Hepatocyte-specific contrast-enhanced MRI findings of focal nodular hyperplasia-like nodules in the liver following chemotherapy in pediatric cancer patients

PURPOSEWe aimed to assess the MRI findings and follow-up of multiple focal nodular hyperplasia (FNH)- like lesions in pediatric cancer patients diagnosed by imaging findings.METHODSWe retrospectively analyzed clinical data and MRI examinations of 16 pediatric patients, who had been scanned using gadoxetate disodium (n=13) and gadobenate dimeglumine (n=3). Hepatic nodules were reviewed according to their number, size, contour, T1- and T2-weighted signal intensities, arterial, portal, delayed and hepatobiliary phase enhancement patterns. Follow-up images were evaluated for nodule size, number, and appearance.RESULTSAll 16 patients received chemotherapy in due course. Time interval between the initial diagnosis of cancer and detection of the hepatic nodule was 2–14 years. Three patients had a single lesion, 13 patients had multiple nodules. The median size of the largest nodules was 19.5 mm (range, 8–41 mm). Among 16 patients that received hepatocyte-specific agents, FNH-like nodules appeared hyperintense in 11 and isointense in 5 on the hepatobiliary phase. During follow-up, increased number and size of the nodules were seen in 4 patients. The nodules showed growth between 6–15 mm.CONCLUSIONLiver MRI using hepatocyte-specific agents is a significant imaging method for the diagnosis of FNH-like lesions, which can occur in a variety of diseases. Lesions can increase in size and number in pediatric patients

The importance of mothers’ self cohesion when their children diagnosed with cancer (eng)

Kanser tanısı almış bir çocuğa sahip olmanın anneler üzerinde muazzam etkileri vardır. Genelde anneler duygularını “bir parçamı kaybediyormuşum gibi” şeklinde tanımlarlar. Bu travmatik deneyimin annelerin psikolojileri üzerindeki etkilerini anlamak için kendilik/kendilik bütünlüğü deneyimleri olarak anılan psikanalitik açıklamalar dikkate alınmalıdır. Bu çalışmada öyküsel sorgulama ve öyküsel analiz yöntemi kullanılarak karşılaştırmalı vaka analizi yapılmıştır. Çocukları kanser tanısı almış iki anne ile yaşadıkları travmatik deneyimler ve bunların kendilik-kendiliknesnesi ihtiyaçları ile ilişkisi konusunda görüşmeler yapılmıştır. Çocuğu kanser tanısı almış tüm anneler bu travmatik deneyimden aynı düzeyde etkilenmemektedir. Annelerin geçmiş ve şu andaki kendiliknesnesi aktarımlarını anlamak klinisyene doğru kişiye müdahale emesi için yardımcı olacaktır. Annelerin yaşadığı stresi psikanalitik bakış açısı ile ele almak ve bu düzeyde müdahale etmek sadece annelerin iyilik halini yükseltmeyecek aynı zamanda çocukların ve daha büyük ölçekte de toplumun iyilik haline katkıda bulunacaktır.Having a child with cancer has an enormous impact on their mothers. Usually mothers describe their feeling as “losing some part of themselves”. In order to understand this traumatic experience on mothers’ psychology, psychoanalytic explanations of self/self-cohesion experiences should be taken into account. In this study a comparative case analysis was performed using narrative inquiry and narrative analysis. Two mothers were chosen. Each mother was interviewed about their self-selfobject needs and its relation to their traumatic cancer experience. The narrative analysis revealed that, the mother who had a weak self cohesion before the diagnose reported more traumatic narratives in comparison to the mother who had a healthy self cohesion. Not all mothers with children who has cancer were affected to the same extent from this traumatic experience. Understanding mother’s earlier and present selfobject transferences will help clinician to intervene to the right person. Understanding mot-hers’ distress from the psychoanalytic perspective and intervene at that level not only improve mothers’ well-being but also the children’s and the society’s at large.Publisher's Versio

Recombinant Human Erythropoietin Treatment for Chemotherapy-Related Anemia in Children

