Adipokines, insulin resistance, and adiposity as a predictors of metabolic syndrome in child survivors of lymphoma and acute lymphoblastic leukemia of a developing country.

BACKGROUND: There is a growing body of evidence indicating that pediatric survivors of cancer are at a greater risk of developing metabolic syndrome. This study evaluated some probable predictors of metabolic syndrome (MS), such as leptin and adiponectin concentrations, the leptin/adiponectin ratio, insulin resistance, and adiposity, in a sample of child survivors of lymphoma and leukemia in Mexico City. METHODS: Fifty two children (leukemia n = 26, lymphoma n = 26), who were within the first 5 years after cessation of therapy, were considered as eligible to participate in the study. Testing included fasting insulin, glucose, adipokines and lipids; body fat mass was measured by DXA. The MS components were analyzed according to tertiles of adipokines, insulin resistance, and adiposity. Comparisons between continuous variables were performed according to the data distribution. The MS components were analyzed according to tertiles of adipokines, insulin resistance, and adiposity. With the purpose of assessing the risk of a present MS diagnosis, odds ratios (OR) with a 95% confidence interval (95% IC) were obtained using logistic regression analysis according to the various metabolic markers. RESULTS: The median children age was 12.1 years, and the interval time from the completion of therapy to study enrollment was 4 years. Among the MS components, the prevalence of HDL-C low was most common (42%), followed by central obesity (29%). The HOMA-IR (OR 9.0, 95% CI 2.0; 41.1), body fat (OR 5.5, 95% CI 1.6; 19.3), leptin level (OR 5.7, 95% CI 1.6; 20.2) and leptin/adiponectin ratio (OR 9.4, 95% CI 2.0; 49.8) in the highest tertile, were predictive factors of developing MS; whereas the lowest tertile of adiponectin was associated with a protective effect but not significant. CONCLUSIONS: Biomarkers such as HOMA-IR, leptin and leptin/adiponectin are associated with each of the components of the MS and with a heightened risk of suffering MS among children survivors of cancer. Given the close relationship between MS with risk of developing type 2 diabetes and cardiovascular disease, it is imperative to implement prevention measures in this population and especially in developing countries where these pathologies have become the leading cause of death.

Utilidad de la proteína C reactiva para el diagnóstico de infección bacteriana en el paciente pediátrico con cáncer, fiebre y neutropenia / Usefulness of C-reactive protein in the diagnosis of bacterial infection in the pediatric patient with cancer, fever and neutropenia

Introducción. El diagnóstico de infección bacteriana en el paciente con cáncer, fiebre y neutropenia se dificulta debido a una pobre respuesta inflamatoria. Se han realizado evaluaciones con reactantes de fase aguda, como la proteína C reactiva, con resultados variables. El objetivo de este trabajo fue calcular la sensibilidad, especificidad, valores predictivos positivos y negativos y razones de verosimilitud de la proteína C reactiva para el diagnóstico de infección bacteriana en pacientes con cáncer y neutropenia febril. Métodos. Se realizó el estudio de la prueba diagnóstica. Se incluyeron pacientes pediátricos con cáncer, y neutropenia (<500 NA/mm³). La proteína C reactiva se cuantificó por nefelometría. Los episodios se clasificaron en cuatro grupos: grupo I, infección microbiológicamente documentada; grupo II, infección clínicamente documentada; grupo III, fiebre por otras causas; y grupo IV, pacientes con neutropenia sin fiebre. Se realizó el cálculo de sensibilidad, especificidad, valores predictivos positivos y negativos, curvas operantes del receptor y razones de verosimilitud. Para la comparación de variables cuantitativas se emplearon la U de Mann-Whitney y Kruskal-Wallis y para variables cualitativas, χ². Resultados. Se incluyeron 127 episodios que se distribuyeron en: 29, 47, 20 y 31 episodios para los grupos I, II, III y IV, respectivamente. Las medianas de la proteína C reactiva fueron 282 mg/L para el grupo I, 205 mg/L grupo II, 27.3 mg/L grupo III y 5.1 mg/L para el grupo IV (p < 0.001). Con la proteína C reactiva de 60 mg/L se obtuvo una sensibilidad de 94%, especificidad de 94%, valor predictivo positivo 96% y valor predictivo negativo 92%; razón de verosimilitud para un resultado positivo 15.6 y de 0.06 para resultado negativo. Conclusiones. La proteína C reactiva es una prueba útil y económica para el diagnóstico de infección bacteriana en el paciente con cáncer, fiebre y neutropenia.

