Cyclosporin drug-interaction-induced rhabdomyolysis. A report of two cases in lung transplant recipients.

In rare cases the use of cyclosporin in transplant patients can cause myopathic changes. We describe two patients, the recipients of lung transplants, who developed severe reversible rhabdomyolysis associated with cyclosporin drug-drug interaction.

Granisetron and ondansetron for chemotherapy-related nausea and vomiting.

The efficacy of granisetron and ondansetron, two serotonin antagonists, as antiemetic agents was studied and compared in the first 24 h follow, by chemotherapy administration. Sixty cancer patients took part in this randomized prospective study. The patients were categorized according to the chemotherapy which was administered. Patients in group A received combinations including the highly emetogenic agents, cisplatinum or adriamycin, patients in group B received regimens which included neither of these agents. Both serotonin antagonists were highly effective, only 9 (16%) out of 58 patients suffered from vomiting, 7 (25%) of the patients on ondansetron and 2 (7%) on granisetron. Splitting the patients into both groups supported the above results. In group A (adriamycin-cisplatinum) only 7 patients (22%) reported vomiting, 5 (33%) on ondansetron vs 2 (12%) on granisetron. In group B, only 2 patients (8%) suffered from vomiting, both patients (15%) on ondansetron while no vomiting was seen in the granisetron patients. Similar results were obtained in preventing nausea in these patients. We conclude that both serotonin antagonists are effective in preventing nausea and vomiting in patients receiving chemotherapy. In all groups tested this study granisetron appeared to be superior, although, this difference failed to reach statistical significance due to the small number of patients analyzed. However, there was no difference in cost effectiveness between the regimens.

Osteolytic lesions as a presenting sign of acute nonlymphocytic leukemia.

Osteolytic lesions occur rarely in acute leukemia, especially in adults. We describe a patient with chronic myelomonocytic leukemia, in whom multiple osteolytic lesions were the presenting sign of the transformation into acute leukemia. Local irradiation to a painful lesion in the left hip resulted in transient but significant symptomatic relief with improved quality of life. We conclude that osteolytic lesions, although rare in adult acute leukemia, indicate an advanced disease state, but may respond to palliative local irradiation.

Is it possible to improve the autopsy rate?

To improve the autopsy rate in a department of internal medicine, the method reported by Clayton and Sivak in 1992 was simplified and applied for a 12 month period, from January through December 1993. The basic principle of this method is involvement of the senior resident staff and supervision of the project by the head and deputy head of the department, on a daily basis. A simple form was designed for this purpose and was completed for each case. Results were compared with those between the same months in 1992. An increase in the autopsy rate from 1.8% in 1992 to 26.7% during the trial period in 1993 was noted.

Transverse nail ridgings (Beau's lines) induced by chemotherapy.

Transverse grooves of the nails, designated as Beau's lines, were observed in a patient with malignant lymphoma given chemotherapy. Beau's lines disappeared in the treatment-free intervals. This observation supports the concept that these lines are the result of the suppressed growth of the nail matrix caused by antimitotic drugs.