Changes in serum lipids and lipoproteins in cancer patients during chemotherapy

We studied serum lipid and lipoprotein changes occurring during chemotherapy in 57 patients with chemosensitive cancers, including 18 malignant lymphomas, 18 breast carcinomas, 14 small-cell lung carcinomas, and 7 urothelial-cell carcinomas. Patients who responded favorably to chemotherapy demonstrated a significant increase in serum total cholesterol and LDL cholesterol values, with the singular exception of breast-cancer patients, who exhibited a nonsignificant decrease in both of these parameters. Serum levels of free cholesterol and HDL cholesterol did not show any significant changes. Finally, serum triglycerides tended to increase after effective chemotherapy, but this was of statistical significance only in breast-cancer patients. Although our findings were based on a rather small number of patients, they indicate that the lipid and lipoprotein disorders reported in cancer patients are reversible by effective treatment of the tumor, suggesting that these disorders are a secondary phenomenon of malignancy.

Paraplegia in a pregnant thalassemic woman due to extramedullary hematopoiesis: successful management with transfusions

The investigation and treatment of a pregnant thalassemic woman who developed severe paraplegia is presented. Magnetic resonance imaging showed a paravertebral mass infiltrating the epidural space, resulting from extramedullary hematopoiesis (marrow heterotopia). The patient was treated successfully with repeated blood transfusions and made a complete recovery. The literature (36 cases) is reviewed and the magnetic resonance imaging features of spinal extramedullary hematopoiesis are presented. The efficacy of transfusions in the management of spinal cord compression due to marrow heterotopia in thalassemic patients is discussed.

Involvement of chromosome 13 in myelodysplastic syndromes

We report 2 of 80 cases of myelodysplastic syndromes (MDS) cytogenetically studied, with involvement of chromosome 13. The first case had a t(6;13), and the second had a t(1;13). Abnormalities of chromosome 13 mainly involving loss of band 13q14 have been described in hematologic malignancies. In both our cases band 13q14 did not participate in the deleted segment.

Involvement of chromosome 5 in large bowel cancer

We present here 3 of 30 cases of large bowel cancer cytogenetically studied, with deletion of chromosome 5. One of them presented a terminal deletion and the other two an interstitial deletion of chromosome 5q. In all three cases the segment 5q12-22 was deleted. Our findings may show that the segment 5q12-22 is important for a subgroup of colorectal cancers.

Myelopathies during the course of multiple myeloma

BACKGROUND

The development of acute non-lymphoblastic leukaemia (ANLL) or myelodysplastic syndromes (MDS) secondary to treatment of multiple myeloma (MM) is well known. In some cases the simultaneous appearance of MM and ANLL has been described.

METHODS

In this series the simultaneous appearance of MM and various myelopathies in 91 untreated patients with MM, and the development of myelopathies during the course of the disease in 72 treated patients were studied.

RESULTS

Simultaneous appearance of MM (IgA/lambda) and refractory anaemia with ring sideroblasts (RAS) was observed in one case (1.1%). Development of myelopathies in treated patients with MM was found in 4 out of 72 cases (cumulative risk at 8 years 28.3%). In one case (IgG/lambda MM) a myeloproliferative disorder (MPD) developed 6 years after the initial diagnosis. Cytogenetic analysis was normal. In the second patient (IgG/k MM) a similar MPD was observed 5 years after the initial diagnosis. The karyotype was 46, XX, -5 + t (20;?). The third patient with lambda light chain disease developed RAS 11 months after the initial diagnosis. The karyotype was 46, XY/hypodiploidy + M. Finally, the fourth case (IgG/k MM) developed ANLL (M4) 28 months after the initial diagnosis and the karyotype was 45, XX, -7, t(1;3).

CONCLUSIONS

The simultaneous appearance of MM and various myelopathies is unusual and probably represents a neoplastic transformation of a single progenitor in both lymphoid and myeloid malignancies. On the contrary, the development of myelopathies during the course of treated patients is a common phenomenon. The time of development and the cytogenetic findings strongly suggest that they are related to treatment with cytostatics.

