Incidence,severity and outcome of central line related complications in pediatric oncology patients; A single center study

BackgroundCentral venous access device (CVAD)-related complications are associated with high morbidity rates. This study was performed to underline the importance of CVAD-complication prevention and treatment.MethodsAn audit of practice of CVAD-related complications in pediatric oncology patients receiving a CVAD between January 2015 and June 2017 was performed. CVADs included were totally implantable venous access ports (TIVAPs), Hickman–Broviac® (HB), nontunneled, and peripherally inserted CVADs.ResultsA total of 201 children, with 307 CVADs, were analyzed. The incidence rates per 1000 CVAD-days for the most common complications were 1.66 for malfunctions, and 1.51 for central line-associated bloodstream infections (CLABSIs). Of all CVADs inserted, 37.1% were removed owing to complications, of which 45.6% were owing to CLABSIs. In 42% of the CLABSIs, the CLABSI could be successfully cured with systemic antibiotic treatment only. Of all included patients, 5.0% were admitted to the intensive care unit owing to CLABSI. The HB-CVAD compared to the TIVAP was a risk factor for CVAD-related complications, CLABSIs and dislocations in particular.ConclusionsThe incidence of CVAD-related complications is high. Research on the prevention and treatment of CVAD-related complications in pediatric oncology patients should be a high priority for all health care professionals.Type of studyPrognosis study (retrospective).Level of evidenceLevel II.     

In vitro synaptotrophic effects of Cerebrolysin in NT2N cells

Recent studies have shown that Cerebrolysin can enhance synaptic function and ameliorate synapto-dendritic alterations in animal models of neurodegeneration, suggesting a synaptotrophic effect. We hypothesize that Cerebrolysin might exert this effect, in part, by regulating the expression of amyloid precursor protein (APP). We studied the patterns of expression of synaptic proteins during differentiation of human teratocarcinoma cell line NTera 2 (NT2) in the presence or absence of Cerebrolysin. This study showed that the terminally differentiated neurons (NT2N) expressed a wide variety of synaptic markers and that expression of these synaptic-associated proteins coincided with the shift in expression from APP770/751 to APP695. Furthermore, APP immunoreactivity was colocalized with synaptophysin-immunoreactive neuritic varicosities in NT2N neurites, and Cerebrolysin treatment of NT2N cells resulted in an augmented and earlier expression of synaptic-associated proteins. This increased synaptic protein expression coincided with an increase in APP695 over APP770/751. These results support the possibility that synaptotrophic effects of Cerebrolysin might be mediated via regulation of APP expression. Received: 17 August 1998 / Accepted: 29 October 1998     

The use of the Küntscher Y nail in the treatment of intertrochantertc and subtrochanteric fractures of the femur.

Conventional nail plates provide a relatively poor fixation of unstable and pathological fractures of the upper femur, and nail-plate failure is not uncommon. A two-part device, the Küntscher Y nail, provides a strong fixation in these cases and is not difficult ot insert if the method described is employed. The results in 91 patients treated with the Y nail are discussed. Since distal migration of the nail has been prevented by use of a flanged medullary nail, no mechanical failure has occurred. Early weight bearing can be permitted after operation.     

Purine metabolism in relation to leukemia and lymphoid cell differentiation

A number of inborn errors of purine metabolism have been associated with immunodeficiency diseases. From studies to the possible mechanism(s) leading to the defects in the immune system, it appeared that the accumulation of deoxyATP and deoxyGTP and the subsequent inhibition of ribonucleotide reductase played an important role. The inhibition of methylation pathways through the accumulation of s-adenosylmethionine seems to be a second valid concept. The amount to which certain subtypes of lymphoid cells were affected by the enzyme deficiencies was strongly related to the enzymatic make-up of the cells. Lymphoid cells from different maturation stages could be affected in a specific way, depending on the different enzyme activities of these cells. Studies on human lymphoblastic leukemias showed that, related to the immunological subtype, the different leukemias could be characterized by a different enzymatic make-up. In this paper we discuss the possibilities for a specific enzyme directed chemotherapy, directed against specific subtypes of human lymphoblastic leukemias. Experimental evidence indicates that for example the adenosine deaminase inhibitor 2'deoxycoformycin can be used as a specific drug against acute lymphoblastic leukemia with the T cell phenotype.     

Metabolic changes in liver of tumor-bearing mice

The hepatic contents of acetyl coenzyme A, free CoA, α-oxoglutarate, and citrate were determined in tumor-bearing mice. Significant decreases in acetyl CoA and free CoA, with a concomitant increase in citrate occurred 24 hr following inoculation of TLX-5 lymphoma cells. Similar changes occurred in mice bearing a C₃H mammary tumor, when the latter was just palpable in situ. There was some indication that in mice bearing Sarcoma 180, the size of the tumor was a factor in inducing these changes. Significant decreases in the α-oxoglutarate content of liver could only be detected in mice bearing the lymphoma or Sarcoma 180. The direction of change in the hepatic contents of acetyl CoA and citrate were opposite to those found in tumor-free animals under gluconeogenic conditions. However, significant increases in citrate would favor gluconeogenesis by inhibition of phosphofructokinase. Starvation of tumor-bearing mice failed to increase the acetyl CoA content of liver or decrease citrate. The data suggest a failure in lipolysis, as well as in the regulation of fatty acid synthesis in liver via changes in citrate.