A Rare Case of "Periportal Cuffing" as an Incidental Finding on 18F-FDG PET/CT

A 7-year-old boy with known diagnosis of hereditary spherocytosis and ulcerative colitis was referred for 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography after detection of a 28 mm lesion suspicious for malignancy in spleen on upper abdomen magnetic resonance imaging (MRI). As an incidental finding, a moderately increased uptake of 18F-FDG was observed in periportal region with no definable mass. MRI revealed compatible findings with "periportal cuffing" as described on ultrasonography.

Clinic Heterogeneity and Management of Pediatric Patients With Germline RET Proto-oncogene Mutation: Single-center Experience

Inherited forms of medullary thyroid carcinoma (MTC) can cause serious problems in diagnosis and follow-up. Family screening is performed, and prophylactic thyroidectomy at an appropriate age can be life-saving. This study aimed to investigate the diagnostic, clinical, laboratory characteristics, and treatment methods of cases with rearranged during transfection ( RET) mutation in the childhood age group. Patients diagnosed with hereditary MTC and patients who were evaluated by detecting MTC and/or RET mutations in their families were included in this study. Nine cases from 6 families were included in the study. Seven patients were evaluated as a result of screening, whereas 2 patients, one of whom was MEN2B, were symptomatic. Prophylactic thyroidectomy was performed in 7 cases. Medullary microcarcinoma was found in all, and additional papillary thyroid carcinoma in one. An inoperable tumor was detected in one patient, and sorafenib treatment was applied. A very heterogeneous clinical presentation can be seen in a group of pediatric patients with RET mutation. In rare RET mutations, the genotype-phenotype relationship is still unclear, and different clinical pictures can be seen. Although prophylactic thyroidectomy is life-saving, it can cause iatrogenic hypothyroidism and hypoparathyroidism. Concomitant papillary microcarcinomas may occur in very young children with germline RET mutation.

Chylothorax due to thrombosis of the jugular and subclavian veins in a patient with gastric cancer: a case report

BACKGROUND

Chylothorax is a rare condition due to leakage of chyle in the thoracic cavity. When large amounts of chyle leak into the thoracic cavity, it can lead to severe respiratory, immune, and metabolic complications. Chylothorax has many potential underlying etiologies, and the most common causes are traumatic chylothorax and lymphoma. Venous thrombosis of the upper extremities is a rare cause of a chylothorax.

CASE PRESENTATION

A 62-year-old Dutch man with a medical history of gastric cancer, treated with neoadjuvant chemotherapy and surgery 13 months prior, presented with dyspnea and a swollen left arm. Computed tomography thorax showed bilateral pleural effusion that was more prominent on the left side. The computed tomography scan further revealed thrombosis of the left jugular and subclavian veins and osseal masses suggesting cancer metastasis. Thoracentesis was performed to confirm the suspicion of gastric cancer metastasis. The obtained fluid was milky with a high level of triglycerides, but contained no malignant cells; hence, the diagnosis of the pleural effusion was chylothorax. Treatment with anticoagulation and a medium-chain-triglycerides diet was started. Furthermore, bone metastasis was confirmed with a bone biopsy.

CONCLUSION

Our case report demonstrates chylothorax as a rare cause of dyspnea in a patient with pleural effusion and a history of cancer. Therefore, this diagnosis should be considered in all patients with a history of cancer with new-onset pleural effusion and thrombosis of the upper extremities or clavicular/mediastinal lymphadenopathy.

AB1498 THE BIOPSYCHOSOCIAL-BASED EXERCISE MODEL VIA TELEREHABILITATION IN PATIENTS WITH INFLAMMATORY AND NON-INFLAMMATORY RHEUMATIC DISEASES: A PROSPECTIVE COHORT STUDY DURING THE COVID-19 PANDEMIC

Background

During the COVID-19 pandemic, the patients with rheumatic disease in the biopsychosocial perspective have been adversely affected by social isolation, uncertainty, and the thought that their chronic disease will worsen and increase in their symptoms. ACR/EULAR (American College of Rheumatology / European League Against Rheumatism) defines recommendations about continuing current pharmacotherapy and the significance of the biopsychosocial approach and exercise for patients with rheumatic diseases during a COVID-19 infection 1, 2.

Objectives

This study aims to investigate the effectiveness of the biopsychosocial exercise performed by telerehabilitation on biopsychosocial status, general health status, and anxiety-depression levels in the patients with inflammatory and non-inflammatory rheumatic diseases.

Methods

Fourteen patients with inflammatory rheumatic diseases (rheumatoid arthritis: 4; ankylosing spondylitis: 4; sjogren’s syndrome: 3; polymyalgia rheumatica: 2; and vasculitis: 1) and eight patients with non-inflammatory rheumatic diseases (fibromyalgia: 6; and osteoarthritis: 2) performed a biopsychosocial-based exercise model (named as “Bilişsel Egzersiz Terapi Yaklaşimi”-(BETY) in original; “Cognitive Exercise Therapy Approach” in English) via telerehabilitation continued for three sessions per week for 12 months 3. Outcome measures were Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), and BETY-Biopsychosocial Questionnaire (BETY-BQ) 4. All outcomes were measured baseline and at the 12th month. The Wilcoxon’s test was used for statistical analysis.

