Impact of Severe Neutropenia and Other Risk Factors on Early Removal of Implanted Central Venous Catheter (ICVC) in Children With Hematologic Malignancies.

BACKGROUND/PURPOSE:: In neutropenic children with hematologic malignancies, the optimal timing of implanted central venous catheter (ICVC) insertion is unclear. The policy in our Institution has been to place ICVC at the time of diagnosis of disease regardless of the absolute neutrophil count. The impact of this strategy on the incidence of ICVC removal within 30 days of placement was evaluated in a series of patients. Other possible risk factors for ICVC early removal were also examined. MATERIALS AND METHODS:: Records of all children with hematologic malignancies who underwent placement of ICVC during 2007 to 2010 were reviewed. The incidence of catheter-related complications and early removal was compared between subjects who were neutropenic at the time of ICVC placement and those who had a normal absolute neutrophil count. RESULTS:: An ICVC was placed in 117 children, and only in 12 (10.2%) children it was removed within 30 days. However, the incidence of complications and removal was not influenced by the presence of neutropenia. Only an age below 2 years was demonstrated to be a risk factor for early complication and removal. CONCLUSIONS:: The policy to place ICVC in neutropenic patients has been reasonably safe, in our hands. Meticulous preoperative evaluation, the accurate surgical technique and considerable care in their postoperative management are essential to prevent complications, especially in newborns and infants, who seem to be at greater risk of ICVC removal

An Unusual Case of Extra-Abdominal Desmoid Tumor

Desmoid tumour is relatively rare and generally non-metastatisizing lesion of mesenchymal origin composed of fibrous tissue and fitting in the group of aggressive fibromatosis; it is a locally aggressive proliferative soft-tissue lesion with controversial nature. This tumour accounts for 0.03% of all tumours and 3% of soft-tissue tumours with annual incidence of two to four cases per million. Although desmoid tumours are more common in persons aged 10-40 years than in others, they do occur in young children and older adults; in children the sex incidence is equal. This is a rare case of extra-abdominal desmoid tumour in a 14-year-old girl affected by spastic tetraparesis. To our knowledge no similar cases are present in literature to date

Does hepatitis B virus play a role in primary liver cancer in children of Western countries?

Hepatitis B virus (HBV) infection was evaluated in serum and liver specimens of eight Italian children with primary liver cancer. All children were negative for HBV markers in serum but four of them showed HBV-DNA sequences and/or HBs antigen expression in the liver. In one case, viral DNA was present in both neoplastic and non-neoplastic tissue, while in one case HBV-DNA was detectable only in nontumoral tissue and in one case only in the tumor area. In these cases, scattered HBsAg was expressed in the cytoplasm of cells in normal part of the liver and in another case neoplastic cells secreted HBsAg in culture. In two cases, the histologic diagnosis was HCC; one case had mixed HPB and one had macrotrabecular HPB. All children were more than 1 year of age. The remaining four children were histologically diagnosed as HPB and were less than 1 year of age. These findings suggest that HBV may be a cofactor for the development of liver cancer also in children of Western countries and that the risk of infection progressively increases with age

Impact of Severe Neutropenia and Other Risk Factors on Early Removal of Implanted Central Venous Catheter (ICVC) in Children With Hematologic Malignancies

Background/Purpose: In neutropenic children with hematologic malignancies, the optimal timing of implanted central venous catheter (ICVC) insertion is unclear. The policy in our Institution has been to place ICVC at the time of diagnosis of disease regardless of the absolute neutrophil count. The impact of this strategy on the incidence of ICVC removal within 30 days of placement was evaluated in a series of patients. Other possible risk factors for ICVC early removal were also examined. Materials and Methods: Records of all children with hematologic malignancies who underwent placement of ICVC during 2007 to 2010 were reviewed. The incidence of catheter-related complications and early removal was compared between subjects who were neutropenic at the time of ICVC placement and those who had a normal absolute neutrophil count. Results: An ICVC was placed in 117 children, and only in 12 (10.2%) children it was removed within 30 days. However, the incidence of complications and removal was not influenced by the presence of neutropenia. Only an age below 2 years was demonstrated to be a risk factor for early complication and removal. Conclusions: The policy to place ICVC in neutropenic patients has been reasonably safe, in our hands. Meticulous preoperative evaluation, the accurate surgical technique and considerable care in their postoperative management are essential to prevent complications, especially in newborns and infants, who seem to be at greater risk of ICVC removal. Copyright © 2013 by Lippincott Williams & Wilkins

