A pilot trial of complement inhibition using eculizumab to overcome platelet transfusion refractoriness in human leukocyte antigen allo-immunized patients.

Heavily transfused patients frequently develop human leukocyte antigen (HLA) allo-immunization resulting in platelet transfusion refractoriness and a high risk for life-threatening thrombocytopenia. Data suggest complement activation leading to the destruction of platelets bound by HLA allo-antibodies may play a pathophysiologic role in platelet refractoriness. Here we conducted a pilot trial to investigate the use of eculizumab, a monoclonal antibody that binds and inhibits C5 complement, to treat platelet transfusion refractoriness in allo-immunized patients with severe thrombocytopenia.

Psychiatric out-patients' reactions to summary letters of their consultations.

The research reported here was an initial attempt to assess the feasibility and utility of providing new referrals to a psychiatric out-patient clinic with written summaries of their consultations. After routine consultations patients were randomly assigned to the experimental group (those sent a summary letter, N = 23) or control group (letter to GP only, N = 29). Subsequent assessment interviews revealed that the summary letters were very well received and patients in the experimental group were significantly more satisfied with their consultations than their control group counterparts.

Development and validation of a multivariate predictor of mortality in very low birth weight.

Accurate prognosis is critical to the design of all prospective research aimed at improving survival. Predictions based on birth weight, gestational age, or any other single variable, fail to take into account the potentially important contribution of other factors. In order to develop a practical and accurate multivariate model, we studied all singleton pregnancies resulting in viable liveborn infants who weighed less than or equal to 1500 g at birth during 1984 and 1985 at the New York Hospital-Cornell Medical Center.