Evaluation of Vitamin D-levels and Bone Mineral Density in Lymphoma and Solid Tumors of Childhood after Treatment

As the survival rate of childhood cancers increases, late effects of the treatment are becoming significantly more critical. The aim of this study is to evaluate serum 25 Hydroxy Vitamin D levels and bone mineral density (BMD) of patients with lymphoma and solid tumors. In this study, we included patients diagnosed with cancer in our pediatric oncology department between 2004 and 2013. These patients were all in remission and completed their treatment. Patient data were collected from corresponding medical files. Vitamin D levels, BMD measurements and other laboratory tests were performed prospectively. The study group consisted of 105 patients who completed treatment at least one year ago. Overall, 59.6 % of the subjects were found to have vitamin D levels less than 20 ng/mL. When the factors affecting vitamin D deficiency were evaluated, there were not any factor related to vitamin D deficiency. However, a positive correlation was observed in the blood sampling time, namely test results taken in summer months (April-September) were higher. In our study, bone mineralization disorder (low BMD) was found in 44.4% of the patients. In addition, we observed that bone health was significantly affected in children who recovered from cancer. 59.6 % of the vitamin D deficiency rate was found to be higher than the similar age group in our country. To our knowledge, this is also the lowest vitamin D levels in children with cancer compared to previously published studies. The rate of low BMD was determined as 44.4%, similar to earlier studies

Evaluation of Leukemia and Solid Tumors in Refugee Children in Turkey: A Tertiary Center Experience

Cancer care is progressively became as a significant worldwide challenge. Wars can cause destructions and delays in cancer diagnosis and treatment of displaced people. Cancer cure rates need to be improved in indefensible populations such as refugees. In this study, we purposed to highlight the clinical peculiarities and outcomes of refugee children with cancer in our hospital. Our purpose was to present our findings and contribute to improve the health care for these children. Seventy one refugee pediatric patients admitted to the oncology and hematology units of our hospital between April 2011 and January 2019 were included in this study. The demographic characteristics of the patients at the initial diagnosis, their countries of origin, living conditions, histopathological diagnoses, treatments, relapse, and mortality data were analyzed retrospectively from the patient files. The median age of patients was 6.5±4.5 years, and the male-to-female ratio was 39/32. While 44 patients (61.9%) presented with complaints and had primary diagnoses in our hospital, the remaining 27 patients (38.1%) were diagnosed in their country and applied to our hospital for treatment. Our mean follow-up period was 18.2±18.8 months (1-90 months). As a result, 44 patients (62%) were alive and 22 (31%) were dead. The survival rate without relapse in the second year was 83.6%. Two and fiveyear survival rates were 77.5% vs. 58.1% respectively. Compared to Turkish children, lower survival rates were found in refugee children. In addition to cancer-specific factors such as tumor type and stage, some problems such as shelter, communication, adherence to treatment, and difficulties supplying medicine may be responsible for lower survival rates in refugee children. Further studies are needed to improve the survival rates of patients

Çocuklarda kemoterapiye bağlı bulantı ve kusma için kullanılan antiemetik tedavinin değerlendirilmesi

