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Invasive fungal infections often prove difficult to eradicate especially in the stem cell transplant setting. Amphotericin has been the mainstay of treatment for years but has significant toxicity. Newer antifungal agents, such as caspofungin, have shown promising results in adults, particularly when used in combination with amphotericin as both drugs differ in their mode of action. However, there are few data from children and no previous published information about the use of Caspofungin after paediatric stem cell transplantation. We report our experience in children with proven invasive fungal infections after stem cell transplantation. This combination was non-toxic, and two of three patients survived their infections.

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Effects of bovine respiratory disease (BRD) on stocker cattle systems are unknown under extensive rangeland environments. Three experiments were conducted to test the hypothesis that BRD-based morbidity is a major factor affecting the productivity and profitability of stocker cattle grazing Southern Plains rangelands. In Exp. 1 (658 male calves; average BW = 231 kg), 17% of the cattle were treated for BRD <8 d, 6% for 8 to 14 d, and 8% for >14 d. Morbid cattle had lower ADG than did healthy cattle (P < 0.10). Cattle requiring 14 d of pharmaceutical therapy gained less than cattle having <14 d therapy (P < 0.01). In Exp. 2, (279 steers and bulls; average BW = 216 kg), the ADG by steers (0.74 kg x animal(-1) x d(-1)) was greater (P < 0.05) than by bulls castrated after arrival (0.64 kg x animal(-1) x d(-1)). Castration after arrival led to a 13.5% loss in daily gain and a 10.3% loss in season-long gain. More (P < 0.05) bulls castrated after arrival (60%) were morbid compared with steers (28%). In Exp. 3, 633 heifers (average BW = 251 kg) were used to test the effects of morbidity on weight gain and reproduction. Heifers with lower initial weights exhibited increased (P < 0.05) morbidity. Heifers requiring two or more antibiotic treatments gained 0.03 kg/d less (P < 0.10) than did healthy heifers and had lower (P < 0.05) conception rates (66 vs. 81%). Conception rate in twice-treated heifers was 19% less than healthy heifers. Morbid heifers conceived 0.6 mo later (P < 0.05) than healthy heifers. Under the conditions of Exp. 1 and Exp. 2, morbidity decreased net returns 9.7 to 21.3% per animal. Adjusted gross returns per animal in Exp. 3 for replacement heifers were 3 to 7.8% less for morbid heifers.

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Allogeneic haemopoietic stem cell transplantation (SCT) is the only curative option for severe bone marrow (BM) failure in patients with Fanconi anaemia (FA). We have developed a non total body irradiation (TBI) conditioning protocol consisting of fludarabine (120-150 mg/m(2)), low dose of cyclophosphamide (40 mg/kg) and antilymphocyte globulin (45 mg/kg). Graft-versus-host disease (GVHD) prophylaxis was with cyclosporin alone for sibling allografts but also included Campath-1 H (days 1-5 post SCT) for the unrelated allografts. We have performed two sibling and two unrelated BM transplants with a follow-up of 11-51 months. All patients experienced minimal toxicity and were discharged from hospital 28-32 days post SCT. Neutrophil and platelet engraftment occurred from days 11 to 19 and 15 to 34, respectively. All patients achieved stable full donor haemopoiesis with normalisation of the peripheral blood count despite one of them having myelodysplasia (MDS) with 8% blasts prior to the SCT. The only site of acute GVHD was in the skin (grade I-II) and only one patient progressed to limited chronic GVHD. This protocol is associated with reduced toxicity and prompt engraftment in FA patients with AA and/or MDS undergoing SCT using sibling or unrelated donors.

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Platelet transfusions are frequently given to neonatal intensive care unit (NICU) patients with severe thrombocytopenia (platelets less than 50 x 10(9) L(-1)) but no study has assessed whether this is clinically appropriate. To address this we conducted a retrospective review of platelet transfusion practice in patients developing severe thrombocytopenia over 3 years in a single NICU. Out of 901 admissions, 53 (6%) developed severe thrombocytopenia. Twenty-seven neonates received a total of 63 platelet transfusions, the main triggers being: platelet count less than 30 x 10(9) L(-1) (all patients), or less than 50 x 10(9) L(-1) in those with previous haemorrhage or clinical instability. No major haemorrhage occurred during severe thrombocytopenia either in neonates in whom platelet transfusions were withheld (26/53) or in neonates given platelets who survived to discharge (22/27). Five preterm neonates given platelets died but all had overwhelming sepsis or necrotizing enterocolitis and none died directly as a result of haemorrhage. Although the widely used liberal triggers for neonatal platelet transfusion highlighted in this review reflect available guidelines, and represent cautious ('safe') haemostatic practice, they are likely to result in unnecessary transfusion for a significant number of NICU patients. Improved practice requires definition of a safe lower limit for platelet count in stable neonates; effective platelet transfusion strategies for sick neonates; and improved therapies for conditions precipitating severe thrombocytopenia.

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Allogeneic stem cell transplantation (SCT) represents the treatment of choice for severe bone marrow (BM) failure in patients with Fanconi's anaemia (FA). However, for FA patients developing leukaemic or myelodysplastic transformation, the results of SCT are much less encouraging. We present a 17-year-old girl with myelodysplastic transformation of FA (refractory anaemia with excess blasts) and oculocutaneous albinism, who was treated by sibling SCT using conditioning with fludarabine, cyclophosphamide (CY) and anti-lymphocyte globulin (ALG). She had rapid engraftment with no toxicity and no graft-versus-host disease (GVHD). Twenty-two months after SCT, she had 100% donor chimaerism on Southern blot analysis.

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A 29-year-old male was treated for recurrent Hodgkin's disease with autologous bone marrow and peripheral blood stem cell transplantation. CT scanning shortly after transplantation showed widespread infiltrates, which appeared to be malignant at thorocoscopy but which biopsy showed to be vasculitis. A prolonged reducing dose of steroids has successfully controlled the vasculitis and his current CT scan of lung has no shadows. The cause of his vasculitis is unclear and the case illustrates the importance of tissue diagnosis in possible relapses of Hodgkin's disease following high-dose chemotherapy.

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