Department Of Pediatric Hematology-Oncology Research Articles

Catheter-associated Bloodstream Infections in Pediatric Hematology-Oncology Patients

Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.

Detection, Control, and Management of a Respiratory Syncytial Virus Outbreak in a Pediatric Hematology-Oncology Department

Immunocompromised patients are at increased risk for severe respiratory syncytial virus (RSV) infection. Palivizumab is approved for prevention of RSV in specific populations but not for treatment. Few studies demonstrated the safety and successful treatment with intravenous (IV) palivizumab. We describe our experience with IV palivizumab treatment for RSV in a pediatric hematology-oncology department during an outbreak. During a short period of renovations, oncology patients were placed in a general pediatric ward. After a case of severe fatal RSV pneumonia in a 2-year-old male patient with acute myeloid leukemia, all patients were actively screened twice weekly regardless of symptoms. Respiratory samples were tested for RSV using rapid immunochromatography detection, immunofluorescence, or reverse transcriptase polymerase chain reaction. A single dose of palivizumab (15 mg/kg) was given to children below 3 years of age who tested positive for RSV. Over a 6-week period, 12 patients tested positive for RSV. Seven patients were treated with palivizumab. Five patients had respiratory symptoms, and 2 were asymptomatic. No adverse events were attributed to IV palivizumab treatment. Early-treated patients had no complications attributed to RSV. Containment of RSV outbreak in high-risk children is difficult. Screening with reverse transcriptase polymerase chain reaction and the early use of IV palivizumab is safe and may prevent complications of RSV infection among these patients.

Idiopathic thrombocytopenic purpura in childhood: Twenty years of experience in a single center

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder with a variable clinical course. A retrospective analysis was carried out of ITP patients presenting to a pediatric hematology-oncology department during a period of 20 years, with a focus on treatment and outcome. One hundred and twenty-four cases were recorded (mean patient age, 8.4 years). Forty-nine children (39.5%) had platelet counts <10,000/µL at diagnosis. No episode of severe bleeding was observed. Peak incidence was observed during spring and summer. Respiratory infections proceeded in 58% of cases. Treatment consisted of i.v. immunoglobulin (IVIG) in 93 children at four dosing schedules. Sixteen children received corticosteroids, 10 children received anti-D immunoglobulin and 14 received no treatment. Recovery was observed in 67% of children on IVIG and in 50% on anti-D globulin. Eight patients did not respond initially and received corticosteroids. Three children with refractory thrombocytopenia received anti-CD20 (rituximab). Fourteen children (11%) had persistent/chronic disease. In 10 of them recovery was observed in 13 months-8 years. Splenectomy was performed in six children with resistant/chronic disease. ITP has a benign course in the majority of cases. Anti-D globulin can effectively be used as an alternative first-line treatment. Rituximab can successfully be used in refractory cases, while splenectomy has currently limited indications.

MECC Regional Initiative in Pediatric Palliative Care

In all the major medical centers throughout the Middle East, there is a functioning pediatric hematology oncology department. In almost all countries, opioids such as morphine, oxycodone, and fentanyl are available. Pediatric palliative care services are still in their infancy and await further recognition and development. Unfortunately, there are still countries in the Middle East where children with cancer are diagnosed when the disease is already at stage III or IV, when the only option left is palliation. To decrease the incidence of late presentation, more effort is needed concerning public awareness, and concomitantly, an urgent need to develop hospital-based and community-based palliative and supportive care services. The initial step in this direction would involve more training of health care providers: Pediatricians, Pediatric Oncologists, Oncology Nurses, and Social Workers with updated pharmacological and nonpharmacological modalities of treatment.

Hyperbaric oxygen treatment of superficial soft tissue lesions in children with oncologic disease

This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the Pediatric Hematology-Oncology Department of the University of Padova and treated adjuvantly with HOT. Between 1996 and 2010, 12 patients (5 males and 7 females, median age 7 years, range 0.5–16) underwent HOT. The effectiveness of HOT varied according to the lesion treated. Ten out of 12 patients were cured. Efficacy was most questionable in 2 patients with skin graft and flaps at risk. Compliance to therapy was close to 100%. In just one case, HOT was interrupted for the appearance of local skin metastases close to the site of primary tumor. HOT showed itself to be safe and effective in most patients even those immunocompromised or critically ill.

