SERUM THYMIDINE KINASE AS A MARKER OF DISEASE ACTIVITY IN PATIENTS WITH MULTIPLE MYELOMA

Serum thymidine kinase (STK) levels have recently been used to detect tumour regression and progression in a number of hematological malignancies. In this study, patients with myeloma were monitored longitudinally for STK and several other potentially useful tumour markers to determine which laboratory parameters are the most useful for differentiating between stable and progressive disease. STK was determined by radioenzyme assay, lymphocyte surface markers were analysed by flowcytometry, plasma cell labelling index (LI) by immunofluorescence with anti BU-1, serum B2-microglobulin (SB2M) by radioimmunoassay and M proteins by radial immunodiffusion. Detailed multiparameter longitudinal investigations of 5 patients and ongoing studies of 70 other patients suggest that STK is a more reliable marker of progressive disease than either SB2M, LI, M-protein or CD10 positive lymphocytes. A rise in STK during the emergence of progressive disease at least paralleled and usually preceded any change in the other parameters which often did not change at all. All samples from patients with progressive disease (n = 29) had a STK above the normal range (0–5U/I) whereas 76% of patients in clear stable disease had a STK within the normal range. All samples (n = 34) from patients with light chain isotype suppression (LCIS) had STK values of less than 12 U/L and 82% of samples (n = 33) from patients without LCIS had a STK above the normal range (0–5U/L). The correlation between STK and LI was r = 0.65; p < 0.001 (n = 21). The radioenzyme assay for STK is simple, reproducible and a valuable tool for monitoring patients with myeloma and when used in conjunction with other clinical and laboratory investigations, aids in the separation of patients with stable myeloma from patients whose disease is progressive.     

Liver tumours and muscle relaxants

Electromyographic studies of the onset of action of tubocurarine or alcuronium were performed on eight occasions in five patients who had liver masses. There was a slow onset of action and an increased dose requirement in those with malignant disease. Normal responses were found in a patient with benign nodular hyperplasia and in another where the malignant tumour was successfully treated with chemotherapy.     

EFFECTS OF TWO DIFFERING HALOTHANE CONCENTRATIONS ON THE METABOLIC AND ENDOCRINE RESPONSES TO SURGERY

The effects of two differing concentrations of halothane, 2.1MAC or 1.2 MAC, on the metabolic and endocrine responses toabdominal hysterectomy were investigated. The changes in bloodglucose and lactate values, and plasma glycerol, cortisol, insulinand catecholamine concentrations were similar in both groups.We conclude that high concentrations of halothane do not suppressthe responses to pelvic surgery, and that accurate quantificationof the dose of halothane, within the concentration range of1.2 to 2.1 MAC, is not essential in studies of metabolic changesassociated with surgery.     

CD30 expression in non-Hodgkin''s lymphoma

The CD30 antigen has been reported as the immunophenotypic hallmark of a recently described category of non-Hodgkin's lymphoma, termed anaplastic large cell lymphoma. From a series of approximately 500 lymphomas, 17 cases showing typical anaplastic features have been identified. They were strongly labelled by monoclonal antibodies recognizing CD30 (Ki-1 or BerH2). However, 36 other lymphomas, mainly high-grade, of non-anaplastic cytology also expressed CD30, either diffusely or focally, with a staining pattern identical to that seen in anaplastic large cell lymphomas. This clearly suggests that such lymphomas cannot be identified solely on the basis of being high-grade non-Hodgkin's lymphomas showing CD30 positivity. From the present results, the distinction between the anaplastic and non-anaplastic types would be better made with antibodies to epithelial membrane antigen than to CD30. Clinical data, available for 48 of the patients (16 with anaplastic large cell lymphomas and 32 with non-anaplastic) revealed no significant differences with regard to age at presentation, sex or clinical signs. A short-term follow-up study of 25 patients revealed that for the first 2 years after diagnosis there were no significant differences in patient survival between anaplastic large cell lymphoma, other CD30+ high-grade lymphomas and all high-grade non-Hodgkin's lymphomas considered together. These findings, which must be confirmed by larger studies, suggest that in a general lymphoma clinic there is probably little justification for differentiating anaplastic large cell lymphomas or CD30+ lymphomas from other high-grade non-Hodgkin's lymphomas.     

The Role of a Third and Possible Fourth Coronary Angioplasty for Recurrent Stenosis

From 1980 to 1985, 1,179 patients underwent percutaneous transluminal coronary angioplasty (PTCA) for the first time. Of these, 92 (7.8%) underwent a second PTCA, 25 (2.1%) a third, and 5 (0.4%) a fourth PTCA of the same vessel and site of the initial stenosis. Success rates for these groups were 78%, 87%, 88%, and 100%, respectively. The left anterior descending coronary artery (LAD) was involved in 14 (56%), the right coronary artery (RCA) in 9 (36%), and the circumflex coronary artery (CX) in 2 (8%). There were no deaths or emergency surgery due to the third and fourth PTCA. Follow-up after the last PTCA indicated symptomatic relief and an improvement in Canadian Cardiovascular Society functional class (CAHA) along with an increase in the exercise time on a standard Bruce stress test. We conclude that a third or fourth PTCA provides a safe and effective therapy for recurrent stenosis.