Comparison of Dose Distributions Calculated by Anisotropic Analytical Algorithm and Pencil Beam Convolution Algorithm at Tumors Located in Liver Dome Site / 의학물리

The purpose of this study is to evaluate the variation of radiation dose distribution for liver tumor located in liver dome and for the interest organs(normal liver, kidney, stomach) with the pencil beam convolution (PBC) algorithm versus anisotropic Analyticalal algorithm (AAA) of the Varian Eclipse treatment planning system, The target volumes from 20 liver cancer patients were used to create treatment plans. Treatment plans for 10 patients were performed in Stereotactic Body Radiation Therapy (SBRT) plan and others were performed in 3 Dimensional Conformal Radiation Therapy (3DCRT) plan. dose calculation was recalculated by AAA algorithm after dose calculation was performed by PBC algorithm for 20 patients. Plans were optimized to 100% of the PTV by the Prescription Isodose in Dose Calculation with the PBC algorithm. Plans were recalculated with the AAA, retaining identical beam arrangements, monitor units, field weighting and collimator condition. In this study, Total PTV was to be statistically significant (SRS: p=0.018, 3DCRT: p=0.006) between PBC and AAA algorithm. and in the case of PTV, ITV in liver dome, plans for 3DCRT were to be statistically significant respectively (p=0.013, p=0.024). normal liver and kidney were to be statistically significant (p=0.009, p=0.037). For the predictive index of dose variation, CVF ratio was to be statistically significant for PTV in the liver dome versus PTV (SRS r=0.684, 3DCRT r=0.732, p<0.01) and CVF ratio for Tumor size was to be statistically significant (SRS r=-0.193, p=0.017, 3DCRT r=0.237, p=0.023).

The Effectiveness of Once-daily Intravenous Busulfan as a Conditioning Regime for Hematopoietic Stem Cell Transplantation in Children with Acute Myelogenous Leukemia

BACKGROUND: There have recently been some reports suggesting that once-daily intravenous busulfan (IV Bu) as a conditioning regime for hematopoietic stem cell transplantation (HSCT) possibly reduces the toxicities without influencing the clinical outcome as compared with the traditional 4 times daily dosage schedule. We report here on the clinical outcome of once-daily IV Bu as a conditioning regime for HSCT in children with AML at a single treatment center. METHODS: We retrospectively analyzed nine AML children who received HSCT with using the once-daily IV Bu (110~130 mg/m2 on 4 consecutive days) conditioning regimen at the Department of Pediatrics, Pusan National University Hospital from 2003 to 2007. RESULTS: The median age at HSCT was 8.25 years. As for the conditioning regimens, the HLA-matched sibling peripheral HSCT (N=4) was Flu/Bu, the CBT and unrelated BMT (N=4) was Flu/Bu/ATG and the autologous HSCT (N=1) was Bu/Cy. There was only one case of primary graft failure in an unrelated donor CBT recipient. The median time to neutrophil engraftment was 14 days and the median time to platelet engraftment was 19 days. The transplant-related toxicities were acceptable; there were no case with CNS toxicity and VOD was observed in two cases (1 mild case of VOD and 1 moderate case of VOD). Acute GVHD was noted in two cases (1 case of grade I and 1 case of IV). With a median follow up of 33 months, there were two cases of relapse and two cases of death. CONCLUSION: Once-daily IV Bu as a conditioning regimen for HSCT in children with AML was well tolerated and convenient with relatively moderate toxicities, but additional studies are needed to determine the therapeutic efficacy and pharmacokinetics of once-daily IV Bu in children who are undergoing HSCT.

A Case of Acute Renal Failure Caused by Rhabdomyolysis due to Hyperosmolar Nonketotic Coma in Children / 소아과

Hyperosmolar nonketotic coma complicated in diabetes mellitus has been a rare cause of rhabdomyolysis, although increasingly reported recently. Acute renal failure can be complicated in 15 percent of rhabdomyolysis patients, but is rare in the case of rhabdomyolysis caused by diabetic hyperosomolar nonketotic coma. We report a 14 years-old boy with acute renal failure complicated by rhabdomyolysis caused by diabetic hyperosmolar coma.

