Impact of Selenium Supplementation in Neutropenia and Immunoglobulin Production in Childhood Cancer Patients.

Essential to human health, selenium (Se) has enzymatic functions of fundamental importance to human biology due to its effects on DNA damage repair, its antioxidant properties, and cancer prevention. The best studied relationships between Se and the immune system is its role in the functions of neutrophils and of lymphocytes. Despite these observations, it is not yet clear by which mechanism Se is able to modify the immune status. This was a double-blind, crossover study: Group 1 received Se and Group 2 received placebo (30 days). After this, Group 1 received placebo and Group 2 received Se (30 days). Every 30 days, blood samples were collected for white blood cell count, red blood cell count, and Ig level measurement (IgA, IgG, IgE, IgM). Of the 36 patients, 17 were suffering from leukemia/lymphomas (LL) and 19 from solid tumors (ST). In the ST group's leukogram, a significant increase in neutrophils was observed after Se usage (P = .0192). During the analyzed period, Se minimized the triggering of neutropenia cases in both groups. IgA and IgG levels in ST patients were significantly higher than those identified in LL patients after Se usage (P = .0051 and P = .0055). For IgA, a significant increase in its production, after Se usage, was observed in the ST group when compared to the LL (P = .0011). The same did not occur to the IgM and IgE immunoglobulins. In our study, the supplementation with Se reduced the neutropenic cases (LL and ST patients) and reduced IgG and IgA levels in LL and increased in ST group.

Diagnóstico precoce dos tumores cerebrais na infância: um desafio para o Pediatra / Early diagnosis of brain tumors in childhood: defying the Pediatrician

Os autores discutem inicialmente a frequência de tumores cerebrais na infância, bem como sua distribuição etária e por gênero. Apresenta os principais sintomas que levam a suspeita clínica, ressaltando que o diagnóstico é essencialmente clínico, incluindo sua classificação e uma análise sucinta de cada tipo. O trabalho finaliza com linhas gerais sobre o tratamento dos tumores cerebrais através da cirurgia, radio e quimioterapia.

Supplementation with selenium can influence nausea, fatigue, physical, renal, and liver function of children and adolescents with cancer.

The drugs used in chemotherapy treatments have little specificity, attack tumor cells, and also injure proliferative tissues. Knowledge of the functions of micronutrients has greatly increased, especially of Selenium (Se) that presents immunomodulatory and antitumor functions. The present study evaluated the health-related quality of life of patients undergoing chemotherapy for the treatment of leukemias and lymphomas (LL) and solid tumors (ST) while receiving Selenium (Se) supplementation. This is a randomized, double-blind, crossover study that evaluated the quality of life (EORTC-QLQ-C30 questionnaire), renal and liver functions of patients supplemented with Se. There was no statistically significant alteration in LL patients. However, the fatigue and nausea scores after 30 days did decrease in this group as well as in the ST group. After 1 year supplementation with Selenium, a more noticeable decrease in the scores concerning fatigue and nausea could be observed in the ST group, when compared with the beginning of the study. The LL patients also presented a decrease in the fatigue scores and physical functions. The kidney function as well as liver function has improved after Selenium supplementation when compared with the placebo intake in LL and ST patients, more remarkably in the LL group. Supplementation with Selenium promotes the reduction of chemotherapy side effects in cancer patients, especially by improving the conditions of patients with fatigue, nausea, and impaired physical function. Renal and liver functions have also improved.

Variáveis de prognóstico em crianças maiores de um ano portadoras de neuroblastoma disseminado / Prognostic variables in children older than one year with advanced neuroblastoma

