Factores de riesgo constitucionales en el cáncer de próstata / Constitutional risk factors in prostate cancer

Introducción: en esta revisión se pretende actualizar y divulgar los principales factores de riesgo constitucionales implicados en la etiopatogenia del cáncer de próstata. Material y métodos: revisión bibliográfica de la literatura científica acerca de los factores de riesgo constitucionales asociados a cáncer de próstata entre 1985 y 2010, obtenida de MedLine, Cancer Lit, Science Citation Index y Embase. Los perfiles de búsqueda han sido Risk Factors, Genetic Factors, Genetic Polymorphisms, Genomics, Etiology, Epidemiology, Hormonal Factors,Endocrinology, Primary Prevention y Prostate Cancer. Resultados: los principales factores de riesgo constitucionales son: edad (antes de los 50 años se diagnostican menos del 0,7% de estas neoplasias y en mayores de 65 años, entre el 75-85%),étnico-raciales y geográficos (los afroamericanos presentan las mayores tasas de incidencia y las más bajas en el sudeste asiático), genéticos, familiares y hereditarios (los síndromes familiares engloban el 13-26% de todos los cánceres de próstata, de los cuales el 5% se heredan de forma autosómica dominante), hormonales (es un tumor hormonodependiente), antropométricos (la obesidad incrementa el riesgo), perinatales, hipertensión arterial y diabetes tipo 2. Conclusiones: los factores de riesgo constitucionales desarrollan un papel muy importante en la etiopatogenia del cáncer prostático, especialmente la edad, los factores étnico-raciales geográficos y los factores genético-familiares. No podemos saber qué porcentaje de estas neoplasias se atribuye a factores constitucionales, porque el conocimiento de dichos factores es actualmente incompleto (AU)

Introduction: The aim of this review is to update and divulge the main constitutional risk factors involved in the etiopathology of prostate cancer. Materials and methods: Bibliographic review of the scientific literature on the constitutional risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, Cancer Lit, Science Citation Index and Embase. The search profiles were Risk Factors, Genetic Factors, Genetic Polymorphisms, Genomics, Etiology, Epidemiology, Hormonal Factors, Endocrinology, Primary Prevention and Prostate Cancer. Results: The principal constitutional risk factors are: age (before the age of 50 years at least 0.7% of these neoplasms are diagnosed and between 75-85% are diagnosed after the age of 65 years), ethnic-racial and geographic (African Americans present the highest incidence rates, and the lowest are found in South East Asia), genetic, family and hereditary (family syndromes cover 13-26% of all prostate cancers, of which 5% are of autosomal dominant inheritance), hormonal (it is a hormone-dependent tumour), anthropometric (obesity increases the risk), perinatal, arterial hypertension and type 2 diabetes. Conclusions: Constitutional risk factors play a very important role in the etiopathology of prostate cancer, especially age, ethnic-racial-geographic factors and genetic-family factors. We cannot know what percentage of these neoplasms are a result of constitutional factors, because our knowledge of these factors is currently lacking (AU)

Factores de riesgo ambientales no dietéticos en el cáncer de próstata / Constitutional Risk Factors In Prostate Cancer

Introducción: Se pretende actualizar y divulgar los principales factores de riesgo ambientales, excluyendo los dietéticos, implicados en la etiopatogenia del cáncer de próstata. Material y método: Revisión bibliográfica de los últimos 25 años de los factores de riesgo ambientales no dietéticos asociados a cáncer de próstata entre 1985 y 2010, obtenida del Med-Line, CancerLit, Science Citation Index y Embase. Los perfiles de búsqueda han sido Environmental Risk Factors/Tobacco/Infectious-Inlammation Factors/Pesticides/Vasectomy/OccupationalExposures/Chemoprevention Agents/Radiation y «Cáncer de Próstata». Resultados: Mientras que algunos factores de riesgo ambientales no dietéticos incrementan el riesgo de padecer la enfermedad, otros lo disminuyen. Entre los primeros destacan la exposición al humo del tabaco; los procesos prostáticos infecto-inflamatorios crónicos y la exposición profesional al cadmio, herbicidas y pesticidas. Los principales factores que reducen el riesgo es elempleo de fármacos quimiopreventivos (finasterida, dutasterida) y la exposición a la radiación ultravioleta solar. La vasectomía, con los datos actuales, no influye en el riesgo de desarrollarla enfermedad. Conclusiones: El lento proceso de carcinogénesis prostática es el resultado final de la interacción de factores de riesgo constitucionales y ambientales. Los factores ambientales no dietéticos desempeñan un papel importante en la etiopatogenia de esta enfermedad. Para valorar apropiadamente los factores de riesgo deben analizarse grandes casuísticas que incluyan todas las variables posibles (AU)

Introduction: The aim is to update and disclose the main environmental risk factors, excluding dietary factors, involved in the etiopathology of prostate cancer. Materials and method: Bibliographic review of the last 25 years of non-dietary environmental risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Environmental RiskFactors/Tobacco/Infectious-Inflammatory Factors/Pesticides/Vasectomy/Occupational Exposures/Chemoprevention Agents/Radiation and Prostate Cancer. Results: While some non-dietary environmental risk factors increase the risk of acquiring the disease, others decrease it. Of the former, it is worth mentioning exposal to tobacco smoke, chronic infectious-inflammatory prostatic processes and occupational exposure to cadmium, herbicides and pesticides. The first factors that reduce the risk are the use of chemopreventive drugs (Finasterida, Dutasteride) and exposure to ultraviolet solar radiation. With the current data, a vasectomy does not influence the risk of developing the disease. Conclusions: The slow process of prostate carcinogenesis is the final result of the interaction of constitutional risk and environmental factors. Non-dietary environmental factors play an important role in the etiopathology of this disease. To appropriately assess the risk factors, extensive case studies that include all the possible variables must be analysed (AU)

[Constitutional risk factors in prostate cancer]. / Factores de riesgo constitucionales en el cáncer de próstata.

INTRODUCTION: The aim of this review is to update and divulge the main constitutional risk factors involved in the etiopathology of prostate cancer. MATERIALS AND METHODS: Bibliographic review of the scientific literature on the constitutional risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Risk Factors, Genetic Factors, Genetic Polymorphisms, Genomics, Etiology, Epidemiology, Hormonal Factors, Endocrinology, Primary Prevention and Prostate Cancer. RESULTS: The principal constitutional risk factors are: age (before the age of 50 years at least 0.7% of these neoplasms are diagnosed and between 75-85% are diagnosed after the age of 65 years), ethnic-racial and geographic (African Americans present the highest incidence rates, and the lowest are found in South East Asia), genetic, family and hereditary (family syndromes cover 13-26% of all prostate cancers, of which 5% are of autosomal dominant inheritance), hormonal (it is a hormone-dependent tumour), anthropometric (obesity increases the risk), perinatal, arterial hypertension and type 2 diabetes. CONCLUSIONS: Constitutional risk factors play a very important role in the etiopathology of prostate cancer, especially age, ethnic-racial-geographic factors and genetic-family factors. We cannot know what percentage of these neoplasms are a result of constitutional factors, because our knowledge of these factors is currently lacking.

