In February 1982, a four-year-old Nevada girl with acute lymphoblastic leukemia in remission was hospitalized with fulminant pneumonia and died eight days later at a hospital in California. An influenza virus was the only pathogen detected, and was present in both antemortem and postmortem specimens. The virus was closely related antigenically to A/New Jersey/8/76 (H1N1) and had a genome very similar to a contemporary enzootic swine influenza virus. The patient had had no known contact with swine, and the source of infection could not be determined. Only five possible secondary cases could be detected by retrospective investigation of 62 contacts, and there was no evidence of spread to the general community. Swine influenza viruses circulate among pigs in the United States annually, and it is likely that sporadic transmissions to humans will continue to be detected. Nevertheless, person-to-person spread under these circumstances appears to be limited.
Levin MJ: Predictability of peak serum gentamicin concentration with dosage based on body surface area. J Pediatr 94:135-138, 1979. 3. Hoecker JL, Pickering LK, Swaney J, et al: Clinical pharmacology of tobramycin in children. J Infect Dis To the Editor.\p=m-\The presence of a hypercoagulable state in patients with a shortened activated partial thromboplastin time (APTT) as manifested by the clinical association with an increased incidence of thromboembolic disease has previously been reported by Hume,1 Gallus et al,2 Pilgeram,3 McKenna et al,4 and McKenna et al.5 A recent review of patients' clinical records at Southern Nevada Memorial Hospital showed that rather than a history of thrombosis, patients with extremely short (less than 20 s) APTTs actually had a history of spontaneous bleeding.All APTT results that were of a coagulation panel were reviewed during a seven-month period from Jan 1 to July 31, 1979. All APTTs of less than 20 s were selected for evaluation of the clinical chart provided that the patient had a simultaneous normal prothrombin time (less than 13 s), to determine the cause for the hospitalization and the type of medication the patient was receiving.A control group of 35 patients hav¬ ing APTTs between 23 and 26 s who also had normal prothrombin times were randomly selected during the same time period, and their charts were also reviewed for cause of hospitalization and type of medication.The APTTs were performed using a reagent containing bovine cephalin and ellagic acid according to the man¬ ufacturer's directions.During the period of evaluation, 1,534 APTTs that had associated nor¬ mal prothrombin times were per¬ formed as part of a coagulation panel.The 1,534 APTTs had a mean of 26.2 s, SD, 7.5 s. A total of 15 APTTs (1.0% ) were recorded as being less than 20 s.
A correlation of the enumeration of platelets in peripheral smears with platelet counts performed by a direct method is presented. A ratio of 1 platelet per oil-immersion field for every 21,000 platelets of the chamber count indicates the normal average range of platelets to be approximately 7--21 per oil-immersion field.
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