Objective: Headache susceptibility (variously described as a “migraine,” “recurrent,” “tension,” “premenstrual,” or “oral contraceptive” headache) is associated epidemiologically with certain gynecologic disorders such as dysmenorrhea, hypermenorrhea, irregular cycles, and ovarian cysts. Autonomic dysfunction such as diarrhea, peripheral vasospasm, and paroxysmal tachycardia are noted in migraineurs (Cady RK, Fox AW. Treating the Headache Patient. Marcel Dekker, Inc. New York, 1995, p. 22). An effort was undertaken to determine if an association exists between headache susceptibility and the occurrence of endometriosis, thereby suggesting that endometriosis also has an autonomic component. Design: Retrospective case analysis. Materials/Methods: A questionnaire (“Autonomic Nervous System and Vascular Complex Questionnaire”) has been developed to evaluate the occurrence of a variety of reported disorders in a female population. Ten questions related to headache susceptibility are included in the general questionnaire. These ten questions were presented to a control group of 24 randomly selected patients who gave no history of spontaneous fetal loss, preterm labor, preeclampsia, or endometriosis. The data from a retrospective review of the same ten questions asked of 23 randomly selected patients with proven endometriosis by laparscopic examination was then recorded. Results: Patients with a diagnosis of endometriosis experienced more frequent headaches (p ≤ 0.025), more severe headaches (p ≤ 0.001), and more premenstrual headaches (p ≤ 0.05). Additionally, this group retired to a dark room more often (p ≤ 0.025) and experienced nausea more often (p ≤ 0.05) with headache occurrence. Chi-squared analysis was used with df = 4. Conclusions: As with other gynecologic disorders, endometriosis appears to occur more frequently in headache susceptible individuals. Endometriosis may be only one of several co-morbid conditions with apparent aberrant autonomic regulation as a common theme, including fibromyalgia, irritable bowel syndrome, and fibrocystic breast disease. This aberrant autonomic regulation could explain a unified concept regarding the origin and perpetuation of endometriosis with its known impact on smooth muscle activity and immune function. Supported By: No support.

Purpose This study was designed to evaluate the safety and efficacy of stopping antibiotic treatment regardless of absolute neutrophil count (ANC) or signs of impending neutrophil recovery in children with febrile neutropenia (FN) and no identifiable infectious source. Patients and Methods Thirty-two consecutive cases of FN without identifiable source were prospectively evaluated. Patients were examined, cultured, and initially treated with ceftazidime ± vancomycin. Antibiotics were discontinued and patients discharged regardless of ANC (WBC/μl X [% segs + bands]) once all the following criteria were met: afebrile × 24 h; cultures negative at 48 h; thermometer and telephone available at home. Prompt notification of fever (T > 38.3°C) and readmission were required. Results Median ANC was 60/μl on admission and 160/μl at discharge. Median length of treatment was 3 days. Four patients were readmitted for FN, and two patients were readmitted afebrile for cultures which became positive after discharge. None of the 32 cases suffered apparent complications from early discharge. Conclusion Results of this preliminary trial suggest that cessation of antibiotics regardless of ANC is safe in cases of FN without identifiable source, provided that marrow is not infiltrated and that recurrent fever receives prompt antibiotic retreatment.

Transforming growth factor‐β2 promotes healing in a variety of animal models and exhibits clinical effects thought to be mediated by connective tissue formation. Two clinical trials were conducted to evaluate the safety and effect of transforming growth factor‐β2 purified from bovine bone and delivered topically to venous stasis ulcers three times per week for up to 6 weeks by means of a lyophilized collagen vehicle. The first was an open‐label trial comparing transforming growth factor‐β2 purified from bovine bone (0.5 µg/cm2) with a placebo consisting of lyophilized collagen vehicle‐without active drug. After no safety issues arose in that trial, a prospectively randomized, closed‐label, observer‐blinded, three‐armed trial was conducted to compare bovine transforming growth factor‐β2 (2.5 µg/cm2) with the collagen matrix placebo vehicle and with a standard dressing. Standardized elastic compression was applied to all test extremities. The rate of reduction of ulcer area as measured by planimetry was the primary measure of effect. No serious safety‐related events occurred in either trial. Clinical evaluation suggested that improvement in the quality and quantity of granulation tissue appeared to precede epithelialization of ulcers treated with bovine transforming growth factor‐β2. In both studies, treatment with bovine transforming growth factor‐β2 appeared to have a positive effect on the rate of ulcer closure, whereas ulcers in the control groups continued to exhibit impaired healing. In the open‐label study, the mean rate of closure of ulcers treated with bovine transforming growth factor‐β2 was significantly greater than that of ulcers treated with placebo. There was likewise enhanced reduction in ulcer area in the ulcers treated with bovine transforming growth factor‐β2 in the second trial. However, because of a higher variability in patient response and a greater placebo effect, the difference was not significant. The placebo was not worse than the standard care arm, thereby showing that the vehicle is not injurious to healing. The combined results of the two trials suggest that, at doses of 0.5 to 2.5 µg/cm2, bovine transforming growth factor‐β2 is safe as a topically applied agent in a collagen matrix vehicle and can have a positive effect on closure of venous stasis ulcers. Large multicenter trials appear to be indicated to evaluate fully the potential utility of transforming growth factor‐β2 in accelerating closure of chronic dermal ulcers.

The present study was undertaken in an attempt to reclassify the 19 cases of childhood acute undifferentiated leukemia (AUL) diagnosed at our institution during the past 12 years. Based on ultrastructural and immunophenotypic data, seven of the cases were reclassified as lymphoid, nine as myeloid, and three remain unclassifiable. Clinical features, clonal karyotypes, and responses to treatment were also examined. Abnormal clonal karyotypes were found in 16 of 17 cases, including eight cases with translocations, three with monosomy 7 or 7q, and one with numerous complex structural rearrangements. Fourteen patients had greater than 10% French-American-British L2 blasts in bone marrow. Although nine of 15 patients who initially received induction therapy for acute lymphoblastic leukemia (ALL) achieved remission, only one patient is a long-term survivor. Only one of 10 patients who received therapy for acute nonlymphoblastic leukemia during the course of their disease remains a long-term survivor. These data suggest that the majority of cases of AUL can be reclassified as either myeloid or lymphoid leukemias, that AUL is associated with a high frequency of chromosomal abnormalities, and that AUL carries a very poor prognosis.