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2.
Klin Padiatr ; 226(6-7): 316-22, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25431864

RESUMO

BACKGROUND: In adolescents aged 10-15 years germ cell tumors of the testis (TGCT) are rare and information for a risk adapted therapy limited. AIMS OF THE STUDY: The protocol MAHO 98 for patients (pts) with TGCTs is stratified according to age, stage and histology. Pts ≥ 10 years received after tumororchiectomy 2 courses (crs) PVB and restaging. Residual tumor was resected and therapy continued in regard to inital stage and response. Chemotherapy: PVB: cisplatin (20 mg/m²/day 1-5), vinblastine (3 mg/m²/day 1+2), and bleomycin (15 U/m²/day 1-3). For consolidation 1 crs PVB has been given to stage II patients with CR. In case of PR, 2 crs PEB (vinblastine substituted by etoposide 100 mg/m²/day 1-3) or relapse 3 crs PEI (bleomycin substituted by ifosfamide 1 500 mg/m²/day 1-5) were given. RESULTS: Between Jan 1998 and Dec 2005, 34 pts (≥ 10 year) were registered, 31 fulfilled the inclusion criteria. Median age: 15;6 years; months (range 13;5-20;2 ). Lugano staging: IA n=14, IB n=2, IC n=3, IIA n=4, IIB n=6, IIC n=1, IIIC n=1. The stage IIIC pt received preoperative chemotherapy, all other pts had tumororchiectomy first. Residual tumor after 2 crs PVB was detected in 4 pts and was resected. Late relapses occurred in 2 pts and were cured by additional therapy. All patients are surviving. CONCLUSION: Young patients with TGCT stage I and II have an excellent prognosis and further reduction of therapy has to be considered.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Orquiectomia , Neoplasias Testiculares/tratamento farmacológico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina/administração & dosagem , Quimioterapia Adjuvante , Criança , Cisplatino/administração & dosagem , Terapia Combinada , Etoposídeo/administração & dosagem , Humanos , Ifosfamida/administração & dosagem , Masculino , Metotrexato/administração & dosagem , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Prognóstico , Risco Ajustado , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Vimblastina/administração & dosagem , Adulto Jovem
3.
Br J Cancer ; 109(10): 2744-50, 2013 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-24136150

RESUMO

BACKGROUND: Non-epithelial gonadal tumours largely comprise sex cord-stromal tumours (SCSTs) and germ cell tumours (GCTs). Specific somatic mutations in DICER1, a microRNA maturation pathway gene, have been identified in these tumours. We conducted a study that aimed to confirm, refine and extend the previous observations. METHODS: We used Sanger sequencing to sequence the RNase IIIa and IIIb domains of DICER1 in 154 gonadal tumours from 135 females and 19 males, as well as 43 extra-gonadal GCTs from 26 females and 17 males. RESULTS: We identified heterozygous non-synonymous mutations in the RNase IIIb domain of DICER1 in 14/197 non-epithelial tumours (7.1%). Mutations were found in 9/28 SCSTs (32%), 5/118 gonadal GCTs (4.2%), 0/43 extra-gonadal GCTs and 0/8 miscellaneous tumours. The 14 mutations affected only five residues: E1705, D1709, E1788, D1810 and E1813. In all five patients where matched and constitutional DNA was available, the mutations were only somatic. There were no mutations found in the RNase IIIa domain. CONCLUSION: More than half (8/15) of Sertoli-Leydig cell tumours (SLCTs) harbour DICER1 mutations in the RNase IIIb domain, while mutations are rarely found in GCTs. Genetic alterations in SLCTs may aid in classification and provide new approaches to therapy.


Assuntos
RNA Helicases DEAD-box/genética , Mutação , Neoplasias Ovarianas/genética , Ribonuclease III/genética , Tumores do Estroma Gonadal e dos Cordões Sexuais/genética , Neoplasias Testiculares/genética , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise Mutacional de DNA , Feminino , Frequência do Gene , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Ovarianas/epidemiologia , Tumores do Estroma Gonadal e dos Cordões Sexuais/epidemiologia , Neoplasias Testiculares/epidemiologia , Adulto Jovem
4.
Klin Padiatr ; 225(6): 296-302, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24158884

RESUMO

UNLABELLED: In 1982 the GPOH opened the 1st protocol for germ cell tumors (GCTs) of the testis (MAHO 82). Here the results of the 5th version (MAHO 98) will be offered for boys <10 year of age.In MAHO 98 watch and wait (w&w) strategy after inguinal tumororchiectomy was widened from 2 to 10-year-old boys with YST stage IA (group I); other invasive measures were omitted. Thus the prognostic impact of a non-recommended surgery like transscrotal operation +/- conventional biopsy (group II) can be evaluated.Clinical diagnosis and staging by ultrasound and tumor marker. In blurry cases, a frozen section was recommended to confirm the diagnosis by histology intraoperatively. Indications for adjuvant chemotherapy were: YST stage IA without elevated AFP, YST stage>IA and all mixed malignant GCTs.From 1998 till 2005 128 boys <10 years with a testicular GCT were registered. HISTOLOGY: YST n=76, teratoma n=46, mixed malignant GCT n=6. Tumor stage IA: n=101. All teratoma patients survive event-free. At all, only 19/82 patients with a malignant GCT received chemotherapy including 5 patients with a tumor progress after w&w (2/49 group I and 3/15 group II patients, respectively) and 1 patient (YST IIIA) with relapse after adjuvant chemotherapy. Transscrotal surgery (n=18) or tumorenucleation (n=6) remained without event. Indeed all patients survived.Prognosis of boys <10 year with a testicular GCT is excellent as ~80% will be cured by high inguinal tumororchiectomy alone. w&w is feasible and safe even after not recommended surgery if suitable follow-up is assured at least in stage IA cases.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Embrionárias de Células Germinativas/terapia , Orquiectomia , Neoplasias Testiculares/terapia , Conduta Expectante , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Biomarcadores Tumorais/sangue , Biópsia , Criança , Pré-Escolar , Terapia Combinada , Progressão da Doença , Humanos , Lactente , Masculino , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/patologia , Estudos Prospectivos , Taxa de Sobrevida , Teratoma/diagnóstico , Teratoma/mortalidade , Teratoma/patologia , Teratoma/terapia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/patologia , Testículo/patologia , Ultrassonografia
5.
Nuklearmedizin ; 52(4): 148-56, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23928982

