Extramedullary haematopoiesis associated with thalassaemia leading to spinal cord compression is an extremely rare event in the course of the disease. The efficacy of radiation therapy is advocated in the management of such a complication. Two patients with thalassaemia, who had presented with spinal cord compression, were successfully treated by a modest dose of local radiotherapy. In one of the patients, however, radiotherapy was resorted to after an initial decompressive laminectomy and partial removal of the intraspinal haematopoietic mass proved unsuccessfil. The other patient was managed solely by radiation therapy.Extramedullary haematopoiesis (EMH) is a common manifestation of severe thalassaemia and it may involve various organs of the body such as liver, spleen, and lymph nodes.'-6 The clinical features secondary to EMH are variable and depend on the site of formation of the haematopoietic tissue. The onset of unexpected clinical signs may be the first indication that haematopoiesis is spreading to an atypical area. Spinal cord compression (SCC) as a consequence of EMH in the intraspinal epidural space is an extremely rare complication. We report two cases of thalassaemia that had presented with SCC. A review of the literature is discussed highlighting the role of radiation therapy in the management of such patients.and there was a complete loss of touch and pinprick sensation below the level ofT7.The radiograph of the skull and spine demonstrated a diffuse osteoporosis but no well defined paravertebral mass was evident. Myelogram, however, revealed a complete extradural block at the level of T9. The CSF examination proved noncontributory. His haemoglobin (Hb) was 8-7 g/dl, haematocrit 28% and white blood cell count (WBC) 7.4 x 109/L. The differential count revealed a slight shift to the left (metamyelocyte 2%, myelocyte 2%). Platelets were adequate. The peripheral smear showed anisopoikilcytosis with microcytosis and hypochromia. A few target cells were also noticed. There were three normoblasts/100 WBC. The corrected reticulocyte count was 2%. A haemoglobin electrophoresis showed 21% Hb F and 2-6% Hb A2.At laminectomy a brownish, soft, vascular extradural mass was seen extending from T5-T9. Only a partial excision of the mass could be accomplished. The histopathological examination of the excised mass confirmed it to be haematopoietic tissue. The postoperative course was uneventful. However, in view of the incomplete excision of the mass and a negligible neurological recovery, radiotherapy was started two weeks after surgery. A total dose of 30 Gy was delivered by a telecobalt unit, over a period of three weeks in 15 sessions. There was a marked neurological improvement at the end of radiation treatment and the patient continued to improve. No complication was observed during or after radiotherapy. The patient has been doing well for a period of five years.
Thousands of chemicals are being used recently in our new high tech foods like ready to eat Japanese, Chinese, packaged and tinned foods. Most food additives act as either preservatives or flavor enhancers like monosodium glutamate (MSG), a sodium salt of glutamic acid. The present study investigated the effect of intraperitoneally administered MSG on cortex of the kidneys of adult albino Wistar rats and compared with control group. The histomorphometry done by calibrating with ocular micrometer on kidney tissue of control and experimental group revealed a significant difference in glomeruli with increase in length, size of bowman's capsule with an increase in bowman's space. The size of renal tubules could not be compared as the cells of these tubules in experimental group were disintegrated and distorted. In the experimental group (rats treated with 4 mg MSG/g body weight), the cortex of the kidneys developed variable pathological changes, which were patchy in distribution with intervening normal areas. There was distortion of renal cytoarchitecture. Many glomeruli (66.4%) showed hypercellularity, i.e., cellular proliferation of mesangial or endothelial cells and infiltration of inflammatory cells. The capillary membrane showed thickening as was evident on PAS stain. Since MSG, as a food additive, was found to be toxic on various organs of the body by various researchers, it should perhaps be stopped from being used as a food additive. This may be a suggestion which needs validation in human studies.
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