Med Pediatr Oncol

Hepatoblastoma incidence in the United States from 1973 to 1992.

Ross JA. Gurney JG.
Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA. ross@epivax.epi.umn.edu
BACKGROUND: There is recent evidence to suggest that extremely low birth weight is associated with the occurrence of hepatoblastoma. PROCEDURE: In light of this possibility, we evaluated trends in hepatoblastoma incidence in the United States among children age 4 years and younger. RESULTS: We found an increasing trend (5.2%) in hepatoblastoma incidence over the past two decades, a period that corresponds with improved survival of very low birth weight children. CONCLUSION: Future studies of hepatoblastoma that incorporate birth weight are appropriate.

Successful management with octreotide of a child with L-asparaginase induced hemorrhagic pancreatitis.

Garrington T. Bensard D. Ingram JD. Silliman CC.
Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
BACKGROUND: Octreotide is a synthetic somatostatin analogue which has been suggested for use in the management of acute pancreatitis. While studies have looked at octreotide use in the setting of pancreatitis due to chronic alcohol use or trauma, little is known of its role in management of drug induced acute pancreatitis; particularly in the pediatric setting. PATIENTS AND METHODS: We present a case of a 5 1/2-year-old white female who developed severe, necrotizing, hemorrhagic pancreatitis with pseudocyst formation secondary to L-asparaginase use as a part of her therapy for acute lymphoblastic leukemia (ALL). She was managed initially with intravenous fluids, bowel rest, nasogastric suctioning, parenteral narcotices, and broad spectrum antibiotics. In addition, within 12 hours of admission to The Children's Hospital (TCH) in Denver, Colorado, she began therapy with octreotide (5 micrograms/kg/day IV divided b.i.d.). With this management, her pseudocyst decompressed without need for surgical intervention, her pancreatitis fully resolved, and she recovered full pancreatic function without any long-term sequelae. CONCLUSION: Use of octreotide may have served a role in limiting the severity of the disease process in this case. Further studies need to be done to verify its usefulness in this setting.

Rhabdomyosarcoma of extrahepatic biliary tree: initial treatment with chemotherapy and conservative surgery.

Year 1998
Pollono DG. Tomarchio S. Berghoff R. Drut R. Urrutia A. Cedola J.
Oncology Unit, Hospital de Ninos Superiora Sor Maria Ludovica, La Plata, Argentina. patologi@netverk.com.ar
BACKGROUND: The very low frequency of rhabdomyosarcoma (RMS) of the extrahepatic biliary tree has impeded the development of a standardized form of treatment. PROCEDURE: Based on the good response of embryonal RMS to chemotherapy, we used a multi-drug protocol as the initial treatment of a 3-year-old girl after obtaining adequate transparietohepatic biliary drainage. The treatment achieved complete remission. Later conservative laparoscopic surgery revealed only residual scar tissue. The patient is alive and well 1 year after remission. DISCUSSION AND CONCLUSIONS: Management of this difficult tumor using modern less invasive techniques for diagnosis and treatment, with the help of preoperative chemotherapy, prevented extensive damage to the biliary tree and allowed complete recovery.