Infant acute lymphoblastic leukemia: a 20-year children's hospital experience

We reviewed our 20-year experience with infant acute lymphoblastic leukemia (ALL). Nine infants (4.2% of all ALL) were identified; all were < 6 months of age. White blood cell counts ranged from 42,000-1.6 million/microL, 6 of 8 had hepatosplenomegaly, and 6 of 9 (66.6%) had central nervous system disease. Of 7 with cytogenetic information, 6 (85.7%) had diploidy; the remaining child was 47, XY,+8,del(21)(q22). Four had the MLL-11q23 abnormality. All received chemotherapy. Four underwent stem cell transplantation. Survival was 67%, (15 months-21 years). Deaths occurred at 9 months, 15 months (graft vs. host), and 7 years (complications of small bowel transplantation). Only 1 undergoing stem cell transplantation died. There were no late recurrences or second malignancies. Despite extensive disease and age < 6 months at diagnosis (a poor prognostic feature), for ALL patients our 67% survival is at least as good as reported, although it is less favorable than childhood ALL.     

Treating childhood acute lymphoblastic leukemia in a developing country 1998-2003: the experience of a single children's hospital in China

PURPOSE: To assess the outcome of children with acute lymphoblastic leukemia (ALL) treating with ALL China-98 in a single children's Hospital in China. PATIENTS AND METHODS: Between 1998 and June 2003, a total of 58 children in our hospital were treated according to ALL China-98. The patients were >or=1 and 相似文献   

Relapsed acute leukemia in children: Oman experience

Acute leukemia (AL) is the most common malignancy in children in Oman. It accounts for over one-third of all childhood cancers, most of which (∼75%) are acute lymphoblastic leukemia (ALL). Over a decade, a total of 128 cases of childhood acute leukemia have been diagnosed and managed at Paediatric Haematology/Oncology Unit, Sultan Qaboos University Hospital, which is the national referral center of pediatric leukemia cases. A retrospective review of case notes was used to study all children with a diagnosis of acute leukemia from January 1993 to January 2003. All the cases were diagnosed using a bone marrow aspirate with morphological and immunophenotypic classification. Over this period, 24 cases relapsed. They were classified as per BFM group as “very early,” “early,” and “late” according to the time from diagnosis to first relapse and were divided into isolated bone marrow (BM), extramedullary site, and combined relapse. Sixteen percent of ALL cases and 58.6% of acute myeloid leukemia (AML) cases so far relapsed. Most of the AML cases relapsed very early on in treatment. Eleven patients had combined relapse in BM and extramedullary site (9 in the central nervous system, 1 in the testicles, and 1 in the eye). The overall outcome of these patients is very poor, and only 6 patients out of 24 are still alive. In conclusion, the relapse rates of childhood AL are more or less similar to those of other reports but the overall outcome is very poor. A large majority of the patients in this study are either very early or early relapsers. Future studies including genetic and molecular analysis may be able to explain the difference in clinical outcome of these relapsed AL cases.     

39例儿童白血病合并败血症临床特点分析

目的探讨儿童急性白血病(AL)化疗后合并败血症的临床特点及降钙素原(PCT)在判断细菌类别中的作用。方法 2014年6月-2016年6月入住安徽医科大学第二附属医院儿科AL患儿39例,回顾性分析患儿化疗期间合并败血症的的发病因素、感染部位、病原学及不同PCT水平时的细菌类别。结果 39例患儿中急性淋巴细胞白血病28例,急性髓细胞白血病11例。15例患儿有明确感染部位,依次为呼吸道、口腔、肛周及皮肤。病原菌中革兰阳性球菌占53.8%(21/39),革兰阴性杆菌占43.6%(17/39),真菌占2.6%(1/39)。中性粒细胞计数0.5×109/L时败血症发病率显著提高(P0.05)。PCT高水平组革兰阴性杆菌检出率高,PCT低水平组革兰阳性球菌检出率高,不同菌种之间PCT水平存在显著性差异(P0.01)。结论 AL患儿合并败血症与粒细胞计数密切相关;PCT的结果对不同的细菌感染有提示作用,高水平的PCT提示革兰阴性杆菌感染可能性大。     

