Thoracic outlet syndrome mimicking angina pectoris with elevated creatine phosphokinase values.

Four patients with elevated creatine phosphokinase (CPK) values and recurrent chest pain were found to have thoracic outlet syndrome. This association of abnormal CPK levels and chest pain due to thoracic outlet syndrome has not been previously reported. Symptoms and CPK values improved with anti-inflammatory medications and/or proper posture instruction. It is proposed that CPK values become elevated by ischemic or neurologic compromise of muscles supplied by the subclavian artery or brachial plexus respectively. Accordingly, chest pain in the same dermatomal distribution as that of angina pectoris may be simulated by ischemic skeletal muscle. Thoracic outlet syndrome therefore should be suspected in any patient with chronically abnormal CPK values and chest pain in whom no other etiology can be determined.

IV N-acetylcysteine treatment of hematologic reactions to chrysotherapy.

Twelve patients with adverse hematologic reactions to chrysotherapy received intravenous N-acetylcysteine (IV NAC) to achieve removal and/or redistribution of gold. Urine gold excretion while on IV NAC doubled that predicted from control measurements. Treatment within 20 days of the last gold injection was associated with better recovery of hematologic parameters. No untoward reactions from IV NAC were encountered. The pathogenesis of gold induced hematologic reactions is examined from both toxic as well as immunological perspectives.