Hypokalemia complicating Duchenne muscular dystrophy

Although patients with Duchenne muscular dystrophy (DMD) have been shown to have decreased total body potassium levels, serum potassium levels have generally been though to be within normal limits. We report two siblings with DMD noted to be hypokalemic in conjunction with a respiratory illness. Hypokalemia may have exacerbated the pre-existing pulmonary insufficiency in these patients. The literature concerning hypokalemia and DMD is reviewed, and recommendations for the closer monitoring of serum potassium levels in patients with DMD are presented.

Progression of orthostatic proteinuria to focal and segmental glomerulosclerosis

Focal glomerulosclerosis, with the nephrotic syndrome and progressive renal insufficiency, developed in a 15-year-old boy who presented initially 1 year earlier with orthostatic proteinuria. Although generally considered to be a benign disorder, this case suggests that on rare occasions, serious glomerular diseases may develop in patients with orthostatic proteinuria or that significant glomerular disease may occasionally present with postural proteinuria.

Pneumococcal carriage amongst Australian aborigines in Alice Springs, Northern Territory

In Alice Springs and its vicinity, a single nasal swab was collected from 282 Australian aborigines in May 1981 to determine nasal carriage rates of pneumococci. Each swab was inoculated on blood agar and on gentamicin blood agar. The carriage rates were 89% in children, 39% in adolescents and 34% in adults. In all, 27 serotypes of pneumococci were met with and 15 (4%) of subjects yielded two or more serotypes. In children, types 23, 19, 6, 22 and 6 were predominant (in that order), whereas type 3 was commonest in older subjects. Approximately 25% children and 5% adults yielded drug-insensitive pneumococci. Resistance to benzylpenicillin, tetracycline and co-trimoxazole was met with, resistant pneumococci showed five resistance patterns and belonged to nine serotypes, predominantly types 19 and 23. All isolates were sensitive to chloramphenicol, erythromycin, lincomycin and rifampicin. The carriage rate of drug-insensitive pneumococci was 100-fold higher amongst children sampled than in non-aboriginal children in Australia.

Biochemical markers and skeletal metabolism in carcinoma of the prostate. Use of decision matrix theory and ROC analysis

The discriminative ability of several skeletal and tumour markers was assessed in 102 patients with prostatic disease. These comprised serum acid and alkaline phosphatase, serum albumin and osteocalcin, urinary excretion of calcium, hydroxyproline and 6-oxo prostaglandin F1 alpha. None of the tests was of value in distinguishing patients with benign prostatic disease from those with tumour not involving the skeleton. Values of serum osteocalcin, urinary excretion of calcium and urinary 6-oxo prostaglandin F1 alpha failed to discriminate significantly between patients with or without metastases. The remaining four markers were compared by decision matrix analysis and receiver operating characteristic (ROC) curves. Serum alkaline phosphatase provided the most sensitive marker of skeletal metastases (80.5%), followed by serum acid phosphatase (80%), hydroxyproline (68%) and albumin (30%). ROC analysis suggested that alkaline phosphatase conformed most closely to the "ideal marker" with highest specificity and sensitivity.

Cardiac output and muscle blood flow in exercising dogs

Average blood flow (q) was determined by trapping of 15 micron radioactive microspheres in the vastus lateralis, the gastrocnemius-flexor digitorum superficialis and the triceps brachii of five 18 kg untrained mongrel dogs at rest and during graded treadmill running. Oxygen uptake (VO2) and cardiac output (Qco) were simultaneously determined. q leveled off in all investigated muscles at 60-100 ml X 100 g-1 X min-1 when VO2 was ca. 70% of peak VO2. Qco increased linearly with VO2 up to peak VO2. The regional blood flow (qR) distribution pattern within the muscle was found to be extremely scattered around q, both at rest and at heavy exercise. qR ranged from approximately 5 to approximately 55 ml X 100 g-1 X min-1 at rest and from approximately 10 to approximately 200 ml X 100 g-1 X min-1 at maximal exercise. No significant topographic pattern was observed in the qR distribution of the gastrocnemius muscle which was essentially similar to that previously found for the isolated-perfused muscle preparation. The results indicate that maximal limb muscle blood flow and/or its uneven distribution may be the primary limiting factor to peak VO2 in untrained running dogs.

Continuous ambulatory venous pressure for diagnosis of venous insufficiency. Preliminary report

We have found that the venous pressure slope during minimal exercise is a sensitive measurement of venous disease. This parameter differed greatly in our two study populations. Due to increased venous pressure, venous insufficiency syndrome patients have a greater volume of pooled blood, which results in smaller pressure changes with each muscle contraction. In patients with incompetent valves, blood flows in a retrograde fashion in the vein, which leads to a higher steady state minimal pressure and notably to a decreased venous pressure slope. Venous pressure slope is a particularly sensitive measurement and a good prognosticator of venous insufficiency syndrome before symptoms become disabling to the patient. Our data indicate a strong correlation between venous pressure slope and venographic results. In fact, patients with abnormal venographic results invariably have demonstrated venous pressure slopes in the abnormal range.

