Clinical features, epidemiology, and short-term outcomes of proliferative lupus nephritis in Eastern India

Race and ethnicity are important predictors of prognosis in lupus nephritis. This study was conducted to determine the clinical features, epidemiological profile, and short-term outcomes in patients of lupus nephritis from a single center in Eastern India. A total of 86 patients of class III/IV lupus nephritis were studied. Seventy-eight of them received cyclophosphamide for induction and eight of them received mycophenolate. The patients were evaluated for response, estimated glomerular filtration rate (eGFR), and proteinuria at 6 months. About 44% patients had a partial or complete response at 6 months and 64% at 1 year. The factors correlating with response at 6 months were older age at diagnosis, hypertension, activity, and chronicity indices and duration of symptoms prior to therapy. Chronicity index and hypertension were the predictors of response by logistic regression at 6 months. Compared to the Caucasian and African American patients, patients with proliferative lupus in Eastern India presented with a lower eGFR, lower proteinuria, and higher chronicity scores. Older age at diagnosis, hypertension, activity, chronicity indices, and duration of symptoms correlated with response. Short-term outcomes were similar to those described in Caucasian patients.

Imaging characteristics of cavernous sinus cavernous hemangiomas

Cavernous hemangiomas occur rarely in the cavernous sinus and are difficult to diagnose preoperatively. The imaging of these lesions resembles other benign paracavernous lesions such as schwannomas and meningiomas. Profuse intraoperative bleeding may be encountered during surgical resection of these lesions. A preoperative diagnosis is therefore important to alert the surgeon. We report on the imaging characteristics of two different histopathological types of cavernous sinus cavernous hemangiomas and the use of contrast-enhanced MRI, diffusion-weighted MRI and magnetic resonance spectroscopy in the differential diagnosis of these lesions.

Antioxidant vitamins and chemoprevention

Free radicals play an important role in human carcinogenesis and the mechanism of their counteraction by antioxidant vitamins has been reviewed. It seems more likely that these vitamins work in concert rather than acting singly. Currently available data are compatible with the notion that these vitamins act as chemopreventives against some important cancers, e.g. carotenoids for lung cancer, ascorbic acid for salivary gland cancer, tocopherols for head and neck cancers etc. Thus, a greater consumption of fruits and vegetables should be encouraged as they are the natural sources of these chemopreventive, antioxidants along with other protective factors packaged by nature. However, much work still remains to be done to establish the role of antioxidant vitamins in carcinogenesis.

Hyperhomocysteinemia and cardiovascular disease: The nutritional perspectives

Several members of the vitamin B-complex family are known to participate in the normal metabolism of homocysteine (Hcy). Leaving aside the genetic determinants of hyperhomocysteinemia (HHC), the deficiencies of these vitamins can also result in HHC. The situation of sustained and long standing HHC is likely to be prevalent in population groups with low/average socio-economic status, geriatric population and alcohol abusers. If not corrected by supplementation, these population groups certainly are more vulnerable to develop atherosclerosis (AS) and subsequently, cardiovascular disease (CVD). Hyperhomocysteinemia per se and/or HHC-induced oxidative stress result(s) in chronic chemical endothelial injury/dysfunction, smooth muscle proliferation, prothrombotic state and oxidation of low density lipoproteins (LDL) leading to diverse cardiovascular complications. In the first decade of the new millennium, major research efforts would be directed towards understanding the basic mechanism of HHC-induced oxidative stress and the pathophysiology of HHC-induced CVD, culminating in the evolution of hitherto unknown therapeutic strategies such as nutriceuticals and oxidant-antidotes.

Modification of the Resch procedure

Controversy surrounds the management of displaced three- and four-part fractures of the proximal humerus. The percutaneous Resch technique of stabilisation involves minimal soft-tissue dissection and a reduced risk of stiffness and avascular necrosis. However, it requires a second operation to remove Kirschner wires and the humeral block. We describe a modification of this technique that dispenses with the need for this second operation and relies on a sequential pattern of screw placement. We report the outcome of 32 three- or four-part fractures of the proximal humerus treated in this way at a mean follow-up of 3.8 years (2 to 8)). There were 14 men and 18 women with a mean age of 56 years (28 to 83). At final follow-up the mean Oxford shoulder scores were 38 (31 to 44) and 39 (31 to 42), and the mean Constant scores were 79 (65 to 92) and 72 (70 to 80) for three- and four-part fractures, respectively. We further analysed the results in patients aged < 60 years with high-energy fractures and those aged ≥ 60 years with osteoporotic fractures. There were no cases of nonunion or avascular necrosis.

