Letter: Maintenance therapy in myeloma: rish versus benefit.
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Biomedical subjects
Publications and source records attributed to P Jacobs.
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A prospective evaluation of the haemostatic mechanism was undertaken in 15 normal primigravidas and in 12 primigravidas with mild to moderately severe pre-eclampsia in order to further examine the possibility that disseminated intravascular coagulation may occur in this clinical syndrome. The only coagulation abnormality demonstrated was a prolongation of bleeding time. The data do not support the suggestion that significant disseminated intravascular coagulation is associated with pre-eclampsia. The addition of the heparinoid drug sodium pentosan polysulphate to the therapeutic regimen resulted in a significant fall in platelet factor 3 availability and in decreased aggregation against ADP but conferred no objective clinical improvement. We conclude that the drug has no place in the management of established pre-eclampsia.
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The association of IgG monoclonal gammopathy with lymphocytic lymphoma and chronic lymphocytic leukaemia is reported. Although rare, such immunoglobulin synthesis may have prognostic importance and is of value in monitoring the effect of therapy. The morphological features which should draw attention to this pattern of protein abnormality are briefly reviewed. This finding emphasises the histogenesis of these tumours from the immune system and questions their classification on a purely morphological basis.
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A 16-year-old boy is reported in whom back pain, due to localised osteoporosis and partial collapse of a lumbar vertebra, drew attention to unsuspected acute lymphoblastic leukaemia. The patient responded promptly to induction therapy, his symptoms disappeared, and he is presently in the maintenance programme. The skeletal lesion continues to heal slowly. Attention is drawn to this unusual presentation of acute lymphoblastic leukaemia, and the importance of bone-marrow examination in the study of unexplained cases of osteoporosis is emphasised.
Hyperuricaemia may complicate thalassaemia and may, on occasion, result in obstruction of urine flow on the basis of crystal formation. Prophylactic therapy with xanthine oxidase inhibitors may prevent this complication, but once it has developed, accurate diagnosis and aggressive therapy can reduce morbidity. The present case report illustrates one approach to the management of acute uric acid nephropathy.
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