Nausea and vomiting associated with chemotherapy is one of the important side effects of treatment in children with cancer. Despite the development of new antiemetic agents, there are still some problems in this regard in children. The combination of a 5-HT3 receptor antagonist plus a corticosteroid is usually used to prevent chemotherapy induced nausea and vomiting (CINV) in children receiving emetogenic chemotherapy. New antiemetic agents do not take part in the current pediatric guidelines. There is also no sufficient data on alternative agents in children with intractable vomiting. This review summarizes the CINV definitions in children, the classification of the antiemetic drugs as standard, newly available and optional drugs in children. Each drug category is discussed according to the mode of action, efficacy in different types of CINV, recommended dose and finally some suggestions for CINV in children.Kemoterapiyle ilişkili bulantı ve kusma, kanserli çocuklarda tedavinin önemli yan etkilerinden birisidir. Yeni antiemetik ajanlar gelişmiş olmasına ragmen çocukluk yaş grubunda halen bazı sorunlar vardır. Çocuklarda kemoterapiye bağlı bulantı ve kusmayı önlemek için genellikle bir 5-HT3 reseptor antagonisti ile kortikosteroid birlikte kullanımı önerilir. Yeni antiemetik ilaçlar güncel pediatri kılavuzlarında yer almazlar. Dirençli kusması olan çocuklarda alternatif ajanların kullanımına ilişkin yeterli veri yoktur. Bu derlemede; çocuklarda kemoterapiye bağlı bulantı kusma ile ilgili tanımlar, çocuklarda kullanılan antiemetik ilaçların standart ilaçlar, isteğe bağlı ilaçlar ve yeni ilaçlar olarak sınıflandırılması özetlenmiştir. Her ilaç kategorisi, etki mekanizması, dozları ve çocuklarda antiemetik tedaviyle ilgili bazı öneriler tartışılmıştır

Role of Surveillance Screening in Detecting Tumor Recurrences After Treatment of Childhood Cancers

OBJECTIVE: As the survival rates in children with cancer reach up to 80%, this improvement in survival increases the number of patients under follow-up. After cancer treatment is completed, patients are taken to follow-up surveillance to ensure the early detection of recurrence and the late effects of treatments. The frequency and necessity of surveillance screening tests are controversial. This study aimed to assess the efficacy of surveillance screening in the detection of recurrence. MATERIAL AND METHODS: The files of 533 children who were diagnosed as having cancer at our pediatric oncology clinic between 2004 and 2013 were retrospectively evaluated. We looked at outcomes after recurrence, the timing and pattern of recurrence, the presence of symptoms during recurrence, physical examination findings, tumor marker levels, laboratory findings, and radiologic tests. RESULTS: Of the 63 patients with recurrence, 23 were symptomatic and 40 were asymptomatic at the time of the recurrence. Tumor location and time of the recurrence did not affect the post recurrence survival. The median post-recurrence survival for patients was 13 (range, 1–98) months. The median post-relapse survival was 10 (range, 1–73) months in patients with symptomatic recurrence, and 16 (range, 1–98) months in patients with asymptomatic recurrence. It was determined that patients in whom recurrence was identified with surveillance tests had longer post-relapse survival time. The 5-year survival rate of 23 patients with symptomatic recurrence was 12.2%; this rate was 49.5% in asymptomatic patients (p<0.05). CONCLUSIONS: It should be considered that surveillance testing offers the benefit of prolonging post recurrence survival

