Factores dietéticos asociados al cáncer de próstata. Beneficios de la dieta mediterránea / Dietetic Factors Associated With Prostate Cancer. Protective Effects of Mediterranean Diet

Objetivo: Revisar los factores de riesgo (FR) dietéticos implicados, con mayor o menor evidencia científica, en la etiopatogenia del carcinoma de próstata (CP), especialmente los característicos de la tradicional dieta mediterránea (DM). Material y métodos: Revisión bibliográfica de los FR dietéticos asociados al CP obtenida de MedLine, CancerLit, Science Citation Index y Embase. Los perfiles de búsqueda han sido Dietetic Factors/ Nutritional Factors/ Mediterranean Diet/ Primary Prevention y Prostate Cancer. Resultados: Los FR dietéticos se asocian al 35% de las muertes por cáncer y al 10-12% del CP. Los principales FR dietéticos, implicados en el CP y característicos de la DM, son los siguientes: ingesta diaria y elevada de alimentos vegetales (cereales, legumbres, frutas frescas-secas, tubérculos, verduras, etc.); consumo de aceite de oliva como lípido habitual; baja ingesta de grasa saturada animal, carne roja y procesada, leche y derivados; consumo regular de pescado pequeño; y escaso consumo alcohólico (vino en las comidas). La DM proporciona numerosos compuestos fitoactivos (licopeno, lupeol, quercetina, genisteína, carnosol, resveratrol, catequinas, vitaminas, etc.) con efectos protectores del CP. Conclusiones: Los FR dietéticos influencian la carcinogénesis prostática. Para conocer con más exactitud los FR dietéticos implicados en el CP son necesarios mejores diseños epidemiológicos. La mayor adherencia a la DM, en contraste con las dietas occidentales, se asocia a menor riesgo de CP. El denominador común del efecto preventivo de la DM se basa en la gran cantidad y calidad de fitoquímicos con propiedades antioxidantes y antiinflamatorias (AU)

Objective: To review diet risk factors (RF) implied, more or less evidence-based, in the etiopathology of prostate carcinoma (PC), especially those that characterize the traditional mediterranean diet (MD). Material and methods: Literature review of PC related diet RF in MedLine, CancerLit, Science Citation Index y Embase. Search profiles were "Dietetic Factors/Nutritional Factors/Mediterranean Diet/Primary Prevention", and "Prostate Cancer". Results: Diet RF are associated with 35% of cancer mortality and 10-12% of PC mortality. The main diet RF, implied in the development of PC but with a protective effect, which are considered characteristic of MD are: high daily ingestion of vegetarian products (cereals, legums, dried and fresh fruits, tubercles, vegetables..); olive oil as main lipid source; low intake of animal saturated fat, processed red meat, milk and dairy products; regular consumption of small fish; and low alcohol intake (wine with meals). The MD contains many phytoactive compounds (lycopene, lupeol, quercetin, genistein, carnosol, resveratrol, catechins, vitamins...) with PC protective effects. Conclusions: Diet RF have a role on prostatic carcinogenesis. Further epidemiologic studies with better designs are needed to clarify PC related diet RF. PC risk is reduced in persons on MD compared with those on western diet. The preventive effect of MD is due to the great number and quality of phytochemicals with antioxidant and antinflammatory properties that contains (AU)

Actitudes, creencias y conocimientos de los pediatras sobre salud medioambiental en Murcia / Pediatrician attitudes, beliefs and knowledge about environmental health in Murcia, Spain

Objetivo: Estudiar las actitudes, las creencias y los conocimientos sobre salud medioambiental pediátrica (SMAP) de los pediatras de la Región de Murcia (RM). Método: Encuesta autocumplimentada, basada en los conocimientos teórico-prácticos sobre SMAP, enviada por correo postal en 2007 a los 293 pediatras que trabajan en la RM. Resultados: Respondieron 164 (56%). El 70% trabaja en atención primaria. El 5% pertenece a alguna organización no gubernamental medioambiental. Según los pediatras, los factores que más afectan a la salud infantil (sobre una puntuación máxima de 10) son: contaminantes del aire interior-tabaco (7,78), lesiones/accidentes (6,64) y contaminación del aire exterior (5,13). El 45% no registra información ambiental en las historias clínicas. Las consultas más frecuentes de los padres (de 1 a 4) son sobre lesiones y accidentes (2,16), radiación ultravioleta (2,06) y contaminación del agua de bebida (2,05). Las enfermedades respiratorias son las más relacionadas con la salud medioambiental. Conclusiones: Se debería asegurar que el contenido de la SMAP sea obligatorio en la enseñanza y la preparación de los futuros pediatras (pregrado, posgrado, formación continuada). Este trabajo podría ayudar a evaluar las necesidades y planificarlas acciones formativas en SMAP(AU)

