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BACKGROUND: Radiotherapy causes the regression of many human tumors by increasing DNA damage, and the novel molecular mechanisms underlying the genomic instability leading to cancer progression and metastasis must be elucidated. Atypical dual-specificity phosphatase 3 (DUSP3) has been shown to down-regulate mitogen-activated protein kinases (MAPKs) to control the proliferation and apoptosis of human cancer cells. We have recently identified novel molecular targets of DUSP3 that function in DNA damage response and repair; however, whether DUSP3 affects these processes remains unknown. METHODS: Tumor cell lines in which DUSP3 activity was suppressed by pharmacological inhibitors or a targeted siRNA were exposed to gamma radiation, and proliferation, survival, DNA strand breaks and recombination repair pathways were sequentially analyzed. RESULTS: The combination of reduced DUSP3 activity and gamma irradiation resulted in decreased cellular proliferation and survival and increased cellular senescence compared with the effects of radiation exposure alone. Gamma radiation-induced DNA damage was increased by the loss of DUSP3 activity and correlated with increased levels of phospho-H2AX protein and numbers of ionizing radiation-induced γ-H2AX foci, which were reflected in diminished efficiencies of homologous recombination (HR) and non-homologous end-joining (NHEJ) repair. Similar results were obtained in ATM-deficient cells, in which reduced DUSP3 activity increased radiosensitivity, independent of increased MAPK phosphorylation. CONCLUSION: The loss of DUSP3 activity markedly increases gamma radiation-induced DNA strand breaks, suggesting a potential novel role for DUSP3 in DNA repair. GENERAL SIGNIFICANCE: The radioresistance of tumor cells is effectively reduced by a combination of approaches through the inhibition of DUSPs.
Assuntos
Reparo do DNA , Fosfatase 3 de Especificidade Dupla/fisiologia , Neoplasias/radioterapia , Tolerância a Radiação , Proteínas Mutadas de Ataxia Telangiectasia/fisiologia , Linhagem Celular Tumoral , Dano ao DNA , Fosfatase 3 de Especificidade Dupla/antagonistas & inibidores , Raios gama , Histonas/análise , Humanos , Proteínas Quinases Ativadas por Mitógeno/metabolismoRESUMO
Ischaemic priapism is a devastating urological condition that has the potential to cause permanent erectile dysfunction. The disorder has been associated with numerous medical conditions and the use of pharmacotherapeutic agents. The aetiology is idiopathic in a number of cases. There are two prior case reports of the association of ischaemic priapism and glucose-6-phosphate dehydrogenase (G6PD) deficiency. We report on a third case of priapism associated with G6PD deficiency and review recently described molecular mechanisms of increased oxidative stress in the pathophysiology of ischaemic priapism. The case report of a 32-year old Afro-Caribbean male with his first episode of major ischaemic priapism is described. Screening for common causes of ischaemic priapism, including sickle cell disease was negative. Glucose-6-phosphate dehydrogenase deficiency was discovered on evaluation for priapism. Penile aspiration was performed and erectile function was good post treatment.Glucose-6-phosphate dehydrogenase deficiency is a cause for ischaemic priapism and should be a part of the screening process in idiopathic causes of the disorder. Increased oxidative stress occurs in G6PD deficiency and may lead to priapism.
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Ice cores from low latitudes can provide a wealth of unique information about past climate in the tropics, but they are difficult to recover and few exist. Here, we report annually resolved ice core records from the Quelccaya ice cap (5670 meters above sea level) in Peru that extend back ~1800 years and provide a high-resolution record of climate variability there. Oxygen isotopic ratios (δ(18)O) are linked to sea surface temperatures in the tropical eastern Pacific, whereas concentrations of ammonium and nitrate document the dominant role played by the migration of the Intertropical Convergence Zone in the region of the tropical Andes. Quelccaya continues to retreat and thin. Radiocarbon dates on wetland plants exposed along its retreating margins indicate that it has not been smaller for at least six millennia.
