Doxorubicin cardiotoxicity and Camellia sinensis cardioprotection determined by speckle-tracking echocardiography

Abstract Doxorubicin (Dox) is a medication used in the treatment of cancerous tumors and hematologic malignancies with potentially serious side effects, including the risk of cardiotoxicity. Flavonoids are plant metabolites with antioxidant properties and can be extracted from Camellia sinensis (CS). The aim of this study is to evaluate the possible cardioprotective effect of CS against injuries induced by Dox in rats. A total of 32 animals were distributed into four groups: (1) control - intraperitoneal injection (I.P.) of 0.5 mL saline weekly and 1.0 mL water by gavage daily; (2) CS - 0.5 mL saline I.P. weekly and 200 mg/kg CS by gavage daily; (3) Dox - 5.0 mg/kg Dox I.P. weekly and 1.0 mL water by gavage daily; and (4) Dox+CS -5.0 mg/kg Dox I.P. weekly and 200 mg/kg CS by gavage daily. Clinical examinations, blood profiles, electrocardiograms, echocardiograms, and histological analyses of hearts were performed over 25 days. The animals in the Dox group showed changes in body weight and in erythrogram, leukogram, electrocardiography, and echocardiography readings. However, animals from the dox+CS group had significantly less change in body weight, improved cardiac function, and showed more preserved cardiac tissue. This study demonstrated that CS prevents dox-induced cardiotoxicity, despite enhancing the cytotoxic effect on blood cells

Características otorrinolaringológicas en niños con trisomía 21: un estudio de 171 pacientes en el Hospital Infantil de México Federico Gómez / Otolaryngological features in children with trisomy 21: a study of 171 patients at the Hospital Infantil de México Federico Gómez

Resumen Introducción: Los niños con trisomía 21 enfrentan una amplia gama de problemas en la región de la cabeza y el cuello, por lo cual es importante reconocer las manifestaciones otorrinolaringológicas que presentan, así como su apropiado manejo. Métodos: Estudio de serie de casos retrospectivo de pacientes pediátricos con trisomía 21. De cada caso se analizó el espectro de manifestaciones otorrinolaringológicas, el manejo establecido y los resultados. Resultados: Se incluyeron 171 niños. La edad media de la primera valoración por otorrinolaringología en la institución fue de 7.2 ± 4.2 años. Las manifestaciones otológicas más frecuentes fueron la estenosis del conducto auditivo externo y la disfunción de la trompa de Eustaquio. Más de la mitad de los pacientes (63 %) presentaron hipoacusia, principalmente de tipo conductivo bilateral, y hasta el 75 % de los pacientes con afectación otológica requirieron algún procedimiento quirúrgico. Las manifestaciones rinológicas más comunes fueron la rinosinusitis crónica y la rinitis alérgica. La apnea obstructiva del sueño estuvo presente en el 30% de los pacientes. El tratamiento principal fue la amigdalectomía, seguida del tratamiento con dispositivos de presión positiva de la vía aérea. Menos del 5 % de los pacientes presentaron un compromiso laríngeo. Conclusiones: Los pacientes pediátricos con trisomía 21 deben ser remitidos sistemáticamente a una evaluación otorrinolaringológica periódica, debido a la alta incidencia de manifestaciones en esta región. Se deben ofrecer tratamientos oportunos para mejorar su salud y calidad de vida.

Abstract Introduction: Children with trisomy 21 face a wide range of conditions in the head and neck region, for which it is important that physicians are aware and have a strong understanding of the ear, nose, and throat (ENT) disorders, and their management as well. Methods: Retrospective case series of pediatric patients with trisomy 21. The spectrum of otolaryngological manifestations, their management, and outcomes of each case were analysed. Results: One hundred and seventeen pediatric patients were included. The mean age was 7.2 ± 4.2 years. More than half of the patients (63 %) had hearing loss (HL). The most frequent presentation was conductive HL, predominating the mild and bilateral type. The most common otological manifestations found were external ear canal stenosis and Eustachian tube dysfunction. Up to 75 % of the patients with otologic involvement required some surgical procedure. The most common rhinological manifestations were chronic rhinosinusitis and allergic rhinitis. Obstructive sleep apnea (OSA) was present in 30% of all patients, which main treatment was tonsillectomy, followed by continuous positive and biphasic positive airway pressure treatments. Less than 5 % of the patients presented a laryngeal compromise. Conclusions: Pediatric patients with trisomy 21 systematically should be referred to periodic ENT assessment due to the high incidence of manifestations in this region. Timely treatments should be offered in order to improve the health and the quality of life of the patient.