儿童急性白血病院内感染临床观察

目的分析急性白血病(AL)患儿院内感染的临床特点及血培养阳性细菌对抗生素的敏感性,探讨其防治措施。方法回顾性分析住院AL患儿院内感染的发生率;细菌感染血培养阳性与化疗时期的关系,血培养阳性患儿与阴性患儿外周血白细胞计数、血小板计数、粒细胞计数绝对值的差异,血培养阳性细菌对抗生素的耐药性及敏感性。结果 AL患儿院内感染的发生率为45.5%(112/246),其中血培养阳性率为25.0%(28/112)。血培养阳性患儿的外周血白细胞计数为(1.05±1.17)×109/L,血小板计数为(55.57±27.57)×109/L,中性粒细胞计数绝对值为(0.13±0.33)×109/L,中性粒细胞减少持续时间为(8.46±3.40)d;血培养阴性患儿的白细胞计数为(2.72±3.00)×109/L,血小板计数为(117.80±133.60)×109/L,中性粒细胞计数绝对值为(1.02±2.34)×109/L,中性粒细胞减少持续时间为(2.48±0.62)d,各项指标在血培养阳性组与阴性组之间的差异有显著性。血培养中的葡萄球菌属、大肠埃希菌、铜绿假单胞菌对青霉素类、头孢三代抗生素、红霉素的耐药率均比较高,葡萄球菌属对替考拉宁和万古霉素相对较敏感,大肠埃希菌对亚胺培南敏感性较高,铜绿假单胞菌对亚胺培南和复方新诺明较敏感。结论本研究结果提示,AL患儿骨髓抑制易发生感染。AL患儿考虑革兰阴性菌感染可选择碳青霉烯类,考虑革兰阳性菌感染可选择替考拉宁和万古霉素,必要时进行细菌药敏物敏感试验,进一步提高治疗效果。     

Effectiveness of antibacterial prophylaxis in children with acute leukemia: A report from a single institution over a 20-year period

Background

Infection is the major cause of treatment-related mortality in childhood acute leukemia, mainly due to bacterial translocation across the intestinal mucosa. Only a few studies have reported the impact of different antibacterial prophylaxis treatments on digestive tract flora and infection-related mortality.

Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience

Abdominal compartment syndrome (ACS) in children results in 100% mortality if left untreated. Decompressive laparotomy (DL) is the only effective treatment if conservative medical therapies have failed. This study aims to determine the incidence of ACS among pediatric patients who underwent an emergency laparotomy (EL), to describe the effect of DL on clinical and laboratory parameters and, to make a better prediction on fatal outcome, to analyze variables and their association with mortality. This retrospective study includes 418 children up to the age of 16 years who underwent EL between January 2010 and December 2018 at our tertiary pediatric referral center. ACS was defined according to the latest guidelines of the World Society of the Abdominal Compartment Syndrome. Fourteen patients had emergency DL for ACS. 6 h preoperatively; median intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were 22.5 mmHg and 29 mmHg, respectively. After DL, IAP decreased and APP increased, both by an average of 60%. Six patients survived, eight patients had a fatal outcome, resulting in a mortality of 57%. An age under 1 year, weight under the 3rd percentile, an open abdomen treatment, an intestinal resection and an elevated serum lactate > 1.8 mmol/L were associated with an increased relative risk of death. Improving the outcome in pediatric patients with ACS by removing or attenuating risk factors is difficult. This emphasizes the need for early diagnosis and prompt DL once the diagnosis of ACS is made.     

Imaging features of pancreatic tumors in children: 13-year experience at a pediatric tertiary hospital

Background

Pancreatic tumors are rare in children, resulting in limited information regarding their frequency and imaging appearances.