Health migration and care disparities

Pediatric Blood & CancerVolume 58, Issue 4 p. 646-646 Letter to the Editor Health migration and care disparities Luisa M. Massimo MD, Corresponding Author Luisa M. Massimo MD [email protected] Paediatric Haematology and Oncology Unit, Istituto Giannina Gaslini, Genova, ItalyGaslini Children' Hospital, Pediatric Hematology Oncology Department, Largo G. Gaslini 8, 16147 Genova, Italy.===Search for more papers by this authorDaniela Caprino MD, Daniela Caprino MD Paediatric Haematology and Oncology Unit, Istituto Giannina Gaslini, Genova, ItalySearch for more papers by this author Luisa M. Massimo MD, Corresponding Author Luisa M. Massimo MD [email protected] Paediatric Haematology and Oncology Unit, Istituto Giannina Gaslini, Genova, ItalyGaslini Children' Hospital, Pediatric Hematology Oncology Department, Largo G. Gaslini 8, 16147 Genova, Italy.===Search for more papers by this authorDaniela Caprino MD, Daniela Caprino MD Paediatric Haematology and Oncology Unit, Istituto Giannina Gaslini, Genova, ItalySearch for more papers by this author First published: 20 December 2011 https://doi.org/10.1002/pbc.24029Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume58, Issue4April 2012Pages 646-646 RelatedInformation

Complex assessment of late side effects affecting quality of life - the "Debrecen model"

As the outcome of childhood cancer improved substantially during the last 3 decades, the attitude of pediatric oncology has changed from "cure at any cost" to "cure at least cost". We investigated factors affecting quality of life in long-term survivors of childhood cancer in the in- and outpatient clinics of the Department of Pediatric Hematology-oncology, Institute of Pediatrics, Medical and Health Science Center, Debrecen. As a part of a comprehensive follow-up care program, we focused our attention on nephrotoxicity, osteoporosis and on cardiovascular morbidity. For long-term survivors of childhood cancer sensitive and cost-effective diagnostic algorithms were developed that can help in guiding secondary and tertiary prevention programs, in addition to assessing accurately the condition of patients. We found that anti-cancer treatments, including some of the supportive interventions, have adverse effects on glomerular (10%) and tubular functions (37%), impair the balance of bone resorption and formation (69%) and increase the frequency of cardiovascular risk factors (62%) in a significant proportion of patients. Our data confirm and extend the findings of other investigators and cooperative groups. In conclusion, we consider it important that the treatment plans of high-risk patients with cancer should be aimed at preserving the anticancer potential of therapy, without enhancing the frequency and severity of complications. The presented "Debrecen model" may help in achieving this goal and in increasing quality of life of long-term survivors of childhood cancer.

Treatment of primary CNS lymphoma with high‐dose methotrexate in immunocompetent patients

Pediatric Blood & CancerVolume 56, Issue 7 p. 1151-1151 Letter to the Editor Treatment of primary CNS lymphoma with high-dose methotrexate in immunocompetent patients Ian Joseph Cohen MB, ChB, Corresponding Author Ian Joseph Cohen MB, ChB icohen@tau.ac.il Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelDepartment of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petah Tikva 49202, Israel.===Search for more papers by this author Ian Joseph Cohen MB, ChB, Corresponding Author Ian Joseph Cohen MB, ChB icohen@tau.ac.il Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelDepartment of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petah Tikva 49202, Israel.===Search for more papers by this author First published: 10 February 2011 https://doi.org/10.1002/pbc.23001Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume56, Issue71 July 2011Pages 1151-1151 RelatedInformation

What do healthcare providers ask their patients with immune thrombocytopenia?

Clinical signs suggestive of immune thrombocytopenia (ITP) include bruising, petechiae, nose bleeds, genitourinary (GU) bleeding, gum bleeding, gastrointestinal (GI) bleeding, and gynecologic bleeding [1]. Clinical experience and adverse events in clinical trials reveal other ITP-associated symptoms such as arthritis, abdominal pain, sleep disturbances, headache, and fatigue. Asking patients about such symptoms supplements the platelet count in assessing disease status and impact, and thus helps in the design of a patient-specific management plan. A short practice patterns survey was administered to healthcare providers attending ITP Continuing Medical Education (CME) activities to assess the questions they ask patients in monitoring visits. A high percentage of respondents routinely ask about signs of bleeding and associated symptoms but not as frequently about health-related quality of life (HRQOL). Only 39% of respondents ask about difficulty with sleep. A short standardized questionnaire may be a useful tool to help healthcare providers gather information about their patients with ITP.

