[Eosinophilia in malignant tumors]. / Eosinofili ved maligne tumorer.

The article presents two cases of malignant tumour and eosinophilia and reviews the literature on this condition. It is associated with disseminated disease and indicates a poor prognosis. Current knowledge supports the view that eosinophilia in malignant tumours is caused by a tumour-produced ectopic hormone-like substance which directly stimulates the growth of the eosinophilic granulocytes in the bone marrow.

Has the incidence of multiple myeloma in old age been underestimated? The myeloma project of health region I in Norway. I.

All patients in the region with newly discovered M components were registered from 15 Aug. 1984-31 Dec. 1986. Among a total of 393 patients enrolled, 162 had multiple myeloma (MM). The incidence rate was 6.6 per 100,000 population per year (age-adjusted to the European standard population), which is somewhat higher than previous reports based on hospital and autopsy records. In particular, the incidence rate was higher in the greater than 70 age group. Thus, the median age was 72 yr, which is the highest reported. As many as 71 (44%) of the 162 MM patients were asymptomatic; these asymptomatic patients had the same age distribution as the symptomatic ones. The stage distribution, occurrence of risk factors, response to chemotherapy, response duration and survival were similar in the age groups below and above the median and, in multivariate survival analysis, age was not an independent risk factor.

Incidence and follow-up of asymptomatic multiple myeloma. The myeloma project of health region I in Norway. II.

During a general population follow-up study in Health Region I in Norway, 162 patients with multiple myeloma (MM) were diagnosed. 71 of these (44%) were asymptomatic, and were observed without chemotherapy. The great majority (90%) were in stage I, and there were only 2 with light chain disease. 45 of the 71 asymptomatic patients developed progressive disease during the 4-5 year follow-up period. Estimated median time to disease progression was 26 months. The presence at diagnosis of osteolytic lesions and/or at least 20% plasma cells in the bone marrow defined a group with significantly shorter time to progression (median 10 vs 39 months). Median survival from diagnosis for the asymptomatic patients was 45 months, which is significantly longer than the 26 months of the symptomatic group. However, when estimated from the start of treatment, the survival was similar for the two groups.

One year's treatment with propranolol after myocardial infarction: preliminary report of Norwegian multicentre trial.

A prospective, randomised, double-blind study was performed to compare the effects of propranolol and placebo on sudden cardiac death in a high-risk group of patients who survived acute myocardial infarction. Altogether 4929 patients with definite acute myocardial infarction were screened for inclusion: 574 (11.6%) died before randomisation, and 3795 (77%) were excluded. Five hundred and sixty patients aged 35 to 70 years were stratified into two risk groups and randomly assigned treatment with propranolol 40 mg four times a day or placebo. Treatment started four to six days after the infarction. By one year there had been 11 sudden deaths in the propranolol group and 23 in the placebo group (p less than 0.038, two-tailed test analysed according to the "intention-to-treat" principle). Altogether there were 25 deaths in the propranolol group and 37 in the placebo group (P less than 0.12), with 16 and 21 non-fatal reinfarctions respectively. A quarter of the patients were withdrawn from each group. Withdrawal because of heart failure during the first two weeks of treatment was significantly more common among propranolol-treated patients than among the controls, but thereafter the withdrawal rate was the same. The significant reduction in sudden death was comparable with that after alprenolol, practolol, and timolol, which suggests that the mechanism of prevention is beta-blockade rather than any other pharmacological property of the individual drugs.

Acetylsalicylic acid-induced prolongation of bleeding time in healthy men.

Bleeding times were determined in 25 healthy men using the Thrombolette bleeding time device. The median bleeding times prior to low and high doses of acetylsalicylic acid (ASA), 245 and 230 s, were not significantly different (P = 0.12). 2 h after randomized ingestion of 0.44 and 3.96 g ASA, the median bleeding times rose to 450 and 430 s, respectively. Both increased in bleeding time were significant (P less than 0.001), but the difference was not significant (P = 0.29). The maximum increase in bleeding time was estimated to occur 2.6 h after ingestion of a single low ASA dose, and 2.4 h after a single high dose. Following ingestion of 0.44 as well as 3.96 g ASA the bleeding time returned to basal levels within 5-6 d. Compared to the younger ones, volunteers with a higher age showed a tendency to have lower plasma salicylate levels as well as smaller increases in bleeding times following ASA ingestion.

Low incidence of thrombocytopenia during treatment with hog mucosa and beef lung heparin.

129 patients with thrombosis were treated with heparin for 5 d and followed with platelet counts and coagulation examinations. Of 77 patients treated with 2 different brands of hog mucosa heparin, only 1 developed persistent thrombocytopenia below 100 X 10(9)/1. Of 52 patients treated with beef lung heparin, 1 patient developed thrombocytopenia. No patient developed intravascular coagulation or activated fibrinolysis during heparin treatment.

Ergotism in a patient with a portosystemic shunt.

A case of ergotism is described in a patient with Banti's syndrome in whom a porto-systemic shunt had been made three times. She was admitted to hospital with severe ischaemia of the extremities after having taken a single oral dose of 1 mg ergotamine tartrate. Her condition improved rapidly after 2 to 3 days and the circulation was normal after one week. The possible mechanism of ergotism in this patient is discussed. Although the plasma concentration of ergotamine was not measured, the likeliest explanation was that the serious side effects were related to the altered pharmacokinetics and loss of first-pass metabolism of the drug due to the venous bypass of the liver.

The value of preoperative haemostatic screening.

The value of preoperative haemostatic screening tests in prediction of surgical bleeding was examined in 101 patients, mainly with abdominal and thyroid lesions. The study demonstrated complete lack of correlation between the preoperative evaluation of bleeding risk and the observed surgical bleeding (phi2 test P approximately 0.85).

The ethanol gelation test in pregnancy.

Coagulation studies in 55 healthy pregnant women indicated that in spite of high coagulation activity, a positive ethanol gelation test for fibrin in plasma is not a normal feature of pregnancy. The four case reports presented stress the value of the ethanol test in monitoring treatment of thromboembolic disease in pregnancy.