Objective

To review all pancreatic tumors seen in children over a decade at a large tertiary pediatric institution and to describe multimodality imaging findings.

Materials and methods

We conducted a retrospective review of imaging studies performed in children with pancreatic tumors between January 2000 and December 2012, analyzing imaging features on available US, CT and MR examinations. We reviewed patient charts for clinical features, management and final diagnosis.

Results

We included 23 children in this study. Of these, 12 had solid and papillary epithelial neoplasms (SPEN), 3 had neuroendocrine tumors, 3 had lymphoma, and 1 each had hemangioendothelioma, benign congenital cysts with adipose tissue, dendritic cell sarcoma, metastatic rhabdomyosarcoma, and lipoma. All children with SPEN were teenage girls. SPEN showed characteristic imaging features including well-defined margins with surrounding capsule, solid-cystic components and hemorrhage.

Conclusion

Pancreatic tumors are uncommon in children. SPEN is the most common tumor and is seen predominantly in teenage girls and shows characteristic imaging features.     

Down syndrome and acute leukemia in children: a 10-year retrospective survey from Childrens Cancer Study Group

Review of 5406 children with acute lymphoblastic (ALL) or nonlymphoblastic leukemia (ANLL) registered with Childrens Cancer Study Group (CCSG) since 1972 identified 115 patients (2.1%) with Down syndrome. The proportion of patients with Down syndrome was the same for ALL (2.1%) and ANLL (2.1%). Patients with ALL with and without Down syndrome did not differ significantly with respect to age at diagnosis, sex, race, morphology (FAB classification), cell surface markers, initial white blood cell count, pretreatment hemoglobin value, hepatomegaly, lymphadenopathy, presence of mediastinal mass, CNS disease at diagnosis, or prognostic group as defined by age and initial white blood cell count. Patients with ALL-Down syndrome less frequently had splenomegaly, had lower pretreatment platelet counts, and more often had normal or elevated IgG or IgA levels. In addition, they had a significantly lower rate of remission (81% versus 94%), a higher mortality during induction therapy (14% versus 3%), and a poorer overall survival with 5-year life table rates of 50% versus 65% (P less than 0.001). If an initial remission was achieved, there were no significant differences with respect to remission duration, survival, or disease-free survival. Patients with ANLL-Down syndrome were younger at diagnosis than those without Down syndrome. There was no significant difference in the remission rates between these patients. Analysis of findings in patients with ANLL provided results similar to those obtained for patients with ALL with regard to clinical outcome after achievement of an initial remission.     

Chest computed tomography in children undergoing extra-corporeal membrane oxygenation: a 9-year single-centre experience

We retrospectively reviewed the imaging findings, indications, technique and clinical impact in children who had undergone chest CT while undergoing extra-corporeal membrane oxygenation (ECMO). Radiology and ECMO databases were searched to identify all 19 children who had undergone chest CT (20 scans in total) while on ECMO at our institution between May 2003 and May 2012. We reviewed all CT scans for imaging findings. Chest CT is performed in a minority of children on ECMO (4.5% in our series). Timing of chest CT following commencement of ECMO varied among patient groups but generally it was performed earlier in the neonatal group. Clinically significant imaging findings were found in the majority of chest CT scans. Many scans contained several findings, with most cases demonstrating parenchymal or pleural abnormalities. Case examples illustrate the spectrum of imaging findings, including underlying pathology such as necrotising pneumonia and severe barotrauma, and ECMO-related complications such as tension haemothoraces and cannula migration. The results of chest CT led to a change in patient management in 16 of 19 children (84%). There were no adverse events related to patient transfer. An understanding of scan technique and awareness of potential findings is important for the radiologist to provide prompt and optimal image acquisition and interpretation in appropriate patients.     