Results

All of the 22 patients were female. The mean age was 57.4 and 55.8 years in the inflammatory and non-inflammatory rheumatic diseases groups respectively, and they had a mean BMI of 25.9 and 25.3 kg/m2. There was no significant difference by time for HAQ score (p = 0.125), HADS anxiety and depression (p = 0.916 and p = 0.663, respectively), and BETY-BQ score (p = 0.753) between the baseline and at the 12th month follow-up in the patients with inflammatory rheumatic diseases. Similarly, in the patients with non-inflammatory rheumatic diseases, there was no significant difference by time for HAQ score (p = 0.546), HADS anxiety and depression (p = 0.343 and p = 0.527, respectively), and BETY-BQ score (p = 0.068) between the baseline and at the 12th month follow-up.

Conclusion

This study showed that biopsychosocial-based exercise through real-time telerehabilitation was able to maintain their conditions before pandemic in biopsychosocial status, general health, and anxiety-depression levels on the patients with inflammatory and non-inflammatory rheumatic diseases during COVID-19 pandemic period in one-year follow-up.

References

[1]England BR, Barber CE, Bergman M, Ranganath VK, Suter LG, Michaud K. Brief Report: adaptation of American College of Rheumatology Rheumatoid Arthritis Disease Activity and functional status measures for telehealth visits. Arthritis Care Res (Hoboken). 2020.

[2]Landewé RB, Machado PM, Kroon F, Bijlsma HW, Burmester GR, Carmona L, Combe B, Galli M, Gossec L, Iagnocco A. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020;79(7):851-8.

[3]Kisacik P, Unal E, Akman U, Yapali G, Karabulut E, Akdogan A. Investigating the effects of a multidimensional exercise program on symptoms and antiinflammatory status in female patients with ankylosing spondylitis. Complementary therapies in clinical practice. 2016;22:38-43.

[4]Edibe Ü, Gamze A, KARACA NB, KİRAZ S, AKDOĞAN A, KALYONCU U, ERTENLİ Aİ, BİLGEN ŞA, KARADAĞ Ö, ERDEN A. Romatizmali hastalar için bir yaşam kalitesi ölçeğinin geliştirilmesi: madde havuzunun oluşturulmasi. Journal of Exercise Therapy and Rehabilitation. 2017;4(2):67-75.

Disclosure of Interests

None declared

The role of galactomannan test results in the diagnosis of pediatric invasive aspergillosis

BACKGROUND

Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunosuppressed children. Early detection of the infection can improve prognosis in this patient population.

OBJECTIVES

To investigate the utility of Aspergillus galactomannan antigen assay (GM-EIA) as a diagnostic tool for IA in at-risk paediatric patients.

PATIENTS/METHODS

For the study, 659 GM-EIA results from 59 patients diagnosed with IA and 3368 GM-EIA results from 351 subjects without evidence for IA (controls) were reviewed retrospectively. Three cut-off values (i.e. ≥0.5, ≥1, ≥1.5) were specified to determine GM-EIA positivity.

RESULTS

The median age was 6.3 years for boys and 14.5 years for girls. There was a significant difference between the girls and boys in terms of age (p < 0.01). For proven/probable/possible IA patients, sensitivity of 67.8% and specificity of 59.8% were detected when the ≥0.5 cut-off value was used for GM-EIA-positivity. The specificity increased to 80% at the cut-off of ≥1 and to 88% at the cut-off of ≥1.5. False positivity rates were 9.14, 3, and 1.45% at the ≥0.5, ≥1 and ≥1.5 cut-offs respectively. In the proven/probable IA group, sensitivity and negative predictive values were 86.9 and 97.2% at the ≥0.5 cut-off, 85.7 and 97.9%, at the ≥1 cut-off and 84.2 and 98.1% at ≥1.5 cut-off respectively. The positive likelihood ratio was 7.57 and the odds ratio was 42.67 at ≥1.5 cut-off.

CONCLUSION

The GM-EIA may be used for both screening and diagnostic purposes in paediatric patients using a cut-off value of ≥1.5 for GM-EIA positivity.

POS1071 DETERMINATION OF THE RELIABILITY AND VALIDITY OF THE BETY-BIOPSYCHOSOCIAL QUESTIONNAIRE IN PATIENTS WITH A DIAGNOSIS OF PSORIATIC ARTHRITIS

Background:

In the literature, there is a lack of questionnaires, which is evaluate patients with psoriatic arthritis (PsA) from a biopsychosocial perspective.

Objectives:

This study was planned to examine the reliability and validity of the BETY- Biopsychosocial Questionnaire (BQ) in individuals diagnosed with PsA.

Methods:

Test-retest method was used to examine the reliability of the BETY-BQ. In comparing the reliability of test-retest results, intraclass coefficient (ICC) was checked. For the internal consistency analysis of the BETY-BQ, the total score of the responses given to the first filled scale was calculated and the Cronbach’s Alpha coefficient was found. Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL), Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS) and Short Form-36 (SF-36) were used in the validity study of 150 individuals with PsA included in the study.

Results:

Test-retest method and intraclass coefficient were examined for reliability analysis (for 30 patients). The correlation (r = 0.844, p <0.001) of the answers given to the BETY-BQ by individuals with 30 PsA after one week interval was very high. While the ICC coefficient (0.915, p <0.001) showed excellent reliability. The Cronbach’s Alpha coefficient (0.940) was examined for internal consistency and the internal consistency of the scale was also found to be excellent. As a result of statistical analysis, the correlation between the scales used and the BETY-BQ was found between r = -0.432 and 0.807 (p <0.001).