The results were good and comparable to those previously reported for the Resch technique and other means of fixation for proximal humeral fractures. We would recommend this modification of the technique for the treatment of displaced three-part and four-part fractures in patients both younger and older than 60 years of age.

Acute pancreatitis in pregnancy: review of three cases and anaesthetic management

Acute pancreatitis is rare in pregnancy, with an estimated incidence of 1 in 1000-3000 pregnancies. Gallstones are the commonest cause. Mortality and morbidity associated with pancreatitis have declined as diagnosis and management options improve. Presentation usually occurs in the third trimester or early postpartum period with severe epigastric pain, nausea, vomiting, anorexia and fever. Blood investigations show an elevated white cell count and increased liver enzyme concentrations. Ultrasound is safe but has lower sensitivity than computerised tomography for detecting gallstones. Management during pregnancy has traditionally been conservative, followed by cholecystectomy after delivery. Recurrence of pancreatitis during pregnancy may necessitate more urgent surgery. The second trimester is considered the safest for surgery, with early involvement of intensive care as the condition can deteriorate rapidly. We present three cases managed in our unit over a six-month period that illustrate the spectrum of disease and the successful use of a multidisciplinary team approach.

Study of Mumps in Children attending a Tertiary Care Centre

Introduction: Mumps is a self-limiting viral infection of the salivary glands with systemic manifestations and complications. It primarily affects young children, with increased incidence in winter and spring. Mumps infection is endemic in developing countries because of poor vaccination coverage. This study is intended to highlight the increased number of mumps cases in children attending tertiary care center in Nepal and thus to emphasize the importance of mumps vaccination, so as to decrease the disease occurrence and disease burden by vaccinating all children. Materials and Methods: This was a prospective study done in Civil Service Hospital of Nepal over a period of 2 years from November 2009 to October 2011. All children less than 14years of age with symptoms of fever and parotid swelling were included in the study group. A detailed history pertaining to the disease was taken, that included; history of exposure and prior vaccination against mumps. Children were asked to follow up either after 5 days or in case of noticing any signs and symptoms of complication. Results: There were total 113 cases diagnosed clinically as mumps of which there were 71 males (62.83%) and 42 females (37.16%) with the peak incidence of disease in the month of March and September with 22 cases (19.46%) in each month. The increase incidence was seen in 4-6 years of age with 58 cases (51.32%). There were 70 patients (61.94%) that had history of exposure to mumps infection. All the patients in this study had either unilateral or bilateral parotitis. None of the children were vaccinated against mumps. And all the school going children had to be off school for a period of 3-5 days. Conclusion: There were large number of children with mumps and none of them were vaccinated. Child can be prevented from the infection by vaccination and thus avoiding possible sufferings and complications. Thus we recommend the use of mumps vaccination in Routine immunization programme. Key words: Mumps; Parotitis; School absenteeism; Nepal; Vaccine DOI: http://dx.doi.org/10.3126/jnps.v32i1.5499   J. Nepal Paediatr. Soc. Vol.32(1) 2012 53-56 

Perioperative concerns of recurrent urinary bladder phaeochromocytoma with skeletal metastasis

We report the perioperative management of a 61-year-old man diagnosed with recurrent urinary bladder phaeochromocytoma with vertebral and rib metastasis following partial cystectomy and nephrectomy. His blood pressure was controlled with antihypertensive agents. Epidural analgesia was avoided in view of vertebral metastasis; instead, analgesia was provided with fentanyl infusion. Intraoperative hypertensive episodes were managed with nitroglycerine, sodium nitroprusside and esmalol. However, after surgery, the patient required inotropic support and was moved to the intensive care unit. Analgesia was maintained with fentanyl infusion, and inotropic support was gradually weaned off. Nuclear ablative therapy was planned for bony metastasis. We recommend that recurrences of extra-adrenal phaeochromocytoma be investigated for bony metastasis and cautiously managed in the perioperative period so as to avoid neurological complications.

