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Lefrant JY, Benhamou D, Fischer MO, Pirracchio R, Allaouchiche B, Bastide S, Biais M, Blet A, Bouvet L, Brissaud O, Brull SJ, Capdevila X, Clausen N, Cuvillon P, Dadure C, David JS, Eley V, Forget P, Fujii T, Godier A, Gopalan D, Guinot PG, Hasanin A, Joannes-Boyau O, Kerever S, Kipnis É, Landau R, Le Guen M, Legrand M, Lorne E, Mercier F, Mongardon N, Myatra SN, Nicolas-Robin A, Peters MJ, Quintard H, Rello J, G Richebe P, Roberts JA, Sanfilippo F, Schneider A, T Sofonea M, Treggiari M, Veyckemans F, Von Ungern-Sternberg BR, Zeidan A, Zieleskiewicz L, Zielinska M, Milman A, Roquilly A. Comments on: Reducing the Risks of Nuclear War-The Role of Health Professionals. Anaesth Crit Care Pain Med 2023; 43:101314. [PMID: 37863196 DOI: 10.1016/j.accpm.2023.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
- Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Dan Benhamou
- Paris Sud University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Avenue, San Francisco, USA
| | | | | | - Matthieu Biais
- Société Heva, Lyon, France; University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, Bordeaux, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bouvet
- Lyon University Hospital, Department of Anaesthesiology and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Olivier Brissaud
- University Hospital Centre Bordeaux, Pediatric Intensive Care Unit, Bordeaux, France
| | - Sorin J Brull
- Mayo Clinic, College of Medicine and Science, Department of Anesthesiology and Perioperative Medicine, Jacksonville, Florida, United States of America
| | - Xavier Capdevila
- Montpellier University Hospital Centre, Department of Anaesthesia and Intensive Care, Montpellier, France
| | - Nicola Clausen
- Department of Anesthesiology and Intensive Care, University Hospital Odense, Denmark
| | - Philippe Cuvillon
- Nîmes University Hospital, CHU Carémeau, Critical Care and Emergency Medicine, Pain Dept, Nîmes, France
| | - Christophe Dadure
- Lapeyronie Hospital, Pediatric Anesthesia Department, Montpellier, France
| | - Jean-Stéphane David
- Civil Hospices of Lyon, Department of Anaesthesiology and Critical Care Medicine, Lyon, France
| | - Victoria Eley
- Royal Brisbane and Women's Hospital, Department of Anaesthesia and Perioperative Medicine, Herston, Australia
| | - Patrice Forget
- University of Aberdeen Institute of Applied Health Sciences, Aberdeen, United Kingdom
| | | | - Anne Godier
- The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Dean Gopalan
- University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | | | - Ahmed Hasanin
- Department of Anaesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olivier Joannes-Boyau
- University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, Bordeaux, France
| | - Sébastien Kerever
- Paris University, Lariboisière University Hospital, Departments of Anaesthesiology and Critical Care, Paris, France
| | - Éric Kipnis
- Lille University School of Medicine, Loos, France
| | - Ruth Landau
- Columbia University Vagelos College of Physicians and Surgeons, New York, United States of America
| | - Morgan Le Guen
- Hospital Foch, Department of Anaesthesiology, Suresnes, France
| | - Matthieu Legrand
- University of California, Zuckerberg San Francisco General Hospital and Trauma Center, Department of Anaesthesia and Perioperative Medicine, San Francisco, California, United States of America
| | - Emmanuel Lorne
- Clinique du Millénaire, Department of Anesthesiology and Intensive Care (Akomé), Montpellier, France
| | - Frédéric Mercier
- Paris-Saclay University, Antoine-Béclère Hospital, Department of Anaesthesia and Critical Care Medicine, Clamart, France
| | | | - Sheila Nainan Myatra
- Homi Bhabha National Institute - Tata Memorial Hospital, Department of Anaesthesiology, Critical Care and Pain, Mumbai, India
| | - Armelle Nicolas-Robin
- Pediatric Palliative Care Mobile Team, University Hospital Robert-Debré, Assistance Publique - Hôpitaux de Paris, Paris University, Paris, France
| | - Mark John Peters
- Great Ormond Street Hospital for Children Paediatric Intensive Care Unit, London, United Kingdom
| | - Hervé Quintard
- Geneva University Hospitals Intensive Care Service, Genève, Switzerland
| | - Jordi Rello
- International University of Cataluna, Faculty of Medicine and Health Sciences, Sant Cugat del Valles, Spain
| | - Philippe G Richebe
- University of Montreal, Department of Anesthesiology and Pain Medicine, Montréal, Quebec, Canada
| | | | - Filippo Sanfilippo
- Policlinico, Department of Anaesthesia and Intensive Care, Catania, Italy
| | - Antoine Schneider
- Lausanne University Hospital Adult Intensive Care Unit, Vaud, Switzerland
| | - Mircea T Sofonea
- Infectious Diseases and Vectors Ecology Genetics Evolution and Control, Montpellier, France
| | - Miriam Treggiari
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut, United States of America
| | - Francis Veyckemans
- Lille University Hospital, Department of Paediatric Resuscitation, Lille, France
| | | | - Ahed Zeidan
- King Fahad Specialist Hospital-Dammam, Department of Anesthesiology, Dammam, Saudi Arabia
| | - Laurent Zieleskiewicz
- Aix-Marseille University, University Hospital of Marseille, Department of Anaesthesia and Intensive Care Medicine, Marseille, France
| | - Marzena Zielinska
- Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Alexandre Milman
- Editorial Office Anaesthesia Critical Care and Pain Medicine, Société Française d'Anesthésie et Réanimation, Paris, France
| | - Antoine Roquilly
- University of Nantes - Anaesthesiology and Intensive Care Unit, Nantes, France
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Lefrant JY, Pirracchio R, Benhamou D, Fischer MO, Njeim R, Allaouchiche B, Bastide S, Biais M, Bouvet L, Brissaud O, Brull SJ, Capdevila X, Clausen N, Cuvillon P, Dadure C, David JS, Du B, Einav S, Eley V, Forget P, Fujii T, Godier A, Gopalan DP, Hamada S, Hasanin A, Joannes-Boyau O, Kerever S, Kipnis É, Kolodzie K, Landau R, Le Gall A, Le Guen M, Legrand M, Lorne E, Mercier FJ, Mongardon N, Myatra S, Nicolas-Robin A, John Peters M, Quintard H, Rello J, Richebé P, Roberts JA, Rocquilly A, Sanfilippo F, Schneider A, Sofonea MT, Veyckemans F, Zetlaoui P, Zeidan A, Zieleskiewicz L, Zielinska M, Von Ungern-Sternberg B, Abou Arab O, Blet A, Bounes F, Boisson M, Caillard A, Carillion A, Clavier T, Frasca D, James A, Sigaut S, Rozencwajg S, Albaladejo P, Bouaziz H. Peace, not war in Ukraine or anywhere else, please. Anaesth Crit Care Pain Med 2022; 41:101068. [PMID: 35460922 DOI: 10.1016/j.accpm.2022.101068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jean-Yves Lefrant
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Université de Montpellier-Nîmes, CHU de Nîmes, 30029 Nîmes, France; Editor-in-Chief of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France.
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA; Deputy Editor-in-Chief of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Dan Benhamou
- University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France; Advisory Editor of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Marc-Olivier Fischer
- Advisory Editor of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France; Caen University Hospital, Anaesthesiology and Critical Care Medicine Department, Caen, France
| | - Rosanna Njeim
- Editorial Assistant of ACCPM, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 74, rue Raynouard, 75016 Paris, France
| | | | | | - Matthieu Biais
- University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, 33300 Bordeaux, France; Univ. Bordeaux, INSERM, Biologie des Maladies Cardiovasculaires, U1034, F-33600 Pessac, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Groupement Hospitalier Est - Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Olivier Brissaud
- University Hospital Centre Bordeaux, Paediatric Intensive Care Unit, 33300 Bordeaux, France
| | - Sorin J Brull
- Mayo Clinic, College of Medicine and Science, Department of Anaesthesiology and Perioperative Medicine, Jacksonville, United States
| | - Xavier Capdevila
- Montpellier University Hospital Centre, Department of Anaesthesia and Intensive Care, 34090 Montpellier, France
| | - Nicola Clausen
- Anæstesiologisk Intensiv Afdeling V, Odense, Odense Universitetshospital, J.B. Winsløws Vej 4, 5000 Odense C, Danmark
| | - Philippe Cuvillon
- Nîmes University Hospital, CHU Carémeau, Critical Care and Emergency Medicine, Pain Dept, 30029 Nîmes, France
| | - Christophe Dadure
- Lapeyronie Hospital, Paediatric Anaesthesia Department, 34090 Montpellier, France
| | - Jean-Stéphane David
- Civil Hospices of Lyon Department of Anaesthesiology and Critical Care Medicine, Lyon, France
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730, China
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Victoria Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston 4006, Queensland, Australia; Faculty of Medicine, The University of Queensland, St Lucia 4067, Queensland, Australia
| | - Patrice Forget
- University of Aberdeen, Institute of Applied Health Sciences, Department of Anaesthesia, Aberdeen, United Kingdom
| | - Tomoko Fujii
- Jikei University Hospital, Intensive Care Unit, Tokyo, Japan
| | - Anne Godier
- Department of Anaesthesia and Intensive care, Hôpital Européen Georges Pompidou, Université de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Dean P Gopalan
- University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Sophie Hamada
- Department of Anaesthesia and Intensive care, Hôpital Européen Georges Pompidou, Université de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Ahmed Hasanin
- epartment of Anesthesia and Critical Care, Cairo University, Cairo, Egypt
| | | | - Sébastien Kerever
- Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, DMU PARABOL, AP-HP. Nord, Paris, France; Fédération Hospitalo-Universitaire PROMICE, INSERM UMR-S 942 MASCOT, Université de Paris, Paris, France
| | - Éric Kipnis
- Department of Anaesthesia and Intensive Care, Lille University Hospital, 1, rue Michel-Polonowski, 59037 Lille, France
| | - Kerstin Kolodzie
- Department of Anaesthesia and & Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Ruth Landau
- Columbia University Vagelos College of Physicians and Surgeons, New York, United States
| | - Arthur Le Gall
- Department of Anaesthesia, Critical Care and Peri-operative Medicine, Rennes University Hospital, Rennes, France
| | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Matthieu Legrand
- Department of Anaesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Emmanuel Lorne
- Department of Anaesthesia and Critical Care Medicine, Clinique du Millénaire, 34960 Montpellier Cedex 2, France
| | - Frédéric J Mercier
- Paris-Saclay University, Antoine-Béclère Hospital, Department of Anaesthesia and Critical Care Medicine, Clamart, France
| | - Nicolas Mongardon
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Faculté de Santé, F-94010 Créteil, France
| | - Sheila Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | - Mark John Peters
- Great Ormond Street Hospital for Children Paediatric Intensive Care Unit, London, United Kingdom
| | - Hervé Quintard
- University Hospital Centre Nice Anesthesia, Resuscitation Emergency Department, Nice, France
| | - Jordi Rello
- International University of Cataluna Faculty of Medicine and Health Sciences, Sant Cugat del Valles, Spain
| | - Philippe Richebé
- niversity of Montreal Department of Anaesthesiology and Pain Medicine, Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal, Montréal, Canada
| | | | - Antoine Rocquilly
- University of Nantes - Anaesthesiology and Intensive Care Unit, Nantes, France
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Policlinico University Hospital, Catania, Italy
| | - Antoine Schneider
- Lausanne University Hospital Adult Intensive Care Unit, Vaud, Switzerland
| | | | - Francis Veyckemans