RESUMO

AIM: To evaluate the use and reliability of the PET-based response criteria for interim PET (iPET) in terms of interobserver variability in pediatric and adolescent patients suffering from non-Hodgkin´s lymphoma (NHL). Particular attention was given to the identification of visual cutoff to separate patients with a favourable outcome. PATIENTS, METHODS: Retrospective analysis of PET-datasets of 18 children and adolescents suffering from NHL who underwent iPET after two cycles of chemotherapy for response assessment. Datasets were evaluated and rated in three independent review centers (RC) (blinded-read, intra-center consensus) using a visual 5-point response scale. Ratings were compared to clinical outcome. Pairwise interobserver agreement was analysed with Cohen's kappa-test (κ). Overall agreement (between attended RCs) was assessed with Fleiss' κ-test. RESULTS: Four patients suffered relapse (early, n = 2; late, n = 2). Per region analyses on interobserver variability revealed a "substantial" agreement (Fleiss' κ = 0.618). Per patient analyses revealed concordant iPET-ratings in eight patients: iPET-negative (iPET-), n = 5; iPET-positive (iPET+), n = 2; iPET-inconclusive (iPET±), n = 1. Discordant ratings were found in the remaining patients. Patients with early relapse were concordantly identified using mediastinal blood pool structures (MBPS, score ≥ 3) as visual cutoff between iPET+ or iPET-, respectively. However, patients with late relapse were not concordantly identified taking the MBPS as visual cutoff. CONCLUSION: The iPET interpretation using a dedicated PET-based response scale assured a low interobserver variability in per-region but not in per-patient analyses in a multicenter read. Using a sensitive read out (iPET+, score ≥ 3) a reliable identification of patients suffering relapse was limited to those with early relapse.


Assuntos
Antineoplásicos/uso terapêutico , Fluordesoxiglucose F18 , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/tratamento farmacológico , Tomografia por Emissão de Pósitrons/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Masculino , Prognóstico , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto Jovem
6.
Klin Padiatr ; 224(6): 359-65, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23143763

RESUMO

BACKGROUND: Ovarian germ cell tumors (oGCTs) are rare and highly heterogeneous with regard to their clinical and histologic appearance. The risk of tumor development is higher in children with aberrant sexual differentiation. Development of gonadoblastomas is seen in young women with 46,XY gonadal dysgenesis. At least 50 % of gonadoblastomas may develop into malignant oGCTs, mostly dysgerminomas. In this study, we evaluated bilateral oGCTs in clinically inapparent patients for sex chromosomal aberrations. PATIENTS AND METHODS: We analyzed tumor samples of 15 patients with synchronous bilateral oGCTs enrolled onto the consecutive MAKEI trials for non-testicular GCTs. Paraffin embedded samples from the Kiel German Childhood Tumor Registry were evaluated for the presence of Y-chromosomal sequences. Molecular genetic techniques included comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization. RESULTS: Among 15 patients with bilateral oGCTs, Y-chromosomal DNA sequences were detected in 6 tumors. Both mature teratomas were negative for Y-chromosomal DNA. Thus, 5 of 12 malignant oGCTs and 1 immature teratoma (with elevated AFP) showed Y-chromosomal material. A 45(X,0) karyotype could not be demonstrated. CONCLUSIONS: These investigations provide additional insight into the development of oGCTs: mature teratomas, which develop from postmeiotic germ cells, are not associated with gonadal dysgenesis. Bilateral immature teratomas, dysgerminomas and mixed malignant oGCTs may frequently show Y-chromosomal DNA, indicating underlying but clinically inapparent gonadal dysgenesis. Thus, the presence of aberrant Y-chromosomal sequences appears to be involved in tumor development in about half of these patients.


