Tumour-like inflammatory abdominal conditions in children.

The presence of a tumour, poor general condition, features of anaemia, increased erythrocyte sedimentation rates and imaging suggesting malignancy were the common features in 4 different tumour-like abdominal conditions that are extremely rare in childhood. These conditions included: extensive retroperitoneal tumour with rib involvement that turned out to be an inflammatory lesion caused by Actinomyces in a 12-year-old girl; multi-loculated tumour of the mesentery/ovary caused by mesenteric lymphadenopathy in the course of a Salmonella enteritidis infection in a 2.5-year-old girl; tumour of the VII - VIII hepatic segments that turned out to be the focus of granuloma in the course of lambliasis in a 5.5-year-old boy with a history of purulent neck lymphadenopathy and a final suspicion of immunocompromise; and a multi-loculated tumour of the small pelvis and inguinal area that turned out to be an abscess of the iliopsoas muscle in a 16-year-old boy. Apart from the imaging, the lesions required cytological examination of the material harvested by fine-needle biopsies (liver tumour) or histopathological investigations (retroperitoneal tumour, mesenteric/ovarian tumour, liver tumour and--on second surgery--the pelvic tumour) and/or bacteriological examination (all cases), serological examination (liver tumour and mesenteric/ovarian tumour), protozoal investigation (liver tumour), and measurement of AFP levels (mesenteric/ovarian tumour). Surgical treatment (retroperitoneal tumour, mesenteric/ovarian tumour and tumour of the small pelvis) and guided antibiotic therapy (all cases including 15 weeks of antibiotics in the first case) allowed complete recovery in 3 patients (actinomycosis, mesenteric lymphadenopathy, abscess of the iliopsoas muscle). Antibiotic and antiprotozoal therapy cured the granulomatous hepatitis; however this patient tended to develop severe right-sided pleural/pulmonary changes (the child was referred for further diagnosis with suspicion of immunocompromise).

Synthetic antiproteases in acute pancreatitis: an experimental study.

Acute pancreatitis was induced in 19 anesthetized dogs by retrograde injection of bile mixed with trypsin into the pancreatic duct. Two groups, of six animals each, were treated with intravenous infusion of synthetic antiproteases: gabexate mesilate and nafamostat mesilate in doses of 1 mg/kg per hr. One group of seven animals remained untreated. Two untreated dogs died during the experiment. All the treated dogs survived. Hemodynamic data were monitored hourly during a 6-hr observation period. In the untreated animals, cardiac output, mean arterial pressure, and left ventricular stroke volume decreased rapidly; an increase of pulmonary vascular resistance and systemic vascular resistance was observed. Synthetic antiproteases, given as a therapy, improved the hemodynamic parameters significantly and prevented the animals from developing shock. Gabexate mesilate and nafamostat mesilate seem to be of value in the treatment of experimentally produced acute pancreatitis in dogs.

Beneficial effect of therapeutic infusion of nafamostat mesilate (FUT-175) on hemodynamics in experimental acute pancreatitis.

Acute pancreatitis was induced in 13 anesthetized dogs by retrograde injection of bile mixed with trypsin into the pancreatic duct. Six animals were treated with intravenous infusion of new synthetic antiprotease. Nafamostat Mesilate, at a dose of 1 mg/kg/h. Four out of seven untreated animals died during the experiment. All the treated dogs survived. Hemodynamic data were regularly monitored during a ten-hour observation period. Cardiac output, mean arterial pressure and left ventricular stroke volume decreased rapidly in the untreated animals. An increase in systemic vascular resistance and pulmonary vascular resistance was observed in dogs without treatment. Nafamostat Mesilate given as therapy significantly improved the hemodynamic parameters, and prevented the animals from developing shock. The study demonstrates an advantageous influence of synthetic antiprotease Nafamostat Mesilate on the course of acute experimental pancreatitis.

Multicenter retrospective analysis of various primary pediatric malignant hepatic tumors--management in a series of 47 Polish patients (1985-1995).

Forty-seven children treated in various Polish centers between 1985 and 1995 for primary malignant liver tumors were retrospectively analyzed. Hepatoblastoma (HB) prevailed--it was found in 39 cases. There were 6 hepatocarcinoma (HCC) cases and 2 cases of undifferentiated sarcoma (UDS). In 44% of HB patients the tumor involved both liver lobes. 18% of children with HB presented with pulmonary metastases at diagnosis. Chemotherapy was applied in 92% of cases (preoperatively in 67%). Tumor resection was performed in 56% of HB patients. Overall survival of patients with hepatoblastoma was 43.6%, while it was 50% for hepatocarcinoma and 100% for undifferentiated sarcoma (2 cases only). Mean observation time was 58 months. The hepatoblastoma subgroup, being the largest (83% of all cases), was analyzed separately for prognostic factors. Completeness of tumor excision strongly influenced survival. Involvement of both lobes of the liver and multifocality of the tumor were other adverse prognostic factors.

Tumour cell proliferation rate as determined by MIB-1 antibody in Wilms' tumour.

