Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 18 de 18
Filtrar
Mais filtros










Base de dados
Tipo de estudo
Intervalo de ano de publicação
1.
J Allergy Clin Immunol ; 143(6): 2238-2253, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30660643

RESUMO

BACKGROUND: CD40 ligand (CD40L) deficiency, an X-linked primary immunodeficiency, causes recurrent sinopulmonary, Pneumocystis and Cryptosporidium species infections. Long-term survival with supportive therapy is poor. Currently, the only curative treatment is hematopoietic stem cell transplantation (HSCT). OBJECTIVE: We performed an international collaborative study to improve patients' management, aiming to individualize risk factors and determine optimal HSCT characteristics. METHODS: We retrospectively collected data on 130 patients who underwent HSCT for CD40L deficiency between 1993-2015. We analyzed outcome and variables' relevance with respect to survival and cure. RESULTS: Overall survival (OS), event-free survival (EFS), and disease-free survival (DFS) were 78.2%, 58.1%, and 72.3% 5 years after HSCT. Results were better in transplantations performed in 2000 or later and in children less than 10 years old at the time of HSCT. Pre-existing organ damage negatively influenced outcome. Sclerosing cholangitis was the most important risk factor. After 2000, superior OS was achieved with matched donors. Use of myeloablative regimens and HSCT at 2 years or less from diagnosis associated with higher OS and DFS. EFS was best with matched sibling donors, myeloablative conditioning (MAC), and bone marrow-derived stem cells. Most rejections occurred after reduced-intensity or nonmyeloablative conditioning, which associated with poor donor cell engraftment. Mortality occurred mainly early after HSCT, predominantly from infections. Among survivors who ceased immunoglobulin replacement, T-lymphocyte chimerism was 50% or greater donor in 85.2%. CONCLUSION: HSCT is curative in patients with CD40L deficiency, with improved outcome if performed before organ damage development. MAC is associated with better OS, EFS, and DFS. Prospective studies are required to compare the risks of HSCT with those of lifelong supportive therapy.

2.
Indian J Crit Care Med ; 20(10): 617-619, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27829721

RESUMO

Wiskott-Aldrich syndrome (WAS) is a rare X-linked primary immunodeficiency due to mutations in the WAS gene expressed in hematopoietic cells. Hematopoietic stem cell transplantation (HSCT) is the treatment of choice when an appropriate human leukocyte antigen-matched donor is available. The use of the extracorporeal membrane oxygenation (ECMO) circuit to infuse donor cells for HSCT has not been previously published in the literature. We describe a case of a child who had successful engraftment after HSCT with infusion of the donor stem cells through the ECMO circuit.

3.
N Engl J Med ; 371(5): 434-46, 2014 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-25075835

RESUMO

BACKGROUND: The Primary Immune Deficiency Treatment Consortium was formed to analyze the results of hematopoietic-cell transplantation in children with severe combined immunodeficiency (SCID) and other primary immunodeficiencies. Factors associated with a good transplantation outcome need to be identified in order to design safer and more effective curative therapy, particularly for children with SCID diagnosed at birth. METHODS: We collected data retrospectively from 240 infants with SCID who had received transplants at 25 centers during a 10-year period (2000 through 2009). RESULTS: Survival at 5 years, freedom from immunoglobulin substitution, and CD3+ T-cell and IgA recovery were more likely among recipients of grafts from matched sibling donors than among recipients of grafts from alternative donors. However, the survival rate was high regardless of donor type among infants who received transplants at 3.5 months of age or younger (94%) and among older infants without prior infection (90%) or with infection that had resolved (82%). Among actively infected infants without a matched sibling donor, survival was best among recipients of haploidentical T-cell-depleted transplants in the absence of any pretransplantation conditioning. Among survivors, reduced-intensity or myeloablative pretransplantation conditioning was associated with an increased likelihood of a CD3+ T-cell count of more than 1000 per cubic millimeter, freedom from immunoglobulin substitution, and IgA recovery but did not significantly affect CD4+ T-cell recovery or recovery of phytohemagglutinin-induced T-cell proliferation. The genetic subtype of SCID affected the quality of CD3+ T-cell recovery but not survival. CONCLUSIONS: Transplants from donors other than matched siblings were associated with excellent survival among infants with SCID identified before the onset of infection. All available graft sources are expected to lead to excellent survival among asymptomatic infants. (Funded by the National Institute of Allergy and Infectious Diseases and others.).