Objective: To study pediatrician attitudes, beliefs and knowledge about pediatric environmental health (PEH) in the region of Murcia, Spain. Method: Were mailed a self administered survey based on theoretical and practical knowledge about issues related to PEH of 293 paediatricians working in the Region of Murcia. Results: The overall response rate was 56%. About 70% of respondents worked in Primary Care and 5% belonged to anon-governmental organization (NGO). Pediatricians stated that the factors most affecting the health of children (maximum score 10) were: indoor air pollutants (7.78) injuries and accidents (6.64), and outdoor air pollution (5.13). 45% did not systematically record information about the environments in the clinical registry. The most frequently asked questions by parents were (maximum score 4) related to: injuries and accidents (2.16), ultraviolet radiation (2.06) and contamination of drinking water (2.05). Pediatricians considered respiratory diseases to be most strongly related to the environment. Conclusions: Pediatric associations and institutions should include an EH syllabus in the curriculum of pregraduate and graduate students as well as in the continuing education of paediatricians. This work would help needs assessment and planning the training in PEH(AU)

[Dietetic factors associated with prostate cancer: protective effects of Mediterranean diet]. / Factores dietéticos asociados al cáncer de próstata. Beneficios de la dieta mediterránea.

OBJECTIVE: To review diet risk factors (RF) implied, more or less evidence-based, in the etiopathology of prostate carcinoma (PC), especially those that characterize the traditional Mediterranean diet (MD). MATERIAL AND METHODS: Literature review of PC related diet RF in MedLine, CancerLit, Science Citation Index y Embase. Search profiles were "Dietetic Factors/Nutritional Factors/Mediterranean Diet/Primary Prevention", and "Prostate Cancer". RESULTS: Diet RF are associated with 35% of cancer mortality and 10-12% of PC mortality. The main diet RF, implied in the development of PC but with a protective effect, which are considered characteristic of MD are: high daily ingestion of vegetarian products (cereals, legumes, dried and fresh fruits, tubers, vegetables..); olive oil as main lipid source; low intake of animal saturated fat, processed red meat, milk and dairy products; regular consumption of small fish; and low alcohol intake (wine with meals). The MD contains many phytoactive compounds (lycopene, lupeol, quercetin, genistein, carnosol, resveratrol, catechins, vitamins..) with PC protective effects. CONCLUSIONS: Diet RF have a role on prostatic carcinogenesis. Further epidemiologic studies with better designs are needed to clarify PC related diet RF. PC risk is reduced in persons on MD compared with those on Western diet. The preventive effect of MD is due to the great number and quality of phytochemicals with antioxidant and antinflammatory properties that contains.

¿Qué decides?: una propuesta para la prevención y deshabituación del consumo de tabaco y cannabis en la adolescencia / ¿What do you decide?: a proposal for prevention and cessation of tobacco and cannabis addiction in adolescence

Introducción: El tabaquismo y el consumo de cannabis tienen graves consecuencias sobre la salud pública y los resultados de un tratamiento son pobres por el elevado número de recaídas. Objetivo: Proponer un programa de prevención y/o deshabituación del consumo de tabaco y cannabis en adolescentes que utilice la exposición a estímulos desencadenantes del consumo, asistida por medios audi-visuales, para reducir el número de nuevos consumidores y de recaídas. Método: Revisión de la situación actual de consumo de tabaco y cannabis y de los programas psicológicos empleados en su prevención y deshabituación. Elaboración de un programa de tratamiento psicológico que incorpore la terapia de exposición, asistida por medios audio-visuales. Resultados: No se ha encontrado trabajos que hayan incluido esta nueva modalidad de terapia de exposición en el programa terapéutico del tabaquismo y/o del cannabis. Se propone terapéutico del tabaquismo y/o del cannabis. Se propone un programa psicológico multicomponente abreviado, complementado con sesiones de exposición mental proyecciones audio-visuales personalizadas con escenas especialmente diseñadas para aplicar las técnicas de autocontrol cognitivo-conductales aprendidas en las primeras sesiones. El objetivo de estas sesiones de exposición es el refuerzo de la prevención del consumo en los no fumadores y la consolidación de los logros y la prevención de recaídas en los antiguos fumadores. Conclusión: El programa presentado, denominado “¿Qué decides?”, puede mejorar los resultados de la prevención y deshabituación del consumo de tabaco y cannabis reduciendo los nuevos consumidores y las recaídas (AU)

