Smärta i samband med intrakraniell kirurgi liknar smärta i samband med all annan form av kirurgi. Syftet var att granska hur barn med hjärntumör smärtbedömts och smärtbehandlats postoperativt efter tumörkirurgi. Metod: Totalt har journaler för 40 barn (20 barn på Akademiska barnsjukhuset i Uppsala och 20 barn på Astrid Lindgrens barnsjukhus vid Karolinska sjukhuset, Stockholm) som opererats för tumörer i hjärnan granskats, avseende smärtbedömning, användandet av smärtskalor, farmakologiska och ickefarmakologisk smärtbehandling de tre första postoperativa dygnen. Resultat: Studien visade att smärtskattning med smärtskalor användes på 12 av 40 barn. Den vanligaste formen av smärtbedömning som återfanns dokumenterad var en bedömning av sjuksköterskan. På Akademiska sjukhuset återfanns ingen dokumenterad smärtbedömning i 60 % av de granskade dygnen, på Astrid Lindgrens barnsjukhus var motsvarande siffra 20 %. De vanligaste läkemedlen som används på båda sjukhusen var paracetamol och opioider, framförallt morfin. Vid Astrid Lindgrens barnsjukhus används företrädelsevis stående ordinationer med paracetamol i kombination med opioidinfusioner. Vid Akademiska sjukhuset används framförallt paracetamol som stående ordination och opioidinjektioner som vid behovsordinationer. I dokumentationen återfanns ingen ickefarmakologisk behandling. För totalt 6 barn fanns omnämnt olika typer av distraktion eller tröst. Slutsats: Slutsatsen blir att utifrån journaldokumentation är systematisk smärtskattning av barn som opererats för tumörer i hjärnan, och utvärdering av given smärtbehandling bristfällig. / Pain in relation to intracranial surgery is similar to pain in relation to all other kind of surgery. Aim: The aim of this study was to review how children with brain tumour were assessed and treated for postoperative pain after tumour surgery. A total of 40 charts of children (20 children at Akademiska University Hospital and 20 children at Astrid Lindgren Children’s Hospital) who had gone through brain surgery have been reviewed with respect to pain assessment, use of assessment tools, pharmacological and nonpharmacological treatment the first tree days after surgery. Result: This study showed that pain assessment tools were used for 12 out of 40 children. The most used documented way of pain assessment was an assessment by the nurse. At the Akademiska University Hospital no documented pain assessment was performed in 60% of the reviewed days. At Astrid Lindgren Children’s Hospital the corresponding number was 20%. The most common drugs used at both hospitals were paracetamol and opioids, particularly morphine. At Astrid Lindgren Children’s Hospital they preferably used standing prescriptions of paracetamol in combination with morphine. At the Akademiska University Hospital they used paracetamol as a standing prescription and opioids as an on demand prescription. In the documentation no nonpharmacological treatment was found. For 6 children there was documentation of different types of distraction or consolation. Conclusion: The conclusion from the study of the documentation is that systematic pain assessment of children who had gone through brain surgery and evaluation of given pain treatment is insufficient.

9 ABSTRACT Tatiana Labudová: Genetic changes in neuroectodermal tumours detected by molecular biological methods. Charles University in Prague, Faculty of Science, Department of Anthropology and Human Genetics Thesis, 75 pages,8 supplements, 2012 This thesis is concerned to neuroectodermal tumours that make a major group of infant tumour diseases. Genetic material gained from patients with neuroectodermal tumours was examined using comparative genomic hybridization (CGH) and interphasic fluorescence in situ hybridization (I-FISH). The aim of this Thesis is to prove chromosomal changes and to create the whole genetic profile. According to these profiles can be determined tumourgenetic cascade or specific genetic changes that lead to malignant tumours. In some cases (f.e. neuroblastoms) the genetic profile helps us to determine a subtype of disease and it's biological behaviour. Keywords: tumour diseases, neuroblastoma, CNS tumours, pheochromocytoma, Ewing's sarcoma, neuroectodermal tumour, comparative genomic hybridization, interphase fluorescence in situ hybridization

Increasing time trends in the recorded incidence of childhood cancer have been reported in many different settings. The extent to which these trends reflect real changes in incidence, rather than improvements in methods for diagnosis and registration, is controversial. Using data from the National Registry of Childhood Tumours (NRCT), this thesis investigates time trends in cancer diagnosed under age 15 in residents of Britain during 1966-2005 (54650 cases), and considers potential sources of artefact in detail. Several different methods are used to estimate completeness of NRCT registration. The history of methods for diagnosis and registration of childhood cancers in Britain is described, and predictions are made for effects on recorded incidence. For each of the 12 main diagnostic groups, Poisson regression is used to fit continuous time trends and ‘step’ models to the annual age-sex-standardised rates by year of birth and year of diagnosis. Age-specific rates by period, and quinquennial standardised rates for diagnostic subgroups, are shown graphically. For three broad groups (leukaemia, CNS tumours and other cancer), geographical variation is compared by period of diagnosis. The results of these analyses are discussed in relation to the predicted artefacts. The evidence for a positive association between affluence and recorded incidence of childhood leukaemia is briefly reviewed. A special form of diagnostic artefact, the ‘fatal infection’ hypothesis, is proposed as an explanation of both this association and the leukaemia time trend. This hypothesis is examined in a novel test based on clinical data. The recorded incidence of childhood cancer in Britain increased in each of 12 diagnostic groups during 1966-2005 (from 0.5% per year for bone cancer to 2.5% for hepatic cancer, with 0.7% for leukaemia). Evidence presented here suggests that these increases are probably artefacts of diagnosis and registration. The potential implications for epidemiological studies of childhood cancer should be considered.