Alterations of bone mineral metabolism of children with different cell lineage types of acute lymphoblastic leukaemia under chemotherapy.

BACKGROUND: Children with haematological malignancies such as acute lymphoblastic leukaemia (ALL) may have alteration of bone mineral metabolism therefore increased risk for osteopenia and osteoporosis. PATIENTS AND METHODS: The purpose of this study was to examine the alterations of bone mineral metabolism in two groups of children (n=42) according to immunophenotyping (B-cell type, T-cell type) both quantitative (bone mineral density z-scores) and qualitative (serum osteocalcin - OC and carboxyl-terminal telopeptide of human type I collagen - ICTP) during diagnosis (T=0), after the intensified chemotherapy period (T=0.5) and the consolidation period (T=1). RESULTS: According to our results 15 patients had osteopenia and 1 child developed osteoporosis at T=0.5 and 13 patients had osteopenia at T=1. Mean BMD z-score was significantly decreased in both groups during chemotherapy and especially statistically significant decline of T-cell type ALL group compared with B-cell type ALL patients. OC mean level remains in low levels for both groups reaching in plateau during chemotherapy and ICTP level was increased in T-cell type ALL group of patients compared with B-cell type in both periods of chemotherapy. CONCLUSIONS: It seems that not only the combination of chemotherapeutic agents but also the cell lineage of ALL are important parameters of altering bone mineral metabolism.

The role of three-dimensional (3D) sonography and 3D power Doppler in the preoperative assessment of borderline ovarian tumors.

PURPOSE OF INVESTIGATION: To determine the value of three-dimensional (3D) sonography and 3D power Doppler in distinguishing borderline ovarian tumors from benign cysts and malignant tumors. METHODS: One hundred and seventy-two women with a mean age of 37 years (range 28-45) and diagnosis of a confirmed pelvic mass were referred for preoperative evaluation with 3D sonography and 3D power Doppler. Sonographic criteria used for the diagnosis of borderline tumors were based on a system that included morphological characteristics, histological evaluation and power Doppler imaging. RESULTS: Ten lesions were histopathologically diagnosed as borderline ovarian tumors, 42 as malignant and 120 as benign. Three-dimensional sonography revealed 120 ovarian tumors which scored below 7 (benign), according to Kurjak's scale, 12 tumors which scored between 7-8 and 40 tumors between 9-13 (malignant). CONCLUSIONS: Preoperative assessment of borderline tumors by 3D imaging may promote improved patient care and introduce laparoscopic management as an alternative surgical approach.

Laparoscopic restaging of borderline ovarian tumours: results of 30 cases initially presumed as stage IA borderline ovarian tumours.

OBJECTIVES: To review our experience with the laparoscopic restaging procedure of presumed early stage borderline ovarian tumours. DESIGN: Retrospective study. SETTING: Cancer centre. POPULATION: Thirty patients with presumed stage I borderline ovarian tumours after limited initial surgery. METHODS: From April 1991 to May 2001, the patients were laparoscopically reassessed. The procedure involved peritoneal cytology, exploration of the peritoneal cavity, infracolic omentectomy, directed or random peritoneal biopsies, and when appropriate, contralateral oophorectomy and hysterectomy and appendectomy. Medical records were reviewed for patients' age, interval time between procedures, tumour stage, histological type, operative time, hospital stay, peri-operative complications and follow up. MAIN OUTCOME MEASURES: Seroperative and postoperative data, pathology and clinical follow up. RESULTS: Laparoscopic restaging was completed in all 30 (100%) identified patients. The mean age was 34.8 (10.5) years; the delay between initial operation and restaging laparoscopy averaged 9.8 (6.6) weeks. The mean operative time was 165.4 (53.8) minutes, and the mean hospital stay was 2.7 (1.3) days. There were two (7.0%) major complications related directly to the procedure. Eight (26.6%) patients were upstaged. Mean follow up was 29.1 (6.6) months, all patients are alive and one (3.2%) recurrence was observed. CONCLUSIONS: Laparoscopic approach of restaging for borderline ovarian tumours is an accurate safe procedure. It is associated with an acceptable rate of minor complications, it has similar morbidity associated with laparotomy and it minimises the incidence of infertility in the young patients. Whenever staging of borderline ovarian tumours is to be considered in an individual patient, laparoscopy provides a suitable alternative approach.