Assuntos
Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Primárias Múltiplas/genética , Neoplasias Ovarianas/genética , Adolescente , Criança , Pré-Escolar , Cromossomos Humanos Y/genética , Hibridização Genômica Comparativa , Disgerminoma/genética , Disgerminoma/patologia , Disgerminoma/terapia , Feminino , Alemanha , Humanos , Hibridização in Situ Fluorescente , Cariotipagem , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Ovário/patologia , Reação em Cadeia da Polimerase , Prognóstico , Teratoma/genética , Teratoma/patologia , Teratoma/terapia , Adulto Jovem
7.
Gesundheitswesen ; 73(4): e74-7, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21225549

RESUMO

OBJECTIVE: The aim of this study was to estimate the prevalence of stalking and related subjective health impairment, based on concrete definitions of stalking, for a representative random sample of the female population in the Austrian Federal State of Styria. METHODS: A representative random sample (randomised last digits procedure) of 2000 women selected from the female population of Styria aged 18 years or older underwent a computer-aided phone interview survey (CATI). Questions centred on the occurrence of stalking, the exact period of stalking, the gender of the stalker, the subjective impairment through stalking, addressing the aspects of life-style and the subjectively perceived state of health, and socio-demographic variables. For data analyses descriptive statistics, and chi(2)-tests and t-tests were applied. RESULTS: Lifetime prevalence varies between ca. 6% and 18%, depending on definition levels. The annual prevalences reveal a range of 1-4%. 39-43% of the stalked women feel they are impaired in their life-style, and 32-40% feel impaired in their health. Higher age and living in a partnership reduce the likelihood of being stalked. 81% of the stalked women are stalked by a male person. CONCLUSION: The prevalences found in this study are in line with other international studies, although, in a direct comparison, they are in the lower range. However, these data document the relevance of the phenomenon of stalking for the female Austrian population.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Perseguição/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Áustria/epidemiologia , Escolaridade , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
8.
Ann Oncol ; 22(5): 1198-1203, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20966182

RESUMO

BACKGROUND: The aim of this study was to evaluate the use and reliability of the new positron emission tomography (PET)-based response criteria for interim positron emission tomography (iPET) in patients with paediatric Hodgkin's lymphoma (pHL). Particular emphasis was put on interobserver variability and on identification of a visual cut-off defining patients with very low risk for relapse. PATIENTS AND METHODS: The iPET scans of 39 pHL patients were evaluated in two independent centres by two PET-experienced specialists in nuclear medicine (blinded read, centre consensus) each. The iPET scans were interpreted using a 5-point scale and were compared with the outcome. Cohen's kappa-test (κ) was used to analyse the interobserver agreement. RESULTS: Concordant ratings were assessed in 19 patients with iPET-negative findings, in 11 patients with iPET-positive findings and in 2 patients with inconclusive ratings. A 'substantial agreement' between attended centres was achieved (κ = 0.748). All patients suffering relapse were concordantly identified, taking mediastinal blood pool structures (MBPS) as visual cut-off between PET-positive and PET-negative findings, respectively. All pHL patients with uptake lower than or equal to MBPS remained in complete remission. CONCLUSION(S): The iPET interpretation assured low interobserver variability. High sensitivity for identification of pHL patients suffering relapse is achieved if [18F]-fluorodeoxyglucose uptake above the MBPS value is rated as a PET-positive finding.


Assuntos
Doença de Hodgkin/diagnóstico por imagem , Avaliação de Processos e Resultados em Cuidados de Saúde , Adolescente , Criança , Gerenciamento Clínico , Intervalo Livre de Doença , Feminino , Doença de Hodgkin/terapia , Humanos , Masculino , Recidiva Local de Neoplasia/prevenção & controle , Variações Dependentes do Observador , Tomografia por Emissão de Pósitrons , Resultado do Tratamento
9.
Klin Padiatr ; 222(3): 140-4, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20514616

RESUMO

BACKGROUND: We analyzed 15 children and adolescents with extracranial germ cell tumor (GCT) and brain metastases reported to the MAHO/MAKEI registry. PATIENTS AND METHODS: Between 1982 and 2009, 2 077 patients were prospectively enrolled onto the MAHO/MAKEI studies (overall survival: 0.88+/-0.03). All patients with advanced malignant GCTs received cisplatin-based chemotherapy (overall survival: 0.81+/-0.04 (734/823). RESULTS: 15 patients with brain metastases were reported; in 6 of them at diagnosis and 9 respectively during follow-up (6 weeks-28 months after end of therapy, mean=10 months). Most patients were male (13/15) and adolescent (10/15). 8 patients suffered from mediastinal GCTs. Pure Choriocarcinoma (CC) or CC in combination with other histologies was diagnosed in 12 patients. Clinical symptoms were reported in most patients. In all patients with secondary brain metastases the previously normalised tumor markers AFP and/ or HCG increased again prior to the onset of neurological symptoms. Only 1 of the patients with primary brain metastases survived, whereas 4 of 9 with secondary metastases are in remission after additional treatment. CONCLUSION: The risk for intracranial metastases increases with age, male gender and mediastinal or testicular primary site and choriocarcinoma histology. Development of neurological symptoms at initial diagnosis or during follow-up should lead to rapid clinical re-evaluation including CNS imaging and assessment of tumor markers. Treatment of brain metastases includes intensified chemotherapy and surgical resection, irradiation has to be considered in special clinical situations.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Embrionárias de Células Germinativas/secundário , Sistema de Registros , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/sangue , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/mortalidade , Criança , Pré-Escolar , Cisplatino/administração & dosagem , Terapia Combinada , Irradiação Craniana , Craniotomia , Feminino , Humanos , Lactente , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/mortalidade , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida
10.
Biol Blood Marrow Transplant ; 16(10): 1428-35, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20399877

