The aim of this study was to compare the type and severeness of brain damage in vitally most endangered newborn infants of different gestational age. We retrospectively analyzed the records of 75 newborn infants treated and decreased at the Department of Intensive Care and Therapy of the Institute of Children's and Adolescents' Health Care in Novi Sad. Diagnoses of hypoxic-ischemic lesion and intracranial hemorrhage in the case of grade four PVH-IVH (periventricular hemorrhage-intraventricular hemorrhage) were established by ultrasonography of the brain and lumbar punction in the case of subarachnoid hemorrhage. These diagnoses were confirmed after forensic-medical expertise. The volume and degree of the damage were compared in regard to the gestational age, Apgar score and time of initial mechanical ventilation and initial parameters of the mechanical ventilation, as well as to values of acido-basic status, concentration of gases in arterialized capillary blood and type of lung damage which always occurred in these patients. In all 75 examined newborns perinatal asphyxia was the dominant etiologic factor for the course and outcome of the disease (in all patients Apgar score was 4 or less). 75% of examines were born before 32 weeks gestation and of low or very low body weight, whereas 72% had intracranial hemorrhage (periventricular-intraventricular) and hypoxic-ischemic damage of the brain parenchyma. The rest of examinees had intracranial hemorrhage or hypoxic-ischemic damage of the brain parenchyma. Although 92% of examinees received mechanical ventilation in the first 3 days of life, only 20% of newborn infants had satisfactory values of acido-basic status and gas concentrations in the blood. We concluded that in the most severe cases of perinatal asphyxia, especially in preterm newborns of low or very low body weight, both intracranial hemorrhage and hypoxic-ischemic encephalopathy develop. Damages of other organs or systems of organs, especially lungs, as a rule contribute to infaust ending.

Asphyxia Neonatorum↗

PubMedDate not supplied

[The effect of extent of tumor resection on the outcome of combined therapy in patients with glioblastoma multiforme].

INTRODUCTION: The importance of the extent of surgery as a prognostic factor in multiform glioblastoma has been investigated for years. Some studies could not establish its influence on survival of patients treated with surgery, postoperative radiotherapy, with or without chemotherapy. On the other hand, there are data suggesting benefit for patients treated with more aggressive surgical approach. The aim of this study was to investigate the influence of the extent of surgery on survival/progression-free survival of patients with multiform glioblastoma treated with two consecutive protocols of a combined approach. MATERIAL AND METHODS: Of 86 patients that entered this study, thirty-seven were treated with surgery, postoperative hyperfractionated radiotherapy using 1.2 Gy b.i.d. to a total tumour dose of 72 Gy in 60 fractions in 30 treatment days and adjuvant chemotherapy consisting of BCNU, vincristine, procarbazine and cisplatin for up to 6 cycles or until tumour progression. Forty-nine patients were treated with surgery and postoperative accelerated hyperfractionated radiotherapy using 1.5 Gy b.i.d. fractions to a total tumour dose of 66 Gy in 44 fractions during 22 treatment days. BCNU and hydroxyurea were given once weekly during the irradiation period. Surgery consisted of biopsy in 25 patients and subtotal or gross total tumour resection in 61 patients. Patients treated with a more radical surgery had longer median survival time and higher 1- and 2-year survival rates than those treated with biopsy (56 v.s. 29 weeks, respectively; 62% and 23% v.s. 16% and 0%, respectively; long rank, p = 0.0000) (Figure 1). They also had longer median time to tumour progression and higher 1-year progression-free survival rate than those treated with biopsy only (33 v.s. 21 weeks, respectively; 20% v.s. 0%, respectively; log rank, p = 0.00000) (Figure 2). Multivariate analyses using both survival and progression-free survival as endpoints confirmed that the extent of surgery was an independent prognostic factor, together with the age, tumour location, and interfraction interval (Tables 3 and 4). DISCUSSION: The benefit of a more radical surgery remains controversial in patients with multiform glioblastoma, although maximal tumour reduction should be supported from the cytokinetic point of view. Findings of various authors support this view. Results of this study add further evidence that the aggressive surgical approach carries significant benefit for patients with multiform glioblastoma regarding the survival and progression-free survival. These observations are confirmed with multivariate analyses that showed independent influence of this prognostic factor.

Brain Neoplasms↗

PubMedDate not supplied

[Problems and perspectives in child health care].