A prospective randomized trial comparing somatostatin, balloon tamponade and the combination of both methods in the management of acute variceal haemorrhage

The aim of this study was to compare the efficacy of: (i) somatostatin infusion, (ii) balloon tamponade with the Sengstaken-Blakemore tube and (iii) the combination of both methods, in the management of acute variceal haemorrhage. Ninety-two consecutive patients with liver cirrhosis who proved to have active variceal bleeding on emergency endoscopy were studied. Thirty-one patients were randomly assigned to an intravenous infusion of 250 micrograms/h of somatostatin (Group I), 30 to the Sengstaken-Blakemore tube (Group II) and 31 to the combination of both methods (Group III). Somatostatin was administered for 24 h, while the gastric and esophageal balloons remained inflated for 48 and 24 h, respectively, then deflated. Patients were under observation for a further 24-h period after withdrawal of treatment. If bleeding recurred, the same treatment was repeated in each group. Following treatment the bleeding was controlled initially in 22 patients (71%) in Group I, in 24 (80%) in Group II and in 25 (80.6%) in Group III. In Group II a significantly (p less than 0.05) higher proportion of patients (14/24) rebled as compared to Groups I (5/22) and III (6/25). Bleeding was controlled following retreatment in four, ten and five patients of the three respective groups. There were marked differences, in the number of complications noticed with each form of therapy. Only three patients (9.7%) in Group I developed complications (p less than 0.05) as compared to ten (33%) in Group II and ten (32%) in Group III. Hospital mortality in all three treatment groups was not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Diffuse pulmonary carcinomatous embolization: a rare and fatal manifestation of ovarian cancer

A 44-year-old female presented with dyspnea and lethal respiratory failure secondary to pulmonary embolic carcinomatosis as a manifestation of ovarian serous cystadenocarcinoma. Diffuse involvement of pulmonary arterioles and muscular arteries ranging from 30 to 950 microns in diameter was observed in conjunction with slight dilatation of pulmonary arteries. Vascular intraluminal changes included the presence of free clusters of malignant cells, superimposed thrombosis, varying degrees of eccentric fibromyxoid intimal proliferation with entrapped malignant cells, and luminal obliteration with neovascularization. The pathobiological aspects of this unique manifestation of ovarian neoplasia are discussed.

Effects of alpha-glucosidase inhibition on meal glucose tolerance and timing of insulin administration in patients with type I diabetes mellitus

OBJECTIVE

Miglitol, an alpha-glucosidase inhibitor, delays absorption of carbohydrates. This study was undertaken to determine the potential of this agent as an adjunct to insulin in the treatment of diabetes.

RESEARCH DESIGN AND METHODS

Twelve nonobese patients with insulin-dependent (type I) diabetes mellitus were randomly selected from the outpatient diabetes clinic. The patients were made euglycemic with the Biostator, and postprandial hyperglycemia was determined under the following conditions: protocol 1, subcutaneous injection of insulin (13 +/- 1 U) given 60 min before the meal, with insulin dosages determined by the Biostator; protocols 2 and 3 same as protocol 1 but with insulin given at the time of meal ingestion; protocols 4 and 5 same as protocol 1 but with insulin given 30 min before the meal. Miglitol (100 mg) was administered in protocols 2 and 4 and placebo in protocols 3 and 5.

RESULTS

When insulin was given 30 min before the meal with miglitol (protocol 4) or placebo (protocol 5), plasma glucose increased from 4.94 +/- 0.16 to 5.94 +/- 0.55 mM and from 5.11 +/- 0.22 to 8.22 +/- 0.72 mM, respectively (P less than 0.01). When insulin was given at the time of the meal with miglitol (protocol 2) or placebo (protocol 3), plasma glucose increased from 5.44 +/- 0.27 to 7.77 +/- 0.5 mM and from 5.72 +/- 0.22 to 10.83 +/- 0.77 mM, respectively (P less than 0.01). When insulin was given 60 min before the meal (protocol 1), plasma glucose initially decreased from 5.61 +/- 0.38 to 4.33 +/- 0.33 mM and then increased to 6.94 +/- 0.66 mM after the meal.(ABSTRACT TRUNCATED AT 250 WORDS)

Globin chain synthesis in myelodysplastic syndromes

Globin chain synthesis was studied in the reticulocytes of 30 patients with various myelodysplastic syndromes (MDS) to determine the alpha:beta globin chain synthetic ratio and its probable prognostic value. The mean (SD) value of the total alpha:beta ratio was 0.82 (0.45) ranging from 0.05 to 1.73. The same ratio in 10 normal controls was 1.01 (0.04). This difference was significant. Furthermore, the alpha:beta ratios were lower than normal in 14 patients (alpha-thalassaemia-like) (group I), almost within normal limits in 11 (group II), and higher than normal in five (beta-thalassaemia-like) (group III). In each group almost all the FAB subtypes were represented. The addition of exogenous haem in several of the test samples resulted in a slight to pronounced increase in the alpha:beta ratios, particularly in group I. In 92% of the high risk cases (refractory anaemia with excess blasts (RAEB), chronic myelomonocytic leukaemia (CMML] or 87.5% of patients who finally developed acute non-lyphoid leukaemia (ANLL) low or normal alpha:beta ratios were found. No significant correlation was noticed between alpha:beta ratios and various haematological variables or survival. It is concluded that in MDS the alpha:beta ratio varied enormously across the entire population of patients, as well as within each FAB subtype, thereby restricting its prognostic value. Although haem deficiency may be implicated in some cases of MDS, why this should be remains unclear.

