The use of an intrathecal pump to manage intractable cancer pain in a pediatric patient: a case report
adolescent; Female; Humans; Pain; Pain Measurement; Analgesics; Prognosis; Fatal Outcome; Infusion Pumps; Injections; Spinal; Implantable; Carcinoma; Intractable; Anus Neoplasms; Condylomata Acuminata; Immunologic Deficiency Syndromes; Neutropenia; Squamous Cell; Vulvar Diseases
A 15-year-old girl with combined immune deficiency syndrome, diagnosed with metastatic squamous cell cancer of the anus, had significant pain secondary to vulvar-perianal condyloma. Conventional treatment with oral and intravenous analgesics was limited by significant side effects of mental status changes and urinary retention leading to clinical deterioration that precluded attempts at chemotherapy. An intrathecal pump was implanted in the challenging setting of neutropenia. There was a drastic improvement in her quality of life and the ability to tolerate further chemotherapy. The option of an intrathecal pump for pain control extended our patient's ability to enjoy important quality time with family by several months.
2014-04
Bengali R; Huang MS; Gulur P
Journal Of Pediatric Hematology/oncology
2014
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Journal Article
<a href="http://doi.org/10.1097/MPH.0b013e31828e5dca" target="_blank" rel="noreferrer">10.1097/MPH.0b013e31828e5dca</a>
Use of intravenous acetaminophen (paracetamol) in a pediatric patient at the end of life: case report
Child; Female; Humans; Pain; Terminal Care; Analgesics; Fatal Outcome; Ovarian Neoplasms; Injections; Intravenous; Acetaminophen; Non-Narcotic; Sertoli-Leydig Cell Tumor
BACKGROUND: For the better part of 100 years, acetaminophen (or paracetamol as it is known outside of the United States) has been a common first-line analgesic in pediatrics and is typically well tolerated with minimal side effects. Its use as an anti-pyretic is also well-documented and thus it is used broadly for symptom control in the general pediatric population. DISCUSSION: In pediatric palliative care, acetaminophen is also used as an adjuvant to opioid therapy for pain as well as an anti-pyretic. For many pediatric patients near end-of-life, however, the ability to tolerate oral intake is diminished and rectal suppository administration can be distressing or contraindicated as in the setting of neutropenia, thus limiting use of acetaminophen by its usual routes. In Europe and Australia, an intravenous formulation of acetaminophen has been used for many years and has only recently become available in the United States. CONCLUSION: Here, we describe a case using intravenous acetaminophen in a pediatric patient at the end of life.
2013-12
Marks AD; Keefer P; Saul D'Anna
Journal Of Palliative Medicine
2013
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Journal Article
<a href="http://doi.org/10.1089/jpm.2012.0117" target="_blank" rel="noreferrer">10.1089/jpm.2012.0117</a>
Haloperidol as a palliative anti-emetic in a toddler: an evidence base challenge
Humans; infant; Male; Palliative Care; Antiemetics; Nausea; Fatal Outcome; Evidence-Based Medicine; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Haloperidol
2008
Siden H
Journal Of Pain And Symptom Management
2008
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Journal Article
<a href="http://doi.org/10.1016/j.jpainsymman.2007.10.001" target="_blank" rel="noreferrer">10.1016/j.jpainsymman.2007.10.001</a>
An unusual clinical and biochemical presentation of ornithine transcarbamylase deficiency in a male patient
Child; Humans; Male; Fatal Outcome; Preschool; Q3 Literature Search; Diagnosis; Differential; Amino Acid Metabolism; Amino Acids/blood; Inborn Errors/diagnosis; Ornithine Carbamoyltransferase Deficiency Disease/blood/diagnosis; Ornithine Carbamoyltransferase/deficiency; Orotic Acid/urine
We report a male patient with a history of recurrent idiopathic vomiting, normal plasma ammonia and glutamine concentrations in acute phase, who died at 3 years of age. Ornithine transcarbamylase deficiency was diagnosed after detecting elevated urinary orotate concentrations in a sample collected just before death, and the diagnosis was confirmed by DNA analysis.
2006
Burlina AB; Peduto A; Di Palma A; Bellizzi A; Sperli D; Morrone A; Burlina AP
Journal Of Inherited Metabolic Disease
2006
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Journal Article
<a href="http://doi.org/10.1007/s10545-006-0193-3" target="_blank" rel="noreferrer">10.1007/s10545-006-0193-3</a>
Nonheart failure-associated elevation of amino terminal pro-brain natriuretic peptide in the setting of sepsis
Female; Humans; Male; Aged; Fatal Outcome; Heart Failure; 80 and over; Biological Markers/blood; Brain/blood; Congestive/blood/drug therapy; Natriuretic Peptide; Peptide Fragments/blood; Protein Precursors/blood; Sepsis/blood/drug therapy; Telemeres
In addition to its importance in clinical assessment, N-terminal pro-brain natriuretic peptide (NT pro-BNP) is a valuable marker for evaluation of treatment and prognosis of heart failure. However, there are situations where NT pro-BNP is not related to myocardial dysfunction. Two cases of sepsis with markedly elevated NT pro-BNP levels that are not indicative of depressed myocardial function are described.
