Pediatric cervicofacial actinomycosis: Case report and review of the literature

Objective: To emphasize important features in the diagnosis and monitoring of patients with childhood cervical actinomycosis. Subject and methods: This study is a case report about the occurrence of actinomycosis in cervicofacial form. We conducted literature review of the last years by means of the Lilacs and Medline databases. Results: A male patient was monitored in an infirmary of pediatric infectious diseases. The diagnosis was made through cervical node biopsy and isolation of the bacteria. Specific penicillin for actinomycosis had been given to the patient for 14 days. After the node decreased, the patient was released but, at the same time, a prescription of amoxycillin, for the minimum of 6 months, was given to him with simultaneous ambulatorial monitoring. Conclusion: Early diagnosis of actinomycosis enables appropriate and prompt treatment, thus preventing the involvement of other areas such as CNS, face, and neck.Objetivo: Enfatizar aspectos importantes para o diagnóstico e manejo clínico de pacientes com actinomicose cervicofacial na infância. Casuística e método: O presente estudo é um relato de caso de actinomicose na forma cervicofacial, acompanhando de revisão da literatura dos últimos anos através dos bancos de dados Lilacs e Medline. Resultados: Paciente do sexo masculino acompanhado na enfermaria de moléstias infecciosas pediátricas por actinomicose cervicofacial. O diagnóstico foi realizado através de biópsia de nódulo cervical e isolamento da bactéria. O antibiótico utilizado foi a penicilina específica para o actimomices, por 14 dias. Alta após diminuição do nódulo, com orientação de amoxicilina por mínimo de 6 meses e acompanhamento ambulatorial. Conclusão: O diagnóstico precoce da actinomicose resulta em tratamento adequado e imediato, evitando-se o acometimento de áreas nobres em SNC, face e pescoço.UNIFESP-EPM Disciplina de Infectologia PediátricaUNIFESP-EPM Departamento de Pediatria Disciplina de Infectologia PediátricaUNIFESP-EPM Infectologia Pediátrica Curso de EspecializaçãoUNIFESP-EPM PediatriaUNIFESP-EPM Instituto de Oncologia PediátricaUNIFESP, EPM, Disciplina de Infectologia PediátricaUNIFESP, EPM Depto. de Pediatria Disciplina de Infectologia PediátricaUNIFESP, EPM Infectologia Pediátrica Curso de EspecializaçãoUNIFESP, EPM PediatriaUNIFESP, EPM Instituto de Oncologia PediátricaSciEL

Malnutrition prevalence in children with solid tumors

OBJETIVE: To evaluate the malnutrition prevalence in children and adolescents with solid tumors, who received treatment in a Brazilian oncology center. METHODS: 44 patients were evaluated during the first month of the oncology therapy, using anthropometric measures and, according to the World Health Organization criteria, the Z-scores of weight/age, height/age, and weight/height. RESULTS: The Z-scores of weight/age, height/age, and weight/height showed 16%, 7% e 16% of malnutrition, respectively. Prevalence of malnutrition was observed in 27% of patients with cerebral tumors, 25% of those with neuroblastomas, and 11% of those with Wilms tumor. CONCLUSION: The high prevalence of malnutrition in this population, may be associated with the disease, its treatment, and the social and economic factors. Nonetheless, failure to identify nutritional risk, due to the lack of a nutritional protocol, may be another cause of malnutrition in patients with solid tumors.OBJETIVO: Avaliar a prevalência de desnutrição entre crianças com tumores sólidos em tratamento num centro oncológico brasileiro. MÉTODOS: Foram avaliados 44 pacientes durante o primeiro mês de tratamento, por meio de medidas antropométricas e, de acordo com recomendações da Organização Mundial de Saúde, seguindo os escores-Z de peso/idade, estatura/idade e peso/estatura para o diagnóstico nutricional. RESULTADOS: De acordo com os escores-Z de peso/idade, estatura/idade e peso/estatura, encontramos, respectivamente, 16%, 7% e 16% de desnutrição entre as 44 crianças. De acordo com os diagnósticos de câncer, 27% dos portadores de tumores cerebrais, 25% dos pacientes com neuroblastomas e 11% com tumores de Wilms, apresentaram desnutrição energético-protéica. CONCLUSÃO: Há uma elevada prevalência de desnutrição na população estudada, que pode estar relacionada à doença, ao tratamento e aos fatores socioeconômicos, como também à falta de um protocolo nutricional para identificar e tratar precocemente a desnutrição em crianças com tumores sólidos.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Instituto de Oncologia PediátricaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP, EPM, Instituto de Oncologia PediátricaUNIFESP, EPM, Depto. de PediatriaSciEL

