RESUMO
Paranasal aspergillosis was encountered in five children with relapsed malignancies. All had received broad-spectrum antibiotics within two weeks of development of aspergillosis, and all had absolute granulocyte counts less than 200/mm3 for at least three weeks. None had received prior antifungal therapy. There was an average delay of eight days before the correct diagnosis was established by either biopsy or culture. These data emphasize the need to obtain surveillance cultures of the upper respiratory tract passages in severely neutropenic patients receiving prolonged antibiotic therapy, and raise a question concerning prophylactic use of antifungal therapy in this group.
Assuntos
Aspergilose/complicações , Leucemia Linfoide/complicações , Doenças dos Seios Paranasais/complicações , Adolescente , Antibacterianos/administração & dosagem , Aspergilose/diagnóstico , Aspergilose/terapia , Criança , Pré-Escolar , Humanos , Masculino , Neutropenia/complicações , Doenças dos Seios Paranasais/diagnóstico , Fatores de TempoRESUMO
Two hundred six technetium-99m sulfur colloid bone marrow scans in 110 pediatrics patients were reviewed. The normal distribution of sulfur colloid in the lower extremities in various age groups was established. There was progressive loss of uptake with increasing age from less than two years to greater than ten years. Tumor replacement was seen as regions of decreased radioactivity, and the extent of the scan defect paralleled the response of the disease to therapy. Both chemotherapy and irradiation resulted in an extension of the Tc-99m SC to peripheral marrow sites. In irradiated areas, marrow scan defects were demonstrated and generally recovered normal activity by six months after the completion of therapy. Marrow scan abnormalities caused by tumor replacement were present in four patients despite normal bone scans and radiographs. Ultimate confirmation of tumor involvement was by needle aspiration or biopsy. Persistent marrow defects were seen in two patients with neuroblastoma who had remission of their disease: biopsy revealed myelofibrosis. Technetium-99m sulfur colloid bone marrow scanning is a sensitive monitor of altered marrow activity associated with pediatric hematologic or oncologic diseases.
Assuntos
Medula Óssea/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Medula Óssea/efeitos dos fármacos , Medula Óssea/efeitos da radiação , Criança , Pré-Escolar , Doença de Hodgkin/diagnóstico por imagem , Humanos , Linfoma/diagnóstico por imagem , Neuroblastoma/diagnóstico por imagem , Estudos Prospectivos , Cintilografia , Valores de Referência , Sarcoma de Ewing/diagnóstico por imagem , Enxofre , Tecnécio , Coloide de Enxofre Marcado com Tecnécio Tc 99m , Tumor de Wilms/diagnóstico por imagemRESUMO
The benefit of antithymocyte globulin in severe aplastic anemia in the pediatric age group was assessed. Four children received ten alternate-day courses of ATG (horse antihuman thymocyte globulin) as well as antihistamines and corticosteroids to minimize allergic reactions. The outcome of 19 other children with severe aplastic anemia who received ATG was also summarized. Combined data reveal that 12 of 23 have had a complete or partial response with residual thrombocytopenia and a probability of 48% survival one year from the start of ATG therapy as projected by life table analysis. Only one death has been recorded in the responding group. Response rate did not appear to be influenced by age, sex, etiology, initial blood count, interval prior to ATG therapy, or dose of ATG employed. Complications were minimal and included minor urticarial reactions and intermittent fever. Therapy with ATG should be considered in childhood severe aplastic anemia when bone marrow transplantation is not possible.
Assuntos
Anemia Aplástica/tratamento farmacológico , Globulinas/uso terapêutico , Terapia de Imunossupressão/métodos , Linfócitos T/imunologia , Análise Atuarial , Doença Aguda , Adolescente , Corticosteroides/uso terapêutico , Anemia Aplástica/imunologia , Animais , Criança , Pré-Escolar , Feminino , Febre/induzido quimicamente , Globulinas/efeitos adversos , Globulinas/imunologia , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Cavalos/imunologia , Humanos , Masculino , Urticária/induzido quimicamenteRESUMO
L-Asparaginase is commonly used for induction therapy of acute lymphocytic leukemia of childhood. Severe clinical bleeding secondary to clotting dysfunction has not been previously reported. We observed intracranial hemorrhagic infarcts with focal seizures and hemiparesis associated with clotting abnormalities, including severe hypofibrinogenemia, probably the result of L-asparaginase administered during induction therapy of acute lymphocytic leukemia.
