Aplastic anemia: continued cause for concern

Article Abstract:

Aplastic anemia (AA) is a rare disease in which all blood cell production is deficient due to the malfunction of the bone marrow. AA most often occurs in people under or over 40 years of age, and is associated with viral infections, such as hepatitis, or exposure to toxins or certain drugs. However, over 70 percent of acquired cases are from unknown causes. In many instances, there may be an underlying defect in the synthesis of blood cells, which may be triggered by other factors to become overt. The disease may be constitutional rather than acquired, such as the inheritable abnormalities of Fanconi's anemia (FA) or dyskeratosis congenita (DC). Pallor and bruising are usual symptoms, while infection and hemorrhage are less common and signify a potentially poor outcome. Biopsy of the bone marrow is essential and reveals reduced numbers of blood cell precursors and an increased number of fat and inflammatory cells. Only 20 percent of children with severe AA survive one year from diagnosis when given only supportive care. Antibiotic treatment and transfusions are used as needed. Curative treatment of acquired AA may be achieved by bone marrow transplantation or by suppression of immune function. Children with severe AA are best treated by transplantation, and have an 80 percent 5-year disease-free survival rate. Survival is best when transplants are performed early, but 70 percent of patients have no family donor. Immune suppression is usually accomplished by antilymphocyte (or antithymocyte) globulin, which is given over five days. When these therapies have failed, cyclosporin or high doses of steroids have sometimes been effective; partly matched transplants have also been tried. Although progress has been made in treating AA, the disorder still presents a major challenge. Accurate and speedy diagnosis and treatment remain the key to obtaining the best possible prognosis for affected children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Aplastic anemia, editorial

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Etiology diagnoses: the cause and effect scenario

Article Abstract:

The role of the health-care professional in issues of industrial health has changed from diagnosis and care following accidents or other incidents to emphasis on avoidance of hazards. Other trends in industrial health management have not been as beneficial. Similarly, modern medicine has come to accept responsibility for individuals' future health, causing society to become increasingly concerned about illness. Presently the physician, and the physician alone, assesses a worker's health, determining the extent of current and future disability. This occurs, often without the physician being concerned in a holistic way with the worker's other health needs, and without knowledge of the workplace environment. What is needed is the establishment of a triad which includes the worker, the industrial health team, and the physician. Each of these participants brings different knowledge and concerns which must be included in making proper decisions regarding the worker's condition, time before returning to work, level of physical disability and continuing rehabilitation needs. As industrial medicine becomes more reliant upon specialists, it is important that smaller communities retain a means of satisfying these needs even if such industrial medicine specialists are not available. Industry should also help general practitioners within the local community to gain industrial medicine training. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Study and teaching, Disability evaluation, Medicine, Industrial, Industrial medicine

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The electrocardiogram in large pericardial effusion: The forgotten "P" wave and the influence of tamponade, size, etiology, and pericardial thickness on QRS voltage

Article Abstract:

The different reports on the electrocardiogram in pericardial effusion are studied. There was no correlation found between the low QRS voltage and tamponade, size of the effusion, etiology, or pericardial thickness.

United States, Usage, Electrocardiogram, Electrocardiography, Pericardial effusion

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