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Current Pediatric Reviews
ISSN: 1573-3963
Upcoming Articles
Different Treatment Strategies for Pediatric Brain Tumors
Amedeo Fiorillo
[Abstract]
Congenital Choledochal Malformation – Current
Concepts and Classification
Saravanakumar Paramalingam and Mark Davenport
[Abstract]
Safety of Inhaled Corticosteroids. Why the Variation
in Systemic Adverse Effects?
Michael B. Anthracopoulos, Kostas N. Priftis
and George Russell
[Abstract]
Abstracts
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Different Treatment Strategies for Pediatric
Brain Tumors
Amedeo Fiorillo
Malignant brain tumors are characterized by high
local aggressiveness and tendency to metastasize within the
central nervous system (CNS), and rarely outside it. Surgical
approach represented and still represents the mainstay of
treatment strategies. However, in the majority of cases, gross
total resection is recommended to achieve long event-free
survival and eventually the cure. In recent years neoadjuvant
chemotherapy and adjuvant post-surgical radiotherapy and chemotherapy
have gained relevance in facilitating complete surgical removal
and in achieving and consolidating complete remission of such
tumors. Post-surgical radiation therapy still represents the
basic adjuvant treatment for children over three years with
standard risk, non metastatic medulloblastoma. This approach
is also considered a very important tool for children affected
by ependymoma. However, associated chemotherapy is also needed
when reduced doses of radiation therapy are administered,
in cases of tumors characterized by a more aggressive biologic
behaviour, such as high grade gliomas, and metastatic tumors
of any origins. The majority of CNS tumors are of neuroepithelial
origin and as such responsive to many antineoplastic drugs,
like alkylating agents, antimetabolites, and alkaloids. However,
in order to reach tumor cells inside the CNS these drugs have
to overcome the blood brain barrier. A number of interesting
tools able to disrupt or bypass the barrier, such as ionizing
radiations, osmotic procedures or the liposomal technology
applied to antiblastic drugs, exists. Starting from a dose
of radiation of 30 Gy the permeability of an irradiated area
is significantly increased compared to that of the unirradiated
surrounding cerebral tissue. Many present treatment regimens
include concurrent radiotherapy and chemotherapy in the post-surgical
phase, and encouraging results have been reported. In the
future better results will certainly come from modern technologies
applied to radiation therapy, such as tomo-therapy, and from
discovery of new drugs or alternative methods of administration
of conventional ones.
[Back to top]
Congenital Choledochal Malformation – Current Concepts
and Classification
Saravanakumar Paramalingam and Mark Davenport
Congenital choledochal malformations (a.k.a. choledochal
cysts) are uncommon but must be considered in the differential
diagnosis of conjugated jaundice in both infant and child.
They are also an important cause of recurrent abdominal pain
due to the presence of a common pancreatic biliary channel
and predisposition to pancreatitis. We present an updated
Kings College Hospital classification based on morphology
derived from previous versions in the literature and review
possible aetiological factors, current diagnostic and surgical
strategies.
[Back to top]
Safety of Inhaled Corticosteroids. Why the Variation
in Systemic Adverse Effects?
Michael B. Anthracopoulos, Kostas N. Priftis
and George Russell
Inhaled corticosteroids (ICS) are currently the mainstay of
therapy in persistent childhood asthma. However, systemic
adverse effects of various available agents - particularly
on growth, bone metabolism, and the hypothalamic-pituitary-adrenal
(HPA) axis - continue to concern the families of asthmatic
children, and are debated within the medical community. Although
there is short- and medium-term suppressive effect of usual
doses of ICS on linear growth, the findings of long term studies
are reassuring, suggesting attainment of the full potential
of adult height. ICS do not appear to exert significant untoward
effects on bone mineral density. Measurable systemic effect
of ICS by sensitive measurements of function of the HPA axis
does not necessarily translate into clinically significant
side effects. However, use of higher than recommended doses
of ICS may on occasion lead to symptomatic adrenal insufficiency
and should be of concern; there may be important differences
among available compounds regarding such potential. Variation
in adverse effects of ICS is explained by differences in their
pharmacokinetic and pharmacodynamic properties, formulation
and delivery devices, and patient factors such as degree of
airway obstruction, suppressive of airway inflammation per
se on/HPA axis, genetic factors, patient training in the use
of delivery devices, and compliance.
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