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2.
Med Hypotheses ; 136: 109479, 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31778890

RESUMO

Although frequently disseminated to other anatomical sites, neuroblastoma (NB) is rarely reported as involving the central nervous system (CNS), which may reflect insufficient research in poorly controlled systemic disease. Here we demonstrate the involvement of the CNS in patients with NB over 18 months of age at diagnosis of extensive systemic disease. Meningeal metastases were observed even in the presence of complete systemic control. Although no improvement in patient's survival was observed, radiotherapy was effective in preventing CNS recurrence after observation of actual or previous dural disease. In conclusion, this study uncovered the uncommon pathologic involvement of the CNS in children with advanced NB and underscores the meningeal surface as a potential pathway for this to occur.

4.
Rev Inst Med Trop Sao Paulo ; 59: e16, 2017 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-28423091

RESUMO

Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.


Assuntos
Neoplasias Abdominais/diagnóstico , Parede Abdominal/parasitologia , Ascaríase/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Humanos , Masculino
5.
J Pediatr Urol ; 13(1): 50.e1-50.e5, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28288778

RESUMO

INTRODUCTION: A high cure rate for Wilms' tumor has been achieved using a multidisciplinary approach. The natural step forward is to offer the benefits of a minimally invasive technique for surgery, which is an obligatory part of treatment. Nevertheless, some authors resist using videolaparoscopic radical nephrectomy (VRN) because of concerns about reducing the cure index. METHODS: The present study included children with unilateral Wilms' tumor treated from December 2003 to December 2015 with neoadjuvant chemotherapy followed by VRN. Patients were selected based on the size of their tumors compared with the contralateral kidney, and on their stature. RESULTS: VRN was performed in 24 patients of age range 10-93 months, with an average of 38.04 ± 23.37 months. The tumoral kidney's largest diameter after chemotherapy averaged 10% of a patient's height. There was no tumor rupture or spillage and no patient presented intra or immediate postoperative complications, except for prolonged ileum in two patients. One patient required intraoperative transfusion because of preoperative anemia. Another developed a late herniation in the umbilical port that required surgical correction. After an average of 6.65 years of follow-up, two patients presented relapse: one with a stage IV disease had relapse in the lung and another with a stage III, involving the liver, had local relapse because of an unwanted delay in the adjuvant treatment. CONCLUSION: VRN can be considered a feasible alternative to open surgery in selected cases of children with Wilms' tumor. The present experience shows that besides the benefits of minimally invasive procedures and better cosmetic results, there is no evidence of increased tumor rupture or spillage, peritoneal or port site metastasis, and the long-term oncological results are the same as open procedures.


Assuntos
Laparoscopia , Nefrectomia , Cirurgia Vídeoassistida , Tumor de Wilms/cirurgia , Quimioterapia Adjuvante , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Terapia Neoadjuvante , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Tumor de Wilms/tratamento farmacológico , Tumor de Wilms/patologia
6.
Rev. Inst. Med. Trop. Säo Paulo ; 59: e16, 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-842796

RESUMO

ABSTRACT Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.


Assuntos
Humanos , Masculino , Pré-Escolar , Neoplasias Abdominais/diagnóstico , Parede Abdominal/parasitologia , Ascaríase/diagnóstico , Diagnóstico Diferencial
7.
World J Surg Oncol ; 14(1): 26, 2016 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-26837305

RESUMO

BACKGROUND: Paragangliomas (PGL) are rare tumors derived from neural crest cells, whose origins may vary along the chain of the sympathetic nervous system. Such tumors are often characterized by secretion of catecholamines, but sometimes they are biochemically inactive, which makes diagnosis often challenging. Malignant paraganglioma is defined by the presence of this tumor at sites where chromaffin cells are usually not found or by local invasion of the primary tumor. Recurrence, either regional or metastatic, usually occurs within 5 years of the initial complete resection but long-term recurrence is also described. Malignancy is often linked to a SDHB mutation. Preoperative embolization has been applied in the surgical management of PGLs with the objective to decrease intra-operative blood loss and surgery length without complications. CASE PRESENTATION: We report two cases of patients with abdominal or pelvic malignant PGLs who have been treated surgically at our center after preoperative embolization. Surgery was a very challenging procedure with multiple surgical teams involved and embolization did not prevent major blood loss and intraoperative complications. Patients required adjuvant treatment with either chemotherapy or radiotherapy. CONCLUSIONS: Many studies in the adult population have established recommendations for the diagnosis and therapeutic management of PGL, but few studies concern the pediatric population. Because malignant PGL is more important in the pediatric population, screening and early diagnosis of PGL is advisable in children with genetic predisposing. Surgical resection is the mainstay of treatment, but a multimodal approach is often required due to the complexity of cases.  The role of preoperative embolization is not established and in our experience it has provided little benefit and major complications.


