Background and aims Multidisciplinary team (MDT) meetings provide a regular, structured meeting of a core group of professionals to provide expert decision-making in individual patient care. We describe our experiences in establishing a virtual pediatric oncology MDT between twinning partners in Cameroon (4 hospitals) and the UK. Methods Monthly video conferencing MDT meetings were established in March 2019, initially using Google meet then using Zoom platforms. Case details were circulated using formal proformas. Standard operating procedures were outlined for the MDT conduct. Results There have been 269 discussions of 201 patients in 21 meetings. Patients have been varied in age (up to 24 years). Eighty-seven (43.3%) patients had NHL, 16 (8.0%) had Wilms tumour, 20 (10.0%) had Acute Lymphoblastic Leukaemia, 19 (9.5%) had Retinoblastoma and 59 (29.4%) had other malignancies. Four of the patients did not have a malignancy. The majority of patients had stage 3 (51, 45.1%) or stage 4 (59, 52.2%). Nine patients had relapsed disease. Core team members reported positive benefits from the MDT, including defining goals of care, shared decision making, professional education and team-building. Conclusions Virtual MDT meetings between geographically dispersed teams are possible and have proved particularly valuable during the COVID-19 pandemic when in-person visits are not permitted. Cancer treatment cannot be done in isolation; the regular MDT meetings have paved the way for informed care through regular consultancy.

AIM OF THE STUDY:We aimed to compare the management of pediatric benign ovarian tumors between an English center and three Egyptian institutions.MATERIALS AND METHODS:This was a retrospective review of all children presenting with benign ovarian tumors between January 2014 and January 2019. A standardized dataset was used to compare between both sides.RESULTS:Eighty-nine patients were included (54 English and 35 Egyptians). Median age at diagnosis in England was 13 years (2-16y), while in Egypt it was 7 years (9m-16y) with P =0.001. Mature teratomas or dermoid cysts were the most common findings in England and Egypt; 75.9% and 82.8% of cases, respectively. The presentation with an acute abdomen represented 27.8% of English and 28.6% of Egyptian patients. Incidentally diagnosed lesions constituted 15% of English patients, whereas none of the Egyptian cases were discovered incidentally. There were variations in diagnostic imaging; England: Ultrasound (USS) (54), magnetic resonance imaging (MRI) (37), and computed tomography (CT) (only one)-Egypt: USS (35), CT (17), and MRI (only one). Minimally invasive surgery (MIS) was performed in 15% of English and 23% of Egyptian patients (P = 0.334). Ovarian-sparing surgery (OSS) was performed in: England 35%, Egypt 37%; P = 0.851. OSS was performed using MIS in 87.5% (7/8) of English patients and 100% (8/8) of Egyptians. Patients presented as emergencies generally had open oophorectomies: England; 86.7% open and 80% oophorectomy-Egypt; 100% open and 90% oophorectomy. Recurrences or metachronous disease occurred in 5.6% of English and 5.7% of Egyptian patients.CONCLUSIONS:There were no significant differences regarding surgical management, tumor pathology, and recurrence or metachronous disease. However, age, incidental diagnosis, and imaging modalities showed notable differences. MIS was correlated with ovarian preservation, whereas emergency surgery generally resulted in open oophorectomy.

A 24-year-old para one had regular antenatal care with her community midwife. At the 36-week visit, she was referred to hospital because she had reduced fetal movements and the presentation was bre...

Thyroid carcinoma is rare in children and adolescents but tends to behave in a more biologically aggressive manner when compared with the disease in adults. Despite this, the prognosis has been reported to be very good in several series. Papillary carcinoma is the commonest type encountered. We report and discuss a case of a 2-year-old child with papillary thyroid carcinoma, which is the youngest reported case from Great Britain. We discussed the difficulty in making diagnosis and the need for early multidisciplinary involvement in management.

