Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: A multicenter nationwide study.

The aim was to evaluate the incidence, clinical course, and outcome of adenoviral infection (AdVI) in pediatric patients diagnosed and treated due to cancer and in pediatric recipients of hematopoietic stem cell. Over a 72-month period, all-in 5599 children with cancer: 2441 patients with hematological malignancy (HM) and 3158 with solid tumors (ST), and 971 patients after transplantation: 741 after allogeneic (allo-HSCT) and 230 after autologous (auto-HSCT) were enrolled into the study. Among cancer patients, 67 episodes of AdVI appeared in 63 (1.1%) children, including 45 (1.8%) with HM and 18 (0.6%; P < .001) with ST. Within transplanted patients, AdVIs were responsible for 88 episodes in 81 (8.3%) children (P < .001), including 78 (10.5%) patients after allo-HSCT and 3 (1.3%) after auto-HSCT. Time to develop AdVI was short, especially after allo-HSCT. The most common clinical manifestation in cancer patients was enteritis diagnosed in 63 (94.0%) cases, while among HSCT recipient asymptomatic adenoviremia was found in 36 (40.9%) cases and the most common clinical manifestation was urinary tract infection. Cancer patients with disseminated disease, as well as HSCT recipients with either asymptomatic viremia or disseminated disease, received antiviral treatment. The most commonly used first-line therapy was cidofovir. None of the cancer patients died due to AdVI, while within HSCT recipients three patients developed disseminated adenoviral disease and died despite antiviral treatment. In cancer patients, AdVIs are rare and associated with very good prognosis even without specific treatment. However, in allo-HSCT recipients, disseminated disease with fatal outcome is more likely to occur.

Hematopoietic stem cell transplantation does not increase the risk of infection-related complications for pediatric patients with Hodgkin and non-Hodgkin lymphomas: A multicenter nationwide study.

BACKGROUND: Hodgkin (HL) and non-Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%-30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second-line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear. OBJECTIVE: The aim of this population-based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL. PATIENTS AND METHODS: We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second-line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally. RESULTS: Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P = .151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram-positives were predominant. The rate of multidrug-resistant bacteria was high, especially for Gram-negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection-related mortality was comparable for each group. CONCLUSIONS: The incidence of IC was comparable during first- and second-line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy.

Inequalities in diagnosis and registration of pediatric very rare tumors: a European study on pleuropulmonary blastoma.

Very rare tumors (VRTs) account for up to 11% of childhood cancers. Dedicated national groups and registries only exist in some European countries. Pleuropulmonary blastoma (PPB) is a very rare intrathoracic pediatric tumor with a potentially severe prognosis. Due to its rarity, it sometimes goes unrecognized. We investigated PPB diagnostic capability and possible correlations between diagnostic performance and VRT-dedicated activities. The number of cases of PPB registered between 2000 and 2014 at pediatric oncology centers in Europe was compared with the number of expected cases. Data sources included VRT registries, population-based cancer registries, and hospital registries. Data were obtained for 25 countries, grouped into 4 geographical regions. The expected cases were 111, and the observed cases were 129. The observed-to-expected ratio was 1.86 for Northern Europe, 1.33 for Southern Europe, 1.22 for Central Europe, and 0.65 for Eastern Europe. More cases than expected were registered in all countries with an official VRT registry.Conclusion: The number of cases observed is consistent with expectations, but disparities exist across Europe. Difficulties in diagnosing PPB emerged in most Eastern countries. The incidence rate of PPB may be underestimated. The creation of VRT-dedicated groups and a European Registry for VRTs could help to reduce inequalities.What is Known:• Very rare pediatric tumors are often not recognized, despite representing almost 11% of childhood cancers .• Pleuropulmonary blastoma is a rare pediatric tumor with a poor prognosis.What is New:• The ability to diagnose and register pleuropulmonary blastoma varies in Europe.Registries dedicated to very rare pediatric tumors improve the diagnostic rates.• The incidence rate of pleuropulmonary blastoma may currently be underestimated.

Rare cancers in children - The EXPeRT Initiative: a report from the European Cooperative Study Group on Pediatric Rare Tumors.

The low incidence and the heterogeneity of very rare tumors (VRTs) demand for international cooperation. In 2008, EXPeRT (European Cooperative Study Group for Pediatric Rare Tumors) was founded by national groups from Italy, France, United Kingdom, Poland and Germany. The first aims of EXPeRT were to agree on a uniform definition of VRTs and to develop the currently most relevant scientific questions. Current initiatives include international data exchange, retrospective and prospective studies of specific entities, and the development of harmonized and internationally recognized guidelines. Moreover, EXPeRT established a network for expert consultation to assist in clinical decision in VRTs.

