Biomedical subjects
Publications and source records attributed to N Giri.
Case records of 78 patients of acute lymphoblastic leukemia have been reviewed. Complete remission occurred in seven cases following an episode of septicemia and supportive care.
We observed 50 patients receiving high-dose cisplatin-based chemotherapy in a prospective, randomized double-blind trial. One group received metoclopramide (MCP) alone (total dose, 6 mg/kg), whereas the other group was given dexamethasone (DMS) (total dose, 60 mg) in addition to MCP. The patient characteristics of the two groups were comparable, confirming satisfactory randomization. Multivariate regression analysis failed to show any statistical significance in the antiemetic response between the two treatment groups. However, female patients receiving Adriamycin (Adria Laboratories, Columbus, OH) concurrently and obese persons exhibited more vomiting. The overall antiemetic response rate was 66%. Because the side effects were minimal, a higher dose of MCP is expected to improve emetic control without increasing toxicity. The use of a 36-hour assessment period in our study gave more meaningful data. An exponential increase in the dose of MCP is probably required, with respect to weight, to obtain the same antiemetic efficacy.
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Avascular necrosis of bone (AVNB) is a known complication of systemic adrenocorticosteroid therapy and is thought to be dose related. However, despite the large amount of prednisolone that has been used in the standard treatment of acute lymphoblastic leukemia (ALL), AVNB has rarely been reported with this disease. We have described our experience with an adolescent girl with ALL who developed multifocal AVNB after aggressive chemotherapy, which included high cumulative doses of corticosteroids along with other cytotoxic drugs, some of which have been associated with AVNB. Five similar cases from literature are reviewed. The occurrence of AVNB may become more common in the future with the increasing use of aggressive chemotherapy. Awareness of this possibility will lead to a more rapid diagnosis and early treatment of AVNB.
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A case of rheumatic heart disease with massive myocardial infarction from coronary embolism complicating bacterial endocarditis is reported. The rarity of this complication in the pediatric age group as compared to the adult age group remains unexplained. Early recognition depends on serial electrocardiographic and enzymatic determinations.
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Thirteen children older than 3 years of age with beta-thalassemia major underwent allogeneic bone marrow transplantation (BMT) from a full human leukocyte antigen (HLA) matched sibling donor in a single institution. These patients received busulfan (Bu). 16 mg/kg followed by cyclophosphamide (Cy) 200 mg/kg for conditioning. Eight of the 13 patients (Group 1) engrafted and have a median age of 13 years (range 5-15 years). The five patients (Group 2) who failed to engraft have a median age of 6 years (range 3-8 years). The association with the following factors was found to be statistically significant: age (older in Group 1), duration of nadir of white blood count (WBC) of < or = .1 x 10(9)/L (longer in Group 1), and the dose of Bu administered to each patient calculated on the basis of body surface area (higher dose in Group 1). The high rate of engraftment failure (5 out of 13) may be related to the suboptimal systemic exposure of Bu in younger children leading to inadequate bone marrow ablation when the standard dose of 16 mg/kg is used.