Rajveer Singh

Central nervous system metastases from primary epithelial ovarian cancer.

Epithelial ovarian carcinoma (EOC) is a common gynecologic malignancy in women.1 Approximately two thirds of patients present with advanced disease. Debulking surgery followed by platinum-based chemotherapy is the standard treatment approach, and 15% to 30% of patients achieve long-term survival.2 Relapse of disease in the pelvis, the abdomen, or both is the most common cause of failure.3 The central nervous system (CNS) is a rare site for metastasis. In this article, we report data on 18 such cases seen at our institution during the past 11 years. A systemic review of the English literature is also presented to assist the management of this interesting though still rare clinical problem.

Ketotifen for asthma in children aged 5 to 15 years: a randomized placebo-controlled trial

BACKGROUND The prophylactic agent ketotifen has been studied in mild-to-moderate asthma. Various trials showed benefit from 10 to 12 weeks of therapy, but no trial in children with followup beyond 12 weeks of the drug is available. OBJECTIVES We studied the efficacy of ketotifen, 1 mg twice a day, orally as a prophylactic drug in children with asthma. METHODS The double-blind, placebo-controlled trial studied 120 asthmatic children of either sex between the ages of 5 to 15 years at a tertiary care hospital. After an observation period of 4 weeks, children were randomly assigned to receive either ketotifen, 1 mg twice a day, or placebo for 6 months. Antiasthma drugs were continued as required. Main outcome measures included average duration for regular antiasthma drugs, average symptom scores, symptom free days, peak expiratory flow rate, FEV1, and need for emergency room visits. RESULTS Of the 120 children enrolled, 13 could not complete the trial. Thus 58 children remained in the treatment group and 49 were in the placebo group. Both groups were comparable in their baseline characteristics. The average number of days that required antiasthma drugs were significantly less in the treatment group: salbutamol (27+/-4.7 versus 37+/-3.5 P < .05), theophylline (37+/-4.7 versus 51+/-4.8 P < .05), oral steroids (2+/-0.4 versus 5+/-1.6 P < .05), and inhalation steroids (18+/-2.7 versus 16+/-10.8 P < .05). The average symptom scores and symptom free days for cough, wheeze, and breathlessness also favored the ketotifen group. Emergency room visits were also significantly lower in the ketotifen group (20 versus 10 P < .05). Statistically significant improvement in all the above parameters were observed after 14 weeks of therapy. The mean PEFR, FEV1 and side effects of medications were comparable between the two groups. CONCLUSIONS Ketotifen, 1 mg twice a day, is an effective prophylaxis for asthma in children between 5 to 15 years. Significant clinical improvement is evident after 14 weeks of therapy.

Single Agent Versus Combination Chemotherapy in Recurrent Cervical Cancer

Objective:Cisplatin and ifosfamide are two most active agents in patients with recurrent and metastatic cervical cancer. Combination of bleomycin, ifosfamide and cisplatinum (BIP) was compared with cisplatinum alone.

Isolated anterior chamber relapse in acute lymphoblastic leukemia

Dear Editor, A 14-month-old male child with pre-B acute lymphoblastic leukemia (ALL) (standard risk) was induced in November 2001 with four drugs. Consolidation chemotherapy included cyclophosphamide, cytosine arabinoside, and etoposide and weekly intrathecal methotrexate for 8 weeks, followed by maintenance chemotherapy. Central nervous system prophylaxis in the form of intrathecal methotrexate 10 mg every 3 months was continued till February 2005. Highdose methotrexate was not given. The child was not given prophylactic radiotherapy due to his age being less than 2 years as per our protocol. Fifteen days later, the child developed pain and redness in his left eye. He was diagnosed with anterior uveitis and treated with atropine and steroid eye drops. One week later, he developed watering, photophobia, and intense pain. Fundus examination including optic disc and peripheral retina were unremarkable. Aqueous humor aspirate from left anterior chamber showed numerous leukemic blasts. Peripheral blood, bone marrow, and cerebrospinal fluid (CSF) examination were normal. The child was started on Berlin–Frankfurt–Münster relapse protocol for ALL along with local atropine, betamethasone, timolol, and acetazolamide. The child was completely asymptomatic by the sixth day of chemotherapy. He also received 24 Gy cranial radiotherapy with anterior chamber of left eye in involved field after induction of remission. Because we did not have the facility for cytogenetics to stratify the risk group, 3 months later, an allogenic stem cell transplant from his human leukocyte antigen (HLA) matched father was done. Ten months after the transplant, there are no ocular sequelae such as visual loss and cataract. Bone marrow and CSF examinations done 1 month back are normal. He continues to be in hematological remission. Relapse of childhood ALL involving the eyeball is an uncommon event occurring in 2.2% of relapsing children [5]. Leukemic hypopyon refers to the presence of leukemic cells layered in the anterior chamber of the eye. Cytologic examination of aqueous cytospin with immune staining is the only way to make a definitive diagnosis. Where the relapse was treated with less intensive chemotherapy or where the relapse occurred on therapy, outcome is poor [5]. We could find 52 cases (49 children and 3 adults) of anterior chamber relapse in ALL from published English literature which are summarized in Table 1 [1–5]. Unilateral involvement was seen in 47 cases with remarkable predominance (90%) of left side. One hypothesis holds that cells are sequestered in long posterior ciliary vessels and pass into anterior chamber through the iris vessels. These leukemic cells proliferate at a later date; thus, the eye acted as sanctuary for leukemic cells [3]. The aqueous humor is known to have structural barrier to blood solutes, which results into relatively low concentration of chemotherapeutic drug in anterior chamber that allowed lymphoblastic cells to Ann Hematol (2006) 85:889–891 DOI 10.1007/s00277-006-0161-x