Assuntos
Embolização Terapêutica/efeitos adversos , Paraganglioma/etiologia , Neoplasias Pélvicas/terapia , Adolescente , Adulto , Criança , Humanos , Masculino , Paraganglioma/patologia , Cuidados Pré-Operatórios , Prognóstico
8.
Einstein (Säo Paulo) ; 13(4): 492-499, Oct.-Dec. 2015. tab
Artigo em Português | LILACS | ID: lil-770485

RESUMO

Abstract Objective To analyze and compare the health-related quality of life of adult survivors of acute lymphocytic leukemia and Wilms’ tumor amongst themselves and in relation to healthy participants. Methods Ninety participants aged above 18 years were selected and divided into three groups, each comprising 30 individuals. The Control Group was composed of physically healthy subjects, with no cancer history; and there were two experimental groups: those diagnosed as acute lymphocytic leukemia, and those as Wilms’ Tumor. Quality of life was assessed over the telephone, using the Medical Outcomes Study 36-Item Short Form Health Survey. Results Male survivors presented with better results as compared to female survivors and controls in the Vitality domain, for acute lymphocytic leukemia (p=0.042) and Wilms’ tumor (p=0.013). For acute lymphocytic leukemia survivors, in Social aspects (p=0.031), Mental health (p=0.041), and Emotional aspects (p=0.040), the latter also for survivors of Wilms’ tumor (p=0.040). The best results related to the Functional capacity domain were recorded for the experimental group that had a late diagnosis of acute lymphocytic leukemia. There were significant differences between groups except for the Social and Emotional domains for self-perceived health, with positive responses that characterized their health as good, very good, and excellent. Conclusion Survivors of acute lymphocytic leukemia showed no evidence of relevant impairment of health-related quality of life. The Medical Outcomes Study 36-Item Short Form Health Survey (via telephone) can be a resource to access and evaluate survivors.


Resumo Objetivo Analisar e comparar a qualidade de vida relacionada à saúde de sobreviventes adultos de leucemia linfocítica aguda e tumor de Wilms entre si, e em relação a participantes sadios. Métodos Foram selecionados noventa participantes, acima de 18 anos, os quais foram divididos em três grupos, sendo cada um com 30 sujeitos: Grupo Controle, que contou com indivíduos fisicamente saudáveis, sem histórico oncológico; grupo experimental formado por pacientes que tiveram diagnóstico de leucemia linfocítica aguda; e grupo experimental formado por pacientes que tiveram diagnóstico de Tumor de Wilms. A avaliação da qualidade de vida foi realizada por telefone e utilizou o Medical Outcomes Study 36-Item Short Form Health Survey. Resultados Os sobreviventes do sexo masculino apresentaram melhores resultados em relação aos do sexo feminino e controles no Aspecto vitalidade, para leucemia linfocítica aguda (p=0,042) e tumor de Wilms (p=0,013). Para os sobreviventes de leucemia linfocítica aguda nos Aspectos sociais (p=0,031), Saúde mental (p=0,041) e Aspectos emocionais (p=0,040), neste último também para as sobreviventes de Tumor de Wilms (p=0,040). Os melhores resultados relacionados ao domínio Capacidade funcional foram registrados para o grupo experimental de pacientes que tiveram diagnóstico tardio de leucemia linfocítica aguda. Observaram-se diferenças significativas entre os grupos, exceto para os domínios Aspectos sociais e emocionais para a percepção da própria saúde, que teve respostas de cunho positivo, que qualificavam a própria saúde como boa, muito boa e excelente. Conclusão O grupo experimental de pacientes que tiveram diagnóstico de leucemia linfocítica aguda não apresentou evidências de comprometimento relevante da qualidade de vida relacionada à saúde. O Medical Outcomes Study 36-Item Short Form Health Survey (via telefone) pode ser um recurso de acesso e avaliação de sobreviventes.