Neoplasia blástica de células dendríticas plasmocitoides: casos clínicos / Blastic plasmacytoid dendritic cell neoplasm: report of three cases

Blastic plasmacytoid dendritic cell neoplasm is a rare hematological malignancy derived from immature plasmacytoid dendritic cells. The tumor cells have an immature blastic appearance, and diagnosis is based on the expression of CD4, CD56 y CD123 in the absence of other lymphoid, natural killer, or myeloid antigens. The majority of affected individuals are older people with a mean age of 66 years. Male to female ratio is approximately 3:1. Common presentation includes cutaneous lesions followed by tumor dissemination. Treatment with conventional chemotherapy is ineffective and allogeneic hematopoietic stem cell transplantation is required to achieve remission. We report three male patients, aged 23, 27 and 51 years with the disease. All had multiple, infiltrated pink plaques and nodules on the skin of their face, neck and thorax, measuring 1 to 12 cm in diameter. All tumors were histologically characterized by a monotonous proliferation of medium size cells with blastic features. Tumor cells were positive for CD123, CD56, CD4 and CD7 in all cases. After a mean of follow-up of 14.6 months, one patient died of the disease, one patient is alive and the disease relapsed after 17 months of remission and one patient is alive with no evidence of the disease.

Neoplasia de células dendríticas plasmocitoides blásticas con respuesta inicial a quimioterapia y recaída en sistema nervioso central: caso clínico / Blastic plasmacytoid dendritic cell neoplasm with complete clinical remission with chemotherapy and central nervous system relapse: report of one case

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive hematologic malignancy that most commonly manifests as cutaneous lesions with or without bone marrow involvement and leukemic dissemination. The demonstration of tumor cells with the characteristic immunophenotype with expression of CD56, generally CD4 and dendritic cell antigens (CD123, cyTCL-1, HLA-DR), in the absence of myeloid or lymphoid lineage markers is required for the diagnosis. Responses to chemotherapy are initially satisfactory, with frequent systemic and central nervous system relapses. We report a 24 year-old male with BPDCN, initially diagnosed and treated as non-Hodgkin CD4+ T-cell lymphoma, with initial complete remission who evolved with early central nervous system relapse. A second attempt of chemotherapy failed and the patient died two months later.

Neoplasia blástica de células dendríticas plasmocitoides: reporte de un caso y revisión de la literatura / Plasmacytoid dendritic cell blast neoplasia: case report and literature review

La neoplasia de células blásticas plasmocitoides dendríticas esun linfoma cutáneo poco frecuente y de mal pronóstico, que característicamenteexpresa antígenos CD4 y CD56. Clínicamentepresenta placas o nódulos de coloración violácea, únicos o múltiples.El diagnóstico se confirma con el estudio anatomopatológicoque evidencia células linfoblástica y fenotipo CD4+ y CD56+, conausencia de marcadores para células mieloides, linfoides B y T ycélulas NK. Presentamos el reporte de un caso de un paciente desexo masculino de 65 años de edad y una revisión de la literatura.

Blastic plasmacytoid dendritic cell neoplasm is a rare andhighly aggressive cutaneous lymphoma that characteristicallyexpress CD4 and CD56 antigens. Clinically presents violet colouredplaques or nodules, in a unique or multiple presentation.The diagnosis is confirmed with the anatomophatologic studythat evidence linfoblastic cells with CD4+ and CD56+ phenotype,and no mieloids, linfoids B and T and natural killers cellsmarkers. We present a case report of a 65-years-old male anda literature review.

