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Biomedical subjects

L Madero López

Publications and source records attributed to L Madero López.

At least 19 recordsLinked to original sources
PubMed2006

[Neuroblastoma presenting as obstructive jaundice].

Obstructive jaundice as a presentation of abdominal tumors in childhood is extremely rare. To date, only 4 cases of neuroblastoma causing obstructive jaundice at diagnosis have been reported in children. We report a 4-year-old boy who presented to the emergency department with abdominal pain, jaundice, choluria and acholia. A diagnosis of unresectable, nonmetastatic neuroblastoma was made. Chemotherapy reduced the size of the tumor and relieved the symptoms of obstructive jaundice without the need for decompressive surgery. Abdominal tumors should be included in the differential diagnoses of obstructive jaundice in childhood.

Abdominal Neoplasms↗
PubMed2006

[Twenty years of treating childhood acute lymphoblastic leukemia].

BACKGROUND: Conventional prognostic factors for relapse in patients with acute lymphoblastic leukemia (ALL) are the main basis of risk-stratified treatments. OBJECTIVES: To analyze conventional risk factors for relapse and design a predictive model for relapse in our series, after 20 years of experience in treating ALL. PATIENTS AND METHOD: We performed a multivariate analysis of conventional prognostic factors in the treatment of ALL in our unit and compared them with the risk groups in the Berlin-Frankfurt-Münster (BFM-ALL) treatment protocols. RESULTS: Between 1984 and 2004, 232 children were diagnosed with ALL and treated according to the different versions of the BFM protocols (BFM83, BFM86, BFM90 and BFM95) at the Hospital Niño Jesús, Madrid, Spain. The event-free survival for all patients was 79.4 % (95 % CI: 72.7-85.4). Overall survival among patients who relapsed was 10.72 % (95 % CI: 6-27.3). The only significant prognostic factor for relapse identified by multivariate analysis was leukocyte [white blood cell (WBC)] count higher than 80,000/ml at diagnosis (hazard ratio [HR]: 4.63; 95 % CI: 1.61-13.3; p 5 0,004). The sensitivity and specificity of WBC in predicting relapses were 31.4 % and 87.5 %, respectively. The sensitivity and specificity of BFM risk group stratification in predicting relapses were 25 and 85.9 respectively. CONCLUSIONS: A leukocyte count at diagnosis higher than 80,000/ml and BFM risk-stratified treatment have insufficient sensitivity and specificity to identify relapses.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

[High-dose chemotherapy with autologous stem cell rescue in children with high-risk and recurrent brain tumors].

BACKGROUND: In the last few years, survival in children with central nervous system (CNS) tumors has slightly improved, especially in children with tumors such as medulloblastoma and those in which complete surgical resection is achieved. However, outcome remains poor in patients with incomplete surgical resection, neuroaxial dissemination, metastatic or recurrent tumors and in very young children. OBJECTIVES: To improve prognosis in patients with high-risk and recurrent tumors, new therapeutic strategies such as high-dose chemotherapy with autologous stem cell rescue (ASCR) have been developed. METHODS: We retrospectively studied patients with high-risk and recurrent CNS tumors who underwent ASCR between September 1995 and December 2002 in our unit. RESULTS: Thirty-five patients underwent ASCR. Seven patients died of treatment-related toxicities (20 %). Thirteen (37 %) are event-free survivors at a median post-ASCR follow-up of 18 months (range: 5-63 months). The 2-year Kaplan-Meier estimates of event-free survival was 37.64 +/- 8.7 % in all patients, 57 +/- 15 % in the group of patients with high-risk medulloblastoma/supratentorial primitive neuroectodermal tumor (stPNET) and 71.43 +/- 17 % in patients aged less than 4 years with medulloblastoma/stPNET. CONCLUSIONS: In our experience, ASCR may be effective in the treatment of malignant tumors of the central nervous system in patients with controlled disease, in certain histologic groups and chemosensitive tumors (medulloblastoma, malignant astrocytoma), as well as in very young children in whom cranial radiotherapy is contraindicated.

Adolescent↗
PubMed2004

[Obstructive lung disease after allogenic stem cell transplantation in children].

INTRODUCTION: Bronchiolitis obliterans is recognized as a life-threatening pulmonary complication that can develop 3 months after bone marrow transplantation. OBJECTIVE: To determine the incidence and clinical progression of obstructive lung disease (OLD) in a population of children who had undergone allogenic hematopoietic stem cell transplantation (HSCT). PATIENTS AND METHODS: We examined a sequential sample of 110 patients who received allogeneic HSCT between January 1992 and June 2002. The incidence of OLD in the 77 children who survived for more than 100 days after transplantation was analyzed. The diagnosis of OLD was based on clinical findings with no evidence of infection, pulmonary function test (FEV1/FVC less than 80 % and FEV1 less than 80 % of predicted value) and computed tomography scan. RESULTS: Eight patients (10.4 %) developed OLD at a median time of onset of 184 days after allogenic HSCT (range: 100-1735 days). All patients with OLD had respiratory symptoms. In six out of eight patients airflow obstruction was diagnosed within 1 year of transplantation. All patients showed chronic graft-versus-host disease (GVHD) (p < 0.01). The incidence of OLD in the 23 patients with chronic GVHD was 34.8 %. Two patients (25 %) had a complete response to intensified treatment of chronic GVHD with immunosuppressant therapy. FEV1 declined rapidly in three patients (37.5 %) who died of respiratory failure. Two patients (25 %) had partial reversal but pulmonary function continued below normal values. In one patient (12.5 %) severe obstructive disease was stable. CONCLUSIONS: The time of onset and form of progression of OLD after HSCT may vary. OLD is strongly associated with chronic GVHD and its incidence depends on the number of patients with chronic GVHD.