- Department of Paediatric Anaesthesia, Jeanne de Flandre hospital, University Hospitals of Lille, 59037 Lille, France
| | - Paul Zetlaoui
- University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Ahed Zeidan
- King Fahad Specialist Hospital, Anesthesiology Department, Dammam, Saudi Arabia
| | - Laurent Zieleskiewicz
- Aix-Marseille University, University Hospital of Marseille, Department of Anaesthesia and Intensive Care Medicine, Marseille, France
| | - Marzena Zielinska
- Wroclaw Medical University, Department of Paediatric Anaesthesiology and Intensive Care, Poland
| | - Britta Von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia; Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia; Team Perioperative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - Osama Abou Arab
- Anesthésie réanimation cardiovasculaire et thoracique, CHU Amiens, Laboratoire MP3CV, EA 7517, Université Picardie Jules Verne, 1 rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fanny Bounes
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France; Pôle Anesthesie Réanimation Médecine peri operatoire CHU Toulouse, 1av du Pr J Poulhes, 31000 Toulouse, France
| | - Matthieu Boisson
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France; INSERM U1070, « Pharmacologie des anti-infectieux et résistances », Université de Poitiers, Poitiers, France
| | - Anaïs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical care and Perioperative medicine Department, Brest, France
| | - Aude Carillion
- Département d'Anesthésie-Réanimation, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013 Paris, France; UMR-S 1166 ICAN, Unité de recherche sur les maladies cardiovasculaires et métaboliques, Sorbonne Université, France
| | - Thomas Clavier
- Département de Réanimation, Anesthésie et Médecine Périopératoire, Unité de Réanimation Chirurgicale Polyvalente, CHU de Rouen, 37 Bd Gambetta, 76000 Rouen, France; Laboratoire INSERM U1096, Université de Rouen-Normandie, France
| | - Denis Frasca
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France; INSERM U1246, SPHERE, Université de Nantes, France
| | - Arthur James
- Sorbonne Université, GRC 29, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013 Paris, France
| | - Stéphanie Sigaut
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Paris, France
| | - Sacha Rozencwajg
- Department of Anaesthesiology and Surgical Intensive Care, Bichat Claude-Bernard Hospital, AP-HP, DMU PARABOL, France
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France; Current President of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), Paris, France
| | - Hervé Bouaziz
- Department of Anaesthesiology and Obstetric Critical Care Unit, University Maternity Hospital of Nancy, 54000 Nancy, France; Past President of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), Paris, France
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Jensen AK, Rechnitzer C, Macklon KT, Ifversen MRS, Birkebæk N, Clausen N, Sørensen K, Fedder J, Ernst E, Andersen CY. Cryopreservation of ovarian tissue for fertility preservation in a large cohort of young girls: focus on pubertal development. Hum Reprod 2016; 32:154-164. [PMID: 27816923 DOI: 10.1093/humrep/dew273] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/15/2016] [Accepted: 10/20/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is there an association between the need for medical puberty induction and the diagnosis or treatment received in girls who have undergone cryopreservation of ovarian tissue for fertility preservation? SUMMARY ANSWER There was a clear association between the intensity of treatment received and requirement for medical puberty induction but no association with the diagnosis. WHAT IS KNOWN ALREADY Although it cannot be predicted which girls will become infertile or develop premature ovarian insufficiency (POI) following intensive chemotherapy or irradiation, patients who are at high risk of POI should be offered ovarian tissue cryopreservation (OTC). This includes girls who are planned to receive either high doses of alkylating agents, conditioning regimen before stem cell transplantation (SCT), total body irradiation (TBI) or high radiation doses to the craniospinal, abdominal or pelvic area. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort study. In total, 176 Danish girls under 18 years of age have had OTC performed over a period of 15 years. An overview of the girls' diagnoses and mean age at OTC as well as the number of deceased is presented. Of the 176 girls, 38 had died and 46 girls were still younger than 12 years so their pubertal development cannot be evaluated yet. For the 60 girls who had OTC performed after 12 years of age, the incidence of POI was evaluated and in the group of 32 girls who were younger than 12 years at OTC, the association between the diagnosis and received treatment and the requirement for medical puberty induction was examined. PARTICIPANTS/MATERIALS, SETTING, METHODS The need for medical puberty induction was assessed in 32 girls who were prepubertal at the time of OTC. MAIN RESULTS AND THE ROLE OF CHANCE Indications for OTC were allogeneic SCT for leukaemia, myelodysplastic syndrome or benign haematological disorders, autologous SCT for lymphoma or sarcoma, and irradiation to the pelvis or to the spinal axis. The mean age at OTC of the 176 girls were 11.3 years. The two most prevalent diagnoses of the 176 girls were malignant tumours and malignant haematological diseases. Among the 32 prepubertal girls, 12 received high dose chemotherapy and either TBI prior to SCT or irradiation to the pelvis, abdomen or the spinal axis, 13 received high dose alkylating agents but no irradiation prior to SCT, six received alkylating agents as part of conventional chemotherapy and one patient had a genetic metabolic disorder and did not receive gonadotoxic treatment. Among these 32 girls, 23 did not undergo puberty spontaneously and thus received medical puberty induction. Among the nine girls, who went through spontaneous puberty, four had received high dose alkylating agents and five had received conventional chemotherapy. LIMITATIONS REASONS FOR CAUTION All information was retrieved retrospectively from patient records, and thus some information was not available. WIDER IMPLICATIONS OF THE FINDINGS OTC should be recommended to all young girls, who present a high risk of developing ovarian insufficiency and/or infertility following high dose chemotherapy and/or irradiation. STUDY FUNDING/COMPETING INTERESTS The Childhood Cancer Foundation (2012-2016) and the EU interregional project ReproHigh are thanked for having funded this study. They had no role in the study design, collection and analysis of the data or writing of the report. The authors have no conflict of interest to disclose.
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Affiliation(s)
- A K Jensen
- Laboratory of Reproductive Biology, Juliane Marie Centre, Section 5712, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - C Rechnitzer
- Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K T Macklon
- Fertility Clinic, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M R S Ifversen
- Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N Birkebæk
- Department of Paediatrics, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - N Clausen
- Department of Paediatrics, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - K Sørensen
- Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Growth and Reproduction, Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Fedder
- Fertility Clinic, Odense University Hospital, 5000 Odense, Denmark
| | - E Ernst
- Fertility Clinic, Aarhus University Hospital, Skejby, Denmark
| | - C Yding Andersen
- Laboratory of Reproductive Biology, Juliane Marie Centre, Section 5712, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Løvschal-Nielsen P, Clausen N, Meinert L. Children's disengagement from cancer care and treatment on the ward: an undesirable social tactic in the long term. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27283124 DOI: 10.1111/ecc.12519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
This anthropological study explores children's non-social reactions during the active treatment period, the on-treatment, in a paediatric oncology ward in a Danish university hospital. It is argued that, although some children's non-social reactions is a tactical disengagement to manage the on-treatment situation, such non-social tactics might ultimately prove an undesirable strategy with negative long-term social consequences for social survivorship. Data were generated over 7 months of ethnographic fieldwork between May 2011 and January 2013, using qualitative methods such as participant observation and open-ended interviewing. Fifty children of both sexes between 4 and 15 years, their families and hospital staff participated in the study. These data formed the basis for the study. The findings show that children's response to care challenges, including exhaustion from care management, exposure from being in a public space, and the open-ended duration of treatment, configure in tactic forms that we term social disengagement. It is suggested that such tactical social disengagement might expand into long-term social patterns, and, as such, change from an alleviating tactic to a socially isolating and damaging tactic for survivors of cancer in childhood.
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Affiliation(s)
| | - N Clausen
- Department of Pediatrics, University Hospital of Aarhus at Skejby, Aarhus, Denmark
| | - L Meinert
- Department of Anthropology, School of Culture and Society, Aarhus University, Aarhus, Denmark
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Clausen N, Petrini P, Claeyssens-Donadel S, Gouw SC, Liesner R. Similar bleeding phenotype in young children with haemophilia A or B: a cohort study. Haemophilia 2014; 20:747-55. [DOI: 10.1111/hae.12470] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2014] [Indexed: 11/27/2022]
Affiliation(s)
- N. Clausen
- Department of Pediatrics; University Hospital of Aarhus at Skejby; Aarhus Denmark
| | - P. Petrini
- Department of Pediatrics; Clinic of Coagulation Disorders; Karolinska Hospital; Stockholm Sweden
| | | | - S. C. Gouw
- Department of Pediatric Hematology; Emma Children's Hospital; Academic Medical Center; Amsterdam The Netherlands
| | - R. Liesner
- Haemophilia Comprehensive Care Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
