Successful treatment of refractory idiopathic thrombocytopenic purpura and neutropenia with the monoclonal antibody, rituximab.

We describe a 22-year-old male with idiopathic autoimmune thrombocytopenia whose diagnosis was made at age of eight. He underwent splenectomy at age ten and ITP recurred at age 21 with episodes of infection and severe neutropenia (absolute count around 170/µl). He showed no response to immunoglobulin, corticosteroids, danazol, cyclosporine and azathioprine. Anti-CD20 antibody was administered at a dose of 375 mg/m(2) once a week for 2 weeks. After the second infusion of rituximab, the platelet count increased from 4,000 to 516,000/mm(3) and neutrophils count raised from 180 to 545/mm(3). The response improvement persisted during follow up for 9 months (neutrophil count 4,390/mm(3)). This observation indicates that B-cells may play a central role in the pathogenesis of ITN. Anti-CD20 antibody therapy may be an efficient treatment for the patients with chronic or recurrent ITN.

Parent and child agreement on reports of problem behaviour obtained from a screening questionnaire, the SDQ.

BACKGROUND AND OBJECTIVES: This study examined the level of agreement between parents and children on the Strengths and Difficulties Questionnaire (SDQ) in a clinical sample in Sydney, Australia. METHODS: Parent and child SDQ reports were collected from 379 parents-child pairs. Children were aged between 11 and 18 years and met criteria for at least one psychiatric diagnosis. RESULTS: Overall agreement between children and parents was low to modest. Sixty nine percent of parent-child pairs agreed that the child's problems were either clinically significant or not ("neither", "both"), while in 27% of pairs only the parents regarded the problems as clinically significant ("parent only"), and in 4% of pairs only the children regarded the problems as clinically significant. There was higher agreement for children with mood, anxiety or somatoform disorders. Children with mood disorders were over-represented in the "child only" group, and those with conduct disorders were more likely to be in the "parent only" group. Children with anxiety and somatoform disorders were more likely to be in the "neither" group. Age was not associated with rates of parent-child agreement, however more girls agreed with their parents that either they did not have a problem ("neither") or they did have a problem without parental endorsement ("child only"). CONCLUSIONS: This study highlights the limited agreement between parent and child reports of problem behaviour and the importance of integrating discrepant information into child and adolescent mental health assessments, formulations and treatments.