Bacteriemias por bacilos Gram negativos multirresistentes en neutropénicos febriles con enfermedades hematológicas / Bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematological diseases

Las infecciones por bacilos Gram negativos multiresistentes (BGN-MR) son frecuentes en nuestro hospital. Presentan limitadas opciones terapéuticas e importante impacto en la morbimortalidad y costos. Objetivo: analizar los factoes de riesgo y evolución de las bacteriemias por BGN-MR en pacientes neutropénicos febriles con patologías hematológicas. Materiales y métodos: estudio prospectivo, descriptivo y observacional de los factores de riesgo para BGN-MR en la población descripta. Se realizó análisis univariado y multivariado de variables clínicas, epidemiológicas, microbiológicas y evolutivas. Resultados: El 27 % de los episodios de neutropenia y fiebre cursaron con bacteriemias por BGN, 42 % de ellos fueron producidos por BGN-MR. En el análisis univariado, dichas bacteriemias se asociaron al uso previo de antibióticos; a las bacteriemias de brecha y neutropenias mayores a 7 días. En el análisis multivariado la bacteriemia de brecha mantuvo su significancia estadística (P<0,001; OR: 5,17; IC 95 % 2,1-12,7). Acinetobacter spp fue el BGN-MR más frecuentemente aislado incluso en los pacientes fallecidos. No se detectó el foco en el 45,9 % de los episodios. Los tratamientos inadecuados fueron significativamente más frecuentes en los pacientes con BGN-MR y la mortalidad tanto global como atribuible también se asoció significativamente al tratamiento inadecuado de las bacteriemias por BGN-MR (P<0,04;RR: 2,46;IC 95 % 1,03-5,9 y P< 0,014; RR: 3,02; IC 95 % 1,22-0,45 respectivamente). Conclusiones: Las bacteriemias por BGN-MR son frecuentes en la población estudiada en especial los que han recibido ATB previo y en las que surgen intratratamiento ATB. Recibieron con mayor frecuencia tratamiento empírico inadecuado, lo que se asoció a mayor mortalidad...

Bacterial infections by multiresistant Gram-negative bacilli (BGN-MR) are an increasing problem in our hospital with a major impact on morbidity, mortality and costs. Objective: to analize risk factors and outcome in bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematologic diseases. Material and Methods: We conducted a prospective, descriptive and observational study to describe the risk factors and outcome of BGN-MR bacteremia in these patients. Results: Twenty seven percent of neutropenia and fever episodes had Gram-negative bacilli bacteremia and 42 % of them were caused by BGN-MR. Previous use of antibioteics, breakthrough bacteremia and prolonged neutropenia (<7 days) were significant in univariate analysis. In multivariate analysis only breakthrough bacteremia was significant (P< 0.001; OR 5,17;IC 95 % 2.1-12.7). Acinetobactersppp was the most common BGN-MR isolated in blood-stream infections and in patients who died. The source of infections was unknown in 45,9 % of the episodes. Inadequate empirical therapy was most common in BGN-MR bacteremia and it was associated with increased overall and attributable mortality (P<0.04; RR: 2.46; IC 95 % 1.03-5.9 y P<0.014; RR: 3.02; IC 95 % 1.22-7.45). Conclusions: BGN-MR was frequent in neutropenic patients with hematological diseases specially in those exposed to antibiotics and in breakthroug bacteremia. Inappropiate antimicrobial therapy was common and is associated with adverse outcome...

