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1.
Environ Pollut ; 314: 120199, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36155226

RESUMO

The waste-to-energy (WTE) incinerator plant located in the Turin area (Italy) started to recover energy from the combustion of municipal solid waste in 2013. A health surveillance program was implemented to evaluate the potential health effects on the population living near the plant. This program included a longitudinal biomonitoring to evaluate temporal changes of some environmental pollutants, including polycyclic aromatic hydrocarbons (PAHs), in residents living in areas near the Turin incinerator (exposed group, E) compared to those observed in subjects living far from the plant (not exposed group, NE). Ten monohydroxy-PAHs (OH-PAHs), consisting in the principal metabolites of naphthalene, fluorine, phenanthrene, and pyrene, were analyzed in urines collected from the E and NE subjects after one (T1) and three years (T2) of plant activity and compared with those determined in the same cohort established before the plant start-up (T0). Spearman correlation analysis was undertaken to explore possible associations between OH-PAHs and personal characteristics, lifestyle variables, and dietary habits. A linear mixed model (LMM) approach was applied to determine temporal trends of OH-PAHs observed in the E and NE subjects and to evaluate possible differences in trend between the two groups. Temporal trends of OH-PAHs determined by LMM analysis demonstrated that, at all times, the E group had concentrations lower than those assessed in the NE group, all other conditions being equal. Moreover, no increase in OH-PAH concentrations was observed at T1 and T2 either in E or in NE group. Significant positive correlations were found between all OH-PAHs and smoking habits. Regarding variables associated to outdoor PAH exposure, residence near high traffic roads and daily time in traffic road was positively correlated with 1-hydroxynaphthalene and 1-hydroxypyrene, respectively. In conclusion, no impact of the WTE plant on exposure to PAHs was observed on the population living near the plant.


Assuntos
Poluentes Ambientais , Fenantrenos , Hidrocarbonetos Policíclicos Aromáticos , Humanos , Hidrocarbonetos Policíclicos Aromáticos/análise , Monitoramento Biológico , Resíduos Sólidos/análise , Flúor/análise , Monitoramento Ambiental , Pirenos/análise , Poluentes Ambientais/análise , Fenantrenos/análise , Naftalenos/análise , Biomarcadores
2.
Clin Ter ; 173(1): 35-38, 2022 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-35147644

RESUMO

CASE REPORT: A 14-year-old girl presented with 1 cm large whitened lesion on the ventral surface of the tongue, appeared from 1 month. Past history showed congenital dyserythropoietic anemia type II. The lesion was excised and microscopic and immunohistochemical analyses were compatible with benign Abrikossoff tumor. Total body MRI was negative. After six months the patient presented a second tongue lesion and four months later another large painful lesion in the soft palate, with the same istological diagnosis. In addition, she had other multiple lesions: two apperead at pharyngeal level (not biopsied) that remain stable over time, and one at the pituitary gland. CONCLUSION: Granular cell tumors, with or without multiple lesions, are rare in children. About 50% of cases involve the head and neck region, with the tongue being the most affected site. Therapy is based on the surgical excision of the lesions; however some tumor forms, although their histological aspect of benignity, often have an important infiltrative power, making the therapeutic approach difficult, as in our case.


Assuntos
Anemia Diseritropoética Congênita , Tumor de Células Granulares , Adolescente , Feminino , Tumor de Células Granulares/complicações , Tumor de Células Granulares/cirurgia , Humanos , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia
3.
Eur Rev Med Pharmacol Sci ; 25(1): 161-164, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33506904

RESUMO

Extramedullary hematopoiesis (EMH) is a proliferation of hematopoietic tissue outside the bone marrow. The most affected areas are paravertebral ones. We report the case of a patient with homozygous Hb Lepore, not regularly transfused since the age of four years until the age of 29 years, when paravertebral heterotopic masses were first observed. After about 10 years she started reporting clinical signs suggestive of sinusitis. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) showed heterotopic masses in the ethmoid and in the frontal sinuses. Involvement of the sinuses of the large facial area represents a rare localization of EMH. Various cases have been reported in patients with thalassemia intermedia, but no case has been reported with HbLepore. The diagnostic gold standard is MRI, which provides highly accurate and clear images. The treatment is based on hydroxyurea and/or an intensive transfusional regime and sometimes on surgery.


