The aim of this study was to evaluate the ability of influenza immunization to evoke a protective... more The aim of this study was to evaluate the ability of influenza immunization to evoke a protective immune response among children with cancer. We evaluated 75 children with cancer who received influenza vaccination. Hemagglutination Inhibition Antibody titers were determined before and after vaccination. The protective rates after vaccination were 79% for H1N1, 75% for H3N2 and 59% for influenza B virus whereas the seroconversion rates were 54%, 44% and 43% respectively. The differences pre- and post-vaccination were significant regardless the method which was used: seroprotection changes, seroconversion and geometric mean titers analyses. Variables such as the pre-vaccination antibody titers, the time when the responses were measured after the vaccination, the age and the type of malignancy as well as the absolute lymphocyte count were found to be correlated with the immune response but the findings were different for each vaccine subunit. In conclusion, influenza vaccination provid...
Clinical chemistry and laboratory medicine, Jan 27, 2018
Background Risk-adjusted treatment has led to outstanding improvements of the remission and survi... more Background Risk-adjusted treatment has led to outstanding improvements of the remission and survival rates of childhood acute lymphoblastic leukemia (ALL). Nevertheless, overtreatment-related toxicity and resistance to therapy have not been fully prevented. In the present study, we evaluated for the first time the clinical impact of the apoptosis-related BCL2L12 gene in prognosis and risk stratification of BFM-treated childhood ALL. Methods Bone marrow specimens were obtained from childhood ALL patients upon disease diagnosis and the end-of-induction (EoI; day 33) of the BFM protocol, as well as from control children. Following total RNA extraction and reverse transcription, BCL2L12 expression levels were determined by qPCR. Patients' cytogenetics, immunophenotyping and minimal residual disease (MRD) evaluation were performed according to the international guidelines. Results BCL2L12 expression was significantly increased in childhood ALL and correlated with higher BCL2/BAX expr...
Hodgkin and non-Hodgkin lymphomas account for approximately 13 % of cancers in children and adole... more Hodgkin and non-Hodgkin lymphomas account for approximately 13 % of cancers in children and adolescents younger than 20 years of age and are the third most common childhood malignancies following leukemia and CNS tumors.
Vincristine overdose (7.5 mg/m2) was accidentally administered to 3 children with acute lymphobla... more Vincristine overdose (7.5 mg/m2) was accidentally administered to 3 children with acute lymphoblastic leukemia. Treatment included double-volume exchange transfusion, phenobarbital administered prophylactically, and folinic acid rescue 18 mg every 3 hours for 16 doses. Vincristine levels were also assayed and showed a dramatic decline in postexchange levels in the 2 patients who survived and an almost unchanged value in the patient who succumbed. Early signs of toxicity in the 2 survivors were peripheral neuropathy (day 4), bone marrow toxicity (day 5), gastrointestinal toxicity (days 6 and 7), and hypertension (days 7 and 8). Marrow aplasia lasted for 4 and 10 days, peripheral neuropathy for 15 and 42 days, gastrointestinal toxicity for 3 and 5 days, and hypertension for 5 and 14 days. The 2 children were discharged on days 13 and 16 and cytostatic therapy was restarted on days 18 and 25. Both are alive without evidence of leukemia. The third patient developed liver and marrow toxicity on day 3 and died on day 9. Postmortem examination showed leukemia infiltration of the liver and spleen.
The relation between creativity and mental illness has been the object of significant interest an... more The relation between creativity and mental illness has been the object of significant interest and research in psychiatry. However, both psychopathology and creativity are issues of profound complexity, some aspects of which are yet to be explored. This study was designed to explore changes in creativity in relation to the type and degree of psychopathology in 2 groups of patients. Forty-four patients, consisting of 20 patients with manic depressive illness (bipolar disorder) and 24 patients suffering from other psychopathologies, participated in this study. There were 23 women (M age = 43.6) and 21 men (M age = 43.7). We applied a psychological battery of tests using measures for creativity, intelligence, and mood changes. All patients signed the informed consent form. The results are as follows: There was no difference in the creative abilities of patients with bipolar illness (creativity score: M = 104.4, SD = 44.9) as compared to those with other types of psychopathology (creativity score: M = 101.8, SD = 40.8). The study data were analyzed according to the degree of severity of illness, namely, mildly, moderately, or severely ill. Creativity was found to be at its highest level in patients who were moderately ill (creativity score: M = 118.3). The lowest creativity score (M = 62.1) was in the group of patients identified as severely ill. The difference was statistically significant (t = 4.35, p < .001).