Preferential involvement of 11q23-24 and 11p15 in breast cancer

Thirty cases of breast cancer were cytogenetically studied by G-banding using direct tumor preparations. Among them 20 cases exhibited abnormalities of the long and/or short arm of chromosome 11. Thus, 11q was involved in 16 cases and 11p in ten cases. There was consistent involvement of bands 11q23-24 (15 cases) and 11p15 (9 cases), where the cellular oncogenes ets and H-ras 1, respectively, are located. These findings suggest that involvement of bands 11q23-24 and 11p15 may be specific in a group of breast cancers, leading to the activation of cellular oncogenes or loss of cancer suppressor genes.

Translocation (1;3)(p36;q21) in secondary leukemia

A case of acute nonlymphocytic leukemia (M4) secondary to treatment for multiple myeloma is described. The patient presented a translocation t(1;3)(p36;q21) and monosomy 7.

Duodenogastric reflux before and after surgical or medical therapy for duodenal ulcer

Duodenogastric reflux was studied in 48 duodenal ulcer patients before and after medical (n = 8) or surgical therapy with either combined truncal vagotomy and gastrojejunostomy (n = 13) or pyloroplasty (n = 12), Polya partial gastrectomy (n = 8), or highly selective vagotomy (n = 7). Seven healthy subjects served as controls. The reflux was assessed both by using 99mTc diethyliminodiacetic acid (HIDA) scintigraphy and by measuring intragastric bile acid levels following endoscopic gastric juice aspiration. Before therapy, duodenal ulcer patients had significantly higher intragastric bile acid concentrations than did normal subjects (p less than 0.001). After truncal vagotomy and drainage, or partial gastrectomy, bile acid levels increased significantly, whereas they remained unchanged after medical therapy. Conversely, they were found to be significantly decreased after highly selective vagotomy. The results of HIDA scan measurements were compatible with those of gastric juice bile acids. We conclude that surgical treatment for duodenal ulcer by highly selective vagotomy is the only form of therapy, among the types considered, that leads to a reduction in duodenogastric reflux. It is of interest that medical therapy of the duodenal ulcer does not improve abnormal duodenogastric reflux, possibly contributing to both the failure of the medical treatment and recurrence of the ulcer.

Association of neutrophil alkaline phosphatase activity and glycosylated haemoglobin in diabetes mellitus

We determined neutrophil alkaline phosphatase (NAP) activity in diabetic patients in conjunction with HbA1c levels. NAP was estimated using semiquantitative cytochemical technique, and we studied its activity in different groups of diabetic patients. We found that NAP score is correlated with the HbA1c level. Non-diabetic patients were used as controls, in whom NAP score and HbA1c were found normal. In diabetic patients the NAP activity and the HbA1c level were altered similarly during the various phases of the disease. Our findings indicate that NAP score could be used as a simple new parameter for diabetes. The pathophysiologic mechanism of our observations needs further investigation.

Invasive balantidiasis presented as chronic colitis and lung involvement

A unique case of chronic balantidiasis is described, presenting with chronic colitis and inflammatory polyposis of the rectum and sigmoid colon and an intrapulmonary mass. Histology of the colonic polyps showed Balantidium coli, and both Aspergillus and Balantidium coli were found in the aspirate of the pulmonary mass. The patient was treated with doxycycline HCl 100 mg/day for 10 days with complete clinical recovery and marked improvement of the endoscopic appearance of the colonic mucosa.

