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We have observed a high incidence (36.4%) of asymmetric septal hypertrophy (ASH), detected with the use of M-mode (MME) and two-dimensional echocardiography (2DE), in normotensive patients with chronic renal failure on maintenance hemodialysis without signs of cardiac diseases. ASH was detected by conventional MME in 11 cases and was confirmed with the use of 2DE in 8 cases showing a diagnostic concordance of 72.7% between the two methods. After dialysis the MME study of the left ventricular (LV) performance showed an evident impairment of cardiac index (CI) due to reduction of LV volume in addition to an abnormality of septal function. The presence of ASH does not impair the percentage of fractional shortening (FS%), the mean circumferential shortening (mean Vcf) and the ejection fraction (EF%), probably because of a compensatory performance of the LV posterior wall. Predialysis serum creatinine and fasting triglycerides have been found significantly higher in the group with ASH. ASH may be considered as a focal and early form of myocardial involvement in uremic patients on regular hemodialytic treatment.

A patient with heavy hypokalaemia is described: hypokalaemia and its effects were the unique clinical manifestations of small cell carcinoma of the lung, associated with ACTH ectopic secretion. The rapid unfavourable evolution denotes the explosive behaviour of the syndrome.

A patient with duodenal plasmacytoma is described. The extramedullary localization preceded the complete humoural picture of multiple myeloma by 15 months. The previously reported cases of myeloma of primary gastrointestinal localization are reviewed.

Carnitine, a naturally occurring compound which is an important cofactor in the transport of fatty acids within inner mitochondria, aids myocardial cells in efficiently meeting energy requirements. L-Carnitine has been texted in this study as a possible protective agent against doxorubicin-induced cardiac toxicity. Rat heart slices were incubated with doxorubicin (14 micrograms/ml), L-carnitine (600 micrograms/ml), and L-carnitine plus doxorubicin for 60 min at 38 degrees C. Cellular oxygen uptake, ATP, intracellular Ca2+, and 14C-Leucine incorporation were measured. L-carnitine pre-incubation significantly reduced (p less than 0.001) the metabolic cardiac impairment due to doxorubicin. The inhibition of oxygen uptake declined from 38% to 7%; of ATP cellular concentration from 78% to 27%; and that of protein synthesis from 11% to 6%. L-carnitine moreover acts to eliminate completely the Ca2+ increase induced by doxorubicin. Thus, it appears L-carnitine may be useful in the prevention of doxorubicin-induced cardiac toxicity.

Epirubicin (EpiDx) belongs to the class of anthracycline antibiotics. It is an analog of doxorubicin (Dx) modified in the sugar moiety and in which the stereochemistry at the hydroxyl group bearing C-4' has been inverted. The purpose of this study was to evaluate in an experimental model and in a clinical trial the cardiotoxic effects of EpiDx vs Dx. Cellular oxygen uptake was measured in vitro for equal concentration of Dx and EpiDx with a Warburg manometric apparatus and ATP intracellular concentration by high-pressure liquid chromatography. Dx inhibits cellular endogenous respiration of rat heart slices by 34% vs control, while EpiDx reduces oxygen uptake by 18%. ATP intracellular concentration was significantly reduced by both anthracycline derivates. The same results were obtained after Dx administration in vivo which enabled us to correlate the biochemical parameter (QO2) with the histological cardiac damages shown by light microscopy. For the clinical trial, we studied a total of 22 patients undergoing chemotherapy for solid tumors in an advanced stage. Nine of these were treated with Dx for a total of 66 therapeutic cycles and reached a maximal cumulative dose of 540 mg/m2. Thirteen were treated with EpiDx for a total of 121 cycles (maximal dose reached 720 mg/m2). The dosage of both agents were equal, 60 mg/m2 every 3 weeks. Acute cardiotoxicity was evaluated, measuring creatine-kinase isoenzyme MB(CK-MB) serum level before and 15 h after anthracyclines administration.(ABSTRACT TRUNCATED AT 250 WORDS)