Recognizing the importance of psychosocial issues in the care and cure of the child with cancer, ... more Recognizing the importance of psychosocial issues in the care and cure of the child with cancer, the board of the International Society of Pediatric Oncology (SIOP) in 1991 constituted a Working Committee on Psychosocial Issues in Pediatric Oncology, with Giuseppe Masera as chair and John Spinetta as co-chair. This committee met for the first time in Rhodes, Greece, in October 1991. The committee discussed various psychosocial issues and developed a document on Aims and Recommendations, summarizing the experiences of major centers. This document was approved by the SIOP board, which recommended diffusion of the document to the pediatric oncology community.
The aim of this study was to explore the complications related to Hickman-Broviac central venous ... more The aim of this study was to explore the complications related to Hickman-Broviac central venous catheters (Hickman-Broviac CVCs) in children with cancer, their incidence, and possible associations of complications and premature removal of CVCs with a number of risk factors. During the study period (1 Jan 2000-31 Dec 2003), 223 CVCs were inserted in 198 children (117 boys, 81 girls) at a mean age of 5.73 years (95% CI 5.19-6.27, SE 0.275). In total, 76 (38.4%) children suffered from solid tumors and 122 (61.6%) from leukemia. The mean follow-up after CVC insertion was 232.5 days (95% CI 214.9-250.2, SE 8.94) for a total of 51,839 catheter-days. A complication occurred in 20.8% of them and in 9.6% the complication led to the removal of the catheter. The most frequent complications were infection (63.9%), obstruction (26.2%), accidental failure (8.2%), and rupture (1.6%). An overall incidence of 1.17 (0.38 and 0.79 for mechanical complication and infection, respectively) per 1000 catheter days for the development of a complication was recorded. Additionally, the study revealed more nonelective removals in cases of leukemia compared to those of solid tumors. Systemic use of CVC does not appear to increase significantly the number of complications, and thus CVC remains an effective and safe tool for the management of childhood malignancies.
The increasing survival rate of children with cancer because of more refined treatments makes nec... more The increasing survival rate of children with cancer because of more refined treatments makes necessary the investigation of psychological burden for the young patients. The aim of the study was to evaluate the development of psychological problems in children with cancer during the initial 6-month period of intensive treatment. This prospective, comparative study was conducted at one of the largest Greek pediatric oncology units in Athens. The sample comprised 132 children with cancer treated during a 30-month period and 100 children with no cancer as control group. Data were collected using the Rutter instruments for parents and teachers. For patients, it was completed by their parents at 1 (T1), 3 (T2), and 6 months (T3) from diagnosis and by teachers at T3. In the control group, the questionnaire was completed by teachers and parents once. The comparison of total Rutter scores for patients at T1, T2, and T3, according to parents&amp;amp;amp;amp;#39; responses, showed statistically significant difference (P &amp;amp;amp;amp;lt; .001). The difference in scores for patients (at T3) and control subjects was also significant according to both parents&amp;amp;amp;amp;#39; (P &amp;amp;amp;amp;lt; .00001) and teachers&amp;amp;amp;amp;#39; (P &amp;amp;amp;amp;lt; .001) responses. Children with leukemia had higher score reduction during treatment (P = .009) compared with the rest. Only age had a marginal impact on score of patients at T1 (R = 0.04). Based on parental reports, children treated for cancer develop psychological problems during the period of intensive treatment. The development and evolution of these problems depend on their age and type of cancer. This information can be used for relevant interventions in specific groups.
