Delayed Elimination After High-dose Methotrexate in Pediatric Patients with Acute Lymphoblastic Leukemia and Non-Hodgkin Lymphoma

BACKGROUND: High doses of methotrexate (MTX) are often used in various chemotherapy protocols to treat acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL) in children, but its delayed elimination increases the occurrence of adverse events, such as bone marrow suppression. The aim of this study was to investigate the elimination of MTX at 24 and 48 hours. METHODS: We retrospectively analyzed electronic medical records of ALL or NHL pediatric patients who received 5 g/m² MTX infusion over 24 hours (between June, 2012 and July, 2018) at the Yonsei University Health System, Korea. The delayed elimination of MTX concentrations was assessed with 100 or 150 µM MTX at 24 hours, and 2 or 5 µM at 48 hours. RESULTS: Among the 85 MTX cycles administered, 23 cycles were classified in delayed elimination group, and 62 cycles showed normal elimination. At 24 hours, the delayed elimination group with MTX concentration > 100 µM showed higher percentage than group with MTX concentration < 100 µM (45.8% vs. 19.7%, p = 0.015). However, no differences were observed at 150 µM MTX (p = 0.66). At 48 hours, the delayed elimination was higher than the normal elimination at both concentration baselines (p < 0.001 at 2 µM, p = 0.024 at 5 µM). CONCLUSIONS: MTX concentrations greater than 100 µM show high probability of delayed elimination at 24 hours. When MTX levels are above normal, leucovorin and hydration regimens should be continued to prevent delayed elimination.

The Study of Clinical Characteristic Changes in Acute Poststreptococcal Glomerulonephtritis: Comparision of Clinical Manifestations between Recent 5 Years and Past 5 Years / 소아과

PURPOSE: The purpose of this study is to evaluate the clinical characteristic changes of acute poststeptococcal glomerulonephritis (APSGN) in recent. The cases of APSGN occurred for the last ten years were divided into group I and II by the unit of 5 years and clinical manifestations and laboratory findings of each groups were analyzed. METHODS: Total of 74 cases of APSGN, diagnosed at the department of Pediatrics, Chungnam National University Hospital from January 1995 to August 2004 were divided into group I (31 cases from January 1995 to December 1999) & II (43 cases from January 2000 to August 2004). In addition, the clinical records of each group were reviewed retrospectively and compared. RESULTS: In both groups, the prevalence rate was much higher in males than females, the seasonal prevalence rate was higher in winter, the upper respiratory infection was most frequent predisposing illness, and one to two weeks of latent period was the highest. However, the average age for group II were younger than group I. The prevalence rate of gross hematuria was higher in group II, but there was no significant difference between two groups. In the course of clinical symptoms, edema and hypertension were relieved within two weeks in both groups. In group II, the prevalence rate of proteinuria was higher, and the duration of proteinuria and gross hematuria were longer than group I. CONCLUSION: In this comparative study, the average age became younger. Clinically the duration of gross hematuria and proteinuria became longer, and the prevalence rate of proteinuria increased in recent 5 years. However, there was no difference between two groups in clinical courses and prognosis.

Clinical Evaluation of Tissue Biopsy for Children with Neck Mass; A Single Center Study / 소아과

PURPOSE: Neck masses, in pediatric population, derive from a multitude of congenital, inflammatory, or neoplastic diseases. The majority of these masses represent benign conditions. However, thorough clinical evaluation is required to rule out malignant diseases. We evaluated the causes, clinical characteristics and outcomes of children with neck masses who underwent tissue biopsy. METHODS: A total of 28 medical records of children with neck mass who underwent tissue biopsy at Chungnam National University Hospital, from January 2000 to March 2004 were retrospectively analyzed. The methods of biopsy were ultrasonography guided core biopsy (CB), fine needle aspiration biopsy (FNAB) and excisional biopsy. RESULTS: Out of 28 patients, half were boys. The most common location of the mass was the posterior cervical area (N=19, 67.9%). Laboratory findings of peripheral blood and serologic studies were nonspecific. In 25 (89.3%) cases, CB or FNAB was initially performed for neck masses. Among them 10 cases (40%) were reactive hyperplasia, 8 (32%) inflammatory granulation tissues, 4 (16%) necrotizing lymphadenitis, and 3 (12%) acute suppurative inflammations. Initially, excisional biopsy was performed for diagnosis in 3 (10.7%) cases. Diagnosis of these cases was thyroglossal duct cyst, dermoid cyst and lymphoblastic lymphoma, respectively. CONCLUSION: Most neck masses in children were benign. CB and FNAB were safe methods for tissue sampling, without need for general anesthesia.