Journal of pediatric hematology/oncology
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J. Pediatr. Hematol. Oncol. · Jul 2009
Postoperative fevers in pediatric solid tumor patients: how should they be managed?
It is unclear how aggressively postoperative fevers should be managed in immunosuppressed pediatric oncology patients after major surgery. Little data exists on this subject. Therefore, a retrospective study of patients treated at our center was undertaken to examine this. ⋯ Postoperative fevers may be indicative of severe infection. We suggest that a standardized approach to the management of these patients, including prompt physical assessment, clinical investigations, and empiric antibiotic consideration is vital to minimize complications.
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J. Pediatr. Hematol. Oncol. · May 2009
Religious/Spiritual coping in adolescents with sickle cell disease: a pilot study.
Religious/spiritual (R/S) coping has been associated with health outcomes in chronically ill adults; however, little is known about how adolescents use R/S to cope with a chronic illness such as sickle cell disease (SCD). Using a mixed method approach (quantitative surveys and qualitative interviews), we examined R/S coping, spirituality, and health-related quality of life in 48 adolescents with SCD and 42 parents of adolescents with SCD. Adolescents reported high rates of religious attendance and belief in God, prayed often, and had high levels of spirituality (eg, finding meaning/peace in their lives and deriving comfort from faith). ⋯ R/S coping was not significantly associated with HRQOL (P=NS). R/S coping, particularly prayer, was relevant for adolescents with SCD and their parents. Future studies should assess adolescents' preferences for discussing R/S in the medical setting and whether R/S coping is related to HRQOL in larger samples.
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J. Pediatr. Hematol. Oncol. · May 2009
From upfront nephrectomy to preoperative chemotherapy and back: a single institution experience in the treatment of Wilms tumor.
Over the past decades, 2 different approaches for the treatment of Wilms tumor have emerged: upfront nephrectomy (UN) and preoperative chemotherapy (PC), with adjuvant treatment adjusted to stage, histology, and chemotherapy response. ⋯ The use of PC reduced the use of radiation; however, patients treated using the SIOP 93-01/German Pediatric Oncology Hematology Group protocol received higher cumulative doses of doxorubicin; these doses were believed to be high in this young group of patients with potential for long-term toxicity. Although selecting a specific protocol for Wilms tumor is important, the development of surgical expertise and referral to specialized centers takes priority.
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J. Pediatr. Hematol. Oncol. · Feb 2009
A prospective appraisal of pulmonary hypertension in children with sickle cell disease.
Pulmonary hypertension (PHT) is a life-threatening complication of sickle cell disease that occurs in 20% to 40% of adults. Measurement of maximal tricuspid regurgitant jet velocity (TRV) by echocardiography provides a noninvasive screening tool; TRV values > or =2.5 m/s are correlated with PHT and increased mortality. Our objective was to estimate the prevalence of PHT in our pediatric sickle cell population and its possible association with various clinical and laboratory findings, including obstructive sleep apnea and/or pulmonary dysfunction. ⋯ Elevation of TRV was relatively uncommon in our pediatric patients as compared with prevalence reported in adults and may be associated with increased hemolysis. There was no association with obstructive sleep apnea or abnormal pulmonary function.
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J. Pediatr. Hematol. Oncol. · Dec 2008
Case ReportsAn uncommon presenting sign of Langerhans cell histiocytosis: focal perianal lesions without systemic involvement.
A 3-year-old boy presented with constipation and perianal lesions resembling condyloma latum. The results of a biopsy of the perianal lesions confirmed the diagnosis of Langerhans cell histiocytosis (LCH). ⋯ In patients with functional constipation associated with perianal lesions that do not respond to conventional treatment, LCH should be part of the differential diagnosis. A simple biopsy of the external lesion and histologic examination of the mass are essential for diagnosis.