Gastrointestinal presentation of late acute lymphoblastic leukemia relapse

Pediatrics InternationalVolume 52, Issue 3 p. e171-e174 Gastrointestinal presentation of late acute lymphoblastic leukemia relapse Vassilios Papadakis, Corresponding Author Vassilios Papadakis Departments of Pediatric Hematology-Oncology andVassilios Papadakis, MD, PhD, Department of Pediatric Hematology-Oncology, Goudi, Athens 11527, Greece. Email: [email protected]Search for more papers by this authorEleftheria Roma, Eleftheria Roma First Department of Pediatrics, University of Athens andSearch for more papers by this authorKalliopi Stefanaki, Kalliopi Stefanaki Pathology, Agia Sofia Children's Hospital,Search for more papers by this authorIoanna Panagiotou, Ioanna Panagiotou First Department of Pediatrics, University of Athens andSearch for more papers by this authorSofia Papargyri, Sofia Papargyri Departments of Pediatric Hematology-Oncology andSearch for more papers by this authorGeorge Paterakis, George Paterakis Department of Immunology, G. Gennimatas General Hospital, Athens, GreeceSearch for more papers by this authorSofia Polychronopoulou, Sofia Polychronopoulou Departments of Pediatric Hematology-Oncology andSearch for more papers by this author Vassilios Papadakis, Corresponding Author Vassilios Papadakis Departments of Pediatric Hematology-Oncology andVassilios Papadakis, MD, PhD, Department of Pediatric Hematology-Oncology, Goudi, Athens 11527, Greece. Email: [email protected]Search for more papers by this authorEleftheria Roma, Eleftheria Roma First Department of Pediatrics, University of Athens andSearch for more papers by this authorKalliopi Stefanaki, Kalliopi Stefanaki Pathology, Agia Sofia Children's Hospital,Search for more papers by this authorIoanna Panagiotou, Ioanna Panagiotou First Department of Pediatrics, University of Athens andSearch for more papers by this authorSofia Papargyri, Sofia Papargyri Departments of Pediatric Hematology-Oncology andSearch for more papers by this authorGeorge Paterakis, George Paterakis Department of Immunology, G. Gennimatas General Hospital, Athens, GreeceSearch for more papers by this authorSofia Polychronopoulou, Sofia Polychronopoulou Departments of Pediatric Hematology-Oncology andSearch for more papers by this author First published: 14 June 2010 https://doi.org/10.1111/j.1442-200X.2010.03113.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume52, Issue3June 2010Pages e171-e174 RelatedInformation

Methotrexate‐associated alterations of the folate and methyl‐transfer pathway in the CSF of ALL patients with and without symptoms of neurotoxicity

Pediatric Blood & CancerVolume 53, Issue 1 p. 127-127 Letter to the Editor Methotrexate-associated alterations of the folate and methyl-transfer pathway in the CSF of ALL patients with and without symptoms of neurotoxicity Ian Joseph Cohen MB, ChB, Corresponding Author Ian Joseph Cohen MB, ChB [email protected] Department of Pediatric Hematology-Oncology, Schneider, Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelDirector Day Ward, Department of Pediatric Hematology Oncology, Schneider Childrens Medical Center of Israel, 14 Kaplan Street, Petah Tikva 49202, Israel.===Search for more papers by this author Ian Joseph Cohen MB, ChB, Corresponding Author Ian Joseph Cohen MB, ChB [email protected] Department of Pediatric Hematology-Oncology, Schneider, Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelDirector Day Ward, Department of Pediatric Hematology Oncology, Schneider Childrens Medical Center of Israel, 14 Kaplan Street, Petah Tikva 49202, Israel.===Search for more papers by this author First published: 01 April 2009 https://doi.org/10.1002/pbc.21990Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume53, Issue115 July 2009Pages 127-127 RelatedInformation

Pulmonary function studies in children treated by chemoradiotherapy and stem cell transplantation