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Panosyan E, Gotesman M, Kallay T, Martinez S, Bolaris M, Lasky J, Fouyssac F, Gentet JC, Frappaz D, Piguet C, Gorde-Grosjean S, Grill J, Schmitt E, Pall-Kondolff S, Chastagner P, Dudley R, Torok M, Gallegos D, Liu A, Handler M, Hankinson T, Dudley R, Torok M, Gallegos D, Liu A, Handler M, Hankinson T, Fukuoka K, Yanagisawa T, Suzuki T, Shirahata M, Adachi JI, Mishima K, Fujimaki T, Matsutani M, Sasaki A, Wada S, Nishikawa R, Suzuki M, Kondo A, Miyajima M, Arai H, Morin S, Uro-Coste E, Munzer C, Gambart M, Puget S, Miquel C, Maurage CA, Dufour C, Leblond P, Andre N, Kanold J, Icher C, Bertozzi AAI, Diez B, Muggeri A, Cerrato S, Calabrese B, Arakaki N, Marron A, Sevlever G, Fisher MJ, Widemann BC, Dombi E, Wolters P, Cantor A, Vinks A, Parentesis J, Ullrich N, Gutmann D, Viskochil D, Tonsgard J, Korf B, Packer R, Weiss B, Fisher MJ, Marcus L, Weiss B, Kim A, Dombi E, Baldwin A, Whitcomb P, Martin S, Gillespie A, Doyle A, Widemann BC, Bulwer C, Gan HW, Ederies A, Korbonits M, Powell M, Jeelani O, Jacques T, Stern E, Spoudeas H, Kimpo M, Tang J, Tan CL, Yeo TT, Chong QT, Ruland V, Hartung S, Kordes U, Wolff JE, Paulus W, Hasselblatt M, Patil S, Zaky W, Khatua S, Lassen-Ramshad Y, Christensen L, Clausen N, Bendel A, Dobyns W, Bennett J, Reyes-Mugica M, Petronio J, Nikiforova M, Mueller H, Kirches E, Korshunov A, Pfister S, Mawrin C, Hemenway M, Foreman N, Kumar A, Kalra S, Acharya R, Radhakrishnan N, Sachdeva A, Nimmervoll B, Hadjadj D, Tong Y, Shelat AA, Low J, Miller G, Stewart CF, Guy RK, Gilbertson RJ, Miwa T, Nonaka Y, Oi S, Sasaki H, Yoshida K, Northup R, Klesse L, McNall-Knapp R, Blagia M, Romeo F, Toscano S, D'Agostino A, Lafay-Cousin L, Lindzon G, Bouffet E, Taylor M, Hader W, Nordal R, Hawkins C, Laperriere N, Laughlin S, Shash H, McDonald P, Wrogemann J, Ahsanuddin A, Matsuda K, Soni R, Vanan MI, Cohen K, Taylor I, Rodriguez F, Burger P, Yeh J, Rao S, Iskandar B, Kienitz BA, Bruce R, Keller L, Salamat S, Puccetti D, Patel N, Hana A, Gunness VRN, Berthold C, Hana A, Bofferding L, Neuhaeuser C, Scalais E, Kieffer I, Feiden W, Graf N, Boecher-Schwarz H, Hertel F, Cruz O, Morales A, de Torres C, Vicente A, Gonzalez MA, Sunol M, Mora J, Garcia G, Guillen A, Muchart J, Yankelevich M, Sood S, Diver J, Savasan S, Poulik J, Bhambhani K, Hochart A, Gaillard V, Bonne NX, Baroncini M, Andre N, Vannier JP, Dubrulle F, Lejeune JP, Vincent C, Leblond P, Japp A, Gessi M, Muehlen AZ, Klein-Hitpass L, Pietsch T, Sharma M, Yadav R, Malgulwar PB, Pathak P, Sigamani E, Suri V, Sarkar C, Jagdevan A, Singh M, Sharma BS, Garg A, Bakhshi S, Faruq M, Doromal D, Villafuerte CJ, Tezcanli E, Yilmaz M, Sengoz M, Peker S, Dhall G, Robison N, Margol A, Evans A, Krieger M, Finlay J, Rosser T, Khakoo Y, Pratilas C, Marghoob A, Berger M, Hollmann T, Rosenblum M, Mrugala M, Giglio P, Keene C, Ferreira M, Garcia D, Weil A, Khatib Z, Diaz A, Niazi T, Bhatia S, Ragheb J, Robison N, Rangan K, Margol A, Rosser T, Finlay J, Dhall G, Gilles F, Morris C, Chen Y, Shetty V, Elbabaa S, Guzman M, Abdel-Baki MS, Abdel-Baki MS, Waguespack S, Jones J, Stapleton S, Baskin D, M, Okcu F. RARE TUMOURS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Classen CF, William D, Linnebacher M, Farhod A, Kedr W, Elsabe B, Fadel S, Van Gool S, De Vleeschouwer S, Koks C, Garg A, Ehrhardt M, Riva M, De Vleeschouwer S, Agostinis P, Graf N, Van Gool S, Yao TW, Yoshida Y, Zhang J, Ozawa T, James D, Nicolaides T, Kebudi R, Cakir FB, Gorgun O, Agaoglu FY, Darendeliler E, Van Gool S, De Vleeschouwer S, Al-Kofide A, Al-Shail E, Khafaga Y, Al-Hindi H, Dababo M, Haq AU, Anas M, Barria MG, Siddiqui K, Hassounah M, Ayas M, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Vugts D, Hoekstra O, van Dongen G, Kaspers G, Cockle J, Ilett E, Scott K, Bruning-Richardson A, Picton S, Short S, Melcher A, Benesch M, Warmuth-Metz M, von Bueren AO, Hoffmann M, Pietsch T, Kortmann RD, Eyrich M, Graf N, Rutkowski S, Fruhwald MC, Faber J, Kramm C, Porkholm M, Valanne L, Lonnqvist T, Holm S, Lannering B, Riikonen P, Wojcik D, Sehested A, Clausen N, Harila-Saari A, Schomerus E, Thorarinsdottir HK, Lahteenmaki P, Arola M, Thomassen H, Saarinen-Pihkala UM, Kivivuori SM, Buczkowicz P, Hoeman C, Rakopoulos P, Pajovic S, Morrison A, Bouffet E, Bartels U, Becher O, Hawkins C, Gould TWA, Rahman CV, Smith SJ, Barrett DA, Shakesheff KM, Grundy RG, Rahman R, Barua N, Cronin D, Gill S, Lowisl S, Hochart A, Maurage CA, Rocourt N, Vinchon M, Kerdraon O, Escande F, Grill J, Pick VK, Leblond P, Burzynski G, Janicki T, Burzynski S, Marszalek A, Ramani N, Zaky W, Kannan G, Morani A, Sandberg D, Ketonen L, Maher O, Corrales-Medina F, Meador H, Khatua S, Brassesco M, Delsin L, Roberto G, Silva C, Ana L, Rego E, Scrideli C, Umezawa K, Tone L, Kim SJ, Kim CY, Kim IA, Han JH, Choi BS, Ahn HS, Choi HS, Haque F, Rahman R, Layfield R, Grundy R, Gandola L, Pecori E, Biassoni V, Schiavello E, Chiruzzi C, Spreafico F, Modena P, Bach F, Pignoli E, Massimino M, Drogosiewicz M, Dembowska-Baginska B, Jurkiewicz E, Filipek I, Perek-Polnik M, Swieszkowska E, Perek D, Bender S, Jones DT, Warnatz HJ, Hutter B, Zichner T, Gronych J, Korshunov A, Eils R, Korbel JO, Yaspo ML, Lichter P, Pfister SM, Yadavilli S, Becher OJ, Kambhampati M, Packer RJ, Nazarian J, Lechon FC, Fowkes L, Khabra K, Martin-Retortillo LM, Marshall LV, Vaidya S, Koh DM, Leach MO, Pearson AD, Zacharoulis S, Lechon FC, Fowkes L, Khabra K, Martin-Retortillo LM, Marshall LV, Schrey D, Barone G, Vaidya S, Koh DM, Pearson AD, Zacharoulis S, Panditharatna E, Stampar M, Siu A, Gordish-Dressman H, Devaney J, Kambhampati M, Hwang EI, Packer RJ, Nazarian J, Chung AH, Mittapalli RK, Elmquist WF, Becher OJ, Castel D, Debily MA, Philippe C, Truffaux N, Taylor K, Calmon R, Boddaert N, Le Dret L, Saulnier P, Lacroix L, Mackay A, Jones C, Puget S, Sainte-Rose C, Blauwblomme T, Varlet P, Grill J, Entz-Werle N, Maugard C, Bougeard G, Nguyen A, Chenard MP, Schneider A, Gaub MP, Tsoli M, Vanniasinghe A, Luk P, Dilda P, Haber M, Hogg P, Ziegler D, Simon S, Tsoli M, Vanniasinghe A, Monje M, Gurova K, Gudkov A, Haber M, Ziegler D, Zapotocky M, Churackova M, Malinova B, Zamecnik J, Kyncl M, Tichy M, Puchmajerova A, Stary J, Sumerauer D, Boult J, Vinci M, Taylor K, Perryman L, Box G, Jury A, Popov S, Ingram W, Monje M, Eccles S, Jones C, Robinson S, Emir S, Demir HA, Bayram C, Cetindag F, Kabacam GB, Fettah A, Boult J, Li J, Vinci M, Jury A, Popov S, Jamin Y, Cummings C, Eccles S, Bamber J, Sinkus R, Jones C, Robinson S, Nandhabalan M, Bjerke L, Vinci M, Burford A, Ingram W, Mackay A, von Bueren A, Baudis M, Clarke P, Collins I, Workman P, Jones C, Taylor K, Mackay A, Vinci M, Popov S, Ingram W, Entz-Werle N, Monje M, Olaciregui N, Mora J, Carcaboso A, Bullock A, Jones C, Vinci M, Mackay A, Burford A, Taylor K, Popov S, Ingram W, Monje M, Alonso M, Olaciregui N, de Torres C, Cruz O, Mora J, Carcaboso A, Jones C, Filipek I, Drogosiewicz M, Perek-Polnik M, Swieszkowska E, Dembowska-Baginska B, Jurkiewicz E, Perek D, Nguyen A, Pencreach E, Mackay A, Moussalieh FM, Guenot D, Namer I, Chenard MP, Jones C, Entz-Werle N, Pollack I, Jakacki R, Butterfield L, Hamilton R, Panigrahy A, Potter D, Connelly A, Dibridge S, Whiteside T, Okada H, Ahsan S, Raabe E, Haffner M, Warren K, Quezado M, Ballester L, Nazarian J, Eberhart C, Rodriguez F, Ramachandran C, Nair S, Quirrin KW, Khatib Z, Escalon E, Melnick S, Classen CF, Hofmann M, Schmid I, Simon T, Maass E, Russo A, Fleischhack G, Becker M, Hauch H, Sander A, Kramm C, Grasso C, Truffaux N, Berlow N, Liu L, Debily MA, Davis L, Huang E, Woo P, Tang Y, Ponnuswami A, Chen S, Huang Y, Hutt-Cabezas M, Warren K, Dret L, Meltzer P, Mao H, Quezado M, van Vuurden D, Abraham J, Fouladi M, Svalina MN, Wang N, Hawkins C, Raabe E, Hulleman E, Li XN, Keller C, Spellman PT, Pal R, Grill J, Monje M, Jansen MHA, Sewing ACP, Lagerweij T, Vuchts DJ, van Vuurden DG, Caretti V, Wesseling P, Kaspers GJL, Hulleman E, Cohen K, Raabe E, Pearl M, Kogiso M, Zhang L, Qi L, Lindsay H, Lin F, Berg S, Li XN, Muscal J, Amayiri N, Tabori U, Campbel B, Bakry D, Aronson M, Durno C, Gallinger S, Malkin D, Qaddumi I, Musharbash A, Swaidan M, Bouffet E, Hawkins C, Al-Hussaini M, Rakopoulos P, Shandilya S, McCully C, Murphy R, Akshintala S, Cole D, Macallister RP, Cruz R, Widemann B, Warren K, Salloum R, Smith A, Glaunert M, Ramkissoon A, Peterson S, Baker S, Chow L, Sandgren J, Pfeifer S, Popova S, Alafuzoff I, de Stahl TD, Pietschmann S, Kerber MJ, Zwiener I, Henke G, Kortmann RD, Muller K, von Bueren A, Sieow NYF, Hoe RHM, Tan AM, Chan MY, Soh SY, Hawkins C, Burrell K, Chornenkyy Y, Remke M, Golbourn B, Buczkowicz P, Barzczyk M, Taylor M, Rutka J, Dirks P, Zadeh G, Agnihotri S, Hashizume R, Ihara Y, Andor N, Chen X, Lerner R, Huang X, Tom M, Solomon D, Mueller S, Petritsch C, Zhang Z, Gupta N, Waldman T, James D, Dujua A, Co J, Hernandez F, Doromal D, Hegde M, Wakefield A, Brawley V, Grada Z, Byrd T, Chow K, Krebs S, Heslop H, Gottschalk S, Yvon E, Ahmed N, Truffaux N, Philippe C, Cornilleau G, Paulsson J, Andreiuolo F, Guerrini-Rousseau L, Puget S, Geoerger B, Vassal G, Ostman A, Grill J, Parsons DW, Lin F, Trevino LR, Gao F, Shen X, Hampton O, Lindsay H, Kosigo M, Qi L, Baxter PA, Su JM, Chintagumpala M, Dauser R, Adesina A, Plon SE, Li XN, Wheeler DA, Lau CC, Pietsch T, Gielen G, Muehlen AZ, Kwiecien R, Wolff J, Kramm C, Lulla RR, Laskowski J, Goldman S, Gopalakrishnan V, Fangusaro J, Mackay A, Taylor K, Vinci M, Jones C, Kieran M, Fontebasso A, Papillon-Cavanagh S, Schwartzentruber J, Nikbakht H, Gerges N, Fiset PO, Bechet D, Faury D, De Jay N, Ramkissoon L, Corcoran A, Jones D, Sturm D, Johann P, Tomita T, Goldman S, Nagib M, Bendel A, Goumnerova L, Bowers DC, Leonard JR, Rubin JB, Alden T, DiPatri A, Browd S, Leary S, Jallo G, Cohen K, Prados MD, Banerjee A, Carret AS, Ellezam B, Crevier L, Klekner A, Bognar L, Hauser P, Garami M, Myseros J, Dong Z, Siegel PM, Gump W, Ayyanar K, Ragheb J, Khatib Z, Krieger M, Kiehna E, Robison N, Harter D, Gardner S, Handler M, Foreman N, Brahma B, MacDonald T, Malkin H, Chi S, Manley P, Bandopadhayay P, Greenspan L, Ligon A, Albrecht S, Pfister SM, Ligon KL, Majewski J, Gupta N, Jabado N, Hoeman C, Cordero F, Halvorson K, Hawkins C, Becher O, Taylor I, Hutt M, Weingart M, Price A, Nazarian J, Eberhart C, Raabe E, Kantar M, Onen S, Kamer S, Turhan T, Kitis O, Ertan Y, Cetingul N, Anacak Y, Akalin T, Ersahin Y, Mason G, Nazarian J, Ho C, Devaney J, Stampar M, Kambhampati M, Crozier F, Vezina G, Packer R, Hwang E, Gilheeney S, Millard N, DeBraganca K, Khakoo Y, Kramer K, Wolden S, Donzelli M, Fischer C, Petriccione M, Dunkel I, Afzal S, Carret AS, Fleming A, Larouche V, Zelcer S, Johnston DL, Kostova M, Mpofu C, Decarie JC, Strother D, Lafay-Cousin L, Eisenstat D, Fryer C, Hukin J, Bartels U, Bouffet E, Hsu M, Lasky J, Moore T, Liau L, Davidson T, Prins R, Fouladi M, Bartels U, Warren K, Hassal T, Baugh J, Kirkendall J, Doughman R, Leach J, Jones B, Miles L, Hawkins C, Bouffet E, Hargrave D, Grill J, Jones C, Jacques T, Savage S, Goldman S, Leary S, Packer R, Saunders D, Wesseling P, Varlet P, van Vuurden D, Wallace R, Flutter B, Morgenestern D, Hargrave D, Blanco E, Howe K, Lowdell M, Samuel E, Michalski A, Anderson J, Arakawa Y, Umeda K, Watanabe KI, Mizowaki T, Hiraoka M, Hiramatsu H, Adachi S, Kunieda T, Takagi Y, Miyamoto S, Venneti S, Santi M, Felicella MM, Sullivan LM, Dolgalev I, Martinez D, Perry A, Lewis PW, Allis DC, Thompson CB, Judkins AR. HIGH GRADE GLIOMAS AND DIPG. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Saulyte Trakymiene S, Clausen N, Poulsen LH, Ingerslev J, Rageliene L. Progression of haemophilic arthropathy in children: a Lithuanian--Danish comparative study. Haemophilia 2012; 19:212-8. [PMID: 23167920 DOI: 10.1111/hae.12058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/29/2022]
Abstract
Recurrent bleeding into joints initiates a sequence of events leading to a progressive joint damage in people with severe haemophilia. This is a continuous process during childhood and adolescence, therefore joint abnormalities may be minimal on physical examination in very young children - even those receiving on-demand treatment. The aim of our study was to quantify the burden of arthropathy in Lithuanian patients who had been treated exclusively by on-demand substitution and compare their physical joint health with age-matched Danish patients who received prophylaxis from an early age. Boys, aged 4-17 years, with severe haemophilia and no signs of inhibitors were included in the study. Joint outcome based on the Haemophilia Joint Health Score (HJHS) was analysed in two different treatment groups and compared within the matched pairs. In total, 32 (16 in each treatment group) patients were enroled. A total of 192 joints were evaluated. Joint status according to treatment strategy was strikingly different: 27.4 for on-demand vs. 3.3 for prophylaxis (<0.001) group. Significance of the difference in joint status comparing different treatment strategies was equally strong both in younger (4-9 years) and older (10-17 years) patient groups: 2.2 vs. 12.5 (P = 0.0002) and 3.9 vs. 36.3 (P < 0.0001) respectively. The results further demonstrate the unequivocal effect of prophylaxis on joint status and give an insight into early and late manifestations of joint impairment based on the HJHS in haemophilia patients with treatment on-demand compared with joint changes that may develop over the time with the preventative treatment.
