Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
Filtros adicionais











Tipo de estudo
Intervalo de ano
1.
Pediatr Blood Cancer ; : e27977, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31489974

RESUMO

BACKGROUND: Corticosteroids, especially dexamethasone, play a critical role in chemotherapy for pediatric hematological malignancies. We previously observed that patients with complaints of headache or photophobia during corticosteroid administration had high intraocular pressure (IOP). PROCEDURE: We measured IOP during corticosteroid administration in 15 patients with acute leukemia or lymphoma undergoing treatment at our institution from January 2016 to December 2018. IOP was measured by an ophthalmologist within seven days of the initiation of standard dose of corticosteroid, which was defined as 60 mg/m2 /day for prednisolone and 10 mg/m2 /day for dexamethasone. RESULTS: Fifteen patients received 52 courses of chemotherapy containing corticosteroids. IOP exceeded 21 mmHg among 13 patients in 28 courses. Twelve of the 13 patients were administered topical treatment, and six of the 12 patients needed additional diuretic agents. IOP during the chemotherapy courses containing dexamethasone was significantly higher compared with IOP during the chemotherapy courses containing prednisolone. Only two patients complained of symptoms, such as headache and photophobia, and one of the two patients underwent trabeculotomy. Funduscopic findings were normal in all patients. There was a dose-associated decrease in IOP with reduction of dexamethasone dose. CONCLUSIONS: IOP should be measured during administration of substantial corticosteroid doses even in patients with no symptoms. Further investigations regarding the level of IOP for intervention need to be conducted.

2.
J Clin Virol ; 116: 34-38, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31082730

RESUMO

BACKGROUND: Echovirus 30 (E30) is one of the most common causative agents for aseptic meningitis. OBJECTIVES: In the autumn of 2017, there was an outbreak caused by E30 in Kushiro, Hokkaido, Japan. The aim of this study was to characterize this outbreak. STUDY DESIGN: Fifty-nine patients were admitted to the Department of Pediatrics, Kushiro Red Cross Hospital (KRCH) with clinical diagnosis of aseptic meningitis. Among those, 36 patients were finally diagnosed as E30-associated aseptic meningitis by the detection of viral RNA using reverse transcription-polymerase chain reaction (RT-PCR) and/or the evidence of more than four-fold rise in neutralizing antibody (NA) titers in the convalescent phase relative to those in the acute phase. We investigated these 36 confirmed cases. RESULTS: The median age was 6 years (range: 6 months-14 years). The positive signs and symptoms were as follows: fever (100%), headache (94%), vomiting (92%), jolt accentuation (77%), neck stiffness (74%), Kernig sign (29%), and abdominal pain (28%). The median cerebrospinal fluid (CSF) white cell count, neutrophil count, and lymphocyte count were 222/µL (range: 3-1434/µL), 144/µL (range: 1-1269/µL), and 85/µL (range: 2-354/µL), respectively. Although the detected viral genes demonstrated same cluster, they were different from E30 strains observed in Japan between 2010 and 2014. CONCLUSION: We mainly showed clinical and virological features of the E30-associated aseptic meningitis outbreak that occurred in Kushiro. To prevent further spread of E30 infection, continuous surveillance of enterovirus (EV) circulation and standard precautions are considered essential.

3.
Pediatr Int ; 61(3): 230-234, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30570800

RESUMO

BACKGROUND: Central venous (CV) catheters are required for chemotherapy but they may become a source of life-threatening infections of the bloodstream. The most effective way to disinfect the port of a CV catheter has not been established. METHODS: We report the data obtained between April 2008 and March 2010 using 83% ethanol (period I) and between April 2010 and March 2014 using 10% povidone-iodine (period II) to sterilize the access port. The participants received chemotherapy or autologous/allogeneic stem cell transplantation at the present institution. RESULTS: No significant difference was observed in patient characteristics between the two periods, such as disease, median age, or the period of neutropenia. The incidence of positive blood culture during periods I and II was 18.5% (31/168) and 11.4% (40/350; P = 0.041), respectively. The incidence of catheter-associated bloodstream infection on blood culture during periods I and II was 11.9% (20/168) and 6.3% (22/350; P = 0.043), respectively. Bacillus cereus infection was not detected during period II. CONCLUSION: The incidence of infection caused by CV catheters was significantly reduced using povidone-iodine; therefore, we recommend this procedure as part of the routine in chemotherapy.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Povidona-Iodo/administração & dosagem , Adolescente , Adulto , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Hemocultura/métodos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Criança , Pré-Escolar , Etanol/administração & dosagem , Neutropenia Febril , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Esterilização/métodos , Adulto Jovem
4.
Pediatr Blood Cancer ; : e27478, 2018 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-30350912

RESUMO

BACKGROUND: Stem cell transplantation (SCT) outcomes have improved over the last three decades, with many patients being rescued with this treatment. However, improved outcomes have led to issues with long-term sequelae. One of these sequelae in children is renal dysfunction, an index of which is estimated using glomerular filtration rate (eGFR). PROCEDURE: We retrospectively analyzed eGFR in 83 pediatric patients who received SCT. Data from all patients extended up to 12 months or more post SCT. The median follow-up time was 127.7 months (range 12.0-268.8 months). RESULTS: Eighteen patients (21.7%) had low eGFR (<90 ml/min/1.73 m2 ) post SCT. Cumulative incidence of low eGFR was 25.8 ± 2.0%. Nine (10.6%) patients had a low eGFR pre-SCT. However, pre- and post-SCT incidence of low eGFR were not correlated. Meanwhile, only two patients (2.4%) exhibited severe renal dysfunction, with eGFRs < 60 ml/min/1.73 m2 . Independent risk factors for low eGFR were solid tumor and use of fludarabine. Moreover, age at SCT ≥ 7 years was also a long-term post-SCT risk factor for low eGFR in all patients. CONCLUSION: Independent post-SCT long-term risk factors for low eGFR in children were solid tumor and use of fludarabine. Moreover, age at SCT ≥ 7 years was a post-SCT long-term risk factor for low eGFR across all patients.