Determination of neoplastic cell proliferation becomes an important and objective element of assessing malignancy of neoplasms and their response to therapy. The basic problem in the management of Wilms' tumours in children is selection of patients to appropriate risk groups. The purpose of the present study was to evaluate proliferation index in 35 Wilms' tumours determined immunohistochemically by using monoclonal antibody MIB-1. The final analysis included 39 preparations of formalin fixed and paraffin embedded tissue sections. Proliferation index of neoplastic cells was determined in blastema, epithelium and stroma of the tumours. We found a marked difference between low proliferation index in stromal cells and high proliferation index in blastemal and epithelial cells. In tumours after chemotherapy we found higher proliferation index in epithelial cells and lower index in blastemal cells as compared to tumours before chemotherapy. Higher proliferation index in blastemal cells and epithelial cells was associated with worse prognosis. Worse prognosis was seen in cases in which after chemotherapy proliferation index in blastemal cells was still high.

The role of endoscopic thrombin injections in the treatment of gastroduodenal bleeding.

One hundred and ninety-one patients who had emergency endoscopy performed for acute gastroduodenal haemorrhage and were found to be bleeding actively (N = 141) or to have an ulcer containing a non-bleeding visible vessel (N = 50) were studied. Patients with active bleeding were divided into two groups: group I included 47 patients in whom diagnostic endoscopy was performed and conventional management applied; and group II contained 94 patients in whom, apart from conventional treatment, endoscopic thrombin injections could also be offered. Fifty patients with non-bleeding visible vessels were admitted to a prospective randomised trial and assigned to either endoscopic injections (group A, N = 25), or no primary endoscopic treatment (group B, N = 25). The introduction of the injection therapy in patients who were actively bleeding resulted in a significant reduction of the emergency operation rate (70.2% v. 12.8%; P < 0.001), mortality rate (21.3% v. 8.5%; P < 0.05 and blood transfusion requirements (4,220 +/- 1,840 ml v. 1,980 +/- 980 ml; P < 0.05). Endoscopic thrombin injections of non-bleeding visible vessels reduced the rebleeding rate (40% v. 4%; P < 0.01) and blood transfusions (2,939 +/- 1070 ml v. 1,390 +/- 552 ml; P < 0.05).

[Ovarian mucinous carcinoma in a 12-year old girl]. / Gruczolakorak sluzowy jajnika u 12-letniej dziewczynki.

Epithelial tumors are uncommon in young girls. The case of 12 years old girl (pre-menarche) with ovarian mucinous carcinoma was described. It was successfully treated by completely removed and then was carried out chemotherapy with ADM, CPM and CDDP. Neoplastic markers and laparoscopy was used to follow-up.

[Ovarian neoplasms in children taken from material of the pediatric children's clinic PAM in Szczecin]. / Guzy jajnika u dzieci w materiale kliniki chirurgii dzieciecej pam w szczecinie.

The authors analysed 19 girls aged six to fourteen years with tumors of ovary treated in the last 27 years in the Department of Pediatric Surgery, Pomeranian Medical Academy in Szczecin. Symptoms procedures tactics, advantage of neoplastic markers in diagnosis and treatment monitoring of malignant processes are discussed. The authors warned against to hastily and to spare operations instead of adnexectomy. This procedure is recognized by many as a typical for girls with ovary tumors.

[Renal gene expression of renin and transforming growth factor Beta 1 in children with glomerulonephritis]. / Nerkowa ekspresja genów reniny i transformujacego cznnika wzrostu beta 1 u dzieci z klebuszkowymi zapaleniami nerek.

Increase of renal expression of transforming growth factor beta 1 (TGF-beta 1) gene caused by activation of the local renin-angiotensin system plays an important role in the pathogenesis of glomerulonephritis (GN). The aim of the present study was to measure the expression of renin and TGF-beta 1 genes (own modification of the RT-PCR method) in the isolated renal glomeruli or in the homogenates of renal biopsy specimens in children with various types of glomerulonephritis. The study enrolled 13 children with glomerulonephritis and 3 boys with Wilm's tumour (control group). The expression of the studied genes was presented using arbitrary units defined as multiplicity of the GAPDH gene. No significant difference was found in expression of mRNA renin in the biopsy specimens of the kidney between GN group and control group. Expression of the TGF-beta 1 gene was found in biopsy specimens in all patients from the control group, and only in one GN child, the sole one who was not treated with converting-enzyme inhibitors. No transcripts of the studied genes were found in all RNA samples obtained from the renal glomeruli using the microdissection method. The RT-PCR method applied in the present study allows evaluation of renal expression of renin and TGF-beta 1 genes. The authors would like to point out that storage of biopsy specimens at -80 degrees C would not prevent the total degradation of RNA during microdissection.

[Malignant tumors of mandible in children]. / Nowotwory zlosliwe zuchwy u dzieci.

