BackgroundHypercalcaemia can cause life-threatening complications. Pharmacological treatment of severe hypercalcaemia is complicated by lack of experience with some effective medicines such as bisphosphonates in newborns.PurposeTo describe the pharmacotherapeutic management of pamidronate in severe hypercalcaemia of a premature newborn.Material and methodsWe report on a preterm infant [weight: 1.080 kg, length 38 cm] who had required total parenteral nutrition (TPN) since birth. In routine blood tests, serum calcium was 15.6 mg/dl on the seventh day of life, reaching as high as 17.2 mg/dl as a consequence of suspected adrenal insufficiency of central origin.ResultsHypercalcaemia persisted despite the conventional treatment for excessive calcium, including removal of calcium from the TPN. The patient received intravenous pamidronate (1 mg/kg) for 1 day. Pamidronate 6 mg was diluted in 30 millilitres of 5% dextrose saline solution, only 10 millilitres were infused in 4 h. His serum calcium level decreased significantly, and about 15 h later, his total calcium level normalised (10.6 mg/dl). His serum calcium concentration returned to normal without any adverse reactions.ConclusionIntravenous pamidronate appeared to be a safe and effective treatment for severe hypercalcaemia in a premature newborn.References and/or acknowledgementsTo my pharmacist colleagues.No conflict of interest.

BackgroundRefractory cancer pain is often difficult to manage. Ketamine is a drug with evidence of efficacy in the treatment of chronic cancer pain.PurposeTo evaluate the efficacy and safety of ketamine rinse solution in paediatric patients with refractory cancer pain.Material and methodsWe report on a paediatric oncology patient who presented with painful conditions refractory to conventional analgesic treatment. Intravenous ketamine was diluted to a final concentration of 10 mg/mL in sterile water to rinse. Mouth rinses with 3 mL (30 mg) once daily was prescribed, specifying two rinses daily if required. Efficacy was measured on a visual analogue scale for pain (VAS pain), the Clinical Global Impression – Global Improvement (CGI-I) Scale, and the reduction of dose or withdrawal of analgesic drug base. Safety was measured in terms of variation in some clinical parameters (blood pressure, heart rate, oxygen saturation) and onset of drug-related symptoms (feeling drunk, drowsiness, nausea, vomiting, nystagmus or hallucinations).ResultsThe case of a male patient 13 years of age [33 kg and 143 cm] is presented. The patient was receiving morphine chloride rescues until the treatment; morphine rescue was no longer needed on the second day of initiating treatment. The VAS pain score before rinsing was 9 and remained on 2 for 24 h after the rinse was applied, achieving a score of 0 on day four. CGI-I Scale at the end of the treatment score was 1 (Very much improved). The patient had no changes in clinical parameters. The total rinsing treatment time was four days, requiring two rinses the first day only. The pain stopped within 10 min of beginning the rinsing.ConclusionKetamine rinsing was effective and safe in our paediatric oncology patient with painful conditions refractory to standard analgesic treatment. Further studies are needed to strengthen our results.References and/or acknowledgementsSpecially thanks Dr Manuel CortiñasNo conflict of interest.

BackgroundLaser photocoagulation (LPC) is considered the standard treatment for retinopathy of prematurity (ROP), but LPC is destructive, causes complications, and does not prevent all vision loss. Recently, bevacizumab (a vascular endothelial growth factor inhibitor) has been used with po-sitive results.PurposeTo evaluate the efficacy and safety of intravitreal bevacizumab vs. LPC in preterm infants with ROP grades 1 to 3+.Material and methodsTen-month retrospective study that included patients with gestational age of less than 30 weeks diagnosed with ROP grades 1 to 3+, and weight <1,500 g. The subjects received either a single dose of bevacizumab 0.625 mg at three months post-gestational age, or LPC at four-to-eight weeks. The primary efficacy and safety endpoints for both arms of treatment were: complete vascularisation (CV) in both eyes, and absence of adverse events.ResultsTwelve patients were included, six for each treatment arm The proportion of females was 50% for the bevacizumab group and 66.6% for the LPC group. Mean gestational age was 25 weeks [23–29] in both groups. Efficacy: CV was achieved in five cases (83.4%) in the bevacizumab arm, and in two patients (33.3%) of those receiving LPC. Safety: no adverse effects were observed in the antiangiogenic treatment arm. In the LPC group, two cases of retinal detachment (inoperable in one case), one of localised reversible haemorrhage, one of retinal fibrosis, and one of laser-related scarring were found.ConclusionIn this cohort, intravitreal bevacizumab was more effective and safer than LPC in the treatment of ROP grades 1–3+. This is consistent with previous published studies, and supports the use of the antiangiogenic over LPC in the treatment of ROP.References and/or acknowledgementsDr Héctor MateoNo conflict of interest.

BackgroundThe use of an alternative liquid anaesthetic sevoflurane has recently been reported in the literature on vascular ulcers. Topical application for management of analgesia appears to be successful.PurposeTo evaluate the stability of sevoflurane in pure polypropylene amber syringes.Material and methodsCommercial solutions of sevoflurane (Sevorane) were packed in polypropylene syringes. The syringes were stored at 23°C for 14 days in a digitally temperature-controlled chamber. The physical parameters monitored were clarity and colour. Chemical stability was determined by means of 19-Fluorine Nuclear Magnetic Resonance (19F-NMR) and gas chromatography coupled with a Flame Ionisation Detector (GC-FID).ResultsOver the 14 days, the clarity and lack of colour of the solutions were maintained. 19F-NMR signals identical to those of the original product were observed in all samples, corresponding to the chemical structure of unchanged sevoflurane. Meanwhile, in the GC-FID analysis, no additional peaks occurred at the storage temperature. No degradation products were observed by either analytical technique.ConclusionPure sevoflurane preserved in amber polypropylene syringes was stable for 14 days at room temperature. This enables it to be stored in a more convenient way, and provides greater comfort in drug instillation onto the ulcer bed from the syringe.References and/or acknowledgementsUniversity of Almería.No conflict of interest.