Pandemic H1N1 influenza infection in children with acute leukemia: a single-center experience

In English literature, there are only 2 specific series of pandemic H1N1 influenza infection in children with leukemia. To increase knowledge about pandemic influenza in children with leukemia and better understand the risk factors for severe disease, we have presented the clinical characteristics of 8 children with acute leukemia and pandemic influenza treated at our center. The mean age of the children (4 girls and 4 boys) was 6.7±2.0 years (range, 4 to 10 y). All these children [3 acute lymphoblastic leukemia and 5 acute myeloid leukemia (AML) cases] were receiving chemotherapy during the course of infection, except 1 who was found to be H1N1 positive at the same time that she was diagnosed with AML. Among the other 7 patients undergoing chemotherapy, 4 were receiving induction, 1 was receiving consolidation, and 2 were undergoing maintenance chemotherapy. In our series, 1 patient with AML had a fatal course. She had recently received a chemotherapy bloc. Her neutrophil count was 0 during the course of H1N1 infection. She developed acute respiratory distress syndrome within a short time after the symptoms commenced and she died within 4 days. In conclusion, the clinical course of H1N1 infection may be fatal in rare cases of leukemic children receiving chemotherapy. Thus, vaccination is advisable for all leukemic children, especially for those under maintenance chemotherapy, as it might be life saving during such pandemics.     

Lawnmower injuries in children: a 10-year experience

Approximately 77,800 annual lawnmower-related injuries are treated in the USA, with 9,300 involving children. This work reviews the literature and reports our 10-year experience with lawnmower injuries. We retrospectively reviewed patients with lawnmower injuries admitted to the Women and Children’s Hospital of Buffalo from 1995 to 2005 and reviewed the literature. Sixteen patients with mower-related injuries were admitted to our institution, with three due to walk-behind mowers and 13 due to riding mowers. The mean age was 7.5 years. Riding mower injuries had a higher average injury severity score (14.3 vs. 9) and a longer average length of hospital stay (15 vs. 2 days). All of the walk-behind mower injuries were extremity injuries, with two requiring amputations. Eleven of the riding mower injuries had extremity injuries alone, one had isolated torso injuries, and one had both extremity and torso injuries. Three required amputations, and the two patients with torso injuries required extensive surgical reconstructions. Pediatric lawnmower injuries, particularly due to riding mowers, are a highly preventable cause of morbidity and mortality. Increased public safety awareness and further manufacturer safety modifications should be strongly encouraged in order to limit this cause of pediatric trauma.     

Readmissions of children with diabetes mellitus to a children's hospital

The characteristics of children with diabetes readmitted to Children's Hospital during a 5-year period, 1984 to 1989, were compared with those characteristics of new-onset patients admitted for stabilization and education and to outpatients in the Children's Hospital diabetes program to determine which characteristics were associated with patients who were readmitted. Changes in the frequency of readmissions were examined to determine whether the introduction of a diabetes team and a program that emphasizes the importance of ensuring that patients at risk of readmission consistently received insulin injections resulted in a reduction of readmissions. Readmissions occurred more frequently in patients who were black (71% compared with 38% of new-onset patients and 31% of outpatients) (P less than .001), from one-parent homes (56% compared with 27% of new-onset patients and 24% of outpatients) (P less than .001), and without third-party insurance (45% compared with 18% of new-onset patients and 15% of outpatients) (P less than .001). Readmissions were very common at 14 to 15 years of age (39% of readmissions vs 18% of outpatients) and very uncommon in children younger than age 9 (6% of readmissions vs 27% of outpatients) (P less than .001). Fewer readmissions for ketoacidosis occurred in the summer than in any other season (P less than .05). Readmissions fell by 47% over the 5-year period while new-onset patients increased by 85%. The reduction in frequency of readmissions was due to fewer readmissions for ketoacidosis and fewer readmissions in blacks, in patients from one-parent homes, and in patients without third-party insurance.(ABSTRACT TRUNCATED AT 250 WORDS)