Spontaneous tumor lysis syndrome in a child with T-cell acute lymphoblastic leukemia.

We report a 5-year-old female who presented with unexplained acute renal failure (ARF) and hyperuricemia and who was subsequently diagnosed of T-cell acute lymphoblastic leukemia (ALL). Peripheral smear was initially unremarkable. She required hemodialysis. Two weeks later, peripheral smear showed 40% blasts and bone marrow demonstrated T-cell ALL. Our case was the fifth and the youngest case of ALL with spontaneous tumor lysis syndrome. However, in contrast to previous reports in ALL or acute myeloid leukemia, our patient did not have blasts noted on periphereal blood smear and her white blood cell count and serum lactate dehydrogenase level were normal on admission, a time when dialysis-dependent ARF and severe hyperuricemia were present. Occult hematologic malignancy should be considered in cases of ARF and hyperuricemia of unknown etiology even when peripheral hematologic findings are not informative.

Hyperleukocytosis from arsenic trioxide.

We report the case of a 14-year-old male treated with arsenic trioxide for recurrent acute promyelocytic leukemia. He developed hyperleukocytosis (WBC 111.6 x 10(9)/L) which then resolved while continuing daily arsenic. Hyperleukocytosis without other complications may not be an indication for adding cytotoxic therapy or steroids, nor for discontinuing arsenic trioxide therapy in children.

A longitudinal study in learning preferences and academic performance in first year medical school.

This is a longitudinal study of first year medical students that investigates the relationship between the pattern change of the learning preferences and academic performance. Using the visual, auditory, reading-writing, and kinesthetic inventory at the beginning of the first and second year for the same class, it was found that within the first year, 36% of the class remained unimodal (single) modality learners (SS), 14% changed from unimodal to multimodality learners (SM), 27% changed from multimodality to unimodal modality learners (MS) and 21% remained as multimodality learners (MM). Among the academic performance through subsequent didactic blocks from Clinical Anatomy, Cell and Subcellular Processes to Medical Neuroscience during first year, the SM group made more significant improvement compared to the SS group. Semi-structured interview results from the SM group showed that students made this transition between the Clinical Anatomy course and the middle of the Medical Neuroscience course, in an effort to improve their performance. This study suggests that the transition from unimodal to multimodality learning among academically struggling students improved their academic performance in the first year of medical school. Therefore, this may be considered as part of academic advising tools for struggling students to improve their academic performances. Anat Sci Educ 11: 488-495. © 2017 American Association of Anatomists.

Patient complaints about physician behaviors: a qualitative study.

PURPOSE: Health care institutions are required to routinely collect and address formal patient complaints. Despite the availability of this feedback, no published efforts explore such data to improve physician behavior. The authors sought to determine the usefulness of patient complaints by establishing meaningful categories and exploring their epidemiology. METHOD: A register of formal, unsolicited patient complaints collected routinely at the Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina was used to categorize complaints using qualitative research strategies. After eliminating complaints unrelated to physician behavior, complaints from March 1999 were analyzed (60) to identify complaint categories that were then validated using complaints from January 2000 (122). Subsequently, all 1,746 complaints for the year 2000 were examined. Those unrelated to physician behavior (1,342) and with inadequate detail (182) were excluded, leaving 222 complaints further analysis. RESULTS: Complaints were most commonly lodged by patient (111), followed by a patient's spouse (33), (52), parent (50), relative/friend (15), or health professional (2). The most commonly identified category was disrespect (36%), followed by disagreement about expectations of care (23%), inadequate information (20%), distrust (18%), perceived unavailability (15%), interdisciplinary miscommunication (4%), and misinformation (4%). Multiple categories were identified in (19%) complaints. Examples from each category provide adequate detail to develop instructional modules. CONCLUSION: The seven complaint categories of physician behaviors should be useful in developing curricula related to professionalism, communication skills, practice-based learning.

Diagnosis of Burkitt lymphoma in pediatric patients by thoracentesis.

The diagnosis of Burkitt lymphoma by thoracentesis has been rarely reported in the literature, particularly in children. From 1995 to 2004, we diagnosed six pediatric patients with mature B-cell neoplasms using thoracentesis as the initial diagnostic procedure. The cytology, immunophenotyping, and cytogenetic results of the pleural fluid cells were consistent with mature B-cell malignancies. We conclude that thoracentesis for the diagnosis of Burkitt lymphoma in children is safe, fast, and accurate. It should be strongly considered as an initial diagnostic procedure for pediatric patients with pleural effusions who are suspected of having B-cell malignancies.

Religiosity is associated with the use of complementary medical therapies by pediatric oncology patients.

PURPOSE: To determine the prevalence of complementary and alternative medicine (CAM) use in pediatric oncology patients, the types of CAM used, and the factors associated with the use of CAM. PATIENTS AND METHODS: A questionnaire regarding CAM use was administered to patients/families seen in the pediatric oncology clinic at Wake Forest University Baptist Medical Center over a 12-month period. RESULTS: Based on 195 completed questionnaires, 91 (47%) patients reported use of CAM since diagnosis. Among CAM users, the most commonly used CAM therapies were faith healing, megavitamins/minerals, massage, other dietary supplements, relaxation techniques, and herbal medicines/teas. Forty-one percent of CAM users had not discussed CAM use with their physician(s). In bivariate analysis, CAM use was not associated with age at the time of survey, time since diagnosis, sex, race, parental education, or family income. A trend was noted between CAM use and older age at diagnosis. Families who reported themselves to be "very" religious were more likely to use CAM than those that are "somewhat" or "not at all" religious. CONCLUSIONS: Use of CAM is common among pediatric oncology patients and often is not discussed with the treating physician(s). Patients from very religious families are more likely to use CAM.