Osteosarcoma metastatic to the kidney and iatrogenic hemorrhage.

A 16-year old female presented painful masses in the lumbar region 5 years after the initial diagnosis of a localized osteosarcoma of the tibia. Abdominal X-ray revealed calcified masses. A bone scan confirmed an increased uptake in the renal areas. An ultrasound-guided fine needle biopsy confirmed the diagnosis of metastases. The procedure was complicated by subcapsular hemorrhage and gross hematuria. Renal metastases from osteosarcoma are usually asymptomatic and invisible on abdominal X-rays. The diagnosis is generally established by radionuclide bone scan or abdominal CT-scan. Our observation suggests that histological documentation of these unusual clinical presentations should be carefully weighed against the risk of the procedure.

Invasive aspergillosis in a paediatric haematology department: a 15-year review.

Invasive aspergillosis (IA) is an increasingly common and often fatal fungal infection in children with haematological disorders. To describe the epidemiology, diagnosis, treatment and outcome of IA in children, retrospective review of the medical records of proven and probable IA between January 1986 and December 2000 was used. Twenty-four patients with IA were identified (10 proven and 14 probable) with a median age of 8.5 years. The incidence of IA was particularly high in acute myeloblastic leukaemia (5.35%) and leukaemia relapse (4%). Twenty-two patients presented with lung involvement. Broncho-alveolar lavage led to a diagnosis in 11 cases, but diagnosis was difficult and repeated invasive explorations were required. Antifungal therapy mainly consisted of amphotericin B. Eight patients underwent open-thorax surgery without any complication. Nine patients (37.5%) were cured of IA and three are still alive. The mortality was 87.5%. Three patients died of massive haemoptysis, including two before neutropenia recovery. Four patients presented with IA recurrence and three were cured again. Despite significant progress having been made in the treatment and diagnosis of IA, it is still a devastating complication in children with haematological disorders. New antifungal therapies and strategies are promising, but objective data are still lacking.

Human parainfluenza virus type 4 infections: a report of 20 cases from 1998 to 2002.

BACKGROUND: Human Parainfluenza Viruses (HPIV) type 4 are responsible for respiratory infections. Unlike HPIV types 1-3, they are associated with mild infections and appear to be infrequent. Thus, they often go undetected. STUDY DESIGN: From 1998 to 2002, in 20 respiratory samples of hospitalised patient, we isolated viruses presenting a large syncytial cytopathic effect when inoculated on LLC-MK2 cells. Most of the patients (16/20) were young infants and all of them presented with respiratory infections. RESULTS: We detected 18 cases during autumn and winter, 1 case during spring and 1 during summer. We could not identify these viruses using the panel of routine assays. Samples were then analysed by specific HPIV 4 RT-PCR and IF assays. All the samples were scored positive with both methods. CONCLUSION: We conclude that HPIV 4 infections are probably underestimated. Their role in viral respiratory infections should be carefully investigated using techniques adapted to their detection and culture.