Wilms' tumour and hypertension: incidence and outcome.
ABSTRACT To determine the incidence and outcome of hypertension associated with Wilms' tumour and to reduce peri-operative morbidity by appropriate treatment.
The medical and nursing case-notes of 17 consecutive patients with Wilms' tumour treated over a 5.5 year period (1989-1994) were analysed retrospectively.
Ten of 17 patients had hypertension, with a mean blood pressure of 150/103 mmHg (130-220 mmHg systolic and 85-145 mmHg diastolic). There was no significant difference between the hyper- and normotensive patients in their mode of presentation. Blood pressure was stabilized preoperatively in all the hypertensive patients. Perioperative monitoring in these patients was performed using arterial and central venous pressure lines. No patient had any peri-operative hyper- or hypotensive episodes caused by handling the tumour or after nephrectomy. Thirteen patients had a favourable histological diagnosis and all the hypertensive patients were in this group. The blood pressure of all patients returned to normal within 1 month of surgery.
Both the recognition of hypertension and appropriate peri-operative treatment is mandatory for the safe surgical management of this condition.
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ABSTRACT: Wilms tumor (WT) is the most common renal malignancy of childhood. Our aim was to verify the epidemiological profile and prognosis of a sample of patients from Brazil and compare them to similar data especially presented in studies developed in Latin America. The sample consisted of consecutive patients diagnosed with WT in an onco-hematology service of a referral hospital in Southern Brazil, in the period between 1989 and 2009. Clinical, radiological, pathological and survival data were collected from the medical records. The analysis was performed using Excel program and SPSS version 18.0. The significance level was of P<0.05. Our final sample consisted of 45 patients. The male/female ratio was 1.25:1. The mean age at diagnosis was 43.9 months and all patients were Euro-descendants. Thirty three patients (73.3%) presented both signs/symptoms of abdominal mass and hypertension. Malformations were observed in 9 patients (20%). There was a case of Fanconi's anemia (2.2%). Three cases were bilateral (6.7%). The majority of patients had stage III and IV (62.2%). We found that patients with malformations had an earlier age at diagnosis (P= 0.018) and more bilateral disease (P= 0.044). The overall survival was 75%. Age at diagnosis was the only significant independent predictor associated to death. We believe that our deaths are closely related to late diagnosis. Oncologic services should also be concerned about the morbidities caused by therapeutical options in these late diagnosed cases and its consequences in the quality of life of the patients.Pediatrics International 01/2014; · 0.88 Impact Factor
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ABSTRACT: There have been a number of advances that have increased our understanding of the biology of Wilms tumor during the last decade. This information is now being incorporated into current pediatric oncology protocols. We present a summary of these advances and outline the current treatment of Wilms tumor. The medical literature was reviewed with an emphasis on the molecular biology of Wilms tumor. The development of Wilms tumor involves several genes, including WT1, the Wilms tumor suppressor gene at 11p13. In addition, certain chromosomal regions (16q and 1p) might be used as prognostic factors for determining the intensity of therapy. Future protocols conducted by pediatric oncology groups will incorporate biological studies. The goal is to identify patients at low risk for relapse which will allow a reduction in treatment intensity and subsequent toxicity. Children at an increased risk for relapse can be selected for more intensive treatment.The Journal of Urology 04/1998; 159(4):1316-25. · 3.75 Impact Factor
Article: Secondary Forms of Hypertension