Background: Tobacco and cannabis smoking has deleterious effects on public health and its treatment has poor results due to its high relapse rate. Aim: To design at tobacco and cannabis smoking has deleterious effects on public health and its treatment has poor results due to its high relapse rate. Aim: To design a tobacco and cannabis cessation and prevention program in adolescence incorporating audiovisual cues in order to reduce the number of new consumers and the risk of relapse. Method: Literature review of tobacco and cannabis cessation and prevention psychological programs. Design a psychological program which includes exposure therapy using audiovisual cues. Results: Literature search failed to retrieve any psychological program which includes exposure therapy using audiovisual cues. Results: Literature search failed to retrieve any psychological program incorporating exposure therapy using tobacco or cannabis audiovisual cues. It is described an abridged psychological program which is followed by exposure sessions to personalized films with specifically designed environments, to put into practice those cognitive and behavioural techniques learned in the first sessions. Conclusion: This program, called “¿what do you decide?”, may reduce tobacco and cannabis consumption by cutting down the number of new consumers and the relapse rate (AU)

Neurotóxicos medioambientales (y II). Metales: efectos adversos en el sistema nervioso fetal y posnatal / Environmental toxins. Metals: adverse effects on the fetal and postnatal nervous systems

Objetivo. Divulgar entre los pediatras la neurotoxicidad del plomo (Pb), mercurio (Hg), manganeso (Mn) y cadmio (Cd) sobre el SNC y las medidas preventivas para minimizar y eliminar su uso en los hábitats fetal, infantil y juvenil. Material y métodos. Revisión bibliográfica sistemática de los efectos del Pb, Hg, Mn, y Cd en el SNC en desarrollo. Búsqueda en las bases de datos Medline, Science Citation Index y Embase de los últimos 20 años de los trabajos observacionales de exposición a bajas dosis en humanos y de experimentación en animales. Resultados. 1) Los principales efectos neurotóxicos de la exposición fetal e infantil a niveles incrementados de Pb son: déficit de atención, disminución del rendimiento y fracaso escolar, impulsividad, agresividad y conducta delictiva; 2) la exposición a Hg en dosis altas provoca retraso mental, alteraciones visuales y de la marcha, y en bajas dosis, del lenguaje, la atención y la memoria; 3) en diversas comunidades autónomas, la población pediátrica supera los límites de seguridad de ingestión de Hg recomendados por la U.S. Environmental Pro-tection Agency; 4) el Mn provoca trastornos de hiperactividad y aprendizaje; 5) la leche materna contiene 6 μg/L de Mn, las fórmulas artificiales unos 77 μg/L, si han sido suplementadas, alrededor de 100 μg/L, y las fórmulas de soja, hasta 300 μg/L; y 6) la exposición al Cd produce trastornos de hiperactividad, alteraciones de la capacidad verbal y disminución del coeficiente intelectual. Conclusiones. 1) Los efectos del Pb, Hg, Mn y Cd sobre el SNC fetal e infantil pueden aparecer con niveles inferiores a los considerados como «seguros»; 2) los pediatras debemos recomendar alternativas para minimizar y eliminar los metales neurotóxicos del entorno infantil; 3) es necesario cuantificar la ingestión diaria de Hg y reducir de forma cautelar el consumo de algunos peces (atún, caballa, emperador, perca, lucio...) en niños, madres lactantes y en mujeres embarazadas y en edades fértiles; 4) los lactantes con fórmulas artificiales ingieren más cantidad de Mn; y 5) las unidades de salud medioambiental pediátrica deben poner en marcha las historias ambientales en los niños con enfermedades neurológicas