Background. Diagnosis of bacterial infection in the patient with cancer, fever and neutropenia is difficult due to the poor inflammatory response. Several evaluations of acute phase reactants such as C-reactive protein (C-RP) have been performed with diverse results. The aim of this study was to calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and likelihood ratios (LR) for C-RP in the diagnosis of bacterial infection of patients with cancer, neutropenia and fever. Methods. We carried out a diagnostic test study. Pediatric patients with cancer and neutropenia (<500 NA/mm³) were selected. C-RP was determined by nephelometry. Episodes were classified into the following groups: group I: microbiologically documented infection; group II: clinically documented infection; group III: fever of unknown origin; group IV: patients with neutropenia without fever. Sensitivity, specificity, PPV, NPV, receiving operating curves (ROC) and LR were calculated. Mann-Whitney U test and Kruskal-Wallis test were used for comparison of quantitative variables. For qualitative variables, χ2 test was used. Results. There were 127 episodes distributed as follows: 29, 47, 20 and 31 for groups I, II, III and IV, respectively. Median of C-RP values were 282 mg/L for group I, 205 mg/L group II, 27.3 mg/L group III and 5.1 mg/L group IV (p <0.001). With a C-RP value of 60 mg/L, we obtained a sensitivity of 94%, specificity 94%, PPV 6% and NPV 92%. LR for a positive test was 15.6 and LR for a negative test was 0.06. Conclusions. C-RP is a useful and economically feasible test for diagnosis of bacterial infection in patients with cancer, neutropenia and fever.

[Prognostic and survival factors among pediatric patients with ependymomas]. / Factores pronósticos y sobrevida de pacientes pediátricos con ependimomas.

BACKGROUND: Ependymomas constitute the third most common intracranial tumors in children. Risk factors include age, location, extent of surgical excision, and radiation therapy. Recently, chromosomal imbalances have been described. OBJECTIVE: Determine global survival of patients with ependymomas according to different prognostic factors. METHODS: We reviewed the medical charts of every pediatric patient with ependymoma from 1996 to 2005. Genomic imbalances were determined using comparative genomic hybridization (CGH). Survival was calculated using the Kaplan and Meier method. We used the Log Rank test for each risk factor. Death risk was calculated by odds ratio (OR). RESULTS: We included 24 patients. Global survival was 58.04%. The presence of chromosomal imbalances, particularly in chromosome 21, significantly affected survival Being under 5 years of age, anaplastic histology, chemotherapy other than ICE (ifosfamida-carboplatin-etoposide) and partial resection increased the risk of death. CONCLUSIONS: Known risk factors were confirmed in our study, including chromosomal imbalances. We describe a new chromosomal imbalance in chromosome 21 among 30% of study participants.

Factores pronósticos y sobrevida de pacientes pediátricos con ependimomas / Prognostic and survival factors among pediatric patients with ependymomas

Antecedentes: El ependimoma es el tercer tumor intracraneano más frecuente en pediatría. Los factores que influyen en el pronóstico son la localización, la edad del paciente, la resección quirúrgica y el tratamiento con radioterapia. Recientemente se ha descrito la presencia de alteraciones cromosómicas en el tumor como factor de mal pronóstico. El objetivo de esta investigación fue determinar la sobrevida de pacientes pediátricos con ependimoma de acuerdo con los diferentes factores pronósticos. Métodos: Se revisaron los expedientes de pacientes pediátricos con ependimoma de 1996 a 2005. Se determinaron las alteraciones cromosómicas mediante hibridación genómica comparativa. Se calculó la sobrevida de acuerdo con el método Kaplan-Meier y prueba de log rank de acuerdo a cada factor pronóstico. Se calculó el riesgo de morir para cada factor de acuerdo con la razón de momios. Resultados: Se incluyeron 24 pacientes. La sobrevida global fue de 58.04%. La presencia de alteraciones cromosómicas, particularmente en el cromosoma 21, afectó significativamente la sobrevida. La edad menor a cinco años, la histología anaplásica, la quimioterapia diferente a ifosfamida-carboplatino-etopósido y la resección parcial aumentaron el riesgo de morir. Conclusiones: Se confirman los factores descritos anteriormente en la literatura, incluyendo alteraciones cromosómicas. Se describe un nuevo desbalance en el cromosoma 21 en 30% de los pacientes.

