Pretherapy gallium-67 scanning in paediatric patients with Hodgkin's disease

To investigate the correlation between gallium-67 [67Ga] uptake and histological subtypes of Hodgkin's disease [HD] in paediatric patients. Subjects and Fifty-eight patients [45 males and 13 females aged 9.2 +/- 4 years, range 1.5-17 years] with histologically diagnosed HD underwent pretherapy 67Ga scanning on days 2, 5, 12 or 14 days after intravenous administration of 25-50 MBq [0.7-1.4 mCi] of 67Ga citrate. The scans were evaluated both visually and quantitatively using the activity of 67Ga in the liver as a reference. Clinical outcome of 11 patients with high diffuse 67Ga skeletal uptake was compared with that of 17 patients showing normal distribution of 67Ga in the skeleton. Of the 58 patients, the 67Ga scans were positive in 47 patients with 117 lesions. Visual analysis did not differentiate between the histological variants of HD. However, quantitative analysis of lesion-to-liver ratios showed significantly higher values of 67Ga uptake in the mixed cellularity type than in the nodular sclerosis type [t = -3.7, p < 0.001]. Patients with high skeletal uptake had a higher relapse rate [6/11] than those with normal skeletal uptake [3/17]. The findings show that quantitative analysis of 67Ga uptake can differentiate between the two main subtypes of HD [mixed cellularity and nodular sclerosis]. Further diffuse skeletal uptake of 67Ga indicates a higher relapse rate

Role of iodine-131 MIBG scanning in the management of paediatric patients with neuroblastoma

To evaluate the role of iodine-131 metoiodobenzylguanidine [iodine-131 MIBG] scanning in the management of paediatric patients with neuroblastoma. Subjects and Forty-three iodine-131 MIBG scans were performed on 26 children, 18 male and 8 female, ranging in age from 8 months to 11 years. Bone scan, computed tomography [CT] images and findings of bone marrow biopsy were compared with the iodine-131 MIBG scan findings. Of the 26 patients, 18 [69%] showed abnormal iodine-131 MIBG avidity and were proven to have a neural crest tumour on histology. The remaining 8 [31%] patients had normal iodine-131 MIBG scans, and histology showed a malignancy other than a neural crest tumour. Iodine-131 MIBG scans showed the primary site in 16 of 17 patients while CT showed 14 primary sites. In follow-up studies, the results were as follows: iodine-131 MIBG showed no evidence of disease in 4 compared with 3 on CT, persistent disease in 2 on iodine-131 MIBG and 4 on CT; recurrence in 1 on iodine-131 MIBG and 0 on CT; MIBG scans detected double the number of bony lesions compared with bone scans. The findings on iodine-131 MIBG scans and bone marrow biopsy were in agreement in 16/18 cases. Patients in whom iodine-131 MIBG scans showed disease resolution had better clinical outcomes. The findings indicate that iodine-131 MIBG scanning is useful for the diagnosis, staging, evaluation of response to therapy and detection of recurrences in patients with neuroblastoma. It exhibited a clear advantage over CT in detecting the primary site and soft issue metastases and was also superior to bone scanning in detecting skeletal metastases. It also reliably demonstrated bone marrow involvement

Experience with totally implantable devices for long-term central venous access in children

Intensive chemotherapy and supportive care for paediatric oncology/haematology patients often requires a reliable venous access. The externally exiting central venous catheters are prone to infection and require special care of external tubings. In an attempt to circumvent these problems, a totally implantable device was inserted in 31 paediatric oncology/haematology patients. In 16 patients the device was electively removed at the completion of therapy. In 9 patients the device is still in use while 4 patients died of their underlying disease, with the device in place and functioning. Only 2 devices required premature removal; one for catheter-related sepsis and the other for refractory occlusion. Ease of nursing care, absence of external tubings, low infection rates and improved patient acceptance because of compatibility with normal activities make them suitable for long-term intermittent venous access in children

Osteogenic sarcoma: initial experience at the Shaukat Khanum Hospital

Osteogenic sarcoma is a malignant tumour of bone in which tumour cells form neoplastic osteoid or bone or both. It is not a very uncommon tumour. We saw 66 patients at the Shaukat Khanum Paediatric Oncology Department between January 1995 to November 1996. There was a male preponderance [73%]. Mean age at presentation was 14.38 years. The average tumour length and width at the time of presentation was 21.2cm and 17.45cm respectively. The common site was femur 44.0%. Metastases were present in 45% at presentation. Serum Alkaline Phosphatase was elevated. Majority [79%] of the patients had no treatment prior to presentation. All the poor prognostic factors were present at presentation in almost all the patients. All received neo- adjuvant chemotherapy and all the patients except one were offered amputations. Sixty five percent patients have been lost to follow up