Bronchiolitis Obliterans↗
PubMed2003

[Topotecan for pediatric patients with resistant and recurrent solid tumors].

BACKGROUND: Topotecan is a cytotoxic drug isolated from the Camptotheca acuminata tree (from China). It is able to block the enzyme DNA topoisomerase I and has recently been used in the treatment of pediatric cancer. OBJECTIVES: To evaluate our preliminary experience with topotecan in the second line treatment of refractory solid tumors in the pediatric age group. PATIENTS AND MEHTODS: We performed a retrospective study of 10 patients with various recurrent solid tumors resistant to first line treatment who were treated with topotecan alone or in association with other chemotherapeutic agents. RESULTS: Ten patients with recurrent solid tumors or tumors that were refractory to conventional treatment (two neuroblastomas, three rhabdomyosarcoma, two PNET/Ewing's sarcoma, one anaplastic astrocytoma, one soft tissue sarcoma and one synovial sarcoma) were included. Five patients showed favorable responses (two had complete responses, two had partial responses and one had stable disease). Five patients showed no response. All patients showed grade II-IV hematological toxicity. CONCLUSIONS: In our experience, topotecan is beneficial in some refractory or recurrent solid tumors, especially neuroblastomas and soft tissue sarcomas. Myelosuppression was tolerable with the use of granulocyte colony-stimulating factors. Patients with a complete response to topotecan could benefit from high-dose chemotherapy and autologous stem cell rescue therapy.

Adolescent↗
PubMed1999

[Allogeneic bone marrow transplantation in children with severe acquired aplastic anemia. The long-term results. The Spanish Group for Bone Marrow Transplantation in Children (GETMON)].

OBJECTIVE: The objective of this study was to evaluate retrospectively the efficacy of allogeneic BMT in the treatment of childhood severe acquired aplastic anemia (SAAA). PATIENTS AND METHODS: Twenty-seven children aged 2 to 16 years (median 11 years) received a BMT from an HLA identical sibling. Conditioning consisted in irradiation (total, nodal or thoraco-abdominal) plus cyclophosphamide (120-200 mg/kg) in 15 patients and cyclophosphamide alone (200 mg/kg) in the rest. Prophylaxis for graft-versus-host disease (GVHD) was cyclosporine and methotrexate in most patients. RESULTS: Twenty-four children achieved the bone marrow graft at a median of 18 days (neutrophils) and 21 days (platelets). Two patients failed engraftment and 1 had a late graft rejection. Three patients developed acute GVHD grades 3-4 and six chronic GVHD, which was extensive in 4 of them. Twenty patients/71%) are alive and disease-free at a median follow-up of 110 months and the estimated disease free survival at 6 years is 67%. CONCLUSIONS: Our results confirm that allogeneic bone marrow transplantation from an HLA identical sibling is the best treatment modality for children with SAAA. Acute GVHD associated with infections and graft rejection were responsible for treatment failures.

Acute Disease↗
PubMed1991

[Control of vomiting induced by antineoplastic chemotherapy in childhood].

Twenty four children aged 2 to 13 years who were to receive cancer chemotherapy were enrolled in a prospective study (before-after-trial) in order to evaluate the efficacy of systematic antiemetic prophylaxis. The regimen of three drugs (metilpednisolone 4 mg/Kg/dose/iv 2 doses; metodopamide 0.5 mg/Kg/dose/iv 4 doses; diphenydramine 1 mg/Kg/dose/iv 4 doses) was used. We found a significative reduction (P less than 0.001) in the incidence of vomiting and nauseousness duration when the antiemetic prophylaxis was used. There were very few and slight adverse effects secondary to antiemetic drugs: Sedation happened in 25% of chemotherapic cycles and hypotension without clinical repercussion in 15%. No patient had distonia. We conclude that systematical antiemetic protection should be used in children receiving chemotherapy. The association of metilpednisolone, metopramide and diphenhydramine is a safe and effective combination.

Adolescent↗
PubMed1990

[Spinal cord compression in children with cancer].

Metastatic cord compression is a rare complication of malignant diseases in childhood. The most common causes are bone and soft tissue sarcomas, neuroblastoma, lymphoma and leukemia. The clinical manifestations, diagnosis, treatment and evolution of eight children with metastatic cord compression are presented. Diagnosis was based on computerized tomography that was pathological in all the cases, and confirmed by myelography in four patients. The cytological analysis of the cerebrospinal fluid was made in three patients being negative for tumoral cells in all of them. Treatment consisted on radiotherapy, chemotherapy and/or surgery depending on the tumor histology. Decompressive laminectomy was made in patients who did not show previous evidence of cancer. Functional prognosis was related with the degree of disablement at diagnosis and treatment.

Adolescent↗
PubMed1987

[Severe encephalopathy in a bone marrow transplant in a case of immunodeficiency].

The case of a child with a severe immunodeficiency (purine-nucleoside-phosphorylase deficit) in whom an allogenic bone marrow transplant was performed is reported. CT scan showed image suggestive of cerebral infarction. Clinical course and hemostasis alterations suggest a non-bacterial thrombotic endocarditis. Neurologic complications in bone marrow transplant are review.

Bone Marrow Transplantation↗