Conclusion:

With this study, it was concluded that the BETY-BQ is a reliable and valid assessment tool in individuals diagnosed with PsA, and is also a biopsychosocial tool that can be used to evaluate individuals with PsA.

References:

[1]Unal E, Arin G, Karaca Nb, Kiraz S, Akdoğan A, Kalyoncu U, et al. Romatizmali hastalar için bir yaşam kalitesi ölceginin gelistirilmesi: madde havuzunun olussturulmasi. Journal of Exercise Theraphy and Rehabilitation. 2017;4(2):67-75.

[2]Husni ME, Merola JF, Davin S. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum. 2017;47(3):351-60

Disclosure of Interests:

None declared.

Secondary intra-arterial chemotherapy and/or intravitreal chemotherapy as salvage treatment for retinoblastoma

PURPOSE

To evaluate the results of secondary intra-arterial chemotherapy (IAC) and/or intravitreal chemotherapy (IVC) as a salvage treatment for retinoblastoma (RB).

MATERIALS AND METHODS

The medical records of 31 (20 male, 11 female) cases (with 38 eyes) who underwent secondary IAC and/or IVC between February 2010 and June 2019 were retrospectively reviewed.

RESULTS

Thirteen (41.9%) cases had unilateral and 18 (58.1%) had bilateral RB. According to the International Classification of RB, 6 (15.8%) eyes had group B, 9 (23.7%) eyes had group C, 16 (42.1%) eyes had group D, and 7 (18.4%) eyes had group E RB at diagnosis. All patients underwent six-cycle intravenous chemotherapy as primary treatment and 8 eyes received external radiotherapy before IAC/IVC. Secondary IAC was performed in 21 (55.3%) eyes, IVC in 10 (26.3%) eyes, and IAC + IVC in 7 (18.4%) eyes. External radiotherapy was applied in 2 (5.3%) eyes after IAC/IVC, one of which was later enucleated. In total, 17 (44.7%) eyes undergoing secondary IAC/IVC treatments were enucleated. Metastasis and death were not observed in any case during the mean follow-up period of 59.3 (median 61, range: 10-98) months.

DISCUSSION

Although 60.5% of the eyes undergoing IAC/IVC consisted of groups D and E RB, globe salvage and survival rates were 55.3% and 100.0%, respectively. External radiotherapy was required in 5.3% of the eyes after IAC/IVC. In conclusion, IAC and IVC are safe and effective treatment methods in eyes with RB unresponsive to other eye-preserving treatments and those demonstrating recurrence.

Is antibiotic lock therapy effective for the implantable longterm catheter-related bloodstream infections in children?

Tural Kara T, Özdemir H, Erat T, Yahşi A, Aysev AD, Taçyıldız N, Ünal E, İleri T, İnce E, Haskoloğlu Ş, Çiftçi E, İnce E. Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream infections in children? Turk J Pediatr 2019; 61: 895-904. Catheter-related bloodstream infections (CRBSIs) are an important problem in pediatric patients with central venous catheters. This study aimed to determine the incidence of CRBSIs, responsible pathogens and outcomes of antibiotic lock treatment (ALT) in pediatric patients. Between January 2010 and November 2015 all hospitalized pediatric hematology, oncology and immunology patients diagnosed with CRBSIs were retrospectively analyzed. Seventy-eight CRBSI episodes were detected in 60 pediatric patients. The incidence of CRBSIs was 4.20/1000 catheter days. The most frequently detected pathogen was methicillin-resistant coagulase-negative Staphylococcus. Pseudomonas aeruginosa, Klebsiella spp., and Escherichia coli were other commonly isolated microorganisms. ALT was administered in 42 patients. The success rate of ALT was 81% (34/42). Catheter was removed without ALT in 36 episodes. Common reasons for catheter removal were sepsis and causative microorganisms which had high probability of biofilm formation. CRBSIs are an important cause of morbidity and mortality in pediatric patients. ALT is safe and effective. It is possible to obtain satisfactory results when ALT is used with intravenous systemic antibiotics for CRBSIs, though in some cases catheter removal is necessary. ALT helps to prevent unnecessary catheter removal in pediatric patients.

FRI0619-HPR INVESTIGATION OF THE RELATIONSHIP BETWEEN BIOPSYCHOSOCIAL STATUS AND QUALITY OF LIFE, EMOTION - STATUS AND FUNCTIONALITY IN INDIVIDUALS WITH PSORIATIC ARTHRITIS

Background:

Due to the chronic processes of rheumatological diseases, patients’ biopsychosocial effects are revealed.

Objectives:

The aim of this study is to evaluate the biopsychosocial status of individuals diagnosed with psoriatic arthritis; to examine the relationship between quality of life, emotion - status and functionality.

Methods:

105 individuals were included in the study. To evaluate the biopsychosocial situation, BETY-BQ (Bilişsel Egzersiz Terapi Yaklaşimi – Biopsychosocial Questionnaire)(1); Psoriatic Arthritis Quality of Life (PsAQoL) Scale to assess quality of life; For the emotion-status assessment; Hospital Anxiety and Depression Scale (HADS-A, HADS-D); Health Assessment Questionnaire (HAQ) was used for functionality. Pearson Correlation Analysis was used in statistical analysis.