LATENT HEPATITIS B VIRUS INFECTION IN CHILDHOOD HEPATOCELLULAR CARCINOMA

The presence of hepatitis B virus (HBV) has been evaluated in liver specimens from 11 children with primary liver tumors and negative results of serologic testing for HBV markers. HBV-DNA sequences were detected by the polymerase chain reaction procedure, using different sets of oligonucleotide primers from highly conserved regions of HBV genome. Two of three children with histologic diagnosis of hepatocellular carcinoma were positive for HBV-DNA in the liver, whereas the remaining children, including six patients with hepatoblastoma, one patient with hemangioma, and one patient with hamartoma, were negative. These findings support the hypothesis of a primary role of HBV in the development of hepatocellular carcinoma in children from nonendemic areas and without overt HBV infection

Epstein-Barr Virus load and immune activation in Human Immunodeficiency Virus type 1-infected patients.

BACKGROUND: Patients infected with HIV-1 are at high risk of developing Epstein-Barr Virus (EBV)-related diseases. Chronic immune activation is a hallmark of HIV-1 pathogenesis and may play a role in B-cell stimulation and expansion of EBV-infected cells. OBJECTIVES: The aim of the study was to define the relationship between parameters of immune activation and EBV load in HIV-1-infected subjects. STUDY DESIGN: A total of 156 HIV-1-infected patients were studied. EBV types 1 and 2 were quantified on peripheral blood mononuclear cells by multiplex real-time PCR. Plasma levels of cytokines and lipopolysaccharide (LPS) were determined by immunoenzymatic assays. B-cell activation was analyzed by flow cytometry. RESULTS: EBV-DNA was detected in 114 patients, and in all but 3 was EBV type 1. The median [interquartile] EBV-DNA load was 43[1-151] copies/10(5) PBMC. EBV-DNA load was higher in patients with detectable HIV-1 plasma viremia, despite good immunological status (CD4>500 cells/\u3bcl), than in patients with undetectable HIV-1 plasma viremia regardless of immunological status (46[5-136] copies/10(5) cells vs 17[1-56] copies/10(5) cells, p=0.008). Patients with high EBV-DNA load (>median value) had higher levels of LPS and proinflammatory cytokines (IL-6, IL-10 and TNF-\u3b1) than patients with low EBV load. Furthermore, percentages of activated B-cells correlated with EBV-DNA load (r(s)=0.754; p<0.001). CONCLUSIONS: Overall, these findings indicate a strong association between HIV-1 viremia, markers of immune activation and EBV load and suggest that persistence of HIV-1 viremia and immune activation, regardless of peripheral CD4 cell depletion/repopulation, may favor expansion of EBV-infected cells and onset of EBV-related malignancies

Oral human papillomavirus and human herpesvirus-8 infections among human immunodeficiency virus type 1-infected men and women in Italy.

Background: Oral human papillomavirus (HPV) and human herpesvirus- 8 (HHV8) infections are sexually transmitted and respectively associated with the development of oropharyngeal carcinoma and Kaposi sarcoma. The aim of the study was to evaluate HPV prevalence and its possible correlation with HHV8 oral shedding, in relation to sex, human immunodeficiency virus (HIV) behavioral risk factor, and immune function. Methods: The study population comprised 100 HIV-infected individuals divided into 3 groups: (1) 38 men who have sex with men (MSM), (2) 24 heterosexual men, and (3) 38 women. DNA was obtained from cells of unstimulated whole saliva. Human papillomavirus sequences were searched for by polymerase chain reaction (PCR) with MY09/MY11 primers or by nested PCR with GP5+/GP6+ primers as the second step. Typing was accomplished by restriction fragment length polymorphism analysis or by direct sequencing or by reverse line blot. Human herpesvirus- 8 sequences were detected and quantified by nested PCR and real-time PCR, respectively. Results: Oral HPV infection was present in 37 (prevalence, 37%) of 100 (13 with high-risk and 24 with low-risk types) patients; the most frequent types were HPV16, HPV6, HPV10, HPV61, HPV66, and HPV83. Human herpesvirus-8 DNA was detected in 46 (46%) of 100 subjects. Both infections had the highest prevalence among MSM and the lowest among women; women had a lower prevalence of high-risk HPV types than did both male groups (P = 0.05). An inverse correlation was observed with concomitant oral HHV8 infection (P = 0.007). Conclusions: High prevalence of oral HPV and HHV8 infections was observed; MSM had the highest figures, despite better control of HIV infection