RESUMO
BACKGROUND: Malignant hepatic tumors (Mht) are rare in children. Among them hepatoblastoma (HB) is the most common. AIM: To report the results of the multidisciplinary management in 6 consecutive children: five HB and one metastatic Wilms tumor (MWT). PATIENTS AND METHODS: The mean age of patients was 42 months. All HB patients had elevated serum alfafetoprotein (median 150,000 ng/ml). All patients received preoperative chemotherapy: HB patients received carboplatin/doxorubicin alternating with cisplatin, and the MWT patient, vincristine alone. Surgery included two formal right and two formal left hepatectomies, one extensive central resection with partial left segmentectomy, and one lateral segmentectomy. Extracorporeal circulation was used in the child with atrial involvement. All patients received postoperative chemotherapy. RESULTS: All tumors had variable regresion on preoperative chemotherapy. Complete resection with negative margins was achieved in all patients. The degree of tumor necrosis on histology ranged from 60% to 90%. Alfafetoprotein levels fell to under 10 ng/ml in all HB cases, one to three months after surgery. All patients survive free of disease at a median follow up of 19 months. CONCLUSION: A multidisciplinary approach including the well timed used of chemotherapy and surgery is highly effective in the management of pediatric malignant tumors.
Assuntos
Hepatoblastoma/terapia , Neoplasias Renais/terapia , Neoplasias Hepáticas/terapia , Tumor de Wilms/terapia , Criança , Pré-Escolar , Terapia Combinada , Feminino , Hepatoblastoma/diagnóstico , Humanos , Lactente , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Neoplasias Hepáticas/diagnóstico , Masculino , Tumor de Wilms/diagnóstico , Tumor de Wilms/secundário , alfa-Fetoproteínas/análiseRESUMO
Acute epiglottitis caused by Haemophilus influenzae type B (Hib) is seldom described in Chile. To reinforce the need to take this severe entity into account in the differential diagnosis of acute upper respiratory tract obstructions, the case of a 9 month old girl is described, who's symptoms were initially attributed to acute laryngitis, but showed not response to racemic epinephrine and betamethasone therapy. The correct diagnosis of acute epiglottitis was suggested five hours after admission by lateral neck's radiographs and confirmed by direct laryngoscopic examination under general anesthesia. Appropriate treatment was soon instituted including tracheal intubation respiratory support and antibiotics. An uneventful clinical course proceeded from then on. Hemophilus influenzae B was isolated from blood cultures.