RESUMO

Major advances in the monitoring and treatment of viral infections after hematopoietic stem cell transplantation (HSCT) have been achieved over the last decade. The appropriate extent of viral monitoring and antiviral therapy remains controversial, and reports in pediatric patients receiving allogeneic unmanipulated hematopoietic stem cells (HSCs) are sparse. A total of 40 pediatric patients who underwent HSCT with either peripheral blood stem cells (PBSCs, n = 30) or bone marrow (BM; n = 10) were prospectively monitored every week for viral DNAemia (VDNA) by simultaneous detection of cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV6), human adenovirus (ADV), and polyoma BK virus (BKV) using real-time TaqMan polymerase chain reaction (PCR). All patients received prophylactic acyclovir and preemptive ganciclovir (GCV) when 500 copies/microg DNA (EBV/HHV6) or >1 copy/microg DNA (CMV) were detected on 2 consecutive measurements. VDNA occurred in 25 of 40 recipients (CMV, 11/40 patients [28%]; EBV, 19/40 [48%]; HHV6, 2/40 [5%]; ADV/BKV, 1/40) and was found exclusively after neutrophil engraftment and in most cases up to day +100. Recurrent VDNA (P = .028) and (readily treatable) viral disease (P = .003) were observed predominantly in patients suffering from nonmalignant diseases, a cohort characterized by delayed lymphocyte engraftment. VDNA occurred more frequently in HLA-mismatched HSCT and in the 24 of 40 patients receiving antithymocyte globulin (ATG). The incidence of EBV, but not that of CMV, was increased in the ATG group. Yet, in these patients, viral loads of both EBV and CMV were higher, but with prompt initiation of preemptive GCV, no posttransplantation lymphoproliferative disorder or other life-threatening morbidities occurred. HHV6 was typically detected at low viral loads (<10(2) copies/microg DNA), with only 5% of HSC recipients fulfilling our HHV6 criteria for triggering GCV treatment. In multivariate analysis, ATG treatment, HLA mismatch, recipient CMV seropositivity, and stem cell source, but not severe acute graft-versus-host disease were identified as independent risk factors for VDNA. This comprehensive viral monitoring program with defined thresholds for initiation of preemptive GCV effectively prevents the development of critical viral disease, even in high-risk patients receiving ATG.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Complicações Pós-Operatórias/epidemiologia , Viroses/epidemiologia , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/tratamento farmacológico , Infecções por Adenoviridae/epidemiologia , Infecções por Adenoviridae/prevenção & controle , Adolescente , Soro Antilinfocitário , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Vírus BK/isolamento & purificação , Transplante de Medula Óssea/estatística & dados numéricos , Criança , Pré-Escolar , DNA Viral/sangue , Feminino , Ganciclovir/uso terapêutico , Doença Enxerto-Hospedeiro/complicações , Neoplasias Hematológicas/cirurgia , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Infecções por Herpesviridae/diagnóstico , Infecções por Herpesviridae/tratamento farmacológico , Infecções por Herpesviridae/epidemiologia , Infecções por Herpesviridae/prevenção & controle , Humanos , Lactente , Masculino , Transplante de Células-Tronco de Sangue Periférico/estatística & dados numéricos , Infecções por Polyomavirus/diagnóstico , Infecções por Polyomavirus/tratamento farmacológico , Infecções por Polyomavirus/epidemiologia , Infecções por Polyomavirus/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Pré-Medicação , Estudos Prospectivos , Transplante Homólogo , Viremia/diagnóstico , Viremia/epidemiologia , Viroses/diagnóstico , Viroses/tratamento farmacológico , Viroses/prevenção & controle , Adulto Jovem
11.
Klin Padiatr ; 222(2): 73-8, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19790029

RESUMO

BACKGROUND: Cat-scratch disease (CSD) is common in children, however the wide spectrum of the clinical presentation of CSD may lead to delayed diagnosis. An atypical presentation of CSD includes in its differential diagnosis diseases such as tuberculosis, other mycobacterioses, Epstein-Barr-Virus infection (EBV) or malignant disease. Since, in a small number of cases, these diseases may be present concurrently with an active CSD, it is important to consider CSD early in the differential diagnosis and order the appropriate tests. These tests include serology and, where possible, histology including molecular diagnostic methods on tissue specimens. PATIENTS AND METHOD: We performed a case series of five patients treated in our hospital with a clinical diagnosis of cat-scratch disease, confirmed by serology. An analysis of the history and clinical symptoms associated specifically with an atypical presentation of CSD was performed. RESULTS: The clinical presentation of CSD no longer encompasses the original typical description from 1950, but rather presents with a wide spectrum of signs and symptoms, including the absence of a documented cat scratch, fever, primary lesions or peripheral lymphadenopathy. Low density lesions in spleen, liver and lymph nodes are typical findings in ultrasound, MRI, or CT. Ignoring CSD as a possibility in investigating possible malignancy or tuberculosis could lead to unnecessary hospitalisation and delay in the proper treatment. CONCLUSION: CSD should also be considered in differential diagnosis of any patient with intraabdominal lymphadenopathy, abdominal pain and fever of unknown origin. A careful history is important, however, often patients with CSD have no history of contact with cats. Therefore in atypical cases of CSD the finding of other clinical symptoms and performance of specific diagnostic tests is important. Our experience suggests that early serological testing for Bartonella henselae should be performed and may avoid invasive diagnostic procedures.


