Cytogenetics abnormalities in acute leukemias of ambiguous lineage: First report of complex variant philadelphia translocations

Background: Acute leukemias of ambiguous lineage (ALAL) are incompletely characterized and are very rare, accounts< 4% of acute leukemias . In most leukaemias the cytogenetic and molecular genetic changes have emerged to be diagnostic as well as prognostic importance. Due to Lack of diagnostic criterias, it is difficult to establish cytogenetic features in ALAL. In present study we reviewed chromosomal aberrations, their molecular background, their prognostic relevance of ALAL & summarized some new chromosome aberrations along with probable mechanism of complex variant translocation. Design and Methods: Present study from Kidwai state cancer institute concentrated on cytogenetic findings of ALAL, especially B+Myeloid MPAL cases, more so regarding complex variant phildelphia chromosome translocations summarised diagnostic criteria based on WHO 2008 classification, clinical, immunophenotyping and molecular features, along with treatment & follow up. Results: Among 32 cases of ALAL cases, 28 MPAL cases reported in the present study 13 cases were B/Myeloid, followed by B+T MPAL, T+Myeloid .4 cases of undifferentiated and unclassifiable leukemias were reported. B/myeloid MPAL were in majority, 13 cases. Cytogenetics abnormality was detected in 4 cases of B/myeloid MPAL. 3 cases were Ph +, another case was hyperdiploid, surprisingly out of 3 Ph+ cases, 2 cases (66.6%) showed complex variant Phildelphia chromosome. Conclusion: B+MYELOID MPAL revealed significant cytogenetic abnormalities. Although Ph+ is reported in MPAL, complex variant Ph with 4 or 3 way translocations are not reported in ALAL especially in B/Myeloid MPAL .Immunophenotyping & cytogenetics in ALAL should be mandatory. Multiple levels of genetic heterogeneity exist in these leukemias with variant Ph translocations. Prognosis improves when treated with Imatinib

Evaluation of Ropivacaine versus Ropivacaine with Fentanyl for Postoperative Epidural Analgesia in Patients Undergoing Elective Lower Abdominal Oncosurgeries- A Randomised Clinical Study

Introduction: Epidural analgesia has emerged as one of the preferred and convenient modes of intraoperative and postoperative management owing to advantage of not interfering with metabolic functions, better tolerability and decrease in reflex activity, similar analgesic properties, less motor blockade and decreased propensity of cardiotoxicity. Neuraxial opioids like fentanyl used in epidural analgesia offer advantage of augmenting local anaesthetic effect and reducing the anaesthetic and analgesic requirement. Aim: To compare the adequacy of analgesia, requirement of rescue analgesics between 0.2% ropivacaine and 0.2% ropivacaine with 2 mcg/cc fentanyl. Materials and Methods: The randomised clinical study was carried out from September 2016 to May 2018 in 70 patients (35 in each group) of American Society of Anaesthesiologists (ASA) 1 and 2 scheduled for elective lower abdominal oncological surgeries. The anaesthetic intervention in group R was 0.2 % ropivacaine and group RF was 0.2% ropivacaine with 2 mcg/cc fentanyl. All data was statistically analyzed and compared using Student t-test, Chi-square/Fisher-Exact test. The p-value <0.05 was considered to be significant. Results: Both the groups were compatible with regard to demographic data and haemodynamic variables. The mean Visual Analogue Scale (VAS) were higher in group R compared to group RF at 0, 2, 4, 12, 18 and 24 hours but the observed difference in both the groups was not statistically significant except at 1 and 6 hours. Number of rescue analgesics as epidural boluses (p-value=0.007) and paracetamol (p-value=0.022) requirement were more in group R compared to group RF respectively. Conclusion: On account of adequate postoperative analgesia, haemodynamic stability, ropivacaine with fentanyl is a better option than ropivacaine alone for epidural infusion