Clodronate Treatment in Patients with Malignancy-associated Hypercalcemia

ABSTRACT. Rastad J, Benson L, Johansson H, Knuutila M, Pettersson B, Wallfelt C, Åkerström G, Ljunghall S (Departments of Surgery and Internal Medicine, University Hospital, Uppsala, Sweden). Clodronate treatment in patients with malignancy-associated hypercalcemia. Acta Med Scand 1987; 221:489–94. The possibility of reducing symptomatic hypercalcemia and of maintaining total serum calcium concentrations <2.8 mmol/1 with clodronate (dichloromethylene bisphosphonate) was evaluated in 28 patients with various types of malignant tumors. Four episodes of hypercal-cemic crisis with mean serum calcium concentrations of 4.43 mmol/1 were controlled within 4–6 days of intravenous clodronate (4 mg/kg BW/day). This was accompanied by a moderate increase in serum creatinine values which, however, returned to pretreatment levels after therapy withdrawal in all but one case. Oral clodronate successfully reduced a mean serum calcium concentration of 3.16 mmol/1 in 22 out of 25 patients after 3–12 days (800–3 200 mg/ day). After reversal of the hypercalcemias oral clodronate controlled the serum calcium concentration for up to 42 weeks in six out of 15 patients After discontinuation of initial therapy five of seven recurrent hypercalcemias were successfully treated with oral or intravenous clodronate. Hypocalcemia and subjective side-effects were uncommon. It is concluded that clodronate is a valuable clinical tool in the management of patients with malignancy-associated hypercalcemia.     

Clinical aspects of LHRH analogues in gynaecology: a review

Summary. LHRH agonists are synthetic peptide analogues of hypothalamic luteinizing hormone releasing hormone (LHRH) with superior potency and longer duration of gonadotrophin release. Paradoxically, repeated administration causes pituitary desensitization with diminished gonadotrophin and oestradiol secretion. A state of hypogonadotrophic hypogonadism is reversibly induced; plasma oestrogen can be reduced to castrate levels. LHRH agonists reliably induce anovulation but are unlikely to replace existing contraceptive methods in most normal women. By contrast these agents offer, for the first time, the prospect of inducing a reversible pseudomenopause essentially free of side-effects. LHRH analogues promise to have a profound impact upon the management of a diverse range of oestrogen-dependent gynaecological diseases both benign and malignant. In particular, they may shortly become the gynaecological treatment of choice in endometriosis, as well as becoming part of the management of common gynaecological disorders such as dysfunctional uterine bleeding and uterine fibroids.     

Diastolic Potentials Recorded by Surface Electrocardiographic Signal Averaging During Sustained Ventricular Tachycardia: Possible Origin From the Reentrant Circuit

ECG signal averaging can detect low amplitude diastolic potentials in sinus rhythm. We, therefore, recorded signal-averaged ECGs during eight episodes of inducible uniform sustained VT with coincident atrial pacing to look for continuous diastolic electrical activity. Simultaneous AV pacing in seven patients served as controls. The number of QRS complexes averaged (187 +/- 47 vs 183 +/- 63), the noise level (1.26 +/- 0.88 vs 1.39 +/- 0.47) and cycle length (385 +/- 52 vs 404 +/- 40) did not differ between VT and paced recordings. In each lead the difference in onset between the unfiltered surface recording and the filtered data (40 Hz bidirectional) was significantly greater in VT than the paced recordings (25 +/- 16 vs 11 +/- 8 msec, P = 0.0012). These late diastolic (pre-QRS) potentials were greater than 15 msec duration in 65% of the leads in VT versus 20% of paced recording (P = 0.021). The maximum value was greater than 20 msec in six VT (75%) versus one (14%) paced recording (P = 0.019). The earliest filtered onset in any lead preceeded the earliest surface activity by greater than 12 msec, in 6 VT versus one paced recording (P = 0.019). Early diastolic (post-QRS) potentials were also longer in VT than pacing (49 +/- 40 versus 5 +/- 20, P = 0.001) and exceeded 38 msec in seven of the VTs but none of the paced recordings (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Brief Report: Erythrocyte Enzymes in Polycythemia Vera

Erythrocyte glutamic oxalacetic transaminase (EGOT), glucose-6-phosphatedehydrogenase (G-6-PD), and hexokinase were found to be increased inpatients with polycythemia vera. This suggests the presence of a populationof erythrocytes younger than normal in these patients. The pathogenesis ofthis phenomonon is unclear but several possible mechanisms are suggested.

Submitted on December 1, 1966 Accepted on January 30, 1967     

HEMORRHAGIC MYOCARDIAL INFARCTION COMPLICATED BY FREE WALL-RUPTURE: A CASE ASSOCIATED WITH UNUSUAL CLINICAL FEATURES FOLLOWING INTRAVENOUS THROMBOLYTIC THERAPY

A patient is described who developed a systolic murmur soon after she was administered intravenous thrombolytic therapy for acute myocardial infarction. She died and autopsy revealed extensive hemorrhagic myocardial infarction and a free-wall rupture. A review of the literature suggests that this may be an unusual complication of thrombolytic therapy.