Spontaneous immunoglobulin changes in human plasma-cell dyscrasia

A series of spontaneous changes affecting the nature of the immunoglobulin secretion of plasma cels is described in a patient initially diagnosed as IgG lambda benign monoclonal gammopathy. After several years a slight increase in the amount of serum monoclonal immunoglobulin occurred; shortly thereafter an aggressive form of multiple myeloma was diagnosed. Unexpectedly a rapid spontaneous decrease of the monoclonal immunoglobulin, accompanied by the appearance in the serum of increasing quantities of a complex containing intact lambda light chains, then occurred. Concomitantly a fragment of the corresponding free light chain was was detected in the urine. A parallel is drawn between the facts observed in this patient and in an animal model recently proposed to explain the different types of structural immunoglobulin abnormalities in multiple myeloma.

Clinical usefulness of urinary 3-methylhistidine excretion in indicating muscle protein breakdown

Urinary excretion of the post-translationally modified amino-acid 3-methylhistidine, derived from the contractile proteins actin and myosin, was measured in patients with conditions associated with nitrogen loss. The ratio of 3-methylhistidine:creatinine excretion, a measure of the fractional catabolic rate of myofibrillar protein was increased in severe injury, thyrotoxicosis, neoplastic disease, prednisolone administration, and sometimes Duchenne muscular dystrophy. In myxoedema, osteomalacia, and hypothermia the ratio was decreased; and starvation, elective operations, and rheumatoid arthritis had little effect. Provided that the diet is meat free, measurement of urinary 3-methylhistidine may provide useful information on the cause of protein loss.

Three day pleural inflammation: a new model to detect drug effects on macrophage accumulation

Mononuclear cell accumulation is of major importance in maintaining chronic inflammatory conditions. In an effort to model this phenomenon, 0.3 ml of a 1% carrageenan solution was injected into the pleural cavity of rats; at various times thereafter peripheral blood and pleural exudate samples were collected. Seventy-two hours after carrageenan injection, 82.3 +/- 3.7 x 10(6) cells (N = 6; mean +/- S.E.) were present in the pleural cavity; over 80% of these cells were macrophages as determined by morphologic and histochemical criteria. Animals treated with dexamethasone had a significantly reduced number of pleural macrophages. Animals treated with the nonsteroidal anti-inflammatory agents, naproxen and indomethacin, had an elevated intrapleural macrophage content. The number of intrapleural cells was not affected by the antirheumatic agents levamisole, d- and dl-penicillamine or gold sodium thiomalate. Animals treated with tilorone, dapsone, hydroxychloroquine, phenylmethane-sulfonyl fluoride and 1,10 phenanthroline had a reduced pleural cell count.

Early detection of doxorubicin cardiotoxicity by M-mode echocardiography

The influence of increasing doses of doxorubicin on the heart was examined in 30 patients with solid tumors, M-mode echocardiography being used to evaluate left ventricular contractility. The function of the left ventricle remained normal in 26 subjects, whereas four patients had evidence of cardiotoxicity after cumulative doses of 220, 380, 420, and 450 mg/m2. Transient overt heart failure was noted in one subject only. Doxorubicin cardiotoxicity can be detected by M-mode echocardiography, a simple and non-invasive technique, prior to the appearance of overt congestive heart failure. Patients demonstrating left ventricular dysfunction are probably not candidates for receiving further therapy with anthracycline antibiotics. Limitation of M-mode echocardiography include a 28% incidence of inadequate studies in this group of patients, and a relative inaccuracy of the technique in evaluating patients with prior myocardial infarction.