Use of cyproheptadine as an appetite stimulant in children with cancer

Bu çalışma, “Ulusal Pediatrik Onkoloji Kongresinde" poster olarak sunulmuştur. (XVII. TPOG Ulusal Pediatrik Kanser Kongresi 1-5 Mayıs 2012, Abant-Bolu)Giriş: Çocuk kanser hastalarında beslenme bozukluğu sıklıkla görülür. Bu hastalarda beslenme durumlarının değerlendirilmesi çok önemlidir. En iyi yaklaşım bu çocuklarda iştahı arttırarak oral gıda alımını arttırmaktır. Kronik hastalığı olan çocuklarda siproheptadin ile iştah artışının uyarılmasını destekleyen bazı çalışmalar vardır. Bu çalışmada amacımız kanserli çocuklarda iştahı arttırarak oral gıda alımını arttırmak amacıyla kullandığımız siproheptadin ile ilgili deneyimimizi paylaşmaktır. Gereç ve Yöntem: İştah arttırmak için siproheptadin kullanan 14 hastanın dosyaları geriye dönük olarak incelendi. Tedavi başlangıcında, 4. ve 8. hafta vücut ağırlığı, boy, vücut kitle indeksi, yaşa göre ağırlık Z skorları, iştah durumu ve yan etkiler kayıt edildi. Bulgular: Siproheptadin yaşları 2,25 ile 16,5 arasında değişen (median: 4,5 yıl) 14 hastada kullanıldı. On bir hastada (%78) 4. ve 8. hafta ölçümlerde kilo artışı saptandı. Hastaların ilk ay ortalama ağırlık artışı 1,44 kg olarak bulundu (p<0,05). Yaşa göre ağırlık Z skorları ortalaması -2,22’den -1,56’ya artış gösterdi (p<0,05). İlaca bağlı ciddi yan etki bildirilmedi. Sonuç: Siproheptadin, kanserli çocuklarda özellikle kısa dönem kullanıldığında iştah ve vücut ağırlığı üzerinde olumlu etkileri olan, yan etkileri az bir iştah uyaranı gibi görünmektedir.Introduction: Malnutrition is frequently seen in pediatric cancer patients. It is very important to evaluate the nutritional status at diagnosis in these patients. The preferable method to treat cancer associated malnutrition in children is to increase their oral food intake with the help of stimulating their appetite. There are some studies supporting the use of appetite stimulants in patients with chronic illness. In this report, our aim is to share our experience with cyproheptadine as an appetite stimulant in children with cancer. Materials and Methods: The medical records of 14 children who were used cyproheptadine as an appetite stimulant were retrospectively evaluated. Their weight, height, body mass index, weight for age Z-score, appetite status and side effects were recorded at baseline, 4th week and 8th week. Results: Cyproheptadine was used in fourteen patients with a median age of 4.5 (range:2.25-16.5 years). Eleven of them demonstrated a response to cyproheptadine (average weight gain was 1.44 kg) Mean weight-for-age z-score was increased from -2.22 to -1.56 (p<0.05). No serious adverse events due to cyproheptadine were reported. Conclusions: It seems that cyproheptadine is a safe and effective agent to stimulate appetite and weight gain in children with cancer, particularly in short term usage

Insulin-like growth factor-1 receptor expression in pediatric tumors: a comparative immunohistochemical study

Background/aim: Insulin-like growth factor-1 receptor (IGF-1R) is a pivotal receptor tyrosine kinase involved in the cell cycle and malignant tumor transformation. It is differentially expressed in various types of tumors. We aimed to determine the expression of IGF-1R in different pediatric tumors and to shed light on possible new indications of anti-IGF-1R treatment approaches. Materials and methods: A total of 147 specimens were analyzed according to their expression of IGF-1R. Specimens included those from rhabdomyosarcomas, Wilms tumors, Ewing sarcoma/primitive neuroectodermal tumors, peripheral neuroblastic tumors, acute lymphoblastic lymphoma, Hodgkin lymphoma, Burkitt lymphoma, retinoblastoma, pleuropulmonary blastoma, Langerhans cell histiocytosis, endodermal sinus tumors (ESTs), and myeloid sarcoma. Analysis was performed on tissue sections by immunohistochemically staining for IGF-1R expression. Results: All six specimens of EST cases showed positivity for IGF-R1. Additionally, about 56\% of the Hodgkin lymphoma, 80\% of the rhabdomyosarcoma, and 70\% of the Wilms tumor specimens showed positivity for IGF-R1 expression. Conclusion: All ESTs examined in our study expressed IGF-1R and to our knowledge this is the first report regarding ESTs and IGF-1R expression. IGF-1R could be included among confirmatory markers for ESTs and, from a therapeutic viewpoint, ESTs should also be examined for IGF-1R expression for beneficial regimens

Cerebral Sinovenous Thrombosis Mimicking Intracranial Mass

 « J’ai été quant à moi productiviste… hier » (p. 68). Autant dire qu’il ne l’est plus, que l’agriculture doit avoir d’autres ambitions et que le problème concerne la société globale. « Il s’agit d’inventer une civilisation qui, mêlant les avantages de la ville et ceux de la campagne, serait faite de la synergie d’une agriculture paysanne modernisée et d’une société se développant en milieu rural. Rien de moins » (p. 187). L’ambition est grande en effet, et se heurte à de nombreux obstacles q..

A Pediatric Patient with Intravenous Cyclosporine Anaphylaxis Who Tolerated the Oral Form

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