[Spurious hyperphosphatemia in multiple myeloma].

We present a 68-year-old woman with Ig A-K multiple myeloma and a laboratory report of extreme hyperphosphatemia (29 mg/dl), but no clinical manifestations attributable to such a high serum phosphorus. The hyperphosphatemia was demonstrated to be spurious and due to interference of monoclonal immunoglobulin with the phosphomolybdate calorimetric assay for phosphorus of some automated systems. In this case, after removal of serum proteins phosphorus values were normal. Normal values of phosphorus were also obtained with the phosphomolybdate calorimetric assay after reduction of paraprotein levels in this patient by chemotherapy. Knowledge of this phenomenon may obviate unnecessary testing and treatment. It may also suggest the presence of dysproteinemia.

Colonic pseudo-obstruction: a late complication of jejunoileal bypass.

Three cases of jejunoileal bypass, performed for morbid obesity, were complicated 3 to 4 years later by symptoms of colonic pseudo-obstruction. In each case the colon was enlarged, dilated and atonic with no demonstrable organic obstruction. In the patient with end-to-side anastomosis, the entire colon was dilated. In the two patients with end-to-end anastomosis, the dilatation affected the colon distal to the anastomosis with the defunctionalized small bowel. Treatment with antianaerobic antibiotics resulted in a dramatic disappearance of symptoms. It is suggested that bacterial overgrowth in the defunctionalized loops of small bowel may play an important role in the development of colonic pseudo-obstruction as a late complication of jejunoileal bypass.

Clinical course of acute atrial fibrillation treated with rapid digitalization.

Forty-seven episodes of acute atrial fibrillation (AF) in 45 patients were examined prospectively to determine the course of the disorder treated with rapid digitalization. Patients received 1.5 mg of digoxin intravenously over 12 hours. In 40 of the 47 attacks, reversion to sinus rhythm occurred with no additional therapy at 1 to 96 hours (median 4 hours) after beginning digoxin. In thirty-two patients, conversion occurred within 8 hours; only one patient showed important ventricular slowing before conversion. Thus, if digoxin facilitates conversion, it does not do so by slowing the ventricular response. Of the 11 patients still in AF at 16 hours, conversion subsequently occurred in only four who were receiving digoxin alone. We conclude that the prognosis for quick reversion to sinus rhythm in patients with acute AF treated with rapid digitalization alone is excellent. If reversion does not occur by 16 to 24 hours, additional measures to restore sinus rhythm are indicated.

Amyloidosis in immunoblastic lymphadenopathy.

A case of immunoblastic lymphadenopathy and systemic amyloidosis in a 21-year-old man is presented. The basic defect in immunoblastic lymphadenopathy is believed to be an abnormal immune reaction, most probably of the B cell system. Although systemic amyloidosis is common in some disorders of the B cell system, no cases of systemic amyloidosis complicating immunoblastic lymphadenopathy have been previously reported. Immunoblastic lymphadenopathy includes elements known to be associated with amyloidosis and we believe that this association is not merely coincidental.

Sheehan's syndrome with diabetes insipidus. A case study.

A case of a woman in whom Sheehan's syndrome and diabetes insipidus were found is presented. This association is very uncommon, but well-documented cases have been reported. Controversial opinions about the primary lesion still exist. To find out whether the pituitary gland responds to hypothalamic releasing factors, three kinds of test were performed. The failure of the pituitary to respond suggested pituitary damage. Because diabetes insipidus was present, presumably the hypothalamus was also damaged. A review of the literature and different opinions about the primary anatomic lesions in this syndrome are discussed.