Effect of isoniazid, a haem inhibitor, on globin chain synthesis in reticulocytes from non-thalassaemic and beta thalassaemic subjects

The effect of isonicotinic acid hydrazide (INH), a potent haem inhibitor, on globin chain synthesis was studied in reticulocytes from the following groups of patients: four non-thalassaemic patients (group i); five beta thalassaemia heterozygotes (group ii); three Hb S/beta thalassaemia heterozygotes (group iii); and two additional patients--one with homozygous beta thalassaemia and the other with thalassaemia intermedia (group iv). This was done to determine whether haem inhibitors depress alpha globin chain synthesis. The progressive increase of INH concentration (10-40 mmol l-1) in reticulocytes from a beta thalassaemia heterozygote resulted in a remarkable decrease of the alpha and beta chain synthesis, ranging from 80% to 97% and from 74% to 96% of control values, respectively, and in a gradual drop of alpha:beta ratio from 1.87 to 1.38. Furthermore, in the samples incubated with 40 mmol l-1 INH, a pronounced inhibition of globin chain synthesis 77 (19%) for alpha chain and 67 (27%) for beta or beta S chain) and a substantial drop of the alpha:beta or beta S ratio in samples with INH (median 1.16) compared with that in samples without INH (median 1.70) were observed. The inhibitory effect of INH was significantly or completely corrected by adding exogenous haem. It is suggested that haem inhibition and the resulting preferential diminution of alpha chain synthesis could provide a new approach to the treatment of homozygous beta thalassaemia with an excess of detrimental free alpha chain in erythroid cells.

Atypical location of extramedullary hematopoietic masses in thalassemia

A case of beta-thalassemia with multiple foci of extramedullary hematopoiesis (EH) is reported. EH masses were demonstrated in the presacral and the costovertebral space. EH foci were also encountered in the spleen.

Cytogenetic study of rectosigmoidal adenocarcinomas

Ten cases of primary rectosigmoidal adenocarcinoma were cytogenetically studied by G-banding technique using direct tumor cell preparations. All cases exhibited both numerical and structural chromosomal aberrations. Chromosomes commonly involved were, according to frequency, #3 and #8 (eight cases each), #1 (seven cases), #6 (six cases), and #7 (five cases). Similar or identical marker chromosomes were frequently identified, and it is noteworthy that i(8q) was found in five out of ten cases studied. The possible specificity of chromosome 8q in rectosigmoidal adenocarcinomas is discussed.

Plasma lipid and lipoprotein response to carbohydrate feeding in cirrhotic patients

Serum lipids and lipoproteins, and glucose and insulin, were measured after an overnight fast, and during 3 days of a eucaloric diet rich in carbohydrate, in 15 patients with cirrhosis and seven normal subjects. Following the high-carbohydrate diet triglyceride rose in all groups but the increase in cirrhotics was lower than in normals. In normals and in cirrhotics with good liver function most of the triglyceride increment was carried in VLDL; in cirrhotics with poor liver function only 31% of the increment was found in VLDL, and 56% in triglyceride-rich LDL. In an earlier study on fat feeding, our cirrhotic patients with poor liver function had an impaired chylomicron and VLDL response; they also carried most of the triglyceride increment in triglyceride-rich LDL. The markedly impaired response of triglyceride-rich lipoproteins to both carbohydrate and fat feeding suggests that sick cirrhotics may have a problem with storage of dietary energy and that this contributes to loss of their adipose tissue.

Effects of prolonged administration of two new alpha-glucosidase inhibitors on blood glucose control, insulin requirements and breath hydrogen excretion in patients with insulin-dependent diabetes mellitus

Alpha-glucosidase inhibitors delay carbohydrate absorption. In order to study the effects of two new alpha-glucosidase inhibitors with long (BAYo1248) and short (BAYm1099) duration of action on glycaemic control, seventeen insulin-dependent diabetics were connected to the Biostator for 24 h and postprandial hyperglycaemia, insulin requirements and breath H2 concentrations were assessed under three conditions: (a) before administration of any alpha-glucosidase inhibitor (control experiments), (b) after administration of BAYo1248 (40 mg before breakfast, nine patients) or BAYm1099 (100 mg before breakfast and dinner, eight patients) for 1 month, (c) after 1-month administration of placebo (double-blind crossover study). All patients were on standard diets (30 kcal kg-1, 45% carbohydrate, 35% fat, 20% protein). BAYo1248 reduced postprandial hyperglycaemia and insulin requirements (vs. values in control and placebo experiments) after breakfast (124 +/- 8 vs. 159 +/- 8 and 158 +/- 8 mg dl-1, 16 +/- 2 vs. 24 +/- 4 and 23 +/- 3 units, P less than 0.01) and lunch (138 +/- 7 vs. 155 +/- 11 and 162 +/- 13 mg dl-1, 19 +/- 3 vs. 24 +/- 3 and 23 +/- 3 units, P less than 0.01) whereas BAYm1099 reduced postprandial hyperglycaemia and insulin requirements after breakfast (127 +/- 4 vs. 167 +/- 12 and 159 +/- 6 mg dl-1, 15 +/- 3 vs. 24 +/- 4 and 21 +/- 3 units, P less than 0.02) and dinner (128 +/- 4 vs. 169 +/- 7 and 157 +/- 10 mg dl-1, 19 +/- 2 vs. 28 +/- 3 and 25 +/- 2 units, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

