Pediatric blood & cancer
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Pediatric blood & cancer · Jan 2013
The use of palliative chemotherapy in pediatric oncology patients: a national survey of pediatric oncologists.
Many children continue receiving chemotherapy after there is no realistic hope for cure. One factor that influences parental decisions to pursue medical therapies is physician preference. To date, no studies have described pediatric oncologists' perspectives and practices regarding palliative chemotherapy (PC). ⋯ According to 80.2% of pediatric oncologists completing the survey, some patients receive chemotherapy beyond medical benefit and 40.8% of these oncologists have prescribed PC for the purpose of parental wishes to a recent patient. The chief aims in prescribing palliative chemotherapy were not achieved for recent patients.
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The rare inherited coagulation disorders (RICD) are uncommon and thus not well-defined in terms of severity or management. Inheritance is autosomal; in some of these disorders in the heterozygote state affected individuals may be mildly symptomatic. ⋯ Factor VII and factor XI deficiencies show a poor relationship between the factor level and bleeding risk. Unlike hemophilia, women are equally affected by these RICD and can have problems related to menstruation and childbirth.
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We are in the midst of an unprecedented period for the development of new therapeutic products to treat patients with bleeding diseases. While current hemostatic treatments are already very effective and safe, new agents to enhance convenience and further improve both short- and long-term efficacy of treatment are under development. ⋯ The strategies being evaluated for hemostatic enhancement range from gene and nucleic acid-based approaches, to the development of complex, naturally occurring molecules such as the non-anticoagulant polysaccharide, fucoidan. There is every likelihood that combinations of these treatment approaches will further improve the quality of bleeding disease management over the next 5 years and beyond.
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Pediatric blood & cancer · Jan 2013
18-fluorodeoxyglucose-positron emission tomography (FDG-PET) evaluation of nodular lesions in patients with Neurofibromatosis type 1 and plexiform neurofibromas (PN) or malignant peripheral nerve sheath tumors (MPNST).
Individuals with Neurofibromatosis type 1 (NF1) are at risk for developing malignant peripheral nerve sheath tumors (MPNST), which frequently arise in preexisting plexiform neurofibromas (PN). Magnetic resonance imaging (MRI) with volumetric analysis and 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) were utilized to monitor symptomatic nodular lesions. ⋯ Nodular target lesions identified on MRI in individuals with NF1 and PN demonstrate increased FDG uptake similar to MPNST, but may be benign on biopsy. Nodular target lesions may be at greater risk for malignant transformation, but their biologic and clinical behavior has not been well studied. Careful longitudinal evaluation will be required to better understand the malignant potential of these lesions.