Gliomatose leptomeningea primária difusa

Universidade Federal de São Paulo (UNIFESP) Department of Neurology and NeurosurgeryUniversidade Federal de São Paulo (UNIFESP) Department of RadiologyUniversidade Federal de São Paulo (UNIFESP) Department of PathologyUniversidade Federal de São Paulo (UNIFESP) Paediatric Oncology Institute Department of PaediatricsUNIFESP, Department of Neurology and NeurosurgeryUNIFESP, Department of RadiologyUNIFESP, Department of PathologyUNIFESP, Paediatric Oncology Institute Department of PaediatricsSciEL

Craniofaringioma cístico: quimioterapia intratumoral com interferon alfa

OBJECTIVE: To assess whether the cystic craniopharyngiomas can be controlled with the use of intratumoral applications of interferon alpha. METHOD: Nineteen patients with the diagnosis of cystic craniopharyngioma were treated with intratumoral chemotherapy with interferon alpha from January 2002 to April 2006. All patients underwent placement of an intracystic catheter connected to an Ommaya reservoir. Through this reservoir were made applications during chemotherapy cycles. Each cycle corresponded to application of 3,000,000 units of interferon alpha three times per week on alternate days totalizing 36,000,000 units. Response to treatment was evaluated by calculating the tumor volume on MRI control after one, three and six months after the end of each cycle. Patients who developed worsening of symptoms or who had insignificant reduction in tumor volume during follow-up underwent repeat cycle chemotherapy. RESULTS: Four patients received four cycles of chemotherapy, three patients received three cycles, six patients received two cycles and six patients received one. The lower percentage of reduction in tumor volume was 60% and the bigger reduction was 98.37%. Eleven patients had a reduction greater than 90%. Five patients had a tumor reduction between 75 and 90% and in three patients the tumors were reduced by less than 75%. No deaths occurred during treatment and side effects of interferon alpha were well tolerated. No treatment was discontinued. Follow-up after the last application ranged from one year and five months to three years and nine months. CONCLUSION: The intratumoral chemotherapy with interferon alpha decreases the volume of cystic craniopharyngiomas and so far can be considered a new therapeutic alternative.OBJETIVO: Avaliar se os craniofaringiomas císticos podem ser controlados com aplicações intratumorais de interferon alfa. MÉTODO: De janeiro de 2002 a abril de 2006, 19 pacientes foram submetidos à colocação de um cateter intracístico conectado a reservatório de Ommaya para aplicações intratumorais de ciclos de 36.000.000 de unidades de interferon alfa. A resposta ao tratamento foi avaliada pelo cálculo do volume tumoral na ressonância magnética de controle ao término de cada ciclo. RESULTADOS: Os pacientes receberam de um a quatro ciclos de quimioterapia. Onze pacientes apresentaram uma redução do volume tumoral maior que 90%; cinco pacientes apresentaram uma redução entre 75% e 90% e três pacientes uma redução menor de 75%. Não houve óbitos durante o tratamento e os efeitos colaterais do inferferon alfa foram bem tolerados. Nenhum tratamento foi interrompido. CONCLUSÃO: A quimioterapia intratumoral com interferon alfa diminui o volume dos craniofaringeomas císticos e pode ser considerada uma nova alternativa terapêutica.Federal University of São Paulo Department of Neurosurgery and Section of Pediatric NeurosurgeryFederal University of São Paulo Department of PediatricsFederal University of São Paulo Laboratory of Pediatric Oncology InstituteUNIFESP, Department of Neurosurgery and Section of Pediatric NeurosurgeryUNIFESP, Department of PediatricsUNIFESP, Laboratory of Pediatric Oncology InstituteSciEL

Fatores precoces para síndrome metabólica em sobreviventes de câncer pediátrico: resultados em adolescentes e adultos jovens tratados por meduloblastoma na infância