Management of pediatric patients with malignant and hematological diseases is frequently associated with pulmonary complications. We assessed pulmonary function at diagnosis and during a 5-year follow-up to identify risk factors associated with pulmonary deterioration. Ninety patients (age range 3-20) who were treated at the Pediatric Hematology-Oncology Department, Sheba Medical Center, Israel, were entered into the study. Pulmonary function testing was performed at diagnosis and at least twice during the study period. At diagnosis and thereafter values of spirometry, total lung capacity, functional residual capacity and diffusion capacity were significantly lower than predicted (P < 0.002 for all indices). The ratio between residual volume and total lung capacity (RV/TLC) was significantly higher than normal at diagnosis and throughout the study (P < 0.001). Age and treatment modalities did not show any effect on lung-function during the study. A subgroup of seven patients (8%) developed Bronchiolitis obliterans (BO) after stem cell transplantation and development of graft versus host disease (GVHD). These patients' baseline FEF25-75 values (small airway disease) were significantly lower than FEF25-75 values of controls and other patients while all other parameters were similar. The RV/TLC in the BO patients gradually increased relative to other patients during the 5-year follow-up. Lung-function in pediatric hemato-oncological patients at diagnosis is lower than predicted. Abnormal baseline FEF25-75 may be a risk factor for the development of BO in the setting of GVHD after treatment. Careful monitoring, especially of FEF25-75 and RV/TLC at baseline and in the first period after diagnosis.

Integration of a palliative and terminal care center into a comprehensive pediatric oncology department

The sharp division between curative cancer therapy and palliative care results in the late introduction of palliative care and a high incidence of suffering in children with cancer. We established a Palliative Care Unit (PCU) that is fully integrated with the Pediatric Hematology Oncology Department (PHOD). We wished to explore the impact of such integrative model on patterns of hospitalizations and exposure to palliative care of pediatric oncology patients. Retrospective search of medical records of patients admitted to the PHOD since PCU establishment in 1999, and of children who died from progressive disease between 1990 and 2005 was performed. Differences in clinical and prognostic variables between PCU and non-PCU patients, and differences in location of death before and after PCU establishment were evaluated. The majority (59%) of patients, who were hospitalized after the PCU establishment, were hospitalized in the PCU, including 49% of the good prognosis patients and 91% of the poor prognosis patients. Poor prognosis patients were hospitalized in the PCU earlier and with higher frequency compared to children with curable disease. After PCU opening there was a significant decline in the percentage of patients who died in the general pediatric ward, hematology-oncology ward, and at home from 40%, 26% and 28% to 4%, 8%, and 16%, respectively. Our integrative model results in exposure of the majority of children with cancer to palliative care. For poor prognosis patients, palliative care is introduced early enough to allow gradual transition from symptom control after diagnosis to end of life care.

Stem Cell Transplantation in Hemoglobinopathies

β-Thalassemia (thal) and sickle cell disease are the most common genetic diseases worldwide. Although supportive therapies such as regular transfusion and chelation for β-thal and hydroxyurea (HU) for sickle cell disease have significantly improved clinical manifestations and the quality of life, they cannot eliminate disease and therapy-related complications. Today, hematopoietic stem cell transplantation (HSCT) is the only curative treatment for patients with hemoglobinopathies. The first successful HSCT was reported in 1981. At that time, more than 1,000 patients underwent HSCT in Pesaro, Italy. Sixty β-thal patients underwent HSCT at the Department of Pediatric Hematology-Oncology, Akdeniz University School of Medicine, Antalya, Turkey between 1998 and 2006. We found stable mixed chimerism in 14 patients out of 45 (31%) in our transplanted thalassemia patients. The thalassemia free survival and overall survival rates were found to be 84.0 and 91.0%, respectively. The literature and our results indicate that HSCT can offer a cure for hemoglobinopathy patients.

Outcome after Relapse in Childhood Acute Lymphoblastic Leukaemia - Results of a Single Center for a Period of 15 Years.

