Hermes
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HERMES
Hermes Published online: 10 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Whole-joint magnetic resonance imaging to assess osteonecrosis in pediatric patients with acute lymphoblastic lymphoma. Inaba H, Varechtchouk O, Neel MD et al. Pediatr Blood Cancer (2020) 67:e28336-e28345. Osteonecrosis is a known complication of treatment for acute lymphoblastic lymphoma. The objective of the study was to evaluate a screening test to identify children with acute lymphoblastic lymphoma at risk for developing symptomatic and extensive joint involvement with osteonecrosis. The authors performed a prospective pilot study on screening whole-joint MRI in 15 pediatric patients, ages 9 to 21 years, with acute lymphoblastic lymphoma who had no to minimal bone marrow involvement with lymphoma at the time of initial diagnosis. MRI was performed to assess for osteonecrosis, regardless of symptoms, in the shoulder, elbow, hip, knee, ankle and hindfoot. Imaging was conducted at the end of induction therapy, after Reinduction I, after Reinduction II, and at the completion of therapy. Based on imaging findings and symptoms, patients were eligible for dexamethasone modification or surgical intervention at any phase. The authors found that lesions affecting 30% or more of the epiphyses peaked in prevalence for the hips (46%) and knees (38%) after Reinduction I and in the shoulders (35%) after Reinduction II. All patients with 30% or greater epiphyseal involvement in the hip became symptomatic or underwent surgical treatment, while 82% of those with abnormal knees and 46% of those with abnormal shoulders became symptomatic or underwent treatment. Based on their findings, the authors plan to perform hip and knee MRI at the end of induction. Those with 30% or greater epiphyseal involvement will be further evaluated for other joint involvement and progression after Reinduction I. The authors indicated that the benefit of interventions in patients with asymptomatic lesions identified at screening warrants continued study.
Long-term outcome of transjugular intrahepatic portosystemic shunt in children with portal hypertension. Di Giorgio A, Nicastro E, Agazzi R et al. J Pediatr Gastroenterol Nutr (2020) 70:615–622. Transjugular portosystemic shunt (TIPS) creation is feasible and effective in children with portal hypertension; however, long-term follow-up is limited because this procedure is often used as a bridge to liver transplantation. The authors evaluated 28 children with a mean age of 10.3 years [±4.3 years] with both cirrhotic and non-cirrhotic portal hypertension who underwent attempted TIPS creation. Placement was successful in 96% (27/28), and clinical success, defined as effective treatment of variceal bleeding or ascites, occurred in 96% (26/ 27) of successful placements. There were no major complications and none of the children developed overt hepatic encephalopathy. Mean follow-up was 2.8±2.4 years (range 0.1–8.1 years). Shunt dysfunction developed in 8 children (29%), half of whom were identified by
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