As scientific techniques for the detection of cytomegalovirus (CMV) improve, we
are able to detect small amounts of CMV in the mucosal wall. As clinicians, we are
unsure how to interpret the results of this novel test. There is controversy in the
literature as to the significance of the detection of CMV in the gut. Whilst the
importance of CMV and reactivation of the virus is clear in those patients such as
allograft recipients with established immune compromise, the role is less clear in
patients with less damaged immune systems. We explore whether the detection of CMV
in such cases influences outcome and how it should be optimally managed. We discuss
the optimal management of such cases, according to current guidelines, with a review
of the literature.
Proliferative endosteal lesions were observed in metaphysis and diaphysis of femur and sternebra of Wistar (CRL[WI]BR) rats administered 3 chemically-distinct anticancer compounds with dissimilar mechanisms of action: trimetrexate glucuronate, an antifolate; pentostatin, an adenosine deaminase inhibitor; and CI-980, a mitotic inhibitor. Islands of woven bone, often circumscribed by conspicuous myelostromal proliferation, were seen on Days 8-28 in rats given trimetrexate glucuronate daily by gavage, and on Day 4 but not Day 29 in rats given a single intravenous dose of pentostatin. Intravenous administration of CI-980 for 1 or 5 days resulted in marrow necrosis, marked centripetal new bone formation, and myelostromal proliferation on Days 4 and 8, respectively. These lesions were not present at the termination of these latter studies (Days 29 and 35, respectively). In conclusion, anticancer compounds induced local bone marrow injury and the release of local inflammatory mediators which may have provided the stimulus for bone formation and myelostromal proliferation.
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