Medical and Pediatric OncologyVolume 40, Issue 3 p. 195-196 Internal thoracic vein cannulation as a complication of central venous catheter insertion Alex C.H. Lee MBChB, FRCSEd, Alex C.H. Lee MBChB, FRCSEd Department of Paediatric Surgery, St. James's University Hospital, Leeds, United KingdomSearch for more papers by this authorJai V. Patel MBChB, MRCP, FRCR, Jai V. Patel MBChB, MRCP, FRCR Department of Clinical Radiology, St. James's University Hospital, Leeds, United KingdomSearch for more papers by this authorSusan V. Picton BMBS, FRCPCH, Susan V. Picton BMBS, FRCPCH Department of Paediatric Oncology, St. James's University Hospital, Leeds, United KingdomSearch for more papers by this authorRoly Squire MBBS, FRCS, FRCS(Paed), Corresponding Author Roly Squire MBBS, FRCS, FRCS(Paed) [email protected] Department of Paediatric Surgery, St. James's University Hospital, Leeds, United KingdomDepartment of Paediatric Surgery,St. James's University Hospital, Leeds, LS9 7TF, United Kingdom.Search for more papers by this author Alex C.H. Lee MBChB, FRCSEd, Alex C.H. Lee MBChB, FRCSEd Department of Paediatric Surgery, St. James's University Hospital, Leeds, United KingdomSearch for more papers by this authorJai V. Patel MBChB, MRCP, FRCR, Jai V. Patel MBChB, MRCP, FRCR Department of Clinical Radiology, St. James's University Hospital, Leeds, United KingdomSearch for more papers by this authorSusan V. Picton BMBS, FRCPCH, Susan V. Picton BMBS, FRCPCH Department of Paediatric Oncology, St. James's University Hospital, Leeds, United KingdomSearch for more papers by this authorRoly Squire MBBS, FRCS, FRCS(Paed), Corresponding Author Roly Squire MBBS, FRCS, FRCS(Paed) [email protected] Department of Paediatric Surgery, St. James's University Hospital, Leeds, United KingdomDepartment of Paediatric Surgery,St. James's University Hospital, Leeds, LS9 7TF, United Kingdom.Search for more papers by this author First published: 15 January 2003 https://doi.org/10.1002/mpo.10120Citations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 Krasna IH, Krause T. Life-threatening fluid extravastion of central venous catheters. J Pediatr Surg 1991; 26: 1346–1348. 10.1016/0022-3468(91)90617-3 PubMedWeb of Science®Google Scholar 2 Wiener ES, McGuire P, Stolar CJ, et al. The CCSG prospective study of venous access devices: an analysis of insertions and causes for removal. J Pediatr Surg 1992; 27: 155–163. 10.1016/0022-3468(92)90304-P PubMedWeb of Science®Google Scholar 3 Tweddle DA, Winderbank KP, Barrett AM, et al. Central venous catheter use in UKCCSG oncology centres. Arch Dis Child 1997; 77: 58–59. 10.1136/adc.77.1.58 CASPubMedWeb of Science®Google Scholar 4 Johnson EM, Saltzman DA, Suh G, et al. Complications and risks of central venous catheter placement in children. Surgery 1998; 124: 991–996. 10.1016/S0039-6060(98)70016-9 Web of Science®Google Scholar 5 Cameron GS. 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AIM:To establish clinical opinion regarding appropriate indications for circumcision and to examine actual clinical practice.METHODS:A questionnaire was sent to all NHS hospital consultants in the Yorkshire region of the UK identified as having a role to play in the management of boys (under 16 years of age) requiring circumcision. Retrospective data on actual clinical practice during a three month study period were also collected via a simple proforma.RESULTS:Of 153 questionnaires sent, 64 were returned. Responses revealed varying opinions regarding appropriate indications for circumcision within each consultant group, and between paediatricians and surgeons. Surgeons were generally more inclined to recommend circumcision for each of the indications listed in the questionnaire. Analysis of clinical practice revealed that almost two thirds of procedures were carried out for phimosis, and nearly half of these children were under the age of 5 years.CONCLUSION:There are differences in the clinical opinions of surgeons and paediatricians on what constitutes an appropriate indication for circumcision. Paediatricians' opinions are generally more in line with current evidence than those of surgeons, possibly resulting in many unnecessary circumcisions.

To investigate the value of Doppler ultrasound scan (USS) assessment of internal jugular vein (IJV) patency after previous open central-venous cannulation (CVC), a prospective study of 66 consecutive children (median age 4.5 years; range 4 months–17 years) who had previously undergone open insertion of at least one indwelling IJV line and required further CVC for completion of therapy was undertaken. All underwent Doppler USS examination prior to surgery. Where patency of the previously cannulated vein was suggested ultrasonographically, the accuracy of this finding was confined at open surgical exploration. Initial CVCs were in situ for a median of 9 months (1 month–4 years) prior to removal. The median interval to repeated CVC was 11 months (3 weeks–45 months). In 79 Doppler USS, 70 (88.6%) veins appeared patent, 3 (4.2%) stenosed, and 6 (7.6%) obliterated. Of the 70 “USS patent” veins, 66 were explored. Patency was confirmed surgically in 59 (89.4%) and a new CVC successfully inserted. Seven (10.6%) apparently patent veins on USS were found to be obliterated at open exploration. Review of USS images in these cases suggested that enlarged collateral veins were usually responsible. Overall, successful recannulation was possible in 74.6% of all previously accessed veins. In children requiring repeated CVC, Doppler USS of neck veins is a valuable but not entirely reliable guide to the presence of underlying vessel patency and should be interpreted with caution. At least three-fourths of previously cannulated IJVs remain patent after catheter removal and can be reused for CVC.

