UNLABELLED In this paper we analyzed group of patients with leukemias in which was implanted peripherally inserted central catheters (PICC), which is safe and permanent intravenous line necessary for treatment in these patients. MATERIAL AND METHODS In the period from January 1999. to September 2000. at the Oncology Department on Pediatric Clinic in Sarajevo we placed PICC in 18 patients with leukemia. Catheters were introduced through vena cubitalis and EMLA was used like local anestetic, All these manipulations were done with respect to asepsa rules. Tip of the catheter had to be situated in vena cava superior and its right position was checked by ultrasound. Management of catheter included everydays heparinisation, according strictly ordered rules and respect asepsa rules. RESULTS PICC was placed in 18 patients with average of 6.5 years. According sex there were 61.1% males, and 38.9% females. Average period of using catheter was 2.7 months. In 44.4% cases catheter was taken out after finished treatment, but in 22.2% cases we had mechanical complications (spontaneous breakage of catheter or stop in it). In 33.3% patients catheter is still in function. CONCLUSION Using PICC in patients with leukemia made significantly easier their treatment regarding decreasing of their traumatisation, regarding simplier vein access and reduction of the infection. In our investigated group we had not infection what was very important fact for outcome of this serious disease.

Breath holding attacks are most common in children aged 6 months to 6 years, in 76% of cases between 6 and 18 months of age. Very often they are misinterpreted as tonic epileptic seizures. They are provoked by frustration, anger or sudden injury. Child starts to cry, then holds the breath at the end of expirium. After a few seconds it becomes cyanotic, and losses consciousness. It is usually floppy, but sometimes stiffness, and clonic seizures can be present, and child can be diagnosed as having epilepsy. The form in which child is pale is less frequent, and crying is usually brief or even absent in this type. Breath holding attacks usually do not last more then one to three minutes. Good heteroanamnesis is essential for diagnosis, revealing provoking factors for each attack. Interictal EEG registration is usually normal. Attacks often spontaneously cease after 5 or 6 years of age, and do not require any medical treatment. In more severe cases behavioral therapy has shown good results. It has been noticed that those children in adolescence have syncope more frequent then rest of population. Seventeen children (12 male and 5 female) were investigated at Pediatric Hospital in Sarajevo as breath holding attacks in period from June 1997 to June 2000. Age of patients was between 5 months and 5.5 years (median was 11 months). Hypochromic anemia was present in 12 patients (76%), with average hemoglobin value of 8.2 g/dl (5.9-11.0 g/dl). All children had normal EEG recording. Iron therapy gave positive response in 8 out of 9 patients that were followed (88.9%). Three patients had not come for follow up. It is concluded that hypochromic anemia is often a part of clinical presentation of breath holding attacks in children, and iron therapy can stop them.

It is shown very rare case of eight years old girl with two secondary sicknesses: myeloic leucosis and adenocarcinoma of rectum that developed after six years of successful treatment. The diagnose of embryonal Rhabdomyosarcoma was set up in Sarajevo six years ago after surgical extirpation of tumor from orbitae and its pathohistology finding. Complete chemo and radiotherapy was performed in Germany (Bonn) according protocol (CWS 91). Diagnoses of acute myeloic leucosis and adenocarcinoma of rectum was set up according: clinical picture, peripheral blood smear, bone marrow smear and biopsy of bleeding polyp of rectum.

The authors report the problem of central venous catheter appliance to the children with malignant diseases, employed for the first time in Bosnia and Herzegovina with the aim of pediatric oncologic patients treatment. During 1997 central venous catheter type Hickman was used in nine children between two and half to eleven years old (average six years and one months). The average time of catheter placement was six months, in two cases catheter were eliminated after two and three months respectively since application (spontaneous elimination and repeated septic attacks, caused bu resistant bacterial strains). Gram-positive bacteria have been isolated with eight children (Staphylococcus aureus and Staphylococcus epidermidis), and gram-negative enterobacteriaceae (Serratia marcescens, Pseudomonas aeruginosa, Klebsiella oxytocia and pneumoniae, Escherichia coli, Salmonella group C and Enterococcus faecalis) in samples taken from the catheter and hemoculture. The central venous catheter is useful in treating oncological patients, but may cause serious consequences, like local infections or septicaemia.

In retrospective study we analyzed 19 patients who were diagnosed and cured because of leukemia at Pediatric clinic in Sarajevo during last two years. From that number, 15 children (78.9%) were with acute lymphoblastic leukemia (ALL), 3 (15.7%) were with acute myeloic leukemia (AML) and 1 was with chronic myeloic leukemia. Among all pediatric malignancies percent of leukemias was 40.4%. Most of children with leukemia from Canton of Zenica-Doboj (42.1%) and then from Canton of Sarajevo (31.5%). Illness began mostly in winter months (36.5%), than in early spring (26.3%), and in autumn (26.3%), but there were no newly diagnosed in summer (July and August). More children with leukemia were from rural areas (57.8%), than from urban areas (42.2%).

This paper reports a very rare case of 5-years old girl with a tumor of the right kidney and metastatic changes in the inferior vena cava and right heart. Following the nefrectomy Wilms' tumour diagnosis was established. There was no an adequate answer on chemotherapy according to SIOP i.v. protocol. Three months later metastatic changes spreaded to lungs, pelvic bones and distant lymphonodes of the neck and axillas. The patient in a very severe condition was evacuated to England (Alder Hay Children's Hospital, Liverpool). After numerous tests the diagnosis of Wilms's tumor was excluded and diagnosis of Ewing's sarcoma (soft tissue) was established.

We report a case of 3,5 year-old boy with tumor of the left kidney which presented metastatica changes in upper stomach and in the lungs. After performed nephrecomy and confirmed P-H diagnosis: Tu-Wilms, intensive chemo and radiotherapy was started according brand new protocol UKW3. Therapy was performed partially in Liverpool (UK) and final part at our hospital. Now, there are no signs of disease in patient and according prognostic criteria he has a good chance of cure.