Health care protection of children in Vojvodina is of particular importance regarding the negative natural birth rate. In spite of difficult economic situation, health care of children in Vojvodina is permanently carried out and would be significantly better in quality if the education of subspecialized personnel, space facilities, technological innovations, computerization and continuous education were available. Introduction of microanalytic laboratory techniques is essential for monitoring of prematures. Propagation of natural nutrition is an obligation of pediatricians. Respiratory diseases are still on the top of morbidity pyramid but tuberculosis is evidently in increase. An important health care problem is the expansion of allergic diseases. The progressive incidence of insulin-dependent diabetes is also evident. The spheres of juvenile gynecological endocrinology and andrology are still underdeveloped and that also applies to adolescent medicine. Toxicology remains an ongoing problem in pediatrics due to an increased number of accidental poisoning. Pediatricians-gastroenterologists are lacking while paediatric hepatology should be brought into more advanced state. Bone marrow and stem cells transplantation is in the responsibility of the Centre for haematology and oncology. Nephrology department lacks children's haemodialysis, ultrasound biopsy of kidneys, urodynamic analyses and new staff facilities. The increased number of survivals in case of children with with sequeles inevitably asks for better development of rehabilitation, prolonged treatment and teamwork. Intensive care and therapy department requires new staff and high technology capacities. Development of children's surgery department inevitably means the reconstruction of space facilities, modern equipment and new subspecializations. Preventive outpatient service is performed through systematic examinations. ultrasound diagnostics of hips, auditive screening and educational program activities related to addiction and veneral diseases. Genetic health of the population is supremely covered by the Center for Medical Genetics, with the tendenca for development of molecular genetics. It is necessary to develop rehabilitation service, prolonged treatment and teamwork. Diagnostic of convulsive conditions should be advanced with more refined diagnostic methods.

Child↗

PubMedDate not supplied

[Hyperfractionated radiotherapy and adjuvant chemotherapy in patients with malignant gliomas].

INTRODUCTION: Malignant gliomas are the most common primary brain tumours in adults. Postoperative radiation therapy significantly improves survival when compared to surgery alone. It is occasionally followed by the adjuvant chemotherapy (CHT). Since this approach carries a significant hazard of local recurrence, new approaches have been tested in order to improve survival figures, hyperfractionated radiation therapy (HFX RT) and recent multiagent CHT. MATERIAL AND METHODS: Fourty eight adult patients with malignant glioma were treated with HFX RT to a total TD of 72 Gy in 60 fractions in 30 treatment days, 1.2 Gy b.i.d. fractions with an interfraction interval of 4.5-6.0 hr. Four weeks after HFX RT, CHT was introduced consisting of BCNU, Vincristine, Procarbazine, and Cisplatin. Six cycles were planned to be administered but CHT was stopped because of tumour progression. Toxicity criteria were made on the basis of joint RTOG/EORTC toxicity criteria. RESULTS: Median survival time in all 48 patients was 52 weeks, and 1-3 year survival time was 48%, 29%, and 29%, respectively. Median progression-free survival was 30.5 weeks. Patients with AA achieved better results than those with GBM, regarding the overall survival and progression-free survival (p = 0.0000). The univariate analysis revealed that the age, performance status, and extent of surgery were important prognostic factors influencing the overall survival and progression-free survival, as well as tumour location and interfraction interval. The multivariate analysis revealed that the performance status, tumour location, and interfraction interval were independent prognostic factors in patients with GBM. Toxicity of this treatment approach was generally considered as mild, with no late toxicity attributed to HFX RT. CHT-related toxicity was mostly haematological. DISCUSSION: The results of this study are in agreement with those using standard and various altered fractionated regimens in malignant glioma. They add evidence that this combined approach is feasible and well tolerated by the patients. Although there is some controversy about dose-escalation in HFX studies in the past, the studies reporting no significant improvement in survival for HFX RT were probably due to somewhat lower total doses used in them. Since this approach contributed to a 3-year survival of 83%, and 3-year progression-free survival of 70% in AA patients (all treated with 4.5 hr interfraction interval), they could serve as a basis for further studies measuring late effects as an endpoint, since there are data showing that aggressive treatment might be hazardous in patients with AA.

Antineoplastic Combined Chemotherapy Protocols↗