Propofol for pediatric radiotherapy

Objective : Pediatric radiotherapy is a day care procedure. In children, anaesthesia is necessary to prevent movement during the therapy. Traditionally intramuscular ketamine is used for these procedure because of its inherent safety in a child who used to be left alone in the cobalt room.Methods : This study was designed to explore the efficacy of propofol and ketamine in pediatric radiotherapy in nineteen children. The inclusion criteria was a child fasting for six hours with no fever or URTI in the past week. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20–22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. The parameters recorded were pulse rate, oxygen saturation and respiratory rate-baseline to every 30 seconds till five minutes. Onset time, recovery time, oral feeding time and any untoward effects like nausea, vomiting, nystagmus were also noted.Result: The drug was graded on a scale of 0–10 according to parental acceptability where 0 is the worst and 10 is the best acceptability. The mean (±SD) of all the measured parameters were calculated and compared between the two groups.Conclusion : Propofol was associated with faster onset, better recovery, early oral feeding time, no nausea and vomiting and better parental acceptability. There was no hypotension, bradycardia and oxygen saturation at 60 seconds, which was betwen 94–95%, was easily treatable with supplementation of oxygen by face mask     

Renal cell carcinoma in peritoneal dialysis patients

Renal cell carcinoma is a rare but serious complication in ESRD patients. In these patients the incidence of renal cell carcinoma (RCC) is 20-40 times higher than in the general population. We performed a retrospective study to measure the incidence rate, prevalence, characteristics and survival among our peritoneal dialysis (PD) patients diagnosed with renal cell carcinoma. The study was carried out among 607 patients who were on the PD program from January 1997 to June 2002. RCC was detected in eight patients (four males and four females) with mean age of 52.1 +/- 10.6 years. Among these eight patients four were new cases that were diagnosed before the patients were started on dialysis (three in native kidneys and one in a transplanted kidney). In the other four patients the RCC was diagnosed after they had been on dialysis for 33-204 months (mean 60.75 +/- 50.48). We found an incidence rate of 1.3 per 1000 patients per year and a prevalence of 1.3%. Six of the eight patients had renal cysts. Tumor size was less than 7 cm in seven patients and in the other patient it was 8.5 cm. Seven of eight patients were alive at the time of study with a survival time ranging from 3-138 months (mean 122.25 +/- 88.2) months. In one patient, the RCC metastasised to the scalp, and, in two other patients, the tumors subsequently involved the second kidney. A cardiovascular complication was the cause of one death. Two patients received a renal transplant 36 and 66 months after diagnosis. We conclude that despite the low rate of metastases and mortality in our study, regular ultrasonography should be added to the follow-up of PD patients. Renal transplantation can be considered in these ESRD patients with RCC; however, close follow-up for metastases is recommended.     

The role of excipients and package components in the photostability of liquid formulations

A phenyl ether-based drug substance exhibits photochemical degradation in citrate buffers with both ultraviolet (300-450 nm range) and visible light (380-700 nm range) exposure, even though the drug molecule itself is non-light absorbing at wavelengths > 300 nm. The major contributors to the observed photosensitivity are the citrate buffer, parts per billion (ppb) levels of iron, oxygen, and light exposure level. Although a primary phenol photodegradate is generated, there are at least eight other species formed as well. The molecular weights and abundance of these species suggest that the product distribution is generated by the reaction of hydroxyl radicals with the drug substance. The generation of the primary photodegradate is linearly proportional to the light exposure amount for a fixed concentration of iron present in the formulation. Conversely, the amount of photodegradation is also nearly linear with iron concentration (through 200 ppb levels) for a fixed amount of light exposure. The proposed mechanism for the photochemical generation of hydroxyl radicals has precedence in the literature for similar combinations of iron, oxygen, carboxylate buffers, and light. Since the buffer salt and oxygen molecular equivalents in the product are significantly higher than the ppb levels of iron employed and more difficult to remove, the control of the extent of photodegradation largely rests on the control of trace levels of iron in the formulated product and control of light exposure. Exposure of drug solutions to a series of transition metals clearly indicates that iron is the key transition metal involved in the observed photochemistry. At manufacture, the primary source of iron is the raw materials (water, drug or excipients) used in the formulation. The level of iron for product stored in glass increases with sample age and can be attributed to iron leaching from borosilicate glass vials. Consideration of adequate light control during the manufacturing and packaging processes will be discussed and can only be defined as a function of the amount of iron present at the time of manufacture in the formulation. The generality of this chemistry to other drug candidates and in the presence of other common buffers will also be discussed.     

Vertebroplasty success in a case of aggressive hemangioma

Vertebral hemangioma is a vascular tumor most oftenly asymptomatic and of casual radiological discovery. More rarely, it can be aggressive, causing neurological complications and therefore requiring a convenient and sustained therapy where vertebroplasty is of essential importance. In this context, we report a case of an aggressive vertebral angioma of L4 which was responsible for lumbocruralgy. She underwent verterbroplasty and then had a very good outcome. In this way we deal with the the different technics of vertebroplasty, their advantages compared to other therapeutic medical, and or surgical methods, as well as their complications.