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- Abrahamsson, Jonas, 1954, et al.
(författare)
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Multiple lymph node metastases in a boy with primary testicular carcinoid, despite negative preoperative imaging procedures.
- 2005
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Ingår i: Journal of pediatric surgery. - : Elsevier BV. - 1531-5037 .- 0022-3468. ; 40:11
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Tidskriftsartikel (refereegranskat)abstract
- A testicular tumor in a 12-year-old boy proved to be a carcinoid tumor. An extensive investigation including a computed tomographic scan of the abdominal and pelvic region as well as both 123I-labeled metaiodobenzylguanidine and 111In-coupled octreotide scintigraphy was normal. Because histopathologic examination of the primary surgical specimen revealed tumor growth in the resection border of the spermatic vessels, a second operation with unilateral lymph node dissection was performed. Surprisingly, 3 lymph node metastases were found. No further treatment was given and the boy is alive without disease 9 years after surgery. This case illustrates that modern scintigraphic techniques do not always detect carcinoid tumors. Because carcinoids respond poorly to other treatment modalities, the importance of initial radical surgery including a meticulous examination of regional lymph nodes is emphasized.
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| 4. |
- Ek, Torben, 1963, et al.
(författare)
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Immune reconstitution after childhood acute lymphoblastic leukemia is most severely affected in the high risk group
- 2005
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Ingår i: Pediatr Blood Cancer. - : Wiley. - 1545-5009 .- 1545-5017. ; 44:5, s. 461-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim was to examine the immune reconstitution after current chemotherapy for childhood ALL, with a special focus on finding immunologic variables that predict a poor immune response to vaccinations. PROCEDURE: In a cross-sectional study of 31 children after treatment with the NOPHO ALL-1992 protocol peripheral blood lymphocyte subsets, T- and B-cell function in vitro and serum immunoglobulins (Ig) were measured. All patients were examined once, at 1 or at 6 months after cessation of chemotherapy, immediately before vaccination with DT and Hib. RESULTS: Lymphocytes, T-cells, and CD4+ T-cells were low at 6 months after treatment. Naive T-cell subsets were more reduced than memory subsets. In the high risk (HR) ALL group, CD8+ T-cells were reduced at 6 months. NK-cells were low at 1 month, but normal at 6 months; however, the CD3+CD56+ (NKT) subset was reduced at both time points. Total B-cell number was low at 1 month, but normal at 6 months. A relative increase of CD5+ B-cells (B-1 cells) was evident, particularly in the HR group. Antigen-independent T- and B-cell function in vitro were affected at 1 month, but virtually normalized at 6 months. Serum IgM level was decreased at 1 month and IgG3 level was increased at 1 and 6 months. CONCLUSIONS: This study shows that immune reconstitution after childhood ALL is slower than previously reported and emphasizes the influence of treatment intensity. The most intensively treated patients still have persistent abnormalities in T-, B-, and NK-cell subsets at 6 months post therapy and show a poor response to immunization with T-cell dependent antigens. In the HR group, routine re-immunizations before this time point are of limited benefit, and the effect of repeated vaccinations should be evaluated.
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| 5. |
- Ek, Torben, 1963, et al.
(författare)
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Interferon gamma and tumour necrosis factor alpha in relation to anaemia and prognosis in childhood cancer
- 2005
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Ingår i: Acta Paediatr. - 0803-5253. ; 94:4, s. 435-7
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Tidskriftsartikel (refereegranskat)abstract
- This study examined whether the initial plasma levels of tumour necrosis factor alpha (TNFalpha) and interferon gamma (IFNgamma) in 131 children with newly diagnosed cancer were associated with haematopoietic suppression, and whether plasma levels of TNFalpha or haemoglobin at diagnosis affects long-term prognosis in childhood acute lymphoblastic leukaemia (ALL). Conclusions: IFNgamma, and possibly also TNFalpha, were related to anaemia in children with solid tumours. Neither TNFalpha levels nor Hb levels were associated with increased risk of ALL relapse.
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| 8. |
- Ewald, Jonas, 1959-, et al.
