RESUMEN
Adolescence is a difficult period, and somatic complaints can hide psychological suffering which has to be deciphered. It is therefore important during the first consultation or during hospitalisation to take the time to establish a good rapport (or therapeutic bond) with the adolescent and his family, and to assess with different tools and compassionate listening all the components of the pain. Once the diagnosis is established, pain management should associate pharmaceutical and complementary therapies, and must be re-assessed after a while.
Asunto(s)
Conducta del Adolescente/psicología , Manejo del Dolor , Dimensión del Dolor , Adolescente , Humanos , Relaciones Médico-PacienteRESUMEN
The purpose of this paper was to determine the cardiac status in children 15 years or more after adriamycin therapy for a solid tumour. Of the 447 pts, 229 pts were fully studied and 218 were not. The following cardiac evaluations were proposed to all the 447 consecutive patients (pts): (1) cardiac Doppler US by one of two expert cardiologists; (2) cardiac rhythm and conduction abnormalities including 24-hour holter ECG; (3) (131)l-mlBG myocardial scintigraphy; (4) serum brain natriuretic peptide levels at rest; (5) an exercise test with VO(2) max measurement. The radiation doses delivered to 6 points in the heart were estimated for all patients who had received radiotherapy. Congestive heart failure was diagnosed in 24 of 229 (10%) evaluated pts, with a median interval of 15 years (0.3-24 years) from the first symptom after adriamycin treatment. Among the 205 remaining pts, 13 asymptomatic pts (6%) had severe (n=4) (FS<20%) or marked (n=9) (20< or =FS<25%) systolic dysfunction. In the 192 others, the median meridional end-systolic wall stress was 91 (53-135) and it exceeded 100 g cm(-2) in 52 pts. Using a Cox model, only the cumulative dose of adriamycin and the average radiation dose to the heart, were identified as risk factors for a pathological cardiac status. In conclusion, the risk of cardiac failure or severe abnormalities increases with adriamycin treatment, radiotherapy and time since treatment, even after a follow-up of 15 years or more. In our series, after an average follow-up of 18 years, 39% of the children had a severe cardiac dysfunction or major ventricular overload conditions. The risk increases with the dose of adriamycin and radiation received to the heart, without evidence for threshold.
Asunto(s)
Antibióticos Antineoplásicos/efectos adversos , Antibióticos Antineoplásicos/uso terapéutico , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Insuficiencia Cardíaca/inducido químicamente , Neoplasias/tratamiento farmacológico , Traumatismos por Radiación , Adolescente , Adulto , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Neoplasias/radioterapia , Factores de Riesgo , Sobrevivientes , Factores de Tiempo , Disfunción Ventricular IzquierdaRESUMEN
The nonrecombinant form of urate oxidase has been routinely used in France since 1975 as standard practice in the initial management of non-Hodgkin's lymphoma (NHL) and acute lymphoblastic leukemia (ALL), and for prevention of tumor lysis syndrome (TLS). A retrospective study was performed to evaluate the frequency of metabolic complications and dialysis in 410 patients with B-cell stage III and IV NHL and L-3 ALL treated in France according to the LMB89 protocol, and to compare these results to those of other series of patients treated without urate oxidase. Of the 57 patients treated at Institut Gustave-Roussy, only five had metabolic complications occurring in the first cycle of chemotherapy. Two patients (3.5%) underwent dialysis: one because of oliguria, the second for preventive reasons. In all the other cases, metabolic problems were successfully resolved or prevented, using nonrecombinant urate oxidase (Uricozyme, Sanofi-Sythélabo, Inc, Paris, France) in combination with hyperhydration. Nonrecombinant urate oxidase is generally well tolerated. However, allergic reactions may occur, with rates varying from 0% to 4.5%. In addition, the extraction technology used to produce the product is limited by a low yield. A recombinant form of urate oxidase (rasburicase) was therefore developed. European clinical development results indicate that this agent produces a sharp and consistent decrease in uric acid levels in patients undergoing cytoreductive therapy. Additionally, there is a very low incidence of anaphylaxis. Studies have demonstrated the efficacy of urate oxidase in lowering uric acid levels, preventing hyperuricemia after the initiation of cytoreductive therapy, and preserving renal function in patients with B-cell advanced stage NHL and ALL.
Asunto(s)
Ácido Úrico/sangre , Adolescente , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Antineoplásicos/toxicidad , Niño , Preescolar , Ensayos Clínicos como Asunto , Europa (Continente) , Femenino , Humanos , Leucemia de Células B/sangre , Leucemia de Células B/complicaciones , Leucemia de Células B/tratamiento farmacológico , Linfoma de Células B/sangre , Linfoma de Células B/complicaciones , Linfoma de Células B/tratamiento farmacológico , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Síndrome de Lisis Tumoral/tratamiento farmacológico , Síndrome de Lisis Tumoral/etiología , Síndrome de Lisis Tumoral/prevención & control , Urato Oxidasa/uso terapéuticoRESUMEN
Chemotherapy has considerably improved the prognosis of solid tumours in children, but may have very adverse effects, particularly on fertility. A study was conducted at the Gustave Roussy Institute to identify the toxic effect of chemotherapy on male fertility. At present, 205 patients, treated during childhood have entered the study. Basal FSH-LH have been assayed to assess possible germ cell damage although azoosperia can not be eliminated. Results were normal in 127 patients (62%) and increased basal FSH levels were found in 78 (38%). Endocrine function was not altered: all patients were either impubertal or intrapubertal at diagnosis and subsequently achieved normal puberty. Multivariate analysis revealed an obvious toxic effect of 2 alkylating drugs: cyclophosphamide and procarbazine. No toxic effect was observed for vincristine, dohorubicin or actinomycin D. Age and pubertal status at diagnosis were not correlated with toxic effects. At present, no conclusion for other drugs may be made but results high dose metotrexate are promising. For lomustine and cisplatin, less favourable, though nonsignificant, results have been obtained. Complete recovery is possible several years later.
Asunto(s)
Antineoplásicos/farmacología , Fertilidad/efectos de los fármacos , Infertilidad Masculina/etiología , Adolescente , Niño , Preescolar , Hormona Folículo Estimulante/análisis , Humanos , Lactante , Recién Nacido , Hormona Luteinizante/análisis , Masculino , Análisis MultivarianteRESUMEN
Inflammatory lesions involving esophagus, stomach and duodenum are frequent in neonates and run a benign course. Thirty-two cases of esophagogastritis associated with duodenitis in 28% of cases were studied. Presenting symptoms included nonspecific symptoms such as feeding difficulties (15 cases), G-I bleeding (14 cases), regurgitation (14 cases) and/or impaired weight gain (4 cases). No precipitating factor could be identified. The diagnosis was established by endoscopy. Gastro-esophageal reflux, which seemed to be secondary to the mucosal lesions, required an anti-reflux treatment, which led to a rapid clinical recovery. Repeat endoscopy invariably showed an improvement or complete recovery of the mucosal lesions which did not seem to be influenced by antacid treatment. The etiology and pathogenesis of neonatal esophagogastroduodenitis remain undetermined.