The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral l... more The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral lymphocytes of 67 children with acute lymphoblastic leukemia (ALL) and 50 control individuals. A statistically significant difference between patients and controls was found for large heterochromatin regions (level 3) of chromosomes 1 and 9 (P &lt; 0.001) and for small heterochromatin regions (level 1) of chromosome 16 (P &lt; 0.001). The patients also showed a significant increase in chromosomes 1 and 9 heteromorphism with respect to controls (P &lt; 0.001).
The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral l... more The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral lymphocytes of 67 children with acute lymphoblastic leukemia (ALL) and 50 control individuals. A statistically significant difference between patients and controls was found for large heterochromatin regions (level 3) of chromosomes 1 and 9 (P &lt; 0.001) and for small heterochromatin regions (level 1) of chromosome 16 (P &lt; 0.001). The patients also showed a significant increase in chromosomes 1 and 9 heteromorphism with respect to controls (P &lt; 0.001).
The aim of this study was to explore the complications related to Hickman-Broviac central venous ... more The aim of this study was to explore the complications related to Hickman-Broviac central venous catheters (Hickman-Broviac CVCs) in children with cancer, their incidence, and possible associations of complications and premature removal of CVCs with a number of risk factors. During the study period (1 Jan 2000-31 Dec 2003), 223 CVCs were inserted in 198 children (117 boys, 81 girls) at a mean age of 5.73 years (95% CI 5.19-6.27, SE 0.275). In total, 76 (38.4%) children suffered from solid tumors and 122 (61.6%) from leukemia. The mean follow-up after CVC insertion was 232.5 days (95% CI 214.9-250.2, SE 8.94) for a total of 51,839 catheter-days. A complication occurred in 20.8% of them and in 9.6% the complication led to the removal of the catheter. The most frequent complications were infection (63.9%), obstruction (26.2%), accidental failure (8.2%), and rupture (1.6%). An overall incidence of 1.17 (0.38 and 0.79 for mechanical complication and infection, respectively) per 1000 catheter days for the development of a complication was recorded. Additionally, the study revealed more nonelective removals in cases of leukemia compared to those of solid tumors. Systemic use of CVC does not appear to increase significantly the number of complications, and thus CVC remains an effective and safe tool for the management of childhood malignancies.
The aim of this study was to evaluate the ability of influenza immunization to evoke a protective... more The aim of this study was to evaluate the ability of influenza immunization to evoke a protective immune response among children with cancer. We evaluated 75 children with cancer who received influenza vaccination. Hemagglutination Inhibition Antibody titers were determined before and after vaccination. The protective rates after vaccination were 79% for H1N1, 75% for H3N2 and 59% for influenza B virus whereas the seroconversion rates were 54%, 44% and 43% respectively. The differences pre- and post-vaccination were significant regardless the method which was used: seroprotection changes, seroconversion and geometric mean titers analyses. Variables such as the pre-vaccination antibody titers, the time when the responses were measured after the vaccination, the age and the type of malignancy as well as the absolute lymphocyte count were found to be correlated with the immune response but the findings were different for each vaccine subunit. In conclusion, influenza vaccination provid...
Clinical chemistry and laboratory medicine, Jan 27, 2018
Background Risk-adjusted treatment has led to outstanding improvements of the remission and survi... more Background Risk-adjusted treatment has led to outstanding improvements of the remission and survival rates of childhood acute lymphoblastic leukemia (ALL). Nevertheless, overtreatment-related toxicity and resistance to therapy have not been fully prevented. In the present study, we evaluated for the first time the clinical impact of the apoptosis-related BCL2L12 gene in prognosis and risk stratification of BFM-treated childhood ALL. Methods Bone marrow specimens were obtained from childhood ALL patients upon disease diagnosis and the end-of-induction (EoI; day 33) of the BFM protocol, as well as from control children. Following total RNA extraction and reverse transcription, BCL2L12 expression levels were determined by qPCR. Patients' cytogenetics, immunophenotyping and minimal residual disease (MRD) evaluation were performed according to the international guidelines. Results BCL2L12 expression was significantly increased in childhood ALL and correlated with higher BCL2/BAX expr...
Hodgkin and non-Hodgkin lymphomas account for approximately 13 % of cancers in children and adole... more Hodgkin and non-Hodgkin lymphomas account for approximately 13 % of cancers in children and adolescents younger than 20 years of age and are the third most common childhood malignancies following leukemia and CNS tumors.