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Affiliation(s)
- S Saulyte Trakymiene
- Clinic of Children's Diseases, Vilnius University and Centre for Pediatric Hematology/Oncology, Children's Hospital, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
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Lins PE, Adamson U, Clausen N, Hamberger B, Efendić S. The role of glucagon, catecholamines and cortisol in counterregulation of insulin-induced hypoglycemia in normal man. Acta Med Scand 2009; 220:39-46. [PMID: 2876589 DOI: 10.1111/j.0954-6820.1986.tb02728.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To study the response of glucose counterregulation to insulin-induced hypoglycemia, six normals were given a 4-hour infusion of insulin (2.4 U/h) +/- somatostatin (50 micrograms/h). Supplementary glucagon (1.5 or 3.0 ng/kg/min) was given in additional experiments. In a separate study, glucagon was supplemented for 4 hours as a constant rate infusion (3.25 ng/kg/min) or at rates stepwise increasing from 1.5 to 5.0 ng/kg/min. Insulin decreased blood glucose by 1.5 mmol/l and simultaneous suppression of glucagon resulted in a more pronounced hypoglycemia enhancing the adrenaline and cortisol responses. The hyperglycemic effect of glucagon substitution (3 ng/kg/min) faded out after about 2 hours, whereafter exaggerated adrenaline and cortisol responses to hypoglycemia were seen. A comparison between the effects of steady state hyperglucagonemia and gradually appearing hyperglucagonemia on the counterregulation of hypoglycemia revealed no significant differences in glucose, adrenaline and cortisol responses to insulin. It is concluded that the glycemic effect of glucagon is transient in the hypoglycemic state. When the hepatic responsiveness to this hormone is decreased during hypoglycemia, adrenaline becomes the essential protective factor.
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Lins PE, Clausen N, Adamson U, Kollind M, Hamberger B, Efendic S. Effect of improved glycemic control by continuous subcutaneous insulin infusion on hormonal responses to insulin-induced hypoglycemia in type 1 diabetics. Acta Med Scand 2009; 218:111-8. [PMID: 4050545 DOI: 10.1111/j.0954-6820.1985.tb08833.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Glucose counter-regulatory capacity and the hormonal responses to insulin-induced hypoglycemia were studied in eight type 1 diabetics before and after improvement of metabolic control by continuous subcutaneous insulin infusion (CSII). The intensified treatment resulted in a decrease in mean glycosylated hemoglobin from 11.6 +/- 0.5 to 9.3 +/- 0.4% within a mean period of 14 weeks. During a constant rate infusion of insulin (2.4 U/h), steady state levels of glucose appeared in all subjects. The steady state glucose level was identical before and after CSII. The counter-regulatory hormonal responses showed significantly higher epinephrine levels, while glucagon, growth hormone, and cortisol were not influenced. In parallel with the heightened epinephrine response the pulse rate response was significantly enhanced. The restitution of blood glucose after insulin hypoglycemia was not modified. It is concluded that a more vigorous catecholaminergic response to hypoglycemia is achieved after improved metabolic control by CSII.
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Ingerslev J, Herlin T, Sørensen B, Clausen N, Chu KC, High KA. Severe factor X deficiency in a pair of siblings: clinical presentation, phenotypic and genotypic features, prenatal diagnosis and treatment. Haemophilia 2007; 13:334-6. [PMID: 17498086 DOI: 10.1111/j.1365-2516.2007.01466.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lie SO, Abrahamsson J, Clausen N, Forestier E, Hasle H, Hovi L, Jonmundsson G, Mellander L, Siimes MA, Yssing M, Zeller B, Gustafsson G. Long-term results in children with AML: NOPHO-AML Study Group--report of three consecutive trials. Leukemia 2006; 19:2090-100. [PMID: 16304571 DOI: 10.1038/sj.leu.2403962] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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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Affiliation(s)
- S O Lie
- Department of Pediatrics, University Hospital, Rikshospitalet, Oslo, Norway
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Hertel NT, Carlsen N, Kerndrup G, Pedersen IL, Clausen N, Hahnemann JMD, Jacobsen BB. Late relapse of adrenocortical carcinoma in Beckwith-Wiedemann syndrome. Clinical, endocrinological and genetic aspects. Acta Paediatr 2003; 92:439-43. [PMID: 12801110 DOI: 10.1111/j.1651-2227.2003.tb00575.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED We report on a girl with an unusual Beckwith-Wiedemann syndrome (BWS) and hemihypertrophy, who developed an adrenocortical carcinoma with atypical clinical behaviour. At 4 y of age the girls was admitted to hospital with cushingoid features, virilization, increased excretion of steroids and low serum ACTH. A right-sided adrenocortical carcinoma was removed. At age 12.5 y the cushingoid features reappeared together with a tumour in the left thigh. A CT scan of the thorax and abdomen revealed pulmonary metastasis only. Corticosteroid excretion was increased and serum ACTH level suppressed. The femoral and the pulmonary metastases were removed and histology showed adrenocortical carcinoma. Excretion of corticosteroids subsequently normalized. Meningeal and pulmonary metastases with similar histologies appeared one year later with normal hormone values. Twenty-two months after the recurrence the girl died of an intracranial metastasis. Southern blot analysis of the LITI transcript in the KvLQT1 gene in the BWS region on chromosome 11p15 revealed hypomethylation of the maternal allele. CONCLUSION Adrenocortical carcinoma in childhood may recur years after onset and at rare sites and hormonal levels may be an insufficient indicator of small metastases.
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Affiliation(s)
- N T Hertel
- Department of Paediatrics, Odense University Hospital, Odense, Denmark.
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Hjalgrim LL, Madsen HO, Melbye M, Jørgensen P, Christiansen M, Andersen MT, Pallisgaard N, Hokland P, Clausen N, Ryder LP, Schmiegelow K, Hjalgrim H. Presence of clone-specific markers at birth in children with acute lymphoblastic leukaemia. Br J Cancer 2002; 87:994-9. [PMID: 12434291 PMCID: PMC2364323 DOI: 10.1038/sj.bjc.6600601] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2002] [Revised: 07/12/2002] [Accepted: 08/05/2002] [Indexed: 11/26/2022] Open
Abstract
Recent studies have suggested that development of childhood acute lymphoblastic leukaemia may often be initiated in utero. To provide further evidence of an prenatal origin of childhood leukaemia, we conducted a molecular biological investigation of nine children with B-precursor acute lymphoblastic leukaemia carrying the chromosomal translocation t(12;21), the most common subtype of all childhood acute lymphoblastic leukaemia. Specifically, for each child we identified the non-constitutive chromosomal sequences made up by the t(12;21) fusion gene. From these, leukaemia clone-specific DNA primers were constructed and applied in nested polymerase chain reaction analyses of DNA extracted from the patients' Guthrie cards obtained at birth. Leukaemia clone-specific fusion gene regions were demonstrated in Guthrie card DNA of three patients, age 2 years 11 months, 3 years 4 months, and 5 years 8 months at leukaemia diagnosis. Our findings are consistent with previous observations, and thus provide further evidence that the development of t(12;21) B-precursor acute lymphoblastic leukaemia may be initiated in utero. Review of the current literature moreover indicates that age at leukaemia may be inversely correlated with the burden of cells with leukaemia clonal markers, i.e. leukaemia predisposed cells at birth, and that certain types of childhood acute lymphoblastic leukaemia develop as a multiple step process involving both pre- and postnatal genetic events.
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MESH Headings
- Adolescent
- Base Sequence
- Biomarkers, Tumor/genetics
- Blood Specimen Collection
- Child
- Child, Preschool
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 21/genetics
- Core Binding Factor Alpha 2 Subunit
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Female
- Gene Rearrangement
- Genes, Immunoglobulin
- Genetic Predisposition to Disease
- Humans
- Infant
- Infant, Newborn
- Male
- Mannose-Binding Lectin/genetics
- Mannose-Binding Lectin/metabolism
- Molecular Sequence Data
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Polymerase Chain Reaction
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Translocation, Genetic/genetics
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Affiliation(s)
- L L Hjalgrim
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Artillerivej 5, DK- 2300 Copenhagen S, Denmark
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16
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Eldrup E, Clausen N, Scherling B, Schmiegelow K. Evaluation of plasma 3,4-dihydroxyphenylacetic acid (DOPAC) and plasma 3,4-dihydroxyphenylalanine (DOPA) as tumor markers in children with neuroblastoma. Scand J Clin Lab Invest 2002; 61:479-90. [PMID: 11681538 DOI: 10.1080/00365510152567121] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Catecholamines and their metabolites are important in the diagnosis of neuroblastoma (NB). Plasma (p-) levels of 3,4-dihydroxyphenylalanine (DOPA) are increased in most NB, probably reflecting decreased DOPA decarboxylase activity. Urine (u-) homovanillic acid (HVA), a DOPA and dopamine (DA) metabolite. is also increased in most NB. DOPAC (3,4-dihydroxyphenylacetic acid) is an important metabolite of DA in tissues with monoamine oxidase (MAO) activity. Because MAO is expressed in NB tumor cells, we studied the importance of measuring p-DOPAC and p-DOPA as compared to u-HVA and u-vanillylmandelic acid (VMA) in the diagnosis and follow-up of NB. DOPAC, DOPA, dopamine, noradrenaline, adrenaline, VMA and HVA were measured by reverse-phase HPLC with electrochemical detection in 106 children (28 with NB (13 newly diagnosed), 25 with other solid tumors, 28 hospitalized for nonneoplastic diseases, and 25 healthy children). P-DOPAC or p-DOPA concentrations were above the upper normal range in 92% of untreated NB patients, as were u-HVA or u-VMA levels. None of these tumor markers was correlated to tumor stage or survival. P-DOPA but not p-DOPAC was correlated to age in NB children. Increased values of p-DOPAC and p-DOPA were found in one patient surviving NB for 10 years. Plasma DOPAC concentrations were decreased in children hospitalized for non-NB diseases, probably reflecting reduced food intake. Plasma analyses of DOPA and DOPAC seem to be useful alternatives in the diagnosis and follow-up of NB if urine sampling is to be avoided. Plasma DOPAC may be an index of nutritional status in various diseases.
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Affiliation(s)
- E Eldrup
- Department of Internal Medicine E. Herlev Hospital, University of Copenhagen, Denmark.