BACKGROUND: Ependymomas constitute the third most common intracranial tumors in children. Risk factors include age, location, extent of surgical excision, and radiation therapy. Recently, chromosomal imbalances have been described. OBJECTIVE: Determine global survival of patients with ependymomas according to different prognostic factors. METHODS: We reviewed the medical charts of every pediatric patient with ependymoma from 1996 to 2005. Genomic imbalances were determined using comparative genomic hybridization (CGH). Survival was calculated using the Kaplan and Meier method. We used the Log Rank test for each risk factor. Death risk was calculated by odds ratio (OR). RESULTS: We included 24 patients. Global survival was 58.04%. The presence of chromosomal imbalances, particularly in chromosome 21, significantly affected survival Being under 5 years of age, anaplastic histology, chemotherapy other than ICE (ifosfamida-carboplatin-etoposide) and partial resection increased the risk of death. CONCLUSIONS: Known risk factors were confirmed in our study, including chromosomal imbalances. We describe a new chromosomal imbalance in chromosome 21 among 30% of study participants.

Phase II study of metronomic chemotherapy with thalidomide, carboplatin-vincristine-fluvastatin in the treatment of brain stem tumors in children.

BACKGROUND: Brain stem tumors (BST) constitute 20% of all intracranial tumors. Survival for these patients has been very poor worldwide. Four different treatment schemes have been evaluated at our institution, with only a discrete increment in survival when treated with carboplatin-vincristine and fluvastatin (CVF). Low-dose, continuous antiangiogenic treatment has been recently introduced in the treatment of cancer. Our objective was to determine tumor response to metronomic chemotherapy combined with an antiangiogenic drug and fluvastatin and to calculate the survival of pediatric patients with brain stem tumors. METHODS: This was a phase II study. A magnetic resonance (MRI) study was made at inclusion and after the fourth course. Routine laboratory analyses were performed prior to each treatment scheme. Patients received four courses of chemotherapy every 28 days consisting of thalidomide alternating with fluvastatin every 14 days and combined with carboplatin and vincristine every 14 days followed by radiotherapy (56 cGy) and four more courses of the same chemotherapy. Toxicity was evaluated according to Miller criteria. RESULTS: Nine recently diagnosed BST patients were included. Five patients had low-grade astrocytomas, three patients had glioblastoma multiforme, and one patient presented high-grade astrocytoma. There was a significant reduction in tumor volume and a significant increase in survival at 24 months. Two patients died. Toxicity included carboplatin allergy in one patient, grades 1 and 3 neutropenia in two patients, and grade 4 thrombocytopenia in two patients. CONCLUSIONS: Metronomic treatment with carboplatin and vincristine associated with fluvastatin and thalidomide significantly increased survival of pediatric brain stem tumor patients. Tumor volume showed a significant reduction. Quality of life was also increased. Sample size must be increased in order to make final conclusions.

Palonosetron hydrochloride is an effective and safe option to prevent chemotherapy-induced nausea and vomiting in children.