Assuntos
Asparaginase/efeitos adversos , Hemorragia Cerebral/induzido quimicamente , Leucemia Linfoide/tratamento farmacológico , Convulsões/induzido quimicamente , Afibrinogenemia/induzido quimicamente , Transtornos da Coagulação Sanguínea/induzido quimicamente , Pré-Escolar , Quimioterapia Combinada , Feminino , Hemiplegia/induzido quimicamente , Humanos , Masculino , Prednisona/administração & dosagem , Vincristina/administração & dosagemRESUMO
Fifty consecutive episodes of septicemia were studied in 41 children who had acute lymphoblastic leukemia. Seventy-six percent of these episodes occurred when the absolute granulocyte count was 200/mm3 or less and were caused by gram-negative enteric and gram-positive mucocutaneous bacteria. In eight patients, Streptococcus pyogenes was isolated at the time when ALL was diagnosed. Multiple anaerobic and aerobic isolates from a single blood culture were associated with abdominal distress, whereas Streptococcus pneumoniae and Hemophilus influenzae septicemia occurred in associated with respiratory illnesses. When patients with severe compromise of anatomic barriers or respiratory disease were excluded, 94% of all patients with septicemia had an AGC of less than 200/mm3. The data provide guidelines for treatment for febrile patients with ALL based upon the AGC, the phase of the disease, and on the presence of associated respiratory or abdominal findings.
Assuntos
Leucemia Linfoide/complicações , Sepse/etiologia , Doença Aguda , Infecções por Escherichia coli/etiologia , Granulócitos , Humanos , Infecções por Klebsiella/etiologia , Leucemia Linfoide/sangue , Leucemia Linfoide/microbiologia , Contagem de Leucócitos , Infecções por Pseudomonas/etiologia , Risco , Infecções Estafilocócicas/etiologia , Infecções Estreptocócicas/etiologiaRESUMO
Quantitation of the urinary metabolites of catecholamines, including VMA, HVA, and metanephrines, from six normal preschool children was performed during a normal diet, a restricted diet, and a diet with increased amounts of vanilla, vanillin, and phenolic acids. Ingestion of these substances has been suspected of producing elevated values of urinary catecholamines and their metabolites. Urine was collected on the fourth day of each diet in two consecutive 12-hour aliquots, beginning at 8:00 AM. Statistically significant diurnal variation in excretion of all three metabolites and total free catecholamines (epinephrine, norepinephrine, and dopamine) was demonstrated. Diet did not alter exceretion of total free catecholamines or any of the three metabolites. This study suggests that a three-day restricted diet is not necessary prior to screening children for neuroblastoma when using quantitative assay methods and that all screening tests should be performed on a 24-hour urine sample.
Assuntos
Catecolaminas/urina , Dieta , Epinefrina/análogos & derivados , Ácido Homovanílico/urina , Ácidos Mandélicos/urina , Metanefrina/urina , Fenilacetatos/urina , Pré-Escolar , Aromatizantes , Humanos , Fenóis , Sono , Fatores de TempoRESUMO
Peripheral blood from a child with adult-type (Philadelphia chromosome positive) chronic granulocytic leukemia was found to contain large numbers of cells capable of colony formation in tissue culture. The majority of the colonies contained granulocytic cells. The source of these granulocytic colonies was found in a population of myeloblasts, promyelocytes, and myelocytes which could be separated from the more mature granulocytic cells of the peripheral blood by sedimentation of the buffy coat on Ficoll-Hypaque. The predominance of granulocytic colonies is in contrast to our observations previously made on the peripheral blood of children with "juvenile" type(Ph1 chromosome negative)CGL in which large numbers of exclusively monocytic colonies were produced in tissue culture. These current studies, when interpreted in light of relevant clinical data, suggest that the "juvenile" and "adult" types of CGL represent two very different forms of chronic leukemia in childhood. The Ph1 chromosome negative form may be classified as a monocytic leukemia with a granulocytic component but the Ph1 chromosome positive adult form, even when it occurs in a child, appears to be a true granulocytic leukemia.