Thyroid Functions in Long-Term Survivors of Pediatric Hodgkin’s Lymphoma Treated with Chemotherapy and Radiotherapy

Objective: Post-treatment endocrine disturbances are common in cancer patients who have received radiotherapy or chemotherapy. The objective of this study was to evaluate the thyroid functions of long-term survivors of pediatric Hodgkin’s lymphoma treated with chemotherapy and radiotherapy

The alteration of growth and bone health in the course of post-treatment periods in pediatric oncology patients

Günümüzde çocukluk çağı kanserlerinde sağkalım oranı kemoterapi (KT) ve radyoterapi (RT) uygulamaları ve yoğun destek bakımları ile belirgin derecede artmıştır. Sağkalım oranı ve süresi arttıkça tedavinin geç etkileri giderek önem kazanmaktadır. Geç etkiler arasında kemik mineral yoğunluğunda azalma, kemik kütlesindeki kayıplara bağlı olarak gelişen osteopeni ve osteoporoz, büyüme geriliği, malnutrisyon ve obezite sık rastlanan sorunlardandır.Bu çalışmada lenfoma ve solid tümör tanısıyla KT ve RT alarak iyileşen, daha önce kemik mineral yoğunlukları ve büyümeleri değerlendirilmiş çocukların yeniden KMY ve büyüme açısından değerlendirilmesi ve bulguların zaman içindeki değişiminin irdelenmesi amaçlanmıştır.Çalışmaya, 2004 yılından önce tanı almış olan lenfomalı 27 (%40.9), solid tümörlü 39 (%59.1) toplam 66 hasta (47 erkek, 19 kız) alındı. Hastaların kemik mineral yoğunlukları (KMY) dexa ile değerlendirildi.Hastaların tanı anındaki yaş ortalaması 6.58±4.80 yıl (35 gün-17.75 yıl), çalışma sırasındaki yaş ortalaması 12.78±4.17 yıl (5.10-23.61 yıl) saptandı. Ortalama izlem süresi 6.55±1.71 yıl (3.91-12.05 yıl) idi. Hastaların tümü kemoterapi, %31.8'i (n=21) RT almıştı.İlk değerlendirmede (2005 yılı) osteoporozu olan 17 hasta (%25.8), osteopenisi olan 26 hasta (%39.4) mevcuttu. 2009 yılında osteoporozu olan 7 hasta (%10.6), osteopenisi olan 13 hasta (%19.7) mevcuttu. İki dönemin karşılaştırılmasında osteopeni ve osteoporozda istatistiksel olarak anlamlı azalma mevcuttu (p=0.001).RT alan ve almayan hastalar arasında kemik mineral yoğunluğunun normal ve osteoporoz olması açısından istatistiksel olarak anlamlı fark saptandı (p=0.028). KMY ile cinsiyet, puberte, evre, kemoterapi ajanlarının her biri için ilacı alıp almama ve doz açısından istatistiksel olarak anlamlı ilişki saptanmadı.Hastalarımızın tanı, 2005 ve 2009 yılındaki vücut ölçümleri karşılaştırıldı. Boyda tanıdakine göre her iki dönemde artış, boy standart deviasyon skorunda (SDS) 2005 yılında tanıdakine göre azalma, 2009 yılında 2005 yılına göre artış mevcuttu. Ağırlıkta tanıdakine göre her iki dönemde artış, ağırlık SDS'de 2005 yılında tanıdakine göre artış, 2009 yılında 2005 yılına göre azalma mevcuttu. Vücut kitle indeksinde (VKİ) tanıdakine göre her iki dönemde artış, VKİ SDS'de 2005 yılında tanıdakine göre artış, 2009 yılında 2005 yılına göre azalma mevcuttu.Sonuç olarak; çalışmamız ağırlık, boy, vücut kitle indeksi ve kemik sağlığının tedaviden sonraki erken dönemde belirgin etkilendiğini göstermiştir. Ancak ikinci değerlendirmede bu bozuklukların, özellikle ağırlık artışı ve büyümede yavaşlamanın, kalıcı olmadığı ve zamanla düzelme gösterdiği anlaşılmıştır. Bununla beraber, ortalama 6,5 yıllık izlem sonunda hastalarımızın üçte birinde düşük KMY'nin halen