P. J. Williamson

Establishing the incidence of myelodysplastic syndrome

Cohen, B.J. & Buckley, M.M. (1988) The prevalence of antibody to human parvovirus B19 in England and Wales. Journal of Medical Microbiology, 2 5 , 151-153. Cohen, B.J., Field, A.M., Gudnadotti, S., Beard, S. & Barbara, J.A. (1990) Blood donor screening for parvovirus B19. Journal of Virological Methods, 30, 233-238. McClain, K., Estrov, Z., Chen, H. & Mahoney, D.H. (1993) Chronic neutropenia of childhood: frequent association with parvovirus infection and correlations with bone marrow culture studies. British Journal of Haematology, 85, 57-62. Ozawa. K., Kurtman, G. & Young, N. (1987) Productive infection by B19 parvovirus of human erythroid bone marrow cells in vitro. Blood. 70, 384-391.

Red cell aplasia in myelodysplastic syndrome.

Six cases of red cell aplasia occurring in patients with myelodysplastic syndromes (MDS) showed a diversity of clinical course and prognosis. In some patients red cell aplasia may have represented an evolution of MDS while in others autoimmune destruction of erythoblasts may have been the mechanism. A proliferative phase is seen in many of these patients, the clinical importance of which is uncertain.

CIRCULATING STEM CELL AUTOGRAFTS IN HIGH-RISK MYELOMA

BCG group and 12 in the control group. One died from REFERENCE another cause in each group. After a follow-up of more than 10 years, the difference in survival is no longer significant for all patients (P=O.I) (Fig 2a). Nevertheless the difference is significant if we consider only stages I and I1 (P=O.O13) (Fig 2b) or high grade malignancy (Kiel’s and W.F. classification) Hcerni. B., Durand. M.. Richaud. P, De Mascarel. A., Hcerni-Simon. G.. Chauvergne, J. & Lagarde. C. (1979) Successful maintenance immunotherapy by BCG of non-Hodgkin’s malignant lymphomas: results of a controlled trial. British journal ojHaematoIogy, 42, 5075 1 4 . (P<0 .05) as was the case 10 years ago. Further follow-up has strengthened our initial findings, supporting the use of adjuvant immunotherapy with BCG in some subsets of non-Hodgkin’s malignant lymphomas. This conclusion is supported by the benefit of BCG therapy for disease-free survival of all patients of our trial: and for actuarial survival and disease-free survival for stages I and I1 or high grade malignancy.

Thrombotic thrombocytopenic purpura mimicking acute small bowel Crohn's disease.

A 39 year old woman presented with a short history of bloody diarrhoea. She subsequently developed microangiopathic haemolysis, platelet consumption, and renal impairment. Initial investigations suggested underlying Crohns disease of the terminal ileum complicated by sepsis and disseminated intravascular coagulation. However, after resection of a perforated caecum and terminal ileum, the diagnosis of thrombotic thrombocytopenic purpura was made. There was weak serological evidence of yersinia infection, this may have caused the early localisation of the lesions to the terminal ileum. This is believed to be the first report of thrombotic thrombocytopenic purpura affecting the small bowel alone at presentation.

A phase-III study of recombinant interleukin 2 and 5-fluorouracil chemotherapy in patients with metastatic colorectal cancer

Sixteen patients with metastatic colorectal cancer have been treated with a regimen involving an 120 h continuous infusion of rIL-2, 18 x 10(6) iu m-2 day followed by three injections of 5FU 600 mg m-2 at weekly intervals. Entry criteria included no previous chemotherapy, ambulatory performance status, and a measurable lesion. In most cases side effects were easily manageable and only one patient required transfer to an intensive care unit with the capillary leak syndrome. In three patients persistent hypotension was found to be unrelated to treatment with rIL-2, being caused respectively by a line infection, pulmonary embolus, and bowel perforation. This last proved a fatal complication. Five patients (33%; [95% confidence limits, 11.8%-61.6%]) achieved a partial response, and two non-responders later achieved a partial response when treated with weekly 5FU. This regimen is currently being evaluated in a phase-III randomised controlled trial.

Four pedigrees of the cation-leaky hereditary stomatocytosis class presenting with pseudohyperkalaemia. Novel profile of temperature dependence of Na +-K + leak in a xerocytic form

We report four pedigrees of the group of Na+–K+‐leaky red cell disorders of the ‘hereditary stomatocytosis’ class. Each showed pseudohyperkalaemia because of temperature‐dependent loss of K+ from red cells on storage of whole blood at room temperature. All pedigrees showed an abnormality in the temperature dependence of the ‘passive leak’ of the membrane to K+. Two pedigrees, both of which showed a compensated haemolytic state with dehydrated red cells and target cells on the blood film, showed a novel pattern, in which the profile was flat between 37°C and about 32°C then dropped as the temperature was reduced to zero. The third showed the ‘shallow slope’ profile, with stomatocytes on the blood film and very markedly abnormal intracellular Na+ and K+ levels. Minimal haemolysis was present. The fourth pedigree, of Asian origin, showed the shoulder pattern (minimum at 32°C, maximum at 12°C) with essentially normal haematology. Both of these latter two forms have previously been seen in other pedigrees. The first variant represents a novel kind of temperature dependence of the passive leak found in these pedigrees presenting with pseudohyperkalaemia.

Dangers of cocaine and adrenaline paste. Accurate measurement of dose and patience are important.

EDITOR,--K E A Nicholson and J E G Rogerss lesson of the week about arrhythmias associated with the use of cocaine and adrenaline paste1 is bound to fuel the controversy surrounding the use of these two drugs in sinonasal surgery. It is unclear from their report whether the overdose of cocaine was intentional or inadvertent: all three patients reported on received two to three times the maximum recommended dose of cocaine for their weight. With no evidence of similar complications when cocaine is used …

A CHILD WHO CHANGED MY LIFE

Just as Dr Hugh Jacksons practice was changed by one childs death (BMJ 1995;310:49), so my life was altered by the death of a boy killed by a V1 flying bomb in 1944. Although this did not lead me to become a doctor, I did eventually become a careers adviser; and over 28 years I must have aided the entry of some 200 students into medical schools. In the autumn of 1944, when I was serving in civil defence in London, I heard our bell announcing “immediate danger overhead”—a warning of the approach of a flying bomb. Soon the roar of its ram jet cut out and the dive began; the V1 struck the road outside Kensal Green station in north west London, very …