Results:

Descriptive data of the individuals participating in the study were recorded (Table 1).While BETY-BQ was highly correlated with PSAQoL Scale(r = 0.826, p <0.001), moderate correlations were found with HADS-A and HADS-D (HADS-A (r = 0.618, p <0.001), HADS-D (r = 0.507, p <0.001)). Low correlation was found between BETY-BQ and HAQ (r = 286, p = 0.003) (Table 2).

Table 1.

Descriptive Statistics

MinimumMaximumMeanStandart DeviationAge (years)206044.9811.04Height (cm)145.00190.00165.618.88Weight (kg)4413875.5417.36VKI(kg/m2)17.8549.0027.546.02Table 2.PsAQoLHADS-AHADS-DHAQBETY-BQr 0.826**p<0.001r=0.618**p<0.001r=0.507**p<0.001r=286**p=0.003

** Correlation is significant at the 0.01 level (2-tailed)

Conclusion:

In this study, it was found that BETY-BQ is a scale that can be used in total to evaluate the quality of life, emotion-status level and functionality of individuals diagnosed with PsA. It was thought that BETY-BQ could be considered and preferred by clinicians when individuals with PsA should be evaluated from a biopsychosocial point of view.

References:

[1] Unal E, Arin G, Karaca Nb, Kiraz S, Akdogan A, Kalyoncu U, et al. Development of a quality of life measurement for rheumatic patients: item pool construction Journal of Exercise Therapy and Rehabilitation. 2017; 4 (2): 67-75.

Disclosure of Interests:

Senem Bulut: None declared, Edibe Ünal: None declared, Aykut Özçadirci: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

AB0857 A NEW BIOPSYCHOSOCIAL QUESTIONNAIRE FOR PATIENTS WITH KNEE OSTEOARTHRITIS

Background:

OA is a problem that cartilage damage occurs, which leads to stiffness in the joint, pain and functional limitations (1). This problem can also cause psychosocial impact like other chronic diseases (2). As with other rheumatic diseases, this complex picture of inflammation required biopsychosocial approaches and measurement methods for knee OA.

Objectives:

This study was planned to investigate the validity and reliability of a new biopsychosocial questionnaire which is named Cognitive Exercise Therapy Approach Biopsychosocial Questionnaire (BETY-BQ) in individuals with knee osteoarthritis (OA).

Methods:

The study included 150 individuals who diagnosed knee osteoarthritis at stage 1 or 2 according to the Kellgren-Lawrence scale. For determining daily living activities; Health Assessment Questionnaire (HAQ), for quality of life Short Form-36 (SF-36) Quality of Life Scale, for anxiety and depression levels; Hospital Anxiety and Depression Scale (HADS), for severity of disease Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and for biopsychosocial evaluation BETY-BQ were used.

Results:

The correlation between BETY-BQ and other scales was examined by Spearman correlation analysis (r=-0.252, 0.633, p<0,05). Cronbach’s alpha coefficient and item-total correlation were used as reliability methods. Cronbach’s alpha coefficient was examined for the internal consistency of the scale and was found to be 0.887 for the first evaluation, 0.917 for measurements after 1 week and 0.843 for measurements after 3 months. Item total correlation, which was another indicator of reliability, ranged from 0.632 to 0.854 (p<0.05).

Table 1.

Correlation coefficients between all questionnaires and Cognitive Exercise Therapy Approach Biopsychosocial Questionnaire (BETY-BQ).

Spearman Correlation AnalysisCognitive Exercise Therapy Approach Biopsychosocial Questionnaire (BETY-BQ)rpWOMAC-Pain0,473<0,001WOMAC-Stiffness0,458<0,001WOMAC-Physical Function0,514<0,001WOMAC-Total Score0,553<0,001hospital anxiety and depression scale- anxiety0,615<0,001hospital anxiety and depression scale-depression0,2520,002*Health Assessment Questionnaire0,633<0,001Short Form-36 Role limitations due to physical health-0,440<0,001Short Form-36 Role limitations due to emotional problems-0,357<0,001Short Form-36 Physical functioning-0,469<0,001Short Form-36 Social functioning-0,355<0,001Short Form-36 Pain-0,487<0,001Short Form-36 General Health-0,513<0,001Short Form-36 Emotional well-being-0,508<0,001Short Form-36 Energy/fatigue-0,453<0,001

Conclusion:

As a result of our study, it was concluded that BETY-BQ is a valid and reliable biopsychosocial questionnaire in individuals with knee OA diagnosis. This result showed that BETY-BQ can be used in clinics to evaluate biopsychosocial involvement in patients with knee OA.

References:

[1]Hunter DJ, Felson DT. Clinical review: osteoarthritis. British Medical Journal [periódico online]. 2006:639-42

[2]Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, et al. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clinical rheumatology. 2010;29(11):1277-83.

Disclosure of Interests:

None declared

A 20-year audit of retinoblastoma treatment outcomes

Objectives

To evaluate the long-term treatment outcomes in intraocular retinoblastoma (RB) including the associated factors for eventual treatment with external beam radiotherapy (EBRT) and enucleation as well as to analyse the risk factors for metastasis and death in extraocular RB.

Methods

Retrospective analysis of 390 eyes from 256 (89.8%) intraocular RB and 29 (10.2%) extraocular RB cases diagnosed and treated between October 1998 and May 2018 at one of the largest tertiary care centers in Turkey.