24-h blood glucose pattern in type I and type II diabetics after oral treatment with pentoxifylline as assessed by artificial endocrine pancreas

Based on the known action of xanthine derivatives on the insulin secretion, the effect of pentoxifylline on carbohydrate homeostasis of type I (IDDM) and type II (NIDDM) diabetics was investigated. Pentoxifylline is known to exert a favorable influence on hemorheological disturbances in such patients. Twenty-four hour blood glucose pattern and insulin requirements were evaluated in type I and type II diabetics by the use of the artificial pancreas before and after a 14-day treatment with pentoxifylline 400 mg p.o. (Trental 400) t.i.d. During the stabilization period before treatment with pentoxifylline, NIDDM patients required 10.1 +/- 3.8 U of insulin and the IDDM 35 +/- 13.7 U. After 2 weeks on pentoxifylline, NIDDM required only 6.3 +/- 2.8 U (p less than 0.05) and IDDM 28.5 +/- 9.7 U (n.s.). Average blood glucose during the 24h decreased by 15.8 +/- 3.5% in NIDDM and by 10.3 +/- 2.5% in IDDM. Moreover, a significant smoothing of glucose fluctuations during the 24h was noted in both groups. It is concluded that pentoxifylline administered concurrently to any antidiabetic type of treatment leads to better blood glucose control as well as to prevention or delay of vascular complications.

Estimation of glycated fetal hemoglobin in normal cord blood by isoelectric focusing. Correlation with maternal glycated hemoglobin and birth weight

Glycated fractions of hemoglobin F and A (F1, A1c) were measured simultaneously in cord and maternal blood, respectively, in 109 normal women at delivery using an isoelectric focusing, method in polyacrylamide gel plates. Cord blood hemoglobin F1 values (mean +/- SD) were 5.92 +/- 1.09% and maternal blood hemoglobin A1c values were 6.51 +/- 0.92%. The difference was statistically highly significant (p less than 0.001) and their values were also significantly correlated (p less than 0.001). Moreover, both values were also well correlated with those of maternal blood glucose (p less than 0.01), actual birth weight (p less than 0.01) and birth weight ratio (p less than 0.01). It is concluded that hemoglobin F1 can be successfully separated and measured by isoelectric focusing. However HbF1 estimation seems to have no obvious advantages against the maternal HbA1c measurement as an index of fetal exposure to glucose during the last weeks of pregnancy.

Myelodysplastic syndromes: analysis of 131 cases according to the FAB classification

The clinical and haematological findings in 131 patients with myelodysplastic syndromes (MDS), none of which had previously received chemotherapy or radiotherapy, classified according to the FAB criteria, were analysed. The distribution among the 5 subgroups was: RA 31 patients, RAS 19, RAEB 23, CMML 29 and RAEBT 29 patients. There were difficulties in the classification of 24 patients. These included, first, 8 cases with myeloid hyperplasia of the bone marrow (BM) but without monocytosis or excess of blasts of the BM. They were classified as RA. Second, 8 cases with sideroblastosis but with monocytosis or excess of blasts of the BM were classified 3 as RAEB, 2 as CMML and 3 as RAEBT. Finally, 8 cases with absolute monocytosis and BM blasts 15-30% were classified as CMML. 37 of 82 dead patients (45.1%) had transformed to acute non-lymphoblastic leukaemia (ANLL). The incidence of evolution to ANLL was low for RA and RAS (6.30% and 12.5% respectively), while it was 37.5% for RAEB, 57.1% for CMML and 77.2% for RAEBT. The median survival for each subgroup was: RA 18 months; RAS 25; RAEB 13; CMML 14 and RAEBT 10 months. It is concluded that the FAB classification with some modifications recognises group of MDS with different prognosis.

