Flávio Augusto Vercillo Luisi

Contribution to the treatment of nausea and emesis induced by chemotherapy in children and adolescents with osteosarcoma

CONTEXT AND OBJECTIVE Chemotherapy-induced emesis is a limiting factor in treating children with malignancies. Intensive chemotherapy regimens along with emetogenic drug administration have increased the frequency and severity of emesis and nausea. Our study was designed to consider the importance of this problem and the need for improvement in emesis treatment for patients receiving chemotherapy. Our objective was to compare the efficacy and safety of the antiemetic drug granisetron and a regimen of metoclopramide plus dimenhydrinate. DESIGN AND SETTING Open, prospective and randomized study at Instituto de Oncologia Pediátrica, Department of Pediatrics, Universidade Federal de São Paulo. METHODS From February to August 1994, 26 patients (mean age: 14 years) with osteosarcoma received 80 chemotherapy cycles of iphosphamide (2,500 mg/m2) plus epirubicin (75 mg/m2) or carboplatin (600 mg/m2), or epirubicin (75 mg/m2) plus carboplatin (600 mg/m2). Eighty chemotherapy treatments were analyzed regarding nausea and vomiting control. Patients were randomized to receive either a single dose of granisetron (50 microg/kg) or metoclopramide (2 mg/kg) plus dimenhydrinate (5 mg/kg infused over eight hours). Emesis and nausea were monitored for 24 hours by means of the modified Morrow Assessment of Nausea and Emesis. Statistical analysis utilized the chi-squared, Student t and Mann-Whitney tests, plus data exploration techniques. RESULTS 62.5% of the patients undergoing chemotherapy responded completely to granisetron, whereas 10% responded to metoclopramide plus dimenhydrinate (p < 0.0001). No severe adverse reactions were found in either of the treatments given. CONCLUSION In children and adolescents with osteosarcoma, granisetron was safe and more efficient than metoclopramide plus dimenhydrinate for controlling chemotherapy-induced emesis and nausea.

Aplicação da ressonância magnética de corpo inteiro para o estadiamento e acompanhamento de pacientes com linfoma de Hodgkin na faixa etária infanto-juvenil: comparação entre diferentes sequências

OBJECTIVE: To compare the performance of the T1, T2, STIR and DWIBS (diffusion-weighted whole-body imaging with background body signal suppression) sequences in the staging and follow-up of pediatric patients with Hodgkins lymphoma in lymph node chains, parenchymal organs and bone marrow, and to evaluate interobserver agreement. MATERIALS AND METHODS: The authors studied 12 patients with confirmed diagnosis of Hodgkins lymphoma. The patients were referred for whole body magnetic resonance imaging with T1-weighted, T2-weighted, STIR and DWIBS sequences. RESULTS: The number of lymph node sites characterized as affected by the disease on T1- and T2-weighted sequences showed similar results (8 sites for both sequences), but lower than DWIBS and STIR sequences (11 and 12 sites, respectively). The bone marrow involvement by lymphoma showed the same values for the T1-, T2-weighted and DWIBS sequences (17 lesions), higher than the value found on STIR (13 lesions). A high rate of interobserver agreement was observed as the four sequences were analyzed. CONCLUSION: STIR and DWIBS sequences detected the highest number of lymph node sites characterized as affected by the disease. Similar results were demonstrated by all the sequences in the evaluation of parenchymal organs and bone marrow. A high interobserver agreement was observed as the four sequences were analyzed.

IN TIME: COMO ESTÁ O ATENDIMENTO DA CRIANÇA COM CÂNCER?

aDepartamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil. bSetor de Oncologia/Disciplina de Especialidades Pediátricas, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil. Recebido em 14 de junho de 2018. In TIme: como esTá o aTendImenTo da crIança com câncer? In Time: what is the status of the care given to children with cancer?

Renal aspergillosis in a 6-year-old male with Burkitt's lymphoma.

© 2015 Wolters Kluwer Health, Inc. All rights reserved. www.pidj.com | 679 specificity in neutropenic patients with pulmonary aspergillosis, but the sensitivity of this test is not well defined in extra pulmonary lesions, such as renal aspergilloma. Encapsulated and localized aspergillosis, as in our case with renal aspergilloma, might hamper the release of the galactomannan to the blood stream and have a negative serum assay result. IA restricted to the urinary tract is rare and has been described in immunocompromised patients with AIDS or in transplant recipients. Galactomannan assay was not performed in a urinary sample, and blood and urinary cultures never grew any organism. Renal aspergillosis can be secondary to hematogenous infection, bezoar formation in renal pelvis and ascending panurothelial aspergillosis. Ascending panurothelial fungal infection is a clinical presentation of primary urinary aspergillosis that has been described in kidney transplant recipients but not after hematopoietic stem cell transplantation. Voriconazole is the best drug to treat IA, but it reaches limited urinary tract tissue concentrations. Most patients with renal aspergillosis reported in the literature were treated with combination antifungal therapy (voriconazole and liposomal amphotericin B or amphotericin B deoxycholate) and surgery. Our patient did not respond to amphotericin B followed by voriconazole probably because of the intense immunosuppression and the low tissue penetration of the drugs in the encapsulated renal lesion. From a surgical standpoint, resection of the entire kidney or spleen and lobectomies is usually recommended over nodulectomy in immunosuppressed patients.

Dermatomiosite juvenil e linfoma de Hodgkin: uma rara associação

Dermatomyositis (DM) in adults is frequently associated with cancer. In contrast, during childhood juvenile dermatomyositis (JDM) is predominantly idiopathic and its association with neoplasia is rare and based only in case reports. Although rare, the presence of neoplasia in JDM patients must always be suspected in face of atypical clinical manifestations and uncommon laboratorial findings. We describe and discuss a case of JDM and Hodgkin disease in an adolescent.