Approximately 25–30 % of children newly diagnosed with acute lymphoblastic leukemia (ALL) will eventually experience leukemic relapse. Bone marrow is the most common site of recurrence. Usually achieving a durable second remission is complicated by toxicity and resistance of the disease. Here we documented our patients in order to see the prognosis of relapsed pediatric ALL cases.RESULTS. From August 1990 to August 2005 children diagnosed with ALL and treated with BFM based protocols in Cerrahpasa Medical Faculty Pediatric Hematology-Oncology Department were enrolled to this study. There were 225 children aged median 6 years( 3 months–18 years) (136 boys/89 girls), 28 % SR, 50 % MR, 22 % HR. The whole group EFS is 72,6 % and RFI 81,8 %. Twenty-nine (12,8 %) patients were relapsed. Bone marrow recurrences were isolated in 19 patients, and combined with an extramedullary site in 8 patients (4 CNS, 2 testis, 1 retinal,1 dermal). Only two patients had isolated extramedullary site (testis) relapse. The median time to recurrence was 23 months (range 4–128 months). Five patients refused a secondary treatment. Of 24 chemotherapy given patients, 6 patients were lost just after induction therapy due to toxicity before a reliable remission evaluation was done. In three early relapses a second remission could not be attained. Twenty-one patients (72.4 %) achieved a second remission (median length, 4 months; range, 1–114 months)( mean16 ± 80 months). The 5-year survival probability among all patients was 27.2 % ± 8.2 %. Of 8 surviving patients, 3 are in remission more than 5 years, 3 are in remission 2–5 years of period and only 2 less than 1 year. One patient who relapsed for second time is in 3th remission for 65 months period. Bone marrow transplantation was the done for only 3 patients, one is very newly done, the other two relapsed after engrafmant and were lost.CONCLUSIONS. Despite acceptable long-term second EFS rates for a minor group of patients, childhood ALL recurrences signal a poor outcome being the problem of childhood ALL therapy.

Twinning: A rewarding scenario for development of oncology services in transitional countries

Pediatric Blood & CancerVolume 45, Issue 2 p. 103-106 Commentary Twinning: A rewarding scenario for development of oncology services in transitional countries† A.J.P. Veerman, Corresponding Author A.J.P. Veerman [email protected] Department of Pediatric Hematology-Oncology, Vrije Universiteit University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric Hematology-Oncology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.===Search for more papers by this author Sutaryo, Sutaryo Department of Pediatric Hemato-Oncology, dr Sardjito Hospital, Gadjah Mada University, Yogyakarta, IndonesiaSearch for more papers by this author Sumadiono, Sumadiono Department of Pediatric Hemato-Oncology, dr Sardjito Hospital, Gadjah Mada University, Yogyakarta, IndonesiaSearch for more papers by this author A.J.P. Veerman, Corresponding Author A.J.P. Veerman [email protected] Department of Pediatric Hematology-Oncology, Vrije Universiteit University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric Hematology-Oncology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.===Search for more papers by this author Sutaryo, Sutaryo Department of Pediatric Hemato-Oncology, dr Sardjito Hospital, Gadjah Mada University, Yogyakarta, IndonesiaSearch for more papers by this author Sumadiono, Sumadiono Department of Pediatric Hemato-Oncology, dr Sardjito Hospital, Gadjah Mada University, Yogyakarta, IndonesiaSearch for more papers by this author First published: 23 June 2005 https://doi.org/10.1002/pbc.20390Citations: 43 † The Wijaya Kusuma ALL 2000 Protocol in Yogyakarta, Indonesia. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume45, Issue2August 2005Pages 103-106 RelatedInformation

A Novel Idea for an Organized Hospital/School Program for Children with Malignancies: Issues in Implementation

The aim of this pilot study was to provide children with cancer hospitalized at the Department of Pediatric Hematology-Oncology of the University Hospital of Heraklion, Crete, with an educational program based on the SIOP guidelines. This would help them to follow the school program during the days of absence due to treatment. The realization of the initial idea generated difficulties that had to be overcome to achieve the goals and caused several changes in the program. Children refused to attend a regular class in the appropriately designed playroom of the Department but were very keen on room-to-room teaching that was adjusted to their needs and wills. This method of teaching was very well accepted by the children. A workup was done with parents and health professionals to convince them of the necessity of such a program and persuade them to participate in the procedure by encouraging children to attend it. Several steps have been taken and others have been planned for the teachers to receive education concerning the special needs of these children after dismissal from the hospital as well as that of their siblings to help in the reentry procedure. An adjustment to the personal needs of the hospitalized children with cancer, especially in areas where the psychosocial resources are minor, has proved very helpful and effective for the reentry of these children to regular school and social life.

Bacteremia in childhood cancer.