BACKGROUND: Emesis and nausea are common adverse effects of chemotherapy. Consequences include dehydration, acute renal failure, esophageal rupture, electrolyte imbalance and undernutrition, among others. First-generation 5-HT3 antagonists significantly reduce these symptoms but are expensive and require administration every 8-12h. Palonosetron, a second generation 5-HT3 antagonist has proven better results in adult populations. Other benefits include a one-dose administration with effect for up to 7 days and a lower treatment cost. No clinical studies have evaluated the safety and efficacy of palonosetron in children. METHODS: Prior to every course, patients were randomized to receive palonosetron or ondansetron. Patients or guardians recorded the number of emetic events and the intensity of nausea over a 7-day period. They also reported any possible adverse effects. Statistical analysis included chi(2) test, relative risk, and Student's t test. RESULTS: Fifty courses were analyzed for each group. There was a significant reduction in emesis on the first 3 days and in the intensity of nausea in the first four days in the palonosetron group. There was an increased risk of presenting emesis and nausea in the acute phase when treated with ondansetron. No adverse effects were reported. The cost of treatment was also reduced when using palonosetron. CONCLUSIONS: Palonosetron is a safe and effective antiemetic treatment in children, as well as being cost effective.

[The influence of different factors on energy intake and Basal metabolic rate in children with cancer]. / Factores que influyen en la tasa metabólica basal e ingesta de energía del paciente pediátrico con cáncer.

OBJECTIVE: to identify the Influence of different factors on energy intake and basal metabolic rate in children with cancer at diagnosis. METHODS: the basal metabolic rate and energy intake were measured during hospitalization and before treatment. The basal metabolic rate and energy from foods were measured by indirect calorimetry. Data were compared by Student t test and a multiple linear regression. RESULTS: energy intake ranged from 636 to 3063 kcal/d, mean 1956 +/- 530 kcal/d. Measured basal metabolic rate was within 10 % of predict for Schofield equation in ten of fourteen patients. Four patients were classified as hypometabolic. Energy intake was related to kind of tumor (solid tumor), sex (males) and loss weight, while basal metabolic rate was related to the age and sex, but only the age reached statistical significance (p < 0.01). CONCLUSIONS: the most influent variables on basal metabolic rate and energy intake were the variables related with age, sex and nutritional status at diagnosis. Physician should be consider the energy requirements of children in order to establish an appropriate nutritional and oncology therapy, and consequently, modify the risk of nutritional deterioration in order to improve the prognostic of patients.

Clinical and molecular parameters for risk stratification in Mexican children with medulloblastoma.

BACKGROUND: Clinical, histological, and more recently, molecular factors have been described as important in survival of the patient with medulloblastoma. Best survival results include aggressive chemotherapeutic protocols. More exact risk analysis may differentiate patients who require aggressive treatments from those with low risk who may respond adequately to less aggressive protocols. METHODS: Twenty six patients were included over a 10-year period and were followed for at least 5 years. Personal variables were obtained from their clinical records. Immunochemistry studies were performed on their formalin-fixed paraffin-embedded tissues. Statistical analysis included chi(2) test, odds risk, linear regression models, and Kaplan-Meier survival analysis. RESULTS: Metastatic disease and chemotherapy with VP16-carboplatin reduce the patient's probability of survival, whereas anaplastic histology increases the probability of death. Global survival and disease-free survival were 66.6 and 45.02%, respectively. Only two patients overexpressed the ERBB2 protein, and no significant difference was found in survival in terms of ERBB2 overexpression. CONCLUSIONS: Risk stratification has become very important in medulloblastoma. We found an increased hazard of death when metastatic disease was present. Gene expression in Mexican children requires a larger sample in order to be analyzed.

Body composition by dilution of deuterium oxide in Mexican children with lymphoma and solid tumors.

