Treatment of Heavily Pre-treated Metastatic Breast Cancer with Eribulin: First local experience in Sabah.

There are many options in the treatment of heavily pretreated metastatic breast cancer however none of the therapeutic agents have shown promising improvement of survival with good toxicity profile. Eribulin is a novel nontaxane microtubule dynamics inhibitor. Two recent clinical trial showed that Eribulin improves progression-free and overall survival in this subset of patients. We report our experience with using Eribulin in five patients with metastatic breast cancer either in second or third-line setting, in our centre.

A Case of Nasopharyngeal Carcinoma with Paraneoplastic Leukemoid Reaction: A Case Report.

We present a case of nasopharyngeal carcinoma complicated with hyperleucocytosis. After ruling our other causes we concluded that the hyperleucocytosis was due to paraneoplastic leukemoid reaction (PLR). The overall survival was 15 months which is rare among patients with PLR.

Adult Klippel-Feil syndrome: haemodynamic instability in the prone position and postoperative respiratory failure.

A 52-year-old patient with Klippel-Feil syndrome was scheduled for elective C1 dorsal laminectomy and occipito-cervical stabilisation under general anaesthesia. Preoperatively she had bulbar symptoms and a history of recurrent aspiration pneumonia, but no evidence of cardiovascular disease. When she was turned prone she developed persistent tachycardia, hypotension and ST segment changes despite fluids, pressors and inotropes. Her condition improved when turned supine, but she had persistent ECG changes and a troponin rise was measured the following day. She was extubated two days postoperatively but aspirated again and subsequently died 12 days later from respiratory failure. If prone positioning is required in patients with Klippel-Feil syndrome we suggest meticulous positioning to avoid sternal compression of the heart. We also suggest thorough preoperative respiratory evaluation and elective postoperative intensive care as these patients are at high risk of developing postoperative respiratory failure.

Changes in clinical research in anaesthesia and intensive care from 1974-2004.

The purpose was to identify how the quality of anaesthesia research has improved from articles published in Anaesthesia and Intensive Care over 25 years. Original papers were included during the periods 1974-1978 and 2000-2004. Each article was classified according to principal research designs and the two five-year periods were compared. All interventional trials were evaluated according to the following a priori criteria: author number; ethics approval; informed consent; competing financial interest; eligibility criteria; sample size calculation; method of randomization; patients accounted for; blind assessment of outcome; adverse outcomes; statistical method stated; type I error; type II error; and anaesthetic department of origin. Comparisons of above criteria were made between the two groups using chi-square test or Fischer's exact test. Two-hundred-and-ninety-two articles were reviewed in 1974-1978 and 529 articles were reviewed in 2000-2004. Animal/laboratory articles decreased from 17.47% to 12.28% (P=0.05). Review articles decreased from 34.35% to 10.4% (P<0.0001). Descriptive trials increased from 28.4% to 52.72% (P<0.0001). Interventional trials increased from 18.84% to 22.31% (P=0.269). Uncontrolled clinical trials decreased from 27.27% to 12.71%, non-randomized controlled trials decreased from 50.91% to 7.63%, and randomized controlled trials increased from 21.82% to 79.66% (P<0.0001). All interventional trials criteria improved and were statistically significant except competing financial interest, method of randomization, patients accounted for; and type II error The quality of anaesthetic research has improved in Anaesthesia and Intensive Care over the past 30 years. However; there is still room for improvement.