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17
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Andersen MT, Nordentoft I, Hjalgrim LL, Christiansen CL, Jakobsen VD, Hjalgrim H, Pallisgaard N, Madsen HO, Christiansen M, Ryder LP, Clausen N, Hokland P, Schmiegelow K, Melbye M, Jørgensen P. Characterization of t(12;21) breakpoint junctions in acute lymphoblastic leukemia. Leukemia 2001; 15:858-9. [PMID: 11368451 DOI: 10.1038/sj.leu.2402095] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2000] [Accepted: 01/19/2001] [Indexed: 11/09/2022]
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18
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Gustafsson G, Schmiegelow K, Forestier E, Clausen N, Glomstein A, Jonmundsson G, Mellander L, Mäkipernaa A, Nygaard R, Saarinen-Pihkala UM. Improving outcome through two decades in childhood ALL in the Nordic countries: the impact of high-dose methotrexate in the reduction of CNS irradiation. Nordic Society of Pediatric Haematology and Oncology (NOPHO). Leukemia 2000; 14:2267-75. [PMID: 11187918 DOI: 10.1038/sj.leu.2401961] [Citation(s) in RCA: 223] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this population-based material from the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), 2860 children below 15 years of age were diagnosed with acute lymphoblastic leukemia (ALL) from July 1981 to June 1998. The annual incidence was 3.9/100,000 children and was stable throughout the study period. The development from regional or national protocols to common Nordic treatment protocols for all risk groups was completed in 1992 through a successive intensification with multidrug chemotherapy, including pulses of methotrexate in high doses and avoidance of cranial irradiation in most children. The overall event-free survival (EFS) at 5 years has increased from 56.5 +/- 1.7% in the early 1980s to 77.6 +/- 1.4% during the 1990s. The main improvements were seen in children with non-high risk leukemia. In high-risk patients, progress has been moderate, especially in children with high WBC (> or =100 x 10(9)/l) at diagnosis. During the last time period (January 1992-June 1998), only 10% of the patients have received cranial irradiation in first remission, while 90% of the patients have received pulses of high dose methotrexate (5-8 g/m2) isolated or combined with high-dose cytosine arabinoside (total dose 12 g/m2) plus multiple intrathecal injections of methotrexate as CNS-targeted treatment, not translating into increased cumulative incidence of CNS relapse.
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Affiliation(s)
- G Gustafsson
- Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
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19
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Pedersen B, Nørgaard JM, Pedersen BB, Clausen N, Rasmussen IH, Thorling K. Many unbalanced translocations show duplication of a translocation participant. Clinical and cytogenetic implications in myeloid hematologic malignancies. Am J Hematol 2000; 64:161-9. [PMID: 10861810 DOI: 10.1002/1096-8652(200007)64:3<161::aid-ajh4>3.0.co;2-q] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
If a translocation is followed by loss of one of the two derivative chromosomes, the result is an unbalanced translocation, showing monosomy for the segments making up the lost derivative. We have found that in most unbalanced translocations, a third event takes place: a morphologically normal copy of one of the two translocation participants is added to the karyotype. This creates a complex abnormal karyotype with monosomy, disomy, and trisomy for different segments of the translocation participants. We have examined 82 unbalanced translocations from 77 patients, 73 of whom had a myeloid hemopoietic malignancy. Acquisition of a normal copy of a translocation participant was found in 49 translocations. Twenty-five of these showed trisomy for 1q. In 16 of the 25 1q-trisomic cases the translocation was t(1;7)(q10;p10) (trisomy for 1q and monosomy for 7q). Patients with trisomy for 1q were younger than the remaining patients. Whereas those with t(1;7))(q10;p10) showed brief survivals, those with trisomy 1q but monosomy for regions other than 7q survived longer than the remaining patients. We conclude that most unbalanced translocations involve a partial trisomy, that 1q is trisomic far more frequently than any other segment, and that partial trisomy is associated with patient age and survival.
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Affiliation(s)
- B Pedersen
- Department of Cytogenetics, Danish Cancer Society, Tage Hansens Gade 2, Aarhus, Denmark.
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20
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Pallisgaard N, Clausen N, Schroder H, Hokland P. Rapid and sensitive minimal residual disease detection in acute leukemia by quantitative real-time RT-PCR exemplified by t(12;21) TEL-AML1 fusion transcript. Genes Chromosomes Cancer 1999; 26:355-65. [PMID: 10534771 DOI: 10.1002/(sici)1098-2264(199912)26:4<355::aid-gcc10>3.0.co;2-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Because previous PCR-based methodologies for detection of minimal residual disease (MRD) in leukemia patients have been too cumbersome to allow for widespread clinical usefulness, we have employed a real-time quantitative PCR (RQ-PCR) system to develop an MRD assay for t(12;21). We initially determined the expression of the different alternatively spliced TEL-AML1 mRNAs found in t(12;21) breakpoint variants I and II. We then optimized PCR primers for the RQ-PCR system and, using the t(12;21)+ REH cell line in spiking experiments, found a linear detection of TEL-AML1 over at least five logs. Moreover, 1 malignant cell in a background of 1,000,000 normal cells could be detected. The expression of the GAPDH, ABL, and beta(2)-microglobulin (beta2M) housekeeping genes were then compared in normal donors and in leukemic patients, and the very stably expressed beta2M was selected as an internal reference gene, allowing us to compensate for variation in RNA quality and day-to-day variation. In 12 samples from t(12;21)-positive patients at diagnosis, the levels of the TEL-AML1 fusion transcripts were found to vary up to 14-fold after normalization to beta2M. Interestingly, in samples obtained from seven patients at diagnosis, during induction chemotherapy, or relapse, the level of TEL-AML1 in peripheral blood (PB) and bone marrow (BM) was found to differ only by threefold, suggesting that MRD may be evaluated in PB samples in most patients. We conclude that this assay could set new standards for t(12;21) MRD detection with its accuracy, its high throughput, and its short turnover time for samples. Genes Chromosomes Cancer 26:355-365, 1999.
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MESH Headings
- Bone Marrow
- Child
- Child, Preschool
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 21
- Core Binding Factor Alpha 2 Subunit
- DNA Primers
- DNA, Neoplasm/metabolism
- Female
- Humans
- Infant
- Male
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- RNA, Neoplasm/isolation & purification
- RNA, Neoplasm/metabolism
- Reference Values
- Reverse Transcriptase Polymerase Chain Reaction/instrumentation
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Sensitivity and Specificity
- Translocation, Genetic/genetics
- beta 2-Microglobulin/genetics
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Affiliation(s)
- N Pallisgaard
- Department of Hematology, Arhus University Hospital, Arhus, Denmark
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21
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Abstract
Three siblings with Morquo's syndrome are described. Cultured fibroblasts from the youngest sibling demonstrated a total absence of N-acethylgalactosamine-6-sulphate-sulphatase whereas beta-galactocidase activity was normal, thus verifying the diagnosis of MPS-IV A. Dental features such as pointed cusps, spade-shaped incisors, thin enamel and pitted buccal surfaces were observed in all three children. Furthermore, in all three siblings the TMJ was affected with severe resorption of the head of the condyle. Histological examination of exfoliated primary molars showed a band of increased porosity following the striae of Retzius in the outer part of the enamel. These developmental disturbances were occasionally associated with minor localized defects in the enamel surface. The importance of close monitoring of dental development and regular dental care in order to prevent attrition of the teeth, loss of vertical face height and subsequent risk of TMJ dysfunction is emphasized.
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Affiliation(s)
- I Rølling
- Department of Oral and Maxillo-facial Surgery, Aarhus University and University Hospital, Denmark
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22
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Nørgaard JM, Jensen PD, Bendix K, Clausen N, Palshof T. Relevance of in vitro leukaemia cell survival to short- and long term clinical outcome in AML. Leuk Lymphoma 1999; 32:327-37. [PMID: 10037030 DOI: 10.3109/10428199909167393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In ninety-three cases of newly diagnosed acute myeloid leukaemia (AML) we investigated the importance to short- and long term clinical outcome of the in vitro short term leukaemia cell survival as measured by a 4-day MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide)-assay. In 67 patients treated by intravenous remission induction therapy we found that patients who after the first induction cycle or after induction therapy overall achieved a complete remission (CR) had leukaemia cells with significantly lower in vitro cell survival ability than cells of non-responders (p = 0.02 and 0.06, respectively). These relations remained statistically significant in subsequent multivariate analyses. Likewise, a favourable effect of low in vitro leukaemia cell survival on overall survival of the patients was detected in the (largest) subgroup of adult patients treated uniformly by the same remission induction regimen as well as in all patients. However, in the 44 patients, who achieved CR, the in vitro leukaemia cell survival did not show significance to remission duration or time to first relapse. Furthermore, the leukaemia cell survival (MTT-assay) did not to correlate with the Bcl-2 expression level (quantitative flow cytometry) of the leukaemia cells (r = 0.18, n = 34, p = 0.32). In addition, in a cell line model employing the growth factor dependent MO7 human AML cell line, growth factor withdrawal was associated with rapid onset of cellular apoptosis as evaluated by morphology, occurrence of a subG1 peak in DNA histograms, and loss of cellular activity in the MTT-assay. In contrast, a more moderate decline in Bcl-2 expression and gradual loss of ability to exclude the trypan blue dye was seen in the leukaemia cells in response to growth factor withdrawal. We conclude, that the MTT-assay provides a simple and sensitive method for measuring in vitro cell survival. The differences in leukaemia cell survival seen in AML may well be clinically relevant and may help to provide a better understanding of clinical drug resistance.
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Affiliation(s)
- J M Nørgaard
- Department of Medicine and Hematology, Aarhus University Hospital, Denmark
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23
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Gustafsson G, Kreuger A, Clausen N, Garwicz S, Kristinsson J, Lie SO, Moe PJ, Perkkiö M, Yssing M, Saarinen-Pihkala UM. Intensified treatment of acute childhood lymphoblastic leukaemia has improved prognosis, especially in non-high-risk patients: the Nordic experience of 2648 patients diagnosed between 1981 and 1996. Nordic Society of Paediatric Haematology and Oncology (NOPHO). Acta Paediatr 1998; 87:1151-61. [PMID: 9846917 DOI: 10.1080/080352598750031149] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
In a multinational, population-based study from the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), 2648 children below 15 y of age were diagnosed with acute lymphoblastic leukaemia (ALL) in the years 1981-1996. The annual incidence was 3.9/100000 children and was stable throughout the study period. The development from regional or national protocols to common Nordic treatment protocols for all risk groups was completed in 1992 through a successive intensification of therapy, based on multidrug chemotherapy including pulses of methotrexate in high doses and avoidance of cranial irradiation in most children. For children with non-B-cell ALL (n=2602), the event-free survival (p-EFS) increased from 0.53+/-0.02 (diagnosed 7/81-6/86) to 0.67+/-0.02 (7/86-12/91) to 0.78+/-0.02 (1/92-12/96). The corresponding p-EFS values at 5 y were 0.57, 0.70 and 0.78, respectively. The main improvements were seen in the group of children with non-high risk leukaemia, with 5-y p-EFS values increasing from 0.60 to 0.76 and 0.85 for the three periods. In high-risk patients, progress has been moderate, especially in children with high white blood cell values at diagnosis. During the last 5-y period, only 10% of the patients received cranial irradiation in first remission while 90% of the patients received high doses of cytostatic infusions (methotrexate isolated or combined with cytarabinoside) and multiple intrathecal injections of methotrexate as CNS-adjusted treatment without any indication of an increased CNS relapse rate.
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Affiliation(s)
- G Gustafsson
- Childhood Cancer Research Unit, Karolinska Hospital, Stockholm, Sweden
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24
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Clausen N. [Leukemia in children]. Ugeskr Laeger 1998; 160:5471. [PMID: 9763917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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25
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Karadima G, Bugge M, Nicolaidis P, Vassilopoulos D, Avramopoulos D, Grigoriadou M, Albrecht B, Passarge E, Annerén G, Blennow E, Clausen N, Galla-Voumvouraki A, Tsezou A, Kitsiou-Tzeli S, Hahnemann JM, Hertz JM, Houge G, Kuklík M, Macek M, Lacombe D, Miller K, Moncla A, López Pajares I, Patsalis PC, Petersen MB. Origin of nondisjunction in trisomy 8 and trisomy 8 mosaicism. Eur J Hum Genet 1998; 6:432-8. [PMID: 9801867 DOI: 10.1038/sj.ejhg.5200212] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Causes of chromosomal nondisjunction is one of the remaining unanswered questions in human genetics. In order to increase our understanding of the mechanisms underlying nondisjunction we have performed a molecular study on trisomy 8 and trisomy 8 mosaicism. We report the results on analyses of 26 probands (and parents) using 19 microsatellite DNA markers mapping along the length of chromosome 8. The 26 cases represented 20 live births, four spontaneous abortions, and two prenatal diagnoses (CVS). The results of the nondisjunction studies show that 20 cases (13 maternal, 7 paternal) were probably due to mitotic (postzygotic) duplication as reduction to homozygosity of all informative markers was observed and as no third allele was ever detected. Only two cases from spontaneous abortions were due to maternal meiotic nondisjunction. In four cases we were not able to detect the extra chromosome due to a low level of mosaicism. These results are in contrast to the common autosomal trisomies (including mosaics), where the majority of cases are due to errors in maternal meiosis.