Papel da imuno-histoquimica no diagnostico de adenopatias cervicais malignas / Value of immunohistochemistry in the diagnosis of malignant cervical lymph nodes

As adenopatias cervicais constituem importante condição clínica, devido à grande variedade de diagnósticos diferenciais que englobam. O uso da imuno-histoquímica tornou-se importante método auxiliar na avaliação diagnóstica de lesões linfonodais, tanto primárias como secundárias. OBJETIVO: Avaliar o uso da imuno-histoquímica no diagnóstico de malignidade nas biópsias de linfonodos. MÉTODO: Estudo retrospectivo, realizado de 2009 a 2011, com base nos resultados anatomopatológicos arquivados de biópsias de linfonodos. RESULTADOS: A casuística constituiu-se de 32 casos de biópsias de linfonodos, com uso de imuno-histoquímica em 50% (16) casos, dos quais 68,75% foram de linhagem hematogênica e 31,25%, de carcinomas. O método foi utilizado em todos os casos de linfoma. CONCLUSÃO: A imuno-histoquímica foi utilizada em 50% dos casos de biópsias de linfonodos suspeitos de malignidade, sendo em lesões de linhagem epitelial em 31,25% e, para linhagem hematopoiética, em 68,75% dos casos. .

The cervical lymph nodes are relevant due to the diversity of clinical entities. The use of immunohistochemistry is a real method to elucidate the diagnosis of adenopathy, both primary and metastatic neoplasms. OBJECTIVE: To assess the value of immunohistochemistry in the diagnosis of cervical lymph nodes malignancies. METHOD: Retrospective study of the database histopathological specimens from 2009 to 2011. RESULTS: Out of 32 biopsies of cervical lymph nodes, in 16 (50%) the immunohistochemistry was employed, being 68.75% (11) in hematological neoplasms and 31.25% (5) in carcinomas. It was used in all cases of lymphoma. CONCLUSION: The immunohistochemistry was used in 50% of the biopsies of lymph nodes under suspicion of malignancy, being 31.25% in epithelial lesions and 68.75% in lymphoproliferative lesions. .

Análisis de la mortalidad en enfermedades Hemato-oncológicas malignas en pediatría en hospitales públicos de Argentina / Analysis of Mortality due to Hemato-Oncological Pediatrics Malignancies in Public Hospitals in Argentina

INTRODUCCIÓN: En Argentina, la mortalidad por enfermedades malignas en edad pediátrica ocupa un lugar relevante y sus causas todavía no han sido estudiadas en el país. OBJETIVO: Analizar las tasas, causas y etapas de los fallecimientos relacionados con neoplasias en centros públicos seleccionados, desde enero de 2000 a diciembre de 2010. MÉTODOS: Se analizaron las historias clínicas de los pacientes fallecidos por cáncer en centros registrados en el Registro Oncopediátrico Hospitalario Argentino (ROHA) y en los registros individuales de los servicios de Hemato-Oncología. Se clasificaron las causas de mortalidad, la etapa en la cual se produjo el óbito y su relación con el tratamiento o con la patología de base. Se pesquisaron las causas de comorbilidad y las demoras en el diagnóstico y tratamiento. RESULTADOS: En 13 centros se analizó exitosamente un promedio >70...

INTRODUCTION: In Argentina, the mortality of pediatric malignant diseases occupies an important place causes have not yet been studied in the country. OBJECTIVE:To analyze mortality rates, causes and moment of death related to neoplasias in selected public centers from January 2000 until December 2010. METHODS: The analysis was conducted in clinical records of patients who died due to cancer. The cases were registered in the Argentine Hospital Oncopediatric Registry (ROHA)and by different registries belonging to hemato-oncological departments. Mortality causes were classified according to the phase of therapy when the event occurred and the relation shipof death with the treatment or underlying disease. Causes of comorbility and delays in diagnosis/treatment were also analyzed. RESULTS: In 13 centers, more than 70...

Neoplasia blástica de células dendríticas plasmocitoides: Caso clínico / Blastic plasmocytoid dendritic cell neoplasm: Report of one case

Background: We report a 74 years old male consulting for multiple painless non pruriginous pink plaques and nodules of truncal distribution that appeared 15 days earlier. A skin biopsy disclosed a blastic plasmocytoid dendritic cell neoplasm. A staging CAT scan showed lymphadenopathies located around the trachea and its bifurcation. A bone marrow biopsy did not show tumor infiltration. The patient has been treated with four cycles of cyclophosphamide-doxorubicin-vincristine-prednisone, obtaining a partial remission of the lesions.