Introdução: Os neuroblastomas apresentam grande diversidade de comportamento clínico, evoluindo desde remissão espontânea à rápida progressão e morte. Heterogeneidade clínica e biológica tem implicado em grande variedade de respostas terapêuticas, inclusive em crianças maiores de 1 ano e em estádios avançados. Objetivo: estudar quadro clínico, aspectos epidemiológicos, características laboratoriais, genéticas e histológicas em crianças maiores de 1 ano portadoras de neuroblastoma disseminado, correlacionando-os com a evolução clínica e tentando definir fatores de risco que possam influir na sobrevida e na possibilidade da indicação do transplante de medula óssea (TMO). Casuística e Métodos: as informações foram obtidas de 53 pacientes admitidos na Unidade de Oncologia (ITACI) do Instituto da Criança do HC-FMUSP no período de 1997 a 2007. Os pacientes foram estudados quanto aos seguintes fatores: sexo, idade, raça, estado nutricional, DHL, Hb, ferritina, VMA, características tumorais (tamanho, localização, metástases, histologia, MYCN), terapêutica utilizada e evolução clínica. Estudamos separadamente também os fatores preditivos para TMO. Resultados: devem ser destacados: 1) crianças submetidas à cirurgia retardada completa apresentam 5 vezes menor chance de óbito do que as demais; 2) pacientes submetidos a TMO apresentam maior sobrevida total e livre de eventos em relação ao grupo não submetido a essa modalidade terapêutica 3) a utilização de retinóides gera 14 vezes menor chance de óbito em relação ao grupo que não os utiliza. 4) surpreendentemente, pacientes com ferritina abaixo de 334 n/ug/l apresentam 8 vezes maior chance de óbito. Conclusões: Não identificamos parâmetros clínicos e laboratoriais, práticos e facilmente disponíveis, de prognóstico para subpopulações de neuroblastomas de prognóstico avançado, sendo o estudo de fatores de ordem molecular e biológicos essenciais, apesar das dificuldades em realizá-lo...

Introduction: Neuroblastomas (NB) have widely diverse clinical behavior, moving from spontaneous remission to progression and death. Clinical and biological heterogeneity factors determine different survival, even with children older than 1 year in advanced stages. Objective: to study the clinical presentation, epidemiology, laboratory findings, genetics and histopathologic characteristics in children older than 1 year with advanced neuroblastoma and their correlation with the survival. Also defining prognostic variables for bone marrow transplantation (BMT) indication. Casuistic and Methods: 53 selected medical records from patients older than 1 year with advanced NB admitted to the Instituto da Criança do HC-FMUSP from 1997 to 2007 were reviewed. The following risk factors were analyzed: age, sex, race, nutritional status, LDH, hemoglobin level, ferritin level, urinary VMA, tumor characteristics such as: site, histology, size, metastases, MYCN, treatment and clinical course. Results: it should be mentioned that: 1) possibility of death in children who underwent complete second look is 5 times lower than remaining ones; 2) patients who underwent BMT have better overall survival and event-free survival in comparison to the group not receiving this treatment modality. 3) the use of retinoids generates 14 times less chance of death in comparison to the group not receiving them. 4) patients whose ferritin level was below 334 n/ug/l had surprisingly 8 times more chances to die from diseases Conclusions: no simple and easily obtainable prognostic variables in a subpopulation of patients with advanced stage neuroblastoma, suitable to be widely employed in a country as ours, were identified. The study of molecular and biologics factors remains essential for precise characterization of these patients...

Impacto do diagnóstico e do tratamento de câncer e de Aids no cotidiano e nas redes sociais de crianças e adolescentes / Impact of cancer and Aids diagnostic and treatment on daily life and social networks of children and adolescents

Introdução: Aids e câncer representam, atualmente, um desafio para a saúde pública, com sérias implicações para os aspectos biológicos, sociais e psicológicos dos indivíduos. Essas doenças crônicas interferem no cotidiano familiar, especialmente, quando atingem crianças e adolescentes. Objetivo: Neste artigo, são apresentados os principais resultados de uma pesquisa sobre processos de estigmatização de pacientes pediátricos com câncer ou HIV, com especial atenção à recepção do diagnóstico e de mudanças no cotidiano familiar ocasionadas pela doença. Casuística e Métodos: Foram realizadas 56 entrevistas semiestruturadas com: pacientes de 7 a 15 anos com câncer ou com HIV, atendidos nos ambulatórios da Faculdade de Medicina do ABC (FMABC) (n = 20); acompanhantes desses pacientes (n = 18); população usuária dos ambulatórios da FMABC (n = 18). Resultados: Em geral, os pacientes e acompanhantes não referiram a presença de estigma relacionado à doença; em contrapartida, a população usuária dos ambulatórios aponta a sua existência. Os pacientes com HIV são orientados pelos seus cuidadores (leigos e profissionais) a não revelar o diagnóstico para sua a rede social, evitando assim situações estigmatizantes. Conclusões: Embora poucas situações de estigmatização tenham sido identificadas nos relatos obtidos, estes revelam estratégias de controle da identidade do doente, objetivando evitar preconceitos. O HIV e o câncer geram diferentes expectativas e sofrimentos nos pacientes e familiares, requisitando dos profissionais de saúde conhecimentos e ações sensíveis aos impactos específicos desses problemas de saúde no cotidiano familiar.

