Ghinescu

Age: 6 years; Date of birth: 1999, June 24

Address: 48A Rau Mare street, Hateg - code 335500, Hunedoara County, ROMANIA

Parents’ names: Stefan Ghinescu (father); Irina Claudia Ghinescu (mother)

Telephone number: +40 74 4488 207

e-mail: stghmail@gmail.com

Medical and personal history of the patient:

? healthy parents; no other tumoral diseases in the family

? his mother is a medical doctor (general practice); he received good care and medical attention; all vaccinations required in Romania were done in time;

? he was a healthy child; very active, everything seemed to be normal

? about October 1st he accuses frequent headaches and nausea; vomits early in the morning few times

? November 21st, 2005: Ophthalmologist discovers modifications at the fundoscopic examination

? November 25th, 2005: MRI examination in Petrosani, Romania discovers tumor. CD #1

? MRI Diagnosis:

- process of tumoral type that replaces space. Morphology and location plead for a subependimar astrocitoma. These are the conclusions of the test.

- it possibly is a cranio-faringiom or an ependinom located there.

- extension phenomena at the optical chiasm level are present and confirm the clinical exam.

- moderate dilatation of the lateral ventricles and subependimar edema caused by obstruction at this level and change of LCR dynamics.

- no other infra and supratentorial evolutive lesions.

? December 8th, 2005: The University Clinic in Tubingen, Germany, agrees to take the case

? MRI and CT exams and blood analysis are done.

? The ophthalmologic exam can not find any sight troubles.

? The neurological exam shows normal status.

? The endocrinological exam shows normal status.

? December 12th, 2005: the first surgery takes place in Tubingen; a probe is taken for the histological exam and the tube that drains the LCR is put on. The histology shows that the tumor is a pylocitic astrocytoma, degree I.

? The general condition of the patient is poor; accuses headaches every day and loses weight.

? The conclusion of the surgeons in Tubingen is that the tumor can not be taken out, due to the location and shape, and suggest that internal radio-therapy by SEED implant is the optimal treatment for the case.

? The case is transferred to the University Clinic in Freiburg, Germany, for the SEED implant.

? MRI and CT exams and blood analysis are done.

? December 22nd, 2005: the second surgery takes place in Freiburg; the histology is repeated and the diagnosis is confirmed. The SEED implant is performed and the radioactive capsule remains in for 21 days.

? The general condition of the patient improves.

? January 9th, 2006: MRI scan is taken in Petrosani, Romania.

? January 12th, 2006: the SEED is explanted in the University Clinic in Freiburg, Germany. The surgeon requires another MRI scan after 3 months.

? The general condition of the patient is good.

? April 2nd, 2006: MRI scan is taken in Petrosani, Romania. The scan is seen by the neurosurgeon in Freiburg, Germany, who considers the disease stable, without significant changes. He suggests observing the patient and requires another MRI scan after 3 months.

? April 6th, 2006: An ophthalmologic exam is performed in Romania; it can not find any sight troubles. The fundoscopic exam shows normal status.

? During 2006, the patient started to gain weight. In January 2006 his weight was 20 kg (44 lbs) and in December 2006 it was 40 kg (88 lbs). We suspected hormonal disturbances and asked for qualified advice.

? June 2006 the patient is seen by an endocrinology professor in Timisoara, Romania. The hormonal analysis din not show any change. Even on a diet, the patient kept gaining weight.

? October 2006, the patient is seen by another endocrinology professor in Bucharest, Romania. The conclusion was that it seems to be a hormonal disturbance, but treatment options in Romania are limited or unavailable, due to the tumor presence.

? December 2006, we contacted the Endocrinology department at the UCLA clinics, and we were advised by Dr. Cohen.

? January 2007: At Dr. Cohen’s recommendation the lab analysis checked the growth hormone and found a lower level than normal.

? March 2007: more hormonal changes are noticed; an early puberty process started. Dr. Cohen suggests that Lupron treatment is necessary and urgent.

? April 2007: the patient receives an endocrinological check at a clinic in Cluj, Romania. Since Lupron is not available in Romania, the treatment used Dipherelyn (triptorelina) 3.75 mg, once every 28 days.

? August 2007: the puberty is stopped and kept under control by the treatment, but the patient keeps gaining weight, reaching 50 kg (110 lbs).

? January 2008: his condition starts degrading quickly. High fever with no acute infection, suggests a hypothalamic disturbance. The patient is also sleeping about 20 hours/day. CT and MRI scans reveal an internal tumoral bleeding, that caused an edema. This condition lasted about three weeks, and then it started improving.

? June 2008: his condition starts degrading quickly again with different symptoms. Severe headaches during the day and the night; frequent vomit episodes; sleepiness. The headaches were so severe that the patient felt he needed cold ice on his forehead.

? The fundoscopic examination shows a pupil prominence at the left eye.

? An MRI scan is taken.

? Two days after the headaches start the patient is treated on Dexamethasone IV 8 mg/day, and painkiller drug IM.

? After two weeks, his condition improved.