ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeWe did a population-based study of children with high-risk neuroblastoma to determine their survival and look for factors that had an impact on survival.MethodsWe carried out a retrospective cohort study of patients diagnosed in Ontario from 1989 to 1995. 162 cases of neuroblastoma were diagnosed in the province with 70 (43%) considered high-risk: all were older than one year of age, with 15 patients classified as International Neuroblastoma Staging System (INSS) stage 3, and 55 INSS stage 4.ResultsStage 3 patients did significantly better than Stage 4 patients with a 5-year overall survival of 67.7% and 22.7% respectively (P = 0.015). In stage 4 patients achieving at least a partial response to up-front therapy and surviving for at least 9.5 months after diagnosis (the median time to transplant), there was no difference in survival between the 19 transplant patients and the 17 treated with chemotherapy alone (P = 0.75). However, patients transplanted by peripheral stem cell (PSC) collection did significantly better than both the bone marrow transplantation (P = 0.002) and chemotherapy-alone group (P = 0.047). There was a significant difference in up-front chemotherapy and use of radiation in the three groups (P< 0.001 andP =0.01 respectively), but no difference in the incidence of bone and bone marrow metastases, MYCN amplification or unfavorable histology.ConclusionsIn this nonrandomized study, we found that stage 4 neuroblastoma patients alive more than 9.5 months after diagnosis, with at least a partial response to initial therapy, did significantly better with PSC transplant compared with bone marrow transplantation or chemotherapy alone.

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeOne of the major problems of any screening program is the occurrence of false-positive results. For neuroblastoma screening, little information is available on the psychological consequences for parents whose children had false-positive results that made further clinical evaluation necessary. It was the aim of this study to evaluate the parents' view by a semistructured interview.Patients and MethodsAmong 267,302 infants screened in the Austrian study between 1991 and 1999, 19 had to be considered as repeatedly false-positive (no clinical evidence of neuroblastoma). Sixteen of 19 parent pairs could be reached by phone and were interviewed separately by use of a semistructured questionnaire to evaluate for psychological consequences resulting from the screening result.ResultsThe psychological burden appeared to be small during the initial screening procedure, but it increased significantly through hospital admission and was then described as severe by 19 of the 32 parents.ConclusionsInvestigators should be aware of the psychological consequences of hospital admission for tumor screening in children. In ongoing neuroblastoma screening studies, laboratory methods as well as cutoff limits should be selected carefully.

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo determine the radiation sensitivities of mesenchymal progenitors and hematopoietic progenitors, and to determine the in vitro effects of amifostine on hematopoietic and mesenchymal progenitors exposed to radiation.MethodsRadiosensitivity of mesenchymal progenitor cells was determined by exposing marrow low-density cells to radiation at doses of 100 to 800 cGy. Mesenchymal cell colonies were established by plating 2.5 × 105marrow low-density cells in long-term marrow culture medium (LTCM). The size, frequency, and cellular composition of the mesenchymal progenitor cells were scored after 14 days of incubation. Mesenchymal progenitor cells were subdivided into progenitors forming fibroblast and adipocyte mixed colonies (CFU-FA), and pure fibroblast colonies (CFU-F). Hematopoietic progenitors were assessed by methylcellulose-based assay.ResultsRadiation at 100 cGy caused a mild decrease in CFU-F and CFU-FA derived colonies by 12% and 13%, respectively; 200 cGy decreased CFU-F by 36% and CFU-FA by 52%; 400 cGy decreased CFU-F by 50% and CFU-FA by 86%; and 600 cGy decreased CFU-F by 24%, with total absence of CFU-FA. Pretreatment with amifostine protected 100% of CFU-F at 100 and 200 cGy, 84% at 400 cGy, 46% at 600 cGy, and 14% at 800 cGy. With CFU-FA colonies amifostine pretreatment provided only minimal radioprotection. For hematopoietic progenitors radiation at 100 cGy reduced CFU-GM by 74% but had no significant effect on CFU-GEMM and BFU-E. Radiation at 200 cGy decreased CFU-GEMM by 72%, BFU-E by 54%, and CFU-GM by 84%; 400 cGy further decreased CFU-GEMM by 83%, BFU-E by 81%, and CFU-GM by 93%. Pretreatment with amifostine resulted in twofold stimulation of CFU-GEMM and BFU-E colonies. All BFU-E colonies were protected up to 200 cGy. For CFU-GEMM amifostine pretreatment resulting in 68% at 200 cGy and 31% at 400 cGy. For CFU-GM colonies it was 54% at 100 cGy, 32% at 200 cGy, and 12% at 400 cGy.ConclusionsMesenchymal progenitor cell subpopulations are differentially sensitive to radiation. Amifostine protects both mesenchymal and hematopoietic progenitors against radiation injury, though the level of protection appears to be dependent upon the sensitivities of these progenitor cells to radiation. Amifostine is a potent stimulant of BFU-E and CFU-GEMM progenitor colonies.