The physiopathological significance of benign monoclonal gammopathy: a study of 64 cases

Sixty-four patients with monoclonal protein in serum but initially without evidence of multiple myeloma, macroglobulinaemia, amyloidosis or lymphoma, were studied. Fifty patients (78%) were observed for a period of exceeding 3 years. Based on the follow-up data the patients were classified into the following four groups: Group 1 = patients with transient monoclonal gammopathy: 4 . 7%; Group 2 = patients without significant increase in monoclonal serum protein: 75%; Group 3 = patients with more than 50% increase in monoclonal serum protein: 14 . 1%; Group 4 = patients in whom multiple myeloma developed: 6 . 2%. The mean interval from discovery of the serum monoclonal protein to evolution to multiple myeloma was 61 months. Retrospective analysis of age, sex, blood count, bone marrow picture, antigenic type and size of serum monoclonal proteins, presence of small amounts of homogeneous light chain in the urine, serum albumin level, levels of residual immunoglobulins, did not help to distinguish initially the patients in whom the monoclonal gammopathy evolved to multiple myeloma from patients in whom the disease remained benign and stable. The evolution to multiple myeloma had occurred abruptly after long periods of stable condition; and until this progression the follow-up data were similar to the patients with benign disease. The possible physiopathology of occurrence and evolution of benign monoclonal gammopathy is discussed.

The effect of 3-methylhistidine in food on its urinary excretion in man

1. To establish whether 3-methylhistidine in food is quantitatively excreted in the urine, five normal adults on a vegetarian diet were given known amounts of 3-methylhistidine in meat or fish. The mean cumulative 5-day increment in 3-methylhistidine excretion in non-hydrolysed urine accounted for an average of 90% of the 3-methylhistidine given during the first 3 days of this period. 2. To define the variation in urinary 3-methylhistidine on a constant mixed intake, the daily 3-methylhistidine excretion was measured for 6 days in four patients on a metabolic "balance" diet. The mean daily variation was less than 10%. 3. The results show that under the conditions of this study the increase in urinary 3-methylhistidine above basal levels can be quantitatively accounted for by the 3-methylhistidine content of additional food; in subjects on a constant diet it should be possible to detect relatively small changes in 3-methylhistidine excretion.

Endoscopic retrograde cholangio-pancreatography: related nosocomial infections

The flexible endoscopes of a gastroenterology department were microbiologically examined after one patient developed a possible nosocomial infection. The endoscopes were found to be contaminated by pseudomonas species. An appropriate cleaning regime was developed and the initial difficulties in sterilising the instruments are described. The medical records of all ERCPed patients for the one and half years prior to and the half year after the monitoring exercise were examined. It was found that approximately 50 percent of patients examined in the half year prior to the introduction of endoscopic monitoring had infections with Pseudomonas species.

Multiple acquired haemostatic defects. Case report and review of the literature

A 14-year-old girl presented with severe haemorrhagic diathesis. Her past history suggested a congenital bleeding disorder. Investigations disclosed severe deficiency of all four vitamin K-dependent factors and a functional defect of platelets. These were caused by simultaneous administration of vitamin K antagonists and anti-inflammatory drugs. A complete clinical and laboratory recovery took place following withdrawal of drugs. The severity of the haemorrhagic diathesis prompted us to describe the case in order to draw the attention of medical personnel to the dangerous potentiation effects of different drugs administered with vitamin K antagonists.

The 3-methylhistidine content of human tissues

1. The amount of 3-methylhistidine (3-MeH) has been measured in eighty-eight samples of tissue taken post-mortem from five adults. 2. The highest concentration (mumol/g fat-free dry weight) of 3-MeH was in skeletal muscle (3.31 +/- 0.05); intermediate values (2-3) were found in cardiac muscle and those tissues containing smooth muscle; and low values (less than 1) occurred in parenchymal tissues such as liver and kidney. 3. There was little variation between the mean 3-MeH content of striated muscles in different individuals, and no significant difference between the 3-MeH concentrations of striated muscles taken from six different sites. 4. The results suggest that it is justifiable to use values obtained from single muscles to calculate the rate of myofibrillar breakdown from urinary 3-MeH excretion.

Measurement of mean corpuscular and packed cell volumes with a Coulter cell counter

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