OBJECTIVE: Scant information exists about the changes in body composition of children during the first months of chemotherapy. These changes can be determined by using a better method than the body mass index. This study compared the changes of body composition by dilution of deuterium oxide in Mexican children with lymphoma and with solid tumors. METHODS: Seventeen patients were enrolled and classified as having lymphoma or solid tumor. Body composition was measured by a deuterium dilution technique after the first course of chemotherapy and again after 2 and 6 mo of therapy. Data were compared by means of paired t and Student's t tests. Simple linear regression was applied to examine the relation between age and changes in fat mass (FM) and fat-free mass (FFM). RESULTS: The groups were similar at baseline. Six months after initiation of chemotherapy, weight and height had increased (P < 0.05) in the lymphoma group, whereas only height had increased in the solid-tumor group; total body water, FM, and FFM increased in the lymphoma group (P < 0.01) but not in the solid-tumor group. Age did not influence FM or FFM in either group. CONCLUSION: In children with lymphoma whose treatment included corticosteroid use, increase in FM content was demonstrated during the first 6 mo of treatment. In patients with solid tumors, FM content did not change during treatment. With an increase in FM content, one should bear in mind that overweight and obesity may result in cardiovascular disease and development of breast cancer in adult life.

Preirradiation ifosfamide, carboplatin and etoposide (ICE) for the treatment of high-grade astrocytomas in children.

BACKGROUND: Astrocytomas are the most common form of primary intracranial tumor; however, survival of patients with high-grade tumors has not changed much compared with that reported in the early 1970s. OBJECTIVE. Our objective was to assess the efficacy, security, and survival rate of postoperative chemotherapy with ifosfamide, carboplatin, and etoposide (ICE) in pediatric patients with anaplastic astrocytomas (AA) and glioblastoma multiforme (GM). METHODS: In a phase II study, we evaluated 25 children with AA or GM. The proposed treatment was four courses of chemotherapy with ICE followed by hyperfractionated radiotherapy, and then four more courses of ICE. Patients were evaluated using MRI after surgery, after the second course of chemotherapy, and again after the last. Toxicity was determined before each course. RESULTS: The overall and disease-free survival at 60 months was 67% and 56% respectively. For supratentorial localization it was 92% at 60 months and 20% at 18 months for brain stem tumors. Fourteen patients had a complete response and 9 died as a result of tumor progression. CONCLUSIONS: Postoperative chemotherapy with ICE reduces the tumor size and increases the survival rate of pediatric patients with malignant astrocytomas with minimal toxicity.

[Neuroblastoma: prognostic factors and survival. Experience in Hospital de Pediatria del Centro Medico Nacional del Siglo XXI and review of the literature]. / Neuroblastoma: factores pronósticos y sobrevida. Experiencia en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI y revisión de la literatura.

Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the literature. In Mexico it is less frequent, fallen to 8th place. Our objective was to analyze our experience and compare it with the one reported in other countries. We included all patients admitted to our hospital during the previous five years and who had not received any treatment. Patients with stages I, II, and IV received cyclophosphamide and epirrubicin. Patients with stages were III and IV received the same chemotherapy alternating with cisplatinum., ifosfamide and etoposide during 12 months as well as massive doses of 131-MIBG and surgical ablation of the remaining tumor when possible. We included 30 patients, 25 with initial presentation in the abdomen. Five were in early stages and 20 (70%) were advanced with an overall survival of 100% and 27% at 5 years respectively. When analyzed by age, 40% were 12 months of age and 60% older, with survival of 100% and 27% in the same period, respectively. According to histology there was 91% survival for differentiated and 23% for undifferentiated tumors. The chemotherapeutic regimen reported is effective but not better than that reported by other authors, in which some benefits are seen with use of transplant and immunotherapy. The most important prognostic factors are still considered to be age, stage and histology.

Survival of children under 3 years old with medulloblastoma: a study from the Mexican Cooperative Group for Childhood Malignancies (AMOHP).

BACKGROUND: The prognosis of medulloblastoma in children under 3 years of age is poor. METHODS: A retrospective analysis was performed to evaluate children under 3 years of age with medulloblastoma. Overall survival (OS) and progression-free survival (PFS) were assessed in children with and without metastasis. RESULTS: A total of 534 children were diagnosed with medulloblastoma during the study period, 49 (9.1%) of whom were under 3 years of age and were evaluated. Their ages ranged from 5 to 35 months with a mean of 18.5 months. In 39 (79.6%) of these patients the tumors were staged as T3M0 or under, while 10 (20.4%) had metastasis at diagnosis. The OS was 38% and PFS 37% in the whole series, while PFS was 32% in those with metastasis and 40% in those without ( P=0.78). For those who received radiotherapy the PFS was 62%, and in those not treated with radiotherapy PFS was nil ( P=0.0001). When the children were divided into those who received surgical treatment plus chemotherapy and those who received surgery plus radiotherapy plus chemotherapy, the PFS was nil and 66%, respectively ( P=0.00001). CONCLUSION: Because of the high morbidity of radiotherapy in children under 3 years old, surgery continues to be the basis of improved prognosis, followed by chemotherapy.

