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Biomedical subjects

Elpis Mantadakis

Publications and source records attributed to Elpis Mantadakis.

27 records · Page 2Linked to original sources
PubMed2003

Three cases of viridans group streptococcal bacteremia in children with febrile neutropenia and literature review.

Three cases of viridans group streptococcal bacteremia in 2 children with brain tumours and in 1 with autoimmune neutropenia are presented. All children were neutropenic. The 2 patients with malignancy also had mucositis. The isolated strains of viridans group streptococci showed considerable resistance to antibiotics. All patients were empirically treated with third generation cephalosporins and amikacin, before antibiotic sensitivities were available and recovered without complications. Viridans group streptococcal bacteremia should be suspected in neutropenic children, especially in the presence of mucositis. Prospective, randomized clinical trials of mouth antiseptics are needed to clarify the usefulness, if any, of such measures in the reduction of viridans group streptococcal bacteremia in this group of patients.

Adolescent↗
PubMed2003

Rhodotorula species fungemia: a threat to the immunocompromised host.

Members of the genus Rhodotorula, family Cryptococcaceae, are common airborne fungi showing remarkable ubiquity. In the recent past they were considered nonvirulent saprophytes. However, during the last two decades they have emerged as opportunistic pathogens in immunocompromised patients. A review of the English literature covering the period 1960-2001 disclosed 47 reported cases of Rhodotorula spp fungemia. The great majority of these infections has been reported after 1990, were catheter-related, and diagnosed in patients with cancer. The treatment of Rhodotorula fungemia remains controversial. Resolution of coexistent neutropenia is essential for recovery. Removal of the central venous catheter is usually sufficient and treatment with systenic antifungals may not be required. If catheter removal is undesirable or impossible or when the infection persists, treatment with amphotericin B is the treatment of choice. Rhodotorula is a fungus with a low virulence and fatality rate. Hence, most patients with Rhodotorula fungemia reported in the literature survived with or without administration of antifungal agents.

Catheters, Indwelling↗
PubMed2002

Methotrexate polyglutamation may lack prognostic significance in children with B-cell precursor acute lymphoblastic leukemia treated with intensive oral methotrexate.

BACKGROUND: The purpose of this study was to determine if a correlation exists between clinical outcome and accumulation and polyglutamation of methotrexate by lymphoblasts in vitro in children with B-cell precursor acute lymphoblastic leukemia (BCP-ALL). PATIENTS AND METHODS: The amount of accumulated methotrexate and of long-chain methotrexate polyglutamates (MTXPG(3-7)) by lymphoblasts was determined in 52 children newly diagnosed with BCP-ALL after incubation with 1 micromol/L [(3)H]MTX for 24 hours in vitro. All patients then received intensive multiagent chemotherapy that used divided-dose oral methotrexate during consolidation and intensive continuation and standard oral weekly methotrexate during maintenance. RESULTS: Eight patients had a bone marrow relapse at a median of 40.4 months (range 18.5-48.3 months) after diagnosis. The median follow-up for the remaining 44 patients is 69.0 months (range 22-92.8 months). There was no significant difference in the amount of accumulated methotrexate (1450.0 +/- 896.3 vs. 640 +/- 472.5 pmol/10 cells) or of accumulated MTXPG (1450.0 +/- 919.4 vs. 617.4 +/- 482.7 pmol/10(9) cells) (median +/- semi-interquartile ranges) between patients who relapsed and those who remained in continuous complete remission. The estimated 5-year event-free survival rate for patients whose lymphoblasts accumulated more than 500 pmol MTXPG(3-7)/10(9) cells was 80.0% +/- 7.3% versus 90.5% +/- 6.4% for those whose lymphoblasts accumulated less than 500 pmol MTXPG(3-7)/10(9) cells. CONCLUSIONS: In the context of effective prolonged divided-dose oral methotrexate-based therapy in the treatment of BCP-ALL, methotrexate accumulation and polyglutamation no longer seem to have prognostic significance.

Administration, Oral↗
PubMedDate not supplied

Remission of a chiasmatic glioma in a non-NF1 patient after brief chemotherapy with vincristine and carboplatin: case report and literature review.

