Effect of a long-term fat-modified diet on serum lipoprotein levels of cholesterol and triglyceride in patients on home haemodialysis.

1. Changes in serum total and lipoprotein fraction triglyceride and cholesterol levels were studied in 24 adults on home haemodialysis. Half the patients were randomly allocated to a low cholesterol (mean 200 mg/day), fat-modified diet (mean polyunsaturated/saturated fat ratio of 1.0 with a mean of 43% of the total energy content derived from fat). 2. Before dietary manipulation, triglyceride levels in all lipoprotein fractions were significantly higher (P less than 0.02) than in a control group of age and sex matched normal subjects. Total cholesterol, very-low-density-lipoprotein (VLDL) and low-density-lipoprotein (LDL) cholesterol were also significantly raised (P less than 0.02), but high-density-lipoprotein (HDL) cholesterol was normal. In the patients on a fat-modified diet triglyceride levels did not alter in any of the lipoprotein fractions. Total cholesterol and LDL cholesterol levels fell significantly into the normal range (P less than 0.002 and less tha 0.001 respectively) but VLDL and HDL cholesterol levels did not change. 3. Hypertriglyceridaemia is the most common lipid abnormality in patients with renal failure and a long-term fat-modified diet is, therefore, of limited therapeutic importance in these patients unless there is a low HDL/LDL cholesterol ratio.

Chemotherapy in pancreatic cancer: results of a controlled, prospective, randomised, multicentre trial.

Forty patients with inoperable pancreatic cancer were included in a prospective, randomised, controlled trial of multiple chemotherapy. The survival of 19 untreated control patients was compared with that of 21 patients who received an initiation course of intravenous fluorouracil, cyclophosphamide, methotrexate, and vincristine given over five days followed by intravenous fluorouracil and mitomycin given over three or five days at six-week intervals thereafter. Median survival in treated patients was 44 weeks, which was significantly longer than the nine weeks seen in controls. In patients without metastases median survival was 48 weeks in the treated group and 12 weeks in controls. In patients with metastases it was 30 weeks in treated patients and seven weeks in controls. The treatment was well tolerated and seemed to confer a significant prolongation of survival, comparing favourably with previous reports of chemotherapy with or without radiotherapy. If the results are confirmed this regimen may be useful in district general hospital practice.

Does the nephrotic syndrome increase the risk of cardiovascular disease?

Cardiovascular mortality and morbidity were assessed, after a mean follow-up period of 5 years, in an unselected series of 159 adults presenting with the nephrotic syndrome between 1972 and 1975. 60% of the deaths were attributed to terminal renal failure, and the incidence of deaths from ischaemic heart-disease (IHD) was not significantly above normal. The proportion of patients experiencing angina and intermittent claudication and the prevalence of ischaemic electrocardiographic changes did not differ significantly from those of a London control population. At follow-up, hypertension was significantly more common (p less than 0.001) in male nephrotic patients than in controls. Earlier reports of a greatly increased incidence of IHD in unselected patients with the nephrotic syndrome were not confirmed. Routine treatment of hyperlipidaemia in the nephrotic syndrome is not, therefore, recommended.

Chemotherapy in advanced gastric cancer: a controlled, prospective, randomised multi-centre study.

Seventy-six patients with advanced gastric adenocarcinoma were studied in a prospecitive, randmoised, controlled trial using vincristine, methotrexate, cyclophosphamide, and 5-fluorouracil in an initiation course and mitomycin-C with 5-fluorouracil as maintenance therapy. Thirty-seven patients were inoperable and 39 had the primary tumour resected with histological evidence of residual disease. Survival in the inoperable group was short and showed no significant difference between treated and control patients. The median survival times for treated and control groups were 9.5 and 9.0 weeks respectively. In the resected patients there was no difference in ultimate overall survival between the groups but up to 20 weeks there was a suggestion that the probability of survival in treated patients was higher (P = 0.06). The patients were well-matched and it is concluded that chemotherapy has had an early effect but that a further trial with more detailed stratification, particularly of staging and histological grade, is needed. No patient received treatment for longer than two years and unacceptable toxicity occurred in only two patients. Nausea occurred more frequently in the treated group but was short-lived and clinically manageable.

Sex hormone changes underlying menstrual disturbances on haemodialysis.

Sequential changes in luteinising hormone (LH), follicle stimulating hormone (FSH), oestradiol (E2), progesterone (PROG), prolactin (PRL) and testosterone (T) were studied throughout the menstrual cycle in ten women on regular haemodialysis. At the time of study seven women were menstruating and three had secondary amenorrhoea. Only one patient had regular menses. In none of the 15 cycles studied was there a normal luteal phase with an adequate PROG rise, although 9 cycles (4 patients) had E2 changes suggesting that ovulation may have occurred. Increased PRL and T levels were found in 9 and 6 women respectively. These hormonal abnormalities can be related to the menstrual disturbances and explain the low fertility seen in these patients. Bromocriptine or prednisolone may prove useful in their treatment.

Home haemodialysis in children. Report of the London Children's Home Dialysis Group.

In January, 1973, a study was established to evaluate, prospectively and independently, the growth and psychosocial adaptation of children in end-stage renal failure treated by home haemodialysis at Guy's Hospital and the Royal Free Hospital. By January, 1975, 26 children had entered the study, but 2 died before they were established on home haemodialysis. In this paper a specified 1-yr period starting 6 mo after the onset of haemodialysis was selected for analysis. School attendance, diet, plasma-biochemistry, bone disease, growth, and emotional symptoms were investigated in each child. Rehabilitation was satisfactory, and average school attendance was 65%. Growth in all the prepubertal children was poor, whereas in most pubertal children it was adequate. At the end of the year, only 5 children were emotionally disturbed, but half the families had stress symptoms. The children at Guy's Hospital were dialysed more intensively than those at the Royal Free Hospital, and they had significantly lower mean plasma urea and creatinine concentrations and a greater energy and protein intake. On the other hand, the children at the Royal Free Hospital had a better school attendance. We conclude that home haemodialysis is an acceptable treatment for children in end-stage renal failure.