Assuntos
Mudança Climática , Camada de Gelo , Clima Tropical , Nitratos/análise , Isótopos de Oxigênio/análise , Peru , Plantas , Compostos de Amônio Quaternário/análise , Áreas AlagadasRESUMO
OBJECTIVE: Suicide is increasingly recognized as a worldwide problem. There is a paucity of quality data pertaining to suicide in developing countries. Epidemiological analysis of suicide data elucidates prevailing patterns that facilitate risk factor identification and the development of germane programmatic responses. This paper analyses temporal variations in suicide rates for the years 2002-2010 in Jamaica and describes the sociodemographic profile of cases and method of suicide for the latter four years. METHOD: Data pertaining to suicides were extracted from the police (The Jamaica Constabulary Force) records. These were summarized and analysed with respect to person, place and time. Population statistics for the computation of rates were obtained from publications of the Statistical Institute of Jamaica. Age-standardized rates were generated for comparison of trends over time. Poisson and binomial probabilities were used to determine statistically significant differences in rates. RESULTS: Suicide rates in Jamaica have remained relatively stable for the period reviewed with mean overall annual incidence of 2.1 per 100 000 population. Rates for males were significantly higher than those for females. The majority (90.4%) of suicide cases were males. A trend for higher rates of suicide was generally noted in the 25-34-year and the 75-year and over age groups. Hanging was the main method used to commit suicide (77.5%). CONCLUSIONS: Age-adjusted rates of suicide indicate no significant changes in Jamaica over the period 2002 to 2010. Continued surveillance of suicide as well as improved recording of the circumstances surrounding suicides are recommended to promote greater understanding of suicides and this will ultimately inform intervention strategies.
OBJETIVO: El suicidio adquiere cada vez mayor reconocimiento como problema mundial. Existe una escasez de datos cualitativos en relación con el suicidio en los países en vías de desarrollo. El análisis epidemiológico de los datos sobre suicidio dilucida los patrones prevalecientes que facilitan la identificación de factores de riesgo y el desarrollo de respuestas programáticas relacionadas. El presente trabajo analiza las variaciones temporales de las tasas de suicidio durante los años 2002-2010 en Jamaica, y describe el perfil demográfico de los casos y métodos de suicidio durante los últimos cuatro años. MÉTODO: Datos relacionados con el suicidio fueron tomados de los archivos de la policía (Jamaica Constabulary Force). Los mismos fueron resumidos y analizados con respecto a la persona, el lugar y el tiempo. Se obtuvieron estadísticas de la población para el cómputo de tasas, Las estadísticas fueron tomadas de las publicaciones del Instituto Estadístico de Jamaica. Se generaron tasas estandarizadas por edad con el fin de hacer una comparación de las tendencias a través del tiempo. Se usaron probabilidades binomiales y de Poisson, para determinar las diferencias estadísticamente significativas en las tasas. RESULTADOS: Las tasas de suicidio en Jamaica han permanecido relativamente estables en el periodo bajo estudio, con una incidencia promedio anual general de 2.1 por 100 000 habitantes. Las tasas de los varones fueron significativamente más altas que las de las hembras. La mayoría (90.4%) de los casos de suicidio fueron varones. Se observó generalmente una tendencia a tasas más altas de suicidio en los grupos de edades de 25-34 años, y 75 años o más. El ahorcamiento fue el método principal usado para cometer suicidio (77.5%). CONCLUSIONES: Las tasas de suicidio ajustadas por edad no indican ningún cambio significativo en Jamaica en el periodo de 2002 a 2010. Se recomienda una vigilancia continuada de los actos de suicidio así como el mejoramiento de los registros de las circunstancias en torno a los mismos, a fin de promover un mayor entendiendo de estos, con lo cual se podrán lograr a la larga estrategias de intervención bien informadas.
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Suicídio/estatística & dados numéricos , Distribuição por Idade , Incidência , Jamaica/epidemiologia , Distribuição por Sexo , Suicídio/tendênciasRESUMO
Suicide is increasingly acknowledged as a global problem. Yet little is known worldwide about suicide rates among adolescents. Several social factors that exist in Jamaica present as stressors and may predispose to suicide. Ascertaining prevailing patterns and associated factors is important for crafting interventions. This paper establishes adolescent suicide rates for the years 2007-2010 in Jamaica and provides related epidemiological data. METHOD: Data pertaining to suicides were extracted from standardized data collected by the police. Information regarding the number of suicides among adolescents, 9-19 years of age, was reviewed for the years 2007-2010. Sociodemographic characteristics of cases: gender, location and occupation along with related variables were also examined. Variation of rates over time was ascertained. Statistically significant associations were determined by reference to p-values and confidence intervals. RESULTS: The incidence for suicide in adolescents was 1.1 per 100 000. Rates for males were significantly higher than females. Most suicide cases were students and the majority of cases was from rural areas (65%). Hanging was the main method used to commit suicide (96.2%). Items of clothing were commonly used for this purpose. CONCLUSION: Male adolescent suicide rates showed an upward trend in contrast to the downward trend for females in the four-year period studied. Continued surveillance is needed for greater understanding of adolescent suicides. Collaboration among health services, parents, schools and communities is integral in prevention efforts. Recent media coverage of suicides provides a window of opportunity to galvanize support for research and the development of intervention strategies.