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Neoplasias Renais/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Qualidade de Vida , Autorrelato , Sobreviventes/psicologia , Tumor de Wilms/epidemiologia , Idade de Início , Análise de Variância , Estudos de Casos e Controles , Seguimentos , Indicadores Básicos de Saúde , Neoplasias Renais/psicologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/psicologia , Fatores Sexuais , Fatores Socioeconômicos , Taxa de Sobrevida , Telefone , Tumor de Wilms/psicologia
9.
Einstein (Sao Paulo) ; 13(4): 492-9, 2015.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26537509

RESUMO

OBJECTIVE: To analyze and compare the health-related quality of life of adult survivors of acute lymphocytic leukemia and Wilms' tumor amongst themselves and in relation to healthy participants. METHODS: Ninety participants aged above 18 years were selected and divided into three groups, each comprising 30 individuals. The Control Group was composed of physically healthy subjects, with no cancer history; and there were two experimental groups: those diagnosed as acute lymphocytic leukemia, and those as Wilms' Tumor. Quality of life was assessed over the telephone, using the Medical Outcomes Study 36-Item Short Form Health Survey. RESULTS: Male survivors presented with better results as compared to female survivors and controls in the Vitality domain, for acute lymphocytic leukemia (p=0.042) and Wilms' tumor (p=0.013). For acute lymphocytic leukemia survivors, in Social aspects (p=0.031), Mental health (p=0.041), and Emotional aspects (p=0.040), the latter also for survivors of Wilms' tumor (p=0.040). The best results related to the Functional capacity domain were recorded for the experimental group that had a late diagnosis of acute lymphocytic leukemia. There were significant differences between groups except for the Social and Emotional domains for self-perceived health, with positive responses that characterized their health as good, very good, and excellent. CONCLUSION: Survivors of acute lymphocytic leukemia showed no evidence of relevant impairment of health-related quality of life. The Medical Outcomes Study 36-Item Short Form Health Survey (via telephone) can be a resource to access and evaluate survivors.


Assuntos
Neoplasias Renais/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Qualidade de Vida , Autorrelato , Sobreviventes/psicologia , Tumor de Wilms/epidemiologia , Adolescente , Adulto , Idade de Início , Análise de Variância , Estudos de Casos e Controles , Feminino , Seguimentos , Indicadores Básicos de Saúde , Humanos , Neoplasias Renais/psicologia , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/psicologia , Fatores Sexuais , Fatores Socioeconômicos , Taxa de Sobrevida , Telefone , Tumor de Wilms/psicologia , Adulto Jovem
10.
Clinics (Sao Paulo) ; 70(6): 387-92, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26106955

RESUMO

OBJECTIVE: The aim of this study was to summarize the experience of a tertiary center in treating hepatoblastoma for the last 21 years. PATIENTS AND METHODS: Fifty-eight cases were included. The tumor extent and prognosis were assessed using the PRETEXT system. The following data were analyzed: age at diagnosis, comorbidities, prematurity, treatment modalities, histopathological findings, surgical details and complications, treatment outcomes, chemotherapy schedules, side effects and complications. Treatment outcomes included the occurrence of local or distant recurrence, the duration of survival and the cause of death. The investigation methods were ultrasonography, CT scan, serum alpha-fetoprotein level measurement and needle biopsy. Chemotherapy was then planned, and the resectability of the tumor was reevaluated via another CT scan. RESULTS: The mean numbers of neoadjuvant cycles and postoperative cycles of chemotherapy were 6±2 and 1.5±1.7, respectively. All children except one were submitted for surgical resection, including 50 partial liver resections and 7 liver transplantations. Statistical comparisons demonstrated that long-term survival was associated with the absence of metastasis (p=0.04) and the type of surgery (resection resulted in a better outcome than transplantation) (p=0.009). No associations were found between vascular invasion, incomplete resection, histological subtype, multicentricity and survival. The overall 5-year survival rate of the operated cases was 87.7%. CONCLUSION: In conclusion, the experience of a Brazilian tertiary center in the management of hepatoblastoma in children demonstrates that long survival is associated with the absence of metastasis and the type of surgery. A multidisciplinary treatment involving chemotherapy, surgical resection and liver transplantation (including transplantations using tissue from living donors) led to good outcomes and survival indexes.


