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Brok JS, Shelmerdine S, Damsgaard F, Smets A, Irtan S, Swinson S, Hedayati V, Jacob J, Nair A, Oostveen M, Pritchard-Jones K, Olsen Ø. The clinical impact of observer variability in lung nodule classification in children with Wilms tumour. Pediatr Blood Cancer 2022; 69:e29759. [PMID: 35652617 PMCID: PMC7615195 DOI: 10.1002/pbc.29759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the extent to which observer variability of computed tomography (CT) lung nodule assessment may affect clinical treatment stratification in Wilms tumour (WT) patients, according to the recent Société Internationale d'Oncologie Pédiatrique Renal Tumour Study Group (SIOP-RTSG) UMBRELLA protocol. METHODS I: CT thoraces of children with WT submitted for central review were used to estimate size distribution of lung metastases. II: Scans were selected for blinded review by five radiologists to determine intra- and inter-observer variability. They assessed identical scans on two occasions 6 months apart. III: Monte Carlo simulation (MCMC) was used to predict the clinical impact of observer variation when applying the UMBRELLA protocol size criteria. RESULTS Lung nodules were found in 84 out of 360 (23%) children with WT. For 21 identified lung nodules, inter-observer limits of agreement (LOA) for the five readers were ±2.4 and ±1.4 mm (AP diameter), ±1.9 and ±1.8 mm (TS diameter) and ±2.0 and ±2.4 mm (LS diameter) at assessments 1 and 2. Intra-observer LOA across the three dimensions were ±1.5, ±2.2, ±3.5, ±3.1 and ±2.6 mm (readers 1-5). MCMC demonstrated that 17% of the patients with a 'true' nodule size of ≥3 mm will be scored as <3 mm, and 21% of the patients with a 'true' nodule size of <3 mm will be scored as being ≥3 mm. CONCLUSION A significant intra-inter observer variation was found when measuring lung nodules on CT for patients with WT. This may have significant implications on treatment stratification, and thereby outcome, when applying a threshold of ≥3 mm for a lung nodule to dictate metastatic status.
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Affiliation(s)
- Jesper Sune Brok
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Susan Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Frederikke Damsgaard
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Smets
- Department of Radiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Sabine Irtan
- Department of Visceral and Neonatal Paediatric Surgery, Sorbonne University, Armand Trousseau Hospital - APHP, Paris, France
| | | | - Venus Hedayati
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- Department of Respiratory Medicine, University College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Minou Oostveen
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Øystein Olsen
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
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Dávila Fajardo R, Pieters BR, Wilde JCH, Heij HA, Chrzan R, Tytgat G, Mavinkurve-Groothuis AMC, Smets A, Kroon PS, Van Damme A, van de Ven KP, de Krijger RR, Lilien MR, Wijnen MH, van den Heuvel-Eibrink MM, Janssens GO. A Role of brachytherapy in bilateral Wilms tumors: A long-term follow-up of three highly selected cases and literature review. Brachytherapy 2020; 20:478-484. [PMID: 33309284 DOI: 10.1016/j.brachy.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/18/2020] [Accepted: 09/01/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe experience with partial nephrectomy combined with brachytherapy as part of the local management of bilateral Wilms tumor (WT) including a review of the available literature. RESULTS (METHODS AND CASE DESCRIPTION) Between 2011 and 2014, three highly selected patients (age nine months, 16 months, and 4 years) with bilateral WT (two synchronous and one metachronous) underwent enucleation and perioperative brachytherapy to the tumor bed. With a minimum follow-up of 5 years, all three patients are in continuous complete remission with preserved kidney function. CONCLUSIONS Although nephron sparing surgery aiming at tumor free-margins remains the gold standard for bilateral WT, tumor enucleation followed by brachytherapy may be considered in carefully selected patients at high risk for end-stage kidney failure. Given the rarity and complexity of the procedure, concentration of care of such patients is mandatory.
