RESUMO
Valproic acid is an effective anti-epileptic medication often used for long-term control of seizure disorders that has been implicated in hematological toxicities, including rare reports of myelodysplasia and acute leukemia. Here, we report a case of valproic acid-related leukemia-like syndrome with a t(8;16) chromosomal translocation. After discontinuing valproic acid, the hematological findings completely resolved.
Assuntos
Anticonvulsivantes/efeitos adversos , Cromossomos Humanos Par 16/ultraestrutura , Cromossomos Humanos Par 8/ultraestrutura , Leucemia Mieloide/induzido quimicamente , Translocação Genética , Ácido Valproico/efeitos adversos , Doença Aguda , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Diferenciação Celular , Divisão Celular/efeitos dos fármacos , Pré-Escolar , Cromossomos Humanos Par 16/genética , Cromossomos Humanos Par 8/genética , Células Clonais/efeitos dos fármacos , Células Clonais/ultraestrutura , Cocarcinogênese , Quimioterapia Combinada , Epilepsia Tipo Ausência/tratamento farmacológico , Feminino , Humanos , Isoxazóis/administração & dosagem , Isoxazóis/uso terapêutico , Lamotrigina , Leucemia Mieloide/genética , Leucemia Mieloide/patologia , Levetiracetam , Células-Tronco Neoplásicas/efeitos dos fármacos , Células-Tronco Neoplásicas/ultraestrutura , Proteínas de Fusão Oncogênica/genética , Fenobarbital/administração & dosagem , Fenobarbital/uso terapêutico , Piracetam/administração & dosagem , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Triazinas/administração & dosagem , Triazinas/uso terapêutico , Ácido Valproico/administração & dosagem , Ácido Valproico/farmacologia , Ácido Valproico/uso terapêutico , ZonisamidaRESUMO
BACKGROUND: Given the increase in 5- and 10-year survival rates of children and adolescents diagnosed with cancer, current psycho-oncology literature is focusing on finding correlates and predictors to their positive psychosocial adjustment. The purpose of this study was to evaluate two potential mediators to adolescent cancer survivors' quality of life (QOL) and depressive symptomology. PROCEDURE: Adolescent cancer survivors (N = 50; 50% males; mean diagnosis age, 13.7; mean age at study, 20.2) were surveyed, testing the mediation effects of their happiness (Subjective Happiness Scale) and past-negative time perspective (Zimbardo Time Perspective Inventory) on QOL (PedsQL 4.0) and depressive symptomology (CES-D). Independent variables included gender and treatment intensity. RESULTS: Happiness significantly mediated the relationship between treatment intensity in both depressive symptomology (beta = -0.65, P < 0.05, CI = -2.46, -6.41) and QOL (beta = 0.54, P < 0.05, CI = 3.66, 9.01). A past-negative time perspective significantly mediated the relationship between gender and depressive symptomology (beta = 0.60, P < 0.05, CI = 3.34, 9.78). Survivors' gender was not associated with happiness and treatment intensity was not associated with time perspective. CONCLUSIONS: Happiness may be a more direct predictor of QOL and depression than the intensity of treatment for cancer. Also, thinking negatively about one's past may be a more direct predictor of depressive symptomology than being female. Therefore, interventions that cultivate happiness and reframe time perspective may be effective ways to improve survivors' QOL and decrease depressive symptoms-regardless of gender and intensity of treatment protocol.
Assuntos
Depressão/etiologia , Felicidade , Neoplasias/psicologia , Psicologia do Adolescente , Qualidade de Vida , Sobreviventes/psicologia , Tempo , Adolescente , Adulto , Atitude , Criança , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Neoplasias/terapia , Testes Psicológicos , Terapêutica/psicologia , Virginia/epidemiologiaRESUMO
Despite aggressive pain management with opiates, debilitating pain still occurs in a subset of children with terminal cancer. A 5-year-old girl with metastatic retinoblastoma, profound opiate tolerance, and refractory pain was treated. Continuous lidocaine infusion was initiated at a dose of 35 microg/kg per minute and increased over 4 days to 50 microg/kg per minute, at which point the patient was discharged for continued end-of-life comfort care. The patient had excellent pain relief without the associated lethargy of high-dose opiates. No complicating neuroexcitatory symptoms or cardiac conduction abnormalities were experienced. Intravenous lidocaine may be an effective alternative to opioids in the treatment of refractory malignant pain in the pediatric patient with terminal cancer.