Security and maximal tolerated doses of fluvastatin in pediatric cancer patients

Background. The role of cholesterol in neoplasic cell growth and its inhibition by drugs has recently been studied. Cholesterol biosynthesis inhibitors have been used as adjuvants in the treatment of cancer and possibly as prophylactic in carcinogenesis. objetive. The objetive of the study was to determine the maximal tolerated doses (MTD) and toxic effects of fluvastatin in pediatric cancer patients. Methods. This study was carried out in a thirid level Social Security Hospital in Mexico City. We included pediatric patients from april 1996 to May 1997. All were terminal cancer patients who did not respond to conventional therapies. Fluvastatin was give p.o. at doses of 2 mg/kg/day dor 14 days every 4 weeks in three patients. Subsequent cohorts of three patients each had increments of 2 mg/kg/day of the drug until maximal tolerated doses were found. Toxic effects of the drug were evaluated by physical exploration, laboratory assays and a questionnaire given to each patient. Results. Twelve patients were included. Diagnoses included two osteosarcomas, eight central nervous system tumors, one lung tumor, and one Ewing's sarcoma. Ten patients died within 1 to 18 months. Two are aolive 22 months after inclusion into the study, both with anaplasic astrocytoma. A total of 27 courses wer administered. The MTD was 8 mg/kg/day. Toxic effects were insomnia, nausea, vomiting, abdominal distention and myalgias. Txocicity was dose-dependent. Laboratory assays demonstrated no significant changes during treatment. Conclusions. Fluvastatin can be safely used at doses of 8 mg/kg/day in pediatric patients with cancer. This dose should be used in additional trials

Survival of patients with Medulloblastoma treated with carboplatin and etoposide before and after radiotherapy

Background. Medulloblastoma represents 20 percent of all tumors of the central nervous system. Patients with partial resection of the tumor and those with extension into the neuraxis at diagnosis have been identified as high-risk patients. The objective of our study was to determine tumor response, survival rates and toxicity with anew scheme of treatment with carboplatin, and etoposide and radiotherapy. Methods. All patients received chemotherapy with carboplatin and etoposide every 4 weeks for four courses, hyperfractionated radiotherapy, and another four courses of the above chemotherapy scheme. Tumor response was classified, and global and disease-free survival rates were calculated according to the actuarial survival method. Results. A total of 26 patients were included, with a median age of 6.9 years. Nineteen achieved complete response after the first four courses of chemotherapy, and two more had a complete response after radiotherapy. A total of seven children have died, three of whom did not respond to initial treatment. Global and disease-free survival rates were 69 percent and 64 percent, respectively, at 60 months of follow-up. There was no renal or auditory toxicity. Hematological toxicity was transitory and reversible. Conclusions. This scheme of treatment is effective and can be safely used for pediatric patients with hig-risk medulloblastomas. Toxicity was not significants, and survival is similar to other reports

Epidemiology of lymphomas in children residing in Mexico City

Background. The aim of this paper is to present the epidemiological characteristics of time, subject and place of lymphomas in children residing in Mexico City, Mexico (MC). Methods. The type of study was a retrospective hospital survey. All records of children with lymphomas registered between 1982 and 1991 at the main hospitals that treat children with cancer in MC were reviewed. Neoplasms were classified into Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NonHL). Trend and incidence by sex, age and area of residence in MC were evaluated. Time of diagnosis, as well as parental occupation and educational level, were registered. Results. A trend was only observed for HD in the total group (r:0.62; P=0.05). In 1991, incidence for HD was 6.12 (rates x 10 at 6) and 3.87 for NonHL. The highest average incidence was found in children 5-9 years of age (5.40= for HD, and in the age groups of 1-4 and 5-9 (3.10 and 3.33, respectively), for NonHL. Incidence was higher among boys for both lymphoma categories, but the male-to-female ratio was much higher in HD. Time of diagnosis, incidence in terms of place of residence, and parental educational level and occupation also differed from one lymphoma category to the other. Conclusion. The epidemiology of HD is different from that of NonHL, both showing a pattern similar to that of Latin American children