OBJETIVO: El suicidio se reconoce cada vez más como un problema mundial. Sin embargo, poco se sabe sobre las tasas de suicidio entre los adolescentes. Varios factores sociales en Jamaica constituyen factores estresantes que pueden predisponer al suicidio. Determinar los patrones prevalecientes y los factores asociados, resulta importante a la hora de diseñar las intervenciones. El presente trabajo establece tasas de suicidio entre adolescentes en los años 2007-2010 en Jamaica, y proporciona datos epidemiológicos relacionados. MÉTODO: Se extrajeron datos en relación con los suicidios a partir de los datos estandarizados recopilados por la policía. Se examinó la información sobre el número de suicidios entre los adolescentes de 9-19 años de edad, durante los años 2007-2010. También se examinaron las características socio-demográficas de los casos - género, lugar, y ocupación - junto con otras variables relacionadas. Se estableció la variación de las tasas a través del tiempo. Se determinaron las asociaciones estadísticamente significativas mediante nm la referencia a los valores p y los intervalos de confianza. RESULTADOS: La incidencia de suicidios en adolescentes fue 1.1 por 100 000. Las tasas para los varones fueron significativamente más altas que para las hembras. La mayoría de los casos de suicidios se trató de estudiantes, y la mayor parte de los suicidios tuvo lugar en áreas rurales (65%). El ahorcamiento fue el método principal usado para cometer suicidio (96.2%). Artículos de vestir fueron comúnmente usados para este propósito. CONCLUSIÓN: Las tasas de suicidio entre adolescentes varones mostraron una tendencia creciente, en contraste con la tendencia descendente para las hembras en el periodo de cuatro años bajo estudio. Se necesita una vigilancia permanente a fin de lograr una mayor comprensión del suicidio entre adolescentes. La colaboración entre los servicios de salud, los padres, la escuela, y la comunidad, son fundamentales para lograr esfuerzos integrados para prevenir los casos de suicidio. La cobertura reciente de los medios de difusión sobre los casos de suicidio abre una ventana que impulsa el apoyo a la investigación y al desarrollo de estrategias de intervención.
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Adulto Jovem , Suicídio/estatística & dados numéricos , Incidência , Jamaica/epidemiologia , População Rural/estatística & dados numéricos , Fatores Sexuais , Suicídio/tendências , Fatores de TempoRESUMO
UNLABELLED: Suicide is increasingly acknowledged as a global problem. Yet little is known worldwide about suicide rates among adolescents. Several social factors that exist in Jamaica present as stressors and may predispose to suicide. Ascertaining prevailing patterns and associated factors is important for crafting interventions. This paper establishes adolescent suicide rates for the years 2007-2010 in Jamaica and provides related epidemiological data. METHOD: Data pertaining to suicides were extracted from standardized data collected by the police. Information regarding the number of suicides among adolescents, 9-19 years of age, was reviewed for the years 2007-2010. Sociodemographic characteristics of cases: gender, location and occupation along with related variables were also examined. Variation of rates over time was ascertained. Statistically significant associations were determined by reference to p-values and confidence intervals. RESULTS: The incidence for suicide in adolescents was 1.1 per 100 000. Rates for males were significantly higher than females. Most suicide cases were students and the majority of cases was from rural areas (65%). Hanging was the main method used to commit suicide (96.2%). Items of clothing were commonly used for this purpose. CONCLUSION: Male adolescent suicide rates showed an upward trend in contrast to the downward trend for females in the four-year period studied. Continued surveillance is needed for greater understanding of adolescent suicides. Collaboration among health services, parents, schools and communities is integral in prevention efforts. Recent media coverage of suicides provides a window of opportunity to galvanize support for research and the development of intervention strategies.