Introduction: Aids and cancer represent, nowadays, a challenge for the public health, with important connotation for biological, social e psychological aspects of the patients. These chronic diseases change the familiar daily routine, especially when children and teens are involved. Objective: In this paper, the core results of a research about stigma among children with cancer or HIV are presented, with special attention to the reception of the diagnostic and the presence of changes on the daily routine caused by both diseases. Patients and Methods: Fifty-six pre-structured interviews were done with three distinct groups, with free selection: pediatric patients between 7 and 15 years old (n = 20); companions of the patients (n = 18) and people that use the clinics of Faculdade de Medicina do ABC (n = 18). Results: In the patient’s group the stigma was not present but, on the other hand, in the general population this stigma was more prevalent. HIV patients were oriented by the doctors and the family to not reveal the diagnostic for the social net, avoiding, with it, prejudice situations. Conclusions: Even thus few prejudice situations have been identified; the results show strategies for the control of the patient identity, trying, in this way, to avoid this prejudice. HIV and cancer promote different expectations and kinds of suffering in patients and in their families, demanding to thehealth professionals’ knowledge and sensible actions for the specific impacts for these problems in the familiar quotidian.

[Therapeutical effectiveness of interferon alpha in a child with craniofacial giant hemangioma: case report]. / Eficácia terapêutica do interferon alfa em criança com hemangioma gigante craniofacial: relato de caso.

Hemangiomas are the most common benign tumors of infancy. Capillary hemangioma generally is presented as a spot or well-defined purple lesion. The diagnosis of these tumors is based on physical examination. Giant hemangioma is a rare and extensive variation of capillary hemangioma, that generally occurs in newborns and suckling infants. There are several therapeutical modalities, as the intralesional injection of steroids, laser therapy, intralesional injection of sclerosing solutions, surgery, radiotherapy and embolization. New therapeutical modalities have been developed, with the objective of getting better results and to make possible the treatment of the lesions of difficult surgical access or refractory cases to the used therapeutical modalities. The best results have been observed with interferon-alpha. This is a case of a patient with three months of age, that presented since birth, a purplish tumor in the superior eyelid of the right eye, plain and purplish cutaneous lesions in the temporal and parietal right region. On computed tomography of the skull, an orbital expansive vascularized process with intracranial extension could be observed. Systemic therapy with steroids was the initial treatment, during forty days, with gradual reduction for four weeks. With the practically unchanged clinical findings, the treatment with interferon-alpha was indicated, in the dose of subcutaneous 3.000.000 U/m(2), three times a week. After 9 months of treatment, a small residual orbital lesion was observed. In this case, interferon-alpha is presented as a good option for the treatment of craniofacial giant hemangioma.

Eficácia terapêutica do interferon alfa em criança com hemangioma gigante craniofacial: relato de caso / Therapeutical effectiveness of interferon alpha in a child with craniofacial giant hemangioma: case report

O hemangioma é o tumor benigno mais freqüente da infância. O hemangioma capilar geralmente apresenta-se como uma mancha ou tumoração violácea bem delimitada. O diagnóstico destas lesões é clínico. O hemangioma gigante é rara e extensa variação do hemangioma capilar, que geralmente ocorre em recém-nascidos e lactentes. Várias são as modalidades terapêuticas, como a injeção intralesional de corticóide, laserterapia, injeção intralesional de soluções esclerosantes, corticoterapia sistêmica, cirurgia, radioterapia e embolização. Novas modalidades terapêuticas têm sido desenvolvidas, com o objetivo de se obter melhores resultados e possibilitar o tratamento de lesões de difícil acesso cirúrgico e refratárias às modalidades terapêuticas utilizadas rotineiramente. Os melhores resultados tem sido obtidos com o interferon alfa. Este é um caso de uma paciente com três meses de idade, que apresentava desde o nascimento, tumoração arroxeada e amolecida em pálpebra superior do olho direito, lesões cutâneas planas e arroxeadas em região temporal e parietal direita. Realizada tomografia computadorizada de crânio evidenciando processo expansivo orbitário vascularizado com extensão para fossa média, seio cavernoso e fossa posterior. O tratamento inicial foi a corticoterapia oral durante quarenta dias, com redução progressiva por quatro semanas. Com o quadro praticamente inalterado, foi iniciado o tratamento com interferon alfa, na dose de 3.000.000 U/m², subcutâneo, três vezes por semana. Após 9 meses de tratamento, observa-se apenas uma pequena lesão orbitária residual. Neste caso, o interferon alfa apresentou-se como boa opção no tratamento do hemangioma gigante craniofacial.