Chronic tubulointerstitial nephritis in a solitary kidney of a child with Noonan syndrome

Noonan syndrome is a genetic disorder with involvement of many organ systems; facial dysmorphism and cardiovascular defects being the common abnormalities. Renal involvement is uncommon and abnormalities of the genitourinary system are usually limited to structural anomalies and cryptorchidism. We report a case of Noonan syndrome with chronic tubulointerstitial nephritis in a solitary kidney.

Optimal wrist angulation shortens time needed for radial artery catheterization: a prospective, randomized, and blinded study

INTRODUCTION

Optimal wrist position is essential for successful catheterization of the radial artery. We planned to study the success rate of radial artery catheterization at various degrees of wrist extension angulations.

METHODS

This prospective, randomized study was performed in 60 consenting patients aged between 18-65 years and undergoing variable surgeries where the anesthetic management required an arterial catheterization. All patients were randomized into three groups of 20 patients each, according to wrist angulation during radial artery catheterization : either 30 degrees (Group 30), 45 degrees (Group 45), or 60 degrees (Group 60). Three metallic angulated wrist boards with angles of 30 degrees, 45 degrees, and 60 degrees (angle measured with calipers) were prepared, on which patient's wrist was kept at the above-mentioned angles of extension. Radial artery catheterization success rate, catheterization time, and numbers of attempts were recorded.

RESULTS

The catheterization time was minimal in group 45 (30.50 +/- 16.82 sec) as compared to 36.00 +/- 14.19 sec and 43.50 +/- 13.80 sec in group 30 and 60, respectively. Radial artery was catheterized at first attempt in 60% of Group 45 and Group 60 patients, and in 50% of Group 30 patients. The arterial catheterization was successful in 14/20 patients in Group 30, 19/20 patients in group 45, and 16/20 patients in group 60.

CONCLUSION

We conclude that a wrist extension of 450 appears to be the optimal wrist joint extension for a successful radial artery cannula insertion.

Clinical Profile and Sensitivity Pattern of Salmonella Serotypes in Children: A Hospital Based Study

Introduction: Enteric fever is a systemic infection caused by the bacteria, Salmonella enterica serovar Typhi (S.typhi) and Salmonella enterica serovara Paratyphi (S. paratyphi A, B and C). Most of the burden of the disease is limited to the developing world and the disease still has the issues like wide spectrum of clinical presentation and multidrug resistance. Objectives: This study was done to analyze the clinical profile and antibiotic sensitivity pattern in the cases of culture positive enteric fever. Methods: A prospective cross-sectional study was conducted in Civil Service Hospital from February 2010 to January 2011 in the paediatric population in the age group of 2 to 14 years. Children with Salmonella species isolated in blood culture were included in the study. Results: Out of the 40 children with culture positive enteric fever, male to female ratio was 1.3:1 with common age group between 11-14 years. S typhi was isolated in 25 cases while S. paratyphi in 15 cases. Clinical features of S. typhi and S. paratyphi were indistinguishable. Both S.typhi and S. paratyphi were found to be 100% sensitive to drugs like Ceftriaxone, Cefotaxime, Cefixime and Chloramphenicol. Sensitivity to Ofloxacin was 100% in S. paratyphi and 92% in S.typhi. Similarly sensitivity of Azithromycin was 92% and 93% for S.typhi and S. paratyphi respectively. Conclusion: Salmonella serotype is still 100 % sensitive to third generation cephalosporin. Some percentage of resistance is seen with Ofloxacin in S. typhi and with Azithromycin in both S.typhi and S. paratyphi. Key words: Enteric fever; S.typhi; S.paratyphi; Sensitivity DOI: http://dx.doi.org/10.3126/jnps.v31i3.4382 J Nep Paedtr Soc 2011;31(3): 180-183