Infection-related mortality affects the overall survival rates of children who are receiving treatment for cancer. The leading cause of mortality is bacteremia and sepsis related to it in febrile neutropenic patients. All positive blood cultures of febrile neutropenic patients treated in the Department of Pediatric Hematology-Oncology, Cerrahpasa Medical School, between January 1995 and January 2001 were reviewed. Cultures grew 159 micro-organisms, 95 (60 per cent) of which were Gram-positive bacteria, 56 (35 per cent) were Gram-negative bacteria and eight (5 per cent) were fungi. Coagulase-negative staphylococci (63, 40 per cent) and S. aureus (8, 5 per cent) were the most frequent Gram-positive pathogens. Klebsiella, E. coli, Enterobacter and Pseudomonas infections were the primary Gram-negative pathogens. Twenty cases were lost because of sepsis: in 11 cases (55 per cent) Gram-negative bacteria, in eight cases (40 per cent) Gram-positive bacteria, and in only one case a fungus were the causative organisms. Although vancomycin was not included in the first-line treatment, the mortality rate of Gram-positive bacteremia was 8 per cent. In Gram-negative bacteremia it was 20 per cent. Gram-negative pathogens, which were resistant to multiple antibiotics, caused the mortality. Drug resistance and mortality due to micro-organisms must be taken into consideration while febrile neutropenia protocols are prepared.

ASSESSMENT OF PERIPHERAL LYMPHADENOPATHIES: Experience at a Pediatric Hematology-Oncology Department in Turkey

Since a large variety of disorders may lead to lymph node enlargement, determining the cause of peripheral lymphadenopathy (LAP) in children can be difficult. This retrospective study evaluated 200 children who were admitted to an Oncology-Hematology department because of lymphadenopathy and aimed to determine the clinical and laboratory findings that were valuable for differential diagnosis. A specific cause for lymphadenopathy was documented in 93 (46.5%) cases. One hundred forty (70%) children were classified as having a benign cause for lymph node enlargements. Fourteen (10%) of these cases underwent an excisional lymph node biopsy, and histopathological examination showed a reactive hyperplasia. Sixty (30%) cases were classified as having a malignant disease-causing lymphadenopathy. In terms of differential diagnosis, some associated systemic symptoms, physical findings, and laboratory investigations showed significant difference between benign and malignant lymphadenopathy groups. The following findings were determined as being important to alert the physician about the probability of a malignant disorder: location of the lymphadenopathy (supraclavicular and posterior auricular), duration of the lymph node enlargement (> 4 weeks), size of the lymph node (> 3cm), abnormal complete blood cell findings, abnormalities in chest X-ray, and abdominal ultrasonography.

Neuroblastoma maturation by [131I] metaiodobenzylguanidine in chemoresistant neuroblastoma

Medical and Pediatric OncologyVolume 33, Issue 4 p. 418-419 Brief Report Neuroblastoma maturation by [131I] metaiodobenzylguanidine in chemoresistant neuroblastoma M. Weyl Ben Arush MD, Corresponding Author M. Weyl Ben Arush MD m_benarush@rambam.health.gov.il Department of Pediatric Hematology-Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelMiri Shitrit Department of Pediatric Hematology-Oncology, Rambam Medical Center, P.O.B. 9602, Haifa 31096, IsraelSearch for more papers by this authorO. Ben Itzhak MD, O. Ben Itzhak MD Department of Pathology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorG. Yossilevski PhD, G. Yossilevski PhD Department of Nuclear Medicine, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorR. El Hasid MD, R. El Hasid MD Department of Pediatric Hematology-Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorS. Postovsky MD, S. Postovsky MD Department of Pediatric Hematology-Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorO. Israel MD, O. Israel MD Department of Nuclear Medicine, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this author M. Weyl Ben Arush MD, Corresponding Author M. Weyl Ben Arush MD m_benarush@rambam.health.gov.il Department of Pediatric Hematology-Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelMiri Shitrit Department of Pediatric Hematology-Oncology, Rambam Medical Center, P.O.B. 9602, Haifa 31096, IsraelSearch for more papers by this authorO. Ben Itzhak MD, O. Ben Itzhak MD Department of Pathology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorG. Yossilevski PhD, G. Yossilevski PhD Department of Nuclear Medicine, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorR. El Hasid MD, R. El Hasid MD Department of Pediatric Hematology-Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorS. Postovsky MD, S. Postovsky MD Department of Pediatric Hematology-Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorO. Israel MD, O. Israel MD Department of Nuclear Medicine, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this author First published: 20 September 1999 https://doi.org/10.1002/(SICI)1096-911X(199910)33:4<418::AID-MPO18>3.0.CO;2-9Citations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue4October 1999Pages 418-419 RelatedInformation