Astrocitomas en pediatría. Factores pronósticos y sobrevida / Pronostic factors and survival in pediatrics astrocytomas

Los tumores cerebrales corresponden a la segunda neoplasia más frecuente en pediatría, siendo los más frecuentes los de origen glial, con ligero predominio del sexo masculino y máxima incidencia a los ocho años de la vida. El presente estudio tiene como objetivo determinar cuáles son los factores que influyen en la sobrevida de estos pacientes. Se analizaron los expedientes clínicos de todos los pacientes con diagnóstico de astrocitoma realizado y manejado en el Hospital de Pediatría del CMN, SXXI, IMSS durante el período comprendido entre el 1 de junio de 1989 y el 1 de junio de 1995, registrando la edad, el sexo, el sitio de la tumoración, el grado de malignidad y la fecha de recaída o defunción. Se calcularon curvas de sobrevida global y libre de enfermedad con prueba de log rank para determinar diferencias. Del total de 39 pacientes se encontraron 43 por ciento supratentoriales, 13 por ciento infratentoriales y 43 por ciento de tallo cerebral, con diferencias significativas en la sobrevida al comparar los dos primeros en conjunto contra el último. Se realizó cirugía y estudio histopatológico en 26 de ellos, encontrando 17 pacientes con alto grado de malignidad y nueve de bajo grado, con mejor sobrevida para estos últimos en forma significativa. De las 17 defunciones, ocho pacientes tuvieron tumor de alto grado de malignidad y nueve de bajo grado, con mejor sobrevida para estos últimos en forma significativa. De las 17 defunciones, ocho pacientes tuvieron tumor de alto grado y de tallo cerebral 10. El 41 por ciento de las defunciones ocurrieron en el primer año y 94 por ciento en los primeros 24 meses. Los pacientes con astrocitoma en cerebelo y aquéllos con bajo grado de malignidad, tiene los mejores pronósticos, mientras que los pacientes con tumoración de tallo cerebral y/o de alto grado de malignidad tiene sobrevidas muy bajas

La deshidrogenasa láctica como factor pronóstico del desarrollo de enfermedad metastásica pulmonar en pacientes con osteosarcoma / Lactic dehydrogenase as a prognostic factor for the development of pulmonary metastasic disease in patients with osteosarcoma

La sobrevida de los pacientes con osteosarcoma ha mejorado con el empleo de la quimioterapia; sin embargo, el pronóstico es malo en aquéllos que desarrollan metástasis en los primeros 12 meses. Se revisa el rol de la hidrogenasa láctica como indicador. Se estudiaron en forma retrospectiva a 18 pacientes con osteosarcoma en dos grupos: grupo A con niveles normales de deshidrogenasa láctica y grupo B con niveles elevados. Se realizó un análisis univariado de porcentajes para establecer la frecuencia de elevación de la enzima y el desarrollo de metástasis. De los 18 pacientes estudiados 10 (99 por ciento) presentaban niveles elevados al diagnóstico, de los cuales 9 (90 por ciento) desarrollan metástasis en los primeros 12 meses. La diferencia fue significativa con un intervalo de confianza del 95 por ciento y una razón de momios de 15 cuando existió deshidrogenasa elevada. El valor de la deshidrogenasa láctica como pronóstico de sobrevida está limitado si se pretende considerar como un dato de valor único aislado. El volumen tumoral, la variedad histológica y la edad del paciente influyen, pero es de utilidad para predecir enfermedad metastásica pulmonar temprana.

