Changes in Mean Platelet Volume and Platelet Distribution Width after Therapy in Childhood Idiopathic Thrombocytopenic Purpura

PURPOSE: Mean platelet volume(MPV) and platelet distribution width(PDW) are useful parameters in evaluating disorders of platelets. In cases with idiopathic thrombocytopenic purpura(ITP), they change as platelet count increases. In this study, we compared the values of MPV and PDW in ITP patients at diagnosis with those of normal children. We also studied whether the early changes in MPV may predict the clinical course. METHODS: From December 1995 to May 2001, 71 patients with ITP were admitted to Ajou University Hospital. They were treated with IVIg 400 mg/kg for five days and MPV, PDW, platelet count were analysed. Normal control group(n=38) was compared. The study group was divided into acute and chronic forms, and also divided into group A, good early responders whose platelets increased more than 100,000/microL within 5 days and group B who did not. RESULTS: Mean value of MPV at diagnosis in ITP patients was lower than the normal control group(P<0.05). In group A, MPV was abruptly increased on the first day after IVIg and then started to decrease. But in group B, MPV was steadily increased until the fourth day after IVIg. In the normal control group, there were inverse correlations between platelet count and MPV(r= -0.415, P<0.05), but in ITP patients, there were positive relationships between platelet count and MPV(r=0.646, P<0.05) at diagnosis. CONCLUSIONS: MPV at diagnosis of ITP was lower than the normal control. MPV and PDW could not predict the course of ITP patients, but MPV could distinguish good early responders. More research is needed to find out the reasons of decreased MPV at diagnosis of ITP.

Identification of Acanthocephala discovered in changran-pickles and myungran-pickles

To identify acanthocephala found in 'Changran-pickles' and 'Myungran-pickles' each organ was measured in permanent slides. In the present report, the results obtained were as follows: 1. Morphology of male worms: Worms possessed 18-19 longitudinal rows, with 4 hooks per row, which became smaller towards the base of proboscis. Each worm contained two testis and six cement glands arranged linearly. Body 22.0 by 0.8-0.6 mm and 15.0 by 0.6-0.4 mm, proboscis 284.8 by 227.6 microgram and 524.9 by 151.4 microgram, proboscis sheath 1570.7 by 72.7 microgram and 751.9 by 280.4 microgram, lemnisci length 2566.7 and 1085.6, testis 2202.9-1860.5 by 737.0-575.7 microgram and 1033.8-981.1 by 463.1-351.6 microgram, cement glands 940.2 by 441.2 microgram and 610.0 by 369.1 microgram. 2. Morphology of female worms: Worms possessed 14-18 longitudinal rows, with 6-10 hooks per row and become smaller toward the base of proboscis. Each worm contained an uterine bell and uterus in the posterior portion and the eggs filled the body cavity. Body 14.0~51.0 mm by 0.7-0.5~2.2-1.4 mm, proboscis 466.1-268.9 microgram by 259.9-252.0 microgram, proboscis sheath 1550.7-506.0 by 298.8-231.1 microgram, lemnisci length 1325.7-473.1 microgram, eggs 112.4 by 28.5 microgram~51.7 by 14.0 microgram. In this present study, the acanthocephala collected in 'Changran-pickles' and 'Myungran-pickles' were identified as Echinorhynchus gadi by morphological features.

Chemotherapy and Low Dose Interleukin-2 Therapy for Acute Myeloid Leukemia in Patient with Down Syndrome / 대한소아혈액종양학회지

A 4-day-old patient with Down syndrome (DS) visited out patient department (OPD) because of jaundice and VSD. Peripheral blood smear showed 21% of myeloblast. After 4 weeks of observation, WBC count was 55,100/mm3 (blast 90%). BM aspirate showed AML (M7) and treatment was started with low dose Ara-C (20 mg/m2 for 21 days). After remission, maintenance therapy was done with low dose Ara-C (16 mg/m2 for 21 days), 6-TG (40 mg/m2 for 21 days) and low dose IL-2 (0.5 106U/m2 for 21 days) alternatively for 2 years. The patient remained in complete remission and VSD was corrected at 9 months of age. This case shows that remission can be achieved with low dose Ara-C and it can be maintained thereafter with low dose Ara-C, 6-TG and IL-2. Low dose IL-2 has the advantage of selectively activating immune cells with high affinity receptors, low treatment related morbidity, good compliance which can be injected at OPD. As the patients with DS have defect in IL-2 secretion, IL-2 may have an beneficial effects on treating AML in DS.

Pamidronate Therapy for Hypercalcemia Due to Stage IV Wilms Tumor / 대한소아혈액종양학회지

The incidence of hypercalcemia in terminal cancer patients is rare but if it is not treated, the consequence is dismal. Hydration, diuretics, corticosteroids are not so effective for the treatment of hypercalcemia in this situation. Pamidronate (synthetic bisphosphonate analogue of pyrophosphonate) decreases the activity and the life span of the osteoclasts. It results in decrease in resorption of bone mineral, directly and indirectly. There are only a few reports on the usage of pamidronate in children. We experienced a case with hypercalcemia in patient with Wilms tumor who was treated with pamidronate. A 5-year-old male patient was admitted to Ajou University Hospital due huge abdominal mass. Abdominal CT revealed a huge mass originating from right kidney (size: 18 11 8 cm) with lung metastasis. The chemotherapy according to National Wilms Tumor Study (NWTS)-4 was started but there was no response after 4 months. Right nephrectomy with mass removal was done and the pathologic finding revealed diffuse anaplastic type. The serum calcium level increased to be 16.7 mg/dL at 7 days after operation which was not responsive to hydration and furosemide. Pamidronate was given at the dose of 1 mg/kg and the serum calcium decreased to 8.0 mg/dL 24 hours later. The pulmonary lesion progressed and the patient died 4 months after operation but the serum calcium level remained within normal range thereafter.