Ectrodactyly: A rare anomaly of limbs

Split-hand/split-foot malformation (SHFM) is a rare congenital malformation of the limbs with median clefts of the hands and feet and aplasia/hypoplasia of the phalanges, metacarpals and metatarsals. When present as an isolated anomaly, it is usually inherited as an autosomal dominant form. We report a case of nonsyndromic form of ectrodactyly because of its rarity. Key words: Split-hand/split-foot malformation; Nonsyndromic ectrodactyly DOI: http://dx.doi.org/10.3126/jnps.v31i3.4429 J Nep Paedtr Soc 2011;31(3): 235-237  

Low- versus high-dose combination of midazolam-ketamine for oral premedication in children for ophthalmologic surgeries

INTRODUCTION

Midazolam and ketamine are useful for oral premedication in children to allay anxiety. We compared the effects of midazolam with a combination of high- and low-dose ketaminemidazolam as an oral premedication.

METHODS

This is a randomised, controlled prospective study conducted in 87 children who were scheduled for ophthalmologic surgeries. Group M received oral midazolam 0.5 mg/kg, Group MKL received oral midazolam 0.25 mg/kg and ketamine 3 mg/kg, and Group MKH received midazolam 0.5 mg/kg and ketamine 6 mg/kg. Standard general anaesthesia technique was used. Sedation levels and ease of parental separation were noted.

RESULTS

A linear increasing trend in sedation was seen in the preoperative sedation scores of all the three groups. At 30 minutes, 23 children in Group MKH had good sedation scores as opposed to 20 in Group MKL and 12 in Group M. The best parental separation time was much shorter in the combination groups. There were no statistically significant differences in the parental separation scores, mean response to induction and mask acceptance. The time to reach Aldrete score of 10 was shorter in Group MKL (22 +/- 5 min) and Group M (36 +/- 1 min) compared to Group MKH (52 +/- 2 min). Group MKH had a higher incidence of excessive salivation compared to the other groups.

CONCLUSION

A combination of low-dose midazolam and ketamine is as effective as high-dose midazolam and ketamine for achieving optimum anxiolysis and a faster recovery, with a lower incidence of excessive salivation in children undergoing ophthalmic surgery.

Effects of intrathecal midazolam in spinal anaesthesia: a prospective randomised case control study

INTRODUCTION

Subarachnoid block with local anaesthetics and adjuvants has been extensively used for surgery. Intrathecal midazolam produces antinociception and potentiates the effect of local anaesthetics. We compared intrathecal bupivacaine with and without midazolam to assess its effect on the duration of sensory block, motor block and pain relief.

METHODS

A total of 100 patients scheduled for elective lower abdominal, lower limb and gynaecological procedures were selected to participate in this prospective, randomised, double-blind study. Patients were randomly allocated into two groups for intrathecal drug administration. Group B received 3 mL 0.5 percent bupivacaine with 0.4 mL saline, and group BM received 3 mL 0.5 percent bupivacaine and 0.4 mL (2 mg) midazolam mixture. The onset, duration of sensory/motor block, time to first rescue analgesia and side effects were noted.

RESULTS

Demographic profile and duration of surgery were comparable between the two groups. The onset of sensory (4.8 versus 4.6 min) and motor block (5.9 versus 6 min) was also comparable between the groups. The duration of sensory blockade was prolonged in the midazolam group (90.8 versus 115.8 min, p-value is 0.001), while the duration of motor blockade was comparable (151.8 versus 151.3 min, p-value is 0.51). The duration of effective analgesia was significantly longer in the midazolam group compared to the control group (121.3 versus 221.1 min, p-value is 0.001). Sedation score was comparable in the two groups.

CONCLUSION

The addition of preservative-free midazolam to bupivacaine intrathecally resulted in prolonged postoperative analgesia without increasing motor block.

Hartree-Fock Cluster Computations for Ionic Crystals

The ICECAP code is applied to charged and uncharged color centers in alkali halides and alkaline-earth oxides, to test the usefulness of complete-cation pseudopotentials for reproducing the cluster boundary conditions. The physical model includes consistency up to electrostatic octupole order between the Hartree-Fock cluster and the surrounding infinite shell-model lattice. The total energy of the system is determined variationally, including distortion and polarization of the cluster and lattice, and LCAO-MO gaussian-localized cluster wave functions. Electronic states with the lattice unrelaxed are also analysed, yielding color-center optical transition energies. Furthermore, consistency between quantum (cluster) and classical (shell-model) descriptions of the perfect lattice is tested.