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Affiliation(s)
- G Karadima
- Department of Genetics, Institute of Child Health, Athens, Greece
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26
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Abstract
OBJECTIVE To assess height and body mass index standard deviation scores up to 20 years after treatment for acute lymphoblastic leukaemia (ALL). SUBJECTS AND METHODS Height and body mass index standard deviation scores were measured in 33 patients (14 boys and 19 girls) with childhood ALL at diagnosis, after the end of treatment, at final height, and at follow up 10-20 years (median, 16.2) after diagnosis. Eleven patients were treated with chemotherapy only and 22 patients were treated with chemotherapy and cranial irradiation. RESULTS In the chemotherapy only group, height standard deviation scores were the same at follow up as at diagnosis, but there was a significant decrease in height standard deviation scores during treatment. Mean body mass index standard deviation scores increased steadily from the start of treatment until final height and continued to increase from final height until follow up. In the cranially irradiated group, mean height standard deviation scores decreased steadily from the start of treatment until follow up. Mean body mass index standard deviation scores increased continuously from the start of treatment until final height and from final height until follow up. CONCLUSION Chemotherapy combined with cranial irradiation and chemotherapy alone might be persisting risk factors for obesity even after final/height has been attained in patients treated for childhood ALL. Chemotherapy is a risk factor for reduced final height only when administered in combination with cranial irradiation. These problems need to be recognised and dealt with at follow up examination.
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Affiliation(s)
- N H Birkebaek
- Department of Pediatrics, University Hospital of Aarhus at Skejby, Denmark
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27
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Birkebaek NH, Fisker S, Clausen N, Tuovinen V, Sindet-Pedersen S, Christiansen JS. Growth and endocrinological disorders up to 21 years after treatment for acute lymphoblastic leukemia in childhood. Med Pediatr Oncol 1998; 30:351-6. [PMID: 9589084 DOI: 10.1002/(sici)1096-911x(199806)30:6<351::aid-mpo9>3.0.co;2-d] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Our aim was to evaluate endocrinological status 10-21 years after treatment for childhood acute lymphoblastic leukemia (ALL) with chemotherapy (C) and cranial irradiation (C + I) or only C, and to correlate the endocrine data with growth parameters. PROCEDURE Of 30 patients (15 females and 15 males), 18 were treated with C + I and 12 were treated with C only. Height standard deviation score (HSDS) and body mass index standard deviation score (BMISDS) before treatment, at end of treatment, and at follow-up were calculated from height and weight registered from the charts. At follow-up examinations, provocative growth hormone (GH) tests (clonidine and insulin tolerance test) and an ACTH test were performed. Furthermore, blood samples for hormonal analysis, IGF-I, IGFBP-3, GHBP, and leptin were drawn. RESULTS Eleven patients (9 treated with C + I and 2 treated with C) showed insufficient response to GH tests. Two patients had hypogonadism. HSDS and IGF-I were significantly lower and GHBP significantly higher in GH-deficient patients compared to the group with normal GH secretion at follow-up. BMISDS steadily increased from start of treatment until follow-up, independent of GH status at follow-up. BMISDS at follow-up was positively correlated with serum leptin (P < 0.001), and serum leptin was significantly higher in the cranial irradiated group as compared to the nonirradiated group. CONCLUSIONS GH deficiency is frequently found at long-term follow-up in patients treated for childhood ALL. Other hormonal deficiencies are rare. HSDS at long-term follow-up is dependent on GH secretory status. Long-term endocrinological follow-up examinations in patients treated for childhood ALL are recommended, as hormonal replacement therapy may be indicated.
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Affiliation(s)
- N H Birkebaek
- Department of Pediatrics, University Hospital of Aarhus at Skejby, Denmark
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28
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Pedersen B, Andersen CL, Søgaard MM, Nørgaard JM, Koch J, Krejci K, Brandsborg M, Clausen N. Trisomy 10 survival: a literature review and presentation of seven new cases. Cancer Genet Cytogenet 1998; 103:130-2. [PMID: 9614911 DOI: 10.1016/s0165-4608(97)00387-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Trisomy 10 as the only chromosome aberration is a rare phenomenon in malignant and premalignant hemopoietic disorders. We describe 7 new cases and have found another 12 in the literature. It appears that, whereas adult patients have myeloid disorders (acute myeloid leukemia, myeloproliferative, or myelodysplastic syndromes), in children the diagnosis is lymphocytic leukemia or lymphoma. The median survival was 122 months in the total material. Age above 60 years proved to be a significant adverse factor (median survival only 5 months; p = 0.003). None of the other clinical, cytogenetic, or hematological variables were of demonstrable prognostic importance. In contrast with the larger trisomy 10 clones, those of limited size were associated with nonleukemic diagnoses, normal or slightly elevated leukocyte counts, and few or no circulating blasts. This may suggest that expansion of the trisomy 10 clone is associated with clinical and hematological progression.
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Affiliation(s)
- B Pedersen
- Department of Cytogenetics, Danish Cancer Society, Aarhus, Denmark
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29
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Abstract
We investigated the cellular drug resistance to aclarubicin (Acla), cytosine arabinoside (Ara-C), daunorubicin (Dau), doxorubicin (Dox), etoposide (Etop) and mitoxantrone (Mitox) using the MTT assay at time of disease presentation in 93 cases of acute myeloid leukaemia (AML). In 31 cases we concomitantly investigated MDR1 (multiple drug resistance 1 gene) expression (semi-quantitative competitive RT-PCR) of the leukaemic cells. Drug resistance towards Dau, Dox and Etop was correlated to the MDR1 expression of the AML cells (P<0.05) with high MDR1 expression being associated with high drug resistance towards these drugs. Although the data did not allow firm conclusions to be drawn on the correlation between MDR1 expression and drug resistance towards Ara-C and Mitox, the drug resistance towards Acla clearly was not correlated to, or dependent on, the MDR1 expression level of the AML blast cells. In addition, when examining the cross-activities among the six drugs distinct patterns emerged. Thus, high to very high degrees of cross-activity were found to exist between Dau, Dox, Etop and Mitox, whereas Ara-C had moderate cross-activity with the other drugs except Acla, which showed absent to moderate cross-activity with the other drugs. We conclude that MDR1 gene expression is of significance for cellular drug resistance towards specific (MDR1-related) drugs in AML, whereas it is not of significance regarding drug resistance towards other drugs, which is the case with the anthracycline Acla. We suggest that in the place of other more or less complicated ways to circumvent MDR1-mediated drug resistance, Acla may be used to replace Dau, Dox and other MDR1-related drugs if proven as potent as the drug it is to substitute.
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Affiliation(s)
- J M Nørgaard
- Department of Medicine and Haematology, Aarhus University Hospital, Denmark
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30
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Hjorth-Sørensen B, Pallisgaard N, Grönholm M, Hokland P, Clausen N, Jørgensen P. A novel MLL-AF10 fusion mRNA variant in a patient with acute myeloid leukemia detected by a new asymmetric reverse transcription PCR method. Leukemia 1997; 11:1588-93. [PMID: 9305618 DOI: 10.1038/sj.leu.2400758] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A novel variant of the chimerical MLL-AF10 mRNA transcript was detected in a pediatric patient with acute myeloid leukemia (AML) by a new asymmetric reverse-transcription polymerase chain reaction (ART-PCR) method. Sequence analysis of the fusion region on the amplified cDNA fragment showed an in-frame joining of exon e5 of the MLL gene and position 1931 of the cDNA sequence of the AF10 gene, giving rise to a new MLL-AF10 transcript. The presence of the new chimerical mRNA product in a sample from the patient was confirmed by classical RT-PCR.
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Affiliation(s)
- B Hjorth-Sørensen
- Institute of Molecular and Structural Biology, Aarhus University, Denmark
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31
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Hasle H, Kerndrup G, Yssing M, Clausen N, Ostergaard E, Jacobsen N, Jacobsen BB. Intensive chemotherapy in childhood myelodysplastic syndrome. A comparison with results in acute myeloid leukemia. Leukemia 1996; 10:1269-73. [PMID: 8709630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Myelodysplastic syndrome (MDS) in children is often considered as a variant of acute myeloid leukemia (AML) and frequently treated as such. However, there are very few reported data on the outcome following AML treatment. We analyzed 20 consecutive cases of de novo MDS treated in Denmark according to the NOPHO AML protocols. The results were compared with those obtained in 31 children with de novo AML treated with the same protocols, and with the outcome in 10 children with MDS who received allogeneic bone marrow transplantation (BMT) without prior AML therapy. Distinction between MDS and AML was made morphologically according to the FAB criteria. All children were followed for at least 37 months. The proportion of complete remission in MDS and AML was 35 percent vs 74 percent. (P = 0.005), resistant disease 25 percent vs 10 percent (P = 0.14), death in cytopenia 40 percent vs 16 percent (P= 0.06), and 3-year survival 15 percent vs 35 percent. (P = 0.11), respectively. Duration of treatment-related cytopenia was similar in MDS and AML, except for a longer period of leukopenia in MDS following the second course of induction. Seven of 10 MDS children receiving BMT without prior chemotherapy are long-term survivors. Our data suggest that conventional AML regimens are associated with a low rate of complete remission, a high risk of death in cytopenia, and a limited curative potential in childhood MDS. Allogeneic BMT was in contrast associated with a high survival rate. BMT may, at least in some patients, be performed successfully without prior induction chemotherapy. The different response to therapy in MDS and AML may reflect fundamental biological differences between the two conditions.
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Affiliation(s)
- H Hasle
- Department of Pediatrics, Odense University Hospital, Denmark
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32
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Abstract
We have investigated the in vitro blast cell survival (viability) and drug resistance to cytosine arabinoside (Ara-C), daunorubicin (Dau), mitoxantrone (Mitox) and aclarubicin (Acla) of fresh leukaemic blast cells from 80 patients with newly diagnosed acute myeloid leukaemia (AML) employing the semiautomated colourimetric MTT(3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide)-assay. In 15 cases we concurrently investigated the relation between in vitro blast cell survival (MTT assay) and blast cell proliferation (3H-thymidine incorporation) in the presence and absence of myeloid growth factors (GFs) G-CSF, GM-CSF and IL-3 (individually and in combination). A highly significant correlation was found between blast cell survival and blast cell proliferation (r = 0.87, P < 1 x 10(-4). Furthermore, in 40 evaluable adult patients who completed intravenous induction chemotherapy and were evaluable for response to chemotherapy we found a positive correlation between in vitro blast survival (MTT assay) and response to chemotherapy with high blast survival being associated with poor response to chemotherapy (P = 0.05). Moreover, in a multivariate analysis, high blast cell survival was significantly associated with high CD13 expression and monocytic phenotype (P = 0.0003 and P = 0.02, respectively). Furthermore, we found an inverse relationship between the baseline proliferation of the blasts and the magnitude of response to the GFs (P < 0.02), indicating that cells with low baseline proliferation were more readily stimulated by growth factors. Finally, we found a significant correlation between leukaemic cell survival and cellular drug resistance towards Dau (P = 0.001) and Mitox (P = 0.03), but not towards Ara-C (P = 0.68) and Acla (P = 0.13). We conclude that high in vitro leukaemic cell survival is associated with drug resistance in vivo and in vitro, and furthermore is correlated with high blast cell proliferation and some adverse prognostic factors previously identified in AML.
