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PubMedDate not supplied

MR imaging of pediatric cerebral abnormalities.

One hundred sixteen magnetic resonance (MR) imaging studies from 105 pediatric patients with a variety of cerebral abnormalities were reviewed to determine the diagnostic efficacy of MR in the pediatric population. All subjects tolerated the MR procedure well, although sedation was necessary for younger children. Compared with CT, MR proved to be advantageous in detection and characterization of the pathology in 23 of 105 patients, especially when the abnormality was located along the base of the brain and midline, or when it involved primarily the white matter. Intracranial calcification was the one abnormality not detected with MR although dense calcifications could be seen as areas of low signal intensity. Some characteristics of various pathological entities were compared in an attempt to differentiate among abnormalities in the same anatomical location: craniopharyngioma from optic chiasm and hypothalamic glioma, cystic glioma from arachnoid cyst, and chronic subdural hematoma from subdural hygroma. The lack of ionizing radiation in MR is of particular interest in pediatric neuroradiology since radiation is of special concern in the young age group.

Adolescent↗
PubMed2002

Iterative neuronavigation using 3D ultrasound. A feasibility study.

Intra-operative ultrasound (iUS) can generate 2D images in real-time as well as near real-time 3D datasets of the current situation during an intervention. Tracked ultrasound can locate the images in 3D space and relate them to patient, devices, andpre-operative planning data. Therefore, tracked US is an efficient means for controlling the validity of pre-operative planning, recognition of changes (brain shift) during the intervention, replanning of the operational path due to situational changes (iterative navigation), and finally, controlling the results (residual tumor). This paper describes a neuronavigation system exploiting this potential of interventional tracked US for permanent control of intervention progress and iterative adaptation of the planned procedure to the current situation.

Brain Mapping↗
PubMed1987

Hyperprolactinemia and hypothyroidism following cytotoxic therapy for central nervous system malignancies.

Endocrinologic dysfunction including hyperprolactinemia and hypothyroidism are recognized complications of irradiation to the hypothalamic-pituitary axis or thyroid gland in the course of treating CNS malignancies. However, the frequency of these adverse effects in both short- and long-term survivors may be underestimated. Sixty-five patients treated in the University of Rochester Cancer Center since 1968 with radiation with or without BCNU chemotherapy for CNS tumors not involving the hypothalamic-pituitary axis were evaluated for thyroid, prolactin, and gonadal disturbances regardless of clinical symptomatology. Prolactin values were elevated in 19 of 47 patients (40%). For males and females treated with greater than 55 Gy, abnormal values were present in nine of 11 (82%) and seven of 14 (50%), respectively. For males and females treated with less than or equal to 55 Gy, two of nine (22%) and one of 13 (8%), respectively, were abnormal (P = .0001). Six of six patients who also received BCNU chemotherapy were hyperprolactinemic, as compared with six of ten (60%) who did not receive BCNU. Seven of eight females with elevated prolactin levels had menstruation abnormalities, and five of seven adult males noted a decrease in libido. Mild abnormalities in testosterone concentration were found in three of nine men evaluated, all of whom had normal gonadotropins. Of 47 patients who did not receive irradiation to the spinal axis (and thus the thyroid gland), ten (21%) had a decreased thyroxin (T4) value. Only one of these patients had an elevated thyroid-stimulating hormone (TSH) value. Of 32 patients who received greater than 55 Gy, ten (31%) had a low T4, compared with zero of 15 who received less than or equal to 55 Gy (P = .0001). Four of eight patients (50%) who also received BCNU had low T4 values, as compared with three of 14 (21%) who did not receive BCNU. Of 15 patients who were treated with 4 to 10 MV photon irradiation to the spinal axis, five patients (33%) had elevated TSH values. The mean spinal axis dose in these patients was 33 Gy. Two euthyroid children in this group manifested the early onset of puberty. The complex of endocrinologic abnormalities observed in several patients receiving only cranial irradiation, that is elevated prolactin, decreased thyroid, and gonadal hormone secretion in the presence of otherwise normal pituitary hormone levels, suggests a radiation-induced insult to the hypothalamic regulation of pituitary function.

Adolescent↗
PubMed2005

Ototoxicity in children receiving platinum chemotherapy: underestimating a commonly occurring toxicity that may influence academic and social development.

PURPOSE: To describe the frequency and severity of ototoxicity in a series of pediatric patients treated with platinum-based chemotherapy. PATIENTS AND METHODS: Serial audiologic evaluations were conducted for 67 patients aged 8 months to 23 years who received platinum-based chemotherapy. Audiologic data was analyzed to determine time to hearing-loss using American Speech-Language-Hearing Association (ASHA) criteria, and the effects of treatment and patient characteristics on the incidence and severity of ototoxicity. RESULTS: Bilateral decreases in hearing were seen in 61% of patients (median time to hearing loss, 135 days). Children treated for medulloblastoma, osteosarcoma, and neuroblastoma had greater incidence and severity of hearing loss. Agreement between the usually reported National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and ASHA criteria was inadequate. CONCLUSION: Traditional reporting of toxicity data (CTCAE) has under-reported ototoxicity and minimized the significance of hearing loss in children. As pediatric patients experience improved survival, the effects and implications of high-frequency hearing loss with regard to academic achievement and speech and language development are important considerations, especially in patients younger than 5 years.

Adolescent↗
PubMed1997

[Primary pediatric tumours of the central nervous system. Anatomopathological study of 623 cases].