devam ettiği ve RT alan hastalarda düşük KMY oranının anlamlı olarak daha fazla olduğu saptanmıştır. Bu da özellikle RT alan hastaların uzun dönem takibini ve gereken hastalarda buna yönelik tedavilerin uygulanması gerektiğini düşündürdü.Nowadays, survival rates in childhood cancers are markedly increased due to effective chemotherapy (CT) regimens, radiotherapy (RT) and intensive supportive measures. As the survival rates and periods are increased the late effects of treatment regimens become more important. Amongst the most common late effects are decreases in bone mineral density and the resultant osteopenia or osteoporosis, growth retardation, malnutrition and obesity. In this study, we aimed to reevaluate the children who had CT or RT with the diagnosis of lymphoma or solid tumors and were previously assessed for their bone mineral densities and growths, as well as to underline the changes in this findings within the times.The study included a total of 66 children (47 boys and 19 girls) with previously diagnosed lymphoma (27 children, 40.9%) and solid tumors (39 children; 59.1%). The bone mineral densities (BMD) were evaluated with DEXA.The mean ages of the patients at diagnosis and at the time of inclusion were 6.58±4.80 years (35 days to17.75 years), and 12.78±4.17 years (5.10 to 23.61 years), respectively. The mean follow-up period was 6.55±1.71 years (3.91 to 12.05 years). All had CT and 21 (31.8%) had RT. In the first evaluation (2005), there were 17 (25.8%) patients with osteoporosis and 26 (39.4%) with osteopenia. In 2009, 7 (10.6%) had osteoporosis and 13 (19.7%) had osteopenia. There were statistically significant decreases in the rates of osteoporosis and osteopenia within the times (p<0.001). The rates of decreased BMDs were significantly differed between those having RT or not (p=0.028). There were no significant associations between BMD and gender, puberty, stage of the disease, each drug of the CT regimens or CT dosages.Anthropometric measurements of the patients at diagnosis, in 2005 and in 2009 were compared. The heights were increased in both study periods. However, the mean height SDS was decreased in 2005 when compared to baseline and increased in 2009 when compared to that of 2005. Similarly, the weights were also increased in both study periods. However, the mean weight SDS was increased in 2005 when compared to baseline and decreased in 2009 when compared to that of 2005. The body mass indexes (BMIs) were increased in both study periods. However, the mean BMI SDS was increased in 2005 when compared to baseline and decreased in 2009 when compared to that of 2005.In conclusion, this study showed that heights, weights, BMIs and bone healths of the patients were significantly influenced in the early periods after the completion of the therapies. These abnormalities, especially weight gain and growth retardations were not sustained in the later periods and improved with times.However, BMD abnormalities were still present in about a third of our study population after the mean follow-up of 6.5 years. In addition, the rate of decreased BMD was significantly higher in those having RT. This suggests that survivors of cancer patients, especially those having RT should be closely followed and cared for long terms