Diagnosis and treatment of renal cell carcinoma in children: a report from the Polish pediatric rare tumor study group.

BACKGROUND: Renal cell carcinoma (RCC) in children is rare, accounting for approximately 1.9-6% of all pediatric renal malignancies. The aim of this study was to transmit our experience in the treatment of RCC in Polish children. METHODS: Clinical data from 21 children (6.3-18 years old) with RCC treated between 1992 and 2009 at Polish pediatric oncological centers were analyzed. RESULTS: In 2 patients, RCC developed as a second malignancy after neuroblastoma or astrocytoma fibrillare, respectively. In 6 patients, initial diagnoses based on imaging studies were unilateral Wilms' tumor, leading to preoperative chemotherapy. The remaining patients underwent surgery at the beginning of treatment. According to the AJCC/TNM staging system, 14 patients had stage I, 5-II, 1-III, and 1-IV. Nephrectomy was performed in 19 patients, heminephrectomy in one, and biopsy in another. Histopathological diagnoses were clear-cell RCC (18 patients), papillary RCC (2 patients), and chromophobe RCC (1 patient). 10 patients were treated with chemotherapy, with or without IL-2, INFα, and antiangiogenic agents. 2 patients died due to disease progression. CONCLUSIONS: RCC in children is mostly operable at diagnosis, resulting in good prognosis. The role of adjuvant chemo- and immunotherapies is unclear. Neoadjuvant chemotherapy proven for children with Wilms' tumors is ineffective, but the delay in adequate therapy did not worsen the outcome if complete nephrectomy is done subsequently.

Serum soluble interleukin-2 receptor, beta2-microglobulin, lactate dehydrogenase and erythrocyte sedimentation rate in children with Hodgkin's lymphoma.

The study was to determine clinical utility of serum soluble interleukin (IL)-2 receptor (sIL-2Ralpha), beta(2)-microglobulin (beta(2)-M), lactate dehydrogenase (LDH) and erythrocyte sedimentation rate (ESR) as markers of diagnosis, prognosis and monitoring of response to therapy in childhood Hodgkin's lymphoma (HL). The markers were measured prospectively before treatment and in complete remission (CR) during and after therapy in 30 children with HL (F/M:19/11; median age: 11.3 years) and once in 50 healthy children (F/M: 24/26; median age: 8.7 years). Median pretreatment levels of all analysed markers were significantly higher than in healthy controls. Increased pretreatment sIL-2Ralpha, LDH and ESR correlated with bulky disease; sIL-2Ralpha, beta(2)-M and ESR with presence of B symptoms and sIL-2Ralpha and LDH with advanced HL stages. There was a correlation between sIL-2Ralpha and LDH and between beta(2)-M and ESR. The levels and rates of elevated markers reflected well the response to chemotherapy, decreasing significantly when patients achieved CR and further on with therapy continuation. Since all patients survived thus the markers' value to predict the outcome was not established. Serum sIL-2Ralpha, beta(2)-M, LDH and ESR may act as markers for diagnostics and used in monitoring of therapy effectiveness in childhood HL. The markers were also increased in subgroups of patients with unfavourable clinical features; however, small sample size of the study did not allow to draw conclusion on their prognostic roles. We were also not able to establish the influence of markers on event free survival and overall survival because all children survived independent of initial clinical characteristics and pretreatment levels of sIL-2Ralpha, beta(2)-M, LDH and ESR.

Angiosarcoma in children - still uncontrollable oncological problem. The report of the Polish Paediatric Rare Tumours Study.

Angiosarcoma in children - still uncontrollable oncological problem. The report of the Polish Paediatric Rare Tumours StudyAngiosarcoma is a rare, highly malignant vascular neoplasm with little data available on its clinical course and management in children. Ten children with angiosarcoma (M/F: 6/4; aged 2, 3-16 years) registered in Polish Paediatric Rare Tumours and Soft Tissue Sarcomas Studies between 1992 and 2006. Primary tumour exceeded 5 cm in seven patients and affected mainly deep tissues (heart-2, head/neck, bladder, brain, liver and upper limb - one patient each). Four patients had regional and two metastatic diseases (lungs and bones). Three patients were initially misdiagnosed as haemangioma. Complete primary excision was unfeasible even in local stages. All patients received supplementing chemotherapy with no response in four. Radiotherapy was given to five children, including three after relapse. Three of five secondary tumour resections proved complete. Seven patients experienced relapses (mainly metastatic) and two continuous progression. Relapsed patients received chemotherapy +/- radiotherapy and surgery (three). Nine patients died of disease (overall survival 6-66 months), and one child after mutilating secondary resection is alive. Angiosarcoma in children is highly aggressive with an extremely poor prognosis. Complete primary excision is unfeasible, even in seemingly local stages. The response to chemotherapy is poor and the large number of metastatic recurrences suggests a need for systemic therapy modifications.