Assuntos
Suicídio/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Humanos , Incidência , Jamaica/epidemiologia , Masculino , População Rural/estatística & dados numéricos , Fatores Sexuais , Suicídio/tendências , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: Suicide is increasingly recognized as a worldwide problem. There is a paucity of quality data pertaining to suicide in developing countries. Epidemiological analysis of suicide data elucidates prevailing patterns that facilitate risk factor identification and the development of germane programmatic responses. This paper analyses temporal variations in suicide rates for the years 2002-2010 in Jamaica and describes the sociodemographic profile of cases and method of suicide for the latter four years. METHOD: Data pertaining to suicides were extracted from the police (The Jamaica Constabulary Force) records. These were summarized and analysed with respect to person, place and time. Population statistics for the computation of rates were obtained from publications of the Statistical Institute of Jamaica. Age-standardized rates were generated for comparison of trends over time. Poisson and binomial probabilities were used to determine statistically significant differences in rates. RESULTS: Suicide rates in Jamaica have remained relatively stable for the period reviewed with mean overall annual incidence of 2.1 per 100 000 population. Rates for males were significantly higher than those for females. The majority (90.4%) of suicide cases were males. A trend for higher rates of suicide was generally noted in the 25-34-year and the 75-year and over age groups. Hanging was the main method used to commit suicide (77.5%). CONCLUSIONS: Age-adjusted rates of suicide indicate no significant changes in Jamaica over the period 2002 to 2010. Continued surveillance of suicide as well as improved recording of the circumstances surrounding suicides are recommended to promote greater understanding of suicides and this will ultimately inform intervention strategies.
Assuntos
Suicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Suicídio/tendências , Adulto JovemRESUMO
OBJECTIVE: This study seeks to identify factors associated with post-traumatic stress disorder (PTSD) following Hurricane Ivan among a cohort of tertiary-level students in Jamaica. METHODS: A 22-item, self-administered questionnaire was administered to a non-random sample. Using parametric and non-parametric analyses, the relationship between PTSD symptoms and several variables was examined. RESULTS: Feeling anxious, worried or fearful and/or experiencing loss and injury during the hurricane were significant (p < 0.01) predictors for PTSD symptoms. CONCLUSIONS: Factors predicting the development of PTSD symptoms were feeling anxious, worried or fearful during the hurricane and experiencing loss of property and/or death or injury of a family member during the hurricane.
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Tempestades Ciclônicas , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Ansiedade/epidemiologia , Medo , Feminino , Humanos , Masculino , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Adulto JovemRESUMO
In vitro and in vivo studies have suggested that the expression of the early response genes for Jun and Fos proteins plays an important role in adrenal cell proliferation. In order to study the expression pattern of the activating protein-1 (AP-1) family of oncogenes in the adrenal gland, we have used immunohistochemistry to localize Jun and Fos protein expression in rat adrenal cortex infused in situ with adrenocorticotropic hormone (ACTH), fibroblast growth factor 2 (FGF2), or both. The expression of AP-1 factors has been found to be correlated with in vivo ACTH and FGF2 proliferation in rats treated with dexamethasone and bromodeoxyuridine (BrdU). Induction of c-Jun and c-Fos in the zona fasciculata and of FosB in the zona reticularis suggests that, after ACTH stimulation, these proteins are the main AP-1 components in these zones. In vivo, ACTH increases BrdU-positive cells in the zona fasciculata and zona reticularis suggesting that the composition of AP-1 complexes in these zones is correlated with proliferation. Patterns of Fos and Jun induction by FGF2 do not resemble those after ACTH induction. However, in isolation, neither affects the zona glomerulosa. In the zona fasciculata, and more so in the zona reticularis, FGF2 modulates responses to ACTH, reducing the numbers of Jun-positive cells, Fos-positive cells, and DNA synthesis. This indicates that FGF2 antagonizes ACTH, and that ACTH thus controls the trophic effect independently of exogenous FGF2. Our results implicate the AP-1 family of transcription factors in the regulation of cell progression and the control of ACTH-induced proliferation in the zona fasciculata and zona reticularis.
