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124 Pattern of Chromosomal Abnormalities in Pediatric Acute Lymphoblastic Leukemia (ALL) June 2011 pediatric acute lymphoblastic leukemia by gene expression profiling. Cancer Cell 2002; 1:133-143. 13. Heerema NA, Sather HN, Sensel MG, et al. Prognostic impact of trisomies of chromosomes 10, 17, and 5 among children with acute lymphoblastic leukemia and high hyperdiploidy (> 50 chromosomes). J Clin Oncol 2000; 18:1876-1887. 14. Chang HH, Lu MY, Jou ST, Lin KH, Tien HF, and Lin DT. Cytogenetics in childhood acute lymphoblastic leukemia in Taiwan: A single-institutional experience. Pediatr Hematol Oncol 2006; 23:495-506. 15. Bhutani M, Kochupillai V, and Bakhshi S. Childhood acute lymphoblastic leukemia: Indian experience. Ind J Med Pediatr Oncol 2004; 25:S2:3-S8. 16. Amre P, Gladstone B, Varghese C, Pai S, Advani S. Clinical significance of cytogenetic findings at diagnosis and in remission in childhood and adult acute lymphoblastic leukemia. Experience from India. Cancer Genet Cytogenet 1999; 110:44-53. 17. Khalid S, Usman M, Adil SN, Ayub A, Khurshid M. Pattern of chromosomal abnormalities in adult acute lymphoblastic leukemia. Ind J Pathol Microbiol 2007; 50:78-81. 18. Paulsson K, Forestier E, Lilljebjörn H, et al. Genetic landscape of high hyperdiploid childhood acute lymphoblastic leukemia. PNAS 2010; 107:21719- 21724. 19. Kwon YJ, Lee JW, Kim MS, et al. Cytogenetic analysis in childhood acute lymphoblastic leukemia: experience at a single institution in Korea. Int J Hematology 2009; 89:150-158. 20. Paulsson K. and Johansson B. High hyperdiploid childhood acute lymphoblastic leukemia. Genes Chromosomes Cancer 2009; 48: 637-660. 21. Arico M, Valsecchi MG, and Rizzari C, et al. Long-term results of the AIEOP-ALL-95 Trial for Childhood Acute Lymphoblastic Leukemia: insight on the prognostic value of DNA index in the framework of Berlin- Frankfurt-Muenster based chemotherapy. J Clin Oncol 2008; 26: 283-289. 22. Sutcliffe MJ, Shuster JJ, Sather HN, et al. High concordance from independent studies by the Children’s Cancer Group (CCG) and Pediatric Oncology Group (POG) associating favorable prognosis with combined trisomies 4, 10, and 17 in children with NCI Standard-Risk B-precursor Acute Lymphoblastic Leukemia: a Children’s Oncology Group (COG) initiative. Leukemia 2005; 19:734-740. 23. Synold TW, Relling MV, Boyett JM, et al. Blast cell methotrexate-polyglutamates accumulation in vivo differs by lineage, ploidy, and methotrexate dose in acute lymphoblastic leukemia. J Clin Invest 1994; 94:1996-2001. 24. Nachman JB, Heerema NA, Sather H, et al. Outcome of treatment in children with hypodiploid acute lymphoblastic leukemia. Blood 2007; 110:1112-1115. 25. Charrin C, Thomas X, Ffrench M, et al. A report from LALA-94 and LALA-SA groups on hypodiploidy with 30-39 chromosomes and near triploidy: 2 possible expressions of a sole entity conferring poor prognosis in adult acute lymphoblastic leukemia (ALL). Blood 2004; 104:2444-2451. 26. Callen DF, Raphael K, Mitchel PM, et al. Acute lymphoblastic leukemia with a haploid karyotype with less than 40 chromosomes: the basis for division into two sub groups. Leukemia 1989; 3:749-752. 27. Harrison CJ. Cytogenetics of leukemia and lymphoma. In: Hoffbrand AV, Catovsky D, and Tuddenham EGD, editors. Postgraduate Haematology, Fifth edition, Blackwell Publishing Ltd, Massachusetts, USA, 2005, 492-508. 28. Kwon WK, Lee JY, Mun YC, Seong CM, Chung WS, Huh J. Clinical utility of FISH analysis in addition to G-banded karyotype in hematologic malignancies and proposal of a practical approach. Korean J Hematol 2010; 45:171-176. 29. Saaz wal S, Bhatia K, Gutierrez MI, Saxena R, Arya LS, Bhargava M. Paucity of TEL-AML 1 translocation by multiplex RT-PCR, in B-lineage acute lymphoblastic leukemia (ALL) in Indian patients. Am J Hematol 2004; 76:80-82. 30. Gurbuxani S, Lacorte JM, Raina V, et al. Detection of BCR-ABL transcripts in acute lymphoblastic leukemia in Indian patients. Leu Res 1998; 22:77-80. 31. Pederson-Biergaard J and Rowley JD. The balanced and unbalanced chromosome aberrations of acute myeloid leukemia may develop in different ways and may contribute to malignant transformation. Blood 1994; 83:80-86. 32. Jena RK, Patnaik SC, Nayak S, et al. Secondary chromosomal abnormalities in acute lymphoblastic leukemia. CARYOLOGIA 2002; 55:349-55.
