Arrhythmias and sudden death represent striking features in the natural history of thalassemia major. Antiarrhythmic treatment, however, does not appear to change the clinical course. During recent years the disease's therapeutics approach has undergone a substantial evolution, being more adequate the transfusional regimens as well as more effective the iron chelation therapy through subcutaneous infusion of deferoxamine. The aim of the present study was to determine possible influences exerted by the current treatment upon disease's arrhythmic disorders. Thirty patients of both sexes were enrolled in the study. The age ranged from 9 to 24 years. No congenital or acquired heart diseases were present. Each patient underwent concentrated red cell transfusions (in order to obtain pretransfusional hemoglobin levels of 10-11 g%), and iron-binding therapy through continuous subcutaneous microinjection of deferoxamine 40-50 mg/kg/day (6-8 hours/day, 6 days/week). Patients were divided in 2 groups: the first group (group A) comprising the 16 patients with good therapeutic compliance and regular pharmacological regimen; the second group (Group B) including the remaining poorly compliant 14 patients. The following parameters were analyzed: age, average hemoglobin levels during the last year, total amount of red cell transfusions, ferritin levels, starting age of iron-binding therapy. Moreover, each patient underwent 24-hour ECG Holter monitoring. Age (Group A: 18 +/- 4.6; Group B: 14 +/- 2.7; p < 0.02), total amount of transfusions (Group A: 272 +/- 73; Group B: 211 +/- 44; p < 0.03), and ferritin levels (Group A: 1697 +/- 860; Group B: 2908 +/- 730; p < 0.002) proved to be significantly different in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Decompression and surgical stabilization in the palliative treatment of vertebral metastases.

Instability of the spine consequent to the diffusion of a primary tumor is a serious complication in cancer patients. The experience of our Service in the surgical treatment of vertebral metastases is reported. Since 1990, 21 patients have undergone surgery. The vertebral metastases were localized at the cervical level in 4 cases, thoracic in 13, and lumbar in 4. Pain was the first symptom in 18 patients. The necessary criterion for intervention was intractable severe pain and/or neurologic deficit. At the thoracic and lumbar levels (17 cases) a posterior approach was always used to perform wide decompressive laminectomy and to stabilize the spine. An anterior approach is unadvisable in light of the risk related to the operation and the long recovery time. In 13 cases Cotrel-Dubousset bars were utilized, in 3 cases Roy-Camille, and in 1 case Louis plates. After surgery, significant pain relief was noted in 85% of patients. Of those with neurologic deficit, improvement in neurologic status was seen in 50%; in 28% neurologic deficit was completely resolved. We conclude that, although palliative, wide laminectomy accompanied by stabilization is a satisfactory treatment of vertebral metastases. Given the appropriate indications, surgical treatment improves the patient's quality of life.

Adenocarcinoma↗