[Non dietetic environmental risk factors in prostate cancer]. / Factores de riesgo ambientales no dietéticos en el cáncer de próstata.

INTRODUCTION: The aim is to update and disclose the main environmental risk factors, excluding dietary factors, involved in the etiopathology of prostate cancer. MATERIALS AND METHOD: Bibliographic review of the last 25 years of non-dietary environmental risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Environmental Risk Factors/Tobacco/Infectious-Inflammatory Factors/Pesticides/Vasectomy/Occupational Exposures/Chemoprevention Agents/Radiation and Prostate Cancer. RESULTS: While some non-dietary environmental risk factors increase the risk of acquiring the disease, others decrease it. Of the former, it is worth mentioning exposal to tobacco smoke, chronic infectious-inflammatory prostatic processes and occupational exposure to cadmium, herbicides and pesticides. The first factors that reduce the risk are the use of chemopreventive drugs (Finasterida, Dutasteride) and exposure to ultraviolet solar radiation. With the current data, a vasectomy does not influence the risk of developing the disease. CONCLUSIONS: The slow process of prostate carcinogenesis is the final result of the interaction of constitutional risk and environmental factors. Non-dietary environmental factors play an important role in the etiopathology of this disease. To appropriately assess the risk factors, extensive case studies that include all the possible variables must be analysed.

Efectos en la salud pediátrica de la radiación electromagnética de frecuencias extremadamente bajas / Effects on pediatric health of extremely low frequency electromagnetic radiation

Introducción y objetivos. La radiación electromagnética de frecuencias extremadamente bajas (REM-FEB) procede principalmente de las instalaciones eléctricas; aunque éstas presentan innumerables ventajas, la radiación asociada tiene efectos adversos en la salud humana. Esta publicación tiene dos objetivos: a) divulgar los efectos adversos que las REM-FEB producen en la población infantil; y b) resaltar la especial vulnerabilidad e indefensión de nuestros niños. Material y métodos. Revisión sistemática de los principales trabajos publicados en MEDLINE, EMBASE, CANCERLIT, LILACS, y Scielo, durante los últimos 25 años, sobre los efectos de la REM-FEB en la salud infantil. El perfil de búsqueda utilizado ha sido la combinación de “pediatric health effects” y “ acute childhhod leukemia2 con “extremely low-frequency fields” y “residential electromagnetic fields”. Resultados. La población infantil presenta efectos adversos a la exposición de la REM-FEB, aguda o accidental (quemaduras, electrocución, traumatismos, etc) y crónica. La International Commission on No-Ionizing Radiation Pretection recomienda como seguras, para la población adulta, exposiciones crónicas inferiores a 100µT. La exposición residencia infantil a dosis superiores a 0,3-0,4µT incrementa el riesgo a desarrollar leucemias agudas (LA). Se desconoce el mecanismo carcinogénico implicado, pero entre las hipótesis más barajadas destacan las de corrientes de contacto y la alteración de la melatonina. La ausencia de un mecanismo biológico conocido y la falta de reproducibilidad en animales de experimentación impiden que la asociación entre la REM-FEB y la LA infantil se considere causal. Actualmente no existen datos estadísticamente significativos para asociar dicha exposición con tumores del sistema nervioso central y otras patologías fetales e infantiles. Conclusiones. La REM – FEB constituye un contaminante ambiental físico omnipresente en los países industrializados. La población pediátrica es especialmente vulnerable a exposiciones crónicas a la REM-FEB, consideradas como seguras para los adultos. La exposición residencial a campos magnéticos iguales o superiores a 0,4 µT, incrementa un 100% el riesgo a desarrollar LA infantil, respecto a exposiciones menores a 0,1 µT, con resultados estadísticamente significativos. A pesar de no haber encontrado un mecanismo causal, la aplicación del principio de precaución es fundamental para proteger la salud infantil (AU)

Introduction and objectives. Electromagnetic fields of extremely low frequencies (EMF-ELF) generated by electric energy, besides its many advantages, produces adverse effects on human health. This article has two objectives: a) to divulge the adverse effects caused by EMF-ELF on pediatric population; and b) to underscore the special vulnerability and defenselessness of children. Material and methods. Systematic review of the published articles in Medline, Embase, Cancerlit, Lilacs, and Scielo on the effects of EMF-EKF on paediatric health during the last 25 years. The search profile combined “paediatric health effects” or “acute childhood leukaemia” and “extremely low-frequency fields” or “residential electromagnetic fields”. Results. The exposure to EMF-ELF causes both acute or accidental (burns, electrocution, traumatism) and chronic adverse effects in children. The International Commission on No-Ionizing Radiation Protection recommends as secure chronic exposure for adult figures under 100 µT. A higher risk of developing acute leukaemia (AL) is associated with home paediatric exposure > 0.3-0.4 . Based on these data, the International Agency of Cancer Research (IARC) classifies EMF-ELF as possible carcinogen (2B). Although the implied carcinogen mechanism is still unknown, the most likely hypotheses are the contact current and the melatonin disorder. A causal relationship between EMF-ELF and AL is not still established due to the absence of a sound biological mechanism and the lack of reproducibility in experimental animals. Nowadays, the development of central nervous system tumours and other fetal and infant disorders is not statistically related to EMF-ELF exposure. Conclusions. EMF-ELF is considered a physical environmental pollutant in industrialized nations. Chronic exposure limits considered safe for adults are deleterious for children. The relative risk of developing AL is increased 100% in children with chronic home exposure≥0.4 µT compared with those with 0.1 µT. In spite of the absence of scientifically proved causal relationship, the application of the precaution principle is necessary to protect paediaric health and wellbeing (AU)

Fibroma desmoplásico de la mandíbula: un tumor de presentación muy infrecuente / Desmoplastic fibroma of the jaw: a rare kind of tumour

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Prevención del cáncer pediátrico / Prevention in childhood cancer

A pesar de las numerosas evidencias basadas en la observación, el establecimiento de la relación causal entre medio ambiente y cáncer pediátrico (CP) ha estado lleno de dificultades metodológicas. Nosotros presentamos un análisis de la naturaleza del problema para proponer algunos de los aspectos relevantes y concretos de utilidad en la práctica pediátrica para la prevención del CP y del cáncer adulto desde la infancia entre los que se encuentran: a) crear unidades de salud medioambiental pediátrica; b) desarrollar la historia clínica medioambiental en el niño con cáncer; c) incorporar la “hoja verde” a los programas de atención del niño sano; d) programa de minimización en el uso de la radiación ionizante; e) implementar las consultas de lactancia materna y deshabituación del consumo de tabaco en pediatría; f) divulgar y fomentar el consumo de una dieta “mas vegetariana”; g) colaborar en el desarrollo de la guía de acción medioambiental escolar (AU)

Despite the various types of observational evidence, the establishment of a causal relationship between the environment and paediatric cancer (PC) has been fraught with inherent methodological difficulties. We have carry out an analysis of the nature of the problem to propose some of the useful and concrete paediatric aspects to prevent of the PC and the adult cancer form the childhood. In this paper, we emphasized the following: a) to create Paediatric Environmental Health Speciality Units; b) to integrate the paediatric environmental history for all children with cancer; c) to incorporate the “green page” to the well-child visit programs; d) to diminish the use of the ionizing radiation; e) to implement breastfeeding and smoking cessation services into paediatric department; f) to disclose and foment the intake of a more vegetarian diet; g) to develop of the guide of school environment health (AU)

[Neonatal tumours and congenital malformations]. / Tumores neonatales y malformaciones congénitas.

