Journal of pediatric hematology/oncology
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Hypothermia has been demonstrated to induce pancytopenia in animals, but whether this association exists in humans is unknown. The authors report the case of an 8-year-old girl in whom hypothermia (temperature 33 degrees C-35 degrees C) is the cause of pancytopenia. The patient developed thermoregulatory dysfunction subsequent to surgical resection of a craniopharyngioma. ⋯ The pancytopenia improved upon rewarming the patient to a temperature of 36 degrees C. This association between hypothermia and pancytopenia has rarely been reported in humans and may be underdiagnosed especially in cases of transient or milder presentations. The authors recommend careful hematologic monitoring of patients with thermoregulatory dysfunction.
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J. Pediatr. Hematol. Oncol. · Nov 2002
ReviewUse of tissue plasminogen activator (rt-PA) in young children with cancer and dysfunctional central venous catheters.
To determine the efficacy and safety of low, nonescalating dose tissue plasminogen activator (rt-PA) in restoring the patency of occluded central venous access devices (CVCs) in children with cancer who weigh less than 30 kg. ⋯ This article describes the use of rt-PA (0.5 mg, without dose escalation) to lyse CVC-associated thrombi specifically in small children with cancer, a patient population in which it is particularly desirable to minimize the degree of fibrinolysis. One dose of 0.5 mg rt-PA, with an additional dose if necessary, is as safe and effective as previously reported escalating dose regimens for CVC clot lysis. There is no statistically significant correlation of treatment failure with patient age, weight, or catheter lumen size, and no significant propensity for rapid rethrombosis following a single dysfunction and treatment. Patients initially treated with a single dose of rt-PA appear to have more subsequent dysfunctions in the month after treatment, an observation that warrants further study.
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J. Pediatr. Hematol. Oncol. · Nov 2002
Home management of pain in sickle cell disease: a daily diary study in children and adolescents.
To determine the incidence of pain and the types of home pain management techniques used by children and adolescents with sickle cell disease (SCD) and their caregivers. ⋯ Pain went untreated on a modest number of days, and many patients relied on relatively ineffective single analgesics. Other patients and families appropriately used potent analgesic combinations in a time-contingent and intensity-dependent pattern. This study suggests that recurrent acute pain from SCD can be successfully managed at home with appropriate training and supervision, and suggests several areas for intervention to improve patient outcomes.
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J. Pediatr. Hematol. Oncol. · Nov 2002
Prospective study of indwelling central venous catheter-related complications in children with broviac or clampless valved catheters.
To compare two types of central venous catheters (Broviac and valved clampless) for the incidence and severity of catheter-related complications in children. ⋯ There were no major differences in the incidence of mechanical or infectious complications between the two devices. Malfunction was more frequent in Broviac catheters, whereas catheter displacement occurred more frequently in clampless valved catheters. These results show the importance of central venous catheter-related mechanical complications in the management of children with hematologic or oncologic malignancies.