtained from the concerned school authorities. Consent forms were randomly distributed to 1,180 elementary schoolgirls aged between 11-13 years in the city of Riyadh. The screening, carried out by two female pediatricians and one female general practitioner, was conducted according to an already established methodolgy [2,3,8,11]. In short, one looks for shoulder or scapular asymmetry while in the standing position, and for spinal hump when bending forward. The girls found to have scoliosis by the aforementioned screening test were subsequently subjected (in the clinic) to detailed history and physical examination by two pediatricians and a pediatric surgeon using standardized checklists with minor changes [9].Complete blood count (CBC), erythrocyte sedimentation rate (ESR), urinalysis and spine x-rays were done on

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