[Neuroblastoma. Results of protocol N-I-87].
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Biomedical subjects
Publications and source records attributed to J L Bezanilla Regato.
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From October 1989 to June 1990 we have evaluated at diagnosis and after six months of treatment the nutritional status of 21 oncologic patients younger than 14 years. At diagnosis, 14% of the children showed slight malnutrition on anthropometric evaluation, although there were biochemical data of protein malnutrition in 47% of the cases. Children with abnormal anthropometric measurements and those with a high risk of becoming malnourished (infants with advanced abdominal diseases) were given dietary supplements. In the follow-up evaluation, 90% of the patients showed normal somatic indexes and 76% showed recuperation in their protein values. The recovery of the nutritional status was most important in the group of patients with Acute Lymphoblastic Leukemia.
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As children with cancer survive longer, the incidence of second malignant neoplasms has increased considerably. We describe here three cases of second solid tumors after 12, 8 and 2 years of initial diagnosis of cancer: one osteosarcoma of left maxilla in a previously treated child with bilateral retinoblastoma, a temporal astrocytoma associated with acute lymphoblastic leukemia and a glioblastoma multiforme in a girl with neurofibromatosis de Von Recklinghausen, after Non Hodgkin lymphoma, respectively. We review the literature about the influence of genetic, immunologic and therapeutic factors involved in the appearance of these second tumors.
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A case of familial hemophagocytic limphohistiocytosis (FHLH) is presented in a 16 months old infant, with clinical picture of prolonged fever, cutaneous purpura, generalized lymphadenopathy and progressive hepatosplenomegaly and laboratory of severe pancytopenia, hypofibrinogenemia and hypertriglyceridemia, with elevation of the pre-beta fraction in the lipidogram, all this compatible with this disease. She also showed bone marrow and ganglionar biopsy infiltrated by histiocytic cells with hemophagocytosis. The patient received chemotherapy with cycles VP-16, vincristine (VCR) and intrathecal methotrexate (MTX), alternating every two-three weeks with VACP, during one year, with resolution of clinical and laboratory parameters after two months of this treatment without relapses. The survival from diagnosis is 39 months.
Bilaterality is uncommon in Wilms' tumor, being present in 4% to 8% of the cases. Definite progress has been made in the treatment with marked improvement in prognosis. The recent trend toward more conservative sugery, preoperative chemotherapy an avoidance of high-dose radiation therapy has yielded good results. This is confirmed in our two cases with synchronous tumors.
The authors review 133 cases of idiopathic thrombocytopenic purpura (ITP), through 17 years of follow-up in children from 2 months to 13 years of age. The clinical presentation of hemorrhagic signs, laboratory findings and different treatments employed are analyzed with special reference to recent treatment of these children.
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Therapeutic protocol and treatment results of 27 children with acute lymphoblastic leukemia are described. A remission rate of 88 per 100 was obtained. Fourteen children are living. Five of those followed for two or more years are living (35 per 100). The prophylaxis of leukemic meningitis was done with intrathecal Methotrexate. Only one child treated in this manner developed leukemic meningitis. Infection was the most frequent cause of death.