Przydatność ultrasonografii w diagnostyce i monitorowaniu leczenia ostrych chorób jamy brzusznej u dzieci z chorobą nowotworową

Background: The aim of this study was to estimate the results of the diagnostic imaging modalities, especially ultrasonography (US) in children during the oncological therapy with the acute abdominal symptoms. Acute abdominal symptoms in children with neoplasms causing a very difficult clinical and diagnostic problems and can occure in any stage of disease. Materials/Methods: We analyzed 249 ultrasounds examinations of the abdominal cavity in 144 girls and 105 boys aged from 1 to 18 years (mean age 1o, 3 years). The more important indication for the US exam in 133 cases was acute abdominal symptoms. We took exams during pre- and postoperative chemotherapy, radiotherapy and after the hematopoietic stem cell transplantation. All the patients were under routine hematological control. Based on the clinical symptoms and the laboratory tests we analysed two groups of children with oncological disease and acute abdomen: I group-111 children with neutropenia, II group-22 children without neutropenia. In the patients who underwent operation procedure the final diagnosis was established on histopathology. In the other cases diagnosis was based on clinical, laboratory and radiological exams, especially ultrasonography. We analyzed clinical picture of disease, the results of therapy and the US changes in examed patients using statistic parameters as: sensitivity, specificity and efficiency. Results: In the group of 133 children with acute abdominal symptoms the most (92- 69,1%) patients suffer from ALL (acute lymphoblastic leukaemia) and 16(12%) - from AML (acute lympoblastic leukaemia), Ewing sarcoma-3(2,2%), osteosarcoma-3(2,2%), NHL-8(6,0%), HL-4(3%), nephroblastoma-4(3%), neuroblastoma- 3( 2,2%). Acute abdominal symptoms can have a very different etiology: bacterial, mycotic and virusal infections or continious infiltration of gastrointestinal tract by tumor. Clinical symptoms of the acute abdominal diseases are very severe, because the oncological patients usually have immunologic deficiency and oblige us to proper clinical observation or to operation procedure, very often as an emergency. The symptoms appeard in the different time of course of oncological diseases. Nonspecific gastrointestinal inflammation with haemorrhage and typhlitis were the main cause of the acute abdominal pain in 71 children with neutropenia during therapy of leucaemia, lymphoma, aplastic anemia and after hematopoietic stem cell transplantation. The accuracy of ultrasound findings verified intraoperatively and by histopathologic examinations was 84%. In all cases the morphological changes were directly related to the signs and symptoms duration. Conclusions: The high-resolution ultrasound has a very important role in diagnosis in all patients with acute abdominal pain and with neoplasms. The authors consider that the US should be the first imaging method in the differential diagnosis of the abdominal changes in children with neutropenia and oncological disease. Proper diagnosis should be established only with clinical information

Viral infections in children undergoing hematopoietic stem cell transplantation

BackgroundDue to clinical reasons, in stem cell transplant setting viral infections are divided as latent (herpesviruses, BKV) and sporadic (adenovirus – ADV, rotavirus – RV, influenza – INFL and others).ObjectiveThe aim of this study was the analysis of incidence and outcome of viral infections in 5 Polish pediatric hematopoietic stem cell transplantation (HSCT) centers.Patients and methodsA total number of 308 HSCTs (allo – 232, auto – 76) performed over a period of 24 months in children and adolescents in participating centers were analyzed retrospectively.ResultsIn the period under analysis, 205 viral infections were diagnosed (197 after allo-HSCT, and 8 after auto-HSCT). After allo-HSCT, infections occurred in 119 (51.3%) patients, of which 51.2% were one of multiple infections: 58 patients were infected with one virus, 29 with two, 16 with three and 16 with four or more viruses. Cumulative incidence of viral infections after allo-HSCT was: CMV – 28.0%, BKV – 18.5%, EBV – 15.5%, ADV – 9.5%, RV – 9.1%, VZV – 2.6%, INFL – 0.9%, HHV6 – 0.9%. In 8 (10.5%) auto-HSCT patients following infections were diagnosed: RV – 4, CMV – 2, ADV – 1, BKV – 1. With respect to specific virus, there were no differences between patients’ age and time from HSCT to beginning of infection (medians: 0.8–2.4 month), except for late VZV infection occurring at median time of 6.5 month after HSCT. Cure rates were lowest for: EBV (90,7%), ADV (93,8%), BKV (94,2%), CMV (94,6%), and reached 100% in case of INFL, HBV, VZV, HHV6 and RV.ConclusionsViral infections in children after HSCT occur in over 50% of the patients after allo-HSCT and 10% after auto-HSCT. Mixed and multiple infections occur frequently. Infections with CMV, EBV, BKV or ADV contribute to deaths in 5–10% patients