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Nowadays with the use of multiple therapeutic methods about 80% of children with malignancy may be cured. It is estimated that there are about 27 000 people cured in childhood of malignancy in Poland. About 50% of them may develop late effects of their treatment, which include second malignancies as well as neurological, cardiological, pulmonological, endocrinological, psychological and other complications. Severe and life-threatening complications may be observed in 21% and 14% of patients, respectively. The quality of life, including educational possibilities and employment, often does not satisfy people after anti-cancer therapy in childhood. It is necessary to provide them long-term follow-up in Outpatient Clinic with standarized program of tests and examinations, with psychological and educational care and with help in finding employment in order to improve this situation. It is essential to educate the patients, their families and the physicians in the field of possible late side effects of therapy, preventive actions and pro-health activities. The implementation of studies on late side effects is very important. They should concern better quality of life of people cured of malignancies, support programs and modifications of current therapy protocols in order to decrease the rate of late effects. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare no conflict of interest.

Introduction: In patients who have undergone hematopoietic cell transplantation (HCT), the metabolic syndrome may develop without obesity defined by Body Mass Index (BMI)., Aim of the Study: The aim of the study was to compare body fat parameters measured using bioelectrical impedance (BIA) and using standard parameters of obesity in patients treated with HCT and healthy controls., Material and Methods: We compared body fat (BF) and body fat percentage (BF%) measured using BIA in 44 patients before HCT and 28 patients after HCT, versus 26 controls. We also compared BMI and other BIA parameters in these groups of patients., Results: The differences in BF and BF% between the patients before HCT and controls were not significant, while both BF and BF% were significantly lower in patients after HCT than in the control group. No significant differences in standard clinical obesity parameters were found in the patients before HCT, and in the patients after HCT, compared with the controls. The differences in other BIA parameters between the patients before HCT and the controls were not significant, while in the patients after HCT some parameters were significantly lower., Conclusion: Significant differences in BF and BF% in the patients after HCT compared with healthy controls suggest that BIA may be useful in screening for body fat abnormalities in patients after HCT., (© Polish Society for Pediatric Endocrinology and Diabetology.)

Until recently chemotherapy was used as adjuvant therapy after enucleation in cases with extraretinal spread of the disease (uveal extension, orbital extension, neoplastic infiltrates of the optic nerve at resection line, intracranial metastasis, generalized disease). Recent experience has proved that use of chemotherapy for intraocular retinoblastoma before local treatment (so called "chemoreduction") has allowed not only to decrease number of enucleations and indications for external beam irradiation or limit the extension of local therapy, but also increase chances for vision preservation and decrease the risk of severe complications. Seventy five children (with 106 involved eyes) aged 0.2 - 106 months with intraocular retinoblastoma diagnosed between January 1996 and June 2009 were the subject of this study. Among 106 involved eyes, in 70 (66%) the V stage according to Reese-Ellsworth classification (R-E) was established. Enucleation before chemotherapy was necessary in 9 (8.5%) cases, and in 22 more children the eye had to be removed after 1-2 courses of chemotherapy. In 68 remaining children (with 70 involved eyes) VEC (vincristine, etoposide, carboplatin) chemotherapy combined with delayed local therapy (cryotherapy, photocoagulation, brachytherapy) was employed. Out of 84 eyes treated by combined methods eye enucleation could be avoided in 47 (67%), including 18 (90%), 13 (87%) and 16 (46%) qualified to R-E group I-II, III-IV and V, respectively. First-line chemotherapy combined with the local treatment should be standard treatment for intraocular retinoblastoma groups I - IV. More effective therapy is required for R-E eye group V cases.

Infections are one of the most important clinical problem and most frequent cause of interventions among chronically ill children under hospice care. Frequent and long-lasting hospitalizations before admission to the hospice cause patients' colonization with nosocomial pathogens. These pathogens usually cause returning infections, difficult to cure in home care. The aim of the study was evaluation of colonization by multidrug-resistant organisms and infections' frequency in chronically and incurably ill children under care of the Cracow Children's Hospice of Father J. Tischner. We analyzed infections in patients of the Hospice in 2008-2009. Frequency of infections, their localization, pathogens and necessity of hospitalization were evaluated. On the basis of microbiological examination we distinguished infections caused by multidrug resistant pathogens. Ninety microbiological examination were made in 24 children. Urine, stool, pharyngeal and nasal swap and others were examined. Nosocomial pathogens including Gram-negative rods with ESBL phenotype, Gram-positive Enterococci with HLAR phenotype and Staphylococci with MRCNS and MRSA phenotype were isolated in 36 (40%) examinations, in 17 (71%) patients. Frequency of infections was higher in patients colonized by nosocomial pathogens in comparison with patients without colonization, but difference was not statistically important. There are many factors that increase risk of infections and make them difficult to treat, like: immobilization, impaired swallowing and coughing reflexes, thorax deformation, neurogenic bladder, tracheostomy. Multi-drug resistant pathogens are additional risk factor that can lead to the necessity of hospitalization. In chronically and incurably ill patients time of hospitalization should be minimized to reduce the risk of colonization with multi-drug resistant pathogens.

A 21-month-old girl was admitted to our Department of Pediatrics to diagnose febrile states lasting for previous two weeks, anemia and increased erythrocyte sedimentation rate (ESR - erythrocyte sedimentation rate). The physical examination revealed the paleness of skin and oral mucosa, silent systolic murmur and hypotrophic constitution. The laboratory tests confirmed anemia and showed increased ESR and moderately increased C Reactive Protein (CRP - C Reactive Protein). The blood culture, the urine culture, the stool culture, the tests of the stool in direction of parasites and the serologic tests carried out in direction of infection caused by Toxoplasma ghondi, Mycoplasma pneumoniae, HAV, HCV, CMV, EBV and Parvovirus B19 were all negative. The chest X-ray picture and ultrasonographic examination of abdomen showed no abnormality. The consulting hematologist carried the bone marrow biopsy out--the bone marrow was poorly cellular. The urinary level of catecholamines and plasma level of neuron-specific enolase (NSE) were greatly increased. The computer tomography scan of head, neck, thorax and abdomen did not confirmed the presence of the tumor. Nevertheless the bone scintigraphy demonstrated the presence of foci of abnormally increased activity in left femur and the right hip-bone--pathognomonic of metastatic disease. During the hospitalization we did not observe the fever, but only the deepening anemia, weakness, irritability, limping and the presence of spectacle-shaped hematomas. The blood parameters temporarily were normal after blood transfusion. The patient was transmitted to the Department of Children's Oncology and Hematology. The trepanobiopsy of the bone marrow showed the presence of metastases of neuroblastoma. The magnetic resonance imaging (MRI) was made, but it did not revealed the presence of the primary tumor. The patient underwent a course of chemotherapy.