Results

Of 351 intraocular RB eyes, 53.3% had group D/E disease at presentation. 75 (21.4%) of 351 eyes underwent primary enucleation. Of the remaining 276 eyes undergoing eye-conserving treatments, 201 (72.8%) were salvaged. Most of these eyes were treated using intravenous chemotherapy and/or focal treatments [transpupillary thermotherapy (TTT) and cryotherapy] initially. EBRT was eventually required in 48 (17.4%) eyes and secondary enucleation in 75 (27.2%) eyes. At mean follow-ups of 76.7 and 39.7 months for intraocular and extraocular RB cohorts, respectively, 180 (46.2%) eyes underwent primary/secondary enucleation and exenteration. Overall, 13 cases developed metastasis and 9 died. Two patients with trilateral RB also expired. Multivariable risk factors for enucleation were the presence of vitreous seeds (p < 0.001), absence of EBRT administration (p = 0.033), 5–9 TTT applications compared with no TTT (p = 0.031), and each 1 mm increase in tumour base diameter (p < 0.001). Univariate factors predictive of metastasis were the presence of extraocular RB detected by imaging methods (p < 0.001) and extrascleral/optic nerve cut end involvement at histopathological examination (p < 0.001).

Conclusions

In our series, 72.8% of the intraocular RB eyes undergoing eye-conserving treatments were saved. The globe salvage rate for all intraocular and extraocular RB eyes was 53.8% and the overall survival rate was 96.1%.

Muramyl Tripeptide Plus Chemotherapy Reduces Metastasis in Non-Metastatic Osteosarcoma: A Single-Center Experience

BACKGROUND

The immunomodulator mifamurtide plus a chemotherapy regimen has been shown to significantly improve the outcome in non-metastatic osteosarcoma patients. We report the results of the addition of mifamurtide to chemotherapy in newly diagnosed patients with osteosarcoma.

METHODS

A total of 36 children with osteosarcoma without detectable metastasis were treated between November 2010 and April 2018 at the Ankara University Department of Pediatric Oncology. Mifamurtide was added to the chemotherapy regimen in 17 patients while the remaining 19 did not receive mifamurtide. The probabilities of metastasis and overall survival were compared between the groups.

RESULTS

The 43-month survival rate was 87.5% and 89.9% in the patients who received and did not receive mifamurtide, respectively (p=0.65). Common side effects of mifamurtide were chills and fever. The addition of mifamurtide in the high-risk group with ≤95% necrosis tended to decrease the probability of distant metastasis (36.4% vs. 58.3%) (p=0.39). The time to metastasis in the group with positive surgical margins (4 months in one patient in the non-mifamurtide group, 7 and 20 months in the mifamurtide group) was also longer in the mifamurtide group. During the 43-month follow up period, median time to metastasis was longer in the mifamurtide group (20 vs. 5 months). In addition, mifamurtide plus chemotherapy decreased the risk of metastasis in the cases with primary site relapse.

CONCLUSIONS

The addition of mifamurtide to chemotherapy might improve event-free survival by decreasing the probability of distant metastasis in bad histologic responders, and also by increasing the time to distant metastasis in the surgical margin positive group. Additional clinical studies are necessary to determine the long-term effects of mifamurtide on metastatic disease.
.

A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed pediatric Hodgkin lymphoma patients before and after stem cell transplantation

Taçyıldız N, Tanyıldız HG, Ünal E, Dinçaslan H, Asarcıklı F, Adaklı Aksoy B, Vatansever G, Yavuz G. A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed pediatric Hodgkin lymphoma patients before and after stem cell transplantation. Turk J Pediatr 2019; 61: 671-676. Hodgkin`s lymphoma (HL) is highly curable disease in its early stages, but in advanced stages, it presents a dilemma when it becomes refractory or relapses after several rounds of chemotherapy. Brentuximab vedotin (BV) is an antibody-drug conjugate that targets the tumor necrosis receptor family protein member CD30 positive malignancies via an anti-CD30 monoclonal antibody linked to monomethyl auristatin-E. In adult and pediatric studies, it has been shown to be an effective salvage therapy for primary refractory HL or relapse after autologous stem cell transplant (ASCT). Between July 2012 and August 2017, we administered BV (1.8 mg/m2 every three weeks; 12 cycles totally) with doxorubucin, vinblastin, dacarbazine (AVD), rituximab + ifosfamide + carboplatin + etoposide (RICE), or bendamustine combination treatment in pediatric HL patients, who were previosuly treated for refractory or relapsed advanced stage HL before (seven patients) or after (one patient) ASCT in our center. After eight BV courses, one patient was able to undergo match unrelated donor (MUD) SCT. Another seven pediatric HL patients, who were not able to go into remission with any other classical HL chemotherapy protocols, received 4-6 courses of BV-AVD and/or RICE/bendamustine. All were able to undergo ASCT after negative positron emission tomography (PET) imaging results. After ASCT, we switched to BV as consolidation therapy until a total of 12 cycles was completed. Patients went into remission after a median 34 (range: 12-42) months from the start of BV treatment. BV is an encouraging, well- tolerated, and effective targeted therapy especially when combined with AVD or when alternated with another targeted therapy combination, including RICE, when needed.

