Bone marrow examination before steroids in thrombocytopenic purpura or arthritis

Corticosteroids were used to treat two children with presumed idiopathic thrombocytopenic purpura and one with juvenile rheumatoid arthritis without examination of the bone marrow. Of the two with presumed idiopathic thrombocytopenic purpura, one had Fanconi's anaemia and the other may have had aplastic anaemia. The third child had acute lymphoblastic leukaemia. The diagnosis of Fanconi's anaemia was delayed. A diagnostic and therapeutic dilemma was caused in the second case. In the third, delayed diagnosis and, perhaps, compromised outlook resulted. These three cases re-emphasize the well aired caveats about the diagnosis of idiopathic thrombocytopenic purpura and juvenile rheumatoid arthritis and provide further support for the arguments of those who believe that if corticosteroids are to be used to treat such children, their bone marrow should be examined first.     

Effects of recombinant human interleukin-6 in cancer patients: a phase I-II study

To define the toxicity profile of recombinant human interleukin-6 (rhIL- 6) and to study its effect on hematopoiesis, biochemical parameters and other cytokines, rhIL-6 was administered in a phase I-II study to 20 patients with breast carcinoma or nonsmall cell lung cancer. RhIL-6 doses were 0.5, 1.0, 2.5, 5.0, 10, and 20 micrograms/kg/d, with at least three patients per dose level. RhIL-6 was administered 24 hours by continuous intravenous infusion followed by subcutaneous (SC) administration for 6 days, partly on an outpatient basis. RhIL-6- related side effects were fever, headache, myalgia, and local erythema. Starting at 2.5 micrograms/kg/d, these side effects were compounded by nausea, reversible increase in liver enzymes, and anemia. Flu-like symptoms were controllable up to and including 10 micrograms rhIL- 6/kg/d with acetaminophen. RhIL-6 increased platelet counts with a decrease in mean platelet volume and increased leukocytes caused by neutrophil, monocyte, and lymphocyte increase, with an increase in T cells and natural killer cells at 1.0 and 2.5 micrograms rhIL-6/kg/d. The reversible anemia was characterized by a decrease in serum iron, and an increase in ferritin and erythropoietin without reticulocytosis. RhIL-6 reduced total cholesterol levels and a dose-related increase of C-reactive protein and serum amyloid A plasma levels was observed. Serum IL-6 levels were increased, especially at 10 and 20 micrograms/kg/d, whereas no change in IL-1 beta and tumor necrosis factor alpha levels was observed. RhIL-6 can be administered with controllable side effects in this setting, up to and including a SC dose of 10 micrograms/kg/d on an outpatient basis, and has a promising stimulating effect on leukopoiesis and thrombopoiesis.     

The Kmod blood group phenotype in a healthy individual

This report describes a healthy blood donor whose red cells have weakened expression of Kell blood group antigens. Kell antigen activity could not be detected by flow cytometric analysis and was demonstrable only by sensitive serologic techniques. As with normal-strength Kell antigens, reactivity could be abolished by treatment with 2-aminoethylisothiouronium bromide (AET). The donor's red cells have Kx antigen activity. Other commonly tested blood group antigens (MNSs, Rh, P1, Lewis, Duffy, and Kidd systems) appear normal. Clinical and serologic examination showed that this case is different from previously described examples of modified Kell expression. The propositus's phenotype has remained unchanged for 19 months, which suggests that it is not a transient condition. However, family studies provide no evidence that it is inherited. A 93-kD protein, which reacted weakly by Western blot with rabbit antibody to Kell protein, was isolated from the propositus's red cells by immunoprecipitation. This finding was not reproduced in subsequent studies, which suggests that the quantity of Kell protein recovered was at the threshold level detectable by the technique used. The red cell phenotype is categorized as Kmod, of which this is the first example reported in a healthy individual.     

The Influence of Finishing Technique on Microleakage

Four different finishing techniques were used in a dentin bonding agent/composite resin restoration to evaluate the possible influence of finishing technique on microleakage. Results indicated that finishing technique affects the ability of the restorative system to resist microleakage. Under the conditions of this study, best results were achieved with a 30-fluted bur followed by a short wet polish. Samples finished dry with polishing disks demonstrated considerable microleakage. This study also suggests that homogeneous nonagglomerated microfilled composite resin does not require disk finishing.