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关键词： 3 Tesla MRI   Cochlear implant   Paediatric   MED-EL SYNCHRONY  

摘要： Objectives: To demonstrate the safety and feasibility of the first reported case of a 3 Tesla MRI scan in a paediatric 3 Tesla-compatible cochlear implant recipient under general anaesthesia. Materials and methods: A three-year-old child with bilateral optic pathway glioma treated with chemotherapy, who subsequently received a right sided 3 Tesla-compatible cochlear implant for sensorineural hearing loss was examined. The CI device chosen was implanted due to its purported MRI compatibility. Following informed consent and hospital executive approval, the child underwent a 3 Tesla MRI scan to assess for growth of the optic pathway glioma. Results: A 3 Tesla MRI scan of the brain was performed under general anaesthesia. There was expected artefact due to the magnet of the receiver stimulator. There was no malfunction of the implant noted after the procedure, and no neurological or otological complications. The child had five more uneventful 3 Tesla MRI scans of the brain without complications. Conclusion: This is the first reported case of a child with a 3 Tesla-compatible cochlear implant undergoing a 3 Tesla MRI scan of the brain under general anaesthesia. Provided manufacturer guidelines are adhered to, 3 Tesla MRI scanning should not be contraindicated in paediatric cochlear implant recipients with a compatible device.

摘要： YResponse criteria for paediatric high-grade glioma vary historically and across different cooperative groups. The Response Assessment in Neuro-Oncology working group developed response criteria for adult high-grade glioma, but these were not created to meet the unique challenges in children with the disease. The Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. We established a subcommittee to develop response assessment criteria for paediatric high-grade glioma. Current practice and literature were reviewed to identify major challenges in assessing the response of paediatric high-grade gliomas to various treatments. For areas in which scientific investigation was scarce, consensus was reached through an iterative process. RAPNO response assessment recommendations include the use of MRI of the brain and the spine, assessment of clinical status, and the use of corticosteroids or antiangiogenics. Imaging standards for brain and spine are defined. Compared with the recommendations for the management of adult high-grade glioma, for paediatrics there is inclusion of diffusion-weighted imaging and a higher reliance on T2-weighted fluid-attenuated inversion recovery. Consensus recommendations and response definitions have been established and, similar to other RAPNO recommendations, prospective validation in clinical trials is warranted.

关键词： Paediatric CT   Radiation dose   Dose optimisation  

摘要： Request for paediatric CT imaging has been increasing recently, and thus assessment of current paediatric CT protocols is of crucial importance as to assess the associated potential risk and possibly identify the need to modify the current practice. The aim of this study was to optimize the current local practice through investigation on the radiation dose distribution and existing routine scanning protocols of paediatric head and abdomen CT examinations at Radiology Department, HUSM, Kelantan, Malaysia. A total of 250 paediatric (age between 0.12 years) CT examinations (134 of head CT and 116 of abdomen CT scans) were retrospectively collected from PACS and further analysed. The dose metrics in volume CT dose index (CTDIvol) and dose length product (DLP) with combination of exposure parameters (kV, mAs, pitch, scan length and acquisition time) for paediatric CT imaging were evaluated. Third quartile values of local dose distribution were then compared with selected international DRLs. The third quartile values for CTDIvol (mGy) and DLP (***) for head and abdomen CT scans with respect to the age groups were 0-3 years (32/557 and 7/232), 4-6 years (61/1105 and 9/251), 7-9 years (117/1454 and 11/405), 10-12years (117/2203 and 14/566) respectively. From the comparative study, the local dose received from paediatric head CT scans were higher than the recommended levels. This is mainly due to selection of scanning parameters which were higher than the optimised paediatric protocols. Tube voltage selection was ranged from 100.120 kV for all age groups except the head CT scan in group 4 that used a constant 120 kV. Applied mAs varied in the ranges from 100.410 mAs for head CT scan and 35-100 mAs for abdominal CT scans and increases as the paediatric age increased. From the findings, review and optimisation on the current scanning protocols is required especially for head CT scan to complement the corresponding age groups and sizes while maintaining the diagnostic values

摘要： Orbital cellulitis is a serious paediatric infection that can cause devastating complications.[1] It can often be treated conservatively,[2] but some patients develop subperiosteal abscesses that require surgery.[3] Some reviews have been published on therapeutic protocols for paediatric orbital cellulitis[1] in order to establish management guidelines. The patients' conditions were secondary to acute sinusitis and included subperiosteal abscesses (63%) and intra-orbital abscesses (17%). [Extracted from the article]

关键词： COVID-19   Anticancer chemotherapy   Immunosuppression   Children  

摘要： Introduction: Since the beginning of COVID-19 pandemic, it is known that the severe course of the disease occurs mostly among the elderly, whereas it is rare among children and young adults. Comorbidities, in particular, diabetes and hypertension, clearly associated with age, besides obesity and smoke, are strongly associated with the need for intensive treatment and a dismal outcome. A weaker immunity of the elderly has been proposed as a possible explanation of this uneven age distribution. Thus, there is concern that children treated for cancer may allso be at risk for an unfavourable course of infection. Along the same line, anecdotal information from Wuhan, China, mentioned a severe course of COVID-19 in a child treated for leukaemia. Aim and methods: We made a flash survey on COVID-19 incidence and severity among children on anticancer treatment. Respondents were asked by email to fill in a short Web-based survey. Results: We received reports from 25 countries, where approximately 10,000 patients at risk are followed up. At the time of the survey, more than 200 of these children were tested, nine of whom were positive for COVID-19. Eight of the nine cases had asymptomatic to mild disease, and one was just diagnosed with COVID-19. We also discuss preventive measures that are in place or should be taken and treatment options in immunocompromised children with COVID-19. Conclusion: Thus, even children receiving anticancer chemotherapy may have a mild or asymptomatic course of COVID-19. While we should not underestimate the risk of developing a more severe course of COVID-19 than that observed here, the intensity of preventive measures should not cause delays or obstructions in oncological treatment. (C) 2020 Published by Elsevier Ltd.

关键词： Paediatric acute pancreatitis   Pancreatic fluid collections   Pseudocysts   Walled off necrosis   Natural history  

摘要： Background & aims: Acute Pancreatitis (AP) tends to have a benign course in children. However there is a paucity of information with respect to severity of AP in children, the categorization of collections viz., walled off necrosis (WON)& pseudocyst and their natural history & outcomes. Methods: A retrospective medical record review of 187 children with pancreatitis diagnosed and managed at our centre was performed. Results: 101 children (59% boys, Median age 9yrs) had AP of which 37.6%, 60.4% and 2% had mild, moderately severe and severe AP. 61.4%(62) had PFC at diagnosis;34%(21) acute pancreatic fluid collections (APFC) and 66%(41) acute necrotic collections (ANC). 52.3%(11of21) of APFC evolved into pseudocysts & 68.2%(28of41) of ANC into WON's. Drainage was required in 31%(12of39) of persisting collections, more frequently in children with traumatic AP. Percutaneous catheter drainage (PCD) was done in 6 children and endoscopic ultrasound (EUS) guided cystogastrostomy with placement of plastic or self expanding metal stents (SEMS) in 6 children. Conclusions: Moderately severe AP is common in hospitalized children with AP with PFC developing in 61.4%, majority being APFC. 48% of APFC and 32% of ANC will resolve and the rest evolve into pseudocyst or WON. Spontaneous resolution is more likely in children with non -traumatic AP having pseudocysts rather than WON's. (C) 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.