Central core myopathy with RYR1 mutation masks 5q spinal muscular atrophy

We report the case of a male who presented in infancy with motor delay and muscle weakness. Typical muscle biopsy features and heterozygous RYR1 mutation confirmed a diagnosis of central core disease. Family studies showed this to be a de-novo mutation. Some years later, his two older teenage brothers presented with proximal muscle weakness. Neurophysiology, muscle biopsy and DNA studies confirmed spinal muscular atrophy. Subsequent genetic studies in the index case also confirmed homozygous deletions of exon 7 and 8 in the SMN gene. Review of the original muscle biopsy showed classical features of central core disease with no evidence to suggest denervation, such that the diagnosis of spinal muscular atrophy could not have been suspected in the absence of the family history.

2-Deoxy-D-glucose reverses the Indian red scorpion venom-induced cardiopulmonary abnormalities in anesthetized rats

Role of 2-Deoxy-D-glucose (2-DG) in reversing the Indian red scorpion (Mesobuthus tamulus concanesis Pocock, MBT) venom-induced toxicity was examined. Femoral arterial pressure, ECG and respiratory movements were recorded in urethane anesthetized rats. Plasma glucose and serum insulin levels were also estimated. Intravenous injection of 5 mg/kg MBT venom produced immediate decrease in mean arterial pressure, heart rate and respiratory frequency followed by an increase and subsequent progressive decrease. ECG pattern exhibited ischaemic changes. There was hyperinsulinemia after venom without corresponding decrease in plasma glucose. The animals died within 37 +/- 9 min and demonstrated significant increase in pulmonary water content. 2-DG pretreatment (0.5 g/kg, iv) improved the cardiopulmonary abnormalities induced by venom and the animals survived for nearly 120 min. There was no hyperinsulinemia and increased pulmonary water content in these animals. In insulin (2 IU/kg) treated rats, the MBT venom-induced cardiopulmonary abnormalities were attenuated and ECG abnormalities were reversed. The pulmonary water content in these animals exhibited a decreasing trend and the animals survived for 120 min. Repaglinide (10 microg/kg, iv) pretreatment failed to reverse the venom-induced cardiopulmonary changes including the increased pulmonary water content. The survival time was similar to venom only group. The present results reveal that 2-DG reverses the venom-induced cardiopulmonary toxicity probably by restoring insulin sensitivity.

Low-dose spinal anaesthesia for a parturient with Takayasu's arteritis undergoing emergency caesarean section

Takayasu's arteritis is a rare form of nonspecific obliterative panarteritis of unknown aetiology. Anaesthesia for patients with Takayasu's arteritis is complicated by severe uncontrolled hypertension leading to end-organ dysfunction, stenosis of major blood vessels affecting regional circulation, and difficulties in the monitoring of arterial blood pressure. The anaesthetic approach for parturients with Takayasu's arteritis has not been standardised in the literature, and previous reports have documented the use of general as well as regional anaesthesia. There are few instances in the literature where low-dose spinal anaesthesia alone is used in patients with Takayasu's arteritis undergoing emergency caesarean section. We present a case of the successful management of a parturient with Takayasu's arteritis, who underwent an emergency caesarean section under low-dose spinal anaesthesia.