Assuntos
Transplante de Células-Tronco Hematopoéticas , Imunodeficiência Combinada Severa/terapia , Complexo CD3/sangue , Feminino , Doença Enxerto-Hospedeiro/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/mortalidade , Humanos , Imunoglobulina A/sangue , Incidência , Lactente , Contagem de Linfócitos , Masculino , Retratamento , Estudos Retrospectivos , Imunodeficiência Combinada Severa/imunologia , Imunodeficiência Combinada Severa/mortalidade , Irmãos , Taxa de Sobrevida , Linfócitos T/imunologia , Condicionamento Pré-Transplante , Resultado do Tratamento
4.
Pediatr Infect Dis J ; 32(9): 933-6, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23538522

RESUMO

BACKGROUND: Pneumocystis carinii pneumonia (PCP) is a potentially life-threatening but preventable infection that may occur after hematopoietic stem cell transplantation (HSCT). Intravenous pentamidine has been used in the prevention of PCP in the post-transplant period, although there are few trials published in the literature evaluating its safety and efficacy. METHODS: We retrospectively reviewed the medical records of children who underwent HSCT from January 1, 2005, to October 1, 2011, who received intravenous pentamidine as first-line PCP prophylaxis initiated at admission. Demographic, clinical, microbiologic, management and outcome data were collected. RESULTS: One hundred sixty-seven consecutive HSCTs in 137 pediatric patients were given intravenous pentamidine before myeloablation and then every 28 days until the subject was at least a minimum 30 days post-HSCT, had stable neutrophil engraftment (absolute neutrophil count >1000/mm for 3 days without growth factor support) and for allogeneic patients, no evidence of active graft versus host disease and weaning on their immunosuppressive therapy. No cases of PCP were seen in this cohort. Ten (7%) had a grade I side effect of nausea/vomiting requiring slower infusion time and 2 (2%) had a grade IV reaction with anaphylaxis (rash) and hypotension with 1 child requiring transfer to the intensive care unit. CONCLUSIONS: Intravenous pentamidine was safe and effective for the prevention of PCP in pediatric HSCT patients. Given the potential neutropenic effects of trimethoprim-sulfamethoxazole, compliance with drug administration and inferior efficacy of other PCP prophylactic medications, intravenous pentamidine should be considered as first-line therapy for the prevention of PCP in children undergoing HSCT.


Assuntos
Antifúngicos/administração & dosagem , Quimioprevenção/métodos , Transplante de Células-Tronco Hematopoéticas , Hospedeiro Imunocomprometido , Pentamidina/administração & dosagem , Pneumonia por Pneumocystis/prevenção & controle , Administração Intravenosa/efeitos adversos , Adolescente , Antifúngicos/efeitos adversos , Quimioprevenção/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pentamidina/efeitos adversos , Pneumocystis carinii/efeitos dos fármacos , Estudos Retrospectivos , Resultado do Tratamento
6.
J Pediatr Hematol Oncol ; 34(6): e241-5, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22584776

RESUMO

A variety of clinical and laboratory parameters have been used to predict bacteremia. We hypothesize that the generation of a cytokine profile could be used to identify patients at higher risk of bacteremia at the time of presentation with febrile neutropenia. We prospectively evaluated children with cancer who presented with an episode of febrile neutropenia. A multiplexed flow cytometric assay was performed which measured 15 cytokines and chemokines obtained before the initiation of antibiotics. Fifty-eight episodes of chemotherapy-induced febrile neutropenia were included in this study during which 4 patients (7%) had bacteremia. An interleukin-5 level of >8 pg/dL had a sensitivity of 67% and a specificity of 96% to predict bacteremia. An monocyte chemotactic protein-1 level >1650 pg/dL had a sensitivity of 80% and a specificity of 82% to predict bacteremia. Erythrocyte sedimentation rate, C-reactive protein, protein C, and other cytokines/chemokines were not predictive of bacteremia. Elevations of interleukin-5 and monocyte chemotactic protein-1 are predictive of bacteremia in children with cancer who have febrile neutropenia. Prospective studies should be undertaken to determine whether these parameters retain predictive value in a larger series of patients and can select children for outpatient management or early discharge.


