Drug-induced immunologic thrombocytopenia, a fairly common disorder, is characterized by drug-dependent antiplatelet antibodies that destroy circulating platelets in the presence of the provoking drug or its metabolites. The development of reliable methods for the detection of platelet-bound immunoglobulins causing in vivo platelet destruction, such as the use of monoclonal antibodies tagged with fluorescein and flow cytofluorimetric analysis, has ushered in a new era to differentiate between immune and non-immune thrombocytopenias. A severe thrombocytopenia developed in an elderly female patient treated with tamoxifen, a non-steroidal anti-estrogen drug, after surgery for breast cancer. A tamoxifen-dependent platelet antibody was detected in the patient's serum and linked on the platelet membranes. This antibody reacted only in the presence of the offending drug and showed platelet specificity. Withdrawal of drug restored platelet count to normal levels.

Trans, trans-muconic acid (tt-MA) is one of the most important metabolites of benzene, a pollutant ubiquitously distributed in ambient air and classified in 1982 as a group I carcinogen. For its sensitivity and specificity, tt-MA excreted in urine is considered a good biological marker of benzene exposure. In this study, seminal tt-MA levels in occupationally nonexposed subjects (n = 32) have been determined. The seminal fluid of normozoospermic subjects contained an average tt-MA concentration (170 +/- 100 ng ml-1) significantly lower than that of teratozoospermic (310 +/- 180 ng ml-1; P < 0.01), oligozoospermic (400 +/- 180 ng ml-1; P < 0.001), and oligoasthenozoospermic (430 +/- 230 ng ml-1; P < 0.01) subjects. A negative correlation existed between tt-MA levels and sperm concentration (r = - 0.62; P < 0.001), percentage of normal spermatozoa (r = - 0.41; P < 0.05), and percentage of vital spermatozoa (r = - 0.89; P < 0.001). Average tt-MA levels detected in seminal plasma were higher in smokers (350 +/- 160 ng ml-1) than in nonsmokers (280 +/- 210 ng ml-1). These results show that seminal plasma tt-MA content could be an important biological indicator for evaluating the negative effects of benzene on spermatogenesis.

Having noticed psychotic traits in some patients showing incoercible vomiting due to antineoplastic drugs we have thought of establishing a therapy with lithium in the days preceding the therapeutic cycle in order to reduce the emetic events. The effectiveness of lithium carbonate (600 mg/mq p.o./day for one week) in the prevention or reduction of vomiting induced by antiblastic therapy has been checked in comparison with metoclopramide and domperidone in 40 patients. In the group pretreated with lithium, 80% of the cases showed favorable results. In the control groups, on the contrary, the efficacy of the antiemetic therapy has shown to be of lesser importance (55%). The undesirable side-effects of lithium appear to be irrelevant. We therefore think that pretreatment with lithium may become, in selected cases not affected by traditional antiemetics, of great importance in the control of emetic symptomatology.

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