The central action of gamma-aminobutyric acid in rats.

The influence of 100--600 microng of gamma-aminobutyric acid (GABA) injected into the right lateral ventricle of the brain on behavior and activity of the cerebral cholinergic system was studied in Wistar rats. Proportionally to dosage, GABA inhibited motor and exploratory activity in the rats. Reduction in the content of acetylcholine in the pons and medulla oblongata was accompanied by increased acetylcholinesterase (AChE) activity. GABA changed AChE activity differently in various parts of the brain. GABA depressed motor and exploratory activity in rats in a degree dependent on its dosage and inborn exploratory of the rats, and this effect was accompanied by changes in the cerebral cholinergic system.

Hepatotoxicological studies of pyrazolone derivatives on rats. Part 3: Quantitative immunologic determination of serum concentration of transferrin, IgG, alpha 2-acute phase protein and VLDL.

At present no sufficiently sensitive liver function tests are available to exactly detect small liver impairments caused by drugs. In this respect immunological quantitation of serum proteins could be useful. We have determined quantitative alterations of four serum proteins (IgG, transferrin, alpha 2-AP = alpha 2-acute phase protein, VLDL = very low density lipoprotein) from rats treated with aminophenazone, phenazone and propyphenazone (each 1,55 mmol/kg body mass/d). The serum concentration of the four proteins examined is temporarily elevated immediately after onset of treatment. In chronic treatment transferrin is increased by the influence of all drugs investigated. Propyphenazone treatment increased the amount of VLDL whereas aminophenazone had the opposite effect, phenazone is without influence in the same period. The alpha 2-AP serum level is decreased in long time treatment, IgG remains unchanged. The observed alterations indicate disturbances of liver function in the investigated rats. Among the drugs used, aminophenazone has the strongest, propyphenazone the smallest liver damaging effect. The results reported support the importance of serum protein quantitation in connection with the search for possible liver damage due to drug action.

Biphasic effect of pyrazolone derivatives on drug-metabolizing enzyme in rat liver.

The pyrazolone derivatives aminophenazone, phenazone, and propyphenazone known as inducers are capable of inhibiting initially monooxygenase-dependent biotransformation steps. In the dose of 1.5 mmol X kg-1 they prolong the hexobarbital narcosis (max. 1 h after administration) due to a reduced hexobarbital metabolism in the liver. An influence on the N-demethylation (aminophenazone as substrate) ist not substantial. The catalytic binding site of cytochrome P-450 is not influenced. In aminophenazone- and phenazone-treated animals the inhibitory phase is followed by a stimulatory one. After the repeated administration the inhibitory phase continues up to the third measured 1 h after administration. The initially inhibitory effect of inducers seems to be caused by a mutual interference of a complete or partial binding to various forms of cytochrome P-450. However, effects on the CNS cannot be excluded.

[Hepatotoxicological studies of pyrazolone derivatives on rats. Part 2: The study of propyphenazone and phenazone (author's transl)]. / Lebertoxikologische Untersuchungen von Pyrazolonderivaten an Ratten. 2. Mitteilung: Untersuchung von Propyphenazon und Phenazon.

In female rats the administration of 1,5 mmol/kg of, respectively, propyphenazone and phenazone over a period of 12 weeks produces a histologically detectable fatty degeneration and reactive-inflammatory changes of the liver, presumably caused by reactive metabolites. These slight morphological alterations do not lead to an increase in plasma enzyme activities. Only in case of phenazone administration, reduced increases in body weight are indicative of a toxic effect. The acceleration of hexobarbital degradation and N-demethylation and the increase in liver weight testify to the inductive activity of both these compounds.

[Enzyme activities in the blood serum from rats with chronic liver damage. part 3: Effect of thioacetamide]. / Enzymaktivitäten im Blutserum von Ratten bei chronischer Leberschädigung.

