Mason G. Robertson

Bone Metastases Mimicking Sickle Cell Crisis

To the Editor.— Sickle cell crises associated with sickle cell thalassemia and other combined hemoglobinopathies are common in a black population. The problem of distinguishing pain of the bone due to thrombotic crises from other causes of pain in the bone can be difficult. Report of a Case.— A 31-year-old rather husky short-statured black American dock worker was hospitalized at Memorial Medical Center in Savannah with severe pains in his legs. Several months previously, he had been hospitalized in the same institution for idiopathic hematuria. Hematological workup, including starch gel hemoglobin electrophoresis had revealed hemoglobin-S thalassemia with a hemoglobin A 2 value of 5.0%. The hematogram revealed a hemoglobin value of 15 gm/ 100 ml, and a normal white blood cell count, differential cell count, and platelet count, but a sickle cell preparation had been positive. He had given no previous history of pains in the bone or crises. On

Postural Hypotension and Steroids

To the Editor.— Earlier literature concerning the use of the adrenal cortical hormones emphasized the occasional development of adrenal crisis, secondary to the prolonged suppression of the pituitary adrenal axis many months after cessation of these steroids. The problem was resurrected in a case in connection with cyclic use of large doses of prednisone as an adjunct to chemotherapy. Report of a Case.— In a 64-year-old black American, lymphadenopathy developed in the left inguinal region in May 1970. Initial biopsies showed only reactive hyperplasia. The lymphadenopathy appeared subsequently in the axilla and supraclavicular areas, and biopsies in October showed lymphosarcoma. The blood pressure at that time was 110/70 mm Hg, but the patient was not specifically checked for postural hypotension. A general medical evaluation was otherwise unremarkable. The hemoglobin level ranged from 9.5 to 10.8 gm/100 ml. The white blood cell count was 3,200/cu mm, with a normal differential cell