Advanced Pediatric Inoperable Thymus Carcinoma (Type C Thymoma): Case Report on a Novel Therapeutic Approach

Although there has been considerable advancement in treatment techniques but still there are some illnesses that continue to exhibit a rather poor curability, such as thymoma. This report highlights the benefit of octreotide and prednisolone therapy in a 15-year-old girl, who was diagnosed with inoperable thymus carcinoma, with chemotherapy and radiotherapy being the last resort. The detection of type 2 somatostatin receptors on the surface of the tumor justified the introduction of treatment with somatostatin analog and prednisolone. Fortunately, after 6 months of this treatment, the tumor showed partial regression. However, 2 months later, somatostatin receptor negative metastases appeared; therefore, a switch over to imatinib became essential, because the tumor was CD-117 positive. Despite the therapy change, the patient's condition deteriorated owing to tumor progression

Gyermekkori agytumorok vizsgálata szomatosztatin-analóg (111In-DTPA-D-Phe1-octreotide) alkalmazásával = Imaging of pediatric brain tumors using somatostatin analogue 111Ih-DTPA-D-Phe1-octreotide

Gyermekkorban a leggyakoribb gyermekkori szolid tumor az agytumor. Az agytumorokat (beleértve a medulloblastomát is) kombinált műtéti-, sugár- és kemoterápiával kezeljük. A kemoterápiának azonban korlátozott hatása van. A gyermekkori agytumorok (különösen a medulloblastoma) szomatosztatinreceptorokat expresszálnak. A jelen vizsgálat célja, hogy megvizsgálja a gyermekkori agytumorokban a szomatosztatinreceptor-státust. A Semmelweis Egyetem II. sz. Gyermekgyógyászati Klinikájának onkológiai részlegén 2000 és 2005 között 45, agydaganattal kezelt gyermeknél végeztünk 56 Octreoscan (111In-DTPA-D-Phe1-octreotide) SPECT vizsgálatot. A 45 gyermekből 21 esetben (46,7%) volt a szövettani diagnózis medulloblastoma. Az Octreoscan-vizsgálattal párhuzamosan MRI-felvételeket is készítettünk. Az 56 Octreoscan-vizsgálat közül 27-nél (48,2%) találtunk egyértelműen kóros aktivitásfelvételt. Ezek közül 16 medulloblastoma, 4 ependymoma, 4 astrocytoma, illetve 3 glioblastoma volt. Az 56 (100%) Octreoscan-vizsgálatból 37 esetben (66,1%) a szcintigram és az elvégzett MRI-vizsgálatok eredményei megegyeztek, 19 vizsgálati eredménynél (33,9%) azonban a két vizsgáló eljárás eltérő eredményt mutatott. Gyermekkori agytumoros betegeknél (beleértve a MBL-t is) az Octreoscanvizsgálat differenciáldiagnózis felállítására nem megfelelő, de a tumorsejtek szomatosztatinreceptoraihoz kötődő (111In-DTPA-D-Phe1-octreotide) izotóp vegyület kimutatása alkalmas lehet a terápiás hatás nyomon követésére. Az Octreoscan-felvételt mutató tumorokban szóba jön a szomatosztatin adjuváns terápiás használata. Malignant solid tumors and leukemias are the second most common causes of death in childhood. The most frequent pediatric solid tumors are brain tumors. Brain tumors, especially medulloblastoma should be treated by surgery, irradiation and chemotherapy. However, chemotherapy has only moderate effect. Pediatric brain tumors, especially medulloblastomas, express somatostatin receptors. The aim of this study was the investigation of the expression of somatostatin receptors in pediatric brain tumors for diagnostic and therapeutic purpose. Fifty-six scintigraphic imagings (111In-DTPA-D-Phe1-octreotide) made in 45 children treated with brain tumor at the Unit of Oncology of the 2nd Department of Pediatrics, Semmelweis University. The diagnosis was medulloblastoma in 21 cases (46.7%). MRI scans have been performed parallel with the Octreoscan images. Octreoscan images were positive in 27 of 56 (48.2%) cases. The 27 positive Octreoscan images consisted of 16 medulloblastomas, 4 ependymomas, 4 astrocytomas and 3 glioblastomas. In 37 (66.1%) cases the results of Octreoscans were the same as those of the MRI scans. However, in 19 scans (33.9%) the outcome was different. Octreoscan imaging is not suitable for differential diagnosis in pediatric brain tumors, including medulloblastomas. Isotopes specifically binding to the somatostatin receptors (111In-DTPA-D-Phe1-octreotide) can be applied in medulloblastomas for diagnosis and follow-up treatment. In Octreoscan-positive tumors the Octreoscan images establish the opportunity to somatostatin analogue and/or specifically targeted radiation therapies

Imaging of pediatric brain tumors using somatostatin analogue 111Ih-DTPA-D-Phe1-octreotide. Gyermekkori agytumorok vizsgálata szomatosztatin-analóg (111In-DTPA-D-Phe1-octreotide) alkalmazásával

