Role of low dose cytarabine in elderly patients with acute myeloid leukemia: An experience.

PURPOSE: To highlight the acceptable results seen after use of low dose cytarabine in elderly patients of acute myeloid leukemia (AML) with comorbidities. MATERIALS AND METHODS: This was a prospective study carried on 30 newly diagnosed patients of AML over 60 years of age who were unfit for standard treatment regimens. We did not use azacytidine and decitabine in our patients because these therapeutic modalities being extremely costly and our patient affordability being poor. After taking patient consent and institutional ethical clearance these patients were treated with 20 mg/m(2) cytarabine subcutaneously in two divided doses 12 h apart for 4 days every week for 4 weeks which constituted a cycle before disease, re-assessment was done. A repeat cycle was administered where ever needed and after attainment of remission, we continued low dose cytarabine for 2 days/week as maintenance after complete or partial response was documented. RESULTS: In our study, we found that around 20% of patients achieved complete remission and 30% partial remission. The remission rates were definitely influenced by counts at presentation, performance at presentation, comorbidities, underlying myelodysplastic syndrome and baseline cytogenetics. CONCLUSION: Low dose cytarabine is effective treatment option for elderly patients with AML when standard treatment options are not warranted.

Giant Fecaloma Causing Small Bowel Obstruction: Case Report and Review of the Literature.

Fecaloma is a mass of hardened feces being impacted mostly in rectum and sigmoid. The most common sites of the fecaloma is the sigmoid colon and the rectum. There are several causes of fecaloma and have been described in association with Hirschsprung's disease, psychiatric patients, Chagas disease, both inflammatory and neoplastic, and in patients suffering with chronic constipation. Up to now several cases of giant fecaloma has been reported in the literature most of them presenting with megacolon or urinary retention. We herein report a case of giant fecaloma leading to bowel obstruction who was successfully treated by surgery. A 30-yrar-old man presented with sign and symptoms of acute bowel obstruction. He underwent exploratory laparotomy and enterotomy. He was found to have a giant fecaloma causing bowel obstruction in the jejunum. He was discharged after the operation with good condition. Jejunal fecaloma is extremely rare condition.

Wait-and-see policy versus cholecystectomy after endoscopic sphincterotomy for bile-duct stones in high-risk patients with co-existing gallbladder stones: a prospective randomised trial.

BACKGROUND AND STUDY AIMS: Endoscopic sphincterotomy (ES) is one of the most important advances in the treatment of common bile duct (CBD) stones. However, the use of ES to remove CBD stones in high-risk patients without cholecystectomy is still debatable. The aim of this study was to compare the efficacy of a wait-and-see policy versus cholecystectomy after ES for CBD stones in high-risk patients with co-existing cholelithiasis. PATIENTS AND METHODS: A total of 162 patients after undergoing ES with the clearance of CBD stones were randomised after informed consent to cholecystectomy or conservative management of their gallbladder stones. RESULTS: The results indicated that cholecystectomy after ES for CBD stones significantly reduced the biliary complications in high-risk patients. CONCLUSION: Every patient who has both CBD stones and gallstones with significant co-morbid illnesses, after clearance of CBD stones by ES, should undergo early cholecystectomy.