5.
Int J Hematol ; 106(2): 291-298, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28401497

RESUMO

Bortezomib has been shown to be effective and well-tolerated in patients with refractory acute lymphoblastic leukemia (ALL) in the Therapeutic Advances in Childhood Leukemia trial. However, the safety and efficacy of bortezomib have not been evaluated in Japanese pediatric patients. Here, we report the results of a clinical trial designed to evaluate the safety of bortezomib combined with induction chemotherapy in Japanese children with refractory ALL. A total of six patients with B-precursor ALL were enrolled in this study. Four-dose bortezomib (1.3 mg/m2/dose) combined with two standard induction chemotherapies was used. Prolonged pancytopenia (grade 4) was observed in all patients. Four of the six patients developed severe infectious complications. Peripheral neuropathy (grade 2) occurred in five patients. The individual plasma bortezomib concentration-time profiles were not related to toxicity and efficacy. Five patients were evaluable for response, and four patients achieved complete response (CR) or CR without platelet recovery (80%). In conclusion, four-dose bortezomib (1.3 mg/m2/dose) combined with standard re-induction chemotherapy was associated with a high risk of infectious complications induced by prolonged neutropenia, although high efficacy has been achieved for Japanese pediatric patients with refractory ALL. Attention must be given to severe infectious complications when performing re-induction chemotherapy including bortezomib.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia de Indução , Leucemia de Células B/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Grupo com Ancestrais do Continente Asiático , Bortezomib/administração & dosagem , Bortezomib/efeitos adversos , Bortezomib/farmacocinética , Criança , Pré-Escolar , Doenças Transmissíveis/etiologia , Humanos , Lactente , Neutropenia/induzido quimicamente , Risco
6.
Pediatr Transplant ; 20(1): 114-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26526424

RESUMO

GVHD and graft failure are serious problems in CBT. PES after CBT also occurs frequently and is associated with transplantation-related complications such as acute GVHD. We reviewed medical records for 70 consecutive child CBT recipients between December 1997 and April 2015. Forty-nine patients received prophylaxis against GVHD with CsA or Tac in combination with mPSL from day +7 (mPSL group), and 21 patients received CsA or Tac with MTX on day +1 and day +3 (MTX group). Neutrophil engraftment was detected in 59 patients (84.3%). Neutrophil engraftment rate in the MTX group was significantly higher than that in the mPSL group (21/21 (100%) and 38/49 (77.6%), respectively, p = 0.027). PES developed in 35 patients, and the incidence of PES in the mPSL group was significantly higher than that in the MTX group (p = 0.036). The incidence of severe acute GVHD (grade III or IV) in the MTX group was significantly lower than that in the mPSL group (p = 0.049). Although this study was a small-scale study, the results showed that increase in the rate of engraftment and decrease in the incidence of early immune reactions such as PES and severe acute GVHD could be achieved by early commencement of immunosuppression using MTX.


Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/prevenção & controle , Metotrexato/uso terapêutico , Neoplasias/terapia , Adolescente , Criança , Pré-Escolar , Ciclosporina/administração & dosagem , Intervalo Livre de Doença , Feminino , Sobrevivência de Enxerto , Doença Enxerto-Hospedeiro/epidemiologia , Humanos , Imunossupressão/métodos , Imunossupressores/uso terapêutico , Incidência , Lactente , Recém-Nascido , Masculino , Neutrófilos/metabolismo , Estudos Retrospectivos , Tacrolimo/administração & dosagem , Fatores de Tempo , Condicionamento Pré-Transplante , Resultado do Tratamento
7.
Brain Dev ; 34(9): 784-6, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22277190

RESUMO

Anti-muscle-specific tyrosine kinase antibody (MuSK-Ab) is the second most frequent autoantibody identified in adult patients with myasthenia gravis (MG). Adult patients with MuSK-Ab demonstrate characteristic clinical features but very little information is available for childhood-onset patients with MuSK-positive MG. We report a childhood-onset female patient with MuSK-positive MG. This patient showed basic clinical features compatible with adult-onset MuSK-positive MG, but some features, including spontaneous improvement, are distinct from those in adult patients. Serial examination of MuSK-Ab titers revealed a gross correlation with clinical severity despite significantly high titers throughout the clinical course. Therefore, childhood-onset MuSK-positive MG may demonstrate a distinct clinical characteristics in the early period of illness.


Assuntos
Autoanticorpos/sangue , Miastenia Gravis/sangue , Receptores Proteína Tirosina Quinases/imunologia , Criança , Progressão da Doença , Estimulação Elétrica , Eletromiografia , Feminino , Humanos , Músculo Esquelético/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA