Consensus guideline for diagnosis and treatment of childhood idiopathic thrombocytopenic purpura.

A practice guideline aimed at standardizing the treatment for childhood idiopathic thrombocytopenic purpura (ITP) is presented. This consensus guideline is based on a survey carried out via a questionnaire prepared by the ITP Committee of the Japanese Society of Pediatric Hematology and sent to society members. The survey questionnaire included questions on the diagnosis of ITP submitted for the purpose of revising the ITP diagnostic guideline prepared in 1990 by the Research Group for Intractable Hematopoietic Disorders; a revised diagnostic guideline also is presented.

[A survey on nosocomial tuberculosis infection control in hospitals in Osaka City].

PURPOSE: To ascertain nosocomial tuberculosis (TB) infection control practice in hospitals in Osaka City. METHOD: A questionnaire was distributed in the orientation meeting and collected at the occasion of medical inspection in all 196 hospitals in Osaka City in 2003. RESULTS: TB patients were diagnosed in about half of hospitals in the past 3 years. Basic TB infection control measures were taken in the majority of hospitals; such as chest X-ray screening for all inpatients, health check for employees, tuberculin skin test (TST) for newly employed staff, and nomination of a person in charge of TB infection control. Control measures were practiced more often in hospitals where TB patients were diagnosed, such as "fiberoptic bronchoscopy is to be conducted last in the working hours to avoid contamination of TB bacilli in a room," "TST (including two-step method) for all newly employed staff," "Staff wear N95 mask when they deal with TB patients/suspects," and the differences were statistically significant. DISCUSSION: It is necessary in hospitals in Osaka City to strengthen nosocomial TB infection control as TB patients were diagnosed in about half of hospitals in the past 3 years. Low cost infection control measures were undertaken more often among hospitals where TB patients were diagnosed. Introduction of high cost equipment or improvement of facilities should be considered in hospitals of high TB risk. Guidelines formulated based on analysis of the survey should facilitate all hospitals to introduce at least low cost effective tuberculosis infection control measures.

[Antiphospholipid antibodies in children with idiopathic thrombocytopenic purpura].

Three antiphospholipid antibodies (aPLs), namely, antiphosphatidylinositol antibody (antiinositol antibody), antiphosphatidylserine antibody (antiserine antibody), and anticardiolipin. beta 2-glycoprotein I complex antibody (antiCL. beta 2-GPI antibody), were determined in 49 children with idiopathic thrombocytopenic purpura (ITP) consisting of 14 newly-diagnosed cases and 35 chronic cases. Determination of aPL was performed twice in the newly-diagnosed patients, once each during the acute and convalescent phases, and once in the chronic patients. The positive rates in the acute and convalescent phases of the newly-diagnosed group and in the chronic group were, respectively, 14.3%, 28.6%, and 18.8% for the antiinositol antibody, 14.3%, 14.3%, and 15.6% for the antiserine antibody, and 21.4%, 28.6%, and 25.0% for either of these 2 antibodies. Thus, antiinositol and antiserine aPLs were present at high incidences; however, all patients were negative for the antiCL. beta 2-GPI antibody. No correlation was noted between either the antiinositol or the antiserine antibody and peripheral platelet count, anti-GP IIb/IIIa antibody or PAIgG. Thus, although some aPLs are present in both acute and chronic pediatric ITP, the aPLs seems to be of an infectious disease type. No results that suggest possible involvement of aPLs in ITP pathology were obtained.