Assuntos
Bacteriemia/diagnóstico , Biomarcadores/sangue , Quimiocina CCL2/sangue , Interleucina-5/sangue , Neoplasias/tratamento farmacológico , Neutropenia/diagnóstico , Antineoplásicos/efeitos adversos , Bacteriemia/sangue , Bacteriemia/induzido quimicamente , Criança , Feminino , Humanos , Masculino , Neutropenia/sangue , Neutropenia/induzido quimicamente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade
7.
Pediatr Blood Cancer ; 57(4): 666-8, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21826781

RESUMO

BACKGROUND: A routine chest radiograph is often performed to evaluate initial fever in patients undergoing hematopoietic stem cell transplantation (HSCT) given the signs and symptoms of infectious pulmonary pathology may be subtle or absent. Studies in patients receiving conventional chemotherapy have shown that chest radiographs do not appear to be helpful in the evaluation of asymptomatic patients with febrile neutropenia. We performed a retrospective review of pediatric stem cell transplant recipients to determine if chest radiographs are useful in the evaluation of initial fever. PROCEDURE: We retrospectively identified 81 consecutive pediatric hematopoietic stem transplant recipients who had a chest radiograph performed as a routine part of the evaluation of initial fever during stem cell transplantation. RESULTS: Seventy-six (94%) of the chest radiographs performed had no evidence of pulmonary infiltrate. Of the five children with positive radiographs, three had symptomatic respiratory infection and two (40%) were asymptomatic. One asymptomatic patient had a history of pulmonary infection with persistent stable infiltrates prior to transplantation. This patient did not have any evidence of pneumonia during the transplant. The second asymptomatic patient had subsequent resolution of the infiltrate with antibiotic administration. None of the patients had a change made in the empiric antibiotic regimen based upon the results of the chest film. CONCLUSIONS: Routine radiographs are not useful in the evaluation of asymptomatic children at the time of an initial febrile event while undergoing HSCT.


Assuntos
Febre/diagnóstico por imagem , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções Respiratórias/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Febre/etiologia , Humanos , Lactente , Masculino , Radiografia Torácica , Infecções Respiratórias/diagnóstico , Estudos Retrospectivos , Adulto Jovem
8.
Crit Care Nurs Clin North Am ; 23(2): 349-76, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21624696

RESUMO

Medical and nursing care of the hematopoietic stem cell transplantation (HSCT) recipient are complex because of the pathophysiology, HSCT process, pre-HSCT conditioning regimens, numerous medications and therapies, acute and chronic complications, adverse effects, resources involved, and environmental considerations. The HSCT process and therapies may affect any body system, requiring proficient and prioritized nursing care, possibly in an intensive care setting. Understanding the timing of potential adverse effects and complications based on engraftment will help provide competent, high-acuity care. Although autogenic and allogeneic HSCT are curative treatment options, there are numerous morbidity and/or mortality risks throughout the HSCT journey.


Assuntos
Transplante de Células-Tronco Hematopoéticas/enfermagem , Enfermagem Pediátrica/métodos , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Cuidados de Enfermagem , Estados Unidos
9.
N Engl J Med ; 362(7): 600-13, 2010 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-20164484

RESUMO

BACKGROUND: We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. METHODS: We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1x10(11), 2.2x10(11), or 4.4x10(11) platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria). RESULTS: In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25x10(11)) than in the medium-dose group (11.25x10(11)) or the high-dose group (19.63x10(11)) (P=0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001). CONCLUSIONS: Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1x10(11) and 4.4x10(11) platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.)