(författare)
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A Matter of Choice? Cost sharing in health and education from a rights of the child perspective in Pangani, Rombo and Geita Disticts in Tanzania : Final report to Sida/Sarec
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This report analyse findings from extensive field research on local level in Pangani, Rombo and Geita districts in the period 2000-2004, on the effects of the introduction of user fees in health and eduction for various types of childrens rights to health and education. The report conclude that a number of reforms have been decided upon and implemented. Still however, the rights of the child to health and education as spelled out in the by Tanzania signed convention on Children’s rights has not been fully respected. Particular children to poorer families, and to a certain girl child’s, rights are violated. Especially vulnerable are orphaned or abandon children, even if they are taken care of by grandmothers. Access to health and education for all children is important for ensuring not only improved life chances for individual children, and households, but also for long term development of the whole country. To increase the fees to health and education does not seem to be a viable road to achieve that, if not poor peoples incomes increase first.Concerning choice health was considered as an emergency cost and always had priority, gender or type of child did not matter. Education was considered to be an investment, and in times of scarce resources, the child considered to have the best opportunities to pass school was given priority, and gender played a lesser role then the team had assumed from the beginning. In no few cases girls were given priority to boys, as girls was considered to be more trustworthy to return the investment in the future. Children belonging to the core family was to a larger exten given priority then other children in the family.
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| 9. |
- Lie, S. O., et al.
(författare)
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Long-term results in children with AML: NOPHO-AML Study Group--report of three consecutive trials
- 2005
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Ingår i: Leukemia. - : Springer Science and Business Media LLC. - 0887-6924 .- 1476-5551. ; 19:12, s. 2090-100
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Tidskriftsartikel (refereegranskat)abstract
- In all, 447 children with acute myeloid leukaemia (AML) have been treated on three consecutive NOPHO studies from July 1984 to December 2001. NOPHO-AML 84 was of moderate intensity with an induction of three courses of cytarabine, 6-thioguanine and doxorubicin followed by four consolidation courses with high-dose cytarabine. The 5-year event-free survival (EFS), disease free survival (DFS) and overall survival (OS) were 29, 37 and 38%. NOPHO-AML 88 was of high intensity with the addition of etoposide and mitoxantrone in selected courses during induction and consolidation. The interval between the induction courses should be as short as possible, that is, time intensity was introduced. The 5-year EFS, DFS and OS were 41, 48 and 46%. In NOPHO-AML 93, the treatment was stratified according to response to first induction course. The protocol utilised the same induction blocks as NOPHO-AML 88, but after the first block, children with a hypoplastic, nonleukaemic bone marrow were allowed to recover before the second block. Consolidation was identical with NOPHO-AML 88. The 5-year EFS, DFS and OS in NOPHO-AML 93 were 48, 52 and 65%. The new NOPHO-AML protocol has been based on experiences from previous protocols with stratification of patients with regard to in vivo response and specific cytogenetic aberrations.
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| 10. |
- Schmiegelow, Kjeld, et al.
(författare)
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Methotrexate/6-mercaptopurine maintenance therapy influences the risk of a second malignant neoplasm after childhood acute lymphoblastic leukemia: results from the NOPHO ALL-92 study.
- 2009
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Ingår i: Blood. - : American Society of Hematology. - 1528-0020 .- 0006-4971. ; 113:24, s. 6077-84
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Tidskriftsartikel (refereegranskat)abstract
- Among 1614 children with acute lymphoblastic leukemia (ALL) treated with the Nordic Society for Paediatric Haematology and Oncology (NOPHO) ALL-92 protocol, 20 patients developed a second malignant neoplasm (SMN) with a cumulative risk of 1.6% at 12 years from the diagnosis of ALL. Nine of the 16 acute myeloid leukemias or myelodysplastic syndromes had monosomy 7 (n = 7) or 7q deletions (n = 2). In Cox multivariate analysis, longer duration of oral 6-mercaptopurine (6MP)/methotrexate (MTX) maintenance therapy (P = .02; longest for standard-risk patients) and presence of high hyperdiploidy (P = .07) were related to increased risk of SMN. Thiopurine methyltransferase (TPMT) methylates 6MP and its metabolites, and thus reduces cellular levels of cytotoxic 6-thioguanine nucleotides. Of 524 patients who had erythrocyte TPMT activity measured, the median TPMT activity in 9 patients developing an SMN was significantly lower than in the 515 that did not develop an SMN (median, 12.1 vs 18.1 IU/mL; P = .02). Among 427 TPMT wild-type patients for whom the 6MP dose was registered, those who developed SMN received higher average 6MP doses than the remaining patients (69.7 vs 60.4 mg/m2; P = .03). This study indicates that the duration and intensity of 6MP/MTX maintenance therapy of childhood ALL may influence the risk of SMNs in childhood ALL.
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