Assuntos
Hepatectomia/métodos , Hepatoblastoma/terapia , Neoplasias Hepáticas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Brasil , Criança , Pré-Escolar , Cisplatino/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Seguimentos , Hepatectomia/mortalidade , Hepatectomia/estatística & dados numéricos , Hepatoblastoma/mortalidade , Hepatoblastoma/patologia , Humanos , Lactente , Recém-Nascido , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Transplante de Fígado/mortalidade , Transplante de Fígado/estatística & dados numéricos , Masculino , Registros Médicos , Terapia Neoadjuvante , Complicações Pós-Operatórias , Taxa de Sobrevida , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Clinics ; 70(6): 387-392, 06/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-749789

RESUMO

OBJECTIVE: The aim of this study was to summarize the experience of a tertiary center in treating hepatoblastoma for the last 21 years. PATIENTS AND METHODS: Fifty-eight cases were included. The tumor extent and prognosis were assessed using the PRETEXT system. The following data were analyzed: age at diagnosis, comorbidities, prematurity, treatment modalities, histopathological findings, surgical details and complications, treatment outcomes, chemotherapy schedules, side effects and complications. Treatment outcomes included the occurrence of local or distant recurrence, the duration of survival and the cause of death. The investigation methods were ultrasonography, CT scan, serum alpha-fetoprotein level measurement and needle biopsy. Chemotherapy was then planned, and the resectability of the tumor was reevaluated via another CT scan. RESULTS: The mean numbers of neoadjuvant cycles and postoperative cycles of chemotherapy were 6±2 and 1.5±1.7, respectively. All children except one were submitted for surgical resection, including 50 partial liver resections and 7 liver transplantations. Statistical comparisons demonstrated that long-term survival was associated with the absence of metastasis (p=0.04) and the type of surgery (resection resulted in a better outcome than transplantation) (p=0.009). No associations were found between vascular invasion, incomplete resection, histological subtype, multicentricity and survival. The overall 5-year survival rate of the operated cases was 87.7%. CONCLUSION: In conclusion, the experience of a Brazilian tertiary center in the management of hepatoblastoma in children demonstrates that long survival is associated with the absence of metastasis and the type of surgery. A multidisciplinary treatment involving chemotherapy, surgical resection and liver transplantation (including transplantations using tissue from living donors) led to good outcomes and survival indexes. .


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Hepatectomia/métodos , Hepatoblastoma/terapia , Neoplasias Hepáticas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Brasil , Cisplatino/administração & dosagem , Doxorrubicina/administração & dosagem , Seguimentos , Hepatectomia/mortalidade , Hepatectomia/estatística & dados numéricos , Hepatoblastoma/mortalidade , Hepatoblastoma/patologia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Transplante de Fígado/mortalidade , Transplante de Fígado/estatística & dados numéricos , Registros Médicos , Terapia Neoadjuvante , Complicações Pós-Operatórias , Taxa de Sobrevida , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Urology ; 84(1): 191-5, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24857277

RESUMO

OBJECTIVE: To compare videolaparoscopic nephrectomy and the open technique as treatments for Wilms tumor, specifically the surgical results, immediate and long-term complications, and patient survival. METHODS: A review of charts of children with unilateral Wilms tumor was performed. There were 2 surgical groups: (1) only open surgery and (2) videolaparoscopy. Complications, transfusion, ruptures, margins, conversions, lymph nodes, and relapse were analyzed. RESULTS: Seventeen children underwent laparoscopic nephrectomy and 15 underwent open nephrectomy. Mean surgical time was 164.71±26.07 minutes for the laparoscopic group, and there were no conversions or ruptures. The mean specimen weight was 145.01±105.85 g for the laparoscopic group and 257.40±162.70 g for the open surgery group. There was 1 preoperative rupture in the open surgery group. Transfusions were not required in either group. The surgical margins were positive in 1 of 17 cases (5.9%) in the laparoscopic group and in 3 of 15 cases (20%) in the open surgery group. One of the 17 (5.9%) laparoscopy-treated patients and 2 of the 15 open surgery-treated patients (13.3%) presented with local tumor relapse. The 5-year event-free survival rate was 93.3% (95% confidence interval, 0.61-0.99) for the laparoscopic group and 79.6% (95% confidence interval, 0.37-0.95] for the open surgery group (P=.446). CONCLUSION: Both techniques showed similar immediate and long-term results.


