Training pediatric hematologist/oncologists for capacity building in Ethiopia.

PURPOSE: A considerable barrier to global pediatric oncology efforts has been the scarcity and even absence of trained professionals in many low- and middle-income countries, where the majority of children with cancer reside. In 2013, no dedicated pediatric hematology-oncology (PHO) programs existed in Ethiopia despite the estimated annual incidence of 6000-12000 cases. The Aslan Project initiative was established to fill this gap in order to improve pediatric cancer care in Ethiopia. A major objective was to increase subspecialty PHO-trained physicians who were committed to practicing locally and empowered to lead programmatic development. METHODS: We designed and implemented a PHO training curriculum to provide a robust educational and clinical experience within the existing resource-constrained environment in Ethiopia. Education relied on visiting PHO faculty, a training attachment abroad, and extraordinary initiative from trainees. RESULTS: Four physicians have completed comprehensive PHO subspecialty training based primarily in Ethiopia, and all have remained local. Former fellows are now leading two PHO centers in Ethiopia with a combined capacity of 64 inpatient beds and over 800 new diagnoses per year; an additional former fellow is developing a pediatric cancer program in Nairobi, Kenya. Two fellows currently are in training. Program leadership, teaching, and advocacy are being transitioned to these physicians. CONCLUSIONS: Despite myriad challenges, a subspecialty PHO training program was successfully implemented in a low-income country. PHO training in Ethiopia is approaching sustainability through human resource development, and is accelerating the growth of dedicated PHO services where none existed 7 years ago.

Influenza A/H1N1 in pediatric oncology patients.

BACKGROUND: Our aim was to determine the clinical and epidemiological features of pandemic influenza A/H1N1 in immunocompromised children with solid tumors and hematological malignancies. PATIENTS AND METHODS: A prospective study was conducted during the H1N1 pandemic between August 2009 and February 2010 in a pediatric hematology-oncology unit. Demographic and clinical data were obtained from all children with suspected H1N1 infection (high fever with or without respiratory symptoms). Laboratory diagnosis of influenza A/H1N1 was performed by means of polymerase chain reaction analysis of nasopharyngeal wash specimens. RESULTS: We identified 57 episodes of suspected influenza A/H1N1 infection in 40 children. In all episodes, children were treated with oseltamivir and antibiotics until influenza A/H1N1 results were received. Of all episodes, 13 (22.8%) tested positive for influenza A/H1N1. Two of the H1N1-positive children (15.4%) had been previously immunized against influenza A/H1N1. No differences between H1N1-positive and H1N1-negative children were noted in terms of demographic features, clinical presentation, laboratory findings, and underlying disease.Three polymerase chain reaction-positive (23.0%) children and 1 H1N1-negative (2.3%) child were admitted to the pediatric intensive care unit and were mechanically ventilated (P=0.03). One (7.7%) H1N1-positive patient died versus none of the H1N1-negative patients (P=0.2). The condition of all other children in both the groups improved rapidly during hospitalization. CONCLUSIONS: Febrile hospitalized pediatric oncology patients, with and without pandemic influenza A/H1N1, had a similar demographic and clinical presentation with a relatively good outcome. This was probably because of early antiviral treatment and possibly because of the relatively low virulence of the virus. Immunization should be encouraged in these patients.

Hallux Valgus Repair with Chevron Osteotomy Significantly Narrows Forefoot Width.

BACKGROUND: Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs. METHODS: A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery's effect on foot width. Measurements were made preoperatively and 3-6 months following surgery. RESULTS: The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9.4 cm (±0.6), and the STW was 10.6 cm (±0.7). Following surgery, significant changes in BW and STW were measured, with a mean narrowing of 1.2 cm (±0.4) in BW (p < 0.001) and 0.95 cm (±0.5) in STW (p < 0.001). Paradoxically, an increase in age led to a lower correction of the IMA (p = 0.04, r = 0.57), but higher BW and STW reductions (p = 0.01, r = 0.35 and p = 0.008, r = 0.37, respectively). CONCLUSIONS: This study reinforced chevron osteotomy as a valid treatment option that significantly narrows forefoot width; it is thus expected to improve cosmetic outcomes, shoe selection options, and quality of life. This study also found that older age correlates with better forefoot narrowing following hallux valgus repair, possibly due to stiffer soft tissues.

[Diagnosis and treatment of spine metastases].

Metastatic disease of the spine occurs in as many as 70% of cancer patients. Patients may present with pain, neurologic deficit, or both. Treatment options include medical therapy, radiation, and surgery. The diversity of patients' conditions, tumors pathology, and the extent of disease complicate decision making and treatment. Treatment goals are palliative, aiming for pain control and maintenance of mobility. A multimodality therapy, results in better outcomes.

Expandable endoprosthesis for limb-sparing surgery in children: long-term results.

PURPOSE: Most children today with bone sarcomas undergo limb-sparing surgery. When treating children younger than 12 years of age, the result is significant limb length discrepancy (LLD). One of the solutions is the use of an expandable endoprosthesis. METHODS: A retrospective analysis of 38 skeletally immature patients with bone sarcoma of the lower limb in whom different types of expandable endoprostheses were used from January 1988 to December 2005 were included. All patients were under the age of 14 years. There were 26 osteosarcoma and 12 Ewing's sarcomas. The data collected included the tumor characteristics, the surgical and other treatment modalities, complications and their treatment, and the final LLD and functional results. RESULTS: Fifty-five percent of the patients survived and had a mean follow-up of 113 months. All survivors reached skeletal maturity at the time of last follow-up. Seventy-one percent of the survivors had satisfactory function and 29% had a poor result. There were three secondary amputations due to local recurrence. Complications were documented in 58% of patients; the most common was infection that was diagnosed 56 times (primary 16% and secondary 84%). A significant correlation was found between function and final LLD (greater than 5 cm = inferior function), the number of complications, and the number of surgical procedures performed other than prosthesis elongation. The younger the patient was at definitive surgery, the shorter the time it took for the prosthesis to fail. CONCLUSION: In order to improve results, the number of operations must be reduced. This can be achieved by the use of novel non-invasive expandable endoprostheses or biological reconstruction.