Acute leukemia is the most common type of cancer in pediatric patients. This type of cancer accounts for a third of all childhood cancer cases. More than half of pediatric acute leukemia patients show signs and symptoms such as hepatomegaly, splenomegaly, pallor, fever and bruising at the time of diagnosis. In early stages of acute lymphoblastic leukemia (ALL), nephromegaly and other renal manifestations such as high blood pressure (HBP) and renal failure are uncommon, although renal infiltration and nephromegaly are common in advanced-stage pediatric patients. This is a retrospective case review with a critical appraisal of the existing evidence from the literature. We present a clinical case of a child with HBP associated with bilateral nephromegaly which resolved after chemotherapy treatment. This patient presented with HBP that required pharmacological treatment, likely owing to nephromegaly. All HBP secondary causes were rejected. Nephromegaly was resolved after chemotherapy treatment, and antihypertensive medication was discontinued. Nephromegaly and HBP are rare manifestations of ALL debut in pediatrics. The present case report illustrates this unusual combination and Suggests clinicians to consider malignancy as its causal factor, especially if the symptoms are accompanied by other suggestive extrarenal manifestations.
Availability of minimally invasive abdominal procedures can be restricted in cases of painful procedures, due to limited access to anesthesia support or the more recent avoidance of aerosol generating medical procedures such as intubation. Intravenous sedation, in many cases is insufficient to effectively control the pain, leaving patients to suffer undue discomfort and a medical team stressed by the situation. Regional nerve blocks can offer a solution but are underutilized, likely in large part due to a lack of knowledge of available options.This manuscript describes four different nerve blocks that can be useful for analgesia related to upper abdominal procedures. Available data are reviewed regarding their effectiveness and the technique used to perform them is described. Information provided aims to help decide which is likely to provide the best analgesia depending on the procedure being done. Increase use of these blocks has the potential to improve patient's accessibility to minimally invasive upper abdominal procedures.
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