2006
Bar SL; Swiggum E; Straatman L; Ignaszewski A
The Canadian Journal Of Cardiology
2006
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Journal Article
<a href="http://doi.org/10.1016/s0828-282x(06)70908-4" target="_blank" rel="noreferrer">10.1016/s0828-282x(06)70908-4</a>
Leigh's syndrome
Female; Humans; Disease Progression; Autopsy; Severity of Illness Index; Risk Assessment; Biopsy; Magnetic Resonance Imaging; Fatal Outcome; infant; Q3 Literature Search; Needle; Basal Ganglia/pathology; Immunohistochemistry; Leigh Disease/diagnosis/physiopathology/therapy
A 15-month-old female child presented with sudden onset cough and hyperventilation along with evidence of metabolic acidosis. She had past history of recurrent vomiting, episodes of abnormal posturing, difficulty in deglutition and regression of milestones since 12 months of age. CT scan of the brain revealed hypodense lesions in bilateral basal ganglia and on MRI there were T2 hyperintensities in bilateral lentiform nuclei, caudate nuclei, thalamus, red nuclei and dentate nuclei. Biochemical examination revealed persistently elevated serum lactate levels with high lactate/pyruvate ratio. Resuscitative measures were of no avail and the child succumbed to the illness on the second day of admission. Neuropathological examination at autopsy demonstrated marked spongiosis, focal necrosis, endothelial proliferation, reactive astrogliosis and extensive demyelination involving bilateral basal ganglia, midbrain and spinal cord which were typical of Leigh's sub acute necrotizing encephalomyelopathy.
2004
Mannan AA; Sharma MC; Shrivastava P; Ralte AM; Gupta V; Behari M; Sarkar C
Indian Journal Of Pediatrics
2004
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Journal Article
<a href="http://doi.org/10.1007/bf02828121" target="_blank" rel="noreferrer">10.1007/bf02828121</a>
Mitochondrial respiratory chain disease presenting as progressive bulbar paralysis of childhood
Child; Humans; Male; Siblings; Fatal Outcome; Preschool; infant; Q3 Literature Search; Bulbar Palsy; Mitochondrial Diseases/complications/diagnosis; Progressive/diagnosis/etiology
We report two siblings with a mitochondrial respiratory chain defect who presented with progressive bulbar paralysis of childhood (Fazio-Londe disease). Mitochondrial respiratory chain defects should be considered in differential diagnosis of this rare clinical entity.
2004
Roeleveld-Versteegh AB; Braun KP; Smeitink JA; Dorland L; de Koning TJ
Journal Of Inherited Metabolic Disease
2004
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Journal Article
<a href="http://doi.org/10.1023/b:boli.0000028836.91788.30" target="_blank" rel="noreferrer">10.1023/b:boli.0000028836.91788.30</a>
Intravenous ketamine infusion as an adjuvant to morphine in a 2-year-old with severe cancer pain from metastatic neuroblastoma
Female; Humans; Palliative Care; Pain; Analgesics; Fatal Outcome; quality of life; Preschool; Non-U.S. Gov't; Research Support; Administration; Oral; Infusions; Intravenous; Intractable/drug therapy/etiology; Combination; Codeine/administration & Drug Therapy; Dyspnea/chemically induced; Hallucinations/chemically induced; Ketamine/administration & Methadone/administration & dosage/adverse effects/therapeutic use; Morphine/administration & Neuroblastoma/physiopathology; Non-Narcotic/administration & dosage/therapeutic use; Opioid/administration & Child
A 2.8-year-old female patient (11.6 kg) was admitted to the hospital for uncontrolled pain and swelling in the left leg relating to a metastatic neuroblastoma. Initially, her pain was managed with oral morphine 2 mg (approx. 0.2 mg/kg) every 4 hours. Because she was quite somnolent but still in significant pain, analgesia was then changed to methadone 1 mg orally every 6 hours (approximately 0.1 mg/kg/dose) and was eventually increased over 36 hours to 2 mg every 6 hours (approximately 0.2 mg/kg/dose). She received oral methadone 0.6 mg (approximately 0.05 mg/kg) every 4 hours as needed for breakthrough pain. She continued to have severe pain and experienced side effects, including respiratory depression, sedation, visual hallucinations, and vomiting. An intravenous ketamine infusion was started at 100 microg/kg/hour. Regular opioid administration was ceased, but she was given intravenous morphine 0.5 to 0.75 mg for breakthrough pain. She required only zero to three doses of breakthrough morphine per day, initially. After starting the ketamine infusion, her pain control improved and her symptoms of opioid toxicity abated. She was more alert and able to partake in limited activities. As a result of pain from progressive disease, the ketamine infusion was increased to 200 microg/kg/hour after 6 days with positive results. Her condition continued to deteriorate. An intravenous morphine infusion was initiated 2 weeks after starting the ketamine infusion and was eventually increased to 50 microg/kg/hour. One week later, she died with reasonable pain control. This case illustrates the use of ketamine as an effective analgesic in an adjuvant setting in a pediatric patient with advanced poorly controlled cancer pain. Ketamine not only eased the child's suffering while preserving life but also improved her quality of life by maintaining the child's ability to communicate and engage in activities.
