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Biomedical subjects

Y Perel

Publications and source records attributed to Y Perel.

67 records · Page 4Linked to original sources

[Castleman's disease (angiofollicular hyperplasia) in children].

This unusual clinicopathologic entity was first recognized by Castleman. Onset is usually in adolescence or early adulthood, occasionally childhood. A single, large mass with no tendency to compress develops, usually in the mediastinum, occasionally at other lymph node sites (superficial, retroperitoneal, abdominal), and exceptionally in extranodal locations. A variety of systemic manifestations may be found, including fever, anemia, hypergammaglobulinemia, and a broad spectrum of inflammatory and autoimmune disorders, presumably associated with specific humoral factors produced by the tumor. Histologic examination shows the characteristic features of angiofollicular lymph node hyperplasia. Two variants have been described, i.e., the plasma cell type (active stage) associated with systemic manifestations, and the hyaline vascular type (quiescent stage). Surgical removal of the tumor ensures permanent (local and systemic) recovery in the overwhelming majority of cases. A role of microorganisms in the etiology of this condition has been suggested. Identical histologic changes can be found in adults with immune dysfunction syndromes. The etiology, pathogenesis and nosology of this very benign disease are still poorly known.

Adolescent↗

[Circulating hematopoietic cells. Results of 6 autologous grafts].

Six patients with acute non-lymphocytic leukemia underwent autologous transplantation of circulating stem cells collected during remission. They were given cyclophosphamide (120 mg/kg) and total body irradiation (1,000-1,200 rads) (five patients) or busulfan (16 mg/kg) and melphalan (140 mg/m2) before the transfusion of 6.7 X 10(8) nucleated cells/kg corresponding to 19.7 X 10(4) CFU-GM/kg. Granulopoietic engraftment was observed in every case and was influenced by the number of CFU-GM injected. Megakaryocytic recovery was obtained in four cases.

Acute Disease↗

[Necrotizing enteritis during the therapeutic induction phase in leukemia. Value of surgical treatment].

A case of typhlitis in a 3,5 year old girl, during induction therapy for acute lymphoblastic leukemia is reported. This typhlitis, or necrotizing enterocolitis involving the coecum and right colon resulted in stercoral peritonitis during the neutropenic phase. After surgery, the patient had a favorable outcome with complete recovery. Knowledge about this uncommon but severe complication of hemopathies leads to follow clinical, microbiologic and radiologic rules of prophylaxis and screening. Typhlitis requires early treatment by supportive care and surgical cure if necessary.

Child, Preschool↗

[Congenital cutaneous candidiasis: a case with review of the literature].

The clinical features of CCC are stereotyped. Twenty-two cases have been found in the literature. Skin lesions are present at birth (12/22) or within the first twelve hours of life (7/22) and sometimes later, up to the sixth day of life. Maculopapular lesions are the first to appear, followed by the more typical vesiculopustular rash and secondary desquamation. Involvement of the upper half of the body is frequent. Interestingly, palm and sole pustules are almost constant. Oral, periungueal and conjunctival lesions are rare. In most cases, healing occurs within ten days of topical treatment using either nystatin or imidazole derivatives. Rarely (2/22), systemic candidiasis may be associated and may progress to death because of lung or meningeal involvement. Differential diagnosis includes post-natal acquired candidiasis, infectious pustulosis-impetigo, herpes, varicella-, and syphilis. In the authors' experience, pustular erythema toxicum is the most difficult diagnosis to rule out and the value of the direct smear must be emphasized. The clinical picture of CCC correspond to intrauterine infection due to a specific chorioamnionitis, for the following reasons: the rash may occur at birth; experimental cutaneous candidiasis required from 2 to 7 days of incubation; C. albicans has already been demonstrated in the adnexae, even in cases with late onset; culture of C. albicans in multiple sites favours intrauterine infection. Ascending infection of the fetal skin by C. albicans via the birth canal occurs probably through intact membranes, but fissures or late amniocentesis may create a portal of entry. CCC is rare as compared with the frequent maternal carriage of C. albicans.(ABSTRACT TRUNCATED AT 250 WORDS)

Candidiasis, Cutaneous↗

[Meningeal hemorrhage, a symptom disclosing spinal tumor in children].

One case of subarachnoid haemorrhage due to a spinal cord tumor, seen in a child, is reported. This exceptional etiology, whose the look is often misleading must be called to mind when meningeal and rachidian syndromes are associated. Ependymoma of cauda equina is the most common tumor.

Adolescent↗

Clinical impact and prognostic value of metaiodobenzylguanidine imaging in children with metastatic neuroblastoma.