Bloodstream infections in pediatric hematology/oncology patients: Six years’ experience of a single center in Turkey

Background/aim

Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalization, and mortality in pediatric patients. Identifying the predominant microorganisms and antimicrobial susceptibilities in centers helps to select effective empirical antimicrobials which leads to positive clinical outcomes. We aimed to identify the causative microorganisms and their antimicrobial susceptibilities in patients with bloodstream infections.

Materials and methods

Data belonging to patients with hematological and/or oncological diseases admitted to our hospital with fever between January 2010 and November 2015 were analyzed.

Results

In total, 71 patients who had 111 bloodstream infection episodes were included. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria, and 4.4% fungi. The most common causative gram-negative pathogen was Escherichia coli and the most commonly isolated gram-positive microorganism was coagulase-negative staphylococci.

Conclusion

Gram-negative microorganisms were predominant pathogens in bloodstream infections. Escherichia coli and coagulase-negative staphylococci were the most commonly isolated responsible pathogens. Beta-lactam/lactamase inhibitors were suitable for empirical treatment. However, in critical cases, colistin could have been used for empirical treatment until the culture results were available. Routine glycopeptide use was not required. By identifying the causative microorganisms and their antimicrobial resistance patterns, it will be possible to obtain positive clinical results.

Genotype-phenotype correlation, gonadal malignancy risk, gender preference, and testosterone/dihydrotestosterone ratio in steroid 5-alpha-reductase type 2 deficiency: a multicenter study from Turkey

BACKGROUND

Studies regarding genetic and clinical characteristics, gender preference, and gonadal malignancy rates for steroid 5-alpha-reductase type 2 deficiency (5α-RD2) are limited and they were conducted on small number of patients.

OBJECTIVE

To present genotype-phenotype correlation, gonadal malignancy risk, gender preference, and diagnostic sensitivity of serum testosterone/dihydrotestosterone (T/DHT) ratio in patients with 5α-RD2.

MATERIALS AND METHODS

Patients with variations in the SRD5A2 gene were included in the study. Demographic characteristics, phenotype, gender assignment, hormonal tests, molecular genetic data, and presence of gonadal malignancy were evaluated.

RESULTS

A total of 85 patients were included in the study. Abnormality of the external genitalia was the most dominant phenotype (92.9%). Gender assignment was male in 58.8% and female in 29.4% of the patients, while it was uncertain for 11.8%. Fourteen patients underwent bilateral gonadectomy, and no gonadal malignancy was detected. The most frequent pathogenic variants were p.Ala65Pro (30.6%), p.Leu55Gln (16.5%), and p.Gly196Ser (15.3%). The p.Ala65Pro and p.Leu55Gln showed more undervirilization than the p.Gly196Ser. The diagnostic sensitivity of stimulated T/DHT ratio was higher than baseline serum T/DHT ratio, even in pubertal patients. The cut-off values yielding the best sensitivity for stimulated T/DHT ratio were ≥ 8.5 for minipuberty, ≥ 10 for prepuberty, and ≥ 17 for puberty.

CONCLUSION

There is no significant genotype-phenotype correlation in 5α-RD2. Gonadal malignancy risk seems to be low. If genetic analysis is not available at the time of diagnosis, stimulated T/DHT ratio can be useful, especially if different cut-off values are utilized in accordance with the pubertal status.

An unusual case of neuroblastoma: a 17-year-old adolescent presented with bilateral diffuse lung metastasis at initial diagnosis

Neuroblastoma (NB) is the most frequently diagnosed neoplasm during infancy and its incidence declines within the first 3-5 years of life. It can be rarely diagnosed in adolescents and young adults. Adolescents have advanced stage of disease, higher frequency of uncommon metastatic sites such as lungs, and worse outcomes. Herein, we describe an unusual case of NB in a 17-year-old adolescent presented with lung metastasis at diagnosis. The patient was diagnosed with stage IV NB. Thorax high-resolution computed tomography (HRCT) scan revealed irregular septal thickening with ground glass opacity consistent with pulmonary parenchymal metastases. After the first cycle of chemotherapy he developed pulmonary hemorrhage and respiratory distress. He required ventilation support and mechanical ventilation was started. Metastatic nodules were determined on second thorax HRCT. We lost the patient due to septic shock and multiple organ failure 2 months after diagnosis. In conclusion, adolescents with NB have unfavorable prognosis. These patients may have lung metastases at diagnosis. Therefore, detailed chest imaging at initial diagnosis is crucial.

Prognostic Factors and a New Prognostic Index Model for Children and Adolescents with Hodgkin's Lymphoma Who Underwent Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Study of the Turkish Pediatric Bone Marrow Transplantation Study Group

Objective:

The prognostic factors and a new childhood prognostic index after autologous hematopoietic stem cell transplantation (AHSCT) in patients with relapsed/refractory Hodgkin’s lymphoma (HL) were evaluated.

Materials and Methods:

The prognostic factors of 61 patients who underwent AHSCT between January 1990 and December 2014 were evaluated. In addition, the Age-Adjusted International Prognostic Index and the Childhood International Prognostic Index (CIPI) were evaluated for their impact on prognosis.