Assuntos
Seio Frontal/diagnóstico por imagem , Hematopoese Extramedular , Hemoglobinas Anormais/análise , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos
4.
Chemosphere ; 166: 418-421, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27705828

RESUMO

The concentration values of polychlorodibenzodioxins (PCDDs), polychlorodibenzofurans (PCDFs), and dioxin-like polychlorobiphenyls (DL-PCBs) in blood serum samples (pools) of metallurgical workers in the area of the city of Brescia (northern Italy) were statistically processed. As to workers' exposure characteristics, pools were divided into 34 professionally exposed (PE) and 11 non-professionally exposed (NPE). A further subdivision of PE pools was according to workplaces in which ferrous (N = 24) and non-ferrous (N = 10) materials were handled. To evaluate the aforesaid differences we applied the age-adjusted Generalized Linear Models. We identified significant (P ≤ 0.05) exposure models of the classification groups. The first subdivision was confirmed by the concentrations of 1,2,3,4,6,7,8-H7CDF, DL-PCB 105, and DL-PCB 189; the second was confirmed by the concentrations of PCDF TEQ97, PCDD + PCDF + DL-PCB (TEQTOT) TEQ97, 2,3,4,7,8-P5CDF, 1,2,3,6,7,8-H6CDD, 1,2,3,4,6,7,8-H7CDD, and PCB 189. Based on the literature, all mentioned congeners have been found in stack gas and fly ash samples of metallurgical plants: therefore, these indicators indicate the exposure to such work environments. Specifically, the concentrations measured in the workers' blood serum appear to depend on the type of material processed during work.


Assuntos
Poluentes Ocupacionais do Ar/sangue , Benzofuranos/sangue , Poluentes Ambientais/sangue , Exposição Ocupacional/estatística & dados numéricos , Bifenilos Policlorados/sangue , Dibenzodioxinas Policloradas/sangue , Adulto , Cinza de Carvão , Dioxinas/química , Humanos , Itália , Masculino , Metalurgia , Pessoa de Meia-Idade , Polímeros
5.
Int J Immunopathol Pharmacol ; 25(2): 407-14, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22697072

RESUMO

Common variable immunodeficiency (CVID) is considered the most common symptomatic antibody deficiency and, although mainly reported in adults, it may present from childhood. Few data on the impact of TACI defects on the clinical and immunological status of children are available. We screened 42 hypogammaglobulinemic children to investigate the frequency and mutational features of TACI defects. The genetic, clinical and immunological characterization was extended to 31 relatives of 11 children with TACI mutations. Of interest, our analysis showed a considerably higher mutation frequency in hypogammaglobulinemic children (13/42; 31%) than in other cohorts of adult patients. In seven out of nine families with the C104R variant, the prevalence of autoimmunity was significantly higher in C104R heterozygous relatives (8/15; 53%) than in those with no C104R mutation (1/11; 9%). Our data suggest a different impact of TACI mutations, from hypogammaglobulinemia in children to autoimmune disease in adulthood.


Assuntos
Agamaglobulinemia/genética , Agamaglobulinemia/imunologia , Autoimunidade/genética , Imunodeficiência de Variável Comum/genética , Imunodeficiência de Variável Comum/imunologia , Mutação , Proteína Transmembrana Ativadora e Interagente do CAML/genética , Adolescente , Adulto , Fatores Etários , Idoso , Envelhecimento/genética , Envelhecimento/imunologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Frequência do Gene , Predisposição Genética para Doença , Heterozigoto , Homozigoto , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo , Adulto Jovem
6.
Minerva Pediatr ; 63(6): 507-13, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22075805