INTRODUCTION: The association between pediatric cancer and congenital abnormalities is well known but, there is no exclusive data on the neonatal period and the underlying etiopathogenic mechanisms are unknown. OBJECTIVES: First, to analyze the frequency of neonatal tumours associated with congenital abnormalities; and second, to comment on the likely etiopathogenic hypotheses of a relationship between neonatal tumours and congenital abnormalities. MATERIALS AND METHOD: Historical series of neonatal tumours from La Fe University Children's Hospital in Valencia (Spain), from January 1990 to December 1999. Histological varieties of neonatal tumours and associated congenital abnormalities were described. A systematic review of the last 25 years was carried out using Medline, Cancerlit, Index Citation Science and Embase. The search profile used was the combination of "neonatal/congenital-tumors/cancer/neoplasms" and "congenital malformations/birth defects". RESULTS: 72 neonatal tumours were identified (2.8% of all pediatric cancers diagnosed in our hospital) and in 15 cases (20.8%) there was some associated malformation, disease or syndrome. The association between congenital abnormalities and neonatal tumours were: a) angiomas in three patients: two patients with congenital heart disease with a choanal stenosis, laryngomalacia; b) neuroblastomas in two patients: horseshoe kidney with vertebral anomalies and other with congenital heart disease; c) teratomas in two patients: one with cleft palate with vertebral anomalies and other with metatarsal varus; d) one tumour of the central nervous system with Bochdaleck hernia; e) heart tumours in four patients with tuberous sclerosis; f) acute leukaemia in one patient with Down syndrome and congenital heart disease; g) kidney tumour in one case with triventricular hydrocephaly, and h) adrenocortical tumour: hemihypertrophy. The publications included the tumours diagnosed in different pediatric periods and without unified criteria to classify the congenital abnormalities. Little data exist on the neonatal period and the majority are from medical institutions registers. The prevalence varies from 15 to 31.6%. To explain this association, the hypotheses are based on prenatal exposures (preconceptional and transplacental exposure), to mutagenic and carcinogenic risk factors. CONCLUSIONS: Neonatal tumours are more often associated to congenital abnormalities than other pediatric cancers. The inclusion and classification criteria needs to be unified to better understand the association between the neonatal tumours and congenital abnormalities. The environmental history in all neonatal tumours associated to congenital abnormalities, including the constitutional and environmental risk factors, will help to improve our knowledge of the underlying prenatal mechanisms and to an advance in its prevention.

Tumores neonatales y malformaciones congénitas / Neonatal tumours and congenital malformations

Introducción: La asociación entre tumores y malformaciones congénitas está bien establecida, pero no existen datos exclusivos en el período neonatal y se desconocen los mecanismos subyacentes que generan dicha relación. Objetivos: Este trabajo tiene dos objetivos: primero, analizar la frecuencia de los tumores neonatales asociados a malformaciones congénitas, y segundo, comentar las posibles hipótesis etiopatogénicas de la relación entre ambas entidades. Materiales y método: Estudio retrospectivo de las historias clínicas de los tumores neonatales, en el Hospital Universitario Materno-Infantil La Fe de Valencia, desde enero de 1990 hasta diciembre de 1999. Selección y descripción de las variedades histológicas asociadas a malformaciones congénitas. Éstas se han agrupado siguiendo los criterios de la Clasificación Internacional de Enfermedades CIE-9, códigos 740.0-759.9. Revisión sistemática bibliográfica de los últimos 25 años, obtenida del Medline, Cancerlit, Index Citation Science y Embase. El perfil de búsqueda utilizado fue la combinación de "neonatal/congenital-tumors/cancer/ neoplasms" y "congenital malformations/birth defects". Resultados: Se identificaron 72 tumores neonatales (2,8 % del total de tumores pediátricos diagnosticados en dichos años) y 15 de ellos (20,8 %) asociados a malformaciones congénitas, enfermedades o síndromes congénitos. Las asociaciones entre tumores neonatales y malformaciones congénitas fueron las siguientes: a) angioma en 3 pacientes: con dos cardiopatías congénitas y una atresia de coanas-laringomalacia; b) neuroblastoma en 2 pacientes: uno con riñón en herradura y anomalías vertebrales, y otro con cardiopatía congénita; c) teratoma en 2 pacientes: uno con fisura palatina y anomalías vertebrales, y otro con metatarso varo; d) tumor del sistema nervioso central en un paciente con hernia de Bochdaleck; e) tumor cardíaco en 4 pacientes con esclerosis tuberosa; f) leucemia aguda en un paciente con síndrome de Down y cardiopatía congénita; g) tumor renal en un caso con hidrocefalia triventricular, y h) tumor adrenal en un caso con hemihipertrofia. En la bibliografía específica, las publicaciones engloban tumores de diferentes épocas pediátricas y sin unanimidad de criterios para clasificar las malformaciones congénitas. Apenas existen datos en el período neonatal y la asociación entre ambas entidades se obtiene de registros de instituciones médicas. La prevalencia oscila entre el 15 y el 31,6 %. Las hipótesis etiopatogénicas que explican la asociación entre tumores neonatales y malformaciones congénitas están basadas en las exposiciones prenatales (preconcepcionales y transplacentarias) a factores de riesgo potencialmente mutagénicos y carcinogénicos. Conclusiones: Probablemente, los tumores neonatales se asocian con mayor frecuencia a malformaciones congénitas que los tumores diagnosticados en épocas posteriores de la vida. Para conocer la prevalencia real de la asociación entre tumores neonatales y malformaciones congénitas, es necesario unificar los criterios de inclusión y definición de ambas entidades. La obtención de una minuciosa historia medioambiental en todos los tumores neonatales asociados a malformaciones congénitas, donde se detallen y registren todos los factores de riesgo constitucionales y ambientales, es fundamental para mejorar nuestros escasos conocimientos de los mecanismos prenatales subyacentes y avanzar en su prevención (AU)