OBJECTIVE: To analyze traits of metabolic syndrome (MetS) in medulloblastoma survivors. SUBJECTS AND METHODS: Sixteen childhood medulloblastoma survivors aged 18.0 (4.4) years, with history of craniospinal radiation therapy (RT) were compared with nine control subjects matched by age, gender, and body mass index, according to fat distribution, metabolic and cardiovascular variables. RESULTS: Medulloblastoma patients showed increases in waist circum-ference and its relationships (all p < 0.05), and HOMA1-IR (p = 0.006), which were modified by growth hormone (GH) secretion status. However, these increases were within normal range. CONCLUSIONS: Adolescent and young adult survivors of medulloblastoma showed centripetal fat deposition and decreased insulin sensitivity, associated with GH status. Pediatric brain tumor survivors following RT should be monitored for the diagnosis of MetS traits predisposing to cardiovascular disease.OBJETIVO: Analisar características que predispõem para síndrome metabólica (SM) em sobreviventes de meduloblastoma. SUJEITOS E MÉTODOS: Dezesseis sobreviventes de meduloblastoma pediátrico, 18,0 (4,4) anos, história de radioterapia (RT) cranioespinhal, comparados a nove controles pareados por idade, sexo e índice de massa corporal, de acordo com distribuição de gordura, variáveis metabólicas e cardiovasculares. RESULTADOS: Pacientes com meduloblastoma mostraram aumento da cintura e relações (todos p < 0,05) e HOMA1-IR (p = 0,006), modificados pela secreção do hormônio de crescimento (GH), mas dentro dos limites de normalidade. CONCLUSÕES: Sobreviventes adolescentes e adultos jovens de meduloblastoma apresentaram deposição centrípeta de gordura e diminuição da sensibilidade à insulina, associados ao estado do GH. Sobreviventes de tumor cerebral pediátrico que receberam RT devem ser monitorados para diagnosticar fatores para SM predispondo à doença cardiovascular.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of PediatricsUNIFESP-EPM Department of MedicineUniversidade de São Paulo Department of Food Science and Experimental Nutrition Pharmaceutical Science SchoolUNIFESP-EPM Department of PediatricsUNIFESP, EPM, Department of PediatricsUNIFESP, EPM Department of MedicineUNIFESP, EPM Department of PediatricsSciEL

Ototoxicity evaluation in medulloblastoma patients treated with involved field boost using intensity-modulated radiation therapy (IMRT): a retrospective review

Abstract\ud \ud Background\ud Ototoxicity is a known side effect of combined radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma. The delivery of an involved field boost by intensity modulated radiation therapy (IMRT) may reduce the dose to the inner ear when compared with conventional radiotherapy. The dose of cisplatin may also affect the risk of ototoxicity. A retrospective study was performed to evaluate the impact of involved field boost using IMRT and cisplatin dose on the rate of ototoxicity.\ud \ud \ud Methods\ud Data from 41 medulloblastoma patients treated with IMRT were collected. Overall and disease-free survival rates were calculated by Kaplan-Meier method Hearing function was graded according to toxicity criteria of Pediatric Oncology Group (POG). Doses to inner ear and total cisplatin dose were correlated with hearing function by univariate and multivariate data analysis.\ud \ud \ud Results\ud After a mean follow-up of 44 months (range: 14 to 72 months), 37 patients remained alive, with two recurrences, both in spine with CSF involvement, resulting in a disease free-survival and overall survival of 85.2% and 90.2%, respectively.\ud Seven patients (17%) experienced POG Grade 3 or 4 toxicity. Cisplatin dose was a significant factor for hearing loss in univariate analysis (p < 0.03). In multivariate analysis, median dose to inner ear was significantly associated with hearing loss (p < 0.01). POG grade 3 and 4 toxicity were uncommon with median doses to the inner ear bellow 42 Gy (p < 0.05) and total cisplatin dose of less than 375 mg/m2 (p < 0.01).\ud \ud \ud Conclusions\ud IMRT leads to a low rate of severe ototoxicity. Median radiation dose to auditory apparatus should be kept below 42 Gy. Cisplatin doses should not exceed 375 mg/m2.This study was supported by Instituto Israelita de Responsabilidade Social\ud (IIRS) of Hospital Israelita Albert Einstein (HIAE)