We describe the case of an 8-year-old girl without neurofibromatosis, who presented with total loss of vision on the left eye, due to a chiasmatic mass with imaging characteristics of glioma, accompanied by a second asymptomatic mass in the middle cranial fossa, along the intracranial route of the right trigeminal nerve. The patient received a total of 10 weekly injections of vincristine and four injections of carboplatin every 3 weeks and achieved a very good partial response (97% volume reduction) after the nineth week of therapy with acceptable toxicity. Given the natural history of opticochiasmatic gliomas, we cannot rule out the possibility of a spontaneous regression. However, we believe the quick response accompanied by visual improvement was most likely due to chemotherapy. A trial of vincristine and carboplatin may be worthwhile in children with symptomatic chiasmatic gliomas, irrespective of their age.

Antineoplastic Agents↗
PubMedDate not supplied

Variability in dose intensity of high-dose methotrexate for nonmetastatic osteosarcoma.

The authors evaluated their ability to maintain planned dosing schedules for high-dose methotrexate (HD-MTX) in patients with nonmetastatic osteosarcoma. Twenty-seven patients who received therapy according to 2 POG protocols (8651 and 9351), both of which included HD-MTX (12 g/m(2)/week for 2 consecutive weeks), between 1988 and 1998 were studied. Significantly fewer HD-MTX infusions were given on the second week to patients treated on POG 9351 (33 vs. 93%; p < .0001). The hydration guidelines were identical and there was no difference in peak serum MTX levels either within or between protocols. Differences in the administration of combination chemotherapy in 9351 compared to 8651 may have contributed to the increased toxicity associated with HD-MTX on 9351, although this is speculative. The use of HD-MTX should be carefully planned so that it does not decrease its dose intensity or that of other effective agents.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

New antileukemic agents.

Despite the tremendous progress in the treatment of childhood leukemias over the last 50 years, certain subgroups of children continue to have poor prognosis. Hence, there is a need for development of new antileukemic agents. In this review, the authors describe results of clinical trials of several new antileukemic compounds with different mechanisms of action (signal transduction inhibitors, nucleoside analogs, DNA hypomethylators, angiogenesis inhibitors, and monoclonal antibodies). Although most of these compounds are not used in pediatric leukemias, the concepts surrounding their clinical development are important to all pediatric hematologists/oncologists.

Angiogenesis Inhibitors↗
PubMedDate not supplied

Infectious toxicity of dexamethasone during all remission-induction chemotherapy: report of two cases and literature review.

Traditionally, children with acute lymphoblastic leukemia receive prednisone, as part of multiagent remission-induction chemotherapy. Recently, many cooperative groups use dexamethasone instead of prednisone during induction. We describe the infectious toxicities experienced by the first two patients in our institution treated with dexamethasone (10 mg/m(2)/day for 4 weeks with gradual tapering) during induction according to the dexamethasone arm of BFM 2000 and review the relevant literature that suggests an increased risk of infectious complications with dexamethasone. Only a prospective two-arm ALL dexamethasone study at two dose levels (6 and 10 mg/m(2)/day) will clarify if indeed the higher dose of dexamethasone during induction is more effective and without unacceptable toxicity.

Adolescent↗
PubMedDate not supplied

Symptomatic relief of patients with advanced bladder carcinoma after regional intra-arterial chemotherapy.

Thirty-two patients (30 men, 2 women), median age 68 years (range 47-85) with histologically confirmed advanced bladder carcinoma (Stages T3 and T4 according to the International Union Against Cancer staging system), who were poor surgical candidates, were prospectively treated with 1-6 (median 4) cycles of intra-arterial epirubicin (60 mg/cycle) delivered through two infusion pumps that were surgically implanted to each internal iliac artery, along with intravenous leucovorin 200 mg per day and 5-fluorouracil 750 mg per day for three consecutive days. Regional intra-arterial chemotherapy was well tolerated. There were 12 complete and 10 partial responses for an overall objective response rate of 69%. Eight patients had stable disease and 2 demonstrated progressive disease. All participating patients had gross hematuria prior to therapy. After the end of treatment, 24 out of 32 patients had resolution of their gross hematuria. Eight out of 15 patients with tumor-associated dysuria at the time of initiation of chemotherapy had significant pain relief at the end of the treatment. Regional intra-arterial chemotherapy is a safe and effective technique for patients with advanced, muscle invasive bladder carcinoma and can improve the quality of life of most affected patients by decreasing the degree of hematuria and dysuria associated with this malignancy.

Aged↗