Abstracts of Theses from the Scandinavian Countries
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- Gunilla Berclund Department of Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden The ‘Starting again’ program for psychosocial rehabilitation after cancer treatment was evaluated. The program emphasized information, physical and coping training. In study I, 30 patients volunteering for rehabilitation were matched with 30 non-partici- pants with regard to diagnosis, gender, age and the dependent variable appraisal of having received sufficient information. The group participants improved significantly more than the compari- son group with respect to appraisal of having received sufficient information, physical strength and social activity. In study 11, including a 3 month follow-up, 199 patients were randomized, 98 to the rehabilitation program and 101 to the control group. Patients in the rehabilitation program improved more than con- trols with respect to depressive symptoms (post intervention), physical training, some physical symptoms, body avoidance, phys- ical strength, cognitive effects, fighting spirit and appraisal of having received sufficient information. In study 111, long term effects were studied at 6 and 12 months. Results showed that patients in the ‘Starting again’ group maintained an improved level as compared to controls with respect to information. physical strength, physical training and fighting spirit. In study IV. 73 patients declining participation in the randomized study were compared with the participants. Non-participants reported lower problem levels than participants throughout and significantly lower problem level concerning 10 of 18 dependent variables. Thus, the rehabilitation program recruited patients with a higher problem level. Effects on three variables were socially validated in study IV: patient appraisal of having received sufficient informa- tion, physical strength and fighting spirit. No negative effects were detected on outcome variables from being randomized to the control condition (resentful demoralization). Overall. the ‘Starting again’ program had positive and no negative effects. February 1995 Endocrinological implications of bone marrow transplantation in childhood-A longitudinal study BIRGIT BORCSTROM Department of Paediatrics, Karolinska Institute. Huddinge Hospi- tal, Huddinge. Sweden Endocrinological sequelae of childhood bone marrow trans- plantation (BMT) were monitored annually, for at least 5 years, in 35 patients, 21 boys and 14 girls, aged from 1 to 18 years at BMT. The 27 children with leukemia were conditioned with cyclophosphamide (CY) and 10 Gy single dose total body irradia- tion (TBI). Six boys with severe aplastic anemia (SAA) received only CY as conditioning. Two girls with other diagnoses were treated by CY and modified, lower dose TBI. The study of growth and growth hormone (GH) secretion comprised 27 patients, 22 with leukemia and 5 with SAA. During the 5-year period after BMT height velocity varied between - 1.7 and -2.7 SD in the children with leukemia. GH secretion, estimated from the re- sponse to a provocation test and from 24-hour GH profiles, was subnormal in the prepubertal children with leukemia and no pubertal increase was observed. In the 5 boys with SAA the growth rates and GH responses to provocation tests were within normal limits. Growth response to GH treatment was studied in 14 patients with leukemia, 10 girls and 4 boys. During the first year of GH treatment the prepubertal girls increased their height velocity by 4.5 SD and the girls at pubertal stage 2-3 increased their height velocity by 2.0 SD. GH treatment increased height velocity before puberty and in early puberty. Although catch-up growth was modest, further reductions of final height could be prevented. The change in craniofacial development was studied in 16 children, of whom 9 received GH treatment and 7 did not. Comparisons were also made with healthy controls. After an average observation time of 3.5 years the children not treated with GH exhibited significantly reduced mandibular length and alve- olar height. The increase in mandibular length was only 30‘X of that found in the healthy controls. Compared with the healthy controls the GH treated patients showed no significant differences in craniofacial increments. Although GH therapy did not induce a catch-up growth, it appears to have prevented further loss in growth potential. Pubertal development was studied in all 35 patients. In 20 of 21 boys there was spontaneous onset or contin- uation of pubertal development after BMT, but boys who had undergone TBI did not have a normal increase of testicular size. On the contrary, girls after BMT with TBI needed estrogen replacement therapy in 12 of 14 cases for pubertal development. All patients, treated with TBI, had elevated gonadotropins follow- ing BMT, girls were more affected than boy. Girls had increased levels of luteinizing hormone (LH) and follicle stimulating hor- mone (FSH) both before and after stimulation with LH-releasing hormone. Boys had a slightly early puberty and signs of damage to the germinal epithelium, with poor growth of testes and high FSH levels. LH levels were also elevated. indicating a reduced sensitivity in the Leydig cells. Androgen status, testosterone and SHBG, remained normal. The boys with SAA had no signs of dysfunction. Adrenocortical function was studied after the ACTH stimulation test. The boys who had undergone TBI showed sub- normal cortisol levels during the adrenarcheal period (7- 14 years of age) but normalization in the postadrenarcheal years. All other groups of patients had normal cortisol levels. After TBI the boys had decreased levels of dehydroepiandrosterone (DHA) in the postadrenarcheal age group. The increase, after ACTH. in 17alfa- hydroxyprogesteron ( I70HP) was lower in the TBI boys than in non-TBI boys. The girls had significantly decreased levels of DHA and its sulfate (DHAS) and 4-androstene-3.17-dione (A4). The boys. who did not receive TBI. had normal levels of adrenal androgens, It is concluded that after BMT with TBI, maintenance of cortisol homeostasis is probably achieved at the cost of reduced androgen secretion. Thyroid function was studied by analysis of blood samples for thyroid stimulating hormone (TSH). triiodthy- ronine (T3), thyronine (T4) and thyroid-releasing hormone (TRH)-test. The patients with SAA had normal results in all tests. Of the 27 patients with leukemia 24 had elevated response in the TRH-test at least once. In 13 of 27 children the basal TSH value was repeatedly elevated and they were treated with levo-thyroxine (L-T4). Only 3 patients had normal test results after BMT with TBI. Of the 2 girls given lower doses of TBI one developed elevated basal TSH and received L-T4. and the other remained normal. February 1995 695
DOI:
https://doi.org/10.3109/02841869509094051Abstract
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Published
1995-01-01
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