Pulmonary thromboembolism in leukaemic children undergoing bone marrow transplantation.

Of 67 leukaemic children transplanted in our BMT unit 3 presented with severe acute respiratory syndrome associated with pulmonary thromboembolism (PTE) as diagnosed by scintiscan and/or angiography in the first month after BMT. Intervention with continuous positive pressure ventilation, urokinase (loading dose, then continuous infusion for 12-18 h) and heparin (continuous infusion for an average of 10 days) has been carried out successfully in two cases. In conclusion, when evaluating patients undergoing BMT and developing early pulmonary complications, PTE must be considered. The pathogenesis of PTE is still difficult to ascertain but urokinase therapy may reduce early morbidity.

[Prognostic importance of the criteria of stability and instability in traumatic injuries of the spine]. / Considerazioni sull'importanza prognostica dei criteri di stabilità ed instabilità delle lesioni traumatiche del rachide.

A traumatic vertebral lesion is unstable when, in spite of correct and timely reduction and immobilisation, a displacement occurs during the days following the trauma. Prompt correct diagnosis (often impeded by the serious conditions of the patients) and subsequent examinations are of great importance, especially in the case of very small, hardly detectable lesions, which do not involve neurological injuries. A series of some 800 vertebral fractures/dislocations was reviewed and numerical coefficients as proposed by Goutallier et al. were assigned to each case. These criteria were generally valid. However certain predictable unstable lesions for which surgery is indicated despite the absence of neurological lesions were stabilised by synostosis or anatomofunctional blocks even without surgical intervention. In contrast surgical stabilisation is necessary not only in the presence of neurological lesions but also when no sign of repair can be seen and/or vertebral dislocations worsen and/or anomalous vertebral movements arise.

Treatment of sialorrhoea with ultrasound guided botulinum toxin type A injection in patients with neurological disorders.

OBJECTIVES: To investigate the safety and efficacy of ultrasound guided botulinum toxin type A (BTX-A) injections into salivary glands for the treatment of sialorrhoea in patients with neurological disorders. METHODS: The parotid and submandibular glands of 10 patients were injected with BTX-A using ultrasound guidance. Before injection, the baseline rate of salivation was assessed using a visual analogue scale. Postinjection, assessments were repeated at regular intervals for up to 1 year. RESULTS: Of the 10 patients treated, nine (90%) reported a subjective reduction in salivation post-treatment and one patient (10%) found no improvement. Visual analogue scale scores showed a reduction of 55% in the mean rate of salivation for all patients and a reduction of 60.8% for the group of responders. No serious adverse events occurred and no procedure related complications were reported. CONCLUSIONS: This is the first study to report (1) the injection of BTX-A (BOTOX) into both parotid and submandibular glands, and (2) the use of ultrasound guidance during the administration of BTX-A into salivary glands. The results suggest that the technique is safe and that BTX-A injections are effective for the treatment of sialorrhoea in patients with neurological disorders.

Acute respiratory failure and pulmonary thrombosis in leukemic children.

Acute respiratory failure (ARF) in an 11-year-old child with pre-T acute lymphoblastic leukemia (ALL) at the beginning of induction therapy was observed, connected with a pulmonary thrombosis and not with an infective origin. A systematic search for this pathology identified six other children with the same pulmonary complication, five of whom where in the early phase of acute nonlymphoblastic leukemia (ANLL) and one in induction therapy for ALL in marrow relapse. At the beginning of the symptomatology, all children presented severe hypoxia and hypercapnia, with no or minimal chest radiograph abnormalities and no clear hemodynamic involvement. In all patients the arteriography and nuclear imaging studies confirmed the diagnosis. The causes of the thrombi could be connected with neoplastic emboli after cell lysis and/or with the vascular damage resulting from antiblastic therapy. Intravenous urokinase treatment and respiratory assistance had been successfully carried out in six of seven children.