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Background. Patients with myeloproliferative disorders (MPD) may have symptomatic thrombocytosis develop that requires prompt and sustained lowering of platelet counts to avert serious thrombotic or hemorrhagic sequelae. Methods. The authors retrospectively studied the short- and long-term effects of plateletpheresis combined with three different chemotherapy regimens (busulfan, hydroxyurea, or busulfan/hydroxyurea) in 30 patients with MPD with symptomatic thrombocytosis. Results. Twenty-nine patients entered first remission (FR) with initial treatment. The average number of plateletphereses to FR was three (standard deviation [SD], [+ or -]3). Average total dose of busulfan (216 mg) and time to FR (1.6 months) were less than for previously reported patients treated without plateletphereses. Addition of hydroxyurea to busulfan decreased the number of plateletpheresis needed (P = 0.02) but did not additionally reduce the amount of busulfan needed or the time to FR. The shortest time to FR was in the hydroxyurea group (mean, 0.6 [+ or-] 0.3 months), but unmaintained remission could be achieved only in the busulfan-treated groups. With median follow-up of 68 months, median survival was 53 months for the busulfan group, 55 months for the hydroxyurea group, and was undefined with no deaths for the busulfan/hydroxyurea group. Neither fatal complications of recurrent symptomatic thrombocytosis nor development of acute leukemia has occurred, except for progression to blast crisis in two patients with chronic myelogenous leukemia. Conclusion. Combined plateletpheresis and chemotherapy is a rapidly effective initial treatment for patients with MPD with symptomatic thrombocytosis. With maintenance therapy or prompt treatment at relapse of disease, prolonged good quality survival can be expected.

Abstract We present a case of bilateral otitis externa that did not respond to local treatment. Cutaneous biopsies revealed bilateral amyloid depositions secondary to multiple myeloma. Persistent, identical bilateral canal [...]

Preterm delivery is when labor occurs before 37 weeks of pregnancy, and affects 5 to 10 percent of pregnancies in the US, resulting in fetal death in 60 to 90 percent of cases. Preterm contractions can be treated with beta-sympathomimetic amines, such as ritodrine, which causes relaxation of the uterine muscle. The side effects of ritodrine include a rapid heart rate, nausea, low blood levels of potassium, and flushing. Serious side effects of ritodrine develop in 1 to 5 percent of treated patients and include low blood pressure, abnormal heart rhythms, insufficient blood supply to the heart, and accumulation of fluid in the lungs. A case is described of a 30-year-old woman with a twin pregnancy who developed vasculitis, the inflammation of the blood vessels, after treatment with ritodrine to stop early uterine contractions at 29 weeks of pregnancy. After more than four weeks of treatment with ritodrine, the patient developed a rash consisting of small, purplish, bleeding spots on the skin of the arms and legs. Blood analysis showed that she had a prolonged bleeding time, but only slightly decreased numbers of platelets (cells involved in blood coagulation). The patient was diagnosed with vasculitis and treated with hydrocortisone. Therapy with ritodrine was discontinued and the twins were delivered by cesarean section. The infants did not have abnormal bleeding or platelet irregularities. A skin biopsy taken from the abdomen during the cesarean section confirmed the diagnosis of vasculitis, which was associated with the presence of neutrophils (a type of white blood cell) and fibrin (a thin whitish protein) in the walls of the small arteries. The rash improved and the patient was discharged five days after the operation. Physicians should be aware of the variety of potential skin and blood related complications caused by prolonged ritodrine treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)