Marrow fibrosis and multiple myeloma.

A retrospective review of pretreatment bone marrow material from 297 patients diagnosed and treated for multiple myeloma (MM) at a single institution during a 22-year period (1961-1982) was performed in order to assess the frequency and significance of associated simple marrow fibrosis (SMF). The presence of SMF was suspected in the hematoxylin and eosin-stained sections in 48 of the 297 cases and was confirmed by reticulin stains in 26 (8.8%) cases, with seven of these also showing collagen on trichrome stain. However, the literature on MM documents little recognition of this association. SMF is often responsible for inadequate marrow aspirates yielding spurious or inconclusive results. Thus, bone marrow trephine biopsies may be required to histologically confirm the diagnosis of MM when there is concurrent SMF.

Accessory septum transversum. The first case report.

Duplication of the septum transversum occurred in a newborn with respiratory distress thought clinically to be due to diaphragmatic paralysis. Surgical plication of the "floppy" diaphragm was attempted via a transabdominal approach. The anomalous septum transversum was perceived to be the diaphragm and was plicated. The central tendon of the diaphragm was redundant and surgical plication may have improved respiratory function. In this first case report, embryology of the diaphragm is reviewed and correlated with autopsy findings. A surgical approach to possible correction is proposed.

Fluorometric assay of antithrombin III. Diagnostic value in 112 patients with abnormal hemostasis.

The authors assessed the diagnostic value of the plasma anti-thrombin III (AT III) assay in 112 adult hospitalized patients with abnormal hemostatic parameters, using the Protopath procedure. In 100 patients tested only once, low AT III was observed in 25 of 29 cases of acute disseminated intravascular coagulation (DIC); 7 of 10 with infections; 8 of 11 with acute liver disease; 19 of 20 with chronic liver disease; and 16 of 30 with other illnesses. The authors conclude that the assay cannot distinguish among disease categories, although it is a sensitive index of DIC. AT III was also repeatedly measured at various time intervals in 12 additional patients. The results suggest enhancement of the diagnostic and prognostic value of the assay with serial testing.