ABSTRACT
BACKGROUND: Umbilical vein catheterisation is a common and useful procedure in the care of critically ill newborns, but several complications may occur. PATIENTS: We report on a newborn, who developed sepsis and necrotizing pneumonia of the right middle lobe due to extended spectrum beta lactamase (ESBL) Klebsiella following malposition of an umbilical vein catheter into a right pulmonary vein. RESULTS: Due to failed conservative treatment the child required lobectomy of the right middle lobe. CONCLUSION: Our case highlights the importance of exact determination of the position of central catheters by x-ray and/or ultrasound immediately after placement.
Subject(s)
Catheterization, Central Venous/instrumentation , Klebsiella Infections/etiology , Klebsiella pneumoniae , Lung Abscess/etiology , Pneumonia, Bacterial/etiology , Pulmonary Veins , Sepsis/etiology , Umbilical Veins , Germany , Humans , Infant, Newborn , Infarction/diagnostic imaging , Infarction/etiology , Infarction/surgery , Klebsiella Infections/diagnostic imaging , Klebsiella Infections/surgery , Lung/blood supply , Lung Abscess/diagnostic imaging , Lung Abscess/surgery , Male , Medical Errors , Necrosis , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Bacterial/surgery , Pulmonary Veins/diagnostic imaging , Sepsis/diagnostic imaging , Sepsis/surgery , Tomography, X-Ray Computed , Umbilical Veins/diagnostic imagingABSTRACT
We analysed the effect of graft-contaminating tumour cells on the long-term survival of 24 patients with high-risk neuroblastoma and found that patients whose grafts contained detectable neuroblastoma cells had a significantly higher probability of survival than did patients with no detectable tumour cells. Estimated contamination of the graft by more than 2000 tumour cells was associated with a significantly higher probability of survival than contamination with fewer tumour cells. We hypothesise that the presence of a critical number of graft-contaminating neuroblastoma cells can elicit a protective antitumour immune response after autologous transplantation.
Subject(s)
Antigens, CD34 , Bone Marrow Purging , Neuroblastoma/therapy , Stem Cell Transplantation , Antineoplastic Agents/adverse effects , Child , Humans , Lymphopenia/chemically induced , Lymphopenia/therapy , Neuroblastoma/complications , Neuroblastoma/drug therapy , Neuroblastoma/immunology , Neutropenia/chemically induced , Neutropenia/therapy , Retrospective Studies , Risk , Survivors , Transplantation, AutologousABSTRACT
We have investigated the purging efficacy of positive selection of autologous mobilized CD34(+) peripheral stem cells in 22 children with high-risk neuroblastoma. CD34(+) cell selection was performed using the method of magnetic-activated cell sorting (MACS). The median purity of the CD34(+) cells post selection was 97.6% (range 81.7-99.7). For detection of contaminating neuroblastoma cells before and after CD34(+) selection, the chimeric anti-disialoganglioside GD2 antibody delta ch 14.18 was used. Prior to positive selection, various numbers of contaminating neuroblastoma cells were found in 17 patients. After positive CD34(+) cell selection, low numbers of neuroblastoma cells were only detectable in four patients. In 18 patients, high-dose chemotherapy was performed and the isolated CD34(+) cells were reinfused. In all patients, a rapid neutrophil recovery was seen with a median time to reach 0.5 x 10(9)/l neutrophils of 12 days (range 8-24 days). Nine of the 18 patients are free of progression with a median follow-up of 55 months (range 45-70 months). Two patients are alive with relapse, six patients died due to progression or relapse and one patient died due to secondary AML 10 months after transplant while in remission from neuroblastoma. In summary, we show that, through a highly effective positive selection method, a high purging efficacy can be obtained without compromising the hematopoietic reconstitution capacity of the graft.