Tumours of central nervous system (CNS) represent the second most frequent malignancy in children under 15 years of age but are the commonest cause of death. The authors present the epidemiologic and histopathologic analysis of 623 primary tumours of CNS occurring during the period 1990 to 1996 in paediatric patients. In this period 3318 biopsies of CNS were analyzed. In this total were included 623 paediatric tumours (18 7%). The age of patients ranged from 5 months to 15 years, 325 tumours occurred in males and 298 in females. The majority affected the posterior fossa. The majority of paediatric neoplasias were of glial origin (n = 277). The most frequent tumours were: astrocytoma (27.9%), medulloblastoma (9.95%), craniopharyngioma (5.93%), ependymoma (4.97%) and glioblastoma (3.37%).

Adolescent↗
PubMedDate not supplied

[Radiotherapy treatment under anesthesia in pediatrics].

A four-year-old boy received 30 sessions of radiotherapy, at a rate of one session daily for five days every week, under anesthesia with midazolam and propofol in spontaneous ventilation. Monitoring was by pulse oximetry and capnography; no adverse events were recorded. The presence of an anesthesiologist during diagnostic and therapeutic procedures outside the operating room is essential, given that lack of cooperation can make the procedure difficult or impossible to perform. Radiotherapy under anesthesia is a special case because it is scheduled daily, and care must be taken to interfere as little as possible with a child's meals or other activities.

Anesthesia, General↗
PubMedDate not supplied

[Peripheral blood stem cell collection in pediatric malignancies: comparison between three mobilizing regimens].

PURPOSE: The optimal method for PBSC (peripheral blood stem cells) mobilization in pediatric patients is still unknown. The present study was conducted to evaluate the safety of apheresis procedures and to compare the efficacy of three methods of PBSC mobilization. PATIENTS AND METHODS: Our study was performed on 28 pediatric patients (in three groups) with solid tumors at onset or on relapse. In two groups we tried to mobilize PBSC administering CHT (based on Carboplatin with Etoposide in the first group and Cyclophosphamide in the second group) followed by granulocyte colony stimulating factor (G-CSF); in the third group the mobilization regimen was based on G-CSF alone. RESULTS: Forty-nine mobilizations have been performed and a median of 6.5 CD34+ cells x 10(6)/Kg were collected, with a median number of one apheresis for each patient. Using Carboplatin with G-CSF and Cyclophosphamide with G-CSF we collected respectively a median value of 6.75 and 7.3 x 10(6) CD34+ cells/kg. The mobilization method based on G-CSF alone showed to be less effective (median of 4.3 CD34+ cells x 10(6)/kg collected). CONCLUSIONS: In our experience the mobilizing regimens based on Carboplatin or Cyclophosphamide associated with G-CSF resulted both effective and better than the one based on G-CSF alone with a scanty number of apheresis procedures.

Adolescent↗
PubMed1991

Differentiation characteristics of newly established medulloblastoma cell lines (D384 Med, D425 Med, and D458 Med) and their transplantable xenografts.

Three new human medulloblastoma (MB) cell lines (D384 Med, D425 Med, and D458 Med) and their transplantable xenografts were examined for antigenic expression with antibodies against neuroectodermal antigens, cytoskeletal proteins, neuroendocrine markers, glioma-associated antigens, tenascin, human lymphocyte antigen molecules, epidermal growth factor receptor, and T-cell antigen by indirect immunofluorescence, avidin-biotin complex peroxidase immunohistochemistry, and immunoblot methods. We found that each of the three cell lines expressed vimentin; low-, middle-, and high-molecular-weight neurofilament proteins; and the synaptic vesicle membrane glycoprotein synaptophysin. Each of the cell lines also reacted with antibodies against neural cell adhesion molecules, but none of them were positive for antibodies against glial fibrillary acidic protein, keratin, microtubule-associated protein tau and microtubule-associated protein 2, human lymphocyte antigen-DR, epidermal growth factor receptor, and T-cell antigen. Immunoreactivities with anti-tenascin and anti-glioma-associated antibodies were variable in these cell lines. Anti-human lymphocyte antigen-A,B and anti-beta 2-microglobulin antibodies reacted with xenografts of D384 Med and D425 Med and were weakly positive for a small population of D384 Med cultured cells. In summary, the detection of neurofilament proteins and synaptophysin and the absence of glial fibrillary acidic protein provide strong evidence for a neuronal phenotype of D384 Med, D425 Med, and D458 Med.

Antigens, Neoplasm↗
PubMed1989

[A case of neurilemmomatosis].

A 25-year-old man had multiple subcutaneous nodules on the neck, trunk and extremities. Those nodules first appeared in the right popliteal fossa about 15 years ago and thereafter gradually increased in the number with hearing loss, tinnitus, and vertigo. The tumors had smooth surfaces and were elastic hard without any adhesion to the overlying skin or to subcutaneous tissue. Histological examination revealed, in most parts of the lesion, Antoni type A neurilemmoma and the Antoni type B picture at the periphery. As extracutaneous lesion, there were bilateral cerebello-pontine angle neurilemmomas, and spinal and adrenal tumors. Similar subcutaneous tumors have been recognized in 6 of 17 family members of the previous four generations of his family. According to a statistical analysis of 119 cases, including this one, in the Japanese dermatological field, of 75 cases of solitary neurilemmoma and 44 cases of multiple ones, the latter showed male predominance and lower age of the onset. Many of them had tumors not only in the skin but also in extracutaneous sites.

Adrenal Gland Neoplasms↗