ABSTRACT
INTRODUCTION: Advances in perinatal care have resulted in increased survival rates for extremely low birth weight children, but it is fundamental to know if these improved survival rates have been accompanied by increased impairment rates. OBJECTIVE: To compare, over two different time periods, the survival and disability rates at 2 years of corrected age, among newborns < or =32 weeks and weighed < or = 1500 g at birth. METHODOLOGY: Follow-up study that included 963 children born in the hospital between 1991 and 2004 who met the study criteria. Neonatal morbidity, mortality and disability to 2 years of corrected age in 2 time periods 1991-1998 (period I) and 1999-2004 (period II) have been evaluated and analysed by subgroups of weight (weight < 1000 g and 1000-1500 g). RESULTS: Mortality decreased significantly during the second period, both for children with birth weight <1000 g (32% vs 44%) as for those with birth weight between 1000 and 1500 g ( 3,6% vs 9%). Analysing all children < or = 1500 g, an increase in the survivors without disability was observed in the second period (69% vs 60%, p=0.003); but by subgroups this increase only was significant in children with birth weight 1000-1500 g (67% vs 82%). CONCLUSIONS: In our study, globally analysing all children with birth weight < or = 1500 g, it can be seen that there has been an increase in survival without an increase in the frequency of disabilities. Analysing by weight subgroups, survival has increased in both groups, but disability has decreased only in the birth weight 1000-1500 g subgroup.
Subject(s)
Infant, Newborn, Diseases/epidemiology , Infant, Very Low Birth Weight , Age Factors , Follow-Up Studies , Gestational Age , Humans , Infant , Infant, Newborn , Time FactorsABSTRACT
The incidence of clinically apparent neonatal thrombosis is about 0.1 to 0.2% in the neonatal intensive care unit (NICU). The optimal treatment modalities for neonates with thromboses are not known. We report on our experience with recombinant tissue type plasminogen activator (rt-PA) in a premature infant with an intracardiac thrombus.
Subject(s)
Catheterization, Central Venous/adverse effects , Heart Diseases/drug therapy , Infant, Premature, Diseases/drug therapy , Plasminogen Activators/administration & dosage , Thrombosis/drug therapy , Tissue Plasminogen Activator/administration & dosage , Diseases in Twins , Dose-Response Relationship, Drug , Female , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Humans , Infant, Newborn , Infant, Premature, Diseases/diagnostic imaging , Infant, Premature, Diseases/etiology , Male , Pregnancy , Thrombosis/diagnostic imaging , Thrombosis/etiology , Time Factors , Treatment Outcome , UltrasonographyABSTRACT
INTRODUCTION: Since the advent of multimodal therapy, survival among patients with osteosarcoma in general and among those with aggressive tumors has improved. Consequently, the pattern of relapse is also changing. Brain metastasis is considered to be a rare event in osteosarcoma, although recent reports suggest that the incidence of this complication may be increasing. CASE REPORT: We report two girls with osteoblastic osteosarcoma of the femur with poor response to preoperative chemotherapy. Both patients developed brain metastasis concurrent with or after the development of lung metastasis. Clinical manifestations of brain metastasis were symptoms of intracranial hypertension in one patient, and a complex partial seizure in the other. DISCUSSION: We advocate periodic neurologic examination and neuroradiologic screening for the early detection of brain involvement in patients whose disease recurs within 1 year of diagnosis, in those with metastasis at diagnosis and in those with a poor histologic response to preoperative chemotherapy.
Subject(s)
Brain Neoplasms/secondary , Femoral Neoplasms/pathology , Frontal Lobe , Osteosarcoma/pathology , Child , Female , HumansABSTRACT
La introducción del tratamiento multimodal ha supuesto una prolongación de la supervivencia, tanto de los pacientes con osteosarcoma globalmente como del subgrupo con tumores más agresivos, lo cual se ha asociado a un cambio en los patrones de metástasis. Tradicionalmente, las metástasis cerebrales constituían una rareza, aunque en los últimos años se ha observado un incremento en su incidencia. Se describen dos niñas con osteosarcoma osteoblástico de fémur cuya respuesta a la quimioterapia preoperatoria había sido escasa. Ambas presentaron metástasis cerebrales a la vez o tras el desarrollo de metástasis pulmonares. Clínicamente se manifestaron con síntomas de hipertensión intracraneal en una paciente; con una crisis parcial compleja en el otro caso. Consideramos que los pacientes con metástasis al diagnóstico, los que recidiven durante el primer año del diagnóstico y aquellos con una respuesta histológica escasa a la quimioterapia prequirúrgica deben ser examinados de forma periódica clínica y radiológicamente para descartar afectación cerebral (AU)
Subject(s)
Child , Female , Humans , Frontal Lobe , Osteosarcoma , Brain Neoplasms , Femoral NeoplasmsABSTRACT
Neurocutaneous melanosis (NCM) is a rare congenital syndrome characterized by large or multiple congenital melanocytic nevi and excessive proliferation of melanotic cells in the leptomeninges. We report the case of a girl with a giant hairy nevus and numerous small nevi since birth. Within the first 2 years of life she developed clinical features of increased intracranial pressure and West s syndrome. At 2 years of age she presented a right facial palsy and myelopathy. Brain and spinal magnetic resonance imaging demonstrated meningeal infiltration. Diagnosis of NCM was established by a detailed cytologic analyses of the cerebrospinal fluid that revealed melanocytic cells. She received palliative treatment. The girl died 2 months after. Patients with large or multiple congenital melanocytic nevi should be carefully followed up with clinical examination and neuroimaging to detect NCM. At present there is no curative treatment. The association of NCM and West s syndrome has not been previously described.