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers (location Academic Medical Center), Amsterdam, The Netherlands
| | - Jim C H Wilde
- Division of Pediatric Surgery, Hôpitaux Universitaires de Genève, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland
| | - Hugo A Heij
- Department of Paediatric Surgery, Amsterdam University Medical Centers (location Academic Medical Center), Amsterdam, The Netherlands
| | - Rafal Chrzan
- Department of Pediatric Urology, Children's University Hospital Cracow, Jagiellonian University Medical College, Krakow, Poland
| | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Anne Smets
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location Academic Medical Center), Amsterdam, The Netherlands
| | - Petra S Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - An Van Damme
- Department of Pediatric Hematology and Oncology, University Hospital Saint-Luc, Brussels, Belgium
| | - Kees P van de Ven
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ronald R de Krijger
- Department of Pathology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc R Lilien
- Department of Pediatric Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc H Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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3
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Haveman LM, Ranft A, Vd Berg H, Smets A, Kruseova J, Ladenstein R, Brichard B, Paulussen M, Kuehne T, Juergens H, Klco-Brosius S, Dirksen U, Merks JHM. The relation of radiological tumor volume response to histological response and outcome in patients with localized Ewing Sarcoma. Cancer Med 2019; 8:1086-1094. [PMID: 30790456 PMCID: PMC6434194 DOI: 10.1002/cam4.2002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/19/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is the modality of choice for local staging and response evaluation of Ewing sarcoma (EwS). Aim of this study was to determine the relevance of tumor volume response (TVR) in relation to histological response (HisRes) and survival, in order to evaluate if early modification of chemotherapy might be indicated in patients with inadequate TVR. Methods Three dimensional (3D)‐tumor volume data at diagnosis, during early induction phase (1‐3 courses of chemotherapy; n = 195) and/or late induction phase (4‐6 courses; n = 175) from 241 localized patients were retrospectively analyzed. A distinction was made between adequate response (reduction ≥67%) and inadequate response (reduction <67% or progression). Correlations between TVR, HisRes, event free survival (EFS), and overall survival (OS) were analyzed using chi‐square tests, log‐rank tests, and the Cox‐regression model. Results Early adequate TVR, noted in 41% of patients, did not correlate with EFS (P = 0.92) or OS (P = 0.38). During late induction phase 62% of patients showed an adequate TVR. EFS for patients with late adequate TVR was better (78%) than for those with inadequate late TVR (61%) (P = 0.01); OS was 80% and 69% (P = 0.26), respectively. No correlation was found between TVR and HisRes. Multivariate analysis showed that poor HisRes, pelvic location and late inadequate TVR were associated with poor outcome. Conclusions Early inadequate TVR does not predict adverse outcome; therefore, changing the treatment to second line chemotherapy is not indicated in case of inadequate early TVR. Late adequate TVR and good HisRes correlate with better EFS; patients with late inadequate TVR might benefit from augmented therapy.
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Affiliation(s)
- Lianne M Haveman
- Emma Children's Hospital, Department of Pediatric Oncology, Academic Medical Center, Amsterdam, The Netherlands.,Prinses Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Andreas Ranft
- Department of Pediatric Hematology and Oncology, University of Essen, Essen, Germany.,Coordinating Center for Clinical Trials, Muenster, Germany
| | - Henk Vd Berg
- Emma Children's Hospital, Department of Pediatric Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Anne Smets
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jarmila Kruseova
- Department of Pediatric Oncology, University Hospital Motol, Prague, Czech Republic
| | | | - Benedicte Brichard
- Saint Luc University Hospital, Department of Pediatric Hematology and Oncology, University of Louvain, Datteln, Belgium
| | - Michael Paulussen
- Witten/Herdecke University, Vestische Kinder- und Jugendklinik, Datteln, Germany
| | - Thomas Kuehne
- Department of Pediatric Oncology and Haematology, University Children Hospital, Basel, Switzerland
| | - Heribert Juergens
- Coordinating Center for Clinical Trials, Muenster, Germany.,Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster, Germany
| | - Stephanie Klco-Brosius
- Department of Pediatric Hematology and Oncology, University of Essen, Essen, Germany.,Coordinating Center for Clinical Trials, Muenster, Germany
| | - Uta Dirksen
- Department of Pediatric Hematology and Oncology, University of Essen, Essen, Germany.,Coordinating Center for Clinical Trials, Muenster, Germany
| | - Johannes H M Merks
- Emma Children's Hospital, Department of Pediatric Oncology, Academic Medical Center, Amsterdam, The Netherlands
