Objective:In this study, we evaluated the frequency of euthyroid sick syndrome (ESS) among patients with childhood cancer and its association with the stage of disease, nutritional parameters and cytokines levels.Methods:Eighty newly diagnosed children were included in the study. ESS was assessed in two different ways. According to criteria 1 ESS was present if free triiodothyronine (fT3) was below the lower limit and free thyroxine was within the normal or low limits, thyroid-stimulating hormone (TSH) was in the normal range. According to criteria 2, in addition to the above, it was required that reverse triiodothyronine (rT3) be performed and was higher than normal limits.Results:Three of our pediatric patients had subclinical hypothyroidism and two had subclinical hyperthyroidism. Out of 75 patients, ESS was identified in 14 (17.3%) according to criteria 1 and in eight (10.6%) according to criteria 2. Only fT3 levels were significantly different in the ESS (+) and ESS (-) groups (p<0.05) according to criteria 1. A significantly negative correlation between interleukin (IL)-6 and fT3 was found, according to both sets of criteria. tumor necrosis factor alpha was negatively correlated with fT3 levels only in the criteria 1 group. There were no correlations between IL-1β and fT3, free thyroxine, rT3 and TSH levels.Conclusion:ESS may occur in childhood cancer and thyroid function testing should be performed routinely when cancer is diagnosed.

The treatment of hemangiomas in infancy may be associated with significant morbidity. In addition to morbidity, an objective response cannot be obtained because of the absence of targeted therapeutic options. Herein, we present an infant with a segmental hemangioma and marked glucocorticoid toxicity due to prior steroid therapy that was successfully treated with propranolol. Propranolol was tolerated well and no side effects were observed during the treatment. The only problem to occur was disease recurrence following the withdrawal of propranolol at age 13 months, which was not within the age of spontaneous regression (generally considered as >18 months).

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Conclusion: The prevention and control of infection contributes to the improvement of the prognosis of patients with hematological malignancies. Physicians must be aware of the infection risks and take precautions for infectious complications through the neutropenic period and standard protocols should be established and implemented for patients with hematological malignancies.

With the improvement of survival rates in childhood cancer, attempts are made to develop less toxic treatment modalities and priority is given to the studies about this subject. Health related quality of life is defined as a multidimensional concept involving physical, emotional, mental and social well being as well as perception of the effects caused by disease and its treatment. In this review, we evaluated health related quality of life and the factors affecting it both in patients receiving cancer treatment and childhood cancer survivors. Furthermore, an emphasize was made to the necessity of parent attendance, parent psychopathology and ways of coping evaluation in the assesment of quality of life in children. Key words: Health, quality of life, childhood cancers ÖZET Çocukluk çağı kanserlerinde genel yaşam hızlarının artmasıyla birlikte, geç yan etkilerin azaltılması hedeflenmekte ve bu konudaki çalışmalara öncelik verilmektedir. Sağlık ilişkili yaşam kalitesi hastanın fiziksel, duygusal, mental ve sosyal davranışlar bakımından iyilik halini kapsayan çok boyutlu bir kavram olup, bir hastalığın ve tedavisinin yarattığı etkilerin hasta tarafından algılanışı olarak tanımlanmaktadır. Bu derlemede kanser tanısı ile tedavi verilen ve/veya tedavisi kesildikten sonra hastalıksız olarak izlenen çocuklarda sağlık ilişkili yaşam kalitesi ve bunu etkileyen faktörlerin gözden geçirilmiştir. Ayrıca, çocukların yaşam kalitesi değerlendirilirken ebeveynlerdeki psikopatolojilerin ve stresle başa çıkma yollarının da mutlaka değerlendirilmesi gerektiğini vurgulamıştır. Anahtar kelimeler: Sağlık, yaşam kalitesi, çocukluk çağı kanserleri

Transfusion associated iron overload is an important complication of supportive treatment in children with cancer. The standart treatment of anemia induced by chemotherapy is erythrocyte transfusion. In patients with solid tumors who are treated with intensive chemotherapy regimens, patients with leukemia, and patients who underwent stem cell transplantation show more transfusion requirement resulting in significant iron overload. Ferritin level measurement is the easiest and cheapest method for evaluation of iron overload. Key words: Transfusion, childhood cancer, ıron, chemotherapy. ÖZKanser tedavisi sırasında saptanan aneminin şiddeti hastada kullanılan kemoterapi rejimi ve yoğunluğuna bağlıdır. Kemoterapinin indüklediği aneminin standart tedavisi eritrosit süspansiyonu transfüzyonudur. Yoğun tedavi rejimleriyle tedavi edilen solid tümör ve lösemi tanılı hastalarla, hematopoetik kök hücre nakli yapılan hastalarda kullanılan yoğun kemoterapi rejimleri nedeniyle daha sık transfüzyon ihtiyacı; bunun sonucunda da daha fazla demir yükü ortaya çıkmaktadır. Ferritin düzeyi demir yükünün ölçümünde kullanılan en ucuz ve en kolay yöntemdir. Anahtar kelimeler: Kanser, çocuk, kemoterapi, demir GirişÇocukluk çağı kanserlerinin tedavisinde kullanılan yoğun kemoterapi rejimleri ile uzun dönem sağ kalımda oranlarında önemli düzeyde artış sağlanmıştır. Ancak bu tedavilere bağlı olarak azımsanamayacak miktarda geç yan etki gelişmesi de kaçınılmaz hale gelmiştir. Bu geç yan