In situ follicular neoplasia/lymphoma: Three illustrative cases exemplifying unique disease presentations.

We report three elderly patients with follicular lymphoma in situ (FLIS) each highlighting a unique pattern of disease presentation and progression. The first patient had incidentally detected FLIS with peripheral blood spill and yet had an 11-year uneventful follow up. The second patient with an overt follicular lymphoma (FL) developed high-grade transformation in jejunum with FLIS extensively involving the Payers patches. The third patient had a FLIS but that qualified as higher grade and was treated in spite of lack of overt FL mainly because of higher grade and patient subsequently did develop overt FL. The first case of typical FLIS confirms that peripheral blood spill does not connote poor prognosis in FLIS, the second case illustrates that FLIS may colonize mucosa-associated lymphoid tissue as part of homing in process of a disseminated FL and the third case validates the aggressive nature of high-grade FLIS.

Illness Experience of Adolescents with Hematologic Malignancies

PURPOSE: The purpose of this study was to describe the experience process of adolescents with hematologic malignancies. The question for the study was "What is the experience of adolescents with hematologic malignancies like?". METHODS: The grounded theory methodology was used for this study. The data were collected through in-depth interview from 10 adolescents with hematologic malignancies. Data collection was done from January to June 2007. Theoretical sampling was used until the data reached saturation. RESULTS: As a result of the analysis, "Reconstructing self-image from deviated and suspended life" was identified as the core category. And 11 subcategories were identified and they were integrated to the core category. 'Establishment of expanded and matured self' was identified as the consequence. CONCLUSION: The results of the study provide a frame for effective individualized nursing intervention strategies in helping adjustment of the adolescents with hematologic malignancies.

Dynamic Contrast Enhanced Magnetic Resonance Imaging of Diffuse Spinal Bone Marrow Infiltration in Patients with Hematological Malignancies

OBJECTIVE: To investigate the significance of the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters of diffuse spinal bone marrow infiltration in patients with hematological malignancies. MATERIALS AND METHODS: Dynamic gadolinium-enhanced MR imaging of the lumbar spine was performed in 26 patients with histologically proven diffuse bone marrow infiltration, including multiple myeloma (n = 6), acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 5), chronic myeloid leukemia (n = 7), and non-Hodgkin lymphoma (n = 2). Twenty subjects whose spinal MRI was normal, made up the control group. Peak enhancement percentage (Emax), enhancement slope (ES), and time to peak (TTP) were determined from a time-intensity curve (TIC) of lumbar vertebral bone marrow. A comparison between baseline and follow-up MR images and its histological correlation were evaluated in 10 patients. The infiltration grade of hematopoietic marrow with plasma cells was evaluated by a histological assessment of bone marrow. RESULTS: Differences in Emax, ES, and TTP values between the control group and the patients with diffuse bone marrow infiltration were significant (t = -11.51, -9.81 and 3.91, respectively, p 0.05). A positive correlation was found between Emax, ES values and the histological grade of bone marrow infiltration (r = 0.86 and 0.84 respectively, p < 0.01). A negative correlation was found between the TTP values and bone marrow infiltration histological grade (r = -0.54, p < 0.01). A decrease in the Emax and ES values was observed with increased TTP values after treatment in all of the 10 patients who responded to treatment (t = -7.92, -4.55, and 5.12, respectively, p < 0.01). CONCLUSION: DCE-MRI of spine can be a useful tool in detecting diffuse marrow infiltration of hematological malignancies, while its parameters including Emax, ES, and TTP can reflect the malignancies' histological grade.

