Lucian Miron

Diagnostic Difficulties in a Pediatric Insulinoma: A Case Report.

AbstractInsulinomas are functional neuroendocrine pancreatic tumors rarely encountered in pediatric pathology.Insulinomas are usually solitary and sporadic, but may occur in association with multiple endocrine neoplasia type 1. Whipples triad—hypoglycemia, simultaneous compatible adrenergic and/or neurological signs, and relief of symptoms upon the administration of glucose—remains the fundamental diagnostic tool.We report a case of insulinoma in an 11-year-old boy with malnutrition and mild psychic retardation.History revealed neuroglycopenic symptoms associated with hypoglycemia that returned to normal values after glucose intravenous infusion; before admission in our unit, the levels of circulating insulin, as well as the abdominal ultrasound and abdominal computed tomography scan, were reported within normal range. During hospitalization in our service, the glycemic curves showed recurring low values associated with low glycated hemoglobin, positive fasting test, and elevated C-peptide. The pancreatic ultrasound was inconclusive, but the magnetic resonance imaging revealed a high signal focal area with a diameter of 1 cm, located in the tail of pancreas. Conventional enucleation of the lesion prompted a spectacular normalization of glucose metabolism and the alleviation of the main clinical symptoms. The child had a favorable evolution in the clinical follow-up, presenting with weight gain and progressive remission to complete disappearance of most symptoms—except for the mental impairments.Although in our case Whipples triad was apparent from the beginning, the diagnosis was delayed due to the failure of conventional imaging methods in locating the tumor. Weight loss and mental impairment contributed to the diagnosis pitfalls.Pediatricians should be aware of confusing and nonspecific symptoms, especially when children with insulinoma present mental or neurological retardation. Despite the existence of medical regimens, surgery remains the gold standard for the therapeutic approach to this condition.

Silent presentation of multiple metastasis Burkitt lymphoma in a child: A case report and review of the literature

Rationale: The Burkitt lymphoma (BL) is a very aggressive B-cell non-Hodgkins lymphoma. It accounts for 34% of lymphoma cases in children. Patient concerns: We present the case of a 6-year-old boy diagnosed with BL, who presented multiple contrasting elements of the disease: silent symptomatology, without involvement of the bone marrow at first, but with multiorgan infiltration and a fast evolution, despite starting the treatment shortly after the symptoms appeared. Diagnoses: He was diagnosed with BL after immunophenotyping from the pleural fluid. Interventions: After a week from admission, chemotherapy was initiated according to protocol NH-BFM therapeutic group III—cytoreductive phase in the acute care ward and subsequently the AA 24 treatment. Outcomes: Following the treatment, the patient developed medullary aplasia and cutaneous toxicity. The patients general state remained severe during the hospitalization. Lessons: Even though the prognosis of BL has improved over time (up to 90% survival rate), in this case the evolution was unfavorable. In our patient, the symptoms appeared abruptly. They appeared late in the phase of multiple-organ dissemination, which generated the pessimistic prognosis.

Chemotherapy in Extended Parotidectomy

Salivary gland tumors (SGTs) comprise a heterogeneous group of cancers, with high variability in their natural history. Surgery (with adjuvant radiation therapy in high-risk patients) remains the standard curative treatment. Systemic chemotherapy alone has yielded modest results, although its association with radiation therapy is still actively studied. Recent progress in molecular medicine has prompted initiation of many clinical trials of targeted agents. Still, while new specific biological targets have been identified in the main histological subtypes of SGTs, the results of these trials are so far disappointing. Further prospective studies, as well as identification of new molecular pathways, could contribute to therapeutic improvements in this group of diseases.

Mathematical model to predict methotrexate elimination in children with acute lymphoblastic leukemia

Abstract Introduction: Methotrexate, a structural analogue to the folic acid, is one of the most frequently used antimetabolites in pediatric oncologic pathology. Its mode of action and toxic effects are now well known. Material and method: Our study aimed to describe the quantitation of the drug in serum of 40 children with acute lymphatic leukemia receiving high doses of methotrexate and to predict serum methotrexate levels at 96 hours, based on 48 h, 72h levels and on alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, and creatinine serum levels. The above mentioned parameters were analyzed by sampling serum levels at 48h, 72h and 96 hours after methotrexate administration and a logical regression model being projected upon obtained results. Results and conclusions: methotrexate serum level at 96 hours does not depend on either AST, ALT, urea, creatinine levels or on the methotrexate level determined at 48 hours, it only depends on the methotrexate serum level at 72 hours. Rezumat Introducere: Metotrexatul, analog structural al acidului folic, este unul dintre cel mai frecvent folosiți antimetaboliți în patologia oncologică pediatrică. Modul de acţiune și efectele toxice sunt bine cunoscute în prezent. Material şi metoda: Studiul realizat și-a propus să determine profilul eliminării metotrexatului la 40 copii cu leucemie limfatică acută trataţi cu doze mari din acest produs şi să prezică nivelul seric al metotrexatului la 96 ore în funcţie de valorile metotrexatemiei la 48h, 72h, respectiv valorile alaninaminotransferazei ALT, aspartataminotransferazei AST, ale ureei şi creatininei serice. Parametrii menţionaţi au fost analizaţi în probe recoltate la 48, 72 şi 96 ore după administrarea metotrexatului și pe baza rezultatelor obţinute elaborându-se un model de regresie logică. Rezultate şi concluzii: Valoarea metotrexatemiei serice la 96 ore nu depinde de nici una dintre valorile AST, ALT, uree, creatinină, nici de valoarea metotrexatemiei la 48 ore, ci doar de cea înregistrată la 72 ore.