AbstractÖz Purpose: We aimed to evaluate iron burden and possible target organ damage in childhood cancer survivors Materials and Methods: Files of patients treated for cancer and completed treatment at least 6 months ago were retrospectively evaluated for treatment duration, duration after cessation of treatment, relapse status, erythrocyte transfusion number given during treatment, liver function tests, ferritin levels, T*2 Magnetic resonance imaging (MRI) results. Results: 118 patients with solid tumors and hematological malignancies were included in the study. There were 44 (37.2%) female, 74 (62.8%) male patients with a mean age of 10.71 ± 4.64 years. There was a weak negative correlation between time after cessation of treatment and ferritin levels. A statistically significant weak positive correlation between ferritin levels and number of erythrocyte transfusions were. Ferritin levels were significantly higher in patients who had relapse (9/118) compared to patients with no relapse (109/118). Conclusion: Transfusion associated iron overload measured by ferritin level was higher patients who were more frequently transfused during treatment. However, abnormal iron accumulation in liver was not detected using qualitative analysis with T*2 MRI method. Amaç:Bu çalışmada kanser tedavisini tamamlamış çocuklarda demir yükünü ve olası hedef organ hasarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kanser tedavisinin tamamlanması üzerinden en az 6 ay geçmiş olan hastaların dosyaları tedavi süresi, tedavi kesildikten sonra geçen süre, nüks durumu, tedavi sırasında verilen eritrosit süspansiyonu sayısı, karaciğer fonksiyon testleri, ferritin düzeyi, T2*Manyetik Rezonans Görüntüleme (MRG) bulguları yönünden retrospektif olarak değerlendirildi. Bulgular: Solid tümör ve hematolojik malignite tanılı 118 hasta çalışmaya dahil edildi. Hastaların 44'ü (%37,2) kız, 74'ü (%62,8) erkek idi. Ortalama yaş 10,71±4,64 yıldı, Ferritin düzeyleri ile tedavi kesildikten sonra geçen süre arasında negatif yönde zayıf korelasyon saptandı. Tedavi süresince verilen eritrosit süspansiyonu sayısı ile ferritin düzeyleri arasında pozitif yönde zayıf korelasyon saptandı. Ferritin düzeyi nüks olan hastalarda (9/118) olmayanlara (109/118) göre istatistiksel olarak anlamlı şekilde yüksek bulundu. Sonuç: Demir yükünün değerlendirilmesi amacıyla bakılan ferritin düzeyleri tedavi sırasında daha sık transfüzyon yapılan hastalarda daha yüksek bulunmuştur. Bununla birlikte, T2*MRG ile karaciğerde anormal demir birikimi tespit edilmemiştir.

Objective: Infection is a common complication in children with malignancies. There is no consistent guidance for environmental infection control and isolation precautions for neutropenic patients (NP). There are differences between centers. The aim of this questionnaire study was to determine these differences in Turkey. Material and Methods:A multicenter-descriptive questionnaire was conducted on 36 centers from different geografical locations of Turkey. Bone marrow transplantation units were excluded. Each center was contacted at least three-times. Questionnaire was answered by two different doctors from each center.Results: Thirty-six centers including 20 (55.5%) University Hospitals, 12 (%33.3) Research Hospitals, three (8.3%) State Hospital and one Private University Hospital participated in this survey. 94.3% of the centers had a bed capacity of 50 beds and over. Twenty-one (58.3%) centers had pediatric infection ward that followed febrile NP. All centers had an infection control committee. 25% (9/36) of the centers always followed pediatric neutropenic fever patients in a single room. 66.6% (24/36) of the centers had toilet in all patients' room. The door features of patients' room included mostly (94.1%, 32/34) manually opened door. Ten (27.7%) centers had hepa filter system, five of them had positive-negative pressure room. Thirteen (38.2%, 13/34) centers prefered hickmann catheter for accessing a patient's central line. Training was given for catheteter care in all centers. Sixteen (44.4%) centers had determined policies about keeping toys in patient rooms. Visitor restrictions were performed in all centers. None of the centers allowed plants or flowers in hospital rooms. There was a neutropenic diet specific for pediatric NP provided in twenty-seven centers (75%). Conclusion:The prevention and control of infection contributes to the improvement of the prognosis of patients with hematological malignancies. Physicians must be aware of the infection risks and take precautions for infectious complications through the neutropenic period and standard protocols should be established and implemented for patients with hematological malignancies.