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Pediatric Just The Facts - part 7

Điều trị ung thư liên quan đến tăng (ICP). • Dexamethasone, ± mannitol hoặc tăng thông khí. • shunting não thất hoặc ventriculostomy thứ ba có thể được yêu cầu. • Các hiệu ứng trễ bao gồm nhận thức thần kinh bệnh tật, không tăng trưởng, bất thường neurobehavioral, endocrinopathies, thâm hụt đầu mối thần kinh, và các hiệu ứng tâm lý xã hội. | 376 SECTION 13 MALIGNANCIES Treatment of tumor-associated increased ICP. Dexamethasone mannitol or hyperventilation. Ventriculoperitoneal shunting or third ventriculostomy may be required. Late effects include neurocognitive morbidity growth failure neurobehavioral abnormalities endocrinopathies focal neurologic deficits and psychosocial effects. 103 LEUKEMIA__ Elaine R. Morgan EPIDEMIOLOGY Most common childhood extracranial malignancy. Incidence 4-6 per 100 000 children. Peak age range 3-6. M F increased incidence in identical twin if one child has leukemia 20-50 within 1 year. PREDISPOSING CONDITIONS Down syndrome acute lymphocytic leukemia ALL and acute nonlymphocytic leukemia ANLL . Human immunodeficiency virus HIV infection ALL Ataxia telangiectasia T-cell ALL Bloom syndrome Kostman syndrome Fanconi syndrome AML Medically treated AA Myelodysplasia Prior chemotherapy INITIAL PRESENTING SYMPTOMS AND SIGNS Most common presentations include fever bone pain fatigue pallor bleeding and respiratory distress secondary to mediastinum mass. Physical findings may include lymphadenopathy and hepatosplenomegaly. Rarely may present with central nervous system CNS symptoms mass lesions testicular involvement skin lesions gingival hypertrophy renal insufficiency disseminated intravascular coagulation DIC and intractable bleeding. INITIAL WORKUP Initial workup includes routine and specialized laboratory studies. Laboratory studies Complete blood count CBC chemistry panel uric acid coagulation studies and bacterial cultures. Chest x-ray LP with cytospin. Bone marrow BM aspirate. Specialized studies for classification include flow cytometry cytochemical stains cytogenetics molecular testing for chromosomal abnormalities. CLASSIFICATION One to two percent of childhood leukemias are classic metaphyseal lesions CML 15 are ANLL and 85 are ALL. ANLL is subclassified histologically and cytogenetically into eight subtypes M0 M7 . The M3 promye-locytic .