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Affiliation(s)
- J M Nørgaard
- Department of Medicine and Haematology, Danish Cancer Society, Aarhus, Denmark
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33
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Clausen N, Kreuger A, Salmi T, Storm-Mathisen I, Johannesson G. Severe aplastic anaemia in the Nordic countries: a population based study of incidence, presentation, course, and outcome. Arch Dis Child 1996; 74:319-22. [PMID: 8669932 PMCID: PMC1511473 DOI: 10.1136/adc.74.4.319] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Incidence data for severe aplastic anaemia (SAA) in children are scanty and vary. Few population based studies have been reported. A retrospective and prospective study was conducted to determine the incidence and course of SAA. PATIENTS AND METHODS All children with a diagnosis of SAA in the Nordic countries from 1982 through 1993 were registered and have been followed up since 1987. RESULTS A total of 101 children were diagnosed with SAA. The mean annual child population was 4.31 million. A constant incidence of 1.95/million children/year was found: 2.4 for boys and 1.5 for girls. A non-significant increase of cases occurred from November to March. Possible aetiological agents were noted in 29%. The actuarial survival was 79% after one year and 68% after five years without significant difference between boys and girls. CONCLUSION The incidence of SAA in the Nordic countries remains stable with a preponderance among boys. SAA has still a high initial mortality and a risk of late deaths.
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Affiliation(s)
- N Clausen
- Department of Paediatrics, University Hospital of Aarhus, Denmark
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34
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Hofstra RM, Cheng NC, Hansen C, Stulp RP, Stelwagen T, Clausen N, Tommerup N, Caron H, Westerveld A, Versteeg R, Buys CH. No mutations found by RET mutation scanning in sporadic and hereditary neuroblastoma. Hum Genet 1996; 97:362-4. [PMID: 8786083 DOI: 10.1007/bf02185773] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Neuroblastoma occasionally occurs in diseases associated with abnormal neurocrest differentiation, e.g. Hirschsprung disease. Expression studies in developing mice suggest that the proto-oncogene RET plays a role in neurocrest differentiation. In humans expression of RET is limited to certain tumor types, including neuroblastoma, that derive from migrating neural crest cells. Mutations of RET are found associated with Hirschsprung disease. These data prompted us to investigate expression of RET and to search for gene mutations in neuroblastoma. Out of 16 neuroblastoma cell lines analyzed, 9 show clear expression of RET in a Northern blot analysis. In a single strandt conformation polymorphism (SSCP) analysis of all exons, no mutations were detected other than neutral polymorphisms. In a patient with neuroblastoma, from a family in which different neurocrestopathies, including neuroblastoma and Hirschsprung disease, had occurred, we also failed to detect RET mutations. Possibly, expression of RET in neuroblastoma merely reflects the differentiation status of the tumor cells. The absence of mutations suggests that RET does not play a crucial role in the tumorigenesis of neuroblastoma.
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Affiliation(s)
- R M Hofstra
- University of Groningen, Department of Medical Genetics, The Netherlands
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35
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Abstract
It is the purpose of the study to report the frequency of parvovirus in children with a diagnosis of Diamond-Blackfan anaemia and to discuss the possible aetiological role of parvovirus in Diamond-Blackfan anaemia. We found parvovirus DNA in 3 of 11 bone marrow smears. Giant pronormoblasts showed low sensitivity (33%) and poor specificity (75%). The presence of giant pronormoblasts was associated with a very high myeloid:erythroid ratio, and may not be specific for parvovirus infection, but a feature of severely suppressed erythropoiesis. The three parvovirus-positive patients were the only children who experienced a remission, and who are free of medication. The seven surviving parvovirus-negative patients are all currently on steroid treatment.
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Affiliation(s)
- E D Heegaard
- Institute of Medical Microbiology and Immunology, University of Copenhagen, Denmark
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36
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Hindkjaer J, Hammoudah S, Clausen N, Koch J, Pedersen B. Partial triplication (7q) in a child with acute lymphoblastic leukemia demonstrated with conventional cytogenetics, PRINS, and chromosome painting. Cancer Genet Cytogenet 1995; 84:19-23. [PMID: 7497437 DOI: 10.1016/0165-4608(95)00058-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In this report we describe a partial triplication (7q) and other structural aberrations found in a child with acute lymphoblastic leukemia (ALL), and we demonstrate the importance of PRimed IN Situ labeling (PRINS) and chromosome painting as a support to banding analysis for the clarification of complex structural chromosome rearrangements. Initially, the der(7) was interpreted as der(7)t(1;7;7). However, PRINS and chromosomes painting showed that der(7) consisted entirely of chromosome 7 material. Further, a derivative chromosome interpreted by banding analysis as a der(17)t(?1;17) was shown to be der(17)t(13;17) by the newly developed PRINS painting technique.
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Affiliation(s)
- J Hindkjaer
- Department of Cytogenetics, Danish Cancer Society, Aarhus, Denmark
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37
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Madsen PS, Hokland P, Clausen N, Ellegaard J, Hokland M. Differential expression levels of the heat shock protein 27 isoforms in pediatric normal, nonleukemic and common acute lymphoblastic leukemia B-cell precursors. Blood 1995; 85:510-21. [PMID: 7812006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Heat shock protein 27 (hsp27) may function as a regulator of microfilament dynamics and may participate in signal transduction pathways of different cell growth regulators, with the mitogen-activated protein kinase-activated protein (MAPKAP) kinase 2 being a major enzyme responsible for its phosphorylation. Using two-dimensional gel electrophoresis, we have compared the expression levels of two hsp27 isoelectric variants (hsp27 isoforms) M2 (molecular weight, 26 kD; isoelectric point, 6.02) and M3 (molecular weight, 26 kD; isoelectric point, 5.60) in pediatric bone marrow CD19+CD10+B-cell precursors (BCPs) purified from either common acute lymphoblastic leukemia (c-ALL) patients, normal donors, or non-c-ALL patients. Compared with normal BCPs, we found increased hsp27 expressions (M2 isoform) (by a factor 5 to 9 of mean level) in c-ALL as well as in non-c-ALL (nonleukemic) precursors. Though increased phosphorylation of hsp27 (M3 isoform) was observed in BCPs from c-ALL patients at relapse (by a factor 3 of mean level compared with normal BCPs and precursors from c-ALL at diagnosis), which might represent a differential enzymatic activity, this was not distinguishable from that of non-c-ALL patients. Therefore, our studies suggest constitutive differences of hsp27 isoforms between pediatric leukemic BCPs and their relatively low-expressing, immunophenotypically normal bone marrow counterparts. In light of the occasional and possibly transient increase of hsp27 expression during nonleukemic BCP differentiation and the possible role of hsp27 in signal transduction to microfilaments, these differences might be of considerable biologic interest and of importance in future studies of regulated normal or dysregulated leukemic hematopoietic cellular differentiation.
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Affiliation(s)
- P S Madsen
- University Department of Medicine and Hematology, Aarhus Amtssygehus, Denmark
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38
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Hasle H, Clausen N, Pedersen B, Bendix-Hansen K. Myelodysplastic syndrome in a child with constitutional trisomy 8 mosaicism and normal phenotype. Cancer Genet Cytogenet 1995; 79:79-81. [PMID: 7850757 DOI: 10.1016/0165-4608(94)00099-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Trisomy 8 is a frequently acquired cytogenetic abnormality in myeloid malignancies, but may also represent a constitutional chromosome abnormality with a wide phenotypic variation. We report a case of myelodysplastic syndrome (MDS) that developed in a child with trisomy 8 mosaicism and normal phenotype. Bone marrow (BM) cells all showed trisomy 8 with additional clonal abnormalities in most cells. Based on the present case and a review of previously published cases of myeloid malignancies in patients with trisomy 8 mosaicism, it appears likely that the malignant cells developed from the trisomic cell population, suggesting that constitutional trisomy 8 may be a predisposing condition to myeloid malignancies. Trisomy 8 in malignant cells is usually considered an acquired abnormality, but this implies a risk of ignoring a constitutional trisomy 8 mosaicism. Examination for constitutional trisomy 8, despite a normal phenotype, may therefore be warranted in hematologic malignancies with trisomy 8 of BM cells to evaluate further the possible association and to preclude erroneous use of trisomy 8 as a tumor marker.
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Affiliation(s)
- H Hasle
- Department of Pediatrics, Odense University Hospital, Denmark
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39
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Kristensen B, Schønheyder HC, Peterslund NA, Rosthøj S, Clausen N, Frederiksen W. Capnocytophaga (Capnocytophaga ochracea group) bacteremia in hematological patients with profound granulocytopenia. Scand J Infect Dis 1995; 27:153-5. [PMID: 7660080 DOI: 10.3109/00365549509018997] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The clinical and microbiological features of 7 cases of bacteremia due to Capnocytophaga (Capnocytophaga ochracea group) are reported. They were diagnosed during 1991-93 at three hospital clinics. Five patients were < 10 years old and all had hematological disorders, 4 acute lymphoblastic leukemia and 1 each had aplastic anemia, non-Hodgkin lymphoma, and myelodysplastic syndrome. All were profoundly granulocytopenic with an absolute granulocyte count < 0.13 x 10(9)/l, and all but 1 had oral lesions as a possible portal of entry. A favourable response to antibiotic therapy was recorded in all patients but one who, being profoundly granulocytopenic, rapidly succumbed to Pseudomonas aeruginosa septicemia. None of the isolates were beta-lactamase producers. In addition to penicillin the isolates were susceptible to broad-spectrum cephalosporins and ciprofloxacin, but resistant to aminoglycosides.
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Affiliation(s)
- B Kristensen
- Department of Clinical Microbiology, Aalborg Hospital, Denmark
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40
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Olofsson MJ, Scheibel E, Clausen N, Pedersen FK, Peitersen B. [HIV antibody positive children in Denmark]. Ugeskr Laeger 1994; 156:2575-9. [PMID: 8016964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The AIDS-committee of The Danish Society of Paediatrics has done a nation-wide study among infants and children under the age of 15 with AIDS or HIV-antibodies in preparation for planning prevention and treatment. Clinical data have been collected from the Departments of Paediatrics and Infectious Diseases, Haemophilia, Dermatology and Internal Medicine up to 1 March 1993. The study includes 44 infants with a risk of vertical transmission from the mother and 16 children with haemophilia. No cases were found to be infected by blood-transfusion. Twenty of the 44 infants with congenital HIV-antibodies were HIV-infected. Seven of them died from AIDS, 10 currently have AIDS and three are asymptomatic. Seventeen infants are well and HIV-antibody negative after the age of 18 months. Seven infants still have unclarified status, but all are well. Three of the patients with haemophilia are dead. The 13 others do not have AIDS. It is surprising that most of the infected infants' mothers were not known to be infected before the infants got sick. Thus infected infants exist in families who are not suspected to be HIV-infected. The AIDS-committee of The Danish Society of Paediatrics has proposed recommendations for HIV-testing of infants and children. HIV-infected families need comprehensive psychosocial care. The risk-factor from blood-transfusion is now eliminated, but vertical transmission will continue to be a risk-factor. The size of the problem in Denmark will not be known until an epidemiological study of pregnant women has been conducted.
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Affiliation(s)
- M J Olofsson
- Dansk Paediatrisk Selskabs AIDS-udvalg, København
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41
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Abstract
Various disorders of the red cell skeleton and membrane have been described in hereditary spherocytosis. To elucidate which aberrations could be used for identification of HS patients in a Danish population, we examined ghosts from 17 HS patients and 20 normals by use of SDS-gel scanning, native spectrin extraction, and limited tryptic digestion. Compared to normals, HS patients had significantly lowered alpha-spectrin (p < 0.004), protein 4.2 (p < 0.025), and actin (p < 0.05), and significantly increased anion-transporter (p < 3 x 10(-6)) and glyceraldehyde-3-phosphate dehydrogenase (G3PD, p < 0.04). Sixteen out of 17 HS patients could be identified by aberrations of the anion-transporter or protein 4.2 outside a 95% confidence interval for normals. Extraction of native spectrin and limited tryptic digest showed no difference between normals and HS patients. RBC separated into young and old fractions were used to examine the occurrence of protein aberrations associated with RBC age. Young RBC contained more G3PD (35%) and less protein 4.1 (6.5%) and actin (8.7%) than old. In male HS patients an increased G3PD content showed a linear correlation (p < 0.001) with a low concentration of blood haemoglobin. We conclude that aberrations of G3PD, and possibly protein 4.1, and actin, are associated with anaemia in HS. Increased anion-transporter or lowered protein 4.2 may be useful for diagnosis of HS, and were inherited in five out of six families where two generations were available.