Hemangiomas are the most commom benign tumors of infancy. Capillary hemangioma generally is presented as a spot or well-defined purple lesion. The diagnosis of these tumors is based on physical examination. Giant hemangioma is a rare and extensive variation of capillary hemangioma, that generally occurs in newborns and suckling infants. There are several therapeutical modalities, as the intralesional injection of steroids, laser therapy, intralesional injection of sclerosing solutions, surgery, radiotherapy and embolization. New therapeutical modalities have been developed, with the objective of getting better results and to make possible the treatment of the lesions of difficult surgical access or refractory cases to the used therapeutical modalities. The best results have been observed with interferon-alpha. This is a case of a patient with three months of age, that presented since birth, a purplish tumor in the superior eyelid of the right eye, plain and purplish cutaneous lesions in the temporal and parietal right region. On computed tomography of the skull, an orbital expansive vascularized process with intracranial extension could be observed. Systemic therapy with steroids was the initial treatment, during forty days, with gradual reduction for four weeks. With the practically unchanged clinical findings, the treatment with interferon-alpha was indicated, in the dose of subcutaneous 3.000.000 U/m², three times a week. After 9 months of treatment, a small residual orbital lesion was observed. In this case, interferon-alpha is presented as a good option for the treatment of craniofacial giant hemangioma.

Aspectos clínicos, terapêuticos e variáveis de prognóstico em crianças maiores de um ano portadoras de neuroblastoma não disseminado / Clinical features, treatment and prognostic variables in children older than one year with non-advanced neuroblastoma

Objetivo: estudar retrospectivamente o quadro clínico, aspectos epidemiológicos, características laboratoriais, genéticas e histológicas em crianças maiores de 1 ano, portadoras de neuroblastoma não disseminado, correlacionando-os com a evolução clínica e tentando definir fatores de risco que possam influir na sobrevida.Casuística e métodos: as informações foram obtidas a partir de 38 prontuários médicos...

Retroperitoneoscopic adrenalectomy in an infant with adrenocortical virilizing tumor.

CONTEXT: Adrenocortical virilizing tumors are rare in the pediatric age group. Laparoscopic surgery is the gold standard method for treatment of adrenal functional tumors under 6 cm in size, in adults. There has been very little use of laparoscopy in children and there is no report of its application in the treatment of adrenal carcinoma in childhood. DESIGN: Case report. CASE REPORT: We performed the first laparoscopic resection using retroperitoneal access for the treatment of an adrenocortical virilizing tumor in a pediatric patient. We believe that retroperitoneoscopic access is a viable and promising option for the treatment of adrenal tumors in children.

Retroperitoneoscopic adrenalectomy in an infant with adrenocortical virilizing tumor

CONTEXT: Adrenocortical virilizing tumors are rare in the pediatric age group. Laparoscopic surgery is the gold standard method for treatment of adrenal functional tumors under 6 cm in size, in adults. There has been very little use of laparoscopy in children and there is no report of its application in the treatment of adrenal carcinoma in childhood. DESIGN: Case report. CASE REPORT: We performed the first laparoscopic resection using retroperitoneal access for the treatment of an adrenocortical virilizing tumor in a pediatric patient. We believe that retroperitoneoscopic access is a viable and promising option for the treatment of adrenal tumors in children

Tratamento de suporte da criança com câncer / Support treatment of children with cancer

O câncer da infância geralmente necessita de tratamento agressivo, que pode causar efeitos indesejáveis como mielossupressao, distúrbios metabólicos e insuficiência renal. Os autores apresentam o caso clínico de um paciente portador de linfoma nao-Hodgkin, com o objetivo de discutir as alteraçoes metabólicas e infecciosas que podem ocorrer durante o tratamento.