Assuntos
Córtex Suprarrenal/efeitos dos fármacos , Córtex Suprarrenal/metabolismo , Hormônio Adrenocorticotrópico/farmacologia , DNA/biossíntese , Fator 2 de Crescimento de Fibroblastos/farmacologia , Proteínas Proto-Oncogênicas c-fos/metabolismo , Proteínas Proto-Oncogênicas c-jun/metabolismo , Córtex Suprarrenal/citologia , Animais , Bromodesoxiuridina , Imuno-Histoquímica , Masculino , Transporte Proteico/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Fase S/efeitos dos fármacos , Fator de Transcrição AP-1/metabolismo , Zona Fasciculada/citologia , Zona Fasciculada/efeitos dos fármacos , Zona Fasciculada/metabolismo , Zona Reticular/citologia , Zona Reticular/efeitos dos fármacos , Zona Reticular/metabolismoRESUMO
Dermatobia hominis causes furuncular myiasis and is endemic to South America. This report describes a case in a young woman who had recently visited Belize, highlighting the importance of clinical history (including travel history) and close liaison between pathologist and surgeon.
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Cisto Epidérmico/diagnóstico , Miíase/diagnóstico , Dermatoses do Couro Cabeludo/diagnóstico , Adulto , Animais , Belize , Dípteros , Cisto Epidérmico/parasitologia , Feminino , Humanos , Dermatoses do Couro Cabeludo/parasitologia , ViagemRESUMO
Ice cores that were recovered from the summit of Sajama mountain in Bolivia provide carbon-14-dated tropical records and extend to the Late Glacial Stage (LGS). Oxygen isotopic ratios of the ice decreased 5.4 per mil between the early Holocene and the Last Glacial Maximum, which is consistent with values from other ice cores. The abrupt onset and termination of a Younger Dryas-type event suggest atmospheric processes as the probable drivers. Regional accumulation increased during the LGS, during deglaciation, and over the past 3000 years, which is concurrent with higher water levels in regional paleolakes. Unlike polar cores, Sajama glacial ice contains eight times less dust than the Holocene ice, which reflects wetter conditions and extensive snow cover.
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In visual science the term filling-in is used in different ways, which often leads to confusion. This target article presents a taxonomy of perceptual completion phenomena to organize and clarify theoretical and empirical discussion. Examples of boundary completion (illusory contours) and featural completion (color, brightness, motion, texture, and depth) are examined, and single-cell studies relevant to filling-in are reviewed and assessed. Filling-in issues must be understood in relation to theoretical issues about neural-perceptual isomorphism and linking propositions. Six main conclusions are drawn: (1) visual filling-in comprises a multitude of different perceptual completion phenomena; (2) certain forms of visual completion seem to involve spatially propagating neural activity (neural filling-in) and so, contrary to Dennett's (1991; 1992) recent discussion of filling-in, cannot be described as results of the brain's "ignoring an absence" or "jumping to a conclusion"; (3) in certain cases perceptual completion seems to have measurable effects that depend on neural signals representing a presence rather than ignoring an absence; (4) neural filling-in does not imply either "analytic isomorphism" or "Cartesian materialism," and thus the notion of the bridge locus--a particular neural stage that forms the immediate substrate of perceptual experience--is problematic and should be abandoned; (5) to reject the representational conception of vision in favor of an "enactive" or "animate" conception reduces the importance of filling-in as a theoretical category in the explanation of vision; and (6) the evaluation of perceptual content should not be determined by "subpersonal" considerations about internal processing, but rather by considerations about the task of vision at the level of the animal or person interacting with the world.
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Ilusões Ópticas/fisiologia , Percepção Visual/fisiologia , Humanos , Psicofísica , Fatores de Tempo , Visão Ocular/fisiologia , Córtex Visual/fisiologiaRESUMO
Two ice cores from the col of Huascarán in the north-central Andes of Peru contain a paleoclimatic history extending well into the Wisconsinan (Würm) Glacial Stage and include evidence of the Younger Dryas cool phase. Glacial stage conditions at high elevations in the tropics appear to have been as much as 8 degrees to 12 degrees C cooler than today, the atmosphere contained about 200 times as much dust, and the Amazon Basin forest cover may have been much less extensive. Differences in both the oxygen isotope ratio zeta(18)O (8 per mil) and the deuterium excess (4.5 per mil) from the Late Glacial Stage to the Holocene are comparable with polar ice core records. These data imply that the tropical Atlantic was possibly 5 degrees to 6 degrees C cooler during the Late Glacial Stage, that the climate was warmest from 8400 to 5200 years before present, and that it cooled gradually, culminating with the Little Ice Age (200 to 500 years before present). A strong warming has dominated the last two centuries.
