Reduced volume of red blood cell priming is safe for pediatric patients undergoing therapeutic plasma exchange.

RATIONAL: Therapeutic Plasma Exchange (TPE) procedures in pediatric patients are challenging due to the large extracorporeal volume of the cell separators, which were designed for adults. Red blood cell (RBC) priming is an alternative for overpassing the risks of hypovolemia, but data referring to the volume of packed RBCs to be infused are yet incomplete. Restricting the volume of RBC priming may potentially be associated with less transfusion reactions. GOAL: To determine the safety of administering a reduced volume of RBC priming for pediatric patients undergoing TPE, in comparison to the standard volume recommended by the cell separators' manufacturers. METHODS: This was a case-control study which enrolled 15 pediatric patients undergoing TPE and weighting more than 10Kg. The TPE procedures (n = 406) were divided in two groups: 1) Group1: TPE with ≤150 mL of packed RBC priming and 2) Group2: TPE with 150-250 mL of RBC priming. Groups were compared in terms of hemoglobin / hematocrit and occurrence of adverse reactions. RESULTS: Group1 and Group2 did not differ significantly in relation to pre- and post-TPE hemoglobin (Hb) levels (p = 0.19 and p = 0.18, respectively). The Δ Hb (Hb pre-TPE - Hb post-TPE) was also not statistically different between the groups. The number of adverse reactions was significantly higher in Group 2 in relation to Group 1 (p = 0.01). The number of allergic reactions was also higher in Group 2 (p = 0.06). CONCLUSIONS: Restricting the volume of RBC priming to less than 150 mL is safe for pediatric patients weighting more than 10Kg and associated with lower rates of transfusion-related adverse reactions.

An unusual abdominal wall mass in a child.

Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.

An unusual abdominal wall mass in a child

ABSTRACT Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.

Non-neoplastic bulky mediastinal mass presentation in an adolescent patient: a case report.

INTRODUCTION: Mediastinal masses in pediatric patients are very heterogeneous in origin and etiology. In the first decade of life, 70% of the mediastinal masses are benign whereas malignant tumors are more frequent in the second decade of life. Among the mediastinal masses, lymph nodes are the most common involved structures and could be enlarged due to a lymphoma, leukemia, metastatic disease, or due to infectious diseases as sarcoidosis, tuberculosis and others. CASE PRESENTATION: We report a case of a 13-year-old Caucasian girl who came to the emergency room with a history of intermittent fever, weight loss and night sweating for at least 1 month. A radiologic image work-up presented an anterior and posterior mediastinal mass. The 18F-fluorodeoxyglucose positron emission tomography presented a high maximum standard uptake value, which directed our decision for mediastinal biopsy for diagnostic elucidation. Histologic examination described the mass as granulomatous tuberculosis. The patient was treated with anti-tuberculosis therapy and developed a full clinical recovery. CONCLUSIONS: The present case report demonstrates that a bulky mediastinal lymphadenopathy detected on 18F-fluorodeoxyglucose positron emission tomography is not always a malignant lesion, and in countries where tuberculosis is endemic, this etiology should not be forgotten during clinical investigations. There is a need for more accurate cut-off values for this technology; meanwhile, the further investigation of patients with bulky mediastinal masses with procedures such as the open biopsy is indispensable.

Simultaneous occurrence of biphenotypic T cell/myeloid lesions involving t(12;13)(p13;q14) in a pediatric patient.

This paper chronicles a 2-year-old girl who presented with acute leukemia/lymphoma syndrome of the T cell immunophenotype. At this time, the cytogenetic analysis of her bone marrow cells showed a reciprocal translocation between the short arm of chromosome 12 and the long arm of chromosome 13, t(12;13)(p13;q14). The immunophenotyping of bone marrow blast cells by flow cytometry revealed a population of cells positive for CD56, CD117, CD45, partial CD33, partial HLA-DR, CD13, CD7, CD2 and CD5. Therefore, a diagnosis of acute leukemia with a mixed T cell/myeloid phenotype was made. The patient had a poor response to classic T cell acute lymphocytic leukemia/lymphoma therapy; thus, her treatment was changed to a myeloid leukemia protocol, which produced a good response. She underwent a successful cord blood transplantation from an unrelated HLA partially matched donor. The coexistence of these two phenotypes prompts questions about the existence of clonal instability, which might influence the choice of therapy. The rarity of the t(12;13)(p13;q14) and the coexistence of T cell/myeloid markers suggest a nonrandom association. To the best of our knowledge, this is the first reported case in which a cell clone bearing a t(12;13)(p13;q14) translocation in a mixed T cell/myeloid lesion was detected.

Uso do cianoacrilato na síntese da pele de ratos: trabalho de pesquisa experimental / Use of cyanoacrylate in rats skin synthesis: experimental research work

O objetivo deste estudo foi investigar o uso dos adesivos etil-cianoacrilato e butil-cianoacrilato com o náilon monofilamentar, comparativamente , na síntese da pele de ratos. Trinta e dois ratos foram distribuídos em três grupos: A, B e C. Estes grupos foram divididos em dois subgrupos, para estudo no sétimo e no décimo-quarto dia pós-operatório. Foram efetuadas no abdome do rato, duas incisões longitudinais e paralelas distando cada uma delas um centímetro da linha mediana, sendo uma do lado direito e a outra do lado esquerdo. Em todos os grupos a síntese da incisão do lado direito, foi realizada com pontos separados de náilon 5-zeros, sendo este considerado o grupo controle (C). Nos animais do grupo A, a síntese do lado esquerdo foi realizada com etil-cianoacrilato (Super Bonder) e nos animais do grupo B, a síntese foi realizada com butil-cianoacrilato (Histoacryl). No sétimo e no décimo-quarto dia pós-operatório, o aspecto macroscópico da cicatriz não mostrou diferença significante. No aspecto microscópico os grupos B e C foram melhores do que o A. Os resultados demonstraram que a síntese com o adesivo sintético é eficaz, mais rápida, indolor e com bons resultados estéticos.

Enxerto de fáscia lata autógena em ferimentos penetrantes provocados no esôfago cervical de cäes / Autogenous graft off fascia lata in the prenetating provoked injuries of the cervical esophagus of dogs

O objetivo da pesquisa foi estudar a eficácia do enxerto autógeno de fáscia lata, para tratar ferimentos penetrantes provocados no esôfago cervical de caes. Foram estudados comparativamente dois procedimentos operatórios para se corrigir lesoes orificiais provocadas na parede do esôfago cervical do cao com uma área padronizada de 3,12cm2,. Foram operados 40 caes, divididos em 2 grupos iguais denominados, grupo A (sutura) e grupo B (enxerto). Cada grupo foi subdividido em dois sub grupos denominados A1, A2 e B1, B2, com 10 animais cada para serem reoperados no 7 e no 30 P.O. respectivamente. No grupo controle, (A) foi aplicada a sutura em plano único extramucoso com pontos simples de náilon 5-zeros. No grupo experimento (B) aplicou-se para ocluir o defeito provocado um enxerto de fásica lata, suturado à borda da parede do esôfago com pontos simples extramucoso em plano único, com fio de náilon 5-zeros. Comparou-se os achados macroscópicos e micorscópicos dos dois grupos nao se observando diferença estatística significante, mas quanto ao aspecto clínico, os animais do grupo A apresentaram resultados melhores no que se refere a formaçao de fístulas apresentando um caso, enquanto o grupo B apresentou cinco casos Conluiu-se que a fáscia lata nao é eficaz para tratar ferimentos penetrantes no esôfago cervical de caes.