Cardiotoxicidad por irradiación en pediatría / Cardiotoxicity by irradiation in Pediatrics

Introducción: La cardiotoxicidad depende de varios factores y se manifiesta por las alteraciones cardiovasculares inducidas por los tratamientos oncoespecíficos en la función y morfología del corazón. Objetivo: Determinar las manifestaciones de cardiotoxicidad en pacientes pediátricos. Métodos: Estudio descriptivo transversal en el que se incluyeron 79 pacientes tratados en el Instituto de Oncología y Radiobiología de Cuba con irradiación tórax-mediastino, entre enero 2008 a diciembre 2014. La enfermedad de Hodgkin estaba presente en 54 pacientes y en 25, tumores del sistema nervioso central: meduloblastomas en 19 y tumores primarios neuroectodérmicos en 6 pacientes. A todos se les hizo historia clínica con examen físico, electrocardiograma de 12 derivaciones y ecocardiograma 2D pre- y postratamientos. Se analizaron las características demográficas y clínicas. Los enfermos con Hodgkin recibieron irradiación con intensidad de 2 400 centigray y de 2 340 los pacientes con tumores del sistema nervoso central; la poliquimioterapia se realizó con antraciclinas, vincristina, vinblastina y otros. Resultados: La edad promedio de todos los pacientes fue de 7 años con predominio del sexo masculino. No se registraron síntomas o signos de cardiotoxicidad. Conclusiones: En nuestra serie de pacientes la irradiación del área cardiaca aparentemente es bien tolerada, sin aparición temprana de cardiotoxicidad, ni en periodos de seguimiento de hasta 9 años. Aparecieron naúseas y leucopenias transitorias en algunos casos. No existió diferencias en las toxicidades en los grupos de tumores estudiados Es necesario mantener un seguimiento estrecho para descartar la aparición de cardiotoxicidad en años siguientes(AU)

Introduction: Cardiotoxicity depends on various factors and it is evident in cardiovascular alterations induced by oncologic treatments directed to the heart´s function and morphology. Objective: To determine the symptoms of cardiotoxicity in pediatric patients. Methods: Descriptive and cross-sectional study in which there were included 79 patients treated in the Cuban Institute of Oncology and Radiobiology with thorax-mediastine irradiation from January 2008 to December 2014. Hodgkin disease was present in 54 patients, tumors of the central nervous system in 25, medulloblastomas in 19, and neuroectodermic primary tumors in 6. All the patients underwent physical examination, 12 -lead electrocardiogram and pre- and post-treatment 2D echocardiograms to include in the clinical records. The demographic and clinic characteristics were analyzed. Hodgkin disease's patients received irradiation with 2 400 cGy intensity and the patients presenting tumors in the central nervous system with 2 340 cGy. Polychemotherapy was carried out with antracyclines, vincristine, vinblastine and others. Results: Average age of all patients was 7 years with predominance of male sex. Symptoms of cardiotoxicity were not recorded. Conclusions: In the serie of analyzed patients, irradiation in the heart area was apparently well beared by the patients, without early appearance of cardiotoxicity, not even in follow up periods of 9 years. Transitory nausea and leucopenia appeared in some cases. There are no differences in the toxicities of the different tumour's groups studied. It is necessary to keep the regular follow up to rule out the appearence of cardiotoxicity in the next years(AU)

Clinical,MRI and pathological features of supratentorial primitive neuroectodermal tumors / 临床神经病学杂志

Objective To investigate the clinical,MRI and pathological features of supratentorial primitive neuroectodermal tumor(PNET).Methods The clinical manifestations of 21 PNET patients were analyzed,the skull imaging examination were taken,including MRI with diffuse weighing imaging(DWI) and measured apparent diffusion coefficient(ADC) of tumor and its edema zone before surgery.After operation,the brain tumor tissues were routine and immunohistochemical staining.The relationship between the histopathologic changes and ADC were analyzed.Results In the group,the age of onset of 11cases(52%) were below 20 years old.Clinical manifestation include headache,dizziness and vomiting(16 cases),visual disorder(5 cases),dysosphresis or epilepsy(3 cases).MRI showed single PNET lesion in all the cases and which located at each brain region,the most of them were located at frontal,temporal,parietal lobes(18 cases),and could growing to cross a brain region.MRI T1WI showed that the lesions were iso-signal and lowiso-signal in 15 cases,interspersed high signal in 6 cases.T2WI showed that the lesions were iso and high mixed signal companing capsule change and necrosis,4 cases with lighter tumor edema,5 cases with vascular air flow sign.The imaging enhanced tumors showed uneven enhancement,and 4cases with meningeal tail sign.The pathological examination showed that PNET cell form was main differentiated to neuron(10 cases) and neuroglia(8 cases).There was no statistical significance between ADC and different cell differentiation.Immunity histochemistry showed that the positive of NSE,Syn and GFAP were more offen.Conclusions In the group,the age of onset is below 20 years old.Manifestations of supratentorial PNET are intracranial pressure incresing,visual disorder and dysosphresis.MRI features are mixed isgnal,vascular air flow sign and meningeal tail sign in the tumor.The tumor edema is lighter.The tumor is differentiation mainly toward nerurons and neuroglias in the pathology.There is no positive relationship between ADC and types of tumor differentiation.