Summary:responsible for tooth defects which are preventable by strict oral hygiene measures.In the current study we evaluated the dental status of Minimal data about oral and dental health in long-term survivors after BMT are available. We studied the den-27 long-term pediatric survivors who underwent BMT for malignant haematological diseases. Besides clarifying the tal status of 27 children (19 males, eight females) with leukaemia, followed up with a routine oral examination, role of BMT on the dental status of transplant patients, the results of this study also emphasise the importance of oral panoramic tomogram and, when necessary, an endoral radiograph at a median of 2 years (range 1-10) after care and quality of life in children cured after BMT. BMT. Community periodontal index treatment necessity (CPITN), dental caries, missing or filled permanentPatients and methods teeth (DMFT) and dento-facial alterations according to WHO criteria were registered and evaluated. Median Twenty-seven children (19 males, eight females) with haematological malignancies who underwent BMT (23 age of the patients at BMT was 9 years (range 1.1-17.9). The mean DMFT score ranged from 1.6 to 12.4 accordallogeneic and four autologous) at different disease stages (Table 1), were consecutively evaluated for oral and dental ing to age at examination and was slightly higher than that which we previously reported in children who status between July 1989 and January 1994. At diagnosis all patients were treated according to protocols of the Italian received chemotherapy alone. CPITN showed the presence of soft deposits in 77.7%, serious gingivitis in Association for Paediatric Haematology and Oncology (Associazione Italiana di Ematologia ed Oncologia 59.2% and parodontal involvement in 3.7% of cases. Dento-facial abnormalities were found in 55.5% of Pediatrica) which have been reported in detail elsewhere. 6,7 Eleven out of 15 patients with ALL received cranial patients, while 62.9% of the patients had tooth abnormalities or agenesis. Nine out of 27 patients (33%) had irradiation (18 Gy) during first-line treatment, as CNS prophylaxis. The median age of our patients at diagnosis root hypoplasia. A negative impact on DMFT index due to multiple post-BMT factors was found. Age is the cruwas 6.6 years (range 0.7-14.7 years); 9 years (range 1-17.9 years) at BMT and 11.6 years (range 4.5-19.9 years) at cial factor in determining a developmental defect of enamel and root. The follow-up of long-term survivors dental evaluation. Conditioning for BMT consisted of highdose vincristine or Ara-C and standard cyclophosphamide 8 after BMT should include regular dental examination.
Summary:Chronic graft-versus-host disease (cGVHD) is a frequent complication of allogeneic bone marrow transplantation (BMT). Thalidomide was found to have immunosuppressive properties and it has been used in a limited number of children with cGVHD. We report our experience with refractory and/or high-risk cGVHD in 14 children. Six children showed complete clinical response to thalidomide in a median time of 2 months. Four children had partial responses and four failed. Side-effects were usually mild (somnolence, constipation) and only two patients developed sensory peripheral neuropathy. An increased incidence of infectious complications attributable to thalidomide was not observed. Nine out of 10 responding patients are alive 49-111 months post-BMT. Thalidomide can be effective particularly in children with prevailing mucocutaneous cGVHD. All patients should be carefully monitored to detect peripheral neuropathy early.
The aim of this study was to compare the Hickman and Groshong central venous catheters (CVCs) for incidence and severity of catheter-related complications in children. Seventy-three patients with hematological malignancies were observed, 42 with Groshong CVCs and 31 with Hickman CVCs. The number of infective episodes per 100 CVC-days was not significantly different (0.25 in the Hickman group versus 0.13 in the Groshong group; P = 0.24). The most frequent type of CVC-related infection in both groups was microbiologically documented sepsis; in most cases Gram-positive bacteria were isolated. Neutropenia (P < 0.001 for both CVCs) and hospital CVC management (P = 0.0047 for the Hickman group, P < 0.001 for the Groshong group) emerged as the major risk factors for the outbreak of infections. The rate of mechanical complication episodes per 100 CVC-days was similar in both groups (1.01 in the Hickman group versus 1.1 in the Groshong group: P = 0.58). Some complications (fissures, ruptures, total lumen obstruction by clots) occurred only in the Groshong group. Our study did not demonstrate any statistically significant difference in the incidence of mechanical and infective CVC-related complications between these two types of catheter.
One hundred fifty-six episodes of fever occurred in 102 children during the first 100 days after bone marrow transplantation (BMT) performed at a single institution: fever of undetermined origin (FUO), 40.3%; septicemia, 7.1%; pneumonia, 19.2%; other infections, 33.4% of cases. The overall incidence of mortality was 22.6% and of mortality due to infections 17.4%. All FUO episodes resolved. Pneumonia was the major cause of death; 60% of recipients who developed pneumonia died, accounting for 90% of deaths attributable to febrile complications. Interstitial pneumonia, occurred rarely, in 3.9% of all febrile episodes. The Cox model showed that the presence of graft-versus-host disease (GVHD) was related to an approximately ninefold increase in the risk of a first episode of FUO (P value .03). The risk of developing pneumonia was fourfold greater in children who received a transplant from a matched unrelated donor or a mismatched family donor (P value .01). Developments in diagnostic tools are needed to diagnose febrile episodes earlier and more precisely with the aim of reducing early mortality after BMT.
Pulmonary thromboembolism (PTE) in leukemic children undergoing intensive chemotherapy should be promptly recognized so that specific therapy can be started. Our experience with the two cases reported here has led us to propose guidelines for the treatment of initial PTE in a pediatric hematology unit. Two children with leukemia developed PTE, the first during the relapse for acute lymphoblastic leukemia and the second at the onset of acute promyelocytic leukemia. In both cases, the diagnosis of PTE was based on clinical assessment of sudden acute respiratory failure with positive pulmonary perfusional scintigraphy in spite of a negative chest X-ray. The subintensive supervision consisted of instrumental monitoring with the assistance of an intensive care anesthetist. The clinical monitoring was based on the serial registration of respiratory rate, cardiac rate, SaO2 and body temperature. The thrombolytic therapy, together with heparin prophylaxis, was successfully administered in the hematology ward without the need for intensive care support (i.e. mechanical ventilation). The success of the treatment was documented by the criterion of a return to the normal cardiorespiratory parameters a few hours after the start of the thrombolytic treatment. Furthermore, a chest CT scan in case 1 and an arteriography in case 2 confirmed the PTE-related hypoperfusion. On the basis of this experience, the authors point out that in the course of acute respiratory failure in leukemic children, the combination of a negative chest X-ray and a positive pulmonary perfusional scintigraphy (compared whenever possible with ventilatory scintigraphy) in the presence of a negative CT scan could be a reliable diagnostic tool for PTE. This pathology should be treated promptly and with specific therapy to avoid progression to a severe, massive PTE.
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