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Mothes A, Léotard S, Nicolle I, Smets A, Chirio D, Rotomondo C, Tiger F, Del Giudice P, Perrin C, Néri D, Foucault C, Della Guardia M, Hyvernat H, Roger PM. Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy. Med Mal Infect 2016; 46:365-371. [DOI: 10.1016/j.medmal.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/28/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
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5
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Kraal K, Blom T, Tytgat L, van Santen H, van Noesel M, Smets A, Bramer J, Caron H, Kremer L, van der Pal H. Neuroblastoma With Intraspinal Extension: Health Problems in Long-Term Survivors. Pediatr Blood Cancer 2016; 63:990-6. [PMID: 26890966 DOI: 10.1002/pbc.25925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 11/06/2022]
Abstract
AIM To evaluate the prevalence of health problems in 5-year survivors treated for neuroblastoma (NBL) with intraspinal extension. PATIENTS AND METHODS Retrospective, single center cohort study (using data from Childhood Cancer Registry and medical records) of patients treated for NBL with intraspinal extension (between 1980 and 2007) who survived ≥ 5 years after diagnosis. Health problems were graded according to the Common Terminology Criteria for Adverse Events (CTCAEv.3.0). RESULTS All eligible patients (n = 19) were included (n = 7 no neurological symptoms at diagnosis), median age at diagnosis was 1.2 years (0.6-10.8 years), and median follow-up time was 15.6 years (6.3-29.5 years). Ninety-five percent of survivors had ≥1 health problem and 48% of survivors had ≥4 health problem with a mean of 3.8 per survivor. Fifty-three percent of survivors had at least one severe (grade 3) or life-threatening/disabling (grade 4) health problem. The three most prevalent health problems were kyphosis and/or scoliosis (68% of patients), motor neuropathy (32% of patients), and sensory neuropathy (26% of patients). Of the 13 patients who underwent a laminectomy, 54% (seven of 13) developed a grade 3 and 23% (three of 13) developed a grade 4 health problem. Among six patients, without laminectomy, 17% developed (one of six) a grade 3 and in 17% developed (one of six) a grade 4 health problem. CONCLUSIONS Ninety-five percent of 5-year survivors treated for a childhood intraspinal NBL have health problems. The high prevalence of grade 3 and 4 health problems (especially in the laminectomy group) emphasizes the importance of specialized long-term multidisciplinary follow-up and identifies optimal treatment with limited morbidity and maximal efficacy.
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Affiliation(s)
- Kathelijne Kraal
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Thomas Blom
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands
| | - Lieve Tytgat
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Hanneke van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital (WKZ), Utrecht, the Netherlands
| | - Max van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Anne Smets
- Department of Radiology, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - Jos Bramer
- Department of Orthopedic Surgery, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - Huib Caron
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands
| | - Leontien Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands
| | - Heleen van der Pal
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre (EKZ/AMC), Amsterdam, the Netherlands.,Department of Medical Oncology, Academic Medical Centre (AMC), Amsterdam, the Netherlands
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6
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Vos A, Vries AMD, Smets A, Verbeke J, Heij H, van der Steeg A. The value of ultrasonography in boys with a non-palpable testis. J Pediatr Surg 2014; 49:1153-5. [PMID: 24952806 DOI: 10.1016/j.jpedsurg.2013.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND In patients with a non-palpable testis (NPT) on physical examination, the testis is assumed either to be situated intra-abdominally or to be hypoplastic or absent. Diagnostic laparoscopy in these boys is considered the preferable first step. In this study the diagnostic value of pre-operative ultrasound for NPT is assessed in comparison with laparoscopy. METHODS All boys aged under the age of 17 years who were diagnosed with an NPT by a pediatric surgeon from 2000 till 2012 were evaluated. All patients of whom clinical, ultrasonographic, and operative findings were available were included. RESULTS Ninety-six boys with 117 NPTs were included. With ultrasound 67 testes were detected in the inguinal canal, which was confirmed peroperatively for 61 testes. Of the 15 testes with an intra-abdominal position on ultrasound, 10 were found intra-abdominally during surgery. The positive predictive value of the ultrasonography is 91% for inguinally located testes and 67% for intra-abdominally located testes. CONCLUSION Ultrasonography has a high positive predictive value for inguinally located testes. When ultrasound locates a testis in an inguinal location, a primary inguinal exploration can be considered, preventing an unnecessary diagnostic laparoscopy.