Subject(s)
Melanosis/diagnosis , Neurocutaneous Syndromes/diagnosis , Fatal Outcome , Female , Humans , Infant, NewbornABSTRACT
La melanosis neurocutánea (MNC) es un síndrome congénito poco frecuente caracterizado por la asociación de nevus cutáneos pigmentados múltiples o de gran tamaño y una excesiva proliferación de células melánicas en leptomeninges. Comunicamos el caso de una niña que al nacimiento mostró un nevus piloso gigante y múltiples nevus de menor tamaño. Durante los dos primeros años de vida desarrolló clínica de hipertensión intracraneal y síndrome de West. A los 2 años de edad presentó una mielopatía compresiva y parálisis facial derecha. Una resonancia magnética craneospinal evidenció infiltración meníngea. La citología del líquido cefalorraquídeo reveló células melánicas con signos de malignidad. Una vez establecido el diagnóstico de MNC se inició tratamiento paliativo. La niña falleció dos meses después. En los pacientes con nevus pigmentados congénitos numerosos o gigantes debe considerarse el diagnóstico de MNC por lo que es preciso un seguimiento clínico y de neuroimagen. Hasta el momento esta entidad carece de tratamiento curativo. La asociación de MNC y síndrome de West no ha sido descrita previamente (AU)
Subject(s)
Child , Infant, Newborn , Female , Humans , Fatal Outcome , Melanosis , Neurocutaneous Syndromes , Carbohydrates , Diabetes Mellitus , Cystic Fibrosis , AlgorithmsABSTRACT
OBJECTIVE: Aggressive fibromatosis is a rare illness in children. We analyzed the records of four patients, taken from a total of 505, all of which had different types of tumours, over a period of ten years. In the four cases, three were male and one female. Their ages ranged from 0-7 years old. We also did a review of this pathology. RESULTS: The illness may present itself a a painless mass found particularly in the pelvic area, knee, buttock and anterior mediastinum, respectively. Two of these cases presented lysis of osseous tissue shown in radiologic assays. The diagnosis was histological in every case. The only treatment was surgical in all of them. Two of the cases required only one intervention to achieve remission and up to now there has been no record of further illness. At the time of writing this paper the patients are alive after a follow-up period of thirty months. CONCLUSIONS: Up to now, no other alternative forms of treatment have been convincing. Adjuvant radiation and chemotherapy are probably beneficial, but the precise indication for its use is not well defined.
Subject(s)
Bone Neoplasms/diagnosis , Fibromatosis, Aggressive/diagnosis , Bone Neoplasms/surgery , Child , Child, Preschool , Female , Fibromatosis, Aggressive/surgery , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The purpose of this study was to reproduce the results obtained by the "BFM Group" in children with NHL and B-ALL treated with BFM 86 and 90 protocols. PATIENTS AND METHODS: From April 1987 until January 1997, we have treated a total of 82 children, 22 with non-B NHL, 49 B-NHL and 11 B-ALL. Forty-four of them were treated according to BFM 86 and 38 according to BFM 90 protocols. RESULTS: Ninety-four percent of the patients achieved complete remission (CR) and 15% of these relapsed, 12% of the cases of B NHL/ALL and 23% of the non-B NHL. The 5 year overall survival (Kaplan Meier) was 81% for the B NHL/ALL it was 83% and for non-B NHL 77%. The event-free survival was 75% for B-NHL, stages I and II it was 80% and stages II and IV 78%, for B-ALL 72% and for non-B NHL 68%. The median follow-up time was 50 months (12-106). CONCLUSIONS: Treatment of NHL and B-ALL with BFM protocols is an effective therapeutic choice, with reproduction of the results of the "BFM group" being feasible.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lymphoma, Non-Hodgkin/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Adolescent , Asparaginase/administration & dosage , Bone Marrow Transplantation , Child , Child, Preschool , Combined Modality Therapy , Daunorubicin/administration & dosage , Disease-Free Survival , Female , Follow-Up Studies , Humans , Infant , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/mortality , Lymphoma, Non-Hodgkin/pathology , Male , Neoplasm Staging , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Prednisone/administration & dosage , Remission Induction , Time Factors , Vincristine/administration & dosageABSTRACT
OBJECTIVE: To evaluate the SIOP protocols in the treatment of mesenchymal tumors. PATIENTS AND METHODS: We present the results obtained in 28 children diagnosed at a single pediatric hematology-oncology unit of having malignant mesenchymal tumors. These diagnoses were made between April 1981 and June 1994 and the children were treated following the consecutive SIOP protocols which have the objective of curing the disease with minimal sequelae. The first four patients with rhabdomyosarcoma were treated with MMT-SIOP 75, the next 9 children, also diagnosed with rhabdomyosarcoma, were treated with MMT-SIOP 84. During the same period of time, there was a case of synovial sarcoma treated only with surgical excision. The last 14 patients were included in the current protocol, initiated in 1989. Eleven of these patients had rhabdomyosarcoma and 3 synovial sarcoma. RESULTS: Overall survival and event-free survival at 5 years were 58% and 36%, respectively. Toxicity never was an important factor, although it was increasingly frequent and severe as protocols evolved. CONCLUSIONS: We conclude that our results are similar to those obtained in patients treated with SIOP protocols.
