Hypertension and hypoglycemia in a child with hepatoblastoma: a case report

Hepatoblastoma is the most common malignant tumor in the pediatric age group. It is treated with chemotherapy and surgery with excellent results. In majority of the cases ,the course of treatment is uncomplicated. Rarely there could be unexpected complications like hypertension due to hypersecretion of renin or severe hypoglycemia due to production of insulin like substances by tumor cells. These episodes can complicate the management of the case. We report a rare case of hepatoblastoma in an eight-year-old child who had both the complications. To the best of our knowledge, this is the first such case to be reported in literature

Treatment failure with disease-modifying antirheumatic drugs in rheumatoid arthritis patients

<p><b>INTRODUCTION</b>Rheumatoid arthritis (RA) patients taking disease-modifying antirheumatic drugs (DMARDs) may experience treatment failure due to adverse effects or a lack of efficacy/resistance. The purpose of this study was to evaluate the prescription patterns, the incidence and reasons for failure, and the time to treatment failure of DMARDs in RA patients.</p><p><b>METHODS</b>The medical records of patients visiting the Rheumatology Clinic were scrutinised retrospectively in order to extract the relevant data, including demographics, clinical and laboratory investigations and drug usage, for analysis.</p><p><b>RESULTS</b>More than 60% of the 474 eligible patients were started on a combination of DMARDs. Hydroxychloroquine (HCQ) (79.7%) and methotrexate (MTX) (55.6%) were the most common DMARDs prescribed initially. There was a significant difference in survival times among the various treatment groups (p ≤ 0.001). Adverse effect was the main reason for treatment failure of sulfasalazine (SSZ) (88.9%) and MTX (75%), while addition or substitution DMARDs was more common for those taking HCQ (72.2%). Adverse event was reported as the most significant predictor of treatment failure. The most commonly reported adverse effects were bone marrow suppression and hepatotoxicity.</p><p><b>CONCLUSION</b>A combination of DMARDs was used to initiate therapy in more than 60% of RA patients, with HCQ and MTX being prescribed most frequently. Adverse effects accounted mainly for treatment failures with MTX and SSZ, while lack of efficacy was responsible for major treatment failures with HCQ.</p>

An Unusual Case of Amoebic Liver Abscess Presenting with Hepatic Encephalopathy: A Case Report

Amoebic liver abscess (ALA) with jaundice and encephalopathy is a rare occurrence and has been recognised and studied more frequently in recent years. We present a case of massive ALA presenting with jaundice, hepatic encephalopathy, and septicaemia that was treated successfully with percutaneous drainage of the abscess, right-sided chest tube insertion, and anti-amoebic therapy.

Three cases of amoebic liver abscess causing inferior vena cava obstruction, with a review of the literature / 대한간학회지

Amoebic liver abscess is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. We report three cases of amoebic liver abscess complicated with obstruction of the IVC and which responded to conservative treatment or radiological intervention.

Outcome of children with Hodgkin's disease. A 10-year experience from a single institution in Kuwait

To evaluate the outcome of children with Hodgkin's disease over a period of Loyrs from a Single instituhon in Kuwait Sixty-three children with previously untreated Hodgkin's disease, who were diagnosed at the Pediatric Oncology Unit of Kuwait Cancer Control Centre, Shuwaikh, Kuwait from January 1998 to December 2007 were included in the study. All cases were proved by histopathology, and staging was carried out according to the Ann Arbor system. Our series included 37 [59%] males and 26 [41%] females with a median age of 10 years [range 3-15 years]. B symptoms were present in 20 [32%] children. Bulky disease was noted in 28 [44%] children, with stages III in 8 [13%] and IV in 12 [19%] children. Chemotherapy was administered as a primary treatment in 63 children. The median number of chemotherapy cycles given was 6 [range 2-8]. Radiotherapy was used in 40 [63%] children. Grade III hematological toxicity was observed in 23[37%] and grade IV in 14 [22%] children. Hypothyroidism was observed in 20 [32%] children. Fifty-five children achieved a complete remission [87%] and 2 children achieved a partial remission [3%] with an overall response rate of 90%. Three children achieved a progressive disease [5%] and response could not be evaluated in 3 [5%] children. At a median follow-up of 67 months [5.5 years], the overall survival was 91%. With moderate toxicity, combined modality therapy is effective in the treatment of childhood Hodgkin's disease

Ewing's sarcoma as second malignant neoplasm after retinoblastoma: a case report

To report a case of a child with the hereditary form of unilateral retinoblastoma [RB], who developed Ewing's sarcoma of the right fibula 3 years after the enucleation of the right eye. The child was diagnosed as a case of RB of the right eye at the age of 9 months. He was fully investigated and found to have locally advanced RB with bone marrow involvement [Reese-Ellsworth stage IVA]. Enucleation was recommended to the family, but they refused. The patient received chemotherapy and diode laser thermotherapy in Kuwait and the UK. He had a local relapse after 11 months and subsequently underwent enucleation of the right eye. After 3 years, he was investigated for a small swelling in his right lower leg. After extensive investigations, it was reported as Ewing's sarcoma. He was treated with chemotherapy, surgery [complete excision of the fibula] and high-dose chemotherapy followed by autologous stem cell transplantation. The child is now nearly 2 years after completing the treatment and is disease free. This case confirms the increased risk of a second malignant neoplasm [SMN] in children with hereditary RB. These children need a very close follow-up for the early diagnosis of SMNs or even subsequent malignancies

Acute transient cerebral toxicity associated with administration of high-dose methotrexate. A case report

To report the first case of transient central nervous system toxicity after administration of high-dose methotrexate [HDMTX] in the Middle East. Clinical Presentation: A 10-year-old boy was diagnosed with osteosarcoma of the proximal end of the left tibia. He underwent primary amputation and was started on adjuvant chemotherapy, which included administration of HDMTX. He developed acute cerebral toxicity after the 5th dose of HDMTX in the form of diplopia, seizures and disorientation. He recovered completely without any complication or neurological sequelae. The acute cerebral toxicity associated with HDMTX was completely reversible and without any sequelae