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1.
Childs Nerv Syst ; 31(9): 1447-59, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26156776

RESUMO

INTRODUCTION: In pediatric population (0-18 years), low-grade gliomas (PLGG) are the most frequent brain tumors and majority are amenable for surgical removal. PATIENTS AND METHODS: A retrospective review of 198 children diagnosed with PLGG between 1980 and 2010 at HSJD was carried out. Several variables were studied to find prognostic factors related to the outcomes (progression-free survival (PFS) and overall survival (OS)). RESULTS: Median age at onset was 88.8 months (3.1 to 214.5 months, SD 53). Surgery was performed in 175 patients (88.4%), achieving gross total resection (GTR) in 77 (44%), subtotal resection (STR) in 87 (49.7%), and 11 (6.3%) biopsies. Pathological review classified 84 tumors as WHO grade I (48%) and 89 as grade II (50.8%). Adjuvant therapy (AT) was given to 75 patients (37.9%), radiotherapy in 24 (12.1%), chemotherapy in 33 (16.7%), and combined in 18 (9.1%). Sixteen patients (8.1%) died, 89 (43.4%) are alive with no evidence of disease, and 93 (47%) alive with disease, median follow-up 65.2 months. Outcome is significantly correlated with age (p = 0001, worse OS for patients younger than 12 months) and extent of tumor resection (p < 0001). OS for GTR/STR/biopsy was >200, 154.3, and 101.9 months, respectively. Patients treated with AT presented worse OS/PFS (p < 0.001) than those not treated. Histology was non significantly related to outcomes. CONCLUSION: In our series of PLGG, the best prognostic markers are tumor location (cerebellar) and the extent of tumor resection (GTR). Infants and patients who require adjuvant therapy because of tumor progression or recurrence have worse outcome.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Glioma/diagnóstico , Glioma/terapia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/complicações , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Glioma/complicações , Humanos , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Masculino , Modelos de Riscos Proporcionais , Estatísticas não Paramétricas
2.
Childs Nerv Syst ; 29(8): 1321-31, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23666431

RESUMO

PURPOSE: Pediatric brain stem tumors (BsT) are a heterogeneous group of diseases. Our aim was to analyze our experience to find out prognostic factors. METHOD: A retrospective study with BsT patients was performed. Imaging characteristics, extension of surgery, pathology, and adjuvant therapy were analyzed and correlated with overall survival (OS) and progression-free survival (PFS) as outcome measures. RESULT: Since 1980 to 2010, we analyzed 65 BsT patients, 41 of them girls (63%), median age of 8 years (range 13.9 months to 17.6 years). Twenty-two patients (33.8%) had diffuse intrinsic pontine gliomas (DIPG) and 43 (66.2%) presented with focal BsT. Histology was available in 42 patients; the most frequent is low-grade glioma in 24/42 patients (57%). DIPG's histology (obtained usually at necropsy) confirmed five high-grade gliomas. After median follow-up of 49.3 months (0.5-175 months), 20/22 DIPG patients have died (90.9%), while 27/43 with focal tumors were alive (62.8%). Variables related to outcome were histology (better for low-grade glioma (LGG) OS p < 0.001), surgery (better if operated OS p < 0.001), and adjuvant therapy (worse if given, PFS p = 0.001, OS p = 0.024). The outcome for DIPG was dismal, median OS/EFS of 14.2/9.4 months, significantly worse than focal BsT (p = 0.000), while OS/EFS was 122.8/87.2 months for focal intrinsic, 88.2/47.1 months for exophytic, and 124.4/54 months for cervico-medullary tumors: no differences were found among them, except the histology (OS p < 0.001 for low-grade vs high-grade tumors). CONCLUSION: BsT in children comprised two different groups: diffuse (DIPG) and focal gliomas. The DIPGs continue having a dismal prognosis, needing new approaches, while focal tumors including LGG have better prognosis.


