Pancytopenia with hypercellular bone marrow--a possible paraneoplastic syndrome in carcinoma of the lung: a report of three cases

Three patients with idiopathic pancytopenia and hypercellular bone marrow who developed carcinoma of the lung within two years of diagnosis are reported. All three patients had macrocytic anemia associated with a megaloblastic marrow in the presence of normal serum vitamin B12 and folic acid levels. Neutropenia with monocytosis, elevated serum muramidase and LAP scores, and increased fetal hemoglobin levels were also found. In all cases Ham's tests were negative with a normal bone marrow karyotype. In all three patients, pancytopenia due to myelodysplasia, a probable preleukemic state, was diagnosed initially prior to the appearance of carcinoma of the lung. One of the patients showed improved leukocyte and platelet counts during chemotherapy, while the other two died before chemotherapy could be administered. In the light of the above findings we suggest that carcinoma of the lung may be the cause of a paraneoplastic syndrome with pancytopenia, particularly in patients with a hypercellular marrow with a normal karyotype.

Coexistence of myelomonocytic leukemia and monoclonal gammopathy or myeloma. Simultaneous presentation in three patients

The coexistence of monoclonal gammopathy or myeloma and nonlymphoblastic leukemia is reported in three untreated patients. One patient had IgG kappa myeloma and monoblastic leukemia, whereas the two others had IgA paraprotein in association with chronic granulocytic and acute myelomonoblastic leukemia, respectively. Simultaneous presentation of monoclonal gammopathy or myeloma and nonlymphoblastic leukemia is rare, and this report reviews the possible pathogenesis of this phenomena.

Hairy cell leukemia: report of an unusual case with hepatomegaly due to a large vascular tumor of the liver, mediastinal mass and pleural effusion containing hairy cells

An unusual patient with hairy cell leukemia (HCL) who developed marked hepatomegaly due to a large vascular tumor in the liver is reported. The relation of this vascular tumor to the microscopic splenic pseudosinuses and hepatic angiomatous lesions encountered in HCL is discussed. To the best of our knowledge this represents the first case report of the association of HCL with large macroscopic hemangioma of the liver causing hepatomegaly. The patient also developed a large paratracheal mediastinal mass with a recurrent pleural effusion which was shown to contain many typical hairy cells. This rare finding is discussed in relation to the isolated cases of lymphocytic lymphoma who present with clinical and morphological features mimicking HCL. This patient had HCL according to all established criteria with characteristic morphological, cytochemical and ultrastructural features and the pleural effusion and mediastinal mass were most probably part of the HCL neoplasia, despite the fact that biopsy was not performed.

Pharmacokinetics of valproic acid obtained after administration of three oral formulations to humans

The pharmacokinetics and bioavailability of valproic acid (VPA) were compared in six healthy volunteers after oral administration of the drug as follows: 1 g in standard tablet form, 1 g in enteric-coated tablet form, and 0.8 g in gelatin-capsule form. Following the administration of standard tablets, VPA concentrations reached a peak mean +/- SD of 105.4 +/- 9.0 micrograms/ml at 1 h and declined monoexponentially, with a terminal half-life of 14.9 +/- 2.4 h. Following the administration of the capsule, the serum concentration reached a peak of 82.1 +/- 14.8 micrograms/ml at 4 h. Following the administration of an enteric-coated tablet, there was an average time lag of 2 h with a delayed peak serum concentration of 93.5 +/- 13.1 micrograms/ml at 6 h. An identical terminal half-life of VPA was obtained for the three oral formulations. The bioavailability of the three VPA formulations was not significantly different, and it may be concluded that these formulations are bioequivalent.

Pharmacokinetics of valpromide after oral administration of a solution and a tablet to healthy volunteers

The pharmacokinetics of valpromide, a primary amide of valproic acid, was investigated in 6 healthy, adult male volunteers, each of whom was given 900 mg as a marketed, enteric-coated tablet and a solution. Valpromide was biotransformed to valproic acid after the administration of the tablet and the solution with a bioavailability of 0.79 +/- 0.24 and 0.77 +/- 0.12, respectively, relative to a marketed tablet of valproic acid. The absorption of valpromide was not rate-limited by dissolution. As a solid, nonhygroscopic, neutral prodrug of valproic acid, valpromide may be a good alternative to valproic acid and sodium valproate.

Comparative pharmacokinetic analysis of a novel sustained-release dosage form of theophylline in humans

The pharmacokinetics and relative bioavailability of theophylline from a new sustained-release formulation ( Theotard ) and from a standard sustained-release formulation (Theo-Dur) were compared in 6 healthy, adult, male volunteers. After a single oral dose of 300 mg Theotard , a mean maximal plasma concentration ( Cbmax of 3.49 +/- 1.05 mg/l was obtained after 8 h (tmax). After an identical dose of Theo-Dur, a peak plasma concentration of 4.68 +/- 1.33 mg/l was obtained after 6.33 h. The mean relative bioavailability of theophylline from Theotard was 1.02 +/- 0.16 relative to that of Theo-Dur. In 5 of the volunteers the Theotard formulation exhibited a more prolonged and uniform absorption rate and yielded more sustained plasma levels.

Developmental differences in identifying and discriminating CV syllables

The purpose of this experiment was to determine whether age-related differences would be observed for identification and discrimination of synthesized, five-formant CV syllables among listeners who showed equal performance scores on a standard clinical test of speech understanding. A second question concerned the relations between performance on identification and discrimination tasks as a function of age. Two 13-item continua that varied in the place of articulation feature ([ba, da, ga]) were used; they differed primarily in the presence of absence of a 5-ms noise burst at the consonant onset. Digitized natural speech syllables were also employed in one experimental task. Strong age effects were obtained for the three tasks--identification of syllables, adaptive estimation of "ba, da-" and "da, ga-" boundaries, and discrimination. With the exception of one condition for six-year-olds, only adults showed significant differences between boundaries and just noticeable differences. Minimal differences were obtained in responses to stimuli with and without initial bursts. Across ages there were no significant differences in the subjects' ability to label the synthesized syllables as compared to the natural speech stimuli. Possible explanations for the observed developmental effects are discussed.