Vincristine overdose (7.5 mg/m2) was accidentally administered to 3 children with acute lymphobla... more Vincristine overdose (7.5 mg/m2) was accidentally administered to 3 children with acute lymphoblastic leukemia. Treatment included double-volume exchange transfusion, phenobarbital administered prophylactically, and folinic acid rescue 18 mg every 3 hours for 16 doses. Vincristine levels were also assayed and showed a dramatic decline in postexchange levels in the 2 patients who survived and an almost unchanged value in the patient who succumbed. Early signs of toxicity in the 2 survivors were peripheral neuropathy (day 4), bone marrow toxicity (day 5), gastrointestinal toxicity (days 6 and 7), and hypertension (days 7 and 8). Marrow aplasia lasted for 4 and 10 days, peripheral neuropathy for 15 and 42 days, gastrointestinal toxicity for 3 and 5 days, and hypertension for 5 and 14 days. The 2 children were discharged on days 13 and 16 and cytostatic therapy was restarted on days 18 and 25. Both are alive without evidence of leukemia. The third patient developed liver and marrow toxicity on day 3 and died on day 9. Postmortem examination showed leukemia infiltration of the liver and spleen.
The relation between creativity and mental illness has been the object of significant interest an... more The relation between creativity and mental illness has been the object of significant interest and research in psychiatry. However, both psychopathology and creativity are issues of profound complexity, some aspects of which are yet to be explored. This study was designed to explore changes in creativity in relation to the type and degree of psychopathology in 2 groups of patients. Forty-four patients, consisting of 20 patients with manic depressive illness (bipolar disorder) and 24 patients suffering from other psychopathologies, participated in this study. There were 23 women (M age = 43.6) and 21 men (M age = 43.7). We applied a psychological battery of tests using measures for creativity, intelligence, and mood changes. All patients signed the informed consent form. The results are as follows: There was no difference in the creative abilities of patients with bipolar illness (creativity score: M = 104.4, SD = 44.9) as compared to those with other types of psychopathology (creativity score: M = 101.8, SD = 40.8). The study data were analyzed according to the degree of severity of illness, namely, mildly, moderately, or severely ill. Creativity was found to be at its highest level in patients who were moderately ill (creativity score: M = 118.3). The lowest creativity score (M = 62.1) was in the group of patients identified as severely ill. The difference was statistically significant (t = 4.35, p < .001).
Recognizing the importance of psychosocial issues in the care and cure of the child with cancer, ... more Recognizing the importance of psychosocial issues in the care and cure of the child with cancer, the board of the International Society of Pediatric Oncology (SIOP) in 1991 constituted a Working Committee on Psychosocial Issues in Pediatric Oncology, with Giuseppe Masera as chair and John Spinetta as co-chair. This committee met for the first time in Rhodes, Greece, in October 1991. The committee discussed various psychosocial issues and developed a document on Aims and Recommendations, summarizing the experiences of major centers. This document was approved by the SIOP board, which recommended diffusion of the document to the pediatric oncology community.
The aim of this study was to explore the complications related to Hickman-Broviac central venous ... more The aim of this study was to explore the complications related to Hickman-Broviac central venous catheters (Hickman-Broviac CVCs) in children with cancer, their incidence, and possible associations of complications and premature removal of CVCs with a number of risk factors. During the study period (1 Jan 2000-31 Dec 2003), 223 CVCs were inserted in 198 children (117 boys, 81 girls) at a mean age of 5.73 years (95% CI 5.19-6.27, SE 0.275). In total, 76 (38.4%) children suffered from solid tumors and 122 (61.6%) from leukemia. The mean follow-up after CVC insertion was 232.5 days (95% CI 214.9-250.2, SE 8.94) for a total of 51,839 catheter-days. A complication occurred in 20.8% of them and in 9.6% the complication led to the removal of the catheter. The most frequent complications were infection (63.9%), obstruction (26.2%), accidental failure (8.2%), and rupture (1.6%). An overall incidence of 1.17 (0.38 and 0.79 for mechanical complication and infection, respectively) per 1000 catheter days for the development of a complication was recorded. Additionally, the study revealed more nonelective removals in cases of leukemia compared to those of solid tumors. Systemic use of CVC does not appear to increase significantly the number of complications, and thus CVC remains an effective and safe tool for the management of childhood malignancies.
