10 64

Letters to the Editor

colonized. In the six months following the presented cases, colonization with phage type 94 dropped rapidly to less than 10% (following dismissal of previously colonized infants). Aside from cohorting of S. aureus colonized infants a n d the emphasis on careful handwashing, no new techniques were employed. COMMENT

No previous report of neonatal disease due to S. aureus phage type 94 has been noted. In our NICU, this organism has indeed presented in a virulent manner. Colonization with this particular phage type should be lool~ed for. This report emphasizes the value of close monitoring of S. aureus colonization in an NICU. Philip G. Rhodes, M.D. Robert T. Hall, M.D. Virgil F.. Burry, M.D. A l Thurn, M.S. The Children's Mercy Hospital 24th at Gillham Rd. Kansas City, Mo. 64108 REFERENCES

1. International Committee on Systematic Bacteriology Subcommittee on the Phage-Typing of Staphylococci, Int J System Bacteriol 25:233, 1975. 2. Blouse LE, Stringfield WB, Marrano RV, et al: Activity and characteristics of a new Staphylococcus phage 94, Proc Soc Exp Biol Med 142:572, 1973.

Adverse reaction to nitrogen mustard therapy To the Editor: Although well recognized as an adverse effect ~ of administration of nitrogen mustard, thrombophlebitis has not occurred in any of our patients with Hodgkin lymphoma prior to that described here, since MOPP 2 (Mustargen, Oncovin, procarbazine, prednisone) chemotherapy was introduced as treatment. Phlebitis occurred despite injection of appropriately diluted nitrogen mustard into "the tubing of a flowing intravenous infusion set," as is recommended?

The Journal of Pediatrics June 1976

CASE REPORT

Patient L. S., a 15-year-old white female, was treated for Hodgkin lymphoma Stage IIA with radiotherapy (4,000 rads in five weeks); there were no related problems, and six weeks later the first course of MOPP chemotherapy was initiated. A dorsal vein of one hand was used on Day 1 and on Day 8 for the injection of nitrogen mustard and vincristine. In each instance within the following 12 hours, progressive swelling with red streaks and tenderness appeared and involved the lower twothirds of each forearm. Elevation of the arms, warm compresses, and physical therapy resulted in complete regression of visible changes within six to seven days. Follow-up visit 12 days later, however, showed limitation in extension of both elbows up to 30 degrees, owing to a tendonlike formation situated laterally in each cubital fossa. The formations were not tender or inflamed and were thought to be sclerotic thrombotic cephalic veins. No other complications were noted. Progressive improvement was obtained with physical therapy. DISCUSSION Appropriate technique and correct calculation of dose and concentration still do not assure complete safety in the use of nitrogen mustard, as our experience demonstrates. The length of interval between administration of nitrogen mustard and the following intravenous vincristine rules out a possible interreaction between the two drugs in our patient. We are not aware of any report of thrombophlebitis secondary to injection of vincristine alone or in sequence with that of nitrogen mustard. Ugo Carpentieri, M.D. L. P. Gustavson, M.D. L. H. Lockhart, M.D. M. E. Haggard, M.D. Department of Pediatrics Division of Hematology & Oncology University of Texas Medical Branch Galveston, Texas 77550 REFERENCES

1. Calabresi P, and Parks RE Jr: Alkylating agents, in Goodman LS, and Gilman A, editors: The pharmacological basis of therapeutics, ed 5, New York, 1975, Macmillan Company, chap 62, pp 1260-61. 2. DeVita VT Jr, Serpick AA, and Carbone PP: Combination chemotherapy in the treatment of advanced Hodgkin's disease, Ann Intern Med 73:881, 1970.

Letter: Adverse reaction to nitrogen mustard therapy.

10 64 Letters to the Editor colonized. In the six months following the presented cases, colonization with phage type 94 dropped rapidly to less than...
73KB Sizes 0 Downloads 0 Views