Paediatric malignancies

This study aims to describe the pattern of paediatric malignancies in a tertiary hospital in North Eastern Nigeria. This was a retrospective study of all paediatric malignancies diagnosed between June 2000 and May 2006 at the Federal Medical Centre; Gombe; Nigeria. Data were collected from the histopathology and haematology registers; as well as patients' case files and were analyzed. A total of 3;313 children were admitted within the study period. Out of this; 68(2.05) children aged less than 15 years (M:F=1:1) had histologically confirmed malignancies. Malignant lymphomas were the most common (42.65) of all the childhood malignancies; with Burkitt's lymphoma ranking highest (68.97). Burkitt's lymphoma also accounted for 29.41of all the malignancies. Other common malignancies included sarcomas 10(14.71); neurofibromatosis 9(13.24); nephroblastoma 8(11.77); acute lymphoblastic leukaemia 5(7.35) and retinoblastoma 4(5.88). The less common paediatric malignancies were melanoma; invasive lobular breast carcinoma and squamous cell carcinoma of the breast; which together accounted for 4.41. Burkitt's lymphoma is the most frequently diagnosed malignant neoplasm in children at the Federal Medical Centre; Gombe

Significance of bone marrow Trephine biopsy in the diagnosis of haematological and non-haematological disorders

To evaluate the frequency and document the histological pattern of various haematologic and non 'haematologic malignancies and infections, which can be diagnosed by Bone marrow trephine biopsy. A retrospective, cross sectional study was carried out at Histopathology department of Army Medical College Rawalpindi from January 2000 to December 2004. The bone marrow trephine biopsies were taken with Jamshidi's - type needle. The tissues were fixed in 10% formal- saline and then decalcified in 5% nitric acid. These were processed under standard conditions. A total of 789 cases with age range of 9 years to 75 years were studied during a period of five years. Majority of the cases showed male preponderance [69.83%] as compared to females [30.16%]. The most common histological findings in order of frequency were reactive changes [22.43%], unremarkable marrow [16.09%], inadequate biopsy [9.63%], megaloblastic anaemia [7.73%], acute leukaemia [6.21%], erythroid hyperplasia [5.95%]. The less common lesions were multiple myeloma [3.92%], lymphoproliferative disorders [3.80%], hypoplastic marrow [3.54%], chronic granulomatous inflammation [2.53%] and myelofibrosis [2.40%]. The miscellaneous group [5.70%] comprises rare diseases. Bone marrow trephine biopsy is a valuable diagnostic tool in the diagnosis of various types of infections and hematologic and non'hematologic malignancies. Majority of our patients showed reactive changes followed by acute leukaemia and erythroid hyperplasia. It has also been proved useful in detecting micrometastases when primary is not known with the other available diagnostic modalities

p53 e as hemopatias malignas / p53 and hematological malignancies

p53 é um gene supressor tumoral, que codifica uma fosfoproteína nuclear que desempenha um papel importante no controle do ciclo celular, no reparo do DNA e na indução da apoptose. Em condições de stress, particularmente por indução de dano no DNA, a proteína p53 bloqueia o ciclo celular, permitindo dessa forma o reparo do DNA ou promovendo a apoptose. Estas funções são efetuadas pela capacidade transcricional da proteína p53 que ativa uma série de genes envolvidos na regulação do ciclo celular. A forma mutada da p53 é incapaz de controlar a proliferação celular, resultando em reparo ineficiente do DNA e na emergência de célulasgeneticamente instáveis. As alterações mais comuns nas neoplasias são mutações pontuais dentro das seqüências codificantes deste gene. Nas hemopatias malignas, estas mutações, freqüentemente do tipo pontuais, têm sido observadas com menor ocorrência do que em tumores sólidos. Nas neoplasias hematológicas estas alterações são mais observadas na crise blástica da leucemia mielóide crônica, progressão da síndrome mielodisplásica para leucemia mielóide aguda, na transformação do linfoma folicular para linfoma de alto grau, na evolução da leucemia linfóide crônica para síndrome de Richter e recorrência de leucemias agudas. Esta revisão tem como objetivo avaliar as alterações do gene p53 nas hemopatias malignas e discutir o significado clínico destas alterações genéticas na patogenia e prognóstico nessasneoplasias.