Assuntos
Neoplasias do Tronco Encefálico/diagnóstico , Neoplasias do Tronco Encefálico/terapia , Adolescente , Idade de Início , Neoplasias do Tronco Encefálico/classificação , Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/patologia , Criança , Pré-Escolar , Transtornos Cognitivos/etiologia , Terapia Combinada , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Hidrocefalia/etiologia , Lactente , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos
3.
J Clin Invest ; 123(4): 1492-500, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23524969

RESUMO

Type II deiodinase (D2) activates thyroid hormone by converting thyroxine (T4) to 3,5,3'-triiodothyronine (T3). This allows plasma T4 to signal a negative feedback loop that inhibits production of thyrotropin-releasing hormone (TRH) in the mediobasal hypothalamus (MBH) and thyroid-stimulating hormone (TSH) in the pituitary. To determine the relative contributions of these D2 pathways in the feedback loop, we developed 2 mouse strains with pituitary- and astrocyte-specific D2 knockdown (pit-D2 KO and astro-D2 KO mice, respectively). The pit-D2 KO mice had normal serum T3 and were systemically euthyroid, but exhibited an approximately 3-fold elevation in serum TSH levels and a 40% reduction in biological activity. This was the result of elevated serum T4 that increased D2-mediated T3 production in the MBH, thus decreasing Trh mRNA. That tanycytes, not astrocytes, are the cells within the MBH that mediate T4-to-T3 conversion was defined by studies using the astro-D2 KO mice. Despite near-complete loss of brain D2, tanycyte D2 was preserved in astro-D2 KO mice at levels that were sufficient to maintain both the T4-dependent negative feedback loop and thyroid economy. Taken together, these data demonstrated that the hypothalamic-thyroid axis is wired to maintain normal plasma T3 levels, which is achieved through coordination of T4-to-T3 conversion between thyrotrophs and tanycytes.


Assuntos
Regulação da Expressão Gênica , Hipotálamo/enzimologia , Iodeto Peroxidase/metabolismo , Hipófise/enzimologia , Tireotropina/genética , Tri-Iodotironina/sangue , Animais , Astrócitos/enzimologia , Composição Corporal , Córtex Cerebral/metabolismo , Ativação Enzimática , Retroalimentação Fisiológica , Proteína Glial Fibrilar Ácida/metabolismo , Hipocampo/metabolismo , Hipotálamo/citologia , Hipotálamo/metabolismo , Iodeto Peroxidase/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Especificidade de Órgãos , Hipófise/citologia , Glândula Tireoide/metabolismo , Glândula Tireoide/fisiologia , Tireotrofos/enzimologia , Tireotropina/sangue , Hormônio Liberador de Tireotropina , Tiroxina/sangue , Tiroxina/fisiologia , Tri-Iodotironina/fisiologia
4.
Actual. enferm ; 6(4): 8-15, dic. 2003. tab
Artigo em Espanhol | LILACS | ID: lil-363468

RESUMO

El estilo de vida es la forma individual en la que cada persona interactúa con la naturaleza, la manera como siente, piensa y actúa; es el conjunto de hábitos que se manifiestan en cada ser humano y en forma colectiva. Existen hábitos en cada individuo que favorecen su salud y que deben ser promovidos con el fin de que cada persona mejore su calidad de vida. Sin embargo, en cada una de las personas existen hábitos que no son saludables y que pueden aumentar el riesgo de padecer una enfermedad. El cambio en los hábitos de vida no saludables, como el sobrepeso, el consumo de licor y cigarrillo, el sedentarismo, el manejo inadecuado del estrés y una dieta no saludable, reducen el riesgo de padecer una enfermedad cardiovascular. Pero lograr un cambio en el estilo de vida no es una tarea sencilla y depende de una férrea voluntad, disciplina y de la incorporación en un programa suficientemente amplio que le permita desarrollar actividades que disminuyan el riesgo de padecer una enfermedad cardiovascular como la práctica de ejercicio, el adecuado manejo del estrés, una dieta adecuada y el desarrollo de actividades que alejen al paciente del consumo de alcohol y cigarrillo. Así mismo, este programa debe brindar la suficiente continuidad, para que el cambio de actitud sea duradero. Por otra parte, toda persona independiente de su condición socioeconómica, ocupación y edad puede lograr un cambio en su estilo de vida que disminuya el riesgo de padecer una enfermedad cardiovascular


Assuntos
Doenças Cardiovasculares , Estilo de Vida , Prevenção Primária/métodos , Prevenção Primária , Prevenção Primária/tendências , Fatores de Risco
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