Alterations in serum gastrin levels and antral G- and D-cell population following extensive proximal small bowel resection (radioimmunoassay and immunocytochemical study in dogs)

Twelve dogs underwent an extensive proximal small bowel resection. Basal and postprandial serum gastrin levels increased significantly one and two months after the resection compared to the respective preoperative levels. The increase in serum gastrin levels two months after the resection was less prominent than the respective increase one month postoperatively. Antral G- and D-cell populations increased significantly two months after the resection compared to the respective populations before the resection. It is concluded that hypergastrinaemia following small bowel resection is due to the quantitative elimination of the inhibiting hormonal factors of gastric secretion and gastrin release. The adaptive increase of antral D-cell population could explain the temporary character of hypergastrinaemia.

Some parameters of haem synthesis in dialysed and non-dialysed uraemic patients

Some parameters of haem synthesis were estimated in 60 uraemic patients (30 non-dialysed, 30 dialysed) and in 30 matched controls. Serum delta-aminolaevulinic acid and erythrocyte coproporphyrin and protoprophyrin were found significantly higher in the non-dialysed uraemics than in the controls. Erythrocyte delta-aminolaevulinic acid dehydrase (ALA-D) activity was 498 +/- 174 mumol/h.l in the non-dialysed patients, 321 +/- 146 in the dialysed (just before haemodialysis) and 833 +/- 281 in the healthy controls, the differences between these groups all being statistically significant (p less than 0.001). After haemodialysis the enzymic activity in the dialysed group increased significantly (380 +/- 167, p less than 0.001), but remained lower than normal (p less than 0.001). A similar pattern - although with less statistical significance of the differences between groups - was observed concerning erythrocyte uroporphyrinogen I synthase activity. Incubation of normal erythrocytes with uraemic plasma resulted in a considerable decrease of their ALA-D activity (from 830 +/- 263 to 616 +/- 126) while incubation of uraemic erythrocytes with normal plasma increased their ALA-D (from 384 +/- 139 to 494 +/- 77). Addition of zinc in the haemolysate caused a similar induction of ALA-D in both controls and uraemics. The zinc-induced uraemic ALA-D practically reached normal levels. The mechanism of enzymic depression and the possible role of elevated delta-aminolaevulinic acid concentrations (to which depressed ALA-D activity considerably contributes) in the pathogenesis of the neurologic manifestations of uraemia, are discussed.

The significance of tibial artery disease in the management of popliteal aneurysms

The clinical, radiographic and histologic features of sixty-one popliteal aneurysms in 36 patients are reviewed. Twenty-seven aneurysms were thrombosed and presented with an acutely ischaemic limb or the sudden onset of severe claudication. Thirty-four patent aneurysms presented with either ischaemic ulceration or claudication due to tibial artery disease or were asymptomatic with normal distal pulses. Thrombosis made reconstruction difficult and at times required a femoro-tibial graft. In others reconstruction was not possible leading to amputation either as primary treatment or following failed revascularization. In patent aneurysms one or more tibial arteries were frequently occluded. It is postulated that obliterative atheromatous disease of the tibial vessels and the slow flow through the aneurysmal vessels is responsible for the high incidence of thrombosis, poor graft patency and a high amputation rate.

Effects of two new alpha-glucosidase inhibitors on glycemic control in patients with insulin-dependent diabetes mellitus

BAYo1248 and BAYm1099 are two new alpha-glucosidase inhibitors. Postprandial glucose tolerance was significantly improved and postprandial insulin requirements were significantly reduced as compared to placebo after breakfast and lunch when 20 mg BAYo1248 were administered prior to breakfast and after breakfast, lunch and dinner when 50 mg BAYm1099 were given prior to all three main meals. Postprandial breath H2 concentrations were mildly increased when these alpha-glucosidase inhibitors were given and no patient complained of any adverse effects (such as flatulence, abdominal pain or diarrhea). BAYo1248 and BAYm1099 might be useful adjuncts to insulin in the treatment of patients with insulin-dependent diabetes mellitus.

Cytogenetic findings in a large bowel adenocarcinoma

Cytogenetic analysis of a biopsy specimen taken during sigmoidoscopy from an adenocarcinoma of the large bowel revealed a hypodiploid karyotype with numerical and structural abnormalities identified as trisomy 7, t(3;12), t(1;17), interstitial deletion of the long arm of a chromosome #5 and loss of the Y chromosome with double X chromosomes. The possibility of this karyotype being a further evolutionary step in a subgroup of large bowel cancers and the clinical value of the above findings are discussed.