Amikacina en dosis única diaria en niños neutropénicos con fiebre / Amikacin once-daily in febrile neutropenic children

Se realizó un ensayo clínico aleatorizado en niños con cáncer, fiebre y neutropenia para evaluar la eficacia de la amikacina en dosis única diaria contra tres dosis al día asociada a carbenicilina en ambos grupos. Se incluyeron 50 pacientes, 25 pacientes en el grupo A que recibieron la dosis diaria única de amikacina, y 25 pacientes en el grupo B que recibieron la amikacina fraccionada en tres dosis cada 8 horas. No hubo diferencias intergrupos: la fiebre remitió en una mediana de 6 días (2-8días) vs 7 días (3-12 días) en los grupos A y B, respectivamente (p= 0.37); la mejoría clínica se observo en una mediana de 6 días (3-10 días) vs 7 días (2-14 días) (p=0.68). Un paciente en el grupo A y dos en el B fallecieron. Los picos máximos de amikacina al 7o. día de tratamiento fueron de 10-60 y de 7-25 µg/mL en los grupos A y B respectivamente, y los niveles séricos de creatinina de 0.3-0.7 mg/dL para el grupo A y de 0.2 - 0.8 mg-dL para el grupo B; ningún paciente presentó elevación de la creatinina mayor al 40 por ciento del basal. Tres pacientes del grupo A tuvieron niveles de amikacina mayores a 40 µg/mL sin que existiera elevación de la creatinina. No encontramos datos que sugieran que la toxicidad fue mayor. La modalidad de administración de aminoglucósido en una dosis al día parece ser igual de efectiva que la convencional

Rabdomiosarcoma: variables que influyen en la mortalidad / Rhabdomyosarcoma Variants who influence mortality

Objetivo. Establecer la relación entre mortalidad y las características clínicas y anatomo-patológicas de niños con rabdomiosarcoma. Diseño. Revisión retrospectiva de las características clínico-patológicas relacionándolas con la mortalidad de los niños con rabdomiosarcoma atendidos de 1963 a 1985. Marco de referencia. Servicio de Oncología. Hospital de Pediatría, Centro Médico Nacional, Instituto Mexicano del Seguro Social. Pacientes. Muestra secuencial de 126 niños con rabdomiosarcoma observados durante un periodo no menor de cinco años. Mediciones y resultados. La mortalidad fue menor en las localizaciones orbitarias (14.8 por ciento) que en el resto (42.4 por ciento) (P<0.01) y mayor en las retroperitoneales y en el tronco (62.5 por ciento cada uno) que en otro sitio (P<0.02). Se tuvieron 18 defunciones en 24 pacientes con enfermedad diseminada y 23 de 93 con padecimiento localizado o locorregional (P<0.01). Aunque la mortalidad fue más baja en las subvariedades no alveolares (34 por ciento) que en las alveolares (46 por ciento), no se encontró diferencia estadística entre las subvariedades histológicas. La mortalidad fue similar entre diversos grupos de edad de niños. Conclusiones. Se encontraron como variables que influyen significativamente en la mortalidad, a la localización del tumor primario y a la extensión inicial de la enfermedad. Porcentualmente la mortalidad fue menor en las subvariedades no alveolares pero con P<0.05. La edad de los pacientes no influyó en la mortalidad

Carcinoma epidermoide del pene en un adolescente: informe de un caso / Carcinoma of the penis in adolescents: A report case

Se informa de un paciente masculino de 15 años de edad, no circuncidado, con deficiente higiene personal y sin antecedentes de vida sexual activa, con un tumor en el pene. La biopsia confirmó carcinoma bien diferenciado, invasor con metástasis a los ganglios linfáticos de la región inguinal. En el tejido de la biopsia se realizó la búsqueda de ADN del virus del papiloma humano tipos 8, 11, 12 y 16 por la reacción en cadena de la polimerasa, la cual fue negativa. Al paciente se le propuso penectomía la que rechazó. Se dio tratamiento paliativo con quimioterapia y radioterapia. Posteriormente presento necrosis total del pene con amputación espontánea. Este es el primer caso de carcinoma epidermoide del pene en un adolescente informado en la literatura latinoamericana