Objective. To make pediatricians aware of the effects of the neurotoxicity of lead (Pb), mercury (Hg), manganese (Mn) and cadmium (Cd) on the CNS and inform them of the preventive measures that can minimize or eliminate their use in fetal, childhood and adolescent environments. Material and methods. A systematic literature search was carried out to explore the effects of Pb, Hg, Mn and Cd on the developing CNS. The search was carried out in the Medline, Science Citation Index and Embase databases and involved observational studies on low-dose exposure in humans and in laboratory animals over the past 20 years. Results. 1) The major neurotoxic effects derived from fetal and postnatal exposure to elevated levels of Pb are attention deficits, below average school performance, increased impulsiveness, aggressiveness and delinquent behavior. 2) Fetal exposure to high-dose Hg causes mental retardation and gait and visual disturbances, and fetal exposure to lower doses may cause lasting impairments in language, attention and memory. 3) In certain autonomous communities, the pediatric population surpasses the safety limits of Hg recommended by the US Environmental Protection Agency. 4) Mn causes hyperactivity and learning disabilities. 5) Breast milk contains 6 μg of Mn per liter; infant formulas about 77 μg/L; the latter, when supplemented, around 100 μg/L; and soy-based formulas up to 300 μg/L. 6) Exposure to Cd in children has been shown to result in hyperactivity and lower verbal and performance intelligence quotients. Conclusions. 1) The effects of Pb, Hg, Mn and Cd on the fetal and postnatal CNS can occur at lower levels of exposure considered "safe". 2) Pediatricians have to recommend alternatives to minimize and eliminate the neurotoxic metals in the childhood environment. 3) As a preventive measure, it is necessary to quantify and decrease the daily Hg intake of children, nursing mothers, pregnant women and women of reproductive age, and reduce the consumption of certain fish (tuna, mackerel, sword fish, perch, pike, etc.). 4) Formula-fed infants ingest a much greater quantity of Mn. 5) Pediatric Environmental Health Units should implement environmental histories in children with neurological disorders

[Environment and pediatric cancer]. / Medio ambiente y cáncer pediátrico.

BACKGROUND: Cancer is the final result of the variable combination of two determinants: endogenous or constitutional factors and exogenous or environmental factors. Between 85 % and 96 % of pediatric cancers (PC) are probably associated with environmental risk factors (RF), most of which have not been identified. The spectacular progress made in survival in PC contrasts with the lack of knowledge of the RF implicated in its etiopathogenesis. OBJECTIVE: 1) To analyze up-to-date knowledge of the interaction among environmental RF in the etiopathogenesis of PC, and 2) to inform pediatricians of the "Environment and Pediatric Cancer" research project directed by the Pediatric Environmental Health Specialty Unit of the Hospital Infantil Universitari La Fe in Valencia (Spain). MATERIAL AND METHODS: Current medical records focus almost exclusively on the diagnosis and treatment of cancer. The Pediatric Environmental Medical Record will contain the validated items required to document and presence or absence of endogenous and exogenous RF associated with PC described in the literature, as well as the main human cancerogenic agents identified by the International Agency for Research on Cancer and the US National Toxicology Program. RESULTS: The project aims to determine the frequency of endogenous and exogenous RF associated with PC in Spain. This project will enable hypotheses to be formulated for future epidemiologic case-control and cohort studies in Spain and other European countries, thus stimulating the introduction of educational and preventive policies in the Spanish population. CONCLUSIONS: The project requires the aid of all hospital and non-hospital pediatricians involved in pediatric cancer in informing parents and offering them the possibility of voluntarily collaborating in the "Environment and Pediatric Cancer" project by contacting the Pediatric Health Specialty Unit (Unidad de Salud Medioambiental del Hospital Infantil La Fe de Valencia [www.pehsu.org]). The collaboration of our colleagues will be essential in gaining greater insight into the RF associated with PC and in achieving prevention in the medium and long term.