2004
Tsui BC; Davies D; Desai S; Malherbe S
Journal Of Pediatric Hematology/oncology
2004
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Journal Article
<a href="http://doi.org/10.1097/01.mph.0000140656.96085.2c" target="_blank" rel="noreferrer">10.1097/01.mph.0000140656.96085.2c</a>
Bowel obstruction in an infant with AIDS
Female; Humans; Fatal Outcome; infant; Polymerase Chain Reaction; Acquired Immunodeficiency Syndrome/complications/pathology; AIDS-Related Opportunistic Infections/complications; Candidiasis/complications; Colonic Diseases/pathology/virology; Enzyme-Linked Immunosorbent Assay; Ileal Diseases/pathology/virology; Intestinal Obstruction/pathology/virology; Pancytopenia/etiology
AIDS accounted for approximately one quarter of all deaths in South Africa in 2000 and has become the country’s single biggest cause of death.1 Paediatric HIV infection is now a common cause of admission to hospital and a major contributor to childhood mortality.2 A recent study reported that 60% of admissions to an academic hospital in Durban (Kwa-Zulu Natal) were infected with HIV.3 We report a case of intestinal obstruction in an infant with HIV infection, the cause of which was only diagnosed at postmortem examination.
CASE REPORT
A 2 month old female presented with a three day history of constipation, anorexia, and progressive abdominal distension. [...]
Loveland J; Bowley DM; Beavon IR; Pitcher GJ
Archives Of Disease In Childhood
2003
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Journal Article
<a href="http://doi.org/10.1136/adc.88.9.825" target="_blank" rel="noreferrer noopener">10.1136/adc.88.9.825</a>
From death notification through the funeral: bereaved parents' experiences and their advice to professionals
Child; Grief; Parents; Attitude to Death; Death; Funeral Rites; Fatal Outcome; bereavement; Sudden
Parents who experience the sudden death of a child will interact with many professionals in the period immediately following the death notification through to the funeral. The way these professionals respond to the parents during this critical period may be perceived as helpful, and thus support them in beginning the process of managing the trauma and starting a healthy grieving process. It may also be perceived as unhelpful, though, and contribute to more prolonged and complicated grieving. This article identifies the interventions that a sample of 20 parents who had experienced the sudden death of a child found helpful with different aspects of grieving. Specific advice is given to police, nurses, doctors, coroners, social workers, crisis counselors, funeral directors, and chaplains or clergy.
2003
Janzen L; Cadell S; Westhues A
Omega
2003
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Journal Article
<a href="http://doi.org/10.2190/6xuw-4pyd-h88q-rq08" target="_blank" rel="noreferrer">10.2190/6xuw-4pyd-h88q-rq08</a>
Myopathy with mitochondrial changes presenting as respiratory failure in two brothers
Child; Humans; Male; Biopsy; Fatal Outcome; Q3 Literature Search; Diagnosis; Differential; Interstitial/diagnosis/pathology; Lung Diseases; Mitochondrial Myopathies/diagnosis/genetics/pathology; Needle; Nuclear Family; Respiratory Function Tests; Respiratory Insufficiency/etiology
Lemos AB; Mosquera J; Mate A; Sirvent J
Pediatric Pulmonology
1999
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Journal Article
<a href="http://doi.org/10.1002/(sici)1099-0496(199903)27:3%3C213::aid-ppul11%3E3.0.co" target="_blank" rel="noreferrer">10.1002/(sici)1099-0496(199903)27:3%3C213::aid-ppul11%3E3.0.co</a>
High-dose oral morphine in cancer pain management: a report of twelve cases
Female; Male; Pain; Analgesics; Aged; Fatal Outcome; Non-U.S. Gov't; Human; Case Report; Support; Intractable/drug therapy/etiology; Middle Age; Morphine/administration & dosage/adverse effects/therapeutic use; Neoplasms/complications; Opioid/administration & dosage/adverse effects/therapeutic; use
We present 12 case reports from patients treated with more than 600 mg of morphine per day. We found no "opioid-nonresponsive pain" under treatment with a combination of morphine and nonopioids, supplemented with coanalgesics where appropriate. Side effects of morphine therapy were controlled with adjuvant drugs. Serious adverse effects were not observed. Episodes of break-through pain, dysphagia, and dyspnea caused by far advanced cancer disease were seen frequently.
