An educational program provided by nurses to parents of children recently diagnosed with cancer, increased the knowledge of their children's disease. However there was no effect on the levels of anxiety. A feasible educational intervention is proposed that could be implemented at other cancer centers for children.
Selective treatment of febrile neutropenia in pediatric cancer patients Management of pediatric patients with cancer and febrile neutropenia (FN) requires appropriate identification of children at high or low risk of acquiring invasive bacterial infections (IBI), in order to implement selective treatment strategies. Based on international and our own research experience, we propose recommendations for diagnostic screening and management of children with cancer and FN according to their risk of IBI. All pediatric patients with FN must be admitted to hospital for at least 24 hours. During this period clinical and laboratory evaluations are aimed to determine their risk of IBI and to identify potential infectious focii. High risk patients should be managed in the hospital until recovery. Low risk patients can be managed as outpatients. Antimicrobial selection and possible adjustments to therapy will depend on the identification of an infectious focus, and/or local epidemiology and susceptibility patterns. Patients will require periodic clinical and laboratory reevaluation (day 3, 5 and 7 of evolution or more frequently if clinically indicated) irrespective of their risk category; response to treatment can be defined as favorable or unfavorable based in preestablished clinical and laboratory criteria in order to monitor the success of selected strategies.
Rhinocerebral mucormycosis healing in a pediatric patient with active leukemia A 14 year old leukemic patient acquired a subacute sinusitis with neurological compromise. Rhinocerebral mucormycosis was diagnosed by nasal biopsy and cerebral MR images. Based on his theorical bad prognosis a conservative approach was adopted with functional surgery for sinusitis and a long treatment with amphotericin B deoxycolate (8.5 months) totaling a dose of 7.700 mg. Acute leukemia chemotherapy was restarted during antifungal therapy and came into oncological remission. After 31 months follow-up the patient is asymptomatic but relapsed of leukemia.
Retinoblastoma in children, experience at a pediatric hospitalMethods: Retrospective analysis of clinical charts of 41 children (59 eyes) diagnosed with retinoblastoma and treated by a multidisciplinary team at Hospital Luis Calvo Mackenna in Santiago-Chile, between 1999 and 2007. The information included gender, laterality, diagnosis age, presenting signs, tumor spread, treatment modality and survival rate. Results: A total of 23 cases (56%) were unilateral and 18 cases (44%) were bilateral. The mean age at diagnosis was 21.6 months (range 2 -84) and 27 children (65.9%) were male. The most common presenting signs were leucokoria (51.2%), strabismus (24.4%) and proptosis (4.9%). Enucleation was performed in 48 eyes (81.3%), being the only required treatment in 17 children (41.5%). The remaining 24 patients received systemic and/or local therapy with chemotherapy, focal therapy and external beam radiation. 5 children died during the follow -up study period, due to extraocular extension to the orbit, central nervous system and bone marrow. Conclusion: In spite of high enucleation rate as initial therapy for retinoblastoma, the survival rate with this current treatment protocol is similar to those from developed countries.
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