Results:

The median age of the 61 patients was 14.8 years (minimum-maximum: 5-20 years) at the time of AHSCT. There were single relapses in 28 patients, ≥2 relapses in eight patients, and refractory disease in 25 patients. The chemosensitivity/chemorefractory ratio was 36/25. No pretransplant radiotherapy, no remission at the time of transplantation, posttransplant white blood cell count over 10x10³/µL, posttransplant positron emission tomography positivity at day 100, and serum albumin of <2.5 g/dL at diagnosis were correlated with progression-free survival. No remission at the time of transplantation, bone marrow positivity at diagnosis, and relapse after AHSCT were significant parameters for overall survival.

Conclusion:

The major factors affecting the progression-free and overall survival were clearly demonstrated. A CIPI that uses a lactate dehydrogenase level of 500 IU/L worked well for estimating the prognosis. We recommend AHSCT at first complete remission for relapsed cases, and it should also be taken into consideration for patients with high prognostic scores at diagnosis.

Secondary Neoplasms in Children with Hodgkin's Lymphoma Receiving C-MOPP and Radiotherapy: Presentation of Four Cases

Patients who survive Hodgkin lymphoma (HL) are at increased risk of secondary neoplasms (SNs). A wide variety of SNs have been reported, including leukemias, non-Hodgkin's lymphomas, and solid tumors, specifically breast and thyroid cancers. Herein we report subsequent neoplasms in four patients with HL receiving chemoradiotherapy. It is interesting that three SNs, fibrosarcoma, thyroid carcinoma, and retrobulbar meningioma, were observed in the radiation area in one of our patients. A hypopharyngeal epithelioid malignant peripheral nerve sheath tumor as an unusual secondary malignant neoplasm developed in another patient, while a benign thyroid nodule and invasive ductal breast carcinoma were observed at different times in the female patient. Follicular adenoma of the thyroid gland developed in one of our patients.

Chemotherapy in Retinoblastoma: Current Approaches

Retinoblastoma (RB) is the most common childhood malignant intraocular tumor. Although enucleation and external beam radiotherapy have been historically used, today the most commonly used eye-sparing approach is chemotherapy. Chemotherapy can be used in both intraocular and extraocular RB cases. Chemotherapeutic agents may be applied in different ways, including systemic, subconjunctival, intra-arterial and intravitreal routes. The main purposes of application of systemic therapy are to reduce the tumor size for local treatment (chemoreduction), or to reduce the risk of metastasis after enucleation surgery (adjuvant therapy). Intra-arterial chemotherapy with the current name “super-selective intra-arterial infusion therapy” could be applied as primary therapy in tumors confined to the retina or as a secondary method in tumor recurrence. The most important advantage of intra-arterial therapy is the prevention of systemic chemotherapy complications. Intravitreal chemotherapy is administered in the presence of persistent or recurrent vitreous seeding. The term “extraocular RB” includes orbital invasion and metastatic disease. Current treatment for orbital invasion is neoadjuvant chemotherapy followed by surgical enucleation and adjuvant chemotherapy and radiotherapy after surgery. In metastatic disease, regional lymph node involvement, distant metastases, and/or central nervous system (CNS) involvement may occur. Among them, CNS involvement has the worst prognosis, remaining at almost 100% mortality. In metastatic disease, high-dose salvage chemotherapy and autologous hematopoietic stem cell rescue therapy are the possible treatment options; radiotherapy could also be added to the protocol according to the side of involvement.

Retinoblastoma in Turkey: results from a tertiary care center in Ankara

PURPOSE

To evaluate the presentation patterns and results of management of retinoblastoma at a tertiary care center in Ankara, Turkey, with special emphasis on globe conservation rate in unilateral and bilateral intraocular retinoblastoma.

METHODS

Patients were grouped according to the International Classification of Retinoblastoma. For intraocular retinoblastoma, group E and some group D eyes underwent primary enucleation. Secondary enucleation was performed after failure of chemoreduction, focal treatments, external beam radiotherapy (EBRT), and intra-arterial chemotherapy used in various combinations. For extraocular retinoblastoma cases, treatment consisted of enucleation/exenteration or orbital biopsy, high-dose chemotherapy, and EBRT to the orbit and metastatic sites.

RESULTS

During the study period from October 1998 to May 2010, 165 of 192 (85.9%) patients had intraocular disease and 27 (14.1%) patients had extraocular disease. In total, primary or secondary enucleation was performed in 70 of 94 eyes with unilateral retinoblastoma (74.5%) and in 34 of 142 eyes with bilateral retinoblastoma (23.9%). The overall globe conservation rate was 69.6%. Only one patient in the intraocular retinoblastoma group died of metastatic retinoblastoma to the central nervous system. Twenty of 27 patients (74.1%) with extraocular retinoblastoma were found to have metastasis to the central nervous system, bone, bone marrow, and/or lymph nodes. At a mean follow-up of 28.0 months (median: 12 months; range: 1 to 120 months), survival was 33.3% despite intensive treatment.

CONCLUSIONS

The overall risk of enucleation was 75% in eyes with unilateral retinoblastoma and 24% in eyes with bilateral retinoblastoma. Extraocular retinoblastoma carries a 75% risk of systemic metastasis and 67% risk of death.

Gamete formation resets the aging clock in yeast

Gametogenesis is a process whereby a germ cell differentiates into haploid gametes. We found that, in budding yeast, replicatively aged cells remove age-induced cellular damage during gametogenesis. Importantly, gametes of aged cells have the same replicative potential as those derived from young cells, indicating that life span resets during gametogenesis. Here, we explore the potential mechanisms responsible for gametogenesis-induced rejuvenation and discuss putative analogous mechanisms in higher eukaryotes.

