Background: Impaired lung function has been detected in up to 65% of all childhood cancer survivors. It is often caused by exposure to radiation therapy and various chemotherapeutics. The first cytotoxic drug ever identified as a causative agent of lung injury was busulfan, reported in the early 1960s. Signs and symptoms of busulfan lung are nonspecific and it is therefore difficult to differentiate the condition from pulmonary impairment caused by other pulmotoxic agents, infections, pulmonary metastases, graft-versus-host disease, or other noninfectious post-transplant complications involving the lungs. Methods: A case example is provided to illustrate the difficulties in management of busulfan-induced lung injury in children. A retrospective review of cases of busulfan-induced lung injury indexed in PubMed until March 2019 was performed. Inclusion criteria for articles was available in full text in English. Results: Impaired lung function caused by busulfan may become an increasing problem for young survivors. Conclusion: Newly developed dyspnea or subclinical damage detected on pulmonary function tests, indicating primarily restrictive disease, should always arouse suspicion of busulfan-induced lung injury in a child conditioned with busulfan, especially after excluding other leading culprits of pulmonary damage affecting oncology patients.

Background Adolescents and young adults diagnosed with acute lymphoblastic leukemia are treated according to pediatric-based regimens to achieve better results. However, implementation of intensive chemotherapy protocols in this age group is associated with increased treatment-related toxicities, affecting almost every organ and system. In this case, the focus of our interest was on rather rare entities: steroid-induced psychosis that seldom develops in children and adolescents, and choroid plexus hemosiderosis, infrequently identified as a first sign of iron overload. Case presentation The aim of this paper is to present a challenging case of a 15-year-old Caucasian male patient treated for high-risk acute lymphoblastic leukemia and who experienced various adverse incidents during intensive chemotherapy, thus necessitating a high-quality multidisciplinary approach. Slow minimal residual disease clearance was an additional concerning issue. Induction and re-induction were complicated by steroid-induced hyperglycemia that required multiple-week insulin. During consolidation, acute kidney injury on the basis of chronic kidney disease was verified, demanding subsequent drug dose modifications. By the end of re-induction, after dexamethasone cessation, infrequent steroid-induced psychosis, presented as incoherent speech, aggressive behavior, and mood swings, required intensive psychiatric support. Neurological evaluation of seizures revealed uncommon choroid plexus hemosiderosis by brain magnetic resonance imaging, warranting appropriate selection of iron chelation therapy in the context of preexisting nephropathy. Ultimately, iron deposits of moderate intensity were verified by liver magnetic resonance imaging, while heart tissue remained intact. The early diagnosis and adequate treatment of aforementioned difficult toxicities resulted in complete recovery of the patient. Conclusions Treating adolescents with high-risk acute leukemia and multiple therapy-related morbidities remains a challenge, even in the era of extensive and effective supportive therapy. Superior survival rates might be achieved by prompt recognition of both frequent and rarely encountered adverse episodes, as well as well-timed and appropriate management by a well-coordinated multidisciplinary team.

Introduction: The use of complementary and alternative medicine (CAM) has become a customary practice among pediatric cancer patients worldwide. The frequency of its use by pediatric cancer patients in Croatia has not been previously determined.Methodology: In order to establish the frequency and detect factors affecting the use of CAM, a singlecenter, observational, cross-sectional study was conducted at the Children's Hospital Zagreb during a twoyear period. The patients' parents and caregivers were offered an anonymous, multi-item questionnaire that collected socio-economic and clinical data, as well as details on CAM and dietary supplement practice.Results: Almost half of the participants reported CAM and more than two-thirds reported dietary supplement consumption, predominantly in the intensive phase of the treatment. Factors regarding children or parents had no effect on CAM and supplement utilization. Herbal medicine, vitamins, and minerals were among the most commonly used items. Every 10th child experienced at least one adverse event during CAM and supplement use.Conclusion: Awareness of the CAM and dietary supplement application in pediatric oncology patients needs to be raised due to the potential interactions with conventional treatment modalities. For this reason, it is extremely important to inform parents and caregivers of pediatric oncology patients about the use of CAM and dietary supplements to predict and mitigate the occurrence and intensity of the side effects. In the majority of our cases, the patient's guardians informed the healthcare professionals about the CAM and supplement implementation in their children, therefore, they were offered additional information about the possible negative impact of CAM and supplement use on standard medical care in a timely manner.

Both acidic and weakly acidic refluxes seemed to play a significant role in the pathogenesis of OME. Localised nasal eosinophilia may serve as a marker of extraoesophageal reflux in children with suspected reflux-related OME.

An 8-year-old boy, diagnosed with autism, was referred to our department from another hospital due to profound normocytic anemia, without manifest bleeding. Problems started 4 months prior to admission, when he refused to stand on his feet after a minor fall, although an x-ray of his legs excluded fractures and other significant bone pathology. Initially, the refusal to walk was explained by a psychological reaction to fall. However, in the following period his condition progressively worsened; he stopped communicating, became incontinent, apathetic, inappetent, and generally very dissatisfied. Finally, he was hospitalized in critical condition and received urgent erythrocyte transfusion (Hb 4.3 g/dL).On admission, he was in poor general condition, agitated, tachycardic, and pale. Although the patient's body mass index (BMI) was 15.4 kg/m 2 (body height 130 cm, body weight 26 kg), placing the BMI-for-age at the 40th percentile, he seemed severely malnourished, he was sarcopenic and edematous. He had a diffuse perifollicular rash, gingival swelling, multiple dental caries, as well as signs of nutritive deficiency on his nails-leukonychia and Beau's lines. In addition, the patient presented with massive swelling of the left thigh (Figure 1). The skin above the swelling was tense and warm, while all arterial pulsations on the distal extremities were well palpable. Initial laboratory findings revealed normocytic anemia with reticulocytosis (post-transfusion Hb was 10.3 g/dL), severe hypoalbuminemia, hyponatremia, and elevated d-dimer levels. We conducted a Doppler ultrasound examination of both of his legs and abdomen, which excluded venous thrombosis, but detected 2 inhomogeneous soft tissue changes, one along the entire length of the left femur, from the trochanter minor to the femoral condyles, and the other along the left iliac bone. To clarify the etiology of those structures, the patient underwent a whole-body magnetic resonance imaging (MRI) scan which revealed multiple soft tissue changes (skin, subcutaneous mass,