RESUMO

In healthy pediatric subjects normal count platelet ranges between 250,000 µL and 450,000 µL. An elevated platelet count greater than 2 SD defines a condition of thrombocytosis. On a clinical level, thrombocytosis is classified "mild" at a platelet count between >500,000 µL and <700,000 µL; "moderate" at a platelet count between >700,000/µL and <900,000/µL; "severe" at a platelet count >900,000/µL; and "extreme" at a platelet count >1,000,000/µL. Thrombocytosis can be classified as primary or secondary. Primary thrombocytosis is divided into familial and essential. Primary thrombocytosis is an extremely rare clonal disease in childhood with incidence of one per million children, i.e., 60 times lower than in adults. It is classified as a myeloproliferative disorder with polycythemia vera, chronic myeloid leukaemia and myelofibrosis and may be associated with thrombotic or haemorrhagic events. Platelet count is generally above 1,000,000/µL. The median age at diagnosis is about 11 years. On the contrary, secondary or reactive thrombocytosis (RT) is very common in pediatric age, occurring in 3-13% of hospitalized children because of several causes. Generally, it is a reactive process caused by infection, chronic inflammation, iron deficiency, tissue damage, cancer, drugs and surgical or functional splenectomy. Thrombocytosis is mild in 72-86% of children, moderate in about 6-8%, and extreme in 0.5-3%. Consultation with a pediatric hematologist is required if elevation of platelet count persists, is unexplained or symptomatic. In the majority of cases no treatment is necessary, and the patient must be only closely monitored.


Assuntos
Trombocitose , Criança , Humanos , Itália/epidemiologia , Monitorização Fisiológica , Transtornos Mieloproliferativos/complicações , Neoplasias/complicações , Contagem de Plaquetas , Fatores de Risco , Índice de Gravidade de Doença , Trombocitose/classificação , Trombocitose/diagnóstico , Trombocitose/epidemiologia , Trombocitose/etiologia , Doenças Vasculares/complicações
7.
Bone Marrow Transplant ; 42(6): 379-84, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18574444

RESUMO

Allogeneic BMT represents the only chance of cure for beta-thalassemia. Occasionally, two affected individuals from the same family share a matched healthy sibling. Moreover, a high incidence of transplant rejection is still observed in Pesaro class III patients, requiring a second BMT procedure. In these settings, one option is to perform a second BM harvest from the same donor. Although BM harvest is a safe procedure in children, ethical issues concerning this invasive practice still arise. Here, we describe our series of seven pediatric, healthy donors, who donated BM more than once in favor of their beta-thalassemic HLA-identical siblings between June 2005 and January 2008. Three donors donated BM twice to two affected siblings and four donors donated twice for the same sibling following graft rejection of the first BMT. All donors tolerated the procedures well and no relevant side effects occurred. There was no significant difference between the two harvests concerning cell yield and time to engraftment. Our experience shows that for pediatric donors, a second BM donation is safe and feasible and good cellularity can be obtained. We suggest that a second harvest of a pediatric donor can be performed when a strong indication for BMT exists.


Assuntos
Temas Bioéticos , Transplante de Medula Óssea/ética , Medula Óssea , Seleção do Doador/ética , Doadores Vivos/ética , Segurança , Talassemia beta/terapia , Adolescente , Criança , Pré-Escolar , Seleção do Doador/métodos , Feminino , Antígenos HLA , Humanos , Masculino , Estudos Retrospectivos , Irmãos , Transplante Homólogo
8.
Minerva Pediatr ; 59(6): 787-800, 2007 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-17978788

RESUMO

In this analysis of hematopoiesis, the regrowth of colony-forming cells in the bone marrow was examined in patients who had undergone medullary ablation and bone marrow transplant. The various stages of erythropoeisis and the factors that influence blood cell production are discussed: hematopoietic microenvironment, cytokines, tissue oxygen. Drawing on results from rodent and human studies, growth hormone factor (GH) function is explained, its interaction with insulin-like growth factors I and II (IGF I and II), and their effects on hematopoiesis. The aim of the study was to show the close link between GH, IGF I and II and erythropoiesis, because patients with GH deficit may present with partially impaired erythyroid proliferation that leads to the onset of anemia.


