Two groups of patients have been studied in order to investigate the relationship between age and the effect of oral anticoagulant therapy. The first group comprised 364 patients aged 23-89 years who showed a stable anticoagulant effect on medium- or long-term warfarin therapy; in this group the elderly subjects were found to require, on average, a lower drug dose to maintain the same degree of anticoagulation. The second group comprised 130 patients aged 15-83 years who had received an initial standard oral dose of 10 mg of warfarin. No significant difference was found in the degree of anticoagulation achieved by 16 hours. Although the maintenance dose in elderly patients is somewhat lower than in younger, the same protocols can be used for the introduction of therapy.
A patient being treated for sickle cell crisis developed swollen, painful, indurated, discoloured thighs after several days in hospital. Imaging revealed the presence of multiple small abscesses in the muscle and methicillin resistant Staphylococcus aureus (MRSA) was cultured from aspirated fluid. Pyomyositis usually occurs in association with damaged muscle and impaired host defences. Staphylococcus is the most frequent organism involved. It is not a common complication of sickle cell disease, although it may be under diagnosed. Availability of advanced imaging techniques facilitates early diagnosis of pyomyositis.
We describe the management of a woman suffering from acute myelomonocytic leukaemia with cutaneous involvement. Following treatment with conventional chemotherapy she was in complete remission, but then suffered an isolated skin relapse. In order to limit side effects and myelotoxicity, an experimental therapy using a continuous infusion of 5-fluorouracil was employed. This was completely successful in eradicating the skin lesions, the patient suffered no side effects and blood counts remained within normal limits throughout. Infusional 5FU may have a role in palliative therapy in haematological malignancy.
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