Background: Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective α2agonist with sedative and analgesic properties. Objective: To investigate the effect of addition of dexmedetomidine to 0.25% bupivacaine for caudal analgesia in children undergoing major abdominal cancer surgery. Study Design: A randomized double-blind trial. Setting: Academic medical center. Methods: Forty pediatric patients, aged 3 – 12 years, weighting 10 – 40 kg, and of American Society of Anesthesiologists (ASA) physical status I and II scheduled for major abdominal cancer surgeries under general anesthesia combined with caudal analgesia were enrolled. They were randomly allocated into 2 groups: Group I (BD): (n = 20) received 1 mL/kg bupivacaine 0.25% with dexmedetomidine 1 μg/kg and group II (B): (n = 20) received 1 mL/kg bupivacaine 0.25%. Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SPO2) were recorded for 120 minutes. Pain was assessed immediately postoperative and at hours 2, 4, 6, 12, 18, and 24 of postoperative period by Face, Legs, Activity, Cry and Consolability (FLACC) score. Time to first request for analgesia and total analgesic consumption [Intravenous acetaminophen 15mg/kg (perfalgan, Squibb)] in the first 24 hours were recorded. The level of sedation was recorded using Ramsay’s sedation scale. Adverse effects were recorded and treated. Results: There was significant reduction in FLACC score in group BD at 2, 4, 6, and 12 hours postoperatively compared to group B. At the eighteenth and twenty-fourth hour there was no significant difference. Time of the first rescue analgesic requirement was significantly prolonged in group BD compared to group B. The mean total consumption of rescue analgesia in the 24 hours of the postoperative period was significantly decreased in group BD (405.00 ± 215.03) mg when compared with group B (810.35 ± 200.93) mg. Limitations: This study is limited by its small sample size. Conclusion: Addition of dexmedetomidine (1 μg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance.

Background The optimal time sequences for chemotherapy and radiation therapy after breast surgery for patients with breast cancer remains unknown. Most of published studies were done for early breast cancer patients. However, in Egypt advanced stages were the common presentation. This retrospective analysis aimed to assess the optimum sequence for our population. Methods 267 eligible patients planned to receive adjuvant chemotherapy [FAC] and radiotherapy. Majority of patients (87.6%) underwent modified radical mastectomy while, 12.4% had conservative surgery. We divided the patients into 3 groups according to the sequence of chemotherapy and radiotherapy. Sixty-seven patients (25.1%) received postoperative radiotherapy before chemotherapy [group A]. One hundred and fifty patients (56.2%) were treated in a sandwich scheme (group B), which means that 3 chemotherapy cycles were given prior to radiotherapy followed by 3 further chemotherapy cycles. A group of 50 patients (18.7%) was treated sequentially (group C), which means that radiotherapy was supplied after finishing the last chemotherapy cycle. Patients' characteristics are balanced between different groups. Results Disease free survival was estimated at 2.5 years, and it was 83.5%, 82.3% and 80% for patient receiving radiation before chemotherapy [group A], sandwich [group B] and after finishing chemotherapy [group C] respectively (p > 0.5). Grade 2 pneumonitis, which necessitates treatment with steroid, was detected in 3.4% of our patients, while grade 2 radiation dermatitis was 17.6%. There are no clinical significant differences between different groups regarded pulmonary or skin toxicities. Conclusion Regarding disease free survival and treatment toxicities, in our study, we did not find any significant difference between the different radiotherapy and chemotherapy sequences.

Objectives: Patients with painful bone metastasis treated with palliative radiation therapy (RTH) may require re-irradiation. This work aims at assessing the efficacy and safety of re-irradiation for painful bone metastases using single 8 Gy fractions versus (4 Gy × 5 fractions). Methods: From June 2011 to December 2012, previously irradiated bone metastases were re-irradiated with single 8 Gy fractions (group I) or, 4 Gy × 5 fractions (group II). Pain management index (PMI) was determined. Pearson’s r correlation coefficient was calculated between negative PMI at presentation and age, ECOG Performance Status, sex, and primary cancer site. Results: Two months after RTH, about one fifth of patients achieved no pain, mild pain in 75.5% of the remaining patients and no patient suffered from severe pain. There was no significant difference (p>0.05) between groups (I and II) regarding pain relief. Negative PMI score, was reduced to from 37% at presentation to 25%, at 2 months follow up. A strong negative association between PMI and performance status (p=0.0057, 95% confidence interval between 0.109 and 0.557) was found. Conclusion: Palliative re-irradiation with either single 8 Gy fraction or with, 4 Gy × 5 fractions was effective and safe in pain relief.