Assuntos
Eritropoese/efeitos dos fármacos , Hormônio do Crescimento/farmacologia , Hormônio do Crescimento/administração & dosagem , Humanos , Somatomedinas/efeitos dos fármacos
9.
Clin Endocrinol (Oxf) ; 65(2): 158-62, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16886954

RESUMO

AIMS: This study aimed to investigate: (i) the relation between fasting time and serum ghrelin, motilin and insulin concentrations and (ii) the correlations between these hormones and anthropometrical parameters of infants in the first 18 months of life. PATIENT AND METHODS: A cross-sectional study on 62 term infants was performed. Blood samples for hormonal assay were obtained at least 1 h after feeding. Weight, length and head circumference were recorded. Plasma ghrelin, motilin and insulin concentrations were determined by radioimmunoassay. RESULTS: Ghrelin and motilin had a significant direct correlation with fasting time (r = 0.447; P < 0.001 and r = 0.36; P = 0.004, respectively). We observed a negative influence of insulin on ghrelin levels (beta = -0.32; P = 0.036). Plasma ghrelin levels correlated significantly with age (r = 0.45, P < 0.001), weight (r = 0.31, P = 0.013), head circumference (r = 0.35, P = 0.006) and length (r = 0.39, P = 0.001). A significant correlation emerged between motilin and age (r = 0.45, P < 0.001), weight (r = 0.43, P = 0.001), head circumference (r = 0.47, P < 0.001) and length (r = 0.48, P < 0.001). CONCLUSIONS: Fasting influence on serum ghrelin concentration confirms the role of this hormone as a physiological meal initiator also in infancy. The correlation between ghrelin, anthropometrical parameters and age supports the hypothesis that this hormone could exert an important influence on growth in the first months of life. Considering motilin, age and weight might play a role in determining its secretion; motilin could be considered one of the numerous factors involved in long-term regulation of energy balance.


Assuntos
Antropometria , Jejum/sangue , Insulina/sangue , Motilina/sangue , Hormônios Peptídicos/sangue , Regulação do Apetite , Estatura , Peso Corporal , Alimentação com Mamadeira , Aleitamento Materno , Cefalometria , Pré-Escolar , Estudos Transversais , Feminino , Grelina , Humanos , Lactente , Masculino , Análise Multivariada
10.
J Pediatr Gastroenterol Nutr ; 41(5): 653-9, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16254526

RESUMO

OBJECTIVES: Ghrelin, a recently discovered hormone mainly secreted by the stomach, has several metabolic functions including regulation of food intake, energy homeostasis and body weight. There are few studies on this hormone in healthy infants during the first year of life. The aim of this study was to examine the correlations between ghrelin and weight gain in healthy term infants in the first year of life. METHODS: 104 healthy term infants aged 0 to 12 months were included in a cross-sectional study. Anthropometric measurements were assessed and mean weight gain was calculated. Serum ghrelin concentrations have been determined at least 3 hours after feeding by radioimmunoassay test. RESULTS: Ghrelin concentrations were correlated negatively to weight gain (r=-0.302; P=0.003) and positively to age (r = 0.412; P < 0.001), weight (r = 0.374; P < 0.001) and length (r=0.387; P<0.001). In breastfed infants a statistically significant negative correlation between ghrelin concentration and infant weight gain (r=-0.407; P=0.001) was observed, whereas in formula-fed infants this correlation was not statistically significant (r=-0.067; P=0.719). CONCLUSIONS: The negative correlation observed between ghrelin concentration and infant weight gain suggests that ghrelin might also play a role in the regulation of body weight in healthy infants with a physiologic energy balance. Further studies are needed to clarify how ghrelin might be involved in both short-term and long-term energy balance.


Assuntos
Aleitamento Materno , Fórmulas Infantis , Recém-Nascido/crescimento & desenvolvimento , Hormônios Peptídicos/sangue , Aumento de Peso/fisiologia , Fatores Etários , Estatura/fisiologia , Estudos Transversais , Feminino , Grelina , Humanos , Lactente , Recém-Nascido/sangue , Masculino , Radioimunoensaio
11.
Pediatr Hematol Oncol ; 20(8): 583-8, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14578027

RESUMO

Secondary malignancies are a well-known late complication occurring in patients who undergo bone marrow transplant (BMT) during childhood. A boy with acute lymphoblastic leukemia experienced a BM relapse at the age of 14 years and underwent an autologous BMT conditioned with TBI and melphalan. Sixteen years later a malignant mesothelioma of the peritoneum was diagnosed. A surgical approach according to the Sugarbaker technique and hyperthermic peritoneal perfusion with CDDP and Adriamycin were performed. The patient is alive and well after a follow-up of 20 months. To the authors' knowledge this is the first case of mesothelioma as a secondary malignancy after BMT.