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Affiliation(s)
- Alexander Vos
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Annebeth Meij-de Vries
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Anne Smets
- Academic Medical Center, Radiology department, Amsterdam, The Netherlands
| | - Jonathan Verbeke
- VU University Medical Center, Radiology Department, Amsterdam, The Netherlands
| | - Hugo Heij
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Alida van der Steeg
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands.
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7
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Affiliation(s)
- L Ollivier
- Département d'imagerie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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Abstract
PURPOSE Doppler pulsed flow and electronic scanning allow for instantaneous measurement of portal vein flow. This method was used to monitor alterations in splanchnic blood flow during exercise. METHODS Measurements of portal vein blood flow were performed in eight healthy males at rest and at 10-min intervals during cycle ergometry at 70% of maximal aerobic capacity. Subjects stopped cycling briefly (approximately 30 s) and stopped breathing while measurements were made. Flow was calculated from values obtained for velocity of red blood cell passage and cross-sectional area of the vessel. RESULTS Cross-sectional area decreased during exercise, resulting in a significant decrease in flow over time (P = 0.0001 by ANOVA). The flow within the portal vein had decreased by 80% after 60 min of exercise (absolute flow, 0.63 +/- 0.13 L x min(-1) at rest and 0.13 +/- 0.04 L x min(-1) at 60 min). CONCLUSION Electronic Doppler flow measurement of portal vein flow is a viable, noninvasive technique that can be used to measure splanchnic blood flow. Values obtained as a result of intensive exercise are in line with earlier results obtained with other techniques.
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Affiliation(s)
- N J Rehrer
- Department of Sports Medicine and Human Physiology, Academic Hospital, Free University of Brussels, Brussels, Belgium.
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Abstract
We report a 3-year, 5-month-old boy with an adrenocortical carcinoma. These tumours are rare and highly malignant in childhood. In most cases they are functional, secreting adrenocortical hormones. In this case there was a misleading coexistence with a second abdominal neoplasm, which was a ganglioneuroma; this is a rare benign tumour arising from the sympathetic nervous system. The imaging investigations and their findings are discussed and correlated with pathology.
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Affiliation(s)
- A Smets
- Department of Radiology, University Hospital Gent, 9000 Gent, Belgium
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Grootjans JJ, Zimmermann P, Reekmans G, Smets A, Degeest G, Dürr J, David G. Syntenin, a PDZ protein that binds syndecan cytoplasmic domains. Proc Natl Acad Sci U S A 1997; 94:13683-8. [PMID: 9391086 PMCID: PMC28366 DOI: 10.1073/pnas.94.25.13683] [Citation(s) in RCA: 337] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The syndecans are transmembrane proteoglycans that place structurally heterogeneous heparan sulfate chains at the cell surface and a highly conserved polypeptide in the cytoplasm. Their versatile heparan sulfate moieties support various processes of molecular recognition, signaling, and trafficking. Here we report the identification of a protein that binds to the cytoplasmic domains of the syndecans in yeast two-hybrid screens, surface plasmon resonance experiments, and ligand-overlay assays. This protein, syntenin, contains a tandem repeat of PDZ domains that reacts with the FYA C-terminal amino acid sequence of the syndecans. Recombinant enhanced green fluorescent protein (eGFP)-syntenin fusion proteins decorate the plasmamembrane and intracellular vesicles, where they colocalize and cosegregate with syndecans. Cells that overexpress eGFP-syntenin show numerous cell surface extensions, suggesting effects of syntenin on cytoskeleton-membrane organization. We propose that syntenin may function as an adaptor that couples syndecans to cytoskeletal proteins or cytosolic downstream signal-effectors.