Assuntos
Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia/métodos , Cirurgia Vídeoassistida , Tumor de Wilms/cirurgia , Adulto , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Taxa de Sobrevida , Tumor de Wilms/mortalidade
13.
Autops Case Rep ; 4(2): 27-33, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-28580324

RESUMO

Although neonatal tumors are rare, neuroblastoma is the most common neoplasia among them. These tumors, which usually involve children in early infancy, are derived from neural crest cells of adrenal gland medulla or sympathetic ganglia. Even though congenital metastatic neuroblastoma presents a favorable prognosis, it may lead to death if not recognized and treated early on. The authors report the case of a 2-month-old child who was born from in vitro fertilization, and whose diagnosis was made after birth. The form of presentation of this case as a metastatic disease concerning this age group is noteworthy.

14.
Front Pediatr ; 1: 48, 2013 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-24400293

RESUMO

Tumors of the kidney, bladder, prostate, testis, and adrenal represent a large part of the adult urologic practice, but are relatively infrequent in children. The natural history and management of these tumors in the pediatric age is different from that of the adults. As result of the successful work of several clinical trial groups in recent decades, there has been a significant improvement in their cure rates. The aim of this article is to review their most significant clinical aspects, as well as to present an update in their management.

15.
In. Lopes, Ademar; Chammas, Roger; Iyeyasu, Hirofumi. Oncologia para a graduação. São Paulo, Lemar, 3; 2013. p.631-639, tab. (Oncologia para a graduação).
Monografia em Português | LILACS | ID: lil-692053
16.
Temas psicol. (Online) ; 20(2): 436-450, dez. 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-684253

RESUMO

O progressivo sucesso dos esquemas terapêuticos para neoplasias malignas de início na infância permitiu uma melhora significativa da sobrevida dos portadores nas últimas décadas. Contudo, sequelas tardias secundárias à toxicidade destes esquemas devem ser devidamente monitoradas. Dada a relevância da avaliação de aspectos da saúde física, saúde mental, bem como fatores emocionais e sociais dos sobreviventes, avaliou-se a qualidade de vida dos entrevistados por uma abordagem alternativa: o contato telefônico. Aplicou-se o questionário SF-36 (Medical Outcomes Study 36 – Item Short Form Health Survey) validado para a língua portuguesa, em trinta indivíduos, maiores de 18 anos e de ambos os sexos, sobreviventes de leucemia linfocítica aguda, sem terapia antineoplásica há pelo menos cinco anos, em acompanhamento médico no Ambulatório Fora de Terapia do ITACI (grupo experimental), e em trinta indivíduos sadios, pareados por sexo e idade ao grupo experimental (grupo controle). Os sobreviventes analisados apresentaram todos os aspectos do SF-36 superiores ao valor médio. Os resultados médios do total de pontos foram estatisticamente semelhantes ao do grupo controle. O SF-36 proporciona dados valiosos para que a equipe de saúde estabeleça condutas terapêuticas aos sobreviventes. A avaliação por telefone se mostrou importante recurso no acompanhamento ambulatorial desta população. Os sobreviventes de Leucemia Linfocítica Aguda avaliados apresentaram adequados escores de qualidade de vida na atualidade.


The progressive success of therapeutic plans for malignant neoplasias that started in childhood allowed an important increase in the survival rate of carriers during the last decades. However, late sequelae secondary to the toxicity of such plans shall be duly monitored. Considering the importance of evaluating the aspects of physical and mental health, as well as emotional and social factors of the survivors, the quality of life of the interviewed persons was evaluated by an alternative approach: telephone calls. The SF-36 questionnaire (Medical Outcomes Study 36 – Item Short Form Health Survey), validated for the Portuguese language, was applied to thirty persons with more than 18 years of age and of both sexes, survivors of acute lymphocytic leukemia, without antineoplastic therapy for at least five years, under medical attendance at the Ambulatory outside the ITACI therapy (experimental group), and also to thirty healthy persons, matched by sex and age to the experimental group (control group). Analyzed survivors scored higher in all aspects SF-36 than the average value. The average results of the total points were statistically similar to the control group. SF-36 provides valuable data for the health team to establish therapeutic procedures to survivors. Evaluation by phone became an important resource in the ambulatory follow-up of this population. Survivors of Acute Lymphocytic Leukemia are presently showing appropriate scores of quality of life.