PURPOSE: The clinical value of metaiodobenzylguanidine (mIBG) scintigraphy in patients with disseminated neuroblastoma (NB) at the time of diagnosis and after induction chemotherapy was evaluated. PATIENTS AND METHODS: The medical records and imaging studies of 30 patients with stage 4 NB who underwent mIBG scintigraphy and 99mTc hydroxy methylene diphosphonate bone scintigraphy at the time of diagnosis were reviewed. Scores were calculated for the mIBG and bone scintigrams, and outcome according to the initial and follow-up imaging studies was determined. RESULTS: Discrepancies between bone scintigraphy and mIBG osteomedullary localization were seen in six patients. For the entire cohort, 2-year event-free survival did not significantly differ for the group of patients with initial mIBG or bone scintigraphy scores > or = 10 compared to those with scores < 10 (P = 0.23 and 0.61, respectively). However, for patients older than 1 year, a trend associating worse outcome with mIBG scores > or = 10 at diagnosis was seen (P = 0.08). A trend correlating abnormal mIBG scintigraphy after induction therapy and poor outcome was also observed (P = 0.09). Outcome did not correlate with the results of the bone scintigram studies performed after induction chemotherapy (P = 0.68). CONCLUSION: Because a discordance between mIBG and bone scintigraphy results were seen in a subset of stage 4 NB patients, both imaging studies should be performed at the time of diagnosis. mIBG imaging studies performed at the time of diagnosis and after induction chemotherapy may be of prognostic value, particularly in stage 4 patients older than 1 year.

3-Iodobenzylguanidine↗

Erythema nodosum in children: a study of 27 patients.

Erythema nodosum (EN) seems to occur in children more rarely than in adults. It still remains the most frequent acute panniculitis, for which the diagnosis is almost always clinical. In a retrospective study of 27 pediatric patients, we have attempted to clarify the clinical spectrum and prognosis of this disease and discuss the differential diagnosis of nodular eruptions on the lower limbs of children. In almost half the patients of our series, the cause of EN remained undetermined. Streptococcal infections (usually of the pharynx) were the most common cause of EN in children (22% of patients in our series), followed by Yersinia infection in about 15% of patients. Tuberculosis, an important cause in the past, was never found, but must always be excluded. A benign course was noted in all patients. Erythema nodosum is easily recognized clinically, but other subcutaneous lesions, especially nodular vasculitis and Schönlein-Henoch purpura, have to be excluded by pathologic study, in cases of atypical presentation or long duration.

Battered Child Syndrome↗

Pheochromocytoma and paraganglioma in children: a report of 24 cases of the French Society of Pediatric Oncology.

Pheochromocytoma and paraganglioma of childhood are rare neuroendocrine tumors. Urinary catecholamine measurements, metaiobenzylguanidine (MIBG) scanning, computed tomographic scanning, and magnetic resonance imaging have greatly facilitated diagnosis. Prognosis after surgical resection is excellent. In this retrospective series collected from French oncology centers, the risk of tumor progression was studied in order to assess prognostic factors and the optimal diagnostic and therapeutic management. Medical records of 24 children with paraganglioma were reviewed. This tumor occurred at a median age of 12.5 years and in most cases was revealed by arterial hypertension. The diagnosis was made by the demonstration of urinary excretion of catecholamines and their metabolites. Six patients had bilateral adrenal pheochromocytomas; two patients had extra-adrenal paragangliomas. In eight patients, the paraganglioma occurred as a familial disease. Surgical excision was the only therapeutic procedure. With a follow-up of 5.2 years, 14 of the patients are still in first complete remission and 6 have developed metastases or shown tumor progression. Despite a high long-term survival rate, the risk of malignancy and of multifocal involvement is of concern and is associated with a significant rate of late events. The outcome depends on adequacy of tumor resection and must be serially assessed.

Adolescent↗

[Use of urine collectors for infants from 0 to 4 years of age in a mass survey of urinary schistosomiasis in Niger].

A simple method, using urine collectors, was devised to obtain sufficient and reliable samples of urine from infants (0-4 years old) for the quantitative diagnosis of urinary schistosomiasis. The use of urine collectors is readily accepted by rural populations and it avoids possible interchange between young children. Urine collection and examination from as many as 100 infants can be undertaken daily by a small, well-trained survey team. Our present observations on S. haematobium among infants in Niger show surprisingly high (14.06 per cent) prevalence rates and suggest that this age group may play a considerable role in the transmission of the infection in some endemic foci.

Child, Preschool↗