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Four consecutive infants and children with hepatoblastomas were treated with a combination of Adriamycin (doxorubicin) and cisplatin. Three patients had unresectable tumors and in each there was a dramatic decrease in tumor size and serum alpha-fetoprotein (AFP) levels. The tumors of two of these patients, including one with pulmonary metastases which cleared, were rendered resectable. The third patient's tumor remained unresectable but his AFP level returned to normal following radiotherapy. All three patients are disease-free, and both without metastases are off therapy from 9 to 24 months. A fourth child received the combination as adjuvant therapy following resection of an embryonal hepatoblastoma and he remains disease-free 7 months after its discontinuation. Therapy was tolerable in all patients and its principal toxicities were myelosuppression and magnesium wasting. Adriamycin and cisplatin in combination were very effective in these patients and deserve further trials, especially in unresectable and metastatic hepatoblastomas.

Introduction: Nuss procedure, a minimally invasive thoracoscopic approach to repair pectus excavatum, results in a smaller scar but significant pain. The purpose of this Institutional Review Boardapproved retrospective study was to compare postoperative pain management outcomes of adolescents who self-selected to receive or not receive preoperative self-hypnosis training before Nuss procedure. Self-hypnosis, an integrative medicine approach to pain management, may be more effective than traditional analgesics alone for managing postoperative pain. Methods:In 2011, 8 of 22 patients who underwent Nuss procedure received preoperative self-hypnosis training and postoperative self-hypnosis coaching. Postoperatively, patients received epidural analgesia with local anesthetic, intravenous patient-controlled opioid analgesia, and intravenous nonsteroidal anti-inflammatory drugs and transitioned to oral opioids and nonsteroidal anti-inflammatory drugs.Results: Self-hypnosis training was associated with use of fewer milligrams per hour of morphine equivalents ( p = .005) and lower mean pain intensity over the first 5 days of hospital stay ( p = .041). Despite the opioid-sparing effect of self-hypnosis training, nausea, vomiting, constipation, and hypoventilation were adverse effects experienced by patients in both groups. Discussion:The results of this retrospective study suggest that selfhypnosis provides an opioid-sparing effect for managing moderateto-severe pediatric postoperative pain after Nuss procedure. Further clinical studies are needed to validate the effectiveness of self-hypnosis for symptom management after painful pediatric surgical procedures.