Assuntos
Humanos , Criança , Leucemia , Qualidade de Vida , Sobreviventes
17.
Temas psicol. (Online) ; 20(2): 436-450, dez. 2012. ilus, tab
Artigo em Português | Index Psicologia - Periódicos técnico-científicos | ID: psi-56167

RESUMO

O progressivo sucesso dos esquemas terapêuticos para neoplasias malignas de início na infância permitiu uma melhora significativa da sobrevida dos portadores nas últimas décadas. Contudo, sequelas tardias secundárias à toxicidade destes esquemas devem ser devidamente monitoradas. Dada a relevância da avaliação de aspectos da saúde física, saúde mental, bem como fatores emocionais e sociais dos sobreviventes, avaliou-se a qualidade de vida dos entrevistados por uma abordagem alternativa: o contato telefônico. Aplicou-se o questionário SF-36 (Medical Outcomes Study 36 – Item Short Form Health Survey) validado para a língua portuguesa, em trinta indivíduos, maiores de 18 anos e de ambos os sexos, sobreviventes de leucemia linfocítica aguda, sem terapia antineoplásica há pelo menos cinco anos, em acompanhamento médico no Ambulatório Fora de Terapia do ITACI (grupo experimental), e em trinta indivíduos sadios, pareados por sexo e idade ao grupo experimental (grupo controle). Os sobreviventes analisados apresentaram todos os aspectos do SF-36 superiores ao valor médio. Os resultados médios do total de pontos foram estatisticamente semelhantes ao do grupo controle. O SF-36 proporciona dados valiosos para que a equipe de saúde estabeleça condutas terapêuticas aos sobreviventes. A avaliação por telefone se mostrou importante recurso no acompanhamento ambulatorial desta população. Os sobreviventes de Leucemia Linfocítica Aguda avaliados apresentaram adequados escores de qualidade de vida na atualidade.(AU)


The progressive success of therapeutic plans for malignant neoplasias that started in childhood allowed an important increase in the survival rate of carriers during the last decades. However, late sequelae secondary to the toxicity of such plans shall be duly monitored. Considering the importance of evaluating the aspects of physical and mental health, as well as emotional and social factors of the survivors, the quality of life of the interviewed persons was evaluated by an alternative approach: telephone calls. The SF-36 questionnaire (Medical Outcomes Study 36 – Item Short Form Health Survey), validated for the Portuguese language, was applied to thirty persons with more than 18 years of age and of both sexes, survivors of acute lymphocytic leukemia, without antineoplastic therapy for at least five years, under medical attendance at the Ambulatory outside the ITACI therapy (experimental group), and also to thirty healthy persons, matched by sex and age to the experimental group (control group). Analyzed survivors scored higher in all aspects SF-36 than the average value. The average results of the total points were statistically similar to the control group. SF-36 provides valuable data for the health team to establish therapeutic procedures to survivors. Evaluation by phone became an important resource in the ambulatory follow-up of this population. Survivors of Acute Lymphocytic Leukemia are presently showing appropriate scores of quality of life.(AU)


Assuntos
Humanos , Criança , Leucemia , Qualidade de Vida , Sobreviventes
18.
Horm Res Paediatr ; 78(2): 73-80, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22922775

RESUMO

BACKGROUND/AIMS: The purpose of this study was to compare adrenal gland reserve in acute lymphocytic leukemia (ALL) patients 8 weeks after treatment with either prednisone (PRED) or dexamethasone (DEX) during the induction phase of therapy. METHODS: A double-blind comparative study of patients treated with PRED and DEX was performed. Sixteen patients received PRED (40 mg/m(2)/day) and 13 patients received DEX (6 mg/m(2)/day), both for 28 days. A low-dose adrenocorticotropic hormone test (1.0 µg/m(2), IV) was performed before and weekly for 8 weeks after abrupt cessation of glucocorticoid therapy. Sixteen children without ALL were used as controls to determine the cutoff peak cortisol level (14.2 µg/dl). RESULTS: Both groups (PRED and DEX) displayed similar mean peak cortisol levels before treatment and during the 8 weeks of evaluation (p = 0.652). No relationship was observed between the incidence of infection/stress and peak cortisol level within each group, nor was there a difference in the frequency of infection/stress between groups (p = 0.359). Although the patients presented variations in peak cortisol during the study period, no signs or symptoms of adrenal insufficiency were observed. CONCLUSION: Patients who received PRED or DEX for 4 weeks showed similar adrenal reserves and infection rates for 8 weeks after abruptly stopping glucocorticoid therapy, suggesting that DEX, which is a better antileukemic drug than PRED, has similar adrenal suppression and recovery rates.


