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OBJECTIVE: The objectives of this study were to determine the overall survival (OS) and event-free survival (EFS) rates of patients with medulloblastoma treated in a national pediatric hospital in Peru, as well as to identify demographic, clinical, imaging, postoperative, and histopathological characteristics and prognostic factors associated with OS and EFS. METHODS: The authors conducted a retrospective study analyzing information from the medical records of children with a diagnosis of medulloblastoma who underwent surgical treatment at the Instituto Nacional de Salud del Niño-San Borja, a public hospital in Lima, Peru, from 2015 to 2020. Clinical-epidemiological variables, degree of disease extension, risk stratification, extent of resection, postoperative complications, status of oncological treatment received, histological subtype, and neurological sequelae were taken into account. The Kaplan-Meier method and Cox regression analysis were used to estimate OS, EFS, and prognostic factors. RESULTS: Of the 57 children evaluated with complete medical records, only 22 children (38.6%) underwent complete oncological treatment. OS was 37% (95% CI 0.25-0.55) at 48 months. EFS was 44% (95% CI 0.31-0.61) at 23 months. High-risk stratification-meaning patients with ≥ 1.5 cm2 of residual postoperative tumor, those younger than 3 years, those with disseminated disease (HR 9.69, 95% CI 1.40-67.0, p = 0.02), and those who underwent subtotal resection (HR 3.78, 95% CI 1.09-13.2, p = 0.04)-was negatively associated with OS. Failure to receive complete oncological treatment was negatively associated with OS (HR 20.0, 95% CI 4.84-82.6, p < 0.001) and EFS (HR 7.82, 95% CI 2.47-24.7, p < 0.001). CONCLUSIONS: OS and EFS of patients with medulloblastoma in the author's milieu are below those reported in developed countries. Incomplete treatment and treatment abandonment in the authors' cohort were also high compared with high-income country statistics. Failure to complete oncological treatment was the most important factor associated with poor prognosis, both in terms of OS and EFS. High-risk patients and subtotal resection were negatively associated with OS. Interventions are needed to promote the completion of adjuvant oncological therapy for medulloblastoma in the disadvantaged Peruvian population.
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The synchronous presentation of venolymphatic anomalies of the orbit and noncontiguous intracranial cavernous malformations is uncommon. Herein, we present a case of an 11-month-old female patient diagnosed with orbital venolymphatic anomaly associated with a large cavernous malformation in the posterior fossa, who underwent complete surgical resection of the latter. The immunohistochemical analysis was positive for podoplanin, a marker expressed by lymphatic endothelial cells, but not vascular endothelium. This exceptional finding suggests lymphatic involvement in the etiology of the lesion. In our review of the literature, we did not find similar cases in patients under 1 year of age.
Assuntos
Células Endoteliais , Órbita , Feminino , Humanos , LactenteRESUMO
Objetivo: Conocer la frecuencia de la indicación de antibióticos en niños con diagnóstico clínico de faringoamigdalitis aguda (FAA) y test rápido positivo para estreptococo beta hemolítico del grupo A atendidos en consultorios externos de pediatría, y el tipo de antibiótico indicado con más frecuencia. Material y Métodos: Estudio descriptivo, transversal. La muestra fue de 351 niños de 3 a 15 años diagnosticados como FAA. Abordados a la salida de la consulta y con firma y consentimiento informado a quienes se les aplico una encuesta y se realizó toma de muestra de secreciones faringoamigdalianas, las fueron analizadas mediante el test de inmunoaglutinación para EbhGA (ACON) con una S=91% y E=98%. Resultados: la frecuencia de prescripción antibiótica fue de 42.7% (150). El antibiótico más usado fue la penicilina con 25.4 %, seguido de Macrólidos (14.2%). 15 casos (4.3%) de faringoamiggalitis bacteriana tuvieron Test EbhGA positivo. Nueve de ellos (60%) recibieron antibióticos, la inflamación y el exudado amigdalino se presentaron en 320 (93,4%). Hubo ausencia de tos en 46 casos (13,1%). Se indicó sintomáticos en 51.5% de pacientes. Conclusiones: La frecuencia de FA estereocoptocócica fue baja según el test de detección rápida, la prescripción antibiótica fue 10 veces más indicada que la positividad del test; el antibiótico más utilizado fue la penicilina.
Objective: Generally is to determine the frequency of indication of antibiotic for children with clinically diagnosed acute pharyngitis and positive test for beta hemolytic streptococcus Group A treated at pediatric, clinics, a specific objective is to determine the frequency with which it is negative test for the detection of beta-hemolytic streptococcus for type A (GABHS) in these patients. Material and Methods: We made across-sectional study. The sample was 351 children of 3-15 years diagnosed by his physician as FAA, the departure of your inquiry, the informed consent, they have participated in a survey of the study variables and underwent sampling pharyngeal secretions, these were analyzed using test for GABHS inmunoagglutination (ACON) with S=91%, E=98%. Results: The frequency of antibiotic prescriptions was 42.7% (150). The first common antibiotic was penicillin with 25.4%, the second one, macrolides with 14.2%. There was a 4.3% (15) case of GABHS bacteria pharyngeal confirmed by positive test. Inflammation and exudate tonsillar was presented in 93.4% (328). There was lack of cough in 13.1% (46). The other antibiotic was symptomatic indication in 51.5% of patients. Conclusions: The antibiotic prescription rate more than the actual by the positive test; the most common antibiotic was penicillin. The test was positive in percentage and the mostly is in the school group, the most common symptom was swelling and amygdaline exudate. The other symptomatic medications were given.