1996
Radbruch L; Grond S; Zech DJ; Bischoff A
Journal of Clinical Anesthesia
1996
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Journal Article
<a href="http://doi.org/10.1016/0952-8180(95)00201-4" target="_blank" rel="noreferrer">10.1016/0952-8180(95)00201-4</a>
Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency with the G1528C mutation: clinical presentation of thirteen patients
Female; Humans; infant; Male; Mutation; Fatal Outcome; infant; Q3 Literature Search; Newborn; Lipid Metabolism; 3-Hydroxyacyl CoA Dehydrogenases/deficiency; Cardiomyopathies/etiology; Hypoglycemia/etiology; Inborn Errors/complications/diet therapy/genetics; Liver Diseases/etiology; Muscle Hypotonia/etiology; Retinal Diseases/etiology
Long-chain 3-hydroxyacyl-coenzyme A (CoA) dehydrogenase is one of three enzyme activities of the mitochondrial trifunctional protein. We report the clinical findings of 13 patients with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency. At presentation the patients had had hypoglycemia, cardiomyopathy, muscle hypotonia, and hepatomegaly during the first 2 years of life. Seven patients had recurrent metabolic crises, and six patients had a steadily progressive course. Two patients had cholestatic liver disease, which is uncommon in beta-oxidation defects. One patient had peripheral neuropathy, and six patients had retinopathy with focal pigmentary aggregations or retinal hypopigmentation. All patients were homozygous for the common mutation G1528C. However, the enoyl-CoA hydratase and 3-ketoacyl-CoA thiolase activities of the mitochondrial trifunctional protein were variably decreased in skin fibroblasts. Dicarboxylic aciduria was detected in 9 of 10 patients, and most patients had lactic acidosis, increased serum creatine kinase activities, and low serum carnitine concentration. Neuroradiologically there was bilateral periventricular or focal cortical lesions in three patients, and brain atrophy in one. Only one patient, who has had dietary treatment for 9 years, is alive at the age of 14 years; all others died before they were 2 years of age. Recognition of the clinical features of long-chain 3-hydroxyacyl-CoA deficiency is important for the early institution of dietary management, which may alter the otherwise invariably poor prognosis.
1997
Tyni T; Palotie A; Viinikka L; Valanne L; Salo MK; von Dobeln U; Jackson S; Wanders R; Venizelos N; Pihko H
The Journal Of Pediatrics
1997
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Journal Article
<a href="http://doi.org/10.1016/s0022-3476(97)70312-3" target="_blank" rel="noreferrer">10.1016/s0022-3476(97)70312-3</a>
An advance directive in two questions.
Female; Humans; Palliative Care; Aged; Resuscitation Orders; Fatal Outcome; DNAR; Pain/et [Etiology]; Advance Directives; Health care reform; Living Wills; Meningitis/et [Etiology]; Pain Management; Pancreatic Neoplasms/co [Complications]; Pancreatic Neoplasms/pa [Pathology]; Pancreatic Neoplasms/th [Therapy]
It has been two decades since advance directives have become an integral part of health care. Impediments to their optimal usage are common and multifactorial. Decisions commonly have to be made when patients are unable to do so or choose not to participate in decision making, often at the end of life. The use of two questions, 1) "If you cannot, or choose not to participate in health care decisions, with whom should we speak?" and 2) "If you cannot, or choose not to participate in decision making, what should we consider when making decisions about your care?," may accomplish the major goals of an advance directive.Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Mahon MM
Journal Of Pain And Symptom Management
2011
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Journal Article
<a href="http://doi.org/10.1016/j.jpainsymman.2011.01.002" target="_blank" rel="noreferrer">10.1016/j.jpainsymman.2011.01.002</a>
Treating a child with a life-threatening condition
Child; Humans; Male; Terminal Care; Physician's Role; Fatal Outcome; Leukemia; Preschool; patient care team; bereavement; infant; hospice care; B-Cell/therapy; MELAS Syndrome/therapy; Palliative Care/ethics/legislation & jurisprudence/organization & administration
Klein SM; Saroyan JM
Pediatric Annals
2011
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Journal Article
<a href="http://doi.org/10.3928/00904481-20110412-07" target="_blank" rel="noreferrer">10.3928/00904481-20110412-07</a>