Assuntos
Transplante de Células-Tronco Hematopoéticas , Hemorragia/prevenção & controle , Transfusão de Plaquetas , Trombocitopenia/terapia , Adulto , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hemorragia/etiologia , Hemostasia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/terapia , Contagem de Plaquetas , Transfusão de Plaquetas/efeitos adversos , Transfusão de Plaquetas/métodos , Trombocitopenia/etiologia
10.
Pediatr Blood Cancer ; 49(5): 751-4, 2007 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-16421913

RESUMO

We report the cases of two children presenting with severe airway compromise secondary to a mediastinal malignancy managed with extracorporeal membrane oxygenation without intubation. Results are presented on the use of ECMO as a primary means of stabilizing a pediatric patient with a critical mediastinal mass, thus providing another management strategy for this difficult situation.


Assuntos
Oxigenação por Membrana Extracorpórea , Neoplasias do Mediastino/terapia , Antineoplásicos/uso terapêutico , Criança , Pré-Escolar , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Radiografia , Indução de Remissão , Insuficiência Respiratória/etiologia
11.
Blood ; 104(7): 2007-9, 2004 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-15205266

RESUMO

Familial hemophagocytic lymphohistiocytosis (FHL) is an inherited, fatal disorder of infancy. We report here a 17-day-old female infant who presented with high fever, hepatosplenomegaly, hypertriglyceridemia, hypofibrinogenemia, thrombocytopenia, and liver failure. Leukocytosis was detected with circulating "atypical" lymphoid cells. Flow cytometric studies revealed expanded subpopulations of CD8+ T cells with unusual immunophenotypic features, including a subset that lacked CD5 expression. A liver biopsy showed hemophagocytic lymphohistiocytosis with exuberant infiltrates of CD8+ T cells that lacked perforin. Mutational studies revealed a 666C-->A (H222Q) missense mutation in the perforin gene. T-cell receptor studies on flow-sorted T-cell subpopulations revealed no evidence of monoclonality. Analysis of T-cell receptor excision circle levels indicated long proliferative history in the aberrant CD8+ T-cell subsets. This case provides an instructive example of uncontrolled reactive proliferation of CD8+ T cells in FHL, resulting in atypical morphology and unusual immunophenotypic features that might suggest malignancy in other clinical settings.


Assuntos
Antígenos CD5/biossíntese , Linfócitos T CD8-Positivos/imunologia , Rearranjo Gênico , Histiocitose de Células não Langerhans/imunologia , Imunofenotipagem/métodos , Biópsia , Divisão Celular , Análise Mutacional de DNA , Feminino , Citometria de Fluxo , Genes Codificadores da Cadeia gama de Receptores de Linfócitos T/genética , Humanos , Recém-Nascido , Fígado/metabolismo , Glicoproteínas de Membrana/genética , Mutação de Sentido Incorreto , Perforina , Proteínas Citotóxicas Formadoras de Poros , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Linfócitos T/imunologia , Fatores de Tempo
12.
J Clin Oncol ; 22(8): 1413-9, 2004 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-15084615