Medio ambiente y cáncer pediátrico / Environment and pediatric cancer

Antecedentes. El cáncer es el resultado final de la combinación variable de dos determinantes, el endógeno o constitucional y el exógeno o medioambiental. Entre el 85-96 por ciento de los cánceres pediátricos están probablemente asociados a factores de riesgo medioambientales, siendo la mayoría de ellos desconocidos. El progreso espectacular en la supervivencia del cáncer pediátrico contrasta con la ignorancia de los factores de riesgo implicados en su etiopatogenia. Objetivo. Analizar el estado actual del conocimiento de las interacciones de los factores de riesgo medioambientales en la etiopatogenia del cáncer pediátrico. Divulgar entre los pediatras el proyecto de investigación "Medio ambiente y cáncer pediátrico" dirigido por la Unidad de Salud Medioambiental (Pediatric Environmental Health Speciality Unit, PEHSU) del Hospital Infantil Universitario La Fe de Valencia. Material y métodos. Las historias clínicas actuales están pensadas, diseñadas y dirigidas casi exclusivamente hacia el diagnóstico y tratamiento del cáncer. La denominada historia medioambiental pediátrica, contendrá los ítems validados necesarios para documentar la presencia o ausencia de los factores de riesgo ambientales y constitucionales asociados al cáncer pediátrico descritos en la literatura específica, así como los principales agentes cancerígenos humanos tipificados por la International Agency for Research on Cancer y por el U.S. National Toxicology Program. Resultados. El proyecto pretende conocer la frecuencia en España de los factores de riesgo medioambientales y constitucionales asociados al cáncer pediátrico. Analizando nuestra realidad se podrán formular hipótesis para futuros estudios epidemiológicos de casos-controles y de cohortes en el ámbito nacional y europeo, fomentando la instauración de políticas educativas y preventivas en la población española. Conclusiones. Es necesaria la ayuda de todos los pediatras hospitalarios y extrahospitalarios que atienden a niños oncológicos, para que informen a los padres y les ofrezcan la posibilidad de colaborar voluntariamente en el proyecto "Medio ambiente y cáncer pediátrico", contactando con la Unidad de Salud Medioambiental del Hospital Infantil La Fe de Valencia (www.pehsu.org). La colaboración de todos nuestros compañeros será fundamental para avanzar en el conocimiento de los factores de riesgo asociados a los cánceres pediátricos y conseguir su prevención a medio y largo plazo (AU)

[Risk factors for Hodgkin's lymphomas]. / Factores de riesgo para los linfomas de Hodgkin.

OBJECTIVE: To divulge the risk factors associated with Hodgkin's lymphoma (HL) in children and adults among pediatricians. METHODS: We performed a literature review of the last 25 years through the Medline, IAR Cancer, and Cancerlit databases. The search profile was "HL risk factors". The most interesting papers, as well as those cited and published more than 25 years prior to the search, were selected. RESULTS: The following risk factors for HL were reported with greater or lesser evidence: a) genetic (variation in the HLA class II region); b) viral infections (Epstein-Barr virus); c) childhood environment and socio-economic status; d) congenital and acquired immunodeficiency; e) medical conditions and f) occupational exposure (the wood industry and its derivatives). CONCLUSIONS: The etiology of most HL is unknown. The most important risk factors are: 1) genetic; 2) Epstein-Barr virus (infectious mononucleosis); 3) congenital and acquired immunodeficiency; 4) occupational exposure (the wood industry).

[Risk factors for non-Hodgkin's lymphomas]. / Factores de riesgo para los linfomas no hodgkinianos.

OBJECTIVE: To divulge the risk factors for non-Hodgkin lymphomas (NHL) in children and adults among pediatricians. METHODS: We performed a literature review of articles published in the last 25 years through the Medline, IAR Cancer and Cancerlit databases. The search profile was "NHL risk factors". The most interesting papers, as well as the most relevant articles cited and published more than 25 years prior to the search, were selected. RESULTS: The following risk factors for the development of NHL were reported with greater or lesser evidence: socioeconomic status, family factors, immunodeficiencies, bacterial and viral infections, vaccinations and drugs, radiation,occupational exposure, exposure to animals, diet, and lifestyle. CONCLUSIONS: The etiology of most NHLs is unknown. The most important risk factors are: a) congenital and acquired immunodeficiency; b) viral (human T-cell leukemia virus type-I, Epstein-Barr virus, AIDS virus), and bacterial (Helicobacter pylori) infections; c) therapy with diphenylhydantoin and antineoplastic drugs, and d) exposure to pesticides and organic solvents.

