Costs of pain in rheumatology.

Chronic pain has been identified as an important issue related to various rheumatic diseases. At the time of a major government spending review, it is appropriate to discuss the pain characterising rheumatic diseases and its related costs. It is clearly essential for healthcare authorities to rationalise their policies on the basis of the increasing expectations of the users of healthcare services while simultaneously balancing their books. There are few published studies concerning the costs of pain of any kind, and the same is true of the costs of the chronic pain associated with diseases such as rheumatoid arthritis, osteoarthritis, and fibromyalgia.

Six years' experience of total parenteral nutrition in children with hematological malignancies at a single center: management, efficacy, and complications.

Total parenteral nutrition (TPN) is an important issue in supportive care of children with leukemia. We studied 131 consecutive children (87 male, 44 female) with hematological malignancies who received TPN at our center from July 1984 to July 1990 with the aim of evaluating the efficacy and complications of TPN. The use of TPN was associated with lack of any alteration of the anthropometric indexes used in this study. The complications were prevalently metabolic, generally mild, and easily controlled. Laboratory monitoring of nutritional status during TPN is probably of little value in this setting. The feasibility of in-ward preparation of TPN by nurses makes TPN possible at low cost provided that patients are selected carefully.

Pulmonary sequestration in a child with acute myeloid leukemia.

The article describes a relatively rare congenital anomaly that was difficult to diagnose in a 10-year-old child with acute nonlymphoblastic leukemia. Just at diagnosis of leukemia, the patient showed a pathologic chest radiograph because of a parenchymal thickening at the right lung apex. The presence of bronchopneumonia was suspected, and broad-spectrum antibiotic therapy was started with subsequent antifungal treatment for persistent fever and concurrent chemotherapy-induced marrow aplasia, which did not favor pulmonary infiltrate recovery. Continuous culture tests, including bronchial swab, proved negative for Koch-Weeks bacillus, fungal organisms, and other pathogens. Computed tomography, however, was suggestive of Aspergillus lung involvement, and apical segmentectomy was performed. The anatomic pathologist suggested the diagnosis of intralobar sequestration. In summary, when pulmonary pathology with an excavation is found in a leukemic child, one must consider the possibility of pulmonary sequestration complicated by an infectious disease.

[The use of urokinase and ammonium chloride in unblocking a central venous catheter in a child with acute lymphoblastic leukemia]. / Uso dell'urokinasi e del cloruro d'ammonio nella disostruzione di un catetere venoso centrale in un bambino con leucemia linfoblastica acuta.

Central venous catheter (C.V.C.) mechanical obstruction in immunocompromised patients can yield several complications sometime life-threatening and can be promptly solved by thrombolytic treatment. The authors describe a case of a child affected by acute lymphoblastic leukemia and experiencing an obstruction of his C.V.C. very difficult to treat with conventional urokinase treatment. Thinking the lack of success to be attributed to a calcium thrombus, the Authors before pulling out the C.V.C., made use of ammonium chloride solution in order to obtain the disappearance of the little bag covering the tip of C.V.C. The treatment was successful as confirmed by the contrast medium examination and the use of C.V.C. lasted for several months without other mechanical obstruction. In our best knowledge this is one of the first attempts with such ammonium chloride solution which have been used successful and rather safely. The only drug induced symptoms were constituted by mild and transient vomiting. Owing to this positive experience the authors believe useful to confirm this treatment in other cases. In this contest an experienced hematoncology team must take care of C.V.C. related complications.