A seven-month old male infant presented to the emergency department with progressive distension of abdomen noticed by his parents since the age of 4 months. A disproportionate increase in size was noticed in the past 3 days. There were multiple episodes of non-projectile vomiting in the previous 2 days. There was no haematemesis or rash over the body. His weight was 7 kg and length was 66cm.On examination, he was afebrile and had massive hepatomegaly; the spleen was not palpable and there was no lymphadenopathy. Routine haemogram showed moderate anemia (7.2 g/dl) and high ESR (46 mm/1st hour). Serum aspartate transaminase was 78 IU/ml, total bilirubin 1.6 mg/dl and indirect bilirubin 1.03 while Alpha Fetoprotein (AFP) was high (302ng/ml). Abdominal CT scan showed a large mass measuring 72 x 68 mm involving almost the entire liver [Table/ Fig-1].Considering the age, clinical symptoms and radiological findings, a provisional clinical diagnosis of hepatoblastoma was made. Consent for open liver biopsy could not be obtained however needle biopsy was performed using Menghini needle and under the cover of diluted intravenous ketamine. Biopsy was immediately fixed in 10% formalin and sent for histopathological examination.Gross examination: Liver biopsy was received in two bits together measuring 10x4x4mm.
Introduction: Acute Lymphoblastic Leukaemia (ALL) is the most common malignancy in children. Due to the better understanding of biology, intensive multi-agent chemotherapy and improved supportive care, ALL is curable in majority of children. Induction phase is the most intense and critical phase of therapy. Aim: To examine the feasibility of high-intensity induction and its tolerance in a resource-limited setting in children with acute lymphoblastic leukaemia. Materials and Methods: This retrospective analysis was done on children admitted for ALL treatment. Data was collected for January 2016 to July 2018, regarding baseline characteristics, tolerance to induction therapy, morbidity, mortality, deviations from protocol, and induction outcomes among children with ALL treated at a tertiary care teaching hospital (Cancer Research Institute, Himalayan Institute of Medical Sciences, Dehradun, Uttrakhand, India). Confirmed cases of ALL with age upto 18 years, who took more than a week of planned induction were included in the study. Data was analysed using Chi-square and Fisher-Exact test. Results: Four-drug induction was feasible and given to 76 patients during the study period. Mean age of the group was 9.3 years. Male: female ratio was 1.3:1. Remission was achieved in 63 (82.8%) patients. Four deaths occurred, and were attributed to infection. Hyperglycaemia (4), CNS events (2), peripherally inserted central line related thrombosis (2) and pulmonary tuberculosis (1) were noted among four, two, two, and one cases, respectively. Febrile neutropenia was noted in 65 cases and seven cases required ICU care; two of them succumbed in the ICU. Baseline blood parameters, subtype of disease, protocol of treatment and age did not affect the induction outcome statistically. Conclusion: Intensive induction chemotherapy has varying complications and can be employed even in resource-limited settings with acceptable results.
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