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PubMedDate not supplied

Bone marrow transplantation for familial hemophagocytic lymphohistiocytosis.

A one year old child diagnosed at two months as having familial hemophagocytic lymphohistiocytosis had a partial response to etoposide. He relapsed and underwent a bone marrow transplant after conditioning with etoposide 65 mg/kg, total body irradiation and cyclophosphamide 60 mg/kg X 2 doses. Post transplant sepsis ensued and the patient expired. At autopsy residual disease was noted. Familial hemophagocytic lymphohistiocytosis continues to be a fatal disorder and etoposide is the only agent known so far with any efficacy. Bone marrow transplantation probably should be attempted early in its course and may have a role in the treatment of this disease.

Bone Marrow Transplantation↗

PubMedDate not supplied

The impact of direct access endoscopy, Helicobacter pylori near patient testing and acid suppressants on the management of dyspepsia in general practice.

Direct access endoscopy services, Helicobacter pylori infection and more effective acid suppression therapy have influenced the management of dyspepsia in the past decade. Three hundred and ten GPs in south London were surveyed via postal questionnaire to determine the impact of these factors on the management of dyspepsia in general practice. Ninety-one per cent of GPs prescribed simple antacids as initial treatment for simple dyspepsia and referred only if symptoms did not improve. When acid suppressants were used, 41% used H2 antagonists compared with 11% for proton pump inhibitors (p = 0.0001). Risk factors for underlying malignancy were the most frequent reason for hospital referral at first consultation. Long outpatient waiting times result in about 90% of GPs choosing direct access endoscopy as the route of referral for all patients with dyspepsia, while only 36% would refer patients with sinister symptoms to direct access endoscopy if waiting times were similar to that of outpatients. H. pylori near patient testing did not seem to influence the management of dyspepsia in general practice.

Antacids↗