Proteínas totais no LCR antes e após radioterapia / Csf protein contents before and after radiotherapy

Com o uso da radioterapia e quimioterapia intratecal associados, passou-se a observar alteraçöes do sistema nervoso central que denotaram lesöes neuronais e vasculares. A atribuiçäo da causalidade dessas alteraçöes a um dos dois fatores terapêuticos passou a ser estudada. Quanto ao papel da radioterapia, há trabalhos experimentais e clínicos que apontam para a possibilidade de ser um fator lesivo. E cogitada a possibilidade da radioterapia lesar a barreira hematencefálica, permitindo com isso a entrada de amethopterin no sistema nervoso. Como as dosagens de irradiaçäo usadas experimentalmente säo bem amiores que as terapêuticas, a analogia feita com o tratamento profilático de pacientes leucêmicos näo parece bastante clara. O propósito desse trabalho é estudar a taxa de proteínas totais no líquido cefalorraquino de pacientes com leucemia aguda, sem comprometimento do sistema nervoso, submetidos a radioterapia, como parametro de avaliaçäo de pertubaçäo da barreira hematencefálica. Para esse estudo foram selecionados 18 pacientes com leucemia aguda, sendo 16 com leucemia linfóide aguda, 2 com leucemia mielóide aguda e que näo tinham sinais ou sintomas clínicos de comprometimento neurológico, nem células blásticas no LCR. As amostras de LCR para este estduo foram colhidas até 8 dias antes do início da radioterapia e de 1 semana até 6 meses após o término dessa mesma sequência radioterápica. A dosagem da taxa de proteínas totais foi feita pelo método de Denis & Ayer. Em conclusäo, pelo método de avaliaçäo empregado, näo se pode evidenciar alteraçäo de permeabilidade da barreira hematencefálica, decorrente de irradiaçäo do sistema nervoso central para profilaxia da neuroleucemia.

Meningoencefalite por herpes simples em paciente portador de leucemia linfóide aguda em remissäo: relato de um caso de necrópsia / Herpes simplex meningoencephalitis in a patient with acute lymphoblastic leukaemia in remission: post mortem case report

Os autores apresentam caso de meningoencefalite por herpes simples em paciente portador de leucemia linfóide aguda em remissäo, após quimioterapia. O diagnóstico foi feito pela necrópsia, através da identificaçäo de corpúsculos intranucleares tipo Cowdry A e confirmado pelo método da imunoperoxidase (PAP) anti-herpes simples-sp

Compromiso ocular como primer signo de recaída en leucemia linfoblástica aguda / Ocular involvement as the first sign of recurrence in acute lynphoblastic leukemia

Se analizaron 137 casos de niños portadores de Leucemia Linfoblástica Aguda, tratados con quimioterapia y radioterapia entre los años 1975 a 1983. Se consideró distribución según sexo, edad, tiempo de seguimiento, recaídas y su localización y sobrevida. Se relatan 3 casos clínicos, cuyo primer signo de recaída fué el compromiso ocular; esto constituye una nueva forma de recaída, cuya referencia es muy escasa en la literatura

Síndrome de sonolência após irradiaçäo cranial em crianças com leucemia linfática aguda / Somnolence syndrome after cranial irradiation in child with acute lymphoeytic leukemia

A síndrome de sonolência é uma alteraçäo transitória do SNC que aparece cerca de quatro a seis semanas após o término da radioterapia e se caracteriza por leve sonolência a moderada letargia, associada algumas vezes a febre baixa. É complicaçäo precoce da radioterapia cranial. Foram analisadas 35 crianças que receberam irradiaçäo profilática do sistema nervoso central por leucemia linfática aguda, associada ao uso do methotrexate intratecal, 14 recebendo 1.800 rad (12 x 150 rad) e 21 recebendo 2.400 rad (16 x 150 rad), atendidas no Departamento de Radioterapia e Serviço de Pediatria do Hospital A.C. Camargo. Apresentaram síndrome de sonolência 47% dos pacientes que receberam 2.400 rad e 35% dos pacientes que receberam 1.800 rad. Os resultados säo comparáveis em freqüência e severidade aos descritos na literatura, näo havendo diferenças estatisticamente significativas entre os grupos analisados

Evaluation of growth hormone release and human growth hormone treatment in children with cranial irradiation-associated short stature.

We studied nine children who had received cranial irradiation for various malignancies and subsequently experienced decreased growth velocity. Their response to standard growth hormone stimulation and release tests were compared with that in seven children with classic GH deficiency and in 24 short normal control subjects. With arginine and L-dopa stimulation, six of nine patients who received radiation had a normal GH response (greater than 7 ng/ml), whereas by design none of the GH deficient and all of the normal children had a positive response. Only two of nine patients had a normal response to insulin hypoglycemia, with no significant differences in the mean maximal response of the radiation and the GH-deficient groups. Pulsatile secretion was not significantly different in the radiation and GH-deficient groups, but was different in the radiation and normal groups. All subjects in the GH-deficient and radiation groups were given human growth hormone for 1 year. Growth velocity increased in all, with no significant difference in the response of the two groups when comparing the z scores for growth velocity of each subject's bone age. We recommend a 6-month trial of hGH in children who have had cranial radiation and are in prolonged remission with a decreased growth velocity, as there is no completely reliable combination of GH stimulation or release tests to determine their response.

Effects of cranial radiation on hearing in children with acute lymphocytic leukemia.

We serially assessed the hearing sensitivity of 61 children with acute lymphocytic leukemia who were admitted to our Total Therapy IX study between December, 1975, and July, 1977. Their treatment included combined chemotherapy, 2,400 rads of cranial radiation, and intrathecal methotrexate. Subjects initially received an otologic examination and middle ear function testing. Audiometric testing was not done until ears were free of outer or middle ear pathology. If the child had no outer or middle ear disease, audiometric thresholds were obtained for the test frequencies: 500, 1,000, 2,000, 4,000, 6,000, and 8,000 Hz. Pure-tone thresholds were obtained before irradiation (61 patients) and at 6, 12, and 36 months thereafter (49, 46, and 22 patients, respectively). The median age at time of baseline testing was 10 years, 2 months. A paired sample test based on group data was used to test whether there were any significant changes from the threshold values at 6, 12, and 36 months after irradiation. Thresholds were not significantly affected for any test frequency at any test time. Assessments of individual audiograms indicated that none of the children had any significant reductions in hearing levels at the end of the third year after cranial irradiation.

Normal growth despite abnormalities of growth hormone secretion in children treated for acute leukemia.

We have studied the relationship between abnormalities of the growth hormone-somatomedin axis and growth in 26 children previously treated for acute lymphatic leukemia. Each child had previously received cranial irradiation, was in complete clinical and hematologic remission, and off all drugs. The mean standing height SDS of the 26 children was significantly less than normal. There was no significant difference between the mean standing height SDS, height velocity SDS, somatomedin activities, and degree of bone age retardation between the 17 children who received the higher dose of cranial irradiation (Group 1) and the nine who had the lower dose of cranial irradiation (Group II). Furthermore, there was no significant reduction in mean height velocity SDS, somatomedin activity, or bone age in either group when compared to normal age-matched controls. The peak GH responses to both insulin hypoglycemia and an arginine test were significantly lowered in Groups I and II when compared to a control group of children. We conclude that only a minority of children, who previously received cranial irradiation for ALL were clinically GH deficient and, therefore, likely to benefit from GH therapy despite the finding that the majority of these children had reduced GH responses to pharmacologic stimuli.