During recent years, attempts have been made to complement more classical concepts of medical teaching by introducing card and board games on medical topics. These teaching tools cover every age and education group, and many different medical topics. In this article we have reviewed all card and board games for medical education purpose listed in NCBI PubMed database and Internet game databases (n = 29). It summarizes games that might be useful to medical teaching staff. To categorize these games, a new schema for medical games categorization, based on the game mechanism and theories on experiential learning circles, is proposed and discussed. Additionally we have a view on card and board games with medical topics for entertainment (n = 22).

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma (STS) in childhood. Whereas more than 90% of patients with localized low-risk RMS can be cured, metastatic RMS have a dismal outcome, with survival rates of less than 30%. The HD CWS-96 trial showed an improved outcome for patients receiving maintenance therapy after completing intensive chemotherapy. Consequently, the international clinical trials CWS-IV 2002 and CWS DOK IV 2004 on metastatic disease of STS of the Cooperative Weichteilsarkom Studiengruppe (CWS) were designed in addition to the CWS-2002P trial for localized RMS disease. All patients received a multimodal intensive treatment regimen. To maintain remission, three options were compared: long-term maintenance therapy (LTMT) versus allogeneic hematopoietic stem cell transplantation (alloHSCT) versus high-dose chemotherapy (HDCT). A total of 176 pediatric patients with a histologically confirmed diagnosis of metastatic RMS or RMS-like tumor were included. A total of 89 patients receiving LTML showed a significantly better outcome, with an event-free survival (EFS) of 41% and an overall survival (OS) of 53%, than alloHSCT (n = 21, EFS 19%, p = 0.02, OS 24%, p = 0.002). The outcome of LTML was slightly improved compared to HDCT (n = 13, EFS 35%, OS 34%). In conclusion, our data suggest that in patients suffering from metastatic RMS, long-term maintenance therapy is a superior strategy in terms of EFS and OS compared to alloHSCT. EFS and OS of HDCT are similar in these strategies; however, the therapeutic burden of LTMT is much lower.

The incidence of invasive mold disease (IMD) has significantly increased over the last decades, and IMD of the central nervous system (CNS) is a particularly severe form of this infection. Solid data on the incidence of CNS IMD in the pediatric setting are lacking, in which Aspergillus spp. is the most prevalent pathogen, followed by mucorales. CNS IMD is difficult to diagnose, and although imaging tools such as magnetic resonance imaging have considerably improved, these techniques are still unspecific. As microscopy and culture have a low sensitivity, non-culture-based assays such as the detection of fungal antigens (e.g., galactomannan or beta-D-glucan) or the detection of fungal nucleic acids by molecular assays need to be validated in children with suspected CNS IMD. New and potent antifungal compounds helped to improve outcome of CNS IMD, but not all agents are approved for children and a pediatric dosage has not been established. Therefore, studies have to rapidly evaluate dosage, safety and efficacy of antifungal compounds in the pediatric setting. This review will summarize the current knowledge on diagnostic tools and on the management of CNS IMD with a focus on pediatric patients.

To investigate antitumor activity and toxicity associated with combined topotecan and carboplatin treatment in children and adolescents with metastasized, untreated soft tissue sarcoma (STS). Patients (n=34) less than 21 years old and untreated, stage IV STS. Patients were treated with topotecan (1 mg/m²/d for 4 days) and carboplatin (150 mg/m²/d for 4 days) (TC course) during week 1 and 4 of a chemotherapy window trial, which was followed by chemotherapy and local therapy from week 6 on. We evaluated the side effects, toxicity and tumor response (using RECIST criteria) 6 weeks after starting the 2 TC chemotherapy courses. The objective response rate (ORR) was 38% (n=13 patients with a partial response (PR)), and a stable disease (SD) was reached in 11 cases. No patient showed a complete response (CR) of all metastatic lesions, although 1 patient showed a CR of the target lesion. 2 patients died of progress of disease (PD). Toxicity was mainly hematological (grade III/IV toxicity 79%), and nonhematological toxicities mainly included infection, fever, nausea,and vomiting. Regarding adverse events, 4 probable and 8 possible events related to study medication occurred among the 66 courses of TC. In conclusion, TC was potent against high-risk STS, but results and toxicity data were not superior to former published monotherapeutic topotecan therapies. Untersuchung zur Polychemotherapie mit Topotecan und Carboplatin bei Kindern und Jungendlichen mit metastasierten, nicht vorbehandelten Weichteilsarkomen be­­züglich Ansprechens und Toxizität. Untersucht wurden 34 Patienten unter 21 Jahren mit nicht-vorbehandelten Stadium-IV-Weichteilsarkomen. Die Patienten wurden in einer Window-Studie mit Topotecan (1 mg/m²/d an 4 Tagen) und Carboplatin (150 mg/m²/d an 4 Tagen) in Woche 1 und 4 behandelt. In Woche 6 erfolgte eine Evaluation des Ansprechens nach RECIST-Kriterien, der To­­xizität und der Nebenwirkungen. Das Ansprechen (objective response rate, ORR) betrug 38% ( n=13 Patienten mit partiellem Ansprechen (PR)), ein Stable disease (SD) konn­te in 11 Fällen beobachtet werden. Kein Patient zeigte ein komplettes Ansprechen aller Metastasen, bei einer Patientin konnte der Primärtumor nicht mehr nachgewiesen werden. Zwei Patienten zeigten einen Progress. Die Toxi­zität beschränkte sich weitgehend auf hämatologische Toxizität, nicht-hämatologische Probleme waren Infektionen, Fieber, Übelkeit und Erbrechen. Die Ergebnisse der Studie waren vergleichbar mit denen aus Studien mit einer Topotecan-Monotherapie. Die TC-Window-Chemotherapie zeigte sich nach 6 Wochen als wirksam gegen Hochrisikosarkome, war jedoch früheren Monotherapiestudien auch in Bezug auf die Toxi­zität nicht überlegen. Langszeitdaten stehen aus.