Objective. The efficacy and safety of recombinant human erythropoietin (rHuEPO) treatment in chemotherapy-induced anemia in children were investigated, rHuEPO is used to treat chemotherapy-induced anemia. Several studies recommend 150 to 300 IU/kg rHuEPO for 2 to 8 months. There are only a few controlled trials in children and no precise data about the optimal dose and duration of rHuEPO treatment is available. Patients and Methods. Thirty-four patients receiving chemotherapy for treatment of their solid tumors between October 1996 and June 1997 were included in this study. Patients were randomly selected for each group. The male/female ratio was 20/14, and the median age was 5 years (range, 1-16 years). They had normal hemoglobin levels at the time of diagnosis. When hemoglobin levels decreased to levels lower than 10 g/dL, rHuEPO (150 IU/kg/d, 3 times a week, subcutaneously) was given to 17 patients for 2 months. Their renal, liver, and pulmonary functions were normal. None of the patients had hematologic disease. We did not use any other drugs such as iron or granulocyte colony-stimulating factor. There were 17 patients in the control group. Fifteen patients got chemotherapy regimens including cisplatin (CDDP), but 19 were treated with regimens without CDDP. At the end of rHuEPO treatment, all patients were examined in terms of transfusion requirements and rate of change in hemoglobin levels. Results. One patient in the study group needed a blood transfusion, whereas 8 patients needed a transfusion in the control group. Patients in the study group had less transfusion requirements compared with the control group. The mean hemoglobin levels before and after the study were 8.48 +/- 0.98 g/dL and 8.41 +/- 1.65 g/dL in the control group and 8.50 +/- 0.85 g/dL and 10.21 +/- 2.14 g/dL in the rHuEPO group, respectively. Optimal hemoglobin increments began in 4 weeks and continued during treatment. CDDP-receiving and CDDP-nonreceiving groups did not have any difference in pretreatment serum erythropoietin levels. rHuEPO treatment was more effective in patients treated with non-CDDP regimens. Mean hemoglobin level increased from 8.68 +/- 0.73 g/dL to 10.26 +/- 1.84 g/dL in 9 patients treated with non-CDDP chemotherapy regimens in the erythropoietin group, although it increased from 8.28 +/- 0.97 g/dL to 10.15 +/- 2.5 g/dL in 8 patients treated with CDDP-containing regimens in the erythropoietin group. rHuEPO caused high blood pressure in only 1 patient that resolved spontaneously after cessation of erythropoietin treatment for a week. Conclusion. rHuEPO treatment (150 IU/kg/d 3 times a week) is effective and safe in children with chemotherapy-induced anemia. It decreases blood transfusion requirements in solid tumor patients. Our results show that the response to rHuEPO in CDDP-induced anemia is less than the response in non-CDDP receiving patients. Higher doses may be necessary in patients using CDDP.Wo

Renal Tumors with Pseudohermaphroditism and Glomerular Disease

Scopu

Long-term neuromusculoskeletal side effects and quality of life in nasopharyngeal cancer patients receiving radiochemotherapy

Aim In this study, we aimed to evaluate the neuromusculoskeletal late side effects and their impact on the quality of life of patients with nasopharyngeal carcinoma treated with radiochemotherapy. Patients and methods Twenty-seven patients were included. The mean follow-up was 61 months (range, 18-111 months). The median external radiotherapy dose applied to the nasopharynx and primary tumor was 70 Gy (range, 61-73 Gy). The mean dose received by the temporomandibular joint in the dose-volume histograms of these patients was 60.7 Gy. The maximal doses of the muscles responsible for cervical motion in different ranges were greater than 60 Gy, and the mean doses were greater than 40 Gy in the muscle groups, except for the extensor muscles. Results Two patients had brachial plexus involvement, while 89% of the patients had restriction in flexion and extension movements. Of the patients, 52% had trismus. There was a significant correlation between extension restriction and general heath score and the physical subscale of the quality-of-life questionnaire (p = 0.01). There was also a correlation between trismus and pain killer usage (p = 0.004). Conclusion This is the first study to analyze long-term muscle and nerve toxicity and their correlation between doses in nasopharyngeal cancer patients following radiochemotherapy. Despite the advances in radiotherapy techniques, it is necessary to pay attention to the doses of the nerves and muscles for late effects

Infantile myofibromatosis: a case with unusual features and review of the literature

A three-month-old boy was admitted for a slowly progressing nodule in his right chin, first recognized at birth and recently accompanied by facial paralysis. It was found to be a soft tissue mass arising in subcutaneous tissue and extending deep into the temporal muscle, causing temporal bone erosion without infiltrating the dura. Initially interpreted as mesenchymal chondrosarcoma, combined chemotherapy (PULSE-VAC) was given. Eighteen months later an additional nodule developed In the paraspinal skin. Evaluation of both lesions showed vimentin and α-smooth-muscle-action positivity. As the final diagnosis was multicenlric infantile myofibromatosis, the child was followed up without therapy. Thirty months later, multiple osteolytic lesions appeared on the skull and long bones of the extremities. Some lesions remained stable and some regressed during two years of follow-up