Liver damage was produced in male Wistar rats aged 15 weeks by daily oral administration of 40 mg/kg thioacetamide over a period of 24 weeks. All of the animals were weighed once a week. Furthermore, the duration of hexobarbital anaesthesia and the activities of the enzymes ASAT, ALAT, GIDH, LDH, LAP and alkaline phosphatase in the serum were determined in 6 experimental and 4 control animals after 3 d and 1, 2 and 4 weeks, and then at intervals of 4 weeks. For the purpose of comparison the same investigations were performed (under identical experimental conditions) both in rats fed normally and rats starved for 24 h to which a single dose of thioacetamide was applied. The histological study of the livers revealed destruction of the lobule architecture and profuse bile-duct proliferations after 12 weeks. Cirrhosis was observed after 16 weeks. The activities of ASAT, ALAT, GIDH and LDH increased for a short time and then returned closely to normal. During the whole experimental period, the LAP and alkaline phosphatase activities remained in the pathological range, as well as the duration of hexobarbital anaesthesia. Enzyme diagnosis is not suitable for assessing the degree of severity of a liver damage produced by thioacetamide.

[Hepatotoxicological studies of pyrazolone derivatives on rats. Part 1: The study of aminophenazone (author's transl)]. / Lebertoxikologische Untersuchunen von Pyrazolonderivaten an Ratten. 1. Mitteilung: Untersuchung von Aminophenazon.

After oral application of aminophenazone to animals (170 and 340 mg/kg daily, over up to 17 weeks), the authors investigated the effect of this drug on some liver functions and performed also a morphological study. They found that aminophenazone produces an increase of the smooth ER, peripheral fatty degradation and reactive-inflammatory responses of the liver, the intensity of these phenomena being dependent upon the dose and time of application. The increase of the smooth ER is the expression of the inductive effect which persists throughout the whole experimental period and manifests itself by accelerated degradation of hexobarbital, increased N-demethylation, increased ascorbic acid synthesis and increased liver weight. The increase in body weight is reduced in the animals treated. The enzyme activities in the plasma lie within the range observed with control animals; they are no indicator of the slight live changes stated. Reactive metabolites and/or the impairment of other metabolic reactions may be considered to be the cause of the hepatotoxic effect of aminophenazone.

[The excretion of hippuric acid and ascorbic acid in the urine of liver-damaged rats (author's transl]. / Die Ausscheidung von Hippursäure und Ascorbinsäure im Urin bei lebergeschädigten Ratten.

The authors investigated the effects of the administration of thioacetamide, carbon tetrachloride and aminophenazone on the excretion of ascorbic acid and hippuric acid in adult male and female Wistar rats. After a single application of thioacetamide and aminophenazone, the ascorbic acid content in the urine showed a dose-dependent increase, whereas that in the liver had decreased. This increase in the urinary ascorbic acid might be due to a release of stored ascorbic acid from the liver cells. When thioacetamide was given for a prolonged period, the ascorbic acid content in the urine increased at the beginning; later one, at the end of three weeks, it was slightly inferior to the control value. Both single and repeated applications of thioacetamide led to a decrease in the excretion of hippuric acid in the urine, which is attributed to an impairment of the mitochondrial hippuric acid synthesis. Long-term treatment with aminophenazone resulted in an increase of ascorbic acid in the urine, which is indicative of an induction effect, whereas the ascorbic acid content in the liver remained unchanged. There was no effect on the excretion of hippuric acid. In regard to their use in the toxicological evaluation of drugs, these two metabolic effects offer no decisive advantage over current liver function tests.

[Unilateral exophthalmus in the course of spontaneous retrobulbar hemorrhage in a patient with arterial hypertension]. / Jednostronny wytrzeszcz w przebiegu samoistnego wylewu pozagalkowego u pacjenta z nadcisnieniem tetniczym.

In this paper we present a case of a 60-year-old patient with labile hypertension, who was admitted to hospital because of unilateral exophthalmus and loss of vision of the left eye. During the hospitalization basic laboratory investigations, USG and NMR of orbits and arteriography of internal carotid arteries were carried out. Body temperature and arterial blood pressure were monitored. Leucocytosis and high values of arterial blood pressure in the early hours of the morning were found. Accessory investigations didn't explain the cause of exophthalmus. Repeated NMR of orbits showed image characteristic for retrobulbar haemorrhage in the left orbit. During the hospitalization hypotensive, anti-inflammatory and oedema-reducing treatment was administered, without surgical intervention. This case demonstrates that modern diagnostic investigations must be preceded by precise history taking concerning the early symptoms of the disease, its course and accompanying systemic diseases. Although spontaneous retrobulbar haemorrhages occur rarely, they must be taken into consideration in differential diagnosis of unilateral exophthalmus, especially in elderly patients with atherosclerosis and hypertension.