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Spontaneous occurrence of Tumor Lysis Syndrome (TLS) is very rare. Only 3 pediatric case reports were reported in literature. All 3 patients presented with therapy-sensitive disease. Unfortunately, only one patient survived. It is preventable in 100% of patients, but TLS is a hard nut to crack. We present three distinct cases of spontaneous tumor lysis syndrome within the pediatric population, each associated with different types of tumors. A 3-year-old boy with mediastinal germ cell tumor of stage III, had hyperuricemia and hyperphosphatemia on presentation, tumor lysis syndrome improved but later died with sepsis, another patient of 4-year-old girl with precursor B cell acute lymphoblastic lymphoma had hyperkalemia, hyperuricemia and hyperphosphatemia on presentation and third patient was 6-year-old boy with abdominal Burkitt lymphoma stage III presented with hyperkalemia, hyperuricemia, hyperphosphatemia and Acute Kidney Injury (AKI) before initiation of chemotherapy. Later both these patients improved and survived. Spontaneous tumor lysis syndrome has high mortality, so it is of utmost importance to diagnose it timely. Swift and effective responses to spontaneous TLS can significantly reduce the risk of mortality linked to this critical emergency condition. [ABSTRACT FROM AUTHOR]

Objectives: Treatment of cancer pain presents a challenging problem. Up to 90% of cancer patients can be treated with conventional pharmacological therapy. The remaining 10% of patients require additional interventions for management of their pain. Intrathecal chemical neurolysis (ICN) is a beneficial intervention in management of cancer pain. The primary objective of this study was to study the effects of pain relief of ICN on the Visual Analogue Score (VAS) of patients with metastatic cancer disease on palliative therapy. Methodology: This retrospective case series was performed at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore (Pakistan). We reviewed the medical records of thirty nine patients who underwent ICN at our institute. The mean VAS before procedure was 7.8. Results: After ICN, mean pain scores fell to 1.44 at first day, 2.23 at first week and 3.5 at first month. Mean opioid analgesic free period was 23.5 days. Conclusion: We conclude that ICN is a beneficial procedure for selected patients with intractable refractory pain. [ABSTRACT FROM AUTHOR]

Left sided superior vena cava (SVC) is a rare anatomic variant of the normal anatomy of the heart and the venous system that has clinical implications. The presence of this variant is relevant to central venous catheter placement, cardioverter defibrillator placement, coronary artery bypass grafting, and numerous other medical procedures. In this report, we describe a rare case of left sided SVC, which was diagnosed during central venous catheter insertion. We also discuss the vascular and anesthetic considerations for individuals with this uncommon variant. [ABSTRACT FROM AUTHOR]