BACKGROUND:Osteogenic sarcoma rarely occurs in soft tissues and generally affects individuals beyond the second decade of life.METHODS:The authors report a rare case of an extra osseous osteogenic sarcoma arising in the retroperitoneum of an adolescent, review the literature, and outline the diagnostic and therapeutic dilemmas. The role of adjuvant chemotherapy, using drugs used in managing bony osteosarcomas, is discussed.CONCLUSIONS:Retroperitoneal sarcomas may simulate ovarian teratomas. Careful consideration of the differential diagnosis of large cystic abdominal masses in adolescent females when size precludes adequate assessment of tumor mobility and imaging fails to demonstrate the ovaries is essential if these rare tumors are to be managed effectively.

BACKGROUND:Cytogenetic studies have become an important part of tumour characterization. In a minority of tumours cytogenetic and/or molecular studies may be of help for diagnosis, selection of treatment protocols and predicting outcome. METHODS:This article reviews the literature on solid tumour translocations and established family cancer syndromes. In addition, the potential importance of genetics in management of patients with breast, ovarian and pancreatic carcinoma is reviewed. RESULTS AND CONCLUSION:Cytogenetic analysis of tumours may help confirm the diagnosis when conventional histology demonstrates no evidence of differentiation along a particular tissue pathway. For patients with well defined cancer syndromes, cytogenetic and molecular analysis offers the prospect of screening to reduce the risk of malignant disease. For many malignancies the underlying genetic anomalies are gradually being elucidated. Further studies designed to demonstrate the significance of these findings can only be undertaken if tumour material is collected and stored in optimal conditions for cytogenetic and/or molecular biological studies.

Abdominal neural crest tumours are usually diagnosed using a combination of cross sectional imaging and urinary catecholamine assay. Although histological confirmation is required, in many cases the diagnosis is not in doubt preoperatively. Neural crest tumours in adolescents are rare, and in particular adrenal neuroblastoma needs to be differentiated from phaeochromocytoma. The role of imaging in making this distinction is highlighted in this case.

Continent, catheterizable enterostomies (Malone stomas) have been formed in 25 patients. A reversed appendicocecostomy was used for the majority, although experience has led to modifications of this procedure. Antegrade enemas are regularly administered via these stomas in the treatment of fecal incontinence and intractable constipation. There have been only two important surgical complications, and the technique has proved to be highly successful. Follow-up of the patients has shown that individual requirements can be met with variations in the administration of the enemas.

Severe haemolysis is an unusual occurrence in association with necrotising enterocolitis (NEC). Activation of the Thomsen-Freidenriech (T) antigen on the neonatal erythrocytes is proposed as the mechanism. This haemolytic process is precipitated by transfusion with serum-containing blood products, which should therefore be avoided. Once haemolysis has become established the outcome is usually fatal. This report describes the management of four neonates who had established haemolysis complicating severe NEC. T activation was confirmed in two infants, but could not be tested for in the other two. Exchange transfusion abolished the haemolysis in two patients, who survived. Despite reduced use of blood products the other two infants died. We believe that exchange transfusion was essential in the successful management of the infants who survived, and recommend early exchange transfusion when haemolysis complicates NEC.

Needle aspiration of neck abscesses with CT-scan guidance was studied in 17 children with 18 abscesses from 1986 to 1991. Clinical and radiologic findings were analyzed according to treatment outcome. A majority of abscesses (55.6%) resolved after treatment with one to two attempts at needle aspiration and parenteral antibiotics. Unilocular abscesses were more likely than multilocular abscesses to resolve with needle aspiration. In general, abscesses in younger children who presented with smaller neck masses on physical examination and smaller abscess cavities on CT scan resolved with needle aspiration. The data support the use of needle aspiration as an effective initial treatment for pediatric neck abscesses. CT scan was found beneficial in documenting the abscesses and in guiding treatment. A treatment protocol is suggested for the use of needle aspiration in the management of neck abscesses in children.