Assuntos
Glândulas Suprarrenais/metabolismo , Hormônio Adrenocorticotrópico/sangue , Antineoplásicos Hormonais/administração & dosagem , Dexametasona/administração & dosagem , Hidrocortisona/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Prednisolona/administração & dosagem , Adolescente , Antineoplásicos Hormonais/efeitos adversos , Criança , Pré-Escolar , Dexametasona/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Prednisolona/efeitos adversos
19.
Autops Case Rep ; 2(3): 39-44, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-31528578

RESUMO

First described by Dr. Benjamin Castleman in 1956, Castleman disease is an uncommon disease of an etiology that is not yet thoroughly known. Three distinct histological subtypes have already been described: hyaline-vascular-, plasma cell-, and human herpes virus 8-associated variant, clinically distinguished in multi or unicentric types. Castleman disease is occasionally diagnosed in children, but more often in young adults, with no gender predominance. The symptoms are rather heterogeneous, varying from an asymptomatic mass in the unicentric Castleman disease type, to life-threatening systemic inflammatory state with systemic symptoms in the multicentric Castleman disease type. The authors report a case of a 15-year-old boy who sought medical attention due to a cervical tumor mass, without systemic symptoms. Pathology exam of the excised mass diagnosed a very typical example of the hyaline-vascular unicentric type of Castleman disease.

20.
Clinics (Sao Paulo) ; 66(10): 1665-9, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22012035

RESUMO

OBJECTIVE: To assess clinical and laboratory features that differentiate acute lymphoblastic leukemia from systemic juvenile idiopathic arthritis at disease onset. METHODS: Fifty-seven leukemia patients with musculoskeletal involvement, without blasts on peripheral blood and without glucocorticoid therapy at disease onset and 102 systemic juvenile idiopathic arthritis patients (International League of Associations for Rheumatology criteria) were retrospectively evaluated. The following features were examined: fever, rheumatoid rash, arthritis, limb pain, hepatomegaly, splenomegaly, pericarditis, myocarditis, pleuritis, weight loss, bleeding, anemia, leukopenia, neutropenia, thrombocytopenia, erythrocyte sedimentation rate, and lactic dehydrogenase levels. RESULTS: The median age at disease onset was significantly higher in leukemia patients than in those with systemic-onset juvenile idiopathic arthritis (5.8 vs. 3.8 years). In addition, the frequencies of limb pain, hepatomegaly, weight loss and hemorrhagic manifestations were significantly higher in leukemia patients than in systemic-onset juvenile idiopathic arthritis patients (70% vs. 1%, 54% vs. 32%, 30% vs. 8%, and 9% vs. 0%, respectively). Likewise, the frequencies of anemia, leukopenia, neutropenia, thrombocytopenia and high lactic dehydrogenase levels were statistically higher in leukemia patients than in patients with systemic-onset juvenile idiopathic arthritis (88% vs. 57%, 39% vs. 1%, 60% vs. 1%, 77% vs. 1%, and 56% vs. 14%, respectively). Remarkably, multivariate analysis revealed that limb pain (OR = 553; 95% CI = 46.48-6580.42) and thrombocytopenia (OR = 754.13; 95% CI = 64.57-8806.72) were significant independent variables that differentiated leukemia from systemic-onset juvenile idiopathic arthritis. The R2 of the Nagelkerke test was 0.91, and the Kaplan-Meier survival curves were similar for acute lymphoblastic leukemia patients with and without limb pain. CONCLUSION: Our study emphasizes the importance of investigating leukemia in patients presenting with musculoskeletal manifestations and, in particular, limb pain associated with thrombocytopenia.


Assuntos
Artrite Juvenil/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Adolescente , Artrite Juvenil/sangue , Criança , Pré-Escolar , Diagnóstico Diferencial , Métodos Epidemiológicos , Feminino , Seguimentos , Humanos , Lactente , Leucopenia/sangue , Masculino , Dor Musculoesquelética/etiologia , Neutropenia/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Estudos Retrospectivos , Trombocitopenia/sangue
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