Delays in diagnosis and treatment among children with cancer: Egyptian perspective

Delayed diagnosis is one of the contributing factors to lower cure rates for cancer in low-income countries. This was a cross-sectional study of 138 children with cancer who were treated at the Pediatric Oncology Unit, Oncology Center of Mansoura University, Egypt. One hundred and sixteen patients were initially misdiagnosed. The median total delay was 37 days, including median patient/parent delay of 3 days and median physician delay of 28 days. The type of cancer significantly influenced the diagnostic delay. Patients' sex, level of parents' education, and residence did not significantly affect the median total delay, while patients aged < 5 years and those who had an initial provisional diagnosis of cancer had the shortest median total delay. We suggest implementation of continuing medical education programmes, improving access to diagnostic facilities, and facilitating referral to give priority to those with suspected cancer to shorten the time for cancer diagnosis

Infantile hepatic hemangioendothelioma: an 8-month old infant successfully treated with a corticosteroid

Infantile hemangioendothelioma is a rare benign vascular tumor of the liver. We report a case of hepatic hemangioendothelioma in an 8- month-old female infant who presented with hepatomegaly and respiratory distress, which was successfully treated with oral prednisolone for six months

Tension gastrothorax: a case report and review of literature

Tension gastrothorax develops when the stomach, herniates through a congenital diaphragmatic defect into the thorax and is massively distended by trapped air. We report a case of tension gastrothorax and review the literature. A previously healthy 8 months old female, presented with severe respiratory distress, misdiagnosed as tension pneumothorax. Intercostal tube was inserted. The tube was noted to drain food as well as air. The patient was investigated by radio-contrast swallow, which demonstrated the presence of the stomach in the chest. The patient was operated upon and the stomach, transverse colon and spleen were reduced back to the abdomen. The defects in the stomach and diaphragm were closed. Tension gastrothorax is a life-threatening condition leading to acute and severe respiratory distress. The presence of air filled structure in left hemithorax in a previously healthy child presenting with acute respiratory distress should prompt the inclusion of tension gastrothorax in the differential diagnosis

Prognostic significance of MRD [minimal residual disease] quantification by PCR in childhood acute leukaemia

Twenty five cases with acute lymphoblastic leukaemia were included in this study. They received induction, intensification and maintenance chemotherapy [Modified Berlin-Frankfurt-Munster BMP 76/79 Protocol], plus prophylactic cranial irradiation to a total dose of 1800 cGy/ 2 weeks/ 10 fractions. MRD quantification was done using real-time PCR. It was found that patients with negative MRD had much better overall and relapse-free survivals than those with positive one, 100% versus 20% and 100% versus 25% at the end of 24 months follow-up. Again, it was found that PCR-MRD levels > 0.01 or more can predict the relapse and the prognosis of those cases was much worse than those with lower levels

Hypertonic saline infusion as a prophylaxis against transurethral resection syndrome

Transurethral resection [TUR] syndrome is a well known complication that occurs during or after transurethral resection of the prostate from the absorption of irrigating fluids. In an attempt to prevent this mishaps, 60 patients subjected to transurethral resection of the prostate were studied. They were divided into two groups: The first group [30 patients] received intravenous isotonic saline [0.9%] and the second group [30 patients] received intravenous hypertonic saline [3%]. The incidence of nausea, vomiting and mental confusion were significantly less in hypertonic saline group than isotonic group. Also, the serum Na and osmolality were significantly lower in isotonic than hypertonic group. Serum Na decreased from 142 +/- 6.2 mEq/l to 125.8 +/- 6.1 mEq/l in group I and from 138.2 +/- 5.8 mEq/l to 129.1 +/- 6.3 mEq/l in group II after three hours. The serum osmolality decreased from 298.2 +/- 12.5 mOsm/kg to 274.2 +/- 13.1 mOsm/kg in group I and from 302.1 +/- 9.5 mOsm/kg to 279.3 +/- 9.9 mOsm/kg in group II. These results confirmed that hypertonic saline infusion minimizes the incidence of clinically manifested TUR syndrome as it titrates with the biochemical changes that occur with this syndrome. The use of hypertonic saline infusion encouraged resection of bigger prostates especially when using distilled water as an irrigating fluid

Radio-isotopic predictive recovery of radiologically non functioning obstructed kidney

Radio-isotopic renal scanning was performed in 65 patients with radiological non-functioning obstructed kidneys. The other kidney was normal in 52 patients and showed impaired function in 13 patients. According to renal uptake of the 99m Tc-DMSA, the patients were classified into 2 groups: Group I [40 patients] showed no uptake and group II [25 patients] showed minimal uptake of less than 15%. Drainage of the obstructed kidney was done despite the uptake of the radio-isotope and the kidney was followed for a period of 3 - 10 months by radionuclide studies using 99m Tc-DMSA alone or combined with 99m Tc-DTPA. In group I, no functional recovery was detected up to 6 months. However, in group II, 19 cases out of 25 [76%] showed improvement of kidney function with mean tubular improvement of 9.5%. In the remaining 6 patients [24%], 3 patient showed no improvement and 3 patients showed deterioration of function. Kidneys with preoperative uptake of more than 10% showed improvement of 26.3% but in those with uptake of less than 10% no recovery was found and even deterioration of function could occur