June 2011 KUWAIT MEDICAL JOURNAL 125 Original Article The Diagnostic Value of Sinus-Track Cultures in Secondary Pediatric Chronic Osteomyelitis Mehmet Ulug 1 , Celal Ayaz 2 , Mustafa Kemal Celen 2 , Serdar Necmioglu 3 1 Department of Infectious Diseases and Clinical Microbiology, Özel Ümit Hospital, Eskişehir, Turkey 2 Department of Infectious Diseases and Clinical Microbiology, Dicle University Medical School, Diyarbakir, Turkey 3 Department of Orthopedics and Traumatology, Diyarbakir, Turkey Kuwait Medical Journal 2011; 43 (2): 125-129 ABSTRACT Objective: To determine and compare the diagnostic value and accuracy of culture of material from a sinus track with culture of material from bone specimens Design: Retrospective study Setting: Dicle University Medical School and Batman State Hospital, Turkey Subjects: Twenty-one patients with secondary chronic osteomyelitis (COM). Material for culture was taken from the sinus as well as the bone specimens Interventions: Surgery for COM Main outcome measures: The diagnostic value of sinus track culture Results: The mean age of patients was 8.5 ± 3.8 years. 15 (71.4%) were male and six (28.6%) were female. Organisms isolated from bone cultures were Staphylococcus 71.4% (15 / 21), Pseudomonas aeruginosa 9.5% (2 / 21), Escherichia coli 9.5% (2 / 21), Proteus mirabilis 4.8% (1 / 21), Klebsiella pneumoniae 4.8% (1 / 21), respectively. Cultures of sinus track material and bone specimens gave identical results in 47.6% of patients. Conclusion: This study shows that if treatment of COM was planned according to the microbiological analysis of material from the sinus-track, it may not result in recovery every time. We found approximately 48% concordance between sinus-track and bone cultures. In other words, antimicrobial therapy guided by antibiograms of bacteria isolated from sinus-track would be inappropriate in 52% of patients with COM and result in treatment failure. KEY WORDS: bacteriology, childhood, chronic osteomyelitis, sinus-track INTRODUCTION Osteomyelitis is an inflammatory process accompanied by bone destruction and caused by an infecting microorganism. The infection can be limited to a single portion of the bone or can involve several regions, such as marrow, cortex, periosteum, and the surrounding soft tissue [1] . It can be caused by bacteria, fungi and a variety of other organisms. Among the pathogenic microorganisms Staphylococcus aureus is by far the most commonly involved in all age groups, including newborns. Group A Streptococcus is next in frequency but constitutes fewer than 10% of all cases [2] . Osteomyelitis in pediatric patients occurs uniquely because of the blood supply, which may be compromised by trauma [3] . Chronic osteomyelitis (COM) can be primary, when it arises from failed treatment of acute hematogenous osteomyelitis (AHO) or secondary, when it is caused by trauma to the bone, open fractures or from postoperative infection [4] . The hallmark of COM is bone necrosis and, as opposed to AHO in which medical treatment results in > 90% cures, COM often requires multiple surgical procedures and long term antibiotics [5] . The most important step in COM is to isolate the offending organisms so that the appropriate antimicrobial therapy can be chosen [6] . In cases of COM, sinus-tracks frequently develop from infected bone to the skin. Several investigators have used cultures of specimens from sinus-tracks to identify the pathogens [7, 8] . In doing so, they have assumed that bacterial cultures from the sinus-track originate from bone infection itself. Material taken from an open sinus-track by swabbing will give misleading results because the isolates may include non-pathogenic microorganisms that are colonizing the site. The aim of this study was to retrospectively compare the diagnostic value of the sinus-track and bone specimen cultures in secondary pediatric COM. Address correspondence to: Dr. Mehmet Ulug, MD, Özel Ümit Hospital, Department of Infectious Diseases and Clinic Microbiology, 26140 Eskişehir, Turkey. Tel: 05324475756, Fax: +902223350170, E-mail: mehmetulug21@yahoo.com
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