Introduction: The association between pediatric cancer and congenital abnormalities is well known but, there is no exclusive data on the neonatal period and the underlying etiopathogenic mechanisms are unknown. Objectives: First, to analyze the frequency of neonatal tumours associated with congenital abnormalities; and second, to comment on the likely etiopathogenic hypotheses of a relationship between neonatal tumours and congenital abnormalities. Materials and method: Historical series of neonatal tumours from La Fe University Children’s Hospital in Valencia (Spain), from January 1990 to December 1999. Histological varieties of neonatal tumours and associated congenital abnormalities were described. A systematic review of the last 25 years was carried out using Medline, Cancerlit, Index Citation Science and Embase. The search profile used was the combination of "neonatal/congenital-tumors/cancer/neoplasms" and "congenital malformations/birth defects". Results: 72 neonatal tumours were identified (2.8 % of all pediatric cancers diagnosed in our hospital) and in 15 cases (20.8 %) there was some associated malformation, disease or syndrome. The association between congenital abnormalities and neonatal tumours were: a) angiomas in three patients: two patients with congenital heart disease with a choanal stenosis, laryngomalacia; b) neuroblastomas in two patients: horseshoe kidney with vertebral anomalies and other with congenital heart disease; c) teratomas in two patients: one with cleft palate with vertebral anomalies and other with metatarsal varus; d) one tumour of the central nervous system with Bochdaleck hernia; e) heart tumours in four patients with tuberous sclerosis; f) acute leukaemia in one patient with Down syndrome and congenital heart disease; g) kidney tumour in one case with triventricular hydrocephaly, and h) adrenocortical tumour: hemihypertrophy. The publications included the tumours diagnosed in different pediatric periods and without unified criteria to classify the congenital abnormalities. Little data exist on the neonatal period and the majority are from medical institutions registers. The prevalence varies from 15 to 31.6 %. To explain this association, the hypotheses are based on prenatal exposures (preconceptional and transplacental exposure), to mutagenic and carcinogenic risk factors. Conclusions: Neonatal tumours are more often associated to congenital abnormalities than other pediatric cancers. The inclusion and classification criteria needs to be unified to better understand the association between the neonatal tumours and congenital abnormalities. The environmental history in all neonatal tumours associated to congenital abnormalities, including the constitutional and environmental risk factors, will help to improve our knowledge of the underlying prenatal mechanisms and to an advance in its prevention (AU)

[Risks factors for pediatric malignant liver tumors]. / Factores de riesgo para los tumores hepáticos malignos pediátricos.

OBJECTIVE: Pediatric Hepatic Malignancies (PHMs) are the result of the interaction between constitutional and environmental risk factors (RFs). We review the evidence on the main RFs associated to PHMs. METHOD: Systematic review of the literature published in the last 25 years on Medline, Embase, Cancerlit, Lilacs and SciElo using the following key words: "etiology/risk factor/epidemiology" and "malignant liver tumors/hepatic cancer" or "hepatoblastoma/hepatocarcionoma". RESULTS: PHMs account for 1 % of all pediatric malignancies. The main types, hepatoblastoma (HB) and hepatocarcionma (HCC) make up 98-99 % of PHM. The main constitutional RFs are: a) Beckwith-Wiedemann (BW) syndrome; b) isolated hemihyperplasia syndrome (IHS); c) adenomatous polyps of the colon; d) hemochromatosis; e) Hereditary Tyrosinemia Type 1; f) a -1-antitrypsin deficiency; g) porphyrias; h) cirrhosis; i) nonalcoholic steatosis; and j) primary sclerosing cholangitis. The main environmental RFs are: a) hepatitis B virus (HBV) and C virus (HCV); b) B1 aflatoxin (B1AF); c) ionizing radiation; d) alcohol; e) hormonal treatments; f) occupational exposure to pesticides, solvents, vinyl chloride and metals; g) smoking; h) arsenic; i) prematury and very low birth weight; and j) trematodes. CONCLUSIONS: The clinical, analytical and ultrasound screening facilitate the early diagnosis of HB in the previously mentioned genetic syndromes, particularly BW and IHS during the first years of life. HBV universal vaccination of newborns provides the biggest opportunity to prevent a substantial proportion of PHMs. Also systematic monitoring of HBV and HCV in blood, hemoderivates, donated organs and drug addicts, are very useful. Other effective measures are: the reduction/elimination of B(1)AF in food, zero alcohol intake during childhood and adolescence as well decreasing prenatal exposure to the tobacco, solvents, pesticides, vinyl chloride, metals, ionizing radiation and hormonal treatments.

Factores de riesgo para los tumores hepáticos malignos pediátricos / Risks factors for pediatric malignant liver tumors

Objetivo: Los tumores hepáticos malignos (THM) pediátricos son el resultado final de la combinación variable de los factores de riesgo (FR) constitucionales y ambientales. La presente revisión pretende divulgar los principales FR asociados a los THM pediátricos para fomentar su prevención primaria y el diagnóstico precoz en los síndromes constitucionales. Método: Revisión sistemática de la bibliografía de los últimos 25 años, obtenida del Medline, Embase, Cancerlit, Lilacs y SciElo. El perfil de búsqueda utilizado fue la combinación de 'etiology/risk factor/epidemiology' and 'malignant liver tumors/hepatic cancer' or 'hepatoblastoma/hepatocarcionoma'. Resultados: Los THM en la época pediátrica constituyen el 1 % del total de cánceres pediátricos. Los dos tipos principales, el hepatoblastoma (HB) y el hepatocarcinoma (HC), engloban el 98-99 % de los THM. Diversos FR constitucionales y ambientales están asociados a un mayor riesgo de desarrollar dichas neoplasias. Los principales FR constitucionales son los siguientes: a) síndrome de Beckwith-Wiedemann (BW); b) síndrome de hemihiperplasia aislada (HA); c) poliposis adenomatosa familiar; d) hemocromatosis; e) tirosinemia hereditaria tipo 1; f) deficiencia de alfa-1 antitripsina; g) porfirias; h) cirrosis; i) esteatosis no alcohólica, y j) colangitis esclerosante primaria. Los principales FR ambientales son los siguientes: a) virus de las hepatitis B (VHB) y C (VHC); b) aflatoxina B1 (AFB1); c) radiación ionizante; d) alcohol; e) tratamientos hormonales; f) exposiciones laborales a solventes, pesticidas, cloruro de vinilo y metales; g) tabaquismo; h) arsénico; i) prematuridad y muy bajo peso al nacimiento, y j) tremátodos. Conclusiones: El cribado clínico, analítico y ecográfico de los principales síndromes genéticos comentados, especialmente el de BW y HA, durante los primeros años de vida, facilitan el diagnóstico precoz del HB. La vacunación universal de los recién nacidos con el VHB, constituye el pilar básico de la prevención primaria de los THM. El control del VHB y VBC en la sangre, hemoderivados, donaciones de órganos y en drogadictos también es de gran utilidad. Otras medidas efectivas en la prevención primaria de los THM son: la reducción/eliminación de alimentos con AFB1, la abstención alcohólica pediátrica y la reducción de las exposiciones prenatales al tabaco, radiaciones ionizantes, solventes, pesticidas, cloruro de vinilo, metales y tratamientos hormonales (AU)

