Establishment of a formal program for retinoblastoma: Feasibility of clinical coordination across borders and impact on outcome.

Retinoblastoma is an ocular tumor that occurs in young children, in either heritable or sporadic manner. The relative rarity of retinoblastoma, and the need for expensive equipment, anesthesia, and pediatric ophthalmologic expertise, are barriers for effective treatment in developing countries. Also, with an average age-adjusted incidence of two to five cases per million children, patient number limits development of local expertise in countries with small populations. Lebanon is a small country with a population of approximately 4.5 million. In 2012, a comprehensive retinoblastoma program was formalized at the Children's Cancer Institute (CCI) at the American University of Beirut Medical Center, and resources were allocated for efficient interdisciplinary coordination to attract patients from neighboring countries such as Syria and Iraq, where such specialized therapy is also lacking. Through this program, care was coordinated across hospitals and borders such that patients would receive scheduled chemotherapy at their institution, and monthly retinal examinations and focal laser therapy at the CCI in Lebanon. Our results show the feasibility of successful collaboration across borders, with excellent patient and physician adherence to treatment plans. This was accompanied by an increase in patient referrals, which enables continued expertise development. However, the majority of patients presented with advanced intraocular disease, necessitating enucleation in 90% of eyes in unilateral cases, and more than 50% of eyes in bilateral cases. Future efforts need to focus on expanding the program that reaches to additional hospitals in both countries, and promoting early diagnosis, for further improvement of globe salvage rates.

Immune thrombocytopenic purpura in childhood: a Lebanese perspective.

UNLABELLED: Immune thrombocytopenic purpura (ITP), due to the production of antiplatelet antibodies, is the most prevalent etiology of thrombocytopenia in children and a frequent cause of consultation for the pediatrician. We review here a series of Lebanese pediatric patients presenting with ITP and we discuss the relevant characteristics of the group. STUDY: A retrospective chart analysis was performed for 40 hospitalized or out-patient children presenting with ITP between January 1998 and December 2001. All cases except two had a diagnosis confirmed by bone marrow aspirate. Patients were equally distributed between the sexes with a mean age of 56 months. More than half of the patients had an episode of fever 2 days to 8 weeks prior to the diagnosis. For 42% of them, the disease appeared in the months between January and March. Ten percent presented with epistaxis but all of these had a platelet count less than 12,000. One-third of the patients had received immunization 2-8 weeks before the diagnosis, with one patient having a relapse 4 weeks after mumps-measles-rubella (MMR) immunization, which was 1 year after the initial cure. Initial treatment consisted of either steroids or intravenous polyvalent immunoglobulin in 58 and 36% of the cases, respectively. None of the patients had life-threatening hemorrhage. Only 10% of the patients developed chronic ITP (unremitting after 6 months). CONCLUSION: ITP is generally a benign disease in infancy and childhood. Certain characteristics of ITP in this series, such as the seasonal variation and the post-vaccine ITP, will need to be better defined in larger prospective studies. Optimal treatment will eventually be targeted towards a better delineation of the disease phenotype.