Hyperphosphatemia in multiple myeloma due to a phosphate-binding immunoglobulin.

Hyperphosphatemia (HP) is usually seen in patients with hypoparathyroidism, renal failure, and tumor lysis. The authors described a patient with HP due to a phosphate-binding immunoglobulin (Ig). An 86-year-old woman had serum phosphate levels as high as 4.75 mmol/l, (normal, 0.77 to 1.45 mmol/l). Serum ionized calcium, blood urea nitrogen (BUN), creatinine, and N-terminal parathyroid hormone (PTH) levels were normal, but serum 1,25-dihydroxyvitamin D level was subnormal at less than 12 pmol/l (normal, 36 to 146 pmol/l). Serum total protein was elevated at 105 g/l (normal, 60 to 80 g/l), and additional studies confirmed a diagnosis of immunoglobulin G (IgG) multiple myeloma. Results of in vitro studies using anti-human IgG antibodies showed that the IgG of the patient bound inorganic phosphate. Several isolated case reports have documented spurious HP due to interference of the paraprotein in the routine serum phosphate assay. In only one patient, however, has actual binding of phosphate to a myeloma protein been documented. The studies of the authors document phosphate binding by an IgG paraprotein and suggest that in this setting HP may be of physiologic significance as evidenced by depressed serum levels of 1,25-dihydroxyvitamin D.

Assessment of the predictive value of X-ray pelvimetry and biparietal diameter in cephalopelvic disproportion.

The value of X-ray pelvimetry and ultrasonic measurement of the biparietal diameter for trial of labor prognosis was assessed in 172 healthy primiparas with suspected cephalopelvic disproportion. A decision diagram which is able to correctly predict 50% of the cesarean sections without increasing the number of unnecessary cesarean sections is proposed. In addition, the study confirms the superfluity of X-ray pelvimetry in cases of high station of the fetal head at the end of pregnancy.

[Peridural analgesia during labor: comparative study of a fentanyl-marcaine combination and marcaine alone]. / Analgésie péridurale au cours du travail: étude comparative de l'association fentanyl-marcaïne et de la marcaïne seule.

A randomised trial was carried out to evaluate the use of a mixture of fentanyl with marcaine in epidural analgesia. Two series of 30 patients each were studied: in the first only marcaine was given for the epidural and in the second marcaine and fentanyl mixed. Stronger and longer analgesia was obtained in the series where fentanyl was added showing that local anaesthetics can be potentiated by opiates. There was no significant difference in the two series as far as the cardiovascular, respiratory and blood gas measurements were concerned, either in the mother or in the fetus.

[A review of six years use of a computerised case history in obstetrics (author's transl)]. / Bilan de six ans d'exploitation d'un dossier informatisé en obstétrique.

The University Centre for Gynaecology and Obstetrics in Toulouse have been using a computerised record system for obstetrics since 1974. This makes it possible for a review for a review to be undertaken each year of the work carried out in the Service and has made it possible to study over six years the evolution of the characteristics of the population who have been followed, as well as the changes in attitudes and techniques adopted during pregnancy and labour. A study has been carried out on the factors associated with perinatal mortality and prematurity. Computerisation of 13,500 records has made it possible to draw curves of birth weights, according to the duration of the pregnancy, and characterising the service given. Finally the adoption of a prospective record system used in common by several teams and checked by people specialised in this work has improved the quality and quantity of retrieval and has made it possible to foresee cooperative studies between different departments.