Spinal cord vascular injuries following surgery of advanced thoracic neuroblastoma: an unusual catastrophic complication.

BACKGROUND: Spinal cord injury is a possible complication associated with removal of thoracic dumbbell neuroblastomas. Our experience with two children whose postsurgical course was complicated by midthoracic spinal cord ischemia is reported there. Permanent paraplegia resulted in both. PROCEDURE AND RESULTS: Preoperative awareness of the origin and distribution of the Adamkiewicz artery (arteria radiculomedullaris magna, ARMM) and of the possible collateral pathways for spinal cord blood supply may be helpful in the planning of operations that involve dissection in the midthoracic posterior mediastinum. Otherwise, a flaccid paraplegia may result. CONCLUSIONS: The syndrome is presumed to be triggered by a spasm, an embolism, or a iatrogenic interruption of the ARMM.

[Acute lymphoblastic leukemia in childhood. A 10-year experience with the DFCI 81-01 protocol]. / Leucemia linfoblástica aguda na criança. Experiência de dez anos com o protocolo DFCI 81-01.

Acute lymphoblastic leukemia is the most frequently encountered pediatric cancer. Approximately 70% of cases can be cured of the disease. In this article, we describe the experience of our Center in the last ten years with a treatment protocol adapted from protocol DFCI 81-01 (from the Dana Farber Cancer Institute, Boston). We conclude that it is easily accomplished, well tolerated and that it allowed us to significantly improve the outcome of our patients (80% 5 year-survival). Nevertheless, we are currently in the process of changing to a new protocol--one that will hopefully achieve a comparable cure rate with less long-term toxicity.

[Application of aspiration cytology in the diagnosis of tumor lesions in children]. / Aplicações da citologia aspirativa no diagnostico das lesões tumorais das crianças.

Fine needle aspiration cytology (FNAC) became increasingly popular for evaluating of both superficial and deep seated lesions, but its use in children has been limited. We report our recent experience with FNAC in the pediatric group. The study population included 34 males and 12 females and the age ranged between 11 months to 16 years. The aspirated sites were: testis (n = 14), lymph node (n = 12), bone (n = 9), pelvis (n = 2), retroperitoneum (n = 1), soft tissue (n = 6), lung (n = 1) and orbit (n = 1). The aims of FNAC were to diagnose a primary lesion (25 cases) and to document relapse of neoplastic disease (21 cases). Of the 46 aspirates, 28 were diagnosed as malignant, 4 as benign, 2 were inconclusive; in the remaining case the material was considered inadequate. Eleven out of 14 testicular cases were normal. FNAC diagnosis was confirmed either by histology (25 cases) or by the clinical evolution (18 cases). We conclude that FNAC can be considered a major diagnostic tool for the characterization of the tumoral lesions in childhood, both for diagnostic purposes and for evaluation of the progression of neoplasia. It may also provide useful information for guiding the therapeutical strategy.