Objective: Pediatric Hepatic Malignancies (PHMs) are the result of the interaction between constitutional and environmental risk factors (RFs). We review the evidence on the main RFs associated to PHMs. Method: Systematic review of the literature published in the last 25 years on Medline, Embase, Cancerlit, Lilacs and SciElo using the following key words: 'etiology/risk factor/epidemiology' and 'malignant liver tumors/hepatic cancer' or 'hepatoblastoma/hepatocarcionoma'. Results: PHMs account for 1 % of all pediatric malignancies. The main types, hepatoblastoma (HB) and hepatocarcionma (HCC) make up 98-99 % of PHM. The main constitutional RFs are: a) Beckwith-Wiedemann (BW) syndrome; b) isolated hemihyperplasia syndrome (IHS); c) adenomatous polyps of the colon; d) hemochromatosis; e) Hereditary Tyrosinemia Type 1; f) a -1-antitrypsin deficiency; g) porphyrias; h) cirrhosis; i) nonalcoholic steatosis; and j) primary sclerosing cholangitis. The main environmental RFs are: a) hepatitis B virus (HBV) and C virus (HCV); b) B1 aflatoxin (B1AF); c) ionizing radiation; d) alcohol; e) hormonal treatments; f) occupational exposure to pesticides, solvents, vinyl chloride and metals; g) smoking; h) arsenic; i) prematury and very low birth weight; and j) trematodes. Conclusions: The clinical, analytical and ultrasound screening facilitate the early diagnosis of HB in the previously mentioned genetic syndromes, particularly BW and IHS during the first years of life. HBV universal vaccination of newborns provides the biggest opportunity to prevent a substantial proportion of PHMs. Also systematic monitoring of HBV and HCV in blood, hemoderivates, donated organs and drug addicts, are very useful. Other effective measures are: the reduction/elimination of B1AF in food, zero alcohol intake during childhood and adolescence as well decreasing prenatal exposure to the tobacco, solvents, pesticides, vinyl chloride, metals, ionizing radiation and hormonal treatments (AU)

Neoplasias neonatales: experiencia de un centro / Neonatal neoplasms: a single-centre experience

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Neurotóxicos medioambientales (IV). Tabaco, alcohol, solventes, flúor y aditivos alimentarios: efectos adversos en el sistema nervioso fetal y postnatal y medidas preventivas / Environmental neurotoxins (IV). Tobacco, alcohol, solvents, fluoride, food additives: adverse effects on the fetal and postnatal nervous system. Preventive measures

Objetivos: 1) Divulgar la neurotoxicidad del humo del tabaco, alcohol y otros solventes, flúor y algunos aditivos alimentarios, y 2) recomendar las medidas preventivas para minimizar/eliminar su exposición. Materiales y métodos: Revisión bibliográfica sistemática de los efectos en el sistema nervioso central (SNC) en desarrollo. Búsqueda en MEDLlNE. Science Citation Index y Embase de los trabajos observacionales de exposición a bajas dosis en humanos y de experimentación en animales de los últimos 10 años. Resultados: 1) El tabaquismo activo y pasivo de las madres gestantes provoca trastornos del aprendizaje, déficit de atención y del cociente intelectual (CI) persistente, y está asociado con un menor rendimiento académico en la descendencia, 2) la exposición fetal a bajas dosis de alcohol se ha asociado con hiperactividad, trastornos de atención, de aprendizaje y deterioro de la memoria en la descendencia; 3) la exposición a solventes por hobbies o aficiones en el hogar puede ser un factor de riesgo considerable, especialmente en áreas mal ventiladas, 4) estudios en animales y humanos sugieren que la exposición al flúor, a los niveles a que se expone la población por fluoración del agua potable y otros suplementos, puede tener efectos adversos sobre el neurodesarrollo. y 5) en animales de experimentación los efectos neurotóxicos por aspartamo y glutamato requieren dosis mucho mayores que las de la dieta humana. Conclusiones: 1) El SNC fetal e infantil es especialmente vulnerable a la exposición a bajas dosis de humo de tabaco y alcohol; 2) no existe un nivel seguro de exposición ni para el tabaco ni para el alcohol; 3) el registro en la consulta de los hobbies o aficiones en el hogar con solventes permitirá detectar familias en riesgo; 4) los suplementos de flúor sólo están indicados en poblaciones de riesgo; 5) la relación entre la dieta y el comportamiento en niños con trastornos de déficit de atención e hiperactividad es incierta, y 6) la historia ambiental pediátrica es necesaria para avanzar en el conocimiento y en los aspectos preventivos, pronósticos y evolutivos de las enfermedades relacionadas con estas exposiciones

Objectives: 1) To make pediatricians aware of the neurotoxicity of: a) tobacco smoke, b) alcohol and other solvents, c) fluoride, and d) certain food additives; and 2) to recommend preventive measures to minimize/eliminate fetal and postnatal exposure. Materials and methods: A systematic review of the literature was conducted to explore the toxic effects of these substances on the fetal and postnatal nervous system. The authors carried out a search for the observational studies on low-dose exposure in humans and laboratory animals indexed over the past 10 years in Medline, the Science Citation Index and Embase. Results: 1) The exposure of women to first hand and second hand cigarette smoke during pregnancy leads to learning disabilities, persistent attention deficits and a low intelligence quotient (IQ) in their children, resulting in poorer academic performance. 2)Fetal exposure to low doses of alcohol is associated with hyperactivity, attention and learning deficits, and poor memory in the child. 3) Exposure to solvents employed in hobbies and pastimes in the home can be a considerable risk factor, especially in poorly ventilated areas. 4) Animal and human studies suggest that exposure to fluoride, at levels similar to those foundin fluoridated drinking water, and to other supplements can have adverse effects on neuronal development. 6) In animal studies, the adverse effects of aspartame and glutamatea re produced at much higher doses than those found in the human diet. Conclusions: 1)The fetal and postnatal central nervous system is especially vulnerable to low-dose exposure to cigarette smoke and alcohol. 2) There are no threshold levels of exposurefor cigarette smoke and alcohol. 3) During well-child visits, the recording pastime and hobbies that involves the use of solvents enables the detection of families at risk. 4) Fluoride supplements are indicated only in populations at risk. 5) Therelation ship between diet and the behavior of children with attention deficit hyperactivity disorder (ADHD) is unclear. 6) The Pediatric Environmental History (PEH) is necessary to expandour knowledge of the health hazards related to these exposures in terms of prevention, prognosis and outcome

[Neonatal tumors: clinical and therapeutic characteristics. Analysis of 72 patients in La Fe University Children's Hospital in Valencia (Spain)]. / Tumores neonatales: características clínicas y terapéuticas. Análisis de 72 casos del hospital infantil La Fe de Valencia.