Assuntos
Bartonella henselae , Doença da Arranhadura de Gato/diagnóstico , Adolescente , Animais , Antibacterianos/uso terapêutico , Biópsia , Mordeduras e Picadas/complicações , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Doença da Arranhadura de Gato/tratamento farmacológico , Gatos , Criança , Pré-Escolar , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Humanos , Laparoscopia , Fígado/patologia , Linfonodos/patologia , Imageamento por Ressonância Magnética , Masculino , Baço/patologia , Tomografia Computadorizada por Raios X , Ultrassonografia
12.
Klin Padiatr ; 221(3): 136-40, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19437360

RESUMO

Growing teratoma is still an often unsolved problem especially in male with mixed malignant GCTs of the testis or the mediastinum. This specific situation with progressive tumor growth and simultaneous normalization of tumor markers during or after treatment of malignant GCTs with teratomatous elements is judged as a fatal situation if this situation can not be controlled by extensive surgery, as teratoma are not sensible to chemotherapy or irradiation. Here, we report the case history of a 17-year old male patient with a testicular malignant GCT and wide spread lymph node metastases, who developed a rapidly progressive growing teratoma within the lymph node metastases. Within the molecular profile of the tumor we could find a cytogenetic picture typically found in malignant adult GCTs. In view of the bulky abdominal, thoracic and cervical metastases and the uncontrolled tumor progression, the situation was considered incurable. However, following an individual treatment attempt, this patient was treated with a four-agent combination of drugs with antiangiogenetic potential as well as low-dose cyclic chemotherapy. This approach resulted in a sustained disease stabilization followed by extensive surgical resection of the metastases. We therefore would like to highlight this treatment approach in unresectable growing teratoma and would like to stimulate further research and collaboration to come to an optimized treatment suggestion for this group of poor prognostic patients.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tumor do Seio Endodérmico/tratamento farmacológico , Tumor do Seio Endodérmico/cirurgia , Excisão de Linfonodo , Metástase Linfática , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/cirurgia , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/cirurgia , Teratoma/tratamento farmacológico , Teratoma/cirurgia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/cirurgia , Adolescente , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab , Terapia Combinada , Relação Dose-Resposta a Droga , Esquema de Medicação , Tumor do Seio Endodérmico/irrigação sanguínea , Tumor do Seio Endodérmico/mortalidade , Tumor do Seio Endodérmico/patologia , Seguimentos , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Interferon-alfa/efeitos adversos , Linfonodos/irrigação sanguínea , Linfonodos/patologia , Metástase Linfática/patologia , Imageamento por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/irrigação sanguínea , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Primárias Múltiplas/irrigação sanguínea , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/patologia , Proteínas Recombinantes , Reoperação , Terapia de Salvação , Taxa de Sobrevida , Teratoma/irrigação sanguínea , Teratoma/mortalidade , Teratoma/patologia , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/patologia , Talidomida/administração & dosagem , Talidomida/efeitos adversos , Tomografia Computadorizada por Raios X , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos
13.
Klin Padiatr ; 219(6): 318-22, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18050041

RESUMO

In nine patients (pts) with soft tissue sarcoma refractory to conventional therapy (incomplete response or relapse) intensified chemotherapy was administered combining 0.75 mg/m (2) topotecan, 100 mg/m (2) etoposide, 100 mg/m (2) carboplatin and 200 mg/m (2) cyclophosphamide on day 1-5 (TECC). To avoid prolonged intervals between the serial TECC courses autologous hematopoietic stem cell supports (median 1.0 x 10(6) CD34+ cells per kg body weight (bw), range 0.5-2.8 x 10(6) CD34+ cells/kg bw, SD 0.6 x 10(6) CD34+ cells/kg bw) were given on day 7. All pts received granulocyte colony stimulating factor (GCSF) from day 8 in addition. All together 39 TECC courses (minimum 2 courses, maximum 6 courses per pt) were administered, with a median interval of 32 (range 21-52) days until recovery. Leukopenia (<1000/microl) occurred 9 days (range 3-13 days; SD 2.4 days) after end of chemotherapy and persisted for 9 (range 3-15 days; SD 3 days) days. In 31/39 TECC courses readmission to hospital was required for supportive therapy mainly due to neutropenic fever. In this period pts received 0.83 (range 0-1) red blood cell units and 2.35 (range 1-4) platelet units. C-reactive protein in neutropenic pts as an indicator for infection after TECC chemotherapy was detectable after 36 of 39 chemotherapy courses leading to further supportive therapy (median 10.4 mg/dl, range 1.1-28.3 mg/dl; SD 6.67 mg/dl). Duration of total inpatient treatment per TECC course including supportive therapy was in median 13.5 days (range 7-53 days; SD 4.3 days). Only two children had a prolonged infection (77 and 100 days). Clinical and objective tumor responses, defined as complete remission, very good partial response and partial response were observed in 9/9 pts at eight weeks after the last TECC course and were maintained at six months in 7/9 pts. Median time to progression and median overall survival time after TECC chemotherapy were 20.3 months and 25.2 months, respectively. These data provide evidence that in very high risk pts refractory to standard high risk therapy, a combination of TECC chemotherapy and stem cell support is feasible in pts with incomplete remission respectively relapsed STS pts and demonstrates promising antineoplastic activity. Therefore, this regimen warrants further investigation in prospective trials.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Sarcoma/terapia , Adolescente , Adulto , Carboplatina/administração & dosagem , Criança , Pré-Escolar , Ciclofosfamida/administração & dosagem , Etoposídeo/administração & dosagem , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Neoplasia Residual/cirurgia , Indução de Remissão , Sarcoma/diagnóstico , Sarcoma/tratamento farmacológico , Fatores de Tempo , Topotecan/administração & dosagem , Transplante Autólogo , Resultado do Tratamento
14.
Klin Padiatr ; 218(6): 340-9, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17080337

