RESUMO
BACKGROUND: Countries with scarce resources have the right to appropriate essential health care but very few reports discuss how this can be achieved. We assessed the survival of a large cohort of pediatric oncological patients to provide hard data on which to base realistic evaluation and planning schemes. PATIENTS AND METHODS: This multicenter retrospective survey covered consecutively diagnosed and treated patients admitted to eight national level hospitals in seven countries in Central America and the Caribbean. The research protocol was discussed extensively, so the data to be collected and the criteria for their evaluation were clearly pre-defined. We analysed 2214 patients diagnosed between 1996 and 1999 with various cancers, classified as hemato-oncological disorders (70%) and solid tumors (30%). RESULTS: Three-year overall survival was 48.4% [standard error (SE) 1.3]. Detailed analysis of acute lymphoblastic leukemia highlighted the wide intercountry variability: 3-year survival was 62.2% (SE 5.3) in Cuba, 74.2% (SE 3.3) in Costa Rica, 61.7% (SE 4.9) in Nicaragua, and lower in the other four countries. CONCLUSIONS: The yield of diagnostic-therapeutic protocols depends largely on the context of care in which they are applied. This paper documents the importance of including epidemiological research in interventions for cooperation in complex health areas such as pediatric oncology.
Assuntos
Neoplasias/epidemiologia , Região do Caribe/epidemiologia , América Central/epidemiologia , Criança , Humanos , Leucemia Mieloide Aguda/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estudos Retrospectivos , Análise de SobrevidaRESUMO
The case of a 30 months-old child with malignant fibrous histiocytoma of the left orbit diagnosed 18 months after treatment with external beam radiotherapy for bilateral retinoblastoma is presented. The clinical and histological characteristics of malignant fibrous histiocytoma and its relation as a second malignant tumor in patients affected with retinoblastoma are analyzed.
Assuntos
Histiocitoma Fibroso Benigno , Neoplasias Primárias Múltiplas , Neoplasias Orbitárias , Retinoblastoma , Histiocitoma Fibroso Benigno/terapia , Humanos , Lactente , Masculino , Neoplasias Primárias Múltiplas/terapia , Neoplasias Orbitárias/terapia , Retinoblastoma/terapiaRESUMO
Since May of 1983 to December of 1988, 62 subcutaneous venous reservoires were implanted in 57 pediatric patients; 29 were boys and the remaining 28 were girls between the ages of 2 and 18 years. Fifty-one patients had malignant illnesses and seven other pathologies. The reservoir was used for the endovenous administration of cytotoxic chemotherapy and antibiotics, hidration, nutrition, the transfusion of blood product and the extraction of samples for laboratory tests. In our experience the most important complication was the infection of the system, on the average 0.06 episodes of infections occurred for every 100 days per reservoir. Other complications observed were less frequent. In our opinion the subcutaneous reservoir represents an useful tool for the care of the pediatric patients who require a central venous catheter for long periods of time.