BACKGROUND: Neonatal tumors, which represent only 1.5-2% of all pediatric tumors, have distinctive features. Their incidence is imprecise, as selection criteria vary and there are few published studies. OBJECTIVE: To analyze and disseminate findings on the histological, clinical, therapeutic and follow-up characteristics of neonatal tumors. MATERIAL AND METHODS: We performed a retrospective study of the clinical records of patients diagnosed with neonatal tumors in La Fe University Children's Hospital in Valencia (Spain) between January 1990 and December 1999. Hamartomas, flat and cavernous cutaneous hemangiomas, nevi, lipomas, subcutaneous fibroma, lymphangiomas, and epidermal cysts were excluded. A systematic review of the literature published in the previous 25 years was performed using Medline, Cancerlit, Index Citation Science, and Embase. The search profile combined neonatal or congenital and tumor or cancer or neoplasm. The most interesting studies, as well as the most relevant references contained in these studies and published before the search period, were selected. RESULTS: The clinical records of 72 patients with neonatal tumors (40 boys and 32 girls), representing 2.8% of all pediatric tumors, were reviewed. The most frequent tumors were hemangiomas (20.8%, 15 patients), neuroblastomas (16.7%, 12 patients), teratomas (12.5 %, 9 patients), and soft tissue tumors (9.7 %, 7 patients). Eighty-six percent of the patients were symptomatic during the first week of life. Although diagnosis was prenatal in 22.2 % of the patients, the most frequent findings on physical examination were identification of a mass or cutaneous lesion in 24 patients (33.3%) and an abdominal mass or hepatomegaly in 13 patients (18%). An associated disease, malformation or syndrome was found in 15 patients (20.8 %). Treatment included surgery (50% of patients) and drugs as monotherapy or coadjuvant therapy (13.9%). Thirteen patients received irradiation after the neonatal period. Spontaneous complete remission took place in six patients. Twenty patients died (27.8%). Mortality was highest in patients with central nervous system tumors or leukemias (83.3% and 75 % respectively). By contrast, none of the patients with hemangiomas or teratomas died. Mortality was low in patients with neuroblastoma (8.3%). At the time of the study, survival was 73 %, with a median follow-up of 8 years. CONCLUSIONS: Due to their biological features, neonatal tumors represent a distinctive subgroup in pediatric oncohematology. The concept of neonatal tumor should be unified to allow the results of different research groups to be analyzed and compared. Despite the methodological limitations found, the clinical, diagnostic, therapeutic, and follow-up characteristics of our patients are similar to those of other published series. The differences found could be explained by the diverse selection criteria employed.

Tumores neonatales: características clínicas y terapéuticas. Análisis de 72 casos del hospital infantil La Fe de Valencia / Neonatal tumors: clinical and therapeutic characteristics. Analysis of 72 patients in La Fe University Children’s Hospital in Valencia (Spain)

Antecedentes Los tumores neonatales, aunque sólo representan el 1,5-2% de los tumores pediátricos, constituyen un subgrupo con personalidad propia. La incidencia es imprecisa, por los criterios de selección variables, y por los escasos estudios publicados. Objetivo Analizar y divulgar las características histológicas, clínicas, terapéuticas y evolutivas de los tumores neonatales. Material y métodos Estudio retrospectivo de las historias clínicas de los pacientes con tumor neonatal, atendidos en el Hospital Infantil Universitario La Fe de Valencia desde enero de 1990 a diciembre de 1999. Se excluyeron los hamartomas, hemangiomas cutáneos planos y cavernosos, nevos, lipomas, fibromas subcutáneos, linfangiomas y quistes epidérmicos. Revisión bibliográfica sistemática de los últimos 25 años obtenida del Medline, Cancerlit, Index Citation Science y Embase. El perfil de búsqueda utilizado fue la combinación de “neonatal, congenital” y “tumors, cancer, neoplasms”. Se seleccionaron los trabajos más interesantes y, de sus referencias, se han recuperdo las más relevantes publicadas previamente al período de la búsqueda. Resultados Se recogieron 72 pacientes con tumor neonatal (40 varones y 32 mujeres), que representan el 2,8% del total de pacientes diagnosticados con tumores pediátricos de nuestra institución. Los hemangiomas son los tumores neonatales más frecuentes (20,8%, 15 casos), seguidos por los neuroblastomas (16,7%, 12 casos), teratomas (12,5%, 9 casos) y los tumores de partes blandas (9,7 %, 7 casos). En el 86 % de los casos las manifestaciones clínicas aparecieron durante la primera semana de vida. Aunque en 16 casos (22,2%) el diagnóstico fue prenatal, la sintomatología predominante fue la visualización de una tumoración o lesión cutánea en 24 casos (33,3 %) y la presencia de una masa abdominal o hepatomegalia en 13 casos (18 %). En 15 casos (20,8 %) existía alguna malformación, enfermedad o síndrome asociado. De las diferentes modalidades terapéuticas, la cirugía fue la opción más empleada (50%). En el 13,9 % de los casos se administró quimioterapia, en monoterapia o con carácter coadyuvante. Únicamente 3 pacientes recibieron radioterapia fuera del período neonatal. En 6 casos se evidenció la regresión espontánea completa de la tumoración. Fallecieron 20 pacientes (27,8 %). Por grupos histológicos, la mayor mortalidad correspondió al grupo de pacientes con tumores del sistema nervioso central (83,3 %) y al de las leucemias (75 %). Por el contrario, ninguno de los pacientes afectados de hemangiomas y teratomas falleció, destacando así mismo la baja mortalidad de los neuroblastomas (8,3 %). En el momento del análisis la supervivencia en nuestra serie es del 73 %, con una mediana de seguimiento de 8 años. Conclusiones Los tumores neonatales, por sus características biológicas constituyen un subgrupo específico dentro de la oncohematología pediátrica. Es necesario unificar el concepto de tumor neonatal para poder analizar y comparar las diferencias de las distintas series publicadas. A pesar de las limitaciones metodológicas encontradas, las características clínicas, diagnósticas, terapéuticas y evolutivas de nuestra serie son similares a las publicadas por otros autores. Probablemente, las diferencias encontradas puedan explicarse por los diversos criterios de selección de los diferentes estudios