Factores de riesgo para los linfomas no hodgkinianos / Risk factors for non-Hodgkin's lymphomas

Objetivo: Divulgar entre los pediatras los factores de riesgo asociados a los linfomas no hodgkinianos (LNH) durante las épocas pediátrica y adulta. Métodos: Revisión bibliográfica de los últimos 25 años obtenida principalmente del Medline, IAR Cancer y Cancerlit, sobre los factores de riesgo para los LNH. Se han seleccionado los trabajos más interesantes y de sus referencias se han recuperado los más relevantes de los años previos a la búsqueda. Resultados: Los diversos factores de riesgo asociados con mayor o menor consistencia al desarrollo de LNH son los siguientes: nivel socioeconómico, factores familiares, déficit inmunológicos, infecciones virales y bacterianas, vacunas y medicamentos, radiaciones, ocupaciones profesionales, exposiciones a animales, factores dietéticos y otros factores relacionados con el estilo de vida. Conclusiones: La etiología de la mayoría de los LNH es desconocida. Los factores de riesgo convincentemente asociados a un mayor riesgo de LNH son: a) inmunodeficiencias congénitas y adquiridas; b) infecciones virales (virus de la leucemia humana T tipo I, virus de Epstein-Barr [VEB] y virus de la inmunodeficiencia humana [VIH]) y bacterianas (Helicobacter pylori); c) administración de difenilhidantoína y quimioterapia antineoplásica, y d) exposiciones ocupacionales a pesticidas y solventes orgánicos (AU)

Factores de riesgo para los linfomas de Hodgkin / Risk factors for Hodgkin's lymphomas

Objetivo: La finalidad del presente trabajo es divulgar entre los pediatras los factores de riesgo asociados al linfoma de Hodgkin (LH) durante las épocas pediátrica y adulta. Métodos: Revisión bibliográfica de los últimos 25 años obtenida principalmente del Medline, IAR Cancer y Cancerlit sobre los factores de riesgo de LH. Se han seleccionado los trabajos más interesantes y de sus referencias se han recuperado los más relevantes de los años previos a la búsqueda. Resultados: Los principales factores de riesgo asociados con mayor o menor consistencia al desarrollo de LH son los siguientes: a) genéticos (variaciones en las regiones de la clase II HLA); b) infecciosos (virus de Epstein-Barr); c) ambiente infantil y clase social; d) inmunodeficiencias congénitas y adquiridas; e) condiciones médicas, y f) exposiciones profesionales (industria de la madera y derivados). Conclusiones: La etiología de la mayoría de los LH es desconocida. Los factores de riesgo convincentemente asociados a un mayor riesgo de LH son: a) genético-familiares; b) virus de Epstein-Barr (mononucleosis infecciosa); c) inmunodeficiencias congénitas y adquiridas, y d) exposición ocupacional a la industria de la madera y derivados (AU)

[Risk factors for lung toxicity in pediatric cancer survivors]. / Factores de riesgo para toxicidad pulmonar en supervivientes de cáncer pediátrico.

OBJECTIVE: Our objectives were to determine the prevalence of alterations in lung function among pediatric cancer survivors with known risk factors and to establish clinical and imaging correlations, as well as to establish follow-up criteria. PATIENTS AND METHODS: Cancer survivors diagnosed at the Pediatric Oncology Unit between 1971 and 1997 who fulfilled at least one of the following criteria were eligible: 1) primary lung or thoracic wall neoplasm; 2) lung metastasis at diagnosis or later, or; 3) irradiation of mediastinum and/or lung fields. Assessment included respiratory symptomatology questionnaire, physical examination, forced spirometry, static lung volumes, maximal static respiratory pressures, single breath CO diffusing capacity, pulse oximetry and imaging studies. RESULTS: Thirty-five (14 females and 21 males) out of 41 survivors were assessed. Mean age at diagnosis, evaluation and follow-up were 9 (1-14), 18 (10-28) and 9 (3-27) years, respectively. The diagnoses included pleuropulmonary blastoma (1), chest wall Ewing's sarcoma (1), Hodgkin's disease (18), nephroblastoma (7), yolk-sac tumor (2), acute leukemia2), non-Hodgkin's lymphoma (1), rhabdomyosarcoma (1), coriocarcinoma of the ovary (1) and osteosarcoma (1). Thirteen patients presented lung metastasis at diagnosis or later. All were administered chemotherapy. Irradiated fields were the mediastinum (dose 20-56 Gy) in 20 cases, the lung (8-30 Gy) in 6 and the spine (24 Gy) in one. Eight underwent thoracotomy. Fourteen percent were dyspneic when walking at the same rate as a person of the same sex and age (grade 2). Twenty percent had a restrictive ventilatory disorder, but none were obstructive. The presence of dyspnea had sensitivity, specificity, positive predictive values and negative predictive value for the diagnosis of restrictive ventilatory disorder of 67%, 96%, 80% and 93%, respectively. Lung irradiation was associated with an increased risk for the development of restrictive disease. Excluding those who received lung irradiation, survivors under 6 years of age at diagnosis obtained lower spirometric values, lung volumes and DLCO values than survivors aged 6 years or older at diagnosis. There were no differences in pulmonary function values between survivors who received mediastinum irradiation and those who did not. The cumulative dose of cyclophosphamide significantly correlated with FVC, FEV1 and FRC. Pulse oximetry values were > or = 95% in all survivors. Maximal static respiratory pressures were within normal limits in all but one survivors whose other pulmonary function results were normal. Thirty-two percent (11 out of 34) had KCO (diffusing capacity adjusted to alveolar volume) values lower than 80% of reference values. Two survivors of nephroblastoma with pulmonary metastasis and who underwent lung irradiation had radiological signs of lung fibrosis. CONCLUSIONS: Pediatric cancer survivors who were administered intensive chemotherapy and/or lung irradiation are eligible for follow-up of lung function. Those diagnosed before 6 years of age and/or with moderate dyspnea are at high risk of having pulmonary restrictive disease. Imaging studies (chest X-ray) have a low sensitivity that prevents their use as a screening method in the follow-up of cancer survivors.