Polypectomy by Intraoperative Total Gut Endoscopy in a Child with Peutz-Jeghers Syndrome / 대한소아소화기영양학회지

Peutz-Jeghers syndrome is an autosomal dominant inherited syndrome characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyps. The most important complications that increase morbidity are intussusception, bleeding and obstruction. Most patients with Peutz-Jeghers syndrome may undergo multiple laparotomies for complications such as intussusception or bleeding every 2 to 3 years during adolescence and early adulthood. To decrease the relaparotomy rate, intraoperative endoscopy may be useful in the treatment of complications that are related to Peutz-Jeghers syndrome. Use of intraoperative endoscopy can lead to a healthier life and to a longer life expectancy for the patient. We describe a case of Peutz-Jeghers syndrome, who underwent polypectomy by total gut endoscopy in an 11-year-old girl presented with intestinal obstruction and anemia. During the course of the operation, the endoscope was inserted per the enterostomy and colostomy sites, and 16 polyps in the small and large intestine were removed endoscopically using a snare.

Clinical Features of Eosinophilic Colitis Developed in Early Infancy / 대한소아소화기영양학회지

PURPOSE: Eosinophilic colitis is a disease characterized by gastrointestinal symptoms, peripheral eosinophilia, eosinophilic infiltration of the colonic wall. The etiology and pathogenesis of this disease is not clear and it is considered to be idiopathic. This study aimed to ascertain the clinical features, treatment and prognosis of eosinophilic colitis in early infancy. METHODS: We reviewed 6 infants retrospectively, presented with bloody stool in early infancy, who were diagnosed with eosinophilic colitis in Pusan National University Hospital between August 2002 and February 2004. RESULTS: Five males and one female were included. The mean age when bloody stool was identified was 79.2+/-56.1 days (10~145 days). All but one infant with atopic dermatitis did not have other allergic diseases. Nobody had a family history of allergic disease. No specific dietary history in infants and their mothers related to food allergy was identified. Peripheral eosinophilia (total WBC count 11,763+/-3,498/mm3, eosinophils 17.0+/-4.3%, absolute eosinophil count 2,044+/-996/mm3) was observed in all infants. Colonoscopy in six infants revealed diffuse erythema, congestion and granulation pattern of mucosa in the rectosigmoid colon. Histopathologic findings of colononic biopsies showed chronic inflammation with severe eosinophilic infiltration in the mucosa. Two infants were treated with hydrolyzed casein-based formula and four infants with prednisolone. Gastrointestinal symptoms and peripheral eosinophilia resolved completely with prednisolone and partially with a hydrolyzed casein-based formula. Relapse was not observed during the follow-up period. CONCLUSION: Our study demonstrated that there is no evidence of a definite relationship between eosinophilic colitis and food-allergic disorders. Clinical course and prognosis of infantile form of eosinophilic colitis is very favorable and treatment with prednisone was effective.

A Comparative Analysis according to Age for Acute Idiopathic Thrombocytopenic Purpura in Children: Especially in Infants under 1 Year of Age / 대한소아혈액종양학회지

PURPOSE: The age-related clinical expression of acute idiopathic thrombocytopenic purpura (acute ITP) in children is unclear. In particular, information about acute ITP during the first year of life is limited. To find several features distinguishing infants from older children with acute ITP. We evaluated the clinical features, laboratory data, treatment outcomes of childhood acute ITP. METHODS: We retrospectively analysed the data of newly diagnosed 61 children with acute ITP at Pusan National University Hospital between January 1999 and December 2003. RESULTS: The mean age at the diagnosis of childhood acute ITP in our study was 4.7+/-3.9 years of age. In the age groups less than 1, 1~10 and older 10 years there were 14 (23.0%), 37 (60.6%), 10 (16.4%) cases, respectively. Male to female ratio was 1.6 : 1. The mean platelet count at the diagnosis of acute ITP in infants was significantly lower compared to the older age groups (P=0.001). Infants responded favorably to initial intravenous immunoglobulin treatment compared to the older age groups (P < 0.05). In infants, platelet count began to rise rapidly after initial intravenous immunoglobulin treatment. Among the 61 cases who were followed up over 6 months, 14 cases (23.0%) progressed to chronic ITP. Chronic ITP was seen significantly less frequently in infants (7.4%) than other age groups (P < 0.05). CONCLUSION: Infants with acute ITP tend to respond favorably to initial intravenous immunoglobulin treatment. Also, they are less likely to develop chronic ITP compared to the older children.

A Case of Shwachman-Diamond Syndrome / 소아과

Shwachman-Diamond syndrome(SD syndrome) is a rare genetic disorder chracterized by pancreatic insufficiency, short stature, skeletal abnormalities and bone marrow dysfunction. Exocrine pancreatic insufficiency and neutropenia are the main components of the syndrome. A hallmark of SD syndrome is varying severity of pancreatic dysfunction due to acinar maldevelopment. The hematologic abnormalities associated with SD syndrome include varying cytopenias, marrow aplasia, myelodysplasia and a high risk of development of leukemia. We report a case of SD syndrome in a 10-year-old boy who presented with failure to thrive and myelodysplastic syndrome.