The increasing survival rate of children with cancer because of more refined treatments makes nec... more The increasing survival rate of children with cancer because of more refined treatments makes necessary the investigation of psychological burden for the young patients. The aim of the study was to evaluate the development of psychological problems in children with cancer during the initial 6-month period of intensive treatment. This prospective, comparative study was conducted at one of the largest Greek pediatric oncology units in Athens. The sample comprised 132 children with cancer treated during a 30-month period and 100 children with no cancer as control group. Data were collected using the Rutter instruments for parents and teachers. For patients, it was completed by their parents at 1 (T1), 3 (T2), and 6 months (T3) from diagnosis and by teachers at T3. In the control group, the questionnaire was completed by teachers and parents once. The comparison of total Rutter scores for patients at T1, T2, and T3, according to parents&amp;amp;amp;amp;#39; responses, showed statistically significant difference (P &amp;amp;amp;amp;lt; .001). The difference in scores for patients (at T3) and control subjects was also significant according to both parents&amp;amp;amp;amp;#39; (P &amp;amp;amp;amp;lt; .00001) and teachers&amp;amp;amp;amp;#39; (P &amp;amp;amp;amp;lt; .001) responses. Children with leukemia had higher score reduction during treatment (P = .009) compared with the rest. Only age had a marginal impact on score of patients at T1 (R = 0.04). Based on parental reports, children treated for cancer develop psychological problems during the period of intensive treatment. The development and evolution of these problems depend on their age and type of cancer. This information can be used for relevant interventions in specific groups.
The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral l... more The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral lymphocytes of 67 children with acute lymphoblastic leukemia (ALL) and 50 control individuals. A statistically significant difference between patients and controls was found for large heterochromatin regions (level 3) of chromosomes 1 and 9 (P &lt; 0.001) and for small heterochromatin regions (level 1) of chromosome 16 (P &lt; 0.001). The patients also showed a significant increase in chromosomes 1 and 9 heteromorphism with respect to controls (P &lt; 0.001).
The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral l... more The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral lymphocytes of 67 children with acute lymphoblastic leukemia (ALL) and 50 control individuals. A statistically significant difference between patients and controls was found for large heterochromatin regions (level 3) of chromosomes 1 and 9 (P &lt; 0.001) and for small heterochromatin regions (level 1) of chromosome 16 (P &lt; 0.001). The patients also showed a significant increase in chromosomes 1 and 9 heteromorphism with respect to controls (P &lt; 0.001).
The aim of this study was to explore the complications related to Hickman-Broviac central venous ... more The aim of this study was to explore the complications related to Hickman-Broviac central venous catheters (Hickman-Broviac CVCs) in children with cancer, their incidence, and possible associations of complications and premature removal of CVCs with a number of risk factors. During the study period (1 Jan 2000-31 Dec 2003), 223 CVCs were inserted in 198 children (117 boys, 81 girls) at a mean age of 5.73 years (95% CI 5.19-6.27, SE 0.275). In total, 76 (38.4%) children suffered from solid tumors and 122 (61.6%) from leukemia. The mean follow-up after CVC insertion was 232.5 days (95% CI 214.9-250.2, SE 8.94) for a total of 51,839 catheter-days. A complication occurred in 20.8% of them and in 9.6% the complication led to the removal of the catheter. The most frequent complications were infection (63.9%), obstruction (26.2%), accidental failure (8.2%), and rupture (1.6%). An overall incidence of 1.17 (0.38 and 0.79 for mechanical complication and infection, respectively) per 1000 catheter days for the development of a complication was recorded. Additionally, the study revealed more nonelective removals in cases of leukemia compared to those of solid tumors. Systemic use of CVC does not appear to increase significantly the number of complications, and thus CVC remains an effective and safe tool for the management of childhood malignancies.
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