Assuntos
Neoplasias Abdominais/etiologia , Transplante de Medula Óssea/efeitos adversos , Mesotelioma/etiologia , Adolescente , Humanos , Masculino , Mesotelioma/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirurgia , Transplante Autólogo
12.
Bone Marrow Transplant ; 31(2): 133-6, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12621496

RESUMO

We describe the successful unrelated cord blood transplantation in two patients affected by a Zap-70 deficiency and an Omenn-like syndrome, respectively. The patients were hospitalised for recurrent infections at the age of 13 and 2 months, respectively. An unrelated cord blood unit was found for each. The conditioning regimen was cyclophosphamide, busulfan and antithymocyte globulin. The total number of infused cells was 15.1 x 10(7)/kg and 17 x 10(7)/kg, respectively. Neutrophil engraftment was achieved on days +15 and +23, and platelet count >50 x 10(9)/l was achieved on days +21 and +52, respectively. One patient presented acute Graft-versus-host disease (GVHD) grade I and the other grade III. Chimerism was mixed and full donor. Normal lymphoproliferative response to mitogens and alloantigens was detectable at 6 months for both. No chronic GVHD was observed in either. The patients are alive and well at 53 and 15 months after transplantation. In conclusion, umbilical cord blood represents a valid alternative source of haemopoietic stem cells.


Assuntos
Sangue Fetal , Imunodeficiência Combinada Severa/terapia , Transplante de Células-Tronco/métodos , Soro Antilinfocitário/uso terapêutico , Bussulfano/uso terapêutico , Ciclosporina/uso terapêutico , Gastroenterite/complicações , Gastroenterite/microbiologia , Doença Enxerto-Hospedeiro/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Lactente , Recém-Nascido , Infecções por Salmonella/complicações , Imunodeficiência Combinada Severa/etiologia , Imunodeficiência Combinada Severa/imunologia , Linfócitos T/imunologia , Quimeras de Transplante , Condicionamento Pré-Transplante/métodos , Transplante Homólogo , Resultado do Tratamento
14.
Haematologica ; 86(5): 478-84, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11410410

RESUMO

BACKGROUND AND OBJECTIVES: In March 1987 AIEOP started the AIEOP-ALL-87 study, based on the previous AIEOP-ALL-82. The aim of this new study was to evaluate, for all risk groups: a) the efficacy of treatment intensification achieved by adding a fourth drug (daunomycin) in the induction phase and a 3-drug reinduction phase for all risk groups; b) the impact of the addition of three doses of intrathecal methotrexate during cranial radiotherapy and extended exposure to weekly high-dose L-aspariginase during late intensification in high risk patients. We report the long-term results of the AIEOP ALL-87 study. DESIGN AND METHODS: From 1987 to 1991, a total of 632 eligible and evaluable children (age 1 to < or =16 years) with non-B-cell acute lymphoblastic leukemia (ALL), were enrolled and stratified as follows: standard risk (SR, 79 patients, 12.5%) had WBC <10,000/mm3, age > or = 3 and <7 years, and FAB L1 morphology. The high risk (HR, 175 patients, 27.7%) group included patients with WBC > or =50,000/mm3 or FAB L3 morphology or T immunophenotype or acute undifferentiated leukemia (AUL) or leukemia-lymphoma syndrome. All the remaining patients formed the intermediate risk group (IR, 378 patients, 59.8%). All patients received a 4-drug induction therapy; intermediate-dose methotrexate was given to HR patients; cranial radiotherapy was given to IR and HR patients, while SR patients received extended intrathecal methotrexate; all patients received a 3-drug reinduction phase; high dose L-asparaginase (HD-L-ASP; E.Coli, Bayer) was given to HR patients; continuation therapy with 6-mercaptopurine, i.m. methotrexate, and monthly vincristine and prednisone pulses was given to all patients. Treatment duration was 2 years. RESULTS: Six hundred and nineteen patients (97.9%) achieved complete remission. The remission rate was 98.7% in the SR group, 98.1% in the IR group, and 97.1% in the HR group. The overall 10-year survival and event-free survival (EFS) rates (SE) are 74.7% (1.8) and 62.8% (2.0) respectively; EFS rates by risk group are 67.5% (5.5) in SR, 62.8% (2.6) in IR, and 61.9% (3.8) for HR. The 10-year EFS for all eligible patients was 63.9% (1.9). INTERPRETATION AND CONCLUSIONS: When compared to the results of the AIEOP-ALL-82 study, treatment intensification in the ALL-87 study has improved long-term survival and EFS from 66.4% and 53.6% to 74.7% and 62.8%, respectively. Failures were mostly due to marrow or extramedullary relapses suggesting that further treatment intensification, as being used in current therapeutic strategies, is appropriate, although patients relapsing after less intensive treatment may have better chances of rescue. These results, although obtained in a relatively large proportion of patients, in which infants were not included, indicate that the addition of high-dose L-asparaginase to a relatively non-intensive treatment may be of major benefit for HR patients and that the addition of intrathecal methotrexate during CRT, may improve the central nervous system-disease control with a marked reduction of nervous system relapses.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Asparaginase/administração & dosagem , Criança , Pré-Escolar , Daunorrubicina/administração & dosagem , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Prednisona/administração & dosagem , Prognóstico , Indução de Remissão , Fatores de Risco , Resultado do Tratamento , Vincristina/administração & dosagem
15.
Exp Hematol ; 29(3): 371-9, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11274766