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Affiliation(s)
- T F Orntoft
- Department of Clinical Chemistry, University Hospital of Aarhus, Denmark
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42
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Nørgaard JM, Langkjer ST, Ellegaard J, Palshof T, Clausen N, Hokland P. Synergistic and antagonistic effects of myeloid growth factors on in vitro cellular killing by cytotoxic drugs. Leuk Res 1993; 17:689-94. [PMID: 7689127 DOI: 10.1016/0145-2126(93)90075-v] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effect of stimulating acute myeloid leukemia blast cells with a combination of growth factors (G-CSF, GM-CSF, and IL-3) on cellular resistance to the antileukemia drugs Ara-C, daunorubicin, aclarubicin, and mitoxantrone was studied. For assessment of in vitro cellular drug resistance the MTT assay was employed. Stimulated cells showed enhanced sensitivity to Ara-C (p < 0.02), whereas a significant increase in cellular drug resistance to daunorubicin (p < 0.02) was observed. Variable and statistically non-significant changes in drug resistance to aclarubicin and mitoxantrone was induced by stimulation of the blast cells. We conclude on the basis of these observations that myeloid growth factors should be used with caution in combination with daunorubicin in AML treatment until further confirmatory evidence has been presented by other investigators.
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Affiliation(s)
- J M Nørgaard
- University Department of Medicine, Aarhus University Hospital, Denmark
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43
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Schrøder H, Clausen N, Thorling K, Hokland P. [Autologous bone marrow transplantation in children with malignant diseases. Bone marrow harvest and procedure-related toxicity]. Ugeskr Laeger 1993; 155:1536-9. [PMID: 8316985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this paper was to present the results of bone marrow harvest followed by cryopreservation in 22 children with various malignant diseases, and the clinical course of autologous bone marrow transplantation (ABMT) performed in 10 children (three with acute lymphoblastic leukemia (ALL), three with acute myeloblastic leukemia (AML) and four neuroblastoma stage IV (NB)). In 20/22 children the harvested bone marrow contained a sufficient number of granulocyte-macrophage-colonyforming units (GM-CFU) for later marrow reinfusion. Hematological reconstitution was obtained in all 10 children who underwent ABMT. No child died of toxicity. The median time to neutrophil count > 0.5 x 10(9)/l, thrombocyte count > 50 x 10(9)/l and to discharge from hospital were 34, 49 and 29 days respectively. Five children are alive with no evidence of active disease 11-21 months after ABMT. Five children have suffered relapse and have died. It was concluded that sufficient amounts of precursor bone marrow cells may be harvested in children during a pause in cystostatic therapy. The acute toxicity of ABMT in children with malignant diseases was only moderate.
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Affiliation(s)
- H Schrøder
- Arhus Kommunehospital, paediatrisk afdeling og onkologisk afdeling
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44
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Clausen N, Schrøder H. [Autologous bone marrow transplantation in children]. Ugeskr Laeger 1993; 155:1531-5. [PMID: 8316984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Autologous bone marrow transplantation is used for children with cancers which are only partially responsive to bone marrow toxic doses of cancer chemotherapy and irradiation. The use of megatherapy and autologous bone marrow transplantation instead of conventional doses for children has yielded substantial benefits in B-cell lymphoma, relapse of leukaemia, disseminated neuroblastoma and germ cell tumors. In the case of Wilms' tumor, rhabdomyosarcoma, osteosarcoma and Ewing's sarcoma with a partial initial response or a relapse, autologous bone marrow transplantation has been used to a limited extent. Based on the best results from conventional therapy and autologous bone marrow transplantation, respectively, the present need for autologous bone marrow transplantation in Denmark is estimated to be 24 transplantations a year.
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Affiliation(s)
- N Clausen
- Arhus Kommunehospital, paediatrisk afdeling
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45
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Schrøder H, Møller J, Thomsen A, Skadborg R, Clausen N. [Screening for neuroblastoma in infants aged 6 months. A method of testing]. Ugeskr Laeger 1991; 153:3615-8. [PMID: 1776206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a number of cases, neuroblastoma (NB) may be diagnosed by routine screening of the urine for vanillinic-mandelic acid (VMA) and homovanillinic acid (HVA) in symptomfree infants at the age of six months. Early diagnosis of this disease may possibly improve the prognosis. The object of this project was to establish a method of measuring VMA and HVA concentrations in urine collected on filter paper and to assess participation by the parents as regards three different methods of collecting urine with the object of establishing a population screening programme for NB in Denmark. A total of 1,111 infants aged 6-8 months participated in the investigation. The equipment for testing the urine was given in three different was: 1) By the health nurses (County of Arhus), 2) By the general practitioner at the 6-month vaccination (County of Ringkøbing) and 3) By post (County of Viborg). In Arhus, the health nurses delivered the equipment to 96.7% of the age group concerned. Altogether, urine samples were obtained from 673 infants (61%). Participation was greatest in the County of Arhus (66%) and the County of Ringkøbing (62%) and lowest in the County of Viborg (54%). Two infants were found with marginally raised VMA or HVA but these values were found to be normal on repeated examinations. No cases of neuroblastoma were found in the material nor in the screened group in the course of 1 1/2 years after the conclusion of the investigation. In just over 3% of the cases, renewed urine samples had to be sent on account of too little urine on the filter paper. If current population investigations reveal that screening for neuroblastoma can alter the course of the disease in children, the method described here may form the basis for introduction of population investigations in Denmark.
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Affiliation(s)
- H Schrøder
- Paediatrisk afdeling og klinisk kemisk afdeling, Arhus Kommunehospital
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46
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Nygaard R, Clausen N, Siimes MA, Márky I, Skjeldestad FE, Kristinsson JR, Vuoristo A, Wegelius R, Moe PJ. Reproduction following treatment for childhood leukemia: a population-based prospective cohort study of fertility and offspring. Med Pediatr Oncol 1991; 19:459-66. [PMID: 1961132 DOI: 10.1002/mpo.2950190603] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Of all children diagnosed with leukemia in Denmark, Finland, Iceland, Norway, and Sweden, 981 had discontinued therapy before 1985 and had been followed up annually after cessation of therapy. Progeny was registered and fertility evaluated among survivors who passed age 18 years without a relapse (n = 299). By April 1989, 48 offspring were registered, one of whom had congenital anomalies. This was no more than expected from the incidence of birth defects in the general population. No childhood malignancies or genetic diseases have so far been diagnosed in the progeny. In the study group, none of the 19 female and 8 male survivors of myeloid leukemias had become parents, and only 4 fathers were reported among the 131 male survivors of acute lymphoblastic leukemia (ALL). However, 23 of the 149 females treated for ALL had delivered 41 children. Fertility was measured as cumulative rates of first birth by maternal age. In a Cox regression analysis, cases who had received prophylactic radiation of the central nervous system (CNS) had a lower first birth rate than those without radiation (rate ratio 0.39, 95% CI 0.15-1.00), indicating that doses of 18-24 Gy to the brain may possibly be a risk factor. By using the Norwegian birth cohort of 1966 as a control group, matching the median year of birth for the study subjects, the group of female ALL survivors as a whole was as likely as the general female population to have given birth up to the age of 23. The first generation of females successfully treated for childhood ALL seems to have a nearly normal reproductive pattern during young adulthood, without increased risk of congenital anomalies in the offspring. However, cranial radiation as CNS prophylaxis may possibly impair subsequent reproduction.
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Affiliation(s)
- R Nygaard
- Department of Paediatrics, University Hospital of Trondheim, Norway
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47
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Jacobsen A, Clausen N. [Psychological follow-up study of families of children with acute lymphoblastic leukemia]. Ugeskr Laeger 1989; 151:2656-60. [PMID: 2815379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The qualities of the multi-disciplinary social, psychological, medical and nursing contributions for children diagnosed consecutively as having acute lymphoblastic leukaemia and their families were investigated. The parents of a total of 39 children, 31 fathers and 36 mothers, participated in a semi-structured interview with the psychologist attached to the department concerning the extent to which the psycho-social requirements of the family had been met by offers from the hospital. The interview concerning the diagnosis took place equally frequently in local hospitals and in Rigshospitalet. In both of these locations only half of the parent couples were satisfied with the course of the conversation. In the course of the disease, the mothers and the fathers experienced three situations differently: the situation at work, the parents' married life and the responsibility for treatment of the child. The family dynamic situation was altered in all of the families. Parents developed a closer relationship to the sick child while the relationship to the siblings equally frequently improved or deteriorated. At the conclusion of treatment, 2/3 felt that a form of security disappeared even though they were pleased to have got so far. In cases with relapse, another crisis developed and was just as difficult as the first, regardless of whether attempts had been made to prepare the families for this possibility. This investigation has pointed out a series of circumstances which the therapeutic system should be familiar with and which they can be prepared for.
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Clausen N, Andersson P, Tommerup N. Familial occurrence of neuroblastoma, von Recklinghausen's neurofibromatosis, Hirschsprung's agangliosis and jaw-winking syndrome. Acta Paediatr Scand 1989; 78:736-41. [PMID: 2512759 DOI: 10.1111/j.1651-2227.1989.tb11135.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A family is reported with ganglioneuromas in the mother and neuroblastomas in her two daughters co-existing with cases of von Recklinghausen's neurofibromatosis, Hirschsprung's agangliosis, and the jaw-winking syndrome in other family members. There were no detectable constitutional chromosomal defects in the family even when high resolution techniques were applied. Similarly, DNA-hybridization analysis did not reveal gross molecular rearrangements in the vicinity of the proto-oncogenes N-myc-, c-myc, neu, and N-ras. However, the aggregation of several rare, autosomal dominant diseases affecting tissue derived from the neural crest not only suggest a link between te pathogenesis of these disease, but also makes it highly likely that a single mutation segregating within the family is responsible for this association.
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Affiliation(s)
- N Clausen
- Department of Paediatrics, University Hospital of Copenhagen, Denmark
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Abstract
L-Asparaginase, an effective agent in the treatment of acute lymphoblastic leukemia, may induce a diabetic state. The pathogenesis of the diabetogenic effect was studied in cultured pancreatic islets. Mean serum concentrations in three children with acute lymphoblastic leukemia were 2.4 U/mL (range 1.4-4.5) before and 31.5 U/mL (range 18.6-51.8) immediately after an intravenous injection of 1000 U/kg L-asparaginase. Glucose-induced insulin release from pancreatic islets of rat and man was measured after 3 and 7 days of culture in media with or without clinically relevant concentrations of Escherichia coli L-asparaginase (0.01-100 U/mL). After culture, the remaining insulin, glucagon, and DNA in the islets were determined. After 7 days of culture of adult rat or human islets, both the accumulation of insulin in the medium and the content of insulin and glucagon in the islets were significantly reduced in the presence of 100 U/mL L-asparaginase compared with controls. Addition of 10(-6) M hydrocortisone to the culture medium enhanced this effect. In newborn rat islets a significant reduction in insulin release and content was observed already in the presence of 0.1 U/mL asparaginase, whereas the glucagon content was unchanged. Removal of the drug resulted in partial recovery of the insulin secretion. To elucidate the mechanisms of of action of the drug, insulin biosynthesis was studied in islets cultured in asparagine-free medium with or without asparaginase. No difference in biosynthesis was seen between media with or without asparagine, whereas 0.1 U/mL asparaginase caused about a 50% reduction under both conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N Clausen
- University Clinics of Paediatrics, University Hospital of Copenhagen, Denmark
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Herlin T, Clausen N. [Histiocytosis syndrome in children]. Ugeskr Laeger 1989; 151:225-8. [PMID: 2783792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The recommended classification of the histiocytosis syndromes in children is as follows: 1. Langerhans' cell histiocytoses. 2. histiocytoses of mononuclear phagocytes. 3. neoplastic histiocytoses. The previous term, histiocytosis X, including eosinophilic granuloma of bone, the Hand-Schüller-Christian syndrome and Letterer-Siwe's disease, is now more correctly called Langerhans' cell histiocytosis (LCH) since the infiltrating cell in histiocytosis X both histologically and immunophenotypically is identified as the Langerhans' cell. Local and generalized LCH differmarkedly with respect to treatment and outcome. It is therefore necessary to perform an extensive investigation at the time of the initial evaluation of the patient. The most common mononuclear phagocytic syndromes are the familial erythrophagocytic lymphohistiocytosis and infection-associated or reactive hemophagocytic syndromes. The pathognomonic cell in familial erythrophagocytic lymphohistiocytosis is possibly a hybrid phenotype sharing characteristics of the two main types the mononuclear phagocyte system - i.e. the Langerhans' cells and phagocytic macrophages. Malignant histiocytosis is rarely seen in children and is a form of the Ki-1 positive anaplastic cell lymphoma.
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