RESUMO

Epileptic seizures are a common and clinically relevant problem in paediatric oncology. Attributable to the heterogeneity of this group of patients and a number of possible comorbidities antiepileptic treatment in paediatric oncology poses a number of diagnostic and therapeutic challenges. This requires a close interdisciplinary approach to the seizing child or adolescent. A prompt and detailed diagnostic work-up is needed in every case in order to establish the diagnosis and, equally important, to detect secondary aetiological factors, e. g. epileptogenic drugs or any acute underlying pathology, such as metabolic or toxic encephalopathies, CNS-infections or cerebrovascular events. This might offer the opportunity for a specific causative treatment and thus prevent unnecessary long-term antiepileptic drug (AED) treatment. If AED treatment is initiated several aspects have to be taken into account. Most importantly, AEDs and chemotherapeutic drugs (CTDs) may interact. Depending on the comedication this may result in reduced tumour or seizure control or unexpected toxicity of AEDs or CTDs. Understanding these interactions will allow to anticipate clinically relevant adverse effects. AED may be further complicated by side-effects, some of them of particular concern for children or adolescents, such as cognitive effects, myelotoxicity, serious rashes, endocrinological disturbances, and many more. Beside critically questioning the need for AED treatment it is therefore important to prefer AED with a good safety-profile in this population. Enzyme-inducing and inhibiting AED should be avoided if possible. Preliminary studies indicate that gabapentin and levetiracetam may provide good options in terms of efficacy and safety. However, more properly designed clinical studies are warranted to raise the level of evidence for robust clinical recommendations. Until that time, clinicians will need to continue to question current policies and adapt their daily practice to evolving scientific data.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Epilepsia/etiologia , Neoplasias/complicações , Adolescente , Fatores Etários , Aminas/administração & dosagem , Aminas/uso terapêutico , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Antineoplásicos/efeitos adversos , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/tratamento farmacológico , Criança , Ácidos Cicloexanocarboxílicos/administração & dosagem , Ácidos Cicloexanocarboxílicos/uso terapêutico , Interações Medicamentosas , Epilepsia/induzido quimicamente , Epilepsia/diagnóstico , Gabapentina , Humanos , Levetiracetam , Neoplasias/tratamento farmacológico , Piracetam/administração & dosagem , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Recidiva , Fatores de Risco , Segurança , Fatores de Tempo , Ácido gama-Aminobutírico/administração & dosagem , Ácido gama-Aminobutírico/uso terapêutico
15.
Haematologica ; 91(5 Suppl): ECR07, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16709515

RESUMO

Isolated renal relapse after allogeneic hematopoietic stem cell transplantation (alloHSCT) in children with acute lymphoblastic leukemia (ALL) is a rare condition. Generally, in ALL, the sites most frequently affected by extramedullary relapse are the central nervous system (CNS) and the testicles. Here we report on three young boys with relapsed B-precursor ALL, who underwent alloHSCT from HLA-identical siblings and suffered a histopathologically proven isolated unilateral renal relapse (two patients) or a combined renal and testicular relapse (one patient) 6, 10 and 12 months post alloHSCT. In all patients at the time of relapse bone marrow showed complete remission with complete donor hematopoiesis. They all received total body irradiation with partial shielding of the kidneys as part of their conditioning therapy, such that renal shielding could be an explanation for the observed accumulation of renal relapses. Moreover, during the past few years so called immune privilege has been postulated for frequent relapse sites such as the CNS, the testicles and the anterior chamber of the eye. Impaired accessability of these organs by cytotoxic T-cells (CTLs) with a reduced graft-versus-leukemia (GvL) effect after alloHSCT is based on a number of different molecular and cellular mechanisms. Similar mechanisms have been shown to be effective in the tubulointerstitial space of the kidney, rendering the kidney a potentially immune privileged site. Due to these observations we advocate sufficient treatment of the kidneys during conditioning therapy.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Rim/patologia , Infiltração Leucêmica , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Células Dendríticas/transplante , Progressão da Doença , Etoposídeo/uso terapêutico , Evolução Fatal , Humanos , Imunoterapia , Rim/efeitos da radiação , Transfusão de Leucócitos , Imageamento por Ressonância Magnética , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirurgia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirurgia , Proteção Radiológica , Recidiva , Terapia de Salvação , Tomografia Computadorizada por Raios X , Condicionamento Pré-Transplante/efeitos adversos , Transplante Homólogo , Irradiação Corporal Total/efeitos adversos
16.
Klin Padiatr ; 217(3): 135-41, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15858704

