Highly effective unconventional management of aspergillosis of the left maxillary sinus in an 11-year-old girl with rhabdomyosarcoma embryonale of the frontal sinus.

Invasive fungal infections are common causes of death in children treated for malignancies, and therefore present an important and growing clinical problem. Fungal invasion usually affects immunocompromised patients, but increased incidences are also associated with intensification of antineoplastic therapy and increased numbers of organ and bone marrow transplantations. Fungal infections in parameningeal and cerebral locations carry high risks of treatment failure. We describe the case of an 11-year-old female patient with rhabdomyosarcoma embryonale of the frontal sinuses with metastases to the neck lymph nodes, treated according to the CWS 2002 protocol for high-risk patients. Left maxillary sinus aspergillosis was diagnosed during chemotherapy following radiotherapy, and 56 days after surgical excision of the tumour. No effect was achieved by use of amphotericin B. Further treatment included intravenous voriconazole at 6 mg per kg body weight every 12 h for 2 weeks, followed by oral voriconazole at 4 mg per kg body weight twice daily for 6 months. Simultaneous excision of necrotic tissues from the nasal cavity, ethmoid bone, maxillary sinus and frontal recess was performed. The sinus was kept open for 3 weeks to allow voriconazole lavage every 12 h for 3 weeks. This unconventional treatment resulted in eradication of sinus aspergillosis and allowed intensive chemotherapy to be continued with no recurrence of aspergillosis.

Congenital nasolacrimal duct mucocele--a case report.

Congenital nasolacrimal duct mucocele (CNDM) is a very rare condition in newborns. Prolapse or expansion of the mucocele into the nose may lead to respiratory distress and difficulty in feeding. The triad of cystic medial canthal mass, dilatation of the nasolacrimal duct and a contiguous sub-mucosal nasal mass on computed tomography (CT) is indicative in the diagnosis of CNDM. The case of a five-week-old girl with infected CNDM is described. The authors aim to emphasize the very rare incidence of CNDM in Polish newborns, delayed diagnosis in the case described and the paramount importance of CT of the head for the correct diagnosis and treatment.

Hodgkin's disease--the rare cause of nephrotic syndrome in children.

PURPOSE: Hodgkin's disease (HD) is a potentially curable malignant lymphoma with distinct histology, biologic behavior and clinical characteristics. Renal involvement in HD is rare, but it may be underestimated because renal lesions are not the major manifestation of the disease. The pathogenesis of proteinuria in HD remains unknown. CASE REPORT: The case of a 17-year-old girl suffering from Hodgkin's disease and nephrotic syndrome has been described. CONCLUSION: The authors would like to underline the very rare coincidence of Hodgkin's disease and nephrotic syndrome, the lack of remission after routine prednisone administration and disappearance of nephrotic proteinuria after anticancer therapy.

[Vesicoureteric reflux: it all depends on the genes?]. / Wsteczny odplyw pecherzowo-moczowodowy--wszystko zalezy od genów?

Vesicoureteric reflux (VUR) defined as reversed urine flow from the urinary bladder to ureter(s) and frequently to kidneys is associated with abnormal structure and/or malfunction of one or both ureterovesical junctions. In the pediatric practice, VUR constitutes an important problem not only because of prevalence but also because of the role it plays in pathogenesis of urinary tract infections, reflux nephropathy and chronic renal failure in children. Recent reports confirm genetic background of vesicoureteric reflux. Vesicoureteric reflux is inherited as a dominant autosomal disease (with possible incomplete gene(s) penetration). The Authors present a review of recent literature with focus on key role of candidate genes in the development of VUR in children.