SERUM TESTOSTERONE OF BOYS WITH KARYOTYPE 47,XXY (KLINEFELTER'S SYNDROME) AT BIRTH

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1112entry. Investigation of gut permeability in patients with CBMMPseems worthwhile, and a trial of a gluten-free diet may be reasonablein these individuals for whom we have very little else to offer in theway of therapy.Department of Dermatology,St Marys Hospital,London W2 1NYMoorfields Eye Hospital,London EC1Department of Oral Medicine,Eastman Dental Hospital,London WC1Department of Oral Pathologyand MRC Immunology Group,Bone & Joint Unit,The London Hospital,London E1J. N. LEONARDLIONEL FRYPETER WRIGHTJ. J. H. GILKESD. M. WILLIAMSD. J. UNSWORTHE. J. HOLBOROWTRIMETHOPRIM-ASSOCIATED MARROW TOXICITYNOT PROVENSIR,-In concluding that trimethoprim was the marrow toxicagent in his patient, Dr Sheehan (Sept. 26, p. 692) seems to haveignored the possible marrow toxic effects of drugs to which hispatient had been exposed before starting trimethoprim therapy.Leucopenia, thrombocytopenia and even pancytopenia have beenassociated with idoxuridine. 1,2 This has only been reported inconnection with systemic therapy with this drug but skin is not asimpenetrable an organ as is often believed. It could allowtransdermal permeation of topically applied creams and ointmentsin quantities sufficient to have a systemic action.3 Indeed, bonemarrow aplasia has been reported in patients takingchloramphenicol containing eye ointments.Tricyclic antidepressants, of which trimipramine is a member,have been associated with a vast number of side effects. Marrowtoxicity is one of them.4 Chlorpheniramine was used to treat a rash,and chlorpheniramine too has been associated with marrowtoxicity. 5,6Sheehans patient had therefore been exposed to four drugs allwith potential marrow toxicity. Any of them, alone or incombination, could have been the culprit. Trimethoprim folic acidantagonism is said to be 50 000 times more sensitive in bacteria thanin man. This patient had normal serum folate levels, but othermechanisms could be involved in trimethoprim associated marrowtoxicity.Welsh National School of Medicine,Department of Medicine,Heath Park, Cardiff CF4 4XN K. GICHERUMISLEADING HEPARIN MONITORING LEADING TOPROTAMINE SULPHATE IN PATIENT WITH LUPUSANTICOAGULANTSIR,-A 69-year-old man was admitted with mitral regurgitationand a critical stenosis of the marginal coronary artery. Mitral valuereplacement and coronary artery bypass were planned. Routinepreoperative coagulation testing revealed a prolonged activatedpartial thromboplastin time (APTT), (44 s; normal 1113SERUM TESTOSTERONE OF BOYS WITH KLINEFELTERS SYNDROME(AND OF CONTROLS) AT MOMENT OF BIRTHt=3-24, DF=4, p

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