RESUMO

BACKGROUND: Peripheral blood stem cell (PBSC) grafts are increasingly used for autologous and allogeneic haematopoietic stem cell transplantation (alloHSCT) with the aim to hasten neutrophil and platelet engraftment and thereby to reduce transplant-related complications due to infections, bleeding and graft failure. Based on the paucity of data on PBSC transplantation in children we performed a retrospective single-center analysis comparing the outcome of children receiving mobilized PBSC from human leukocyte antigen (HLA)-identical sibling donors to bone marrow (BM) transplant recipients. PATIENTS AND METHODS: Between 1996 and 2004, 16 children with haematologic malignancies and standard indication for alloHSCT underwent PBSC transplantation from HLA-identical sibling donors. The outcome of these children was compared to a historic control group of 19 bone marrow (BM) transplant recipients. Time to neutrophil engraftment, incidence of acute and chronic graft-versus-host disease (GvHD), relapse rate, transplant-related mortality, event-free and overall survival were analyzed. RESULTS: Neutrophil engraftment was achieved significantly faster after PBSC compared to BM transplantation with a median time to neutrophil engraftment of 11 (range: 8-21) and 19 (16-44) days for the PBSC and BM cohort, respectively (p < 0.001). Two of 19 (11 %) BM recipients did not achieve primary neutrophil engraftment and both patients died due to infectious complications. The rate of clinically significant acute GvHD > or = grade II was higher in the PBSC compared to the BM group (75 vs. 39 %; p = 0.045). Incidences of chronic GvHD (PBSC vs. BM: 60 vs. 44 %), death of disease (13 vs. 21 %) and death of complication (13 vs. 16 %) were comparable between both groups (p = ns). With a median follow up of 4.7 years (PBSC) and 10.2 years (BM) overall survival (PBSC vs. BM: 68.6 +/- 13.5 vs. 63.2 +/- 11.1 %; p = 0.65) and event-free survival (67.0 +/- 12.1 vs. 63.2 +/- 11.1 %; p = 0.80) is without demonstrable difference in both groups. CONCLUSIONS: Transplantation of PBSC compared to BM is associated with faster neutrophil engraftment and a higher rate of > or = grade II acute GvHD. As overall survival and event-free survival is similar when using PBSC and BM, PBSC is an alternative stem cell source for HLA-identical sibling transplantation. Further prospective analyses with higher number of patients stratified according to well established risk factors are required to define the precise role of both stem cell sources for children with haematologic malignancies.


Assuntos
Transplante de Medula Óssea , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Transplante de Células-Tronco de Sangue Periférico , Adolescente , Adulto , Transplante de Medula Óssea/mortalidade , Criança , Pré-Escolar , Interpretação Estatística de Dados , Feminino , Doença Enxerto-Hospedeiro/epidemiologia , Transplante de Células-Tronco Hematopoéticas/mortalidade , Teste de Histocompatibilidade , Humanos , Incidência , Lactente , Masculino , Seleção de Pacientes , Transplante de Células-Tronco de Sangue Periférico/mortalidade , Estudos Retrospectivos , Irmãos , Análise de Sobrevida , Fatores de Tempo , Doadores de Tecidos
17.
Klin Padiatr ; 216(6): 356-63, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15565551

RESUMO

BACKGROUND: Beside the transplantation of haematopoietic stem cells derived from bone marrow (BMT) and peripheral blood (PBSCT) in the absence of a well-matched donor, transplantation of cord blood (CBT) has been shown to be a valid alternative. To validate the efficacy of CBT in comparison to BMT and PBSCT we performed a single-centre based matched-pair analysis. PATIENTS AND METHODS: Between 1996 and 2003, 15 paediatric patients with non-malignant and malignant diseases of heterogenous risk underwent CBT. 198 paediatric patients undergoing BMT or PBSCT during the same time and at the same centre were available for selection as appropriate controls for matched-pair analysis. Matching criteria in descending hierarchy were disease, risk status, type of donor, age at HSCT, gender and year of transplantation. 47 % of CB grafts were < or = 4/6 HLA-matched whereas close to 90 % of grafts in the BMT and PBSCT cohorts were completely matched. RESULTS: Neutrophil engraftment was comparable in CB and BM recipients (p = 0.529) while engraftment following PBSCT occurs significantly earlier (p < 0.01). Median time to neutrophil recovery was 20 (range: 13-36), 19 (14-28) and 14 (9-24) days for the CBT, BMT and PBSCT cohort respectively. Of note contrary to the expectation, with regard to a reduced risk of Graft-versus-Host-Disease (GvHD) there was no clear advantage in the CBT cohort with a similar overall GvHD rate in all 3 groups. This observation can be attributed to the fact that in the CBT cohort the proportion of patients with an HLA-mismatched donor was higher than in the other cohorts. Rate of death of complications (DOC) was high in CB recipients (40 %), but not statistically different from BM (27 %) and PBSC recipients (13 %). In contrast to the CBT and BMT cohort with only 1 patient dead of disease (DOD), 4 PBSC recipients (31 %) died suffering from a relapse. 2-year event-free survival (EFS) in patients with malignant disease was 38.5 %, 69.2 % and 33.0 % for the CBT, BMT and PBSCT cohort respectively. 5-year overall survival (OS) was 53.3 % in the CBT, 66.4 % in the BMT and 50.9 % in the PBSCT cohort. There was no statistical difference between the cohorts transplanted with CB and BM or PBSC regarding EFS and OS (EFS: p = 0.24 and p = 0.72; OS: p = 0.53 and p = 0.64). CONCLUSIONS: Transplantation of < or = 4/6 HLA-matched CB grafts seems to be associated with a higher risk of GvHD, graft rejection and lethal opportunistic infection. With an overall survival of 53 % in our 15 patients this analysis documents that even in high risk patients, CB may be a valid alternate HSC source in children who lack a well-matched donor. This is especially true, if a > 4/6 HLA-matched CB with > 2.0 x 10 (7) total nucleated cells/kg bodyweight is available. Thus, parallel to the search for a BM or PBSC donor, searching for an adequate CB unit should be initiated.


