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

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

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)

Use of interferon alpha in intratumoral chemotherapy for cystic craniopharyngioma

Objectives: This study analyzed the intratumoral activity of interferon alpha (IFN-alpha) in the treatment of cystic craniopharyngiomas. Patients and methods: From January 2000 to January 2004, nine patients presenting with cystic craniopharyngiomas were treated with intratumoral injection of IFN-alpha at the Pediatric Oncology Institute of the Federal University of São Paulo-Escola Paulista de Medicina. Age ranged from 1 year and 10 months to 18 years (mean 10 years). All intratumoral catheters were inserted by a subfrontal approach. Doses varied from 36 to 108 MU. Results: There was complete disappearance of the lesion in seven cases. in two cases, partial reduction of tumor size was observed at follow-up. Follow-up varied from 1 year to 3 years and 6 months (mean 1 year 8 months). Conclusions: IFN-alpha proved to be an effective drug in the control of cystic craniopharyngiomas. Additional studies should be carried out to determine the optimal dose of IFN-alpha in the treatment of cystic craniopharyngioma. in addition, other drugs possessing high efficacy and low neurotoxicity should be analyzed.Universidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Neurol & Neurosurg, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Pediat, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Genet, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Neuroradiol, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Neurol & Neurosurg, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Pediat, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Genet, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Neuroradiol, BR-4023061 São Paulo, BrazilWeb of Scienc

Diffuse Intrinsic Brainstem Tumor in an Infant: A Case of Therapeutic Efficacy With Vinorelbine

Brainstem gliomas constitute 10% to 20% of all pediatric tumors of the central nervous system, and diffusely infiltrative brainstem gliomas are the most common brainstem tumors associated with a poor prognosis. A small subset of these tumors is benign, showing low-grade features on histology. the role of chemotherapy in the management of these tumors is ill defined, especially in the neonates. There are anecdotal reports of spontaneous remission, but the natural history of these tumors does not support a wait-and-see approach. Thus, we report a successful experience of chemotherapy in a 4-month-old girl with a diffuse brainstem fibrillary astrocytoma, treated with vinorelbine (30 mg/m(2)/d on days 0, 8, and 22), a vinca alkaloid that has shown activity against glioma. Our experience suggests that vinorelbine may be effective in pediatric low-grade gliomas as this patient showed significant clinical improvement over a short period of time.Universidade Federal de São Paulo, GRAACC, IOP, Dept Pediat Oncol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, IOP, Dept Neurol & Neurosurg, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, IOP, Dept Pathol, BR-04023062 São Paulo, BrazilHosp Sick Children, Div Hematol Oncol, Toronto, ON M5G 1X8, CanadaUniversidade Federal de São Paulo, GRAACC, IOP, Dept Pediat Oncol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, IOP, Dept Neurol & Neurosurg, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, IOP, Dept Pathol, BR-04023062 São Paulo, BrazilWeb of Scienc

Single agent vinorelbine in pediatric patients with progressive optic pathway glioma

The management of progressive unresectable low-grade glioma remains controversial. Treatment options have included radiotherapy, and more recently chemotherapy, usually following an initial period of observation. Within this context, we evaluated vinorelbine, a semisynthetic vinca alkaloid that has shown evidence of activity against glioma. From July 2007 an institutional protocol with vinorelbine (30 mg/m 2 days 0, 8, 22) for a total of 18 cycles, has been conducted at IOP/GRAACC/UNIFESP for children with optic pathway glioma (OPG). the main objectives were clinical and radiological response, as well as toxicity profile. Twenty-three patients with progressive OPG with a mean age of 69 months (4-179) were enrolled. Three patients had a diagnosis of neurofibromatosis type 1. Twenty-two patients were assessable for response with an overall objective response rate of 63%, with eight patients showing stable disease. the most important toxicity was hematologic (grade III/IV neutropenia) observed in four patients. Gastrointestinal toxicity (grade I/II vomiting) was observed in seven patients and only 1 patient showed grade I peripheral neuropathy. the median progression-free survival (PFS) was 33 months (6.9-69) with a 3 and 5 year PFS of 64 +/- 19 and 37 +/- 20%, respectively, for an overall 3 and 5 year-survival of 95 +/- 10%. This study suggests that vinorelbine may be an interesting option for pediatric low-grade gliomas, showing low toxicity profile and providing a good quality of life for patients with such chronic disease.Universidade Federal de São Paulo, IOP GRAACC, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, IOP GRAACC, Dept Radiol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, IOP GRAACC, Dept Nursing, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, IOP GRAACC, Neurosurg Dept, BR-04023062 São Paulo, BrazilUniv Toronto, Hosp Sick Children, Toronto, ON M5G 1X8, CanadaUniversidade Federal de São Paulo, IOP GRAACC, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, IOP GRAACC, Dept Radiol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, IOP GRAACC, Dept Nursing, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, IOP GRAACC, Neurosurg Dept, BR-04023062 São Paulo, BrazilWeb of Scienc