Subject(s)
Mesenchymoma/therapy , Adolescent , Child , Child, Preschool , Clinical Protocols , Combined Modality Therapy , Disease-Free Survival , Female , Humans , Infant , Male , Medical Oncology , Mesenchymoma/mortality , Mesenchymoma/pathology , Neoplasm Staging , Pediatrics , Rhabdomyosarcoma/mortality , Rhabdomyosarcoma/pathology , Rhabdomyosarcoma/therapy , Societies, Medical , Spain/epidemiologyABSTRACT
PURPOSE: The objective of this article was to present the diagnosis of a fatal infection by Mycobacterium avium complex (MAC) in a child with acute myelogenous leukemia, a disease rarely reported in non-HIV infected children. METHODS: Specific identification of MAC was made by culture in BACTEC system from an open lung biopsy. RESULTS: A 5-year-old girl diagnosed with acute nonlymphoblastic leukemia was admitted because of fever during the maintenance phase after achieving a complete remission of her malignancy. A mild dry cough started on day 4 of admission, and a chest roentgenogram revealed a pulmonary infiltrate. An insidious respiratory distress developed and mechanical ventilation was undertaken. An open-lung biopsy, carried out on day 10 of ventilatory support, revealed acid-fast bacilli subsequently grown as MAC. In spite of combined antimycobacterial treatment, the patient followed a downhill course and died on day 41 of hospitalization. CONCLUSION: This report describes a new case of fatal MAC infection in an immunocompromised, non-HIV infected child. MAC must be added to the list of infectious microorganisms that can infect children with acute nonlymphoblastic leukemia. As modern immunosuppressive therapeutic modalities evolve, it is likely that MAC will become a more common and recognized pathogen in the immunocompromised child.
Subject(s)
Leukemia, Promyelocytic, Acute/microbiology , Mycobacterium avium Complex , Mycobacterium avium-intracellulare Infection/complications , Child, Preschool , Fatal Outcome , Female , HumansABSTRACT
The objective of this report is to present the results of the BFM group in the treatment of 41 children with non-Hodgkin's B cell lymphoma and acute B cell lymphoblastic leukemia according to the BFM 86 and 90 protocols. Forty-one children, between 2 and 16 years of age, were treated from November 1987 to October 1993. Of these, 25 were treated with the BFM 86 protocol (18 non-Hodgkin's B cell lymphomas and 7 acute B cell lymphoblastic leukemias) and the rest with the BFM 90 protocol (15 non-Hodgkin's B cell lymphomas and 1 acute B cell lymphoblastic leukemia). Complete remission was achieved in 97.5% of the patients. A relapse occurred in 12.5% of the cases. Currently, 80.4% remain in continuous complete remission and 17% have died. The 5 year actuarial survival rate of those treated with the BFM 86 and 90 protocols was 79% and 87%, respectively, and event free survival in the same period was 76% and 87%, respectively. There was no statistically significant difference in the results obtained with the two treatment protocols.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Burkitt Lymphoma/drug therapy , Lymphoma, B-Cell/drug therapy , Adolescent , Asparaginase/administration & dosage , Burkitt Lymphoma/mortality , Burkitt Lymphoma/pathology , Child , Child, Preschool , Daunorubicin/administration & dosage , Disease-Free Survival , Female , Humans , Lymphoma, B-Cell/mortality , Lymphoma, B-Cell/pathology , Male , Neoplasm Staging , Prednisone/administration & dosage , Spain/epidemiology , Survival Analysis , Vincristine/administration & dosageSubject(s)
Abscess/drug therapy , Candidiasis/drug therapy , Fluconazole/therapeutic use , Liver Abscess/drug therapy , Splenic Diseases/drug therapy , Abscess/complications , Adolescent , Candidiasis/complications , Female , Humans , Liver Abscess/complications , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Splenic Diseases/complicationsABSTRACT
We describe 2 cases of proximal tubular defects induced by the administration of ifosfamide at a dosage of 6 g/m2/course over 2 days in children with a diagnosis of malignant mesenchymal tumors. This adverse effect could be minimized dividing dosage of the drug. However at present it is not clear if divided doses are completely safe.