RESUMO

OBJECTIVE: The aim of this study was to investigate and compare immune reconstitution in allogeneic cord blood transplantation (CBT) and bone marrow transplantation (BMT) recipients. MATERIALS AND METHODS: Twenty-three children underwent CBT from either human leukocyte antigen-identical siblings (11 cases) or unrelated donors (12 cases) were enrolled in the study, together with 23 matched children receiving BMT. Patients were analyzed 2-3 and 12-15 months after transplant. Recovery of T-, B-, and NK-lymphocyte subsets, proliferative in vitro response to mitogens, as well as cytotoxic activities, were investigated. RESULTS: CBT recipients showed a marked increase in the number of B lymphocytes as compared with patients who underwent BMT (p < 0.001). The absolute number of CD3(+) and CD8(+) T cells, as well as the proliferative response to T-cell mitogens, recovered with time after transplantation, irrespective of the source of stem cells used. Recipients of unrelated CBT had a better recovery of CD4(+) T lymphocytes (p < 0.01). Among patients experiencing acute graft-versus-host disease (GVHD), children given CBT had a much greater production of CD4(+) CD45RA(+) T cells than BMT recipients (p < 0.005). Recovery of NK cell number and innate cytotoxic activities was fast, irrespective of the source of stem cells used. CONCLUSIONS: Despite the much lower number of lymphocytes transferred with the graft, recovery of lymphocyte number and function toward normal in CBT recipients was rapid and comparable to that observed after transplantation of bone marrow progenitors. This prompt immune recovery possibly was favored by the reduced incidence and severity of GVHD observed in children who underwent CBT.


Assuntos
Sangue Fetal/citologia , Sobrevivência de Enxerto , Transplante de Células-Tronco Hematopoéticas , Doença Aguda , Adolescente , Adulto , Antígenos CD/análise , Doenças da Medula Óssea/terapia , Transplante de Medula Óssea/efeitos adversos , Contagem de Células , Criança , Pré-Escolar , Feminino , Seguimentos , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/imunologia , Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Imunofenotipagem , Imunossupressores/uso terapêutico , Lactente , Ativação Linfocitária , Contagem de Linfócitos , Subpopulações de Linfócitos/imunologia , Subpopulações de Linfócitos/patologia , Masculino , Neoplasias/terapia , Núcleo Familiar , Doadores de Tecidos , Condicionamento Pré-Transplante , Transplante Homólogo/efeitos adversos , Resultado do Tratamento
17.
Bone Marrow Transplant ; 26(9): 1005-9, 2000 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11100281