Comparing different revisions of the Childhood Health Assessment Questionnaire to reduce the ceiling effect and improve score distribution: Data from a multi-center European cohort study of children with JIA

BACKGROUND

The original version of the Childhood Health Assessment Questionnaire (CHAQ30orig) suffers from a ceiling effect and hence has reduced clinical validity. The purpose of this study was to evaluate the effect of adding eight more demanding items (CHAQ38) and a new categorical response option (CATII) on discriminant validity and score distribution in a European patient sample.

METHODS

Eighty-nine children with Juvenile Idiopathic arthritis (JIA) and 22 healthy controls, aged 7-16 years, were recruited from eight centres across Europe. Eight new CHAQ items and scoring option were translated back and forth for the countries in which they were not already present. Demographic, clinical, and CHAQ data were collected on-site. Subsequently, five different scoring methods were applied, i.e. the original method (CHAQ30orig) and four alternatives. These alternatives consisted of the mean item scores for the 30 and 38-question versions with either the original (CATI), or the new categorical response option (CATII). The five versions were tested for their ability to distinguish between patients and controls. Furthermore score distributions were evaluated and visualized by box and whisker plots.

RESULTS

Two CHAQ revisions with the new response option showed poor discriminative ability, whereas one revised version (CHAQ38CATI) had comparable discriminative ability comparable to the original CHAQ. A profound ceiling effect was observed in the original scoring method of the CHAQ (27%). The addition of eight more demanding items and application of a plain mean item score reduced this significantly to 14% (chi2 = 4.21; p < 0.05).

CONCLUSIONS

Revising the CHAQ by adding eight more demanding items and applying a plain mean item scoring (CHAQ38CATI) maintained discriminant ability and reduced the ceiling effect in a European patient sample. The new categorical response option (CATII) seemed promising, but was less able to distinguish children with JIA from healthy controls and had less favourable distribution characteristics. The CHAQ38CATI is advocated for future use in mildly affected JIA patients.

Trace Element Analyses (Zinc and Selenium) in Pediatric Malignant Lymphomas

Ninetysix untreated patients with Malignant lymphoma's, 81 Hodgkin's disease and 15 Burkitt's lymphoma were studied for zinc (Zn) and selenium (Se) status. Plasma and hair Zn, and Se levels were measured by atomic absorption spectrophotometry. Chronic Zn and Se deficiencies (low plasma and low hair Zn and Se levels together) were found to be associated with Malignant lymphoma's in Turkish children. This was most likely due to poor "nutritional environment" of the patients since majority of the Malignant lymphoma cases were from low socioeconomic class. Supplemention of the patients with physiological doses of Zn and Se, in addition to standard chemo radiotherapy regimen was proposed.

Endocrinologic Late Effects of Chemoradiotherapy in Pediatric Acute Leukemia

This study intends to describe growth and endocrine disorders secondary to chemotherapy among long-term survivors of pediatric acute leukemia. Sixteen patients including 14 ALL and 2 AML entered the study. Four were females and 12 were males with the mean age of 17.38 ± 3.81 years. Following the completion of their therapy, the mean follow up period of the patients was 62.43 ± 41.11 months. Somatic growth, sexual maturation, hypothalamic- pituitary-thyroid axis and hypothalamic-pituitary-gonadal axis were evaluated in all the patients. Two out of 16 had pathologic short stature (12.5%) and 3 patients had enuchoid status (18.75%) with antrophometric measurements. Eleven patients had normal thyroid gland dimensions and homogeneous thyroid tissue on ultrasonographic examination. One patient had Ia and another four patients had Ib diffuse goitre according to WHO criteria. Two out of 16 patients were diagnosed as subclinic primary hypothyroidism (12.5%), and three of them were diagnosed as subclinic central hypothyroidism (18.75%) according to TRH testing. Three patients were subclinic subtle central hypothyroidism. Thyroid auto-antibodies were in normal range in all patients. Eight patients (66.6%) out of 12 male subjects revealed impaired HHG axis. Hypergonadotropic hypogonadism (Leydig and Sertoli dysfunction) were observed in five of them and isolated Sertoli dysfunction was detected in three of them. Azoospermia was encountered in all patients with isolated Sertoli dysfunction. Testicular biopsy was obtained from only one of them and atrophic testicular tissue was detected. Female patients show normal pubertal development and gonadal functions.

CONCLUSION

Subclinic subtle primary and subclinic central hypothyroidism were found in 31.2%, impaired Sertoli and Leydig with Sertoli cell function in 66.66% of long-term survivors pediatric acute leukemia and testicular tissue was more sensitive to adverse effects of chemotherapy than ovarian tissue.

Characteristics of "Early Type-I Pattern" (0-6 years) Hodgkin's Disease in Turkish Children

The clinico-epidemiologic characteristics of 54 children with HD in 0-6 years of age group were retrospectively analyzed. This group represented 27% of 200 HD cases observed in our center and was named as early type-I pattern HD. The association of EBV with HD was also shown by serologic and immunohistochemical methods (LMP1) in these very young Turkish patients. T-cell immune deficiency, cytokine imbalance and Zn deficiency were additional findings found in these patients. This series seems to be the largest one studying early type-I HD, by several aspects.