Gyermekkorban a leggyakoribb gyermekkori szolid tumor az agytumor. Az agytumorokat (beleértve a medulloblastomát is) kombinált műtéti-, sugár- és kemoterápiával kezeljük. A kemoterápiának azonban korlátozott hatása van. A gyermekkori agytumorok (különösen a medulloblastoma) szomatosztatinreceptorokat expresszálnak. A jelen vizsgálat célja, hogy megvizsgálja a gyermekkori agytumorokban a szomatosztatinreceptor-státust. A Semmelweis Egyetem II. sz. Gyermekgyógyászati Klinikájának onkológiai részlegén 2000 és 2005 között 45, agydaganattal kezelt gyermeknél végeztünk 56 Octreoscan (111In-DTPA-D-Phe1-octreotide) SPECT vizsgálatot. A 45 gyermekbôl 21 esetben (46,7%) volt a szövettani diagnózis medulloblastoma. Az Octreoscan-vizsgálattal párhuzamosan MRI-felvételeket is készítettünk. Az 56 Octreoscan-vizsgálat közül 27-nél (48,2%) találtunk egyértelműen kóros aktivitásfelvételt. Ezek közül 16 medulloblastoma, 4 ependymoma, 4 astrocytoma, illetve 3 glioblastoma volt. Az 56 (100%) Octreoscan-vizsgálatból 37 esetben (66,1%) a szcintigram és az elvégzett MRI-vizsgálatok eredményei megegyeztek, 19 vizsgálati eredménynél (33,9%) azonban a két vizsgáló eljárás eltérő eredményt mutatott. Gyermekkori agytumoros betegeknél (beleértve a MBL-t is) az Octreoscanvizsgálat differenciáldiagnózis felállítására nem megfelelő, de a tumorsejtek szomatosztatinreceptoraihoz kötődő (111In-DTPA-D-Phe1-octreotide) izotóp vegyület kimutatása alkalmas lehet a terápiás hatás nyomon követésére. Az Octreoscan-felvételt mutató tumorokban szóba jön a szomatosztatin adjuváns terápiás használata. Malignant solid tumors and leukemias are the second most common causes of death in childhood. The most frequent pediatric solid tumors are brain tumors. Brain tumors, especially medulloblastoma should be treated by surgery, irradiation and chemotherapy. However, chemotherapy has only moderate effect. Pediatric brain tumors, especially medulloblastomas, express somatostatin receptors. The aim of this study was the investigation of the expression of somatostatin receptors in pediatric brain tumors for diagnostic and therapeutic purpose. Fifty-six scintigraphic imagings (111In-DTPA-D-Phe1-octreotide) made in 45 children treated with brain tumor at the Unit of Oncology of the 2nd Department of Pediatrics, Semmelweis University. The diagnosis was medulloblastoma in 21 cases (46.7%). MRI scans have been performed parallel with the Octreoscan images. Octreoscan images were positive in 27 of 56 (48.2%) cases. The 27 positive Octreoscan images consisted of 16 medulloblastomas, 4 ependymomas, 4 astrocytomas and 3 glioblastomas. In 37 (66.1%) cases the results of Octreoscans were the same as those of the MRI scans. However, in 19 scans (33.9%) the outcome was different. Octreoscan imaging is not suitable for differential diagnosis in pediatric brain tumors, including medulloblastomas. Isotopes specifically binding to the somatostatin receptors (111In-DTPA-D-Phe1-octreotide) can be applied in medulloblastomas for diagnosis and follow-up treatment. In Octreoscan-positive tumors the Octreoscan images establish the opportunity to somatostatin analogue and/or specifically targeted radiation therapies

Factors influencing antimicrobial resistance and outcome of Gram-negative bloodstream infections in children

OBJECTIVE: The aim of this study was to collect data about pediatric Gram-negative bloodstream infections (BSI) to determine the factors that influence multidrug resistance (MDR), clinical course and outcome of children affected by Gram-negative sepsis. METHODS: In this observational, prospective, multicenter study we collected cases of pediatric Gram-negative BSI during a 2-year period. We analyzed epidemiological, microbiological and clinical factors that associated with acquisition of MDR infections and outcome. RESULTS: One-hundred and thirty-five BSI episodes were analyzed. Median age of children was 0.5 years (IQR 0.1-6.17, range 0-17 years). Predominant bacteria were Enterobacteriaceae (68.3 %), and Pseudomonas spp. (17.9 %). Multidrug resistance was detected in 45/134 cases (33.6 %), with the highest rates in Escherichia coli, Enterobacter and Pseudomonas spp. Acquisition of MDR pathogens was significantly associated with prior cephalosporin treatment, older age, admission to hemato-oncology unit, polymicrobial infections, higher rate of development of septic shock, and multiple organ failures. All-cause mortality was 17.9 %. Presence of septic shock at presentation and parenteral nutrition were associated with higher mortality. Pseudomonas spp., and Enterobacter spp. BSIs had the highest rate of mortality. Inappropriate empiric antibiotic therapy was more frequent in MDR patients, although not significantly associated with poor outcome. CONCLUSION: Rates of multidrug resistance and mortality in children with Gram-negative bloodstream infections remain high in our settings. Empiric broad-spectrum antibiotics and combination therapy could be recommended, especially in children with malignant diseases, patients admitted to the PICU, and for cases with septic shock, who have higher mortality risk