Background Neonatal tumors, which represent only 1.5-2% of all pediatric tumors, have distinctive features. Their incidence is imprecise, as selection criteria vary and there are few published studies. Objective To analyze and disseminate findings on the histological, clinical, therapeutic and follow-up characteristics of neonatal tumors. Material and methods We performed a retrospective study of the clinical records of patients diagnosed with neonatal tumors in La Fe University Children’s Hospital in Valencia (Spain) between January 1990 and December 1999. Hamartomas, flat and cavernous cutaneous hemangiomas, nevi, lipomas, subcutaneous fibroma, lymphangiomas, and epidermal cysts were excluded. A systematic review of the literature published in the previous 25 years was performed using Medline, Cancerlit, Index Citation Science, and Embase. The search profile combined “neonatal or congenital” and “tumor or cancer or neoplasm”. The most interesting studies, as well as the most relevant references contained in these studies and published before the search period, were selected. Results The clinical records of 72 patients with neonatal tumors (40 boys and 32 girls), representing 2.8% of all pediatric tumors, were reviewed. The most frequent tumors were hemangiomas (20.8%, 15 patients), neuroblastomas (16.7%, 12 patients), teratomas (12.5 %, 9 patients), and soft tissue tumors (9.7 %, 7 patients). Eighty-six percent of the patients were symptomatic during the first week of life. Although diagnosis was prenatal in 22.2 % of the patients, the most frequent findings on physical examination were identification of a mass or cutaneous lesion in 24 patients (33.3%) and an abdominal mass or hepatomegaly in 13 patients (18%). An associated disease, malformation or syndrome was found in 15 patients (20.8 %). Treatment included surgery (50% of patients) and drugs as monotherapy or coadjuvant therapy (13.9%). Thirteen patients received irradiation after the neonatal period. Spontaneous complete remission took place in six patients. Twenty patients died (27.8%). Mortality was highest in patients with central nervous system tumors or leukemias (83.3% and 75 % respectively). By contrast, none of the patients with hemangiomas or teratomas died. Mortality was low in patients with neuroblastoma (8.3%). At the time of the study, survival was 73 %, with a median follow-up of 8 years. Conclusions Due to their biological features, neonatal tumors represent a distinctive subgroup in pediatric oncohematology. The concept of neonatal tumor should be unified to allow the results of different research groups to be analyzed and compared. Despite the methodological limitations found, the clinical, diagnostic, therapeutic, and follow-up characteristics of our patients are similar to those of other published series. The differences found could be explained by the diverse selection criteria employed

[Risk factors associated with neonatal tumors. Experience of a pediatric environmental health specialty unit in Valencia (Spain)]. / Factores de riesgo asociados a los tumores neonatales. Experiencia de una unidad de salud medioambiental pediátrica (PEHSU-Valencia).

BACKGROUND: Neonatal tumors (NT) result from a variable combination of constitutional and environmental determinants. Multiple risk factors (RF) are involved in their development, although most are unknown. OBJECTIVE: To document the constitutional, environmental, preconceptional and transplacental RF associated with the development of NT with greater or lesser scientific evidence. PATIENTS AND METHODS: We investigated known RF in NT diagnosed at La Fe University Children's Hospital from January 1990 to December 1999, using a questionnaire completed by parents in a personal interview, either at the Pediatric Environmental Health Specialty Unit (PEHSU-Valencia) or at their home. RF associated with NT and childhood cancer were identified through a literature review of the last 25 years through Medline, Cancerlit, Science Citation Index, and Embase. RESULTS: The questionnaire was completed in 59 of 74 NT diagnosed during the period studied. All patients were Caucasians born in Spain. Constitutional-genetic factors were identified in 13.6 %: dominant hereditary syndromes in 5 (familial retinoblastoma in 1 and tuberous sclerosis in 4), and non-hereditary chromosomal syndromes in 3 (trisomy 21). Notable environmental factors were: a) ionizing radiation: preconceptional exposure in 32.2 % and in utero exposure in 6.8 %; b) non-ionizing radiation; 54.2 % reported preconceptional exposure and in utero exposure at home; c) pregnancy-related problems: infections in 13.6 % (8 patients) and a prior history of miscarriage in 20.3 %; d) drugs/chemicals administered during pregnancy: capillary dye in 42.4 %, daily facial make-up in 45.8 %, antacids in 30.5 %, acetaminophen in 34 %, hormone therapy in 10 %, cocaine and marijuana consumption in 11.7 %; e) tobacco: exposure to active smoking in 93.2 % of patients; f) alcohol: in utero exposure in 6.8 %; g) occupational exposure in parents: paternal in 49 % of cases (hydrocarbons in 15, metal in 3, chemical in 2, timber in 2, and agriculture in 7). Four were exposed to pesticides, 3 to solvents, and 3 to paints; and maternal in 12 cases (20 %): low frequency non-ionizing radiation in 6 (textile in 5, and railway in 1), 5 in the service sector (2 hairdressers, 3 cleaners), and 1 the in chemical industry. In another 6 there was exposure to solvents and paints (footwear industry). CONCLUSIONS: The hypotheses formulated in this observational study, which should be analyzed in future case-control and cohort studies, are: a) to scientifically document genetic-constitutional RF in the etiopathogenesis of NT; b) to determine the frequency and etiology of prior miscarriage and its possible association with NT; c) to determine the importance of active smoking before and during pregnancy as a RF for NT; d) to establish the importance of parental occupational exposure in the etiopathogenesis of NT; and e) to define more precisely the role of other physical and chemical RF in the development of NT. To determine and record the RF involved in the etiopathogenesis of NT, the environmental history should be documented in pediatric cancers. The identification of RF is one of the main objectives of Pediatric Environmental Health Specialty Units.

Factores de riesgo asociados a los tumores neonatales. Experiencia de una unidad de salud medioambiental pediátrica (PEHSU-Valencia) / Risk factors associated with neonatal tumors. Experience of a pediatric environmental health specialty unit in Valencia (Spain)