Perianesthetic management of the first robotic partial cystectomy in bladder pheochromocytoma. A case report

The authors report the perianesthetic considerations of a rare case of pheochromocytoma of the urinary bladder for which the first reported robotic partial cystectomy and ureteric reimplantation were performed. A 59-year-old male patient, known to be hypertensive, was posted for transurethral resection of a bladder tumor. In the operation room, after attaching the monitors, a subarachnoid block was given. Upon manipulation of the tumor, the blood pressure and heart rate increased markedly. A pheochromocytoma was suspected and was later confirmed by raised urine catecholamine levels and meta-iodobenzyl-guanidine scan. The patient was started on tablet prazosin and atenolol. After optimization, a robotic partial cystectomy was planned. In the operating room, an epidural catheter and a radial artery cannula were inserted. After the induction of anesthesia and the securing of the airway, surgery was started. After the insertion of the verres needle, pneumoperitoneum was created very slowly, and then the patient was positioned in 40 degrees Trendelenburg. Surges in arterial blood pressure (ABP) were managed with titrated doses of sodium nitroprusside and nitroglycerine and boluses of esmolol and labetalol. ABP drops postoperatively were managed with fluid and dopamine infusion. Robotic surgery is a safe alternative to the open technique for pheochromocytoma of the urinary bladder. Care should be taken during the positioning of the patient for robot placement and during pneumoperitoneum creation.

Unpredicted neurological complications after robotic laparoscopic radical cystectomy and ileal conduit formation in steep trendelenburg position: two case reports

Robotic surgery is becoming popular for minimally invasive surgical evolution as robotic devices allow unprecedented control and precision in minimally invasive procedures. Two cases of robotic radical cystectomy with ileal conduit urinary diversion surgeries having perioperative neurologic complications related to prolonged surgery in steep head down position are presented. In these patients, neurological deterioration occurred after extubation probably due to cerebral edema. We suggest the duration and positioning should be optimized for such prolonged surgery in steep head down position and some recommendations should be made. Moreover, in such surgeries a great vigilance has to be observed in the perioperative period.

Information processing in patients with intracranial tumours: a preliminary evaluation of the clinical utility of inspection time

Psychomotor slowing is a common feature in many patients with intracranial tumours. We therefore performed a preliminary study to determine if inspection time, a measure of the efficiency of the brain's information processing, was impaired in patients with intracranial tumours. Inspection time, and some other neuropsychological and functional tests, were compared in 23 people with intracranial tumours and 24 spinal surgery controls prior to surgery. Groups were matched for sex, age and education. Inspection time scores were poorer in the brain tumour group (p < 0.003) and the effect size was moderate (eta2 = 0.197). The brain tumour group also had lower scores on the Boston Aphasia Severity Rating Scale, more anxiety on the Hospital Anxiety Depression Scales, but better Karnovsky Performance scores. Other cognitive and functional tests showed no significant differences between the groups, although group sizes were small. There were no significant changes in inspection time after spinal surgery; however, after intracranial tumour surgery, approximately 30% of patients showed no change, 30% deteriorated and 40% improved. This preliminary study suggests that recording inspection time, in a neuro-oncological setting, may prove informative and practically useful in assessing non-motor processing speed in people with brain tumours.

Quality assurance in the management of peritonitis: a prospective study

The aim of this study was to assess the quality of care indicators in the management of peritonitis. A total of 124 cases with diagnosis of secondary and tertiary peritonitis were included. Detailed clinical history, examination, relevant investigations and details of operative findings were noted. The following quality indicators-surgical consultation time, waiting period for surgery, diagnostic accuracy, antibiotic utilization pattern, morbidity, mortality, length of hospital stay, and accessibility of service to patients were assessed. The mean age of patient was 37.4 years with male to female ratio of 4.4:1. More than half of the patients (51.6%) surgical consultation time was less than half an hour. Majority of patients (67.7%) were operated only after 6 hours. Duodenal ulcer perforation was the commonest etiology for peritonitis and the clinical diagnostic accuracy was 97.3%. The commonest bacteria isolated from peritoneal fluid culture was E. coli which was sensitive to Amikacin mostly. The overall morbidities were seen in 20.1% of patients and burst abdomen was the leading complication. A total of 8 patients (6.4%) died in this study and when Mannheim's peritonitis index (MPI) score was compared, score of more than 26 was found to be a significant predictor of mortality (p<0.0001). Most of the patients after reaching the tertiary care hospital were managed satisfactorily. Though there are lots of parameters that still need to be improved.