C-II anapolipoproteinemia and severe hypertriglyceridemia. Report of a rare case with absence of C-II apolipoprotein isoforms and review of the literature

A new case of C-II anapolipoproteinemia (complete apolipoprotein C-II deficiency) as the cause of severe hypertriglyceridemia with chylomicronemia (type I lipoprotein phenotype) is described. The patient was a five-year-old boy living in Connecticut. He had splenomegaly, episodic abdominal pain, and bloody stools. Absence of apolipoprotein C-II (and its isoforms C-II1 and C-II2) was documented by a sensitive and specific radioimmunoassay, analytical isoelectric focusing, and in vitro lipolytic assay. Decreased levels of high- and low-density lipoprotein cholesterol and apolipoproteins A-I and A-II and increased levels of plasma triglycerides and apolipoprotein E were found. Post-heparin extra-hepatic lipoprotein lipase activity was within normal range. Incorporation of exogenous purified human apolipoprotein C-II to an incubation mixture of purified lipoprotein lipase and the patient's triglyceride-rich lipoproteins resulted in a dramatic increase in the catabolic rate of the defective triglyceride-rich lipoproteins. The absence of the isoforms of apolipoprotein C-II in this patient indicates that a common gene exists for the C-II isoproteins, which appear to be necessary for normal triglyceride transport in humans. A literature review of 23 reported cases indicates that xanthomas and hepatosplenomegaly are less common in C-II anapolipoproteinemia than in lipoprotein lipase deficiency, the other major etiologic cause of genetic chylomicronemia.

Drug combinations in the treatment of gastric adenocarcinoma: a randomized Southwest Oncology Group study

The FAM combination with the simultaneous administration of 5-fluorouracil, doxorubicin, and mitomycin C is considered standard chemotherapy for gastric adenocarcinoma. This study was initiated to determine whether a kinetically designed sequential administration of these three drugs would be superior and whether the presence or absence of easily measurable tumor would imply differences in survival. To do so, the Southwest Oncology Group tested two schedules in a randomized study of 239 patients. Independent judgments of response were made by two authors with the same results. Equivalent response rates (23% of all eligible sequential and 30% simultaneous) and median survival durations (22 and 23 weeks, respectively) were seen. Patients with and without readily measurable tumors each lived a median of 22 weeks. Higher degrees of hematologic toxicity were associated with prolonged survival (median 27 weeks versus 20 weeks, p = 0.04). Patients treated by community oncologists were described as having higher response rates than those treated in major medical centers (64% versus 31%, p = 0.03). The meaning of this is questionable in that there were no statistical differences in survival or toxicity. Those with prior exposure to 5-fluorouracil had only a tendency, without statistical significance, for a slightly inferior response and survival.

Cisplatin. An active drug in the treatment of disseminated gastric cancer

Cis-diamminedichloroplatinum (DDP) was administered at 100 mg/m2 intravenously bolus with every 3-week schedule in patients with measurable and nonmeasurable incurable gastric cancer. Twenty patients were treated, 12 with measurable and 8 with nonmeasurable disease. Four of the 12 (33%) patients with measurable lesions had objective remissions. One remission was complete, lasting 60+ weeks. Patients with nonmeasurable disease were not eligible for response evaluation; they were followed for toxicity and survival. Hematologic, renal, and gastrointestinal toxicities were similar to those reported in other patient populations receiving DDP. Neurotoxicity proved to be dose limiting in two patients. The median survival was 38+ weeks for responders, 24 weeks for all patients, and 13 weeks for those 8 patients with nonmeasurable disease. DDP should be considered an active drug against gastric cancer. A better understanding of the dose response relationship for DDP in gastric cancer is necessary before the best dose and schedule can be chosen for DDP in combination with other active agents.

Randomized comparisons of radiotherapy and CCNU versus radiotherapy, CCNU plus procarbazine for the treatment of malignant gliomas following surgery. A Southwest Oncology Group Report

One hundred and fifteen eligible patients with histologically verified malignant gliomas (astrocytoma grade III-IV) were randomized to receive either radiotherapy 6 000 rads/7 week plus CCNU 130 mg/M2 every 6 weeks (treatment 1) or radiotherapy 6 000 rads/7 weeks plus CCNU 75 mg/M2 day 1 plus procarbazine 100 Mg/m2 days 1-14 every 6 weeks (treatment 2) within 4 weeks following surgical resection. The response rates showed no statistically significant differences between treatment 1 CR/PR - 24/17% and treatment 2 CR/PR - 14/14% (P-value = 0.31). The median survival was also not significantly different: 55 and 50 weeks for treatments 1 and 2, respectively. The most important prognostic parameter identified was age with younger patients showing higher response rates and longer survival. Patients' performance status was also a useful prognostic parameter for response and survival. Neither the extent of surgical resection nor the tumor grade correlated significantly with the outcome. Further studies are needed to identify active chemotherapeutic agents for the treatment of brain tumors.

Clinical trial of chlorozotocin, DTIC, and dactinomycin in metastatic malignant melanoma

Thirty evaluable patients with metastatic malignant melanoma were treated with a combination of chlorozotocin, DTIC, and dactinomycin. One complete and four partial responses were achieved, for an overall response rate of 17%. Cumulative myelotoxicity was noted, as well as universal gastrointestinal intolerance. One patient developed probable drug-related nephrotoxicity. A survival advantage was noted for responding patients. We conclude that the addition of chlorozotocin did not improve response rate or response duration and that further trials with this drug combination cannot be recommended.

Phase I--II study of intermittent bolus administration of DTIC and actinomycin D in metastatic malignant melanoma

Twenty-six patients with disseminated malignant melanoma were treated with intermittent bolus DTIC and actinomycin D in an escalating dose schedule, starting at 650 and 1 mg/m2 respectively. Courses were repeated at 3--4-week intervals. Twenty four patients were evaluable for toxicity and 22 were evaluable for response. Two patients (9%) had a complete remission lasting 7+ and 14 months, and three patients (14%) had a partial remission lasting 2+, 5+, and 14+ months. Nausea and vomiting, lasting 24 hours, was observed in 88% of patients, while diarrhea was noted in 17%. Stomatitis and alopecia were less frequently observed. All responses occurred at nonmyelosuppressive doses and in patients with visceral-predominant metastases. This schedule offers the patient the convenience of single-day treatment and less prolonged gastrointestinal intolerance. Further evaluation of this drug combination and schedule would appear to be indicated.