Pre-operative control of arterial hypertension using ketoconazole in pediatric patients with adrenocortical tumors.

Adrenocortical tumors are rare in childhood, appearing more frequently in some regions such as South and South-eastern regions of Brazil and India. Common clinical signs include virilization, Cushing's syndrome, feminization and hypertension, either isolated or in association. The aim of this report is to present our experience with the pre-operative use of ketoconazole in children with an adrenocortical tumor to control elevated blood pressure levels non-responsive to the usual treatment. Over the last 16 years, of 46 children diagnosed as having adrenocortical tumor, 17 developed hypertension (diastolic pressure greater than the 95th percentile for age and sex according to data from the Task Force on Blood Pressure Control in Children), associated with virilization and/or Cushing's syndrome. In three of these 17 patients, conventional antihypertensive therapy failed, and they were treated with ketoconazole (200-300 mg/day). This resulted in rapid control of the blood pressure. It is concluded that in selected patients, ketoconazole may be useful adjuvant therapy for the palliative control of the arterial hypertension secondary to adrenocortical tumors, without side effects.

Median sternotomy for the resection of bilateral pulmonary metastases in children.

Childhood cancer often results in pulmonary metastases, and proper identification and prompt treatment of these lesions increases the survival of these patients. Between 21 May 1995 and 26 June 1996, nine children (five with osteosarcoma, two with Wilms' tumor, and one each with hepatoblastoma and an adrenocortical tumor) underwent median sternotomy at our institution for resection of bilateral pulmonary metastases. These five boys and four girls ranged in age from 2 to 16 years (median, 11 years). Identification and resection of metastases in all lobes of the lungs was greatly facilitated by the median sternotomy approach because both thoracic cavities were fully accessible. In each of five patients, as many as 23 metastases were removed using wedge resection or a stapling device. Multiple biopsies only were obtained from the four remaining patients, whose lesions were too numerous and diffuse for effective resection. All nine patients recovered uneventfully; the median hospitalization was 3 days (range, 2-5 days). We find that median sternotomy is a safe, effective, and relatively simple procedure for resecting bilateral pulmonary metastases in children with cancer.