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Autores principales:	Hideki Tomiyama, Hiroki Hamamoto, Ryo Tanaka, Yoshiro Imai, Koji Komeda, Mitsuhiro Asakuma, Sang‐Woong Lee
Formato:	Artículo Open Access
Publicado:	Wiley 2025
Materias:	Pediatrics International
Acceso en línea:	https://onlinelibrary.wiley.com/doi/10.1111/ped.70133
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

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Successful long‐term survival of patients with trisomy 18 and hepatoblastoma after cardiac surgery Hideki Tomiyama Hiroki Hamamoto Ryo Tanaka Yoshiro Imai Koji Komeda Mitsuhiro Asakuma Sang‐Woong Lee Pediatrics International Abstract Background Most patients with trisomy 18 (18T) die of cardiac or other severe anomalies within the first few years. Although surgical intervention for cardiac lesions or other diseases has improved these patients' prognoses in recent years, some survivors face the risk of developing neoplasms, such as hepatoblastoma. However, the treatment strategy remains controversial because of the poor prognosis. We evaluated the merits of aggressive therapeutic interventions for malignant tumors in 18T patients. Methods We encountered five patients who underwent hepatoblastoma treatment within the last 11 years. These patients, four girls and one boy, were aged 10 months to 3 years and 9 months at diagnosis; all had previously undergone cardiac interventions. Results Three patients were diagnosed with PRETEXT I, whereas the remaining two were diagnosed with PRETEXT II and IV. Primary resection of the tumor was conducted in three patients with PRETEXT I, followed by chemotherapy in two patients. Open biopsy and neoadjuvant chemotherapy were administered in two patients (PRETEXT II and IV), and subsequent tumor resection could be conducted only in the PRETEXT II patient and not in the PRETEXT IV patient. Four patients who underwent liver resection achieved disease‐free survival for 6–10 years postoperatively, and the PRETEXT IV patient did not have tumor regrowth for approximately 2 years and died of another cause. All treatments, including chemotherapy and surgical resection, were administered safely. Conclusions Surgical treatment of hepatoblastoma in 18 T patients can be performed safely after cardiac intervention, after obtaining informed consent regarding the associated risks and benefits. 10.1111/ped.70133 http://creativecommons.org/licenses/by/4.0/

if (filemtime($filename) + $maxlifetime < time()) { unlink($filename); $count++; } } return $count; } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ protected function saveSession($sessId, $data): bool { $sessFile = $this->path . '/sess_' . $sessId; if ($handle = fopen($sessFile, 'w')) { $return = false; // Lock the file for exclusive access to avoid issues with multiple // processes writing session simultaneously: if (flock($handle, LOCK_EX)) { $return = fwrite($handle, $data); // Make sure that there's no trailing data by truncating the file to // the correct length: ftruncate($handle, strlen($data)); fflush($handle); flock($handle, LOCK_UN); } fclose($handle); if ($return !== false) { return true; } } // If we got this far, something went wrong with the file output... // It is tempting to throw an exception here, but this code is called // outside of the context of exception handling, so all we can do is // echo a message.

// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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