By Jan Hendrik Reynor Becker
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4 An aproach to swellings in the child Head and neck rhabdomyosarcoma Embryonal rhabdomyosarcoma of the scalp, face and parotid, where radical surgery is a possibility, has a good prognosis. By contrast, lesions of the nasopharynx, pterygoid fossa and inner ear have a poor prognosis due to the inaccessibility of the tumours. g. a total evisceration of the eye which improves the prognosis to a survival of 90%. Alveolar rhabdomyosarcoma • Mostly located on the trunk and limbs. • The natural course is less favourable than with the embryonal type.
Staging Much like the previously discussed tumour, except: • Stage IV–S – Like a Stage I or II, both with distant disease limited to one or more of the following systems: liver, skin and bone 43 PAEDIATRIC BOOK 3/12/05 1:08 am 4 An aproach to swellings in the child Page 44 marrow, in a baby less than 1 year of age without radiological proof of bone metastases. Special investigations • Abdominal X-ray – shows typical calcifications in the tumour • Excretory urogram – shows a tumour on the outside of the kidney that displaces the kidney • Ultrasound – determines the size of the tumour and the presence or absence of metastases in the liver and lymph nodes • Bone marrow aspiration for malignant cells • Skull and long bone X-rays for metastases • 24-hour urine sample to determine the presence of active metabolites (VMA, metanephrines and normetanephrines) • CT scan and MRI according to discretion • Histology Management Combination of surgery, chemotherapy and radiotherapy.
While you are waiting for the blood and the patient needs fluid, a crystalloid (Plasmalyte® B or Ringer’s lactate® at 20 ml/kg) is administered. As soon as the blood is available, it is given according to need as calculated according to the Hb or Hct determined. Blood is not given alone during resuscitation – it must be administered in a 3 : 1 ratio of crystalloid:colloid (blood). If blood alone is administered as a resuscitation fluid, the mortality is higher than when the above ratio of 3 : 1 is administered.