Assuntos
Transplante de Medula Óssea , Transplante de Células-Tronco de Sangue do Cordão Umbilical , Doenças Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Leucemia/terapia , Transplante de Células-Tronco de Sangue Periférico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Doença Enxerto-Hospedeiro , Doenças Hematológicas/mortalidade , Teste de Histocompatibilidade , Humanos , Lactente , Leucemia/mortalidade , Masculino , Análise por Pareamento , Recidiva , Fatores de Risco , Fatores de Tempo , Doadores de Tecidos
18.
Mol Genet Metab ; 82(1): 69-75, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15110325

RESUMO

Maple syrup urine disease (MSUD) is associated with increased branched-chain amino acids (BCAA), their keto acids (BCKA), and acute or chronic encephalopathy. Aim of treatment is to reduce BCAA and BCKA to prevent or minimize brain dysfunction. We investigated 14 juvenile and adult patients with MSUD by means of cerebral magnetic resonance imaging (MRI) and correlated MRI changes to biochemical control measured as median plasma BCAA concentrations over 6-36 months prior to investigation. Abnormalities consisted of an increased signal in the white matter on T2-weighted images which is compatible with a disturbed water content of the white matter and dysmyelination. Areas affected most commonly were mesencephalon, brain stem, thalamus and globus pallidus; supratentorial lesions seem to be restricted to severe cases. No patient with white matter changes had acute neurological/encephalopathic symptoms indicating that the severity of dysmyelination does not correlate to acute neurotoxicity.


Assuntos
Encéfalo/patologia , Doença da Urina de Xarope de Bordo/patologia , Bainha de Mielina/patologia , Adolescente , Adulto , Aminoácidos de Cadeia Ramificada/sangue , Criança , Humanos , Cetoácidos/sangue , Imageamento por Ressonância Magnética , Bainha de Mielina/metabolismo
19.
Transplant Proc ; 35(8): 2855-7, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14697920

RESUMO

PURPOSE: This study evaluates the impact of living renal donors (LD) aged 60 years and older on graft performance and patient survival in an old-for-young constellation. PATIENTS AND METHODS: We analyzed 144 consecutive LDs between January 1983 and December 2002 (19 patients 60+/125 controls). RESULTS: Mean donor age in the 60+ group was 63.7 (+/- 2.6) years and 43.7 (+/- 9.0) years for the <60 group. Mean recipient age was 42.4 (+/- 15.2) years versus 32.6 (+/- 15.3) years HLA-A, -B, and DR-mismatches were 3.16 (+/- 1.3) for the 60+ group and 3.13 (+/- 1.7) for the controls (P = NS). Rejection episodes in the first year following LD did not differ (53% versus 33%, P =.25). Mean serum creatinine for 65+ versus <65 after 1, 3, and 12 months was 1.91 +/- 1.2 versus 1.48 +/- 0.85 mg/dL (P =.16), 1.82 +/- 0.89 versus 1.29 +/- 0.35 mg/dL (P <.05) and 1.80 +/- 0.31 versus 1.37 +/- 0.38 mg/dL (P <.05) and mean creatinine clearance at 12 months 62 versus 82 mL/min (P =.06). Censored 1-, 3-, and 5-year graft survival was 100% versus 95% (P = NS), 100% versus 93% (P = NS) and 100% versus 83% (P = NS) with no significant difference in the log-rank test for Kaplan Meier. CONCLUSION: No impact of donor age was found for graft survival but function of the 65+ kidneys at 3 and 12 months was reduced. Living renal donors 60+ are acceptable for carefully allocated recipients.


Assuntos
Transplante de Rim/fisiologia , Doadores Vivos/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Família , Feminino , Sobrevivência de Enxerto/fisiologia , Teste de Histocompatibilidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
Transplant Proc ; 35(8): 2860-2, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14697922

RESUMO

PURPOSE: A retrospective, single-center analysis was conducted to compare the results of living donor kidney transplantation between living unrelated (LURD) and living related (LRD) donors. PATIENTS AND METHODS: One hundred forty-seven consecutive living renal transplantations were performed at our institution, starting in 1983. Graft and patient survival were assessed as well as transplant function, including a subgroup analysis for the period of kidney transplantation. RESULTS: Mean follow up for the LRD group was 88.5 months and for the LURD cohort 34.4 months. One- and 3-year graft survival (censored for death with functioning graft) for LRD versus LURD was 97.5% versus 94.4% (P =.4) and 95.3% versus 88.8% (P =.35). Patient survival at 1 and 3 years was 95.1% versus 94.7% (P =.91) and 87.8% versus 90.0% (P =.79). Of the related recipients, 37% experienced at least one episode of rejection in the first year following renal transplantation, compared to 34% in the LURD group (P =.80). Mean serum creatinine for LRD versus LURD after 1, 3, and 12 months () was 1.52 +/- 0.81 versus 1.59 +/- 1.17 mg/dL (P =.98), 1.41 +/- 0.55 versus 1.30 +/- 0.40 mg/dL (P =.51), and 1.44 +/- 0.39 versus 1.40 +/- 0.40 mg/dL (P =.75). Mean creatinine clearance after 1 year was 82.2 versus 71.7 mL/min (P =.26). Subgroup analysis for the time between 1996 and 2002 revealed no difference between LURD and LRD. Multivariate analysis could exclude an impact of the significantly different recipient age and of first/second warm ischemic time on the endpoints described above. CONCLUSION: LURD is a good way to meet the growing organ shortage and should be encouraged.


Assuntos
Transplante de Rim/fisiologia , Doadores Vivos , Nefrectomia/estatística & dados numéricos , Coleta de Tecidos e Órgãos/estatística & dados numéricos , Creatinina/sangue , Família , Feminino , Sobrevivência de Enxerto , Humanos , Transplante de Rim/mortalidade , Transplante de Rim/estatística & dados numéricos , Masculino , Núcleo Familiar , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
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