RESUMO

PURPOSE: To determine the dose limiting toxicity (DLT), maximum-tolerated dose (MTD), and pharmacokinetic profile of tirapazamine (Sanofi Synthelabo Research, Malvern, PA) combined with cyclophosphamide in children with recurrent solid tumors. PATIENTS AND METHODS: Patients received a 2-hour infusion of tirapazamine, followed by 1,500 mg/m(2) cyclophosphamide, and mesna once every 3 weeks. Dose escalation of tirapazamine began at 250 mg/m(2) and was increased by 30% in subsequent cohorts. If DLT was hematologic, less-heavily pretreated patients were to be enrolled until their DLTs were encountered, and MTDs defined. Pharmacokinetic profiles were also characterized. RESULTS: Twenty-three patients were enrolled onto the study. Pharmacokinetic data were calculated for 22 patients. Prolonged neutropenia was the DLT at 420 mg/m(2) in heavily pretreated patients. Grade 3, reversible ototoxicity was the DLT in less-heavily pretreated patients at 420 mg/m(2). Two (one with neuroblastoma and one with rhabdomyosarcoma) had partial responses. One child with neuroblastoma had prolonged stable disease (10 cycles) at a dose of 250 mg/m(2). This patient had disease detectable in the bone marrow only and all evidence of bone marrow involvement resolved for 17 cycles of therapy. Four other patients had stable disease. An apparent dose-proportional increase in tirapazamine maximal concentration and area under the curve(last) was observed. Tirapazamine clearance, volume of distribution at steady-state, and terminal half-life did not appear to be dose-dependent. CONCLUSION: The recommended dose of tirapazamine given with 1,500 mg/m(2) of cyclophosphamide once every 3 weeks is 325 mg/m(2). Neutropenia and ototoxicity were dose-limiting. Based on early evidence of antitumor activity, additional studies appear warranted.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Neoplasias/tratamento farmacológico , Triazinas/uso terapêutico , Adolescente , Adulto , Criança , Pré-Escolar , Ciclofosfamida/efeitos adversos , Ciclofosfamida/metabolismo , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Neutropenia/induzido quimicamente , Tirapazamina , Triazinas/efeitos adversos , Triazinas/metabolismo
13.
Pediatr Blood Cancer ; 42(1): 93-8, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14752800

RESUMO

BACKGROUND: To determine the maximum-tolerated duration and dose-limiting toxicity of a daily schedule of orally administered cyclophosphamide and topotecan in pediatric patients with recurrent or refractory malignant solid tumors. METHODS: Patients received oral cyclophosphamide (50 mg/m2/dose) in the morning followed by topotecan (0.8 mg/m2/dose) 8-12 hr later for an escalating number of consecutive days (10, 14, and 17 days). RESULTS: Seventeen pediatric patients were treated with oral cyclophosphamide and topotecan for durations of 10-17 days for a total of 58 treatment courses. Reversible hematologic toxicity (neutropenia and thrombocytopenia) was the dose-limiting toxicity. Nonhematologic toxicities of greater than grade 3 were not observed. A partial response (neuroblastoma following myeloablative chemotherapy and stem cell rescue) and prolonged stable disease (medulloblastoma) were each observed in one patient. CONCLUSIONS: The recommended duration of therapy with a daily schedule of both oral cyclophosphamide (50 mg/m2/day) and topotecan (0.8 mg/m2/day) for previously treated pediatric patients with recurrent or refractory solid tumors is 14 consecutive days. The observed dose limiting toxicity (DLT) was reversible neutropenia. This regimen was well tolerated in heavily pretreated patients and demonstrated activity against recurrent pediatric solid tumors.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias/tratamento farmacológico , Terapia de Salvação , Administração Oral , Adolescente , Criança , Pré-Escolar , Ciclofosfamida/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Masculino , Dose Máxima Tolerável , Topotecan/administração & dosagem
14.
Leuk Lymphoma ; 44(2): 343-8, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12688355

RESUMO

The role of the thymus in immune reconstitution in adults receiving chemotherapy is controversial. Detection of T-cell-receptor gene rearrangement excisional circles (TREC) in peripheral blood T cells has been shown to estimate thymic output. Therefore, we measured TREC levels to assess the contribution of the thymus to immune recovery following treatment with fludarabine. Patients who had received fludarabine alone or a fludarabine containing regimen were identified. Cryopreserved peripheral-blood mononuclear cells were obtained and analyzed by four-color flow cytometry utilizing fluorochrome-conjugated antibodies against CD4, CD8, CD45RO and CD27. Proportions of naïve T cells in each CD4+ and CD8+ subset were measured by gating on CD45RO-negative, CD27+ cells. Quantification of TREC in sorted naïve CD4+ and CD8+ T cells was performed by real-time PCR. Thirteen patients received a mean of 3.8 +/- 0.4 courses of fludarabine and samples were obtained at a average of 18.8 (range 3.6-40.3) months after completing chemotherapy. Ten (77%) had detectable TREC levels. There was a positive correlation (Spearman's rank correlation) between the degree of TREC expression and the percentage of naïve T cells (r = 0.6, p = 0.03), naïve CD4+ (r = 0.6, p = 0.03) and naïve CD8+ (r = 0.66, p = 0.01) cells. We conclude that increased thymic output as demonstrated by an increase in TREC levels correlated with, and was predictive ofincreased numbers of naive T cell following fludarabine administration. The thymus appears to play a role in immune recovery in adults after receiving chemotherapy.