Effects of prolonged (6 months) alpha-glucosidase inhibition on blood glucose control and insulin requirements in patients with insulin-dependent diabetes mellitus

To examine prolonged alpha-glucosidase inhibition on blood glucose control, Acarbose, a potent alpha-glucosidase inhibitor, was administered for six months to insulin-dependent diabetic patients. Acarbose administration significantly diminished postprandial blood glucose increases by 20-30% and reduced insulin requirements by about 40% in these patients. Symptoms related to its use almost disappeared after the first month of treatment. These results suggest that prolonged alpha-glucosidase inhibition improves glucose tolerance in patients with insulin-dependent diabetes mellitus. Thus, an agent like acarbose might be a useful adjunct to insulin in the treatment of diabetic patients.

Myeloproliferative disorder during the course of multiple myeloma

A patient with multiple myeloma who developed a myeloproliferative disorder 6 years after initial diagnosis is described. The 2 disorders coexisted for 3 years. Possible explanations for this occurrence are discussed.

Primary gastric lymphoma--the experience of a general hospital

We analysed 29 consecutive cases of primary gastric lymphoma (20 men and 9 women) treated in our unit between January 1977 and May 1983. Median age was 55 years. Abdominal pain and weight loss were the main presenting symptoms while there was no palpable disease in the majority of cases. Upper gastrointestinal radiology was abnormal, but not diagnostic, in all cases. Endoscopy with multiple biopsies was performed in 22 cases; carcinoma was diagnosed in 11, lymphoma in 8 while no diagnosis was made in 3 cases. Twenty six patients underwent laparotomy. Gastrectomy was performed in twenty while the tumour was unresectable in six. Histology was reported as diffuse in 28 cases (16 histiocytic, 8 lymphocytic and 4 mixed) and nodular (lymphocytic) in one. All our patients received multichemotherapy. Complete remission after 6 courses was documented in 18 patients (62%). Neither perforation nor gastrointestinal bleeding was a problem in our series. Eighty four per cent complete responders are predicted to be alive at 4 years. Advanced stage (II2B and IV) and tumour size greater than 10 cm adversely influenced survival. We suggest that in limited primary gastric lymphoma an attempt at 'curative' surgery combined with multichemotherapy currently gives very promising results.

Immune abnormalities in myelodysplastic syndromes

The immune states of 52 patients with myelodysplastic syndromes classified according to the FAB criteria were studied. Serum electrophoresis and immunoelectrophoresis, direct Coombs test, and tests for organ and non-organ specific antibodies were performed. Twenty six patients had immunoglobulin abnormalities: six (11.5%) had monoclonal gammopathy; 17 (32.6%) had polyclonal increases in serum immunoglobulin; while in three (5.8%) immunoglobulin concentrations were decreased. The distribution of immunoglobulin abnormalities among the five myelodysplastic syndrome subtypes was fairly uniform. Results of direct Coombs test were negative in all cases. Organ specific antibodies were not detected in any of the patients tested, although two patients were found positive for antinuclear antibodies. The presence of immunoglobulin abnormalities indicates an involvement of the lymphoplasmatic system in myelodysplastic syndromes.

Cytogenetic study in multiple myeloma

Ten patients with multiple myeloma (MM) were studied cytogenetically, using the G-banding technique. It was found that five patients had a normal karyotype, whereas five patients exhibited various chromosomal abnormalities. The presence of marker chromosomes was a consistent finding. Among those, the 14q+ marker chromosome was present in three cases, partial or complete trisomy for 1q was detected in four cases, and chromosome #6 was involved in two cases. In one case the 14q+ marker chromosome was determined to result from a translocation between chromosomes #11 and #14. In one patient with Bence Jones kappa multiple myeloma, there was a translocation between chromosomes #2 and #8.

Rapid proteolysis of puromycyl peptides in non-thalassaemic and thalassaemic erythroid cells

The proteolytic degradation of labelled pyromycyl polypeptides was investigated in human intact erythroid cells derived from the bone marrow of eight non-thalassaemic patients and the peripheral blood of eleven thalassaemics (eight splenectomized beta thalassaemia heterozygotes and three sickle-cell beta thalassaemics). These abnormal polypeptides are rapidly degraded to soluble trichloroacetic-acid (TCA) fragments with a half-life of 12 min both in bone marrow and peripheral blood. This comes very close to the half-life reported for the puromycyl peptide degradative system in rabbit reticulocytes (15 min). The relationship of the present proteolytic system to the ATP-dependent one, described in rabbit reticulocytes, and to that responsible for the free alpha-chain degradation in beta thalassaemia is discussed.

