Vascular Tumor with Kasabach Merritt Phenomenon Treated with Steroids and Vincristine: A Retrospective Study.

Vascular tumours (VT) with Kasabach-Merritt phenomenon (KMP) are rare and aggressive tumors. In absence of evidence based treatment guidelines, we studied varied presentation and response to therapy with vincristine and steroids in VT with KMP at our center. In this retrospective observational study, infants with a symptomatic/disfiguring rapidly growing VT with features of KMP were included. Demographic, treatment and outcome data was retrieved from patient file. Complete response (CR) was defined as complete clinical regression of VT with normalization of coagulopathy and thrombocytopenia. Partial response (PR) was defined as decrease in size of VT by more than 80%, absence of clinical bleed with normalization of coagulopathy and platelet count > 50,000/cumm. Five infants (2-male, 3-female) with age range (0-7 month) treated with daily prednisolone and weekly vincristine were included. The location of VT was: face (2), hemi-thorax (2) and urinary bladder (1). Four of five infants showed PR within two months; while two of these attained CR to treatment. There were no significant adverse effects over 9-32 (range) month follow-up. Two children (one in PR, one immediately after presentation) succumbed to intra-cranial hemorrhage. Combination therapy of steroids with vincristine is effective and safe in management of VT with KMP.

Clinicohematological Profile of Febrile Neutropenia in Childhood Acute Leukemia and Utility of Serum Procalcitonin Levels in Neutropenic Patients.

INTRODUCTION: This study was planned to explore the clinical and hematological profile of febrile neutropenia (FN) in Indian children with focus on correlation of degree of neutropenia with fever and procalcitonin (PCT) level and the utility of serum PCT levels in cases of FN. MATERIALS AND METHODS: Children below 12 years, receiving chemotherapy for hematological malignancy having oral temperature more than 100°F and absolute neutrophil count (ANC) below 500/mm3 were included. The aim of this study was to observe the clinicohematological profile of FN and utility of serum PCT levels in neutropenic patients. PCT was done by two-step two-site electrochemiluminescence immunoassay. Serum PCT values were reported as nanogram/ml. RESULTS: Four categories were made based on serum PCT levels which had negative correlation with ANC but no correlation with microbiologically detected infections. DISCUSSION: PCT is generally used to support the diagnosis of bacterial infection or sepsis in the emergency department or to monitor the treatment of sepsis with regard to reviewing antimicrobial treatment. The use of PCT has been well established as a marker for infection in adults and in nonneutropenic children, but similar data are lacking in pediatric population, more so in children with FN in Indian contexts. This study aims to fulfill this lacuna. CONCLUSION: The higher levels of PCT had a high negative correlation with ANC but low correlation with microbiologically detected infections.

Homogeneous nucleation with magic numbers: aluminum.

Homogeneous nucleation of clusters that exhibit magic numbers is studied numerically, using as an example aluminum at 2000 K, based on recent calculations of free energies [Li et al., J. Phys. Chem. C 111, 16227 (2007)] and condensation rate constants [Li and Truhlar, J. Phys. Chem. C 112, 11109 (2008)] that provide a database for Al(i) up to i=60. The nucleation behavior for saturation ratios greater than about 4.5 is found to be dominated by a peak in the free energy change associated with the reaction iAl-->Al(i) at i=55, making it the critical size over a wide range of saturation ratios. Calculated steady-state nucleation rates are many orders of magnitude lower than predicted by classical nucleation theory (CNT). The onset of nucleation is predicted to occur at a saturation ratio of about 13.3, compared to about 5.1 in CNT, while for saturation ratios greater than about 25 the abundance of magic-numbered clusters becomes high enough to invalidate the assumption that cluster growth occurs solely by monomer addition. Transient nucleation is also predicted to be substantially different than predicted by CNT, with a much longer time required to reach steady state: about 10(-4) s at a saturation ratio of 20, compared to about 10(-7) s from CNT. Magic numbers are seen to play an important role in transient nucleation, as the nucleation currents for clusters of adjacent sizes become equal to each other in temporally successive groups, where the largest cluster in each group is the magic-numbered one.