Assuntos
Rearranjo Gênico do Linfócito T , Timo/fisiologia , Vidarabina/análogos & derivados , Vidarabina/uso terapêutico , Adulto , Idoso , Linfócitos T CD4-Positivos/citologia , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/citologia , Linfócitos T CD8-Positivos/metabolismo , Feminino , Humanos , Sistema Imunitário/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Subpopulações de Linfócitos T/citologia , Subpopulações de Linfócitos T/metabolismo , Timo/imunologia , Vidarabina/farmacologia
16.
J Pediatr Hematol Oncol ; 24(9): 710-3, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12468909

RESUMO

PURPOSE: This study was undertaken to determine if central venous catheter (CVC)-related infection in children with cancer could be prevented by monthly flushing of the catheter with urokinase. PATIENTS AND METHODS: Between August 1994 and July 1998, 103 patients with cancer were randomized at the time of subcutaneous CVC placement to receive monthly flushing of their catheters with either 5000 IU of urokinase-heparin or heparin alone. Patients subsequently had blood cultures taken from their CVCs during an episode of fever. RESULTS: Seventy-four of the 103 patients (72%) enrolled in the study received at least 6 catheter flushes: 40 with urokinase-heparin and 34 with heparin. The median number of flushes was 9.5 in the urokinase-heparin group and 10.2 in the heparin-only group (P = 0.62). There were 5 positive blood cultures in the urokinase-heparin group and seven in patients receiving heparin alone (P = 0.27). Staphylococcus epidermidis was isolated from the blood of 3 patients receiving urokinase-heparin and 6 in those receiving heparin alone (P = 0.17). CONCLUSION: Prophylactic monthly catheter flushes with 5000 IU urokinase did not significantly decrease the number of documented bacteremic events in children with cancer who have CVCs.


Assuntos
Bacteriemia/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Heparina/uso terapêutico , Ativadores de Plasminogênio/uso terapêutico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Adolescente , Adulto , Anticoagulantes/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , Leucemia/tratamento farmacológico , Linfoma/tratamento farmacológico , Masculino , Neoplasias/tratamento farmacológico
17.
J Pediatr Hematol Oncol ; 24(8): 662-5, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12439040

RESUMO

The authors report a fatal case of acute bacterial myocarditis in a nonneutropenic child with acute lymphoblastic leukemia. She was admitted to the hospital with a urinary tract infection resulting from and remained persistently febrile despite resolution of the infection. On hospital day 4 signs of acute cardiac failure developed. Despite aggressive resuscitation measures, she died. Pathologic examination revealed the cause of death to be bacterial myocarditis. In addition, she was found to have a generalized decrease in her serum immunoglobulin levels. Acute bacterial myocarditis in patients with malignancy has been rarely reported. The rapid clinical deterioration and death in the patient in this report is particularly interesting.


Assuntos
Infecções por Klebsiella/etiologia , Klebsiella pneumoniae , Miocardite/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Doença Aguda , Agamaglobulinemia/complicações , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cefotaxima/uso terapêutico , Criança , Quimioterapia Combinada/uso terapêutico , Evolução Fatal , Feminino , Humanos , Hospedeiro Imunocomprometido , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/isolamento & purificação , Miocardite/microbiologia , Oxacilina/uso terapêutico , Pericardite/etiologia , Pericardite/microbiologia , Pleurisia/etiologia , Pleurisia/microbiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Indução de Remissão , Dor de Ombro/etiologia , Tobramicina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA