Early asymptomatic decline in left ventricular ejection fraction in adult cancer patients receiving doxorubicin

To determine the frequency of doxorubicin induced early asymptomatic decline in left ventricular ejection fraction by serial echocardiography and to identify risk factors associated with cardiotoxicity. Quasi-experimental study. Oncology Department, Combined Military Hospital, Rawalpindi from January 2012 to December 2012. Patients who were started on doxorubicin-based chemotherapy during the study period and had completed at least 300 mg/m[2] cumulative dose were included in this study. Electrocardiography, chest X-ray and echocardiography were done at baseline and one to three months after completion of chemotherapy. All patients were evaluated for the presence of the following risk factors: pre-existing coronary artery disease, diabetes mellitus, hypertension, chest wall irradiation and a cumulative dose exceeding 400 mg/m[2]. Asymptomatic cardiac dysfunction was defined as ejection fraction [EF] fall greater than 10% on follow-up echocardiography with minimum or no symptoms. Significant change was observed in ejection fraction after completion of chemotherapy. Out of 54 patients, 27.8% showed 5%, 13% showed 10% decline, 16.7% had 15% decline, one [1.9%] patient had 20% decline in EF after completion of chemotherapy while 40.7% had no change in ejection fraction. Thirty one percent of the patients developed > 10% decline, in left ventricular ejection fraction with the use of doxorubicin in the cumulative dose range of 300-400 mg/m[2]. Pre-existing coronary artery disease, hypertension and a cumulative dose exceeding 400 mg/m[2] are identifiable risk factors in this study. This entails regular monitoring for cardiac dysfunction by echocardiography during doxorubicin treatment

Primary embryonal rhabdomyosarcoma of the liver in a young male

Rhabdomyosarcoma [RMS] occurs infrequently in the liver. Rhabdomyosarcomas are malignant tumours that display features of striated muscle differentiation. They are the most common soft-tissue sarcomas among children. In adults however, these are very rare. We report a case of a primary embryonal rhabdomyosarcoma of the liver in a 17 years old boy. This was confirmed by histological examination using immunohistochemical analysis [LCA negative, desmin positive, myogenin focally positive and cytokeratin negative] and site was confirmed by PET CT scan. He received multiple chemotherapies including [doxorubicin, ifosfamide, dacarbazine; gemcitabine, paclitaxel; vincristine, actinomycin D, cyclophosphamide] but longest sustained stable disease was seen with gemcitabine-paclitaxel regimen. The patient died 31 months after the first presentation, secondary to complicated abundant abdominal progressive disease. The poor prognosis and early death of most previously reported cases imply the need for investigation of a more effective treatment method of this uncommon tumour

Intracranial hypertension: a three year experience at military hospital, Rawalpindi

Idiopathic intracranial hypertension is a syndrome associated with multiple clinical conditions and is an important mimicker of cerebral venous thrombosis. Given the difference in prognosis of these two conditions they should be differentiated. This study was carried out in indoor and outdoor patients from 1998 to 2000 in Military hospital Rawalpindi. All patients who presented with headache and papilloedema were evaluated further as per protocol after informed consent. Out of 40 registered patients, 12 [30%] were male and 28 [70%] female. The age range was 18 to 45 years, mean was 27.28 + 6.64 years. On neuroimaging 16 [40%] patients found to be suffering from dural sinus thrombosis and all patients had a normal CT scan. Among 16 patients with dural sinus thrombosis 1 [6.3%] patient had protein C deficiency, 2 [12.5%] had pregnancy, 1 [6.3%] had postpartum haemoohage, 1 [6.3%] had puerperal sepsis, 5 [31.3%] were evaluated from high altitude, 1 [6.3%] had ear infection, 1 [6.3%] had factor V Leiden, 1 [6.3%] had antiphospholipid antibody syndrome and in the remaining 3 [18.75%] no etiology was found. In patients with isolated raised intracranial pressure a high index of suspicion should be kept for cerebral venous thrombosis as an underlying etiology especially when it occurs with the background of a hypercoaguable state