Primary bone tumors represent about 7% of paediatric malignancies. Osteosarcoma and Ewing's tumor are the most frequent ones, however they are rare in facial bones. Mandibular localization is slightly more frequent and of better prognosis than maxillary one. Until 1995 there were only about 70 cases reported in the medical literature, mainly in the oncological or dental periodics. Our material consists of two children with Ewing's tumor of the mandible and one patient with osteosarcoma. The diagnosis was based on histopathological or cytological studies. The combined treatment--chemotherapy and radiotherapy--was performed in two patients with Ewing's tumor. The recommended resection of the mandible including the tumor mass has not been performed. No facial asymmetry is seen after termination of the radiotherapy. The boy with osteosarcoma underwent primary mandibular partial resection; a two-year chemotherapy was introduced only when metastases in the regional lymph nodes occurred (BLM, CTX, ACT-D, ADM, CDDP). The mandible was reconstructed surgically in 5 years after termination of radiotherapy and the anatomical relationship in the masticatory organ was restored. All children are now in good condition under our long-term observation. We present these cases of mandibular tumors regarding their rare occurrence and positive results of the introduced treatment.

[Functional reconstruction of the masticatory organ after combined therapy in a 9-year-old boy with osteosarcoma of the mandible]. / Funkcjonalne odtworzenie narzadu zucia po skojarzonym leczeniu osteosarcoma zuchwy u 9-letniego chlopca.

Resection of the considerable part of the arch of the mandible disturbs breathing, swallowing, speaking and alters the facial symmetry. One-staged reconstruction of the mandible is contraindicated in patients with malignant tumor and serious prognosis. The course of the combined treatment in 9-year-old boy with osteosarcoma of the mandible is presented (May 1987--resection of the anterior part of the body of the mandible and suprahyoid lymphadenectomy); the most severe postoperative functional disorders were treated immediately (tracheostomy, nasogastric tube for 3 weeks). The reconstruction of the mandible and restoration of the anatomical relationship in the masticatory organ were performed after 5 years. Because of the metastatic disease in the nuchal and cervical lymph nodes boy underwent chemotherapy (Jan 5th 1988-Feb 21st 1990) of the primary site of the tumor 7 months after surgery. The following cytostatic drugs were administered; BLM, CTX, ACT-D, ADM, CDDP. The functional rehabilitation, small correctional surgery and improvement in perception in the oral cavity facilitated the restoration of important functions of the masticatory organ (proved by the following studies: gustometric, manometric, logopedic, stereognostic, rentgenotelevision of the swallowing process). In addition, the self-perception and the boy's social status improved significantly after favourable change in patient's appearance.

[Surgical treatment of cancer of the stomach]. / Operacyjne leczenie raka zoladka.

Patients operated on for gastric carcinoma in the years 1949-1963 were compared with those treated in 1975-1982.

[Immunohistochemical evaluation of the percentage of proliferating neoplastic cells of Wilms' tumor in children by means of the MIB-1 monoclonal antibody]. / Immunohistochemiczna ocena odsetka proliferujacych komórek nowotworowych guza Wilmsa u dzieci przy pomocy przeciwciala monoklonalnego MIB-1.

Quantifying the proliferation of neoplastic cells is an important and objective element in estimating the degree indicating the malignancy of neoplasms and their reaction to applied treatment. The basic problem in the procedure dealing with the Wilms' tumors in children is the classification of patients into appropriate risk groups. The goal of this study was to explore the possibility of determining the proliferation index in Wilms' tumors with the aid of monoclonal antibody MIB-1. The material comprised segments of the tumors taken from 35 children treated at the Children and Youth Oncology Clinic of the Mother and Child Institute in Warsaw as well as at the Pediatric Surgery Clinic of the Pomeranian Medical Academy in Szczecin in the years from 1982 to 1994. Specimens for immunohistochemical investigations were prepared from the tissues of tumors, fixed in paraffin and embedded in paraffin blocs. The positive response of the reaction for the Ki-67 antigen was visible in the form of red-stained granules (Figs. 1, 2, 3, 4). The index for proliferation of the cell nuclei was determined in the individual components of the tumors: blastema, epithelial tissue and stroma. Distinct difference was disclosed to exist between low values for stromal cells (3.3%) and high ones for blastemic cells (22.3%) and epithelial cells (23.7%). The post chemotherapy group revealed higher values of the index within the epithelial cells and lower among blastemic cells as compared to the group without chemotherapy. The prognostic significance of the proliferation index when using monoclonal antibody MIB-1 was studied by dividing the tumors into two groups, namely: below and above 20% of the index value. It was noticed that there was a concurrency of higher proliferation values among blastemic and epithelial cells with worse prognosticating cases. The cases, in which after chemotherapy the index of proliferation within blastema persisted being high, were recorded to predict poorer prognosis.

Aspiration cytology in the diagnosis of malignant tumors in children.

On the basis of 65 fine-needle aspiration biopsies (FNAB) the efficiency of aspiration cytology combined with immunocytochemistry in preoperative diagnosis of malignant tumors in children was evaluated. All FNAB were performed under ultrasound or fluoroscopy guidance. There were no false-positive diagnoses. Morphological type of the tumor was properly diagnosed preoperatively in 50 patients. In 10 aspirates, the tumor type could not be diagnosed on the basis of light microscopy and immunocytochemistry. Due to technical reasons, five false-negative diagnoses (7.7%) were made. This study showed that FNAB is a safe, rapid, and effective method, which enables preoperative diagnosis of children's tumors in most cases.