Intravenous pamidronate for refractory lymphedema

Based on beneficial reports of pamidronate use for reflex sympathetic dystrophy in reduction of pain and swelling, this drug can be studied as a novel treatment for refractory lymphedema. This study aims to determine the effectiveness of pamidronate on lymphedema and its possible side effects. Twelve cases of lower limb refractory lymphedema were enrolled. They received intravenous pamidronate monthly for 3 consecutive months and were followed by measuring any discomfort with visual analog scale [VAS] and physician global assessment, based on objective signs of limb volume and circumference. The limb volume, circumference, and satisfaction of the patients improved significantly. Pamidronate when is added to conservative treatments may reduce lymphedema and improve the patient's comfort

[ comparison of intraluminal with intravenous administration of vancomycin in permanent haemodialysis catheter infection on the rate of its treatment and catheter removal]

Background: Patients who use Permcath permanent catheter as the vascular access for hemodialysis are occasionally confronted with catheter-related infections. Permcath infections can lead to catheter removal in Haemodialysis patients. Successful use of a 'locked-in' antibiotic has decreased catheter infections. This study evaluates the impact of the intraluminal vancomycin in comparison with intravenous antibiotic administration

Material and Methods: This experimental nonrandomized controlled study included 67 end stage renal disease patients enrolled for HD from 2005 to 2007 at our hospitals. The patient was studied in to 2 groups. In the first group [intervention group], vancomycin was injected via each lumen of permcath, with IV Ceftriaxone for 7 days, and then oral antibiotics was administered according to the culture fore three weeks. If the culture was negative, Cefixime was administered. In the second group intravenous Vancomycin + intravenous Amikacin prescribed. In both groups, if the patients had it enough response after 72 hours, permcath was removed. Our endpoint is to assessment of catheter removal

Results: Patients characteristics didn't differ between 2 groups. Of 28 patients in group 1, 1 catheter removal, and of 39 patients in group2, 22 catheter removals were done. There is a significant reduction of catheter removal in the first group [p<0.001]

Conclusions: This study has shown that administration of Vancomycin via permcath is more effective than intravenous, and increase life time of catheter