[Central nervous system tumors in children less than three years of age]. / Tumores de sistema nervioso central en niños menores de 3 años.

OBJECTIVE: Central nervous system (CNS) tumors are the most frequent solid tumors in children. Twelve to twenty percent are diagnosed in patients younger than two years of age and these patient present more morbidity and mortality due to the illness and the treatment itself. PATIENTS AND METHODS: A retrospective study of CNS tumors in children younger than three years of age diagnosed in our hospital between 1985 and 1995 was carried out. RESULTS: We treated 21 patients between 1985 and 1995. There were 10 male and 11 females. The mean age was 20.3 months (range: 0-32 months). The mean time between symptoms and treatment was 2.4 months (range: 0-18 months). The most common symptoms included ataxia, nausea and vomits. The most common locations of the tumor were: infratentorial (57.1%) and supratentorial (38.1%). Complete surgery was performed in 3 patients, subtotal in 10, partial in 5, and a biopsy in 2. The anatomical-pathological diagnosis was: astrocytoma (6), ependinoma (5), meduloblastoma (4), ganglioglioma (1), neuroblastoma (1), and primitive neuroectodermic tumor (1). We could not document the histology in 3 patients. Ten patients received chemotherapy that was well tolerated and 14 received radiotherapy whose sequels were updated. The mean follow-up period was 44.42 months (range: 0-136 months). Overall survival was 42.86%. There were no statistically significant differences in survival between those who were irradiated and those who were not, nor between those with supra-or infratentorial tumors. CONCLUSIONS: CNS tumors in children younger than three years of age have a worse prognosis than in older children. New therapeutic schedule with chemotherapy are being tested to avoid radiotherapy side-effects.

[Down's syndrome and leukemia]. / Síndrome de Down y leucemia.

OBJECTIVE: Children with Down's Syndrome (DS) have a high risk for leukemia and need special clinical management. For this reason we have reviewed our experience. PATIENTS AND METHODS: All children with DS diagnosed a having acute leukemia during a 21-year period were reviewed retrospectively. Treatment was administered according to current protocols in our unit at the time of diagnosis without any initial modification. RESULTS: There were 13 children with DS and acute leukemia [6 ALL, 4 AML and 3 transient leukemias (TL)]. No patient presented CNS leukemia at diagnosis. All children with AML and DS were under three years of age and standard treatments did not achieve satisfactory results. TL regressed in two newborns without developing AMKL later. Five out of six patients with DS and ALL achieved complete remission. Currently, 4 of these children are alive and off therapy. Toxicities related to treatment were observed in almost all of the patients. CONCLUSIONS: Children with DS suffer a higher risk of developing leukemia. They should receive standard protocols, but aggressive supportive care might be provided as they have a higher incidence of treatment related toxicities. Prognosis of these children is similar or even better in some cases than children without DS. TL is a true neoplastic process capable of spontaneous remission and it can progress to AMKL.