Antecedentes: Los tumores neonatales son el resultado final de la combinación variable del determinante constitucional y del medioambiental. Cada uno está constituido por multitud de factores de riesgo , mayoritariamente desconocidos. Objetivo: Documentar los factores de riesgo constitucionales y medioambientales preconcepcionales y transplacentarios asociados con mayor o menor evidencia científica al desarrollo de los tumores neonatales. Pacientes y métodos: Descripción de los factores de riesgo presentes en los tumores neonatales diagnosticados en el Hospital Infantil Universitario La Fe de Valencia, desde enero de 1990 a diciembre de 1999, obtenidos mediante un cuestionario a través de una entrevista personal a los padres de los pacientes, en la Unidad de Salud Medioambiental Pediátrica (PEHSU-Valencia) o en el domicilio de los pacientes. Revisión bibliográfica de los últimos 25 años del Medline, Cancerlit, Index Citation Science y Embase de los factores de riesgo asociados a los tumores neonatales y cánceres infantiles en general. Resultados: En 59 de los 74 tumores neonatales registrados se realizó el cuestionario. Todos eran de raza blanca y nacionalidad española. Los factores genéticos-constitucionales se asociaron en el 13,6 %: cinco síndromes hereditarios dominantes (un retinoblastoma familiar y cuatro esclerosis tuberosas) y tres síndromes cromosómicos no hereditarios (trisomía 21). Los factores ambientales más destacables asociados fueron: a) radiación ionizante: 32,2 % exposición preconcepcional y 6,8 % transplacentaria; b) radiación no ionizante: 54,2 % relataban exposición preconcepcional y transplacentaria en el entorno ambiental domiciliario; c) problemas gestacionales: 13,6 % infecciones gestacionales (8 casos) y el 20,3 % (12 casos) presentaban el antecedente de aborto en una gestación anterior; d) fármacos/medicaciones/drogas durante la gestación: 42,4 % tintes capilares, 45,8 % maquillaje facial diario, 30,5 % antiácidos, 34 % paracetamol, 10 % tratamiento hormonal, 11,7 % consumo de marihuana y cocaína; e) tabaco: la exposición al tabaquismo activo estuvo asociada al 93,2 % de los pacientes; f) alcohol: en el 6,8 % exposición transplacentaria; g) exposición ocupacional de los padres: en el 49 % existía exposición ocupacional paterna de riesgo (15 hidrocarburos, tres metales, dos químicas, dos madereras y siete agricultores). En ellos destaca exposición a pesticidas en cuatro, solventes en tres y pinturas en tres. En 12 casos (20 %) existía exposición materna ocupacional de riesgo: seis a radiaciones no ionizantes de baja frecuencia (cinco industria textil y una ferroviaria), cinco en el sector de servicios (dos peluqueras y tres limpiadoras), y una en la industria química. En otras seis existía exposición a solventes y pinturas (sector del calzado). Conclusiones: Las hipótesis que formulamos en el presente trabajo observacional, y que deben analizarse en futuros estudios de casos-controles y cohortes, son las siguientes: a) documentar con mayor solidez científica la presencia de los factores de riesgo constitucionales-genéticos en la etiopatogenia de los tumores neonatales; b) constatar la frecuencia y la etiología del antecedente materno de aborto o pérdida fetal, y su hipotética relación con los tumores neonatales; c) importancia del tabaquismo activo preconcepcional y transplacentario como factores de riesgo en los tumores neonatales; d) averiguar la importancia de los factores de riesgo ocupacionales parentales en la etiopatogenia de los tumores neonatales, y e) detallar con más precisión la contribución del resto de factores de riesgo físicos y químicos en el desarrollo de los tumores neonatales. Así mismo, el conocimiento y obtención de los factores de riesgo implicados en la etiopatogenia de los tumores neonatales, plantean la necesidad de documentar la historia medioambiental en los cánceres pediátricos. Determinar los factores de riesgo constituye uno de los principales objetivos de las Unidades de Salud Medioambiental Pediátrica

Background: Neonatal tumors (NT) result from a variable combination of constitutional and environmental determinants. Multiple risk factors (RF) are involved in their development, although most are unknown. Objective: To document the constitutional, environmental, preconceptional and transplacental RF associated with the development of NT with greater or lesser scientific evidence. Patients and methods: We investigated known RF in NT diagnosed at La Fe University Children's Hospital from January 1990 to December 1999, using a questionnaire completed by parents in a personal interview, either at the Pediatric Environmental Health Specialty Unit (PEHSU-Valencia) or at their home. RF associated with NT and childhood cancer were identified through a literature review of the last 25 years through Medline, Cancerlit, Science Citation Index, and Embase. Results: The questionnaire was completed in 59 of 74 NT diagnosed during the period studied. All patients were Caucasians born in Spain. Constitutional-genetic factors were identified in 13.6 %: dominant hereditary syndromes in 5 (familial retinoblastoma in 1 and tuberous sclerosis in 4), and non-hereditary chromosomal syndromes in 3 (trisomy 21). Notable environmental factors were: a) ionizing radiation: preconceptional exposure in 32.2 % and in utero exposure in 6.8 %; b) non-ionizing radiation; 54.2 % reported preconceptional exposure and in utero exposure at home; c) pregnancy-related problems: infections in 13.6 % (8 patients) and a prior history of miscarriage in 20.3 %; d) drugs/chemicals administered during pregnancy: capillary dye in 42.4 %, daily facial make-up in 45.8 %, antacids in 30.5 %, acetaminophen in 34 %, hormone therapy in 10 %, cocaine and marijuana consumption in 11.7 %; e) tobacco: exposure to active smoking in 93.2 % of patients; f) alcohol: in utero exposure in 6.8 %; g) occupational exposure in parents: paternal in 49 % of cases (hydrocarbons in 15, metal in 3, chemical in 2, timber in 2, and agriculture in 7). Four were exposed to pesticides, 3 to solvents, and 3 to paints; and maternal in 12 cases (20 %): low frequency non-ionizing radiation in 6 (textile in 5, and railway in 1), 5 in the service sector (2 hairdressers, 3 cleaners), and 1 the in chemical industry. In another 6 there was exposure to solvents and paints (footwear industry). Conclusions: The hypotheses formulated in this observational study, which should be analyzed in future case-control and cohort studies, are: a) to scientifically document genetic-constitutional RF in the etiopathogenesis of NT; b) to determine the frequency and etiology of prior miscarriage and its possible association with NT; c) to determine the importance of active smoking before and during pregnancy as a RF for NT; d) to establish the importance of parental occupational exposure in the etiopathogenesis of NT; and e) to define more precisely the role of other physical and chemical RF in the development of NT. To determine and record the RF involved in the etiopathogenesis of NT, the environmental history should be documented in pediatric cancers. The identification of RF is one of the main objectives of Pediatric Environmental Health Specialty Units

Meconium and neurotoxicants: searching for a prenatal exposure timing.

BACKGROUND: Exposure to organochlorine compounds (OCs) has been a subject of interest in recent years, given their potential neurotoxicity. Meconium is easily available and accumulates neurotoxicants and/or metabolites from the 12th week of gestation. AIMS: To determine whether neurotoxicants, specifically OCs, could be detected in serially collected meconium, and to compare the results with those obtained in cord blood samples. METHODS: A sample of cord blood and three serial stool samples were analysed in 10 newborns. Pentachlorobenzene (PeCB), hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs), dichlorodiphenyl trichloroethane (p,p'-DDT) and its metabolite dichlorodiphenyl dichloroethylene (p,p'-DDE), and hexachlorocyclohexane isomers (alpha-, beta-, gamma-, and delta-HCH) were analysed by gas chromatography. RESULTS: From serial stool collection and analysis in newborns, there was an increase in the concentrations of HCB, p,p'-DDE, PCBs, and beta-HCH between the first and last stools of the newborn. Levels of DDT diminished as pregnancy progressed. Concentrations in cord blood were positively associated with concentrations in meconium for p,p'-DDE and beta-HCH. CONCLUSIONS: Meconium is a very useful instrument for the investigation of fetal exposure to neurotoxicants; serial collection and analysis of meconium should estimate the timing and degree of in utero exposure of the fetus to neurotoxicants. Analysis and interpretation of neurotoxicants in meconium results is a complex process. Measurement in meconium of a wide range of neurotoxic substances should facilitate early identification of harmful exposures, and enable rehabilitation and instigation of preventive measures.