G-banded karyotype of a primary renal-cell carcinoma

Cytogenetic findings of a primary renal-cell carcinoma are reported. The chromosome number was near triploid and there was tetrasomy for the long arm of chromosomes #1 and #3. The following structural chromosomal abnormalities were identified by the G-banding technique: i(1q), t(3;17), 6q-, 7p+, and a ring chromosome of unknown origin. Chromosomes #1, #3, #6, #7, and #17 involved in this case are often implicated in malignancy.

Plasma secretin, pancreozymin, and somatostatin-like hormone in chronic renal failure patients

Twenty patients with chronic renal failure (CRF) and ten patients on hemodialysis were included in the study of plasma secretin and pancreozymin measurement. Plasma somatostatin-like hormone (SLH) was measured in seven patients with CRF, eight patients in continuous ambulatory peritoneal dialysis (CAPD), and ten patients on hemodialysis. Normal subjects were used as sex- and age-matched healthy controls. Plasma secretin, pancreozymin, and SLH were determined by radioimmunoassay. Basal plasma concentration of secretin and pancreozymin was found significantly increased in hemodialysis patients in comparison to controls. Also test meal induced a significant increase of both hormones in hemodialysis patients. Basal plasma SLH was found significantly increased in both predialysis and dialysis (hemodialysis, CAPD) patients in comparison to controls. Correlation between clinical gastrointestinal disturbances and elevated hormone levels was not found. We believe that more reliable plasma measurement of these hormones will help the clinical investigation of gastrointestinal pathophysiology in uremia for the future.

Inhibition of pancreatic glucagon responses to arginine by human insulin (recombinant DNA) and purified porcine insulin in normal and diabetic subjects

This study investigates and compares human insulin (recombinant DNA) and purified porcine insulin (PPI) in healthy volunteers and in type II diabetic patients, in terms of whether both these insulins were capable of influencing in a different manner pancreatic glucagon, C-peptide, and free fatty acids (FFA) concentrations. The findings reveal that the beta-cell of human pancreas apparently recognizes human insulin more readily than PPI, as assessed by the inhibition of C-peptide, and a similar conclusion follows for the alpha-cell; this conclusion is underscored by the inhibited glucagon values. The delayed increments of glucagon under human insulin following arginine stimulation may be the result of a more rapid insulin absorption from subcutaneous tissue and a greater biologic action of this insulin in comparison with the PPI. Finally, human insulin has additional properties as demonstrated by its stronger antilipolytic effects.

Effects of secretin and cholecystokinin-pancreocymin on water, electrolyte and glucose absorption in human jejunum. A comparison between different hormone preparations

The effects of natural secretin (90%) and synthetic secretin as well as impure (10%) and pure (99%) cholecystokinin-pancreozymin (CCK) on net absorption of water, electrolytes, and glucose in human jejunum were studied in 31 normal subjects. An intestinal perfusion technique with a triple-lumen tube was used. Net absorption of water and solute was significantly inhibited by both hormones only with larger doses, pure CCK being less active than impure CCK. A dose-dependent response of water and electrolyte absorption to graded doses of pure CCK was observed, without concomitant inhibition of glucose absorption with lower doses. The findings suggest that secretin and CCK may not be of physiologic importance regarding intestinal absorption in man. The definite changes in intestinal motility and transit rate caused by these hormones seem more likely to result in a reduction of intestinal absorption and an increase in the secretion of water and electrolytes along the proximal small bowel.

Synthetic human gastrin I and gastrin-like pentapeptide in studies of intestinal absorption in man. Role of gastrin in human intestinal absorption

The effects of synthetic human gastric I (SHG I) and gastrin-like pentapeptide (PG) on jejunal water, electrolyte, and glucose absorption were studied in 11 normal subjects. The i.v. administration of graded doses of SHG I increased plasma gastrin levels similar to those after food intake and in the Zollinger-Ellison syndrome. SHG I and PG caused no significant changes in the net movement of water and solute. The findings indicate that gastrin has no direct effect on intestinal absorption in normal man, and does not account for the mechanism of diarrhea in the Zollinger-Ellison syndrome.

Gastrin release and gastric secretion induced by dimethylxanthine in man

Gastrin release and gastric secretion in response to i.v. dimethylxanthine (2 mg/kg for 5 min followed by a 55-min infusion of 2.5 mg/kg) were studied in 25 normal subjects. Gastrin release was significantly stimulated, whereas gastric acid and pepsin secretion was inhibited. The adenylcyclase activation may, therefore, play a role in the mechanism of gastrin release. Moreover, dimethylxanthine seems to be a useful aid in studies on G-cell function in man.