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Affiliation(s)
- J J Grootjans
- Laboratory for Glycobiology and Developmental Genetics, Center for Human Genetics, University of Leuven, and Flanders Interuniversity Institute for Biotechnology, 3000 Leuven, Belgium
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Abstract
Langerhans cell histiocytosis (LCH) is an uncommon group of disorders affecting mainly children and young adults. In children, pulmonary involvement occurs mostly in the disseminated forms; isolated pulmonary lesions are unusual. A retrospective study was undertaken on a group of 42 children diagnosed with LCH over a 19-year period. Eight children (19 %) had radiological evidence of pulmonary involvement. The lung lesions were either present at the time of diagnosis or, when appearing during the course of the disease, always coinciding with exacerbation or recurrence of the disease in other sites. Lung involvement did not appear to be an unfavourable prognostic factor. However, the toxic effects of treatment on the lungs might lead to important pulmonary sequelae.
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Affiliation(s)
- A Smets
- Department of Radiology, University Hospital Gent, Gent, Belgium
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12
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Affiliation(s)
- M Van Winckel
- Department of Pediatrics, University Hospital Ghent, Belgium
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13
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Affiliation(s)
- E Robberecht
- Section of Pediatric Gastroenterology, University Hospital, Ghent, Belgium
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14
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Abstract
Idiopathic infantile arterial calcification (IIAC) is a rare hereditary, fatal disease. Death occurs usually within the first 28 months of life. IIAC is characterized by calcifications along the internal elastic membrane and proliferation of the intimal layer of muscular arteries. Specific therapy consists of administration of diphosphonates, but its effectiveness has been a matter of controversy. We report a case treated with diphosphonates which has had an unusual outcome.
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Affiliation(s)
- A Thiaville
- Department of Radiology, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
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15
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Abstract
Tracheal compression by the innominate artery is frequently suspected in infants with noisy breathing and no obvious aortic arch anomalies or pulmonary artery sling. However the diagnosis is difficult to confirm. The findings after using magnetic resonance imaging in two infants with tracheal compression syndrome are presented.
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Affiliation(s)
- F de Baets
- University Hospital, Department of Paediatrics, Ghent, Belgium
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Guermazi F, Lenoir P, Verboven M, Smets A, Braeckman J, Jonckheer MH, Piepsz A. [Technetium 99m labeled dimercaptosuccinic acid (99m Tc-DMSA) scintigraphy in the diagnosis and follow-up of urinary infections in children]. Arch Fr Pediatr 1993; 50:391-398. [PMID: 8239890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The site of a urinary tract infection (UTI) is located by clinical findings plus imaging techniques. Renal imaging with technetium 99mTc-dimercaptosuccinic acid (99mTc-DMSA) has shown promise but its efficacy for detecting acute pyelonephritis is still debated as is its ability to differentiate between acute, potentially curable disease and scarring, definitive changes. PATIENTS AND METHODS The files of all the 166 patients that underwent one or two (32 patients) 99mTc-DMSA imaging sessions for UTI in 1989 and 1990 in our department were analysed. The results of this technique were compared with the clinical and laboratory data and with those of other imaging techniques (ultrasonography and retrograde voiding cystourethrogram). The patients (92 girls and 74 boys, mean age: 5 years, range 15 days-17 years) were assigned to one of 3 categories: 1) acute pyelonephritis (27 patients), 2) low UTI (60 patients) and 3) uncertain UTI (79 patients), on the basis of the clinical and laboratory data. RESULTS The first 99mTc-DMSA imaging was normal in 110 children; changes were unilateral in 45 and bilateral in 11 children. Images suggesting either acute or chronic changes were observed respectively in 19 and 48 children. 4 of the 7 acute changes were normalized on the second radioisotope scanning while 2 became worse; 19 of the 23 chronic changes were unchanged at the second scanning. Radioisotope scanning changes were seen in 81% of the patients classified as acute pyelonephritis and in only 27% of those with lower UTI. Reflux was detected in 56% of abnormal kidneys and in 36% of normal kidneys. The results of radioisotope scanning and ultrasound scan findings were not correlated in 24 patients (19 only abnormal radioisotope imaging, 5 only abnormal ultrasound scan). CONCLUSIONS DMSA scans are useful for investigating and following UTI. They help to distinguish acute pyelonephritis and lower UTI. It is a reliable method of detecting structural abnormalities and identifying children at risk of progressive renal damage.
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Affiliation(s)
- F Guermazi
- Service de Médecine Nucléaire, Institut Salah Azaïez Bab Saadoun, Tunis, Tunisie
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