Background: Based on beneficial reports of PAMIDRONATE use for reflex sympathetic dystrophy in reduction of pain and swelling, this drug can be studied as a novel treatment for refractory lymphedema. This study aims to determine the effectiveness of PAMIDRONATE on lymphedema and its possible side effects.Methods: Twelve cases of lower limb refractory lymphedema were enrolled. They received intravenous PAMIDRONATE monthly for 3 consecutive months and were followed by measuring any discomfort with visual analog scale (VAS) and physician global assessment, based on objective signs of limb volume and circumference.Results: The limb volume, circumference, and satisfaction of the patients improved significantly.Conclusion: PAMIDRONATE when is added to conservative treatments may reduce lymphedema and improve the patient’s comfort.

Calciphylaxis is a complication of chronic kidney disease characterized by necrotic lesion in the skin. Histological examination reveals microcalcification of medium-sized blood vessels. We report on a 21-month-old girl with end-stage renal disease with severe calcium-phosphate imbalance. Calciphylaxis process started when she received calcium gluconate intravenously the day before the surgery to correct hypocalcemia and continued progressively despite peritoneal dialysis and forced stopping calcium-containing medication. PAMIDRONATE, 0. 5 mg/kg/d, was administered for 6 days and then once a week for 5 weeks. After 1 week, the skin lesion started to heal and circulation improved, and after 6 weeks, all skin lesions completely recovered. PAMIDRONATE was effective to stop calciphylaxis in this case with advanced renal insufficiency and severe calcium-phosphate imbalance. Medical or surgical debridement are not suggested and lesions might recover without scar by PAMIDRONATE.

Background: Hereditary hyperphosphatasia is a congenital and rare disease with high bone turn over. The disease is defined with extremely elevated alkaline phosphatase levels. Neonates with hyperphosphatasia are normal at birth but develop progressive long bone deformities, fracture, vertebral collapse, skull enlargement due to massively thickened calvarium, and deafness. Case Presentation: Here, we described a male patient with progressive deformity in limbs and pain during walking that onset of symptoms was from age of two. The patient admitted to the Shahid Sadoughi Hospital, Yazd, was born from a non-consanguineous marriage. He was treated with PAMIDRONATE until halt of the disease progression and followed up for 18 months. Conclusion: Bisphosphonate is the treatment of choice for hyperphosphatasia because it can normalize bone turnover, improve growth rates, and skeletal quality.

The main objective of this study was to determine the efficacy and safety of PAMIDRONATE in improving bone mineralization and reducing fracture incidence in osteogenesis imperfecta (OI).Materials and Methods: Intravenous PAMIDRONATE was administered to 64 children, aged 18 months to 10 years old, with severe OI, in a 1 Mg/kg single daily dose for 3 sequentional days at 4 month intervals, for over a period of 24-48 months. Clinical status, biochemical characteristics including bone turnover markers, the bone mineral density of the lumbar spine and femoral neck, and radiologic changes were assessed regularly during treatment.Results: The number of fractures decreased from median of 8 (range 4-11) to 0 fractures/year (range 0-4) (P<0.05). After 16 months of treatment, there was significant improvement in bone mineral density (BMD-DEXA) z-scores of the lumbar spine from median of -5.90 (range - 7.01 to -4.76) to -2.70 (range -4.46 to -1.98) (P<0.0001).Serum alkaline phosphatase (ALP) (bone formation marker) decreased from a median of 731.0 U/L (range 438-998 U/L) to 183 U/L (range 95-286 U/L) (P<0.001), implying a significant reduction in bone turnover and its resorption and increase in bone mineralization. There was no improvement either in their height growth velocities or in their standard deviation scores. Mobility and ambulation improved in all but 5 children, (all five took the drug for less than 2.5 years).There was a significant relief in chronic pain and fatigue but no adverse effects in any of the children using the drug.Conclusion: Cyclic PAMIDRONATE administration is effective in improving bone mineralization and reducing fracture incidence in childhood osteogenesis imperfecta.

PAMIDRONATE is a bisphosphonate derivative that can inhibit bone resorption by actions on osteoclasts and increase bone density in spite of treatment with steroids. This drug has the anti-inflammatory effect by increase apoptosis of monocytes.5-10 percent of rheumatoid arthritis patients is seronegative and may be resistant to conventional disease modifying anti rheumatic drugs (DMARDs). Intravenous (IV) PAMIDRONATE can be effective in disease control in seronegative rheumatoid arthritis. We report two cases of seronegative and drug resistant rheumatoid arthritis that favorably responds to PAMIDRONATE.

McCune-Albright Syndrome (MAS) is a rare sporadic disease characterized by bone fibrous dysplasia, Café au lait spots and a variable association of hyperfunction endocrine disorders. There is not any certain treatment available for this syndrome, and both physical and emotional disability in these patients is still a major concern for physicians. In present report we have described a 10-year-old girl, presented with precocious puberty, multiple Café au lait macules and fibrous dysplasia, successfully treated with PAMIDRONATE in a four-year follow-up period.