RESUMO

Thrombotic thrombocytopenic purpura (TTP) has emerged as one of the main transplant-related complications over the last 15 years. The current study defines the incidence and the risk factors for the occurrence of TTP in 131 consecutive leukemic children who were transplanted between January 1994 and December 1997 at four Italian pediatric centers. Patients with ALL (101), AML (21), MDS (9), underwent an HLA-identical sibling BMT (82) or an HLA-identical unrelated BMT (49), receiving a conditioning regimen consisting of high-dose chemotherapy in 24 patients and of F-TBI combined with high-dose chemotherapy in 107 patients. The diagnosis of TTP was retrospectively evaluated on the basis of parallel criteria. TTP treatment varied according to the protocol of each treatment center. Twenty-eight of 131 patients (21.4%) developed TTP at a median of 46 days (range 21-80) after BMT. Multivariate analysis demonstrated that the risk of TTP was higher in patients who underwent unrelated BMT (P value = 0.02). Acute GVHD, stage of disease at BMT, conditioning with TBI, gender, age, did not appear to be associated with the occurrence of TTP. As to the outcome, TTP resolved in 19 patients while in nine it was the principal cause of death (32.1%). In patients with TTP, LDH peak value was the only statistically significant factor (P = 0.001) related to severe TTP. In conclusion, our experience demonstrates that leukemic children undergoing BMT, especially from an unrelated donor, should be carefully assessed for TTP which appears to be a severe and relatively common transplant-related complication when strict diagnostic criteria are applied.


Assuntos
Transplante de Medula Óssea/efeitos adversos , Leucemia/terapia , Púrpura Trombocitopênica Trombótica/etiologia , Doença Aguda , Criança , Pré-Escolar , Terapia Combinada , Feminino , Fibrinolíticos/uso terapêutico , Doença Enxerto-Hospedeiro , Humanos , Imunossupressores/uso terapêutico , Incidência , Lactente , L-Lactato Desidrogenase/sangue , Leucemia/complicações , Masculino , Plasma , Plasmaferese , Inibidores da Agregação Plaquetária/uso terapêutico , Polidesoxirribonucleotídeos/uso terapêutico , Prognóstico , Púrpura Trombocitopênica Trombótica/sangue , Púrpura Trombocitopênica Trombótica/epidemiologia , Púrpura Trombocitopênica Trombótica/terapia , Indução de Remissão , Estudos Retrospectivos , Fatores de Risco , Condicionamento Pré-Transplante , Resultado do Tratamento
18.
Food Addit Contam ; 17(8): 679-87, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11027029

RESUMO

The cadmium content of muscle, liver, kidney and blood samples from 62 horses slaughtered in Italy was investigated. Cadmium was determined by graphite furnace atomic absorption spectrometry (GFAAS) after wet digestion of the samples. The mean and median contents of all samples were (on a fresh weight basis) 75 and 41 micrograms kg-1 for muscle, 2.46 and 2.10 mg kg-1 for liver, 20.0 and 13.5 mg kg-1 for kidney. The cadmium level in blood samples was always below 6 micrograms l-1. The cadmium concentrations in muscle, liver and kidney were found to be related to the life span of the specimens and increased with age. Females exhibited higher levels than males, but this difference was significant only in the case of muscle tissue. The geographical origin was recognized as the main factor influencing the cadmium content of the equine specimens analysed. The differences between horses coming from the three main breeding countries considered in this study (Poland, Lithuania, Hungary) were marked and statistically significant. The average intake of cadmium from equine meat was estimated for the general population and for population groups resident in areas with high consumption of this food item. While the cadmium intake from equine meat for the average consumer accounts for about 1% of the total cadmium intake estimated for Italy, in the latter case the enhanced consumption of equine muscle is often accompanied with the consumption of substantial quantities of equine liver and this may lead to high cadmium intakes.


Assuntos
Cádmio/análise , Contaminação de Alimentos , Cavalos , Carne/análise , Fatores Etários , Animais , Feminino , Itália , Rim/química , Fígado/química , Masculino , Concentração Máxima Permitida , Músculos/química , Espectrofotometria Atômica/métodos
19.
Bone Marrow Transplant ; 25(10): 1067-71, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10828867