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Models are developed for the survival, history, and spread of variant alleles, in order to consider what can, and what cannot, be inferred from this type of data. The high variances of the processes involved, and questions of sampling, place severe limitations on inferences. Nonetheless, by combining information on a number of rare variants observed in a group of interrelated populations, reliable qualitative inferences are possible. These ideas and models are developed in the context of data on five rare variants and six private polymorphisms observed in eight Chibcha-speaking tribes of Costa Rica and Panama. The decline and fragmentation of the Amerindian populations of Central America over the last 300 years create considerable difficulties in attempting inference of past genetic events. However, these tribes have been well studied genetically, anthropologically, and linguistically and thus provide an excellent framework for the study of rare-variant spread.
Assuntos
Frequência do Gene/genética , Indígenas Centro-Americanos/genética , Polimorfismo Genético/genética , Evolução Biológica , América Central , Humanos , Modelos Genéticos , Processos EstocásticosRESUMO
Two ice cores, covering 1500 years of climatic information, from the summit (5670 meters) of the tropical Quelccaya ice cap, in the Andes of southern Peru, provide information on general environmental conditions including droughts, volcanic activity, moisture sources, temperature, and glacier net balance. The net balance record reconstructed from these cores reflects major precipitation trends for the southern Andes of Peru. These records indicate extended dry periods between 1720 and 1860, 1250 and 1310, and 570 and 610; wet conditions prevailed between 1500 and 1720. Establishing a tropical precipitation record may help explain climatic fluctuations since the tropical evaporation-precipitation cycle is a principal mechanism driving the atmospheric circulation.
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Snow accumulation measured during 1982-1983 on the Quelccaya ice cap, Peru, was 70 percent of the average from 1975 through 1983. Inspection of 19 years (1964 through 1983) of accumulation measured near the summit of Quelccaya reveals a substantial decrease ( approximately 30 percent) in association with the last five El Niño-Southern Oscillation (ENSO) occurrences in the equatorial Pacific. The ENSO phenomenon is now recognized as a global event arising from large-scale interactions between the ocean and the atmosphere. Understanding this extreme event, with the goal of prediction, requires a record of past occurrences. The Quelccaya ice cap, which contains 1500 years of annually accumulated ice layers, may provide a long and detailed record of the most extreme ENSO events.
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Nine children with neuroblastoma and five with Ewing sarcoma were found at diagnosis to have epidural extension of tumor. Five children underwent laminectomy prior to referral, with good neurologic recovery in only one. Management in the other nine children did not include laminectomy. All 14 patients were given chemotherapy without radiotherapy. Rapid regression of tumor with neurologic recovery occurred in response to chemotherapy in all patients with neurologic deficits. The responses observed in these children indicate that for chemotherapy-sensitive tumors, effective chemotherapy is a feasible alternative to laminectomy and radiation therapy in the management of epidural disease.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Laminectomia , Neuroblastoma/tratamento farmacológico , Sarcoma de Ewing/tratamento farmacológico , Neoplasias da Medula Espinal/tratamento farmacológico , Adolescente , Neoplasias Ósseas , Criança , Pré-Escolar , Terapia Combinada , Espaço Epidural , Humanos , Lactente , Neoplasias do Mediastino , Neuroblastoma/radioterapia , Neuroblastoma/secundário , Neuroblastoma/cirurgia , Sarcoma de Ewing/radioterapia , Sarcoma de Ewing/secundário , Sarcoma de Ewing/cirurgia , Neoplasias da Medula Espinal/radioterapia , Neoplasias da Medula Espinal/secundário , Neoplasias da Medula Espinal/cirurgiaRESUMO
Since 1974 we have entered 12 children with sickle cell disease and strokes on a transfusion protocol to maintain hemoglobin S less than 20%. Serial arteriography, EEGs, brain or CT scans, and neuropsychologic testing were also obtained. Transfusion has been stopped in ten patients after one to two years. Seven of these ten patients have had second strokes five weeks to 11 months after cessation of transfusion (median three months). Arteriography was normal at the time of the initial stroke in two patients; one of these had a second stroke. Arteriograms did not improve during transfusion therapy. EEGs and brain and CT scans were occasionally useful at the time of the initial stroke but were of little value in following these patients. Neuropsychologic testing indicated severe impairment of sensory-motor and cognitive processes at the time of the initial stroke and was useful in following improvement or deterioration and in designing remedial education programs. We conclude that short-term transfusion therapy will not prevent second strokes once transfusion is stopped and that arteriography is of limited value in these patients.