Urothelial Carcinoma of the Bladder in Pediatric Patient: Four Case Series and Review of the Literature

Background: Urothelial carcinoma of the bladder is a rare condition in children, and most cases in this age group are noninvasive and low-grade. However, no follow-up protocol has been defined for this patient group. The objective of this study was to draw attention to bladder tumors in children and focus on the current recommendations for postoperative follow-up along with a case study of four patients. Case Report: Four patients aged <18 years with urothelial carcinoma who were treated in our clinics between 2001 and 2015 were retrospectively evaluated. The results were compared with those of published pediatric case series in the literature. No abnormalities were found in the patients’ physical examinations and laboratory analyses, except hematuria (microscopic or macroscopic). Ultrasonography was used in all the patients to detect lesions in the bladder. Surgical resections were performed endoscopically, except in one patient. Histopathological evaluations revealed low-grade superficial urothelial carcinoma. No recurrence or complication was observed for all patients. Conclusion: Although rarely encountered during childhood, urothelial carcinoma should be considered as a differential diagnosis in pediatric patients with hematuria

The evaluation of malignancies in Turkish PID patients; A multicenter study

WOS: 00043131160017

The performance of classification criteria for juvenile spondyloarthropathies

Juvenile spondyloarthropathies (JSpA) are a group of rheumatologic diseases with a disease onset before 16; characterized with enthesitis, lower extremity oligoarthritis, involvement of the axial skeleton and HLA B27 positivity. The diversity of classification criteria along with the phenotype heterogeneity makes the classification of JSpA challenging. The aim of our study was to evaluate the performance of the pre-determined and recently proposed classification criteria for JSpA. The study group consisted of 113 patients with JSpA and 150 patients with juvenile idiopathic arthritis (JIA). Eligible criteria for JSpA were applied to all of the enrolled patients. The analysis of sensitivity, specificity and the kappa index were used to verify the performance of the JSpA criteria. The Amor criteria showed the highest sensitivity (98.2%) while the ASAS criteria for the axial SpA had highest specificity (100%). The sensitivity and specificity of the remaining criteria were: 93.8 and 63.8% for ESSG, 95.6 and 62.7% for Garmisch-Partenkirchen, 91.2 and 75.3% for ASAS criteria for peripheral SpA, respectively. Criteria proposed by our group showed the high sensitivity, specificity and kappa value: 90.3, 90.7, 0.843%, respectively. We suggest that criteria proposed by us could be used in the classification of JSpA. However, neither the pre-determined nor the new criteria are totally adequate and efficacious for the classification and diagnosis of this disease. The evaluation of the validity and reliability of proposed criteria in multicentric studies are mandatory, to increase its utility in routine clinical practice

Adrenomedullin-A New Marker in Febrile Neutropenia: Comparison with CRP and Procalcitonin

In this study, we aimed to determine serum adrenomedullin levels and compare them with levels of C-reactive protein (CRP) and procalcitonin (PCT). Cancer patients aged 0-18years who experienced febrile neutropenia attacks were included in the study. Adrenomedullin, CRP, and PCT were analyzed at admission, day 3, and days 7-10 later. Fifty episodes of febrile neutropenia that developed in 37 patients were analyzed in this study. The mean age of the patients was 7.5 +/- 4.7 (1-18) years. The patients had leukemia (73%), solid tumors (19%), and lymphoma (8%). The percentages of the patients in the clinically documented infection (CDI), fever of unknown origin (FUO), sepsis, and microbiological documented infection (MDI) categories were 34%, 34%, 20%, and 12%, respectively. During the study period, four patients were lost. In the MDI group, adrenomedullin levels on day 3 were significantly higher than those in the CDI and FUO groups. PCT levels were significantly higher in the sepsis group than those in the CDI group at admission, day 3, and days 7-10. In the sepsis group, PCT levels on days 7-10days were significantly higher than those in the sepsis group. PCT values from the deceased patients on days 7-10 were significantly higher than those from patients who survived. CRP levels did not differ significantly among the febrile neutropenia groups. First, in our study, adrenomedullin was used as a biomarker in the febrile neutropenia episodes of children with cancer. Among adrenomedullin, CRP, and PCT, procalcitonin demonstrates the highest correlation with the severity of infection

Hepatic Focal Nodular Hyperplasia Developing After Childhood Cancers: Two-Center's Experience from Turkey

Even though Focal nodular hyperplasia (FNH) is a rare lesion of the liver in children, it is reported at increased rates in treated pediatric cancer patients. The aim of this retrospective study is to describe the clinical and radiological characteristics and clinical course of patients diagnosed as FNH after primary malignancy in childhood. We retrospectively evaluated the diagnostic work-up, radiologic findings, clinical course and outcome of 8 patients, diagnosed as FNH after pediatric cancer treatment at the Department of Pediatric Hematology-Oncology of the Kanuni Sultan Suleyman Training and Research Hospital and Istanbul University, Oncology Institute, between 1993 and 2011. FNH lesions were diagnosed in 8 of 1600 solid tumors (0.5%) after a median interval of 8 (2-18) years, from the termination of the antineoplastic therapy for the primary cancer. Five patients had a history of neuroblastoma and two patients had rhabdomyosarcoma and one of them had primitive neuroectodermal tumor. FNH was incidentally found at USG or MRI performed during routine follow-up. Two children underwent surgical biopsies to rule out liver metastases. The lesions were stable for a median of 12 months (3-108 months) follow-up, no malign transformation was detected. FNH may be encountered as a radiological finding during follow-up in pediatric malignancies without hematopoetic stem cell transplantation and may be misdiagnosed as liver metastasis. FNH should be considered in the differential diagnosis of liver lesions encountered during follow up children with cancer. After the diagnosis of these benign lesions radiologically without biopsy, close imaging follow-up is recommended