RESUMO

Mycophenolate mofetil (MMF) is an alternative immunosuppressant which inhibits the proliferation of T and B lymphocytes. The purpose of the present study was to evaluate the safety and efficacy of MMF as salvage therapy for chronic GVHD (cGVHD) in children receiving allogeneic bone marrow transplantation. Fifteen children, 3-16 years of age, who had received grafts from HLA-compatible siblings (n = 8), partially matched related donors (n= 2) or matched unrelated donors (n = 5), developed extensive cGVHD which had proved unresponsive to standard immunosuppressive therapy. Patients were treated with MMF at the dose of 15-40 mg/kg/day in combination with other immunosuppressive therapy for a median of 4 months (range 1-15 months). The overall response rate (complete or partial response) was 60%. Thirteen percent had only minor responses, whereas 27% of patients had progressive disease. Best responses were seen in patients with GI tract (60% of complete responses) or mouth (33% of complete responses) cGVHD and skin involvement (43% of complete responses) that did not include sclerodermatous manifestations. Once MMF was started, improvements in the clinical manifestations of cGVHD allowed a significant reduction of steroids in 45% of patients and discontinuation in 27% of cases. Six patients (40%) experienced adverse events, with gastrointestinal symptoms predominating. Five patients experienced opportunistic infections. MMF was discontinued after 35-180 days in six patients for the following reasons: parents choice (n = 2), liver toxicity (n = 1), poor compliance (n = 2), and no response (n = 1). In conclusion, these preliminary results suggest that MMF in combination with other immunosuppressive agents may have a role to play in patients with cGVHD. Prospective clinical trials are needed to establish exact indications for therapy and dosage scheduling. Bone Marrow Transplantation (2000).


Assuntos
Transplante de Medula Óssea/efeitos adversos , Doença Enxerto-Hospedeiro/tratamento farmacológico , Imunossupressores/uso terapêutico , Ácido Micofenólico/análogos & derivados , Adolescente , Corticosteroides/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Criança , Pré-Escolar , Terapia Combinada , Ciclosporina/uso terapêutico , Resistência a Medicamentos , Feminino , Gastroenteropatias/induzido quimicamente , Humanos , Imunossupressores/efeitos adversos , Masculino , Ácido Micofenólico/efeitos adversos , Ácido Micofenólico/uso terapêutico , Infecções Oportunistas/etiologia , Terapia PUVA , Pró-Fármacos/uso terapêutico , Segurança , Transplante Homólogo/efeitos adversos , Resultado do Tratamento
20.
Blood ; 95(2): 422-9, 2000 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-10627445

RESUMO

Allogeneic stem cell transplantation is the only treatment that can restore a normal hematopoiesis in Fanconi anemia (FA). In this retrospective multicenter study, we analyzed the results of this approach using HLA-matched unrelated bone marrow donors, and tried to identify covariates predicting the outcome of the transplant. From January 1985 to June 1998, 69 FA patients were transplanted with unrelated HLA-matched donors. Patients' characteristics before and after transplant were provided by the European group blood and marrow transplant registry and were analyzed in collaboration with the European Fanconi Anemia Registry. The 3-year probability of survival was 33%. Extensive malformations, a positive recipient cytomegalovirus serology, the use of androgens before transplant, and female donors were associated with a worse outcome. Primary graft failures were observed more frequently when female donors were used, mainly because the grafts contained lower nucleated cell doses per kilogram of recipient body weight compared with grafts coming from male donors. The probability of grade III-IV acute graft-versus-host disease (GVHD) was 34%. Elevated serum alanine/aspartate transaminases before transplantation; limb, urogenital tract, or nephrologic malformations; and non-T-cell-depleted grafts were predictors of severe acute GVHD. This study shows the dramatic impact of preexisting congenital malformations on the outcome of FA patients transplanted with HLA-matched unrelated donors. If the use of T-cell depletion has led to a dramatic reduction of acute GVHD incidence, no significant outcome improvement was observed with this approach, mainly because of an increased risk of graft failure. (Blood. 2000;95:422-429)


Assuntos
Anemia de Fanconi/terapia , Transplante de Células-Tronco Hematopoéticas , Adolescente , Adulto , Idade de Início , Criança , Pré-Escolar , Europa (Continente) , Anemia de Fanconi/mortalidade , Feminino , Doença Enxerto-Hospedeiro/epidemiologia , Transplante de Células-Tronco Hematopoéticas/mortalidade , Teste de Histocompatibilidade , Humanos , Masculino , Análise de Sobrevida , Transplante Homólogo , Resultado do Tratamento
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