The better bisphosphonate in patients with bone metastasis: Zoledronic acid or ibandronic acid? A study from Eastern India

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Background: Ibandronic acid is a third generation bisphosphonate which acts by inhibition of osteoclasts. Zoledronic acid also has a similar mechanism of action. This study was designed to study superiority or inferiority of either agent over other in terms of efficacy in reducing bone pain and complications in patients with bone metastases. Methods: From Jan 2005 to Dec 2008, 240 patients of various malignancies with bone metatstasis were enrolled and were randomized on a 1:1 basis to receive monthly IV infusions of ibandronate or zoledronate and were analysed for pain relief, skeletal related events and adverse events. Results: Patients in both the arms were well matched for their diagnosis, stage of disease, burden of skeletal disease and performance status. Different diagnoses were, carcinoma breast (n=99), carcinoma prostate (n=54), myeloma (n=48), carcinoma lung (n=23), others (n=20). Median follow up was 18 months. At 18 months, mean increases in British Pain Inventory pain scores were lower with zoledronate compared to ibandronate (0.43 vs 0.88 [p=0.02]). Analgesic use as defined by 4 point analgesic scale was less with zoledronate as compared to ibandronate. Incidence of skeletal related events was not significantly different between two arms (33% for zoledronate vs 39% for ibandronate [p=0.2]). Median time to first skeletal related event was not reached in either arm. At 18 months of median follow up, percentage of patients with skeletal related events were 39% in zoledronate arm vs 43% in ibandronate arm (p=0.06). Zoledronate caused fever in 30 (12.5%) patients and hypocalcemia in 10 patients. Ibandronte caused hypocalcemia in 3 patients. No cases of osteonecrosis of jaw were observed. Conclusions: Zoledronate is the preferred bisphosphonate in developing countries for its shorter infusion time and availability of cheaper generic brands. This study also indicates that it may be slightly better than ibandronate in reducing bone pain and preventing skeletal related events.

No significant financial relationships to disclose.

Pegylated liposomal doxorubicin in ovarian cancer patients with renal compromise

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Background: Ovarian cancer patients with renal compromise poses problem in choosing chemotherapy for them. Pegylated liposomal doxorubicin (PLD) can be used in such cases. However there is not much data regarding the efficacy and toxicity of PLD. We used PLD in a few renal compromised ovarian and peritoneal cancer patients. Methods: The clinical records of patients with recurrent ovarian and peritoneal cancer patients with high creatinine or low creatinine clearance level who were given PLD at the Netaji Subhas Chandra Bose Cancer Research institute) (NCRI) from July 2005 to July 2008 was reviewed retrospectively to study efficacy and toxicity. Results: Twenty-one patients were identified, which included 16 with epithelial ovarian cancer, 5 with peritoneal cancer. Renal compromise was diagnosed and graded according to creatinine clearance test (CCT) as severe when less than 28 mL/min/1.5 m2, moderate when CCT is 28–55 mL/min/1.5 m2, and mild when CCT is 55–84 mL/min/1.5 m2. Normal value was taken as 85 mL/min/1.5 m2. Patients had distribution as mild: 4 patients, moderate:7 patients, and severe:10 patients. The initial doses of PLD were classified into regular initial dose (40 mg/m2/4 weeks) and lower initial dose (20–30 mg/m2/4 weeks). The median cycle was 5 (range 1–12). We used lower dose for moderate and severe renal disease. The incidence of palmar-plantar erythrodysesthesia 5/21 (23.8%), stomatitis 6/21(28.5%), and hematologic toxicity 3/21(14.2 %). Dose reduction due to toxicities occurred in 19.04 % (4/21) patients. Amongst 21 cases no patient had deterioration of renal function while and after the treatment with PLD. However we had primary treatment with PLD in four cases (2 moderate and 2 severe) while others had platinum based initial treatment. We did not have any complete responder though we had 6 (28.5%) partial responders, 8 (38.1%) stable diseases and 7(33.3%) progressive diseases. Conclusions: Patients with renal compromise who received PLD therapy at an initial dose lower than 40 mg/m2/4 weeks tolerated their treatment well. They required subsequent dose reduction due to mucocutaneous and cardiological toxicities in 19% cases. Treatment response in this population with ovarian and peritoneal cancer was similar to that of patients with normal renal function.

No significant financial relationships to disclose.