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The purpose of this study was to investigate whether Her-2/neuexpression at diagnosis of osteosarcoma could provide biologic and prognostic information that predicts the risk of pulmonary metastases and outcome.Human epidermal growth factor (Her-2/neu) expression in 25 initial pretreatment osteosarcoma biopsies and 12 posttreatment pulmonary metastatic osteosarcoma resection specimens was assessed by standard immunohistochemical techniques on formalin-fixed paraffin-embedded tissue. As a screening analysis to determine if gene amplification may be a mechanism for increased Her-2/neuexpression, FISH analysis was conducted on seven Her-2/neuimmunostain-positive samples and five Her-2/neuimmunostain-negative samples. Cytoplasmic Her-2/neureactivity was identified in 11/25 (44%) of primary tumors and in 7/12 (58%) resection specimens from pulmonary metastases. Cytoplasmic Her-2/neuexpression was associated with shorter overall metastasis-free survival. Her-2/neugene amplification was identified by FISH analysis in six of the seven immunostain-positive samples but was also identified in two of the five immunostain-negative samples. Her-2/neuexpression in patients with osteosarcoma is associated with an increased risk of metastasis and may define a subset of patients with a more aggressive tumor phenotype. Her-2/neugene amplification may provide a mechanism for Her-2/neuoverexpression in certain cases of osteosarcoma. Whether Her-2/neuexpression influences outcome needs to be examined further in a prospective fashion. The hope is that Her-2/neuexpression will identify patients who may benefit from the addition of directed biologic therapy.

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo report a comparison of international normalization ratio (INR) measurements on four near-patient (point-of-care or bedside) whole blood INR monitors in children.Patients and MethodsThe INR results from 19 ambulatory pediatric subjects (30 hospital visits) receiving warfarin sodium were analyzed on four near-patient monitors and compared with plasma INR measurements on the laboratory CA-1000 Analyze. The instruments evaluated were CoaguChek, Hemochron Jr. Signature, ProTime Microcoagulation System, and RapidpointCoag.ResultsThe INR measurements ranged from 1.05 to 5.25. Over the entire INR range, the near-patient instrument with the least bias relative to the CA-1000 was the RapidpointCoag (r2= 0.923). The correlations (r2) of the CoaguCheck, Hemochron Jr., and ProTime were 0.877, 0.834, and 0.885, respectively. Precision studies involved repeated analysis of one nonmedicated adult (mean CA-1000 INR = 0.908) and one adult receiving oral anticoagulation therapy (mean CA-1000 INR = 2.42). The coefficient of variation on the near-patient monitors for both adult volunteers ranged from 4.9% to 22.3%. Bilirubin levels up to 20 mg/dL did not interfere in any of the methods.ConclusionsNear-patient testing whole blood INR monitors offer acceptably accurate and precise measurements. Values obtained on near-patient monitors may vary considerably from the reference method, and data obtained should serve as a supplement to, but not a replacement for, routine clinical laboratory measurements.

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo evaluate the safety and efficacy of alteplase for restoring function to occluded central venous catheters in a pediatric population.Patients and MethodsA phase III, open-label, single-arm, multicenter trial was performed in 995 adult and pediatric patients with dysfunctional nondialysis catheters and ports. This report is a subset analysis of subjects between 2 and 18 years of age (N = 122) who were enrolled in the study. Alteplase (2 mg/2 mL) was instilled into the dysfunctional catheter lumen and assessed at 30 and 120 minutes. Subjects weighing ≥30 kg received 2 mL of alteplase; subjects <30 kg received 110% of the internal lumen volume (not exceeding 2 mL). Alteplase dosing was repeated once after 120 minutes if the catheter remained dysfunctional. The primary safety endpoint was the rate of intracranial hemorrhage (ICH) within 5 days of treatment.ResultsThe overall efficacy following up to two instilled doses of alteplase was 87%. In 70 patients (57%), restoration of catheter flow occurred by 30 minutes following a single dose of alteplase. Restoration of function was related to the duration of occlusion (P= 0.04). For catheters with occlusions of 0, 1 to 14, and >14 days duration, the efficacy was 91%, 78%, and 60%, respectively. Success was independent of the patient's age, sex, body weight, CVC type, or catheter age. There were no cases of death, ICH, major bleeding episodes, or embolic events attributable to treatment.ConclusionsAn alteplase regimen of up to two 2-mg doses is safe and effective for restoration of function to occluded central venous catheters in a pediatric population.

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeFew studies address the association ofChlamydia pneumoniaeinfection with pulmonary disease and outcome in patients with underlying pathology such as sickle cell disease (SCD). SCD patients are susceptible to the pulmonary disorder known as acute chest syndrome (ACS), where the etiology remains ill defined. The purpose of this study was to analyze the clinical course and outcome ofC. pneumoniae-associated ACS among SCD patients as part of the National Acute Chest Syndrome Study.Patients and MethodsThis was a longitudinal study of SCD patients presenting with ACS to multiple U.S. medical centers. Two hundred ninety-six SCD patients who developed ACS were tested by PCR forC. pneumoniaeand by standard techniques for other respiratory pathogens. These infections were evaluated for association with ACS, clinical course, and complications.ResultsForty-one (14%) patients with first episodes of ACS were PCR positive forC. pneumoniae.Compared with other infections,C. pneumoniae-infected patients were older, were more likely to present with chest pain, and had higher hemoglobin levels at diagnosis. Both groups had similar rates of respiratory failure and prolonged hospitalization. Of the 89 patients with single-pathogen infections, 27 (30%) were due toC. pneumoniae, 21% toMycoplasma pneumoniae, 10% to RSV, 4% toStaphylococcus aureus, and 3% toStreptococcus pneumoniae.ConclusionsC. pneumoniaewas the most prevalent pathogen in this study of ACS and was responsible for significant morbidity. Additional research is required to develop effective treatment guidelines for ACS.

ISSN:1077-4114    

出版商:OVID    

年代:2003

数据来源: OVID