Tri-modality bladder-sparing approach consists of transurethral resection, chemotherapy twice weekly Gemcitabine and radiotherapy is well tolerated, with high rate of bladder preservation. This approach may be considered as a reasonable alternative to cystectomy in the proper selected patients.

Tri-modality bladder-sparing approach consists of transurethral resection, chemotherapy twice weekly Gemcitabine and radiotherapy is well tolerated, with high rate of bladder preservation. This approach may be considered as a reasonable alternative to cystectomy in the proper selected patients.

Tri-modality bladder-sparing approach consists of transurethral resection, chemotherapy twice weekly Gemcitabine and radiotherapy is well tolerated, with high rate of bladder preservation. This approach may be considered as a reasonable alternative to cystectomy in the proper selected patients.

reoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy improved local control, promoted sphincter – preserving surgery and was associated with reduced toxicity but did not improve overall survival.

reoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy improved local control, promoted sphincter – preserving surgery and was associated with reduced toxicity but did not improve overall survival.

reoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy improved local control, promoted sphincter – preserving surgery and was associated with reduced toxicity but did not improve overall survival.

The aim of this work is to study the effects, adverse effects and recovery time of IV mixed propofol and ketamine (ketofol) in 3:1 ratio as a sedative analgesic in children with acute lymphoblastic leukemia undergoing bone marrow aspiration. Methods: This was a prospective, observational pilot study of twenty patients; 3-12 years with ALL requiring sedation for BMA were included. Mixture of ketofol (3:1) was administered intravenously. Patient satisfaction was the primary outcome in our study. Faces pain scale – revised (FPS-R) was used to assess the degree of analgesia. Secondary outcomes included sedation time, recovery time, adverse events and safety. Results The median dose of ketofol is 3 mg/kg of propofol and 1 mg/kg of ketamine. The median score on the pain faces scale was 2 (1-3; 95%CI 1.08-2.92). Median recovery time was 22 minutes (16-30; 95%CI 14.08-29.32). The cardiorespiratory adverse events were transient, tolerable and easily corrected. Conclusion Combination of ketamine and propofol produced effective analgesic sedation with rapid recovery and absence of clinically significant adverse events among children requiring procedural sedation and analgesia for bone marrow aspiration. A high recommendation of using large sample size should be considered for further assessment and verification of our results.