Early outcomes after allogeneic stem cell transplantation for leukemia and myelodysplasia without protective isolation: a 10-year experience.

Although it is common practice to use some form of isolation to protect allogeneic stem cell transplant patients from infection, the necessity for these practices in all environments has not been demonstrated. The current study evaluated patterns of infection and 100-day transplant-related mortality in 288 patients with myelodysplasia and leukemia transplanted without isolation. Patients were allowed out of hospital at any time within constraints of the medication schedule. Fever, foci of infection, and positive cultures within 28 days and death within 100 days because of the transplant procedure were recorded. Fever occurred in 57% of patients, and 10% had a clinical or radiographic focus of infection. Most infections were apparently endogenous; blood cultures from 24% of recipients grew organisms, 87% of which were gram-positive bacteria. Four patients (1%) died with aspergillus infection in circumstances indicating that isolation would not have been helpful. Twenty percent of patients remained without evidence of infection throughout. Transplant-related mortality at 100 days was 1% for 108 patients with early leukemia receiving transplants from matched siblings. For patients at higher risk, by virtue of donor and/or disease status, mortality was 21%. These figures compare favorably with those reported to the International Bone Marrow Transplant Registry, the majority of patients having been subjected to some form of isolation. We conclude that allogeneic stem cell transplantation can be safely performed in some environments without confining patients continuously to the hospital.

Errors in estimating peritoneal fluid by bioelectrical impedance analysis and total body electrical conductivity.

Whole-body bioelectrical impedance analysis (BIA) and total body electrical conductivity (TOBEC) have been used to estimate body composition and generalized changes in total body water (TBW). The sensitivity of these methods to measure small, rapid, localized changes in body water has not been fully evaluated. We compared the prediction of TBW by whole-body and segmental BIA and TOBEC with deuterium oxide dilution (D2O) in 10 control subjects and 7 renal failure patients receiving continuous ambulatory peritoneal dialysis (CAPD) prior to and after dialysate infusion. Using D2O as the reference method, there was no significant mean residual error between TBW predicted by BIA and TOBEC in controls (-1.2 +/- 1.5 and -0.9 +/- 1.0 kg) and CAPD patients pre-infusion (-1.0 +/- 2.0 and 0.29 +/- 2.01 kg). After infusing 1.9 +/- 0.18 kg dialysate, the mean residual error between change in body weight and the three methods was -0.44 +/- 0.53 kg for D2O (p < 0.1), -1.7 +/- 0.25 kg for BIA (p < 0.0001), and 1.2 +/- 0.4 kg for TOBEC (p < 0.001). Segmental BIA detected a 7.6% reduction in trunkal resistance with no significant change across the limbs, consistent with abdominal fluid accumulation. It is concluded that whole-body BIA underpredicts and TOBEC overpredicts small changes in peritoneal fluids.

An easy and accurate method of estimating newborn birthweight for resuscitation.

Emergency administration of medication based on birthweight is often required in newborn resuscitation. Actual weighing is often delayed because of the emergency situation. Therefore drugs are given according to weight estimates by physicians or nurses. The purposes of this study were to develop a measuring tape using the infant's length and head circumference to determine body weight and to evaluate the performance of the tape measurements to staffs' estimates. Weight, length, and head occipitofrontal circumference (OFC) measurements of 200 newborn infants were collected. By regression analyses, the best log curve for both length and OFC versus weight was determined. From these data, a measuring tape was constructed with the corresponding weights marked for both length and OFC. Forty-five newborn infants with gestational ages of 26 to 40 weeks were studied. Prior to actual weighing, estimates of the birthweights were obtained and recorded from the tape measurements using both the length and OFC and staffs' estimates. For infants less than 2 kg, the average percent error was less by the tape length (1.2%) and OFC (0.7%) compared with staffs' estimates (-7.2%). The tape was also useful in estimating weights of small for gestational age infants. The tape OFC (7.8% error) was more accurate than staffs' estimates (26% error) in these growth-retarded infants. The clinical precision of the tape was 3% with an intrameasurer variability of 5%. We conclude that estimating the birthweight in infants using our tape method is a practical and more accurate way than staff estimates, especially for low birthweight and small for gestational age infants.

Chronic lymphocytic (autoimmune) thyroiditis in children.

Chronic lymphocytic (autoimmune) thyroiditis is one of the most common causes of non-toxic goiter in children and accounts for most of the acquired juvenile hypothyroidism. Asymptomatic goiter is the most common presentation though subclinical hypothyroidism and growth failure are frequently seen. Thyroid function is variable depending on the degree of thyroid destruction. Thyroiditis is the prototype of autoimmune diseases. Thyroglobulin or microsomal antibodies are present in serum of virtually all individuals. Cellular destruction is currently thought to be related to a dysfunction of suppressor T-lymphocytes, allowing appearance of "forbidden clones" of helper T-lymphocytes which stimulate production of cytotoxic auto-antibodies against thyroid tissue. The resultant lymphocytic infiltration, disruption of thyroid follicles and fibrosis produce the typical pathologic and clinical picture of an enlarged, firm thyroid with gradual loss of thyroid function. In children, the process may arrest before complete loss of thyroid function and spontaneous recovery occurs. Those who become hypothyroid must take thyroxine supplement.