Megestrol acetate therapy is a powerful appetite stimulant which led to weight gain, composed of both fat mass and fat-free mass. Megestrol acetate is well tolerated, with few and mild side-effects. If megestrol acetate therapy is started at the onset of anorexia, the use of more expensive, invasive and complicated techniques of nutritional support may be avoided.
Partial splenic embolization (PSE) was introduced as an alternative to splenectomy to avoid the risk of post-splenectomy sepsis and to reduce the number of situations in which surgery would be dangerous or not feasible [5]. PSE is an accepted therapy for the treatment of secondary hypersplenism in various disorders, including oesophageal variceal haemorrhage [3] As an alternative to surgical splenectomy, PSE was performed on a 7-year-old girl with hereditary spherocytosis and hypersplenism who initially presented with a haemolytic crisis; haemoglobin values of 6.8 g/dl, jaundice and splenomegaly. She needed blood transfusions on two occasions due to persistent anaemia, with Hb values between 6.8-9 g/dl. PSE was performed following the Spigos protocol [8].Peripheral blood cell counts were repeated on days 1, 3, 7 and 15, and then 1, 3, 6, and 12 months after PSE (see Table 1). Abdominal ultrasound 1 month after PSE showed a 17% reduction in spleen size, with embolization of approximately 75% of the spleen.Maddison [7] performed the first successful splenic arterial embolization in 1973. The procedure was initially associated with significant morbidity and mortality, but subsequent series report substantially improved results [6]. We performed the embolization technique described by Spigos [1,3,6,8] because it has a very low risk of complications, although Israel et al. [5] recently reported a lower rate of complications using polyvinyl alcohol.The increase in haemoglobin values found in our patient has been observed in patients affected by other diseases who have required PSE [5]. The thrombocytosis observed in our patient during the first 15 days after PSE that returned to normal values over 3 months, has been previously reported [3,5]. This increase in platelet count appears to be
Debido al aumento de la supervivencia de los pacientes oncológicos pediátricos como consecuencia de tratamientos más agresivos y de nuevas terapias, se ha observado un incremento en la incidencia de segundos tumores.
Se presentan cinco casos de pacientes que desarrollaron una segunda neoplasia al cabo de un periodo variable, comprendido entre 6 meses y 17 años desde el diagnóstico del tumor primario. Los segundos tumores han sido: un histiocitoma fibroso maligno de órbita tras retinoblastoma bilateral, un osteosarcoma multifocal tras eduloblastoma de cerebelo, un sarcoma de Ewing de peroné tras neuroblastoma de glándula suprarrenal, un carcinoma medular de tiroides tras osteosarcoma de fémur y una leucemia linfoblástica aguda tras osteosarcoma de fémur.
Se realiza una revisión de la literatura y se comentan los diferentes factores predisponentes genéticos, inmunológicos y terapeúticos.
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