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Cancer and the kidney: renal complications of neoplasia
Betafactams Blood-brain barrier
Renal failure
Paraneoplastic syndromes leukemia
Platelets
Rubinstein Df3, Longo D: Peripheral destruction of platelets in chronic lymphocytic leukemia: recognition, prognosis and therapeutic implications. Am J Mad 1961; 71: 729-732.
Ly~h~ytfc
In patients with chronic lymphocytic leukemia and depressed platelet counts, it is important to discriminate between the fhrombocytopenia due to bone marrow replacement with abnormal lymphocytes and that caused by increased peripheral destruction of platelets. The former is due to progressive chronic iynrphocytic leukemia and, as a Rai StaQe IV, carries a poor prognosis. The latter, as illustrated in four patients seen at fhe National Cancer Institute, may be remediable by either splenectomy alone or splenectomy followed by immunosuppressive and antitumor therapy. In all four patients, survival was substantially longer than for patients whose condition was classified as Rai Stage IV. Tha importance of identify&r the subgoup of patients with chronic lymphocytic leukemia with reversible thromb~~o~ia is emphasized.
Continued on page A66
Various renal complications occur during the course of neoplastic disease. The therapeutic and prognostic implications differ according to the reversibility of both the underlying malignancy and the superimposed complications in the kidney. Since the mechanisms of renal failure vary signifi~tly in patients with different types of malignancy, it is essential to avoid Qeneralizations about etiologic factors or likely outcomes of the disease processes. The pathophysiologic abnormalities shouki be determined in each patient, and the reversibility of both the neoplastic and renal problems assessed before therapeutic decisions are made. This often requires a team effort by the internist, oncologist, nephrologist, urologist and, more importantly, the patient.
Fer MF, f&Kinney TD, Richardson RL, Hande KR, Oldham RK, Greco FA: Cancer and the kidney: renal complications of neoplasia. Am J Mad 1981; 71: 704-718.
Electrolyte abnormalities
Neoplasms
The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achiive bactericidal levels in purulent cembrospinal fluid. Because optimaf antibiotic therapy of meningftii occur when tha cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered. The newer cephalosporins or cephalosporin-type antibiotics (cefotaxima, moxala&m), by virtue of their marked activity against gmm+egative bacilli and their ability to achiive signifi~t CSF levels, merit serious cons~atfon as therapy for punitive baciltary meningitis. Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a gowing number of cases. In the goup presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures.
C~ai~ns Gram-negative aerobic bacilli
rneni~i~~
We measured three systemic markers of skeletal muscle oxygen availability-exercise VO,, mixed venous lactate concentration and oxygen debt-durfng submaximal exercise in 15 patients with heart failure both before and after hydralazine (nine patients) or isosorbide dinitrate (eight patients) administration. Hydralazine increased the cardiac output during exercise from 4.9 f 1.2 liter/min to 6.5 f 1.8 liter/min (pO. 10). lsosorbkfe dinitrate increased the cardiac output during exercise from 4.6 f 0.9 liter/min to 5.3 f 0.8 liter/min (p O. lo), does not enhance skeletal muscle nu~itional flow.
Meningitis
Gram-~atfve
Landesman SH, Corrado ML, Shah PM, Armengaud M, Sarza M, Cherubin GE: Past and current roles for ~e~losp~in antibiotics in treat~nt of meningitis. Emphasis on use in gram-negative bacillary meningitis. Am J Med 1981; 71: 693-703.
Exercise
Wilson JR: Circ~atory improvement after hydralazine or isosorbide &nitrate administration in patients with heart failure. Effect on metabolic responses to submaximal exercise. Am J Med 1981; 71: 627-633.
Nitrates
Heart failure
Renal failure
Paraneoplastic syndromes leukemia
Platelets
Rubinstein Df3, Longo D: Peripheral destruction of platelets in chronic lymphocytic leukemia: recognition, prognosis and therapeutic implications. Am J Mad 1961; 71: 729-732.
Ly~h~ytfc
In patients with chronic lymphocytic leukemia and depressed platelet counts, it is important to discriminate between the fhrombocytopenia due to bone marrow replacement with abnormal lymphocytes and that caused by increased peripheral destruction of platelets. The former is due to progressive chronic iynrphocytic leukemia and, as a Rai StaQe IV, carries a poor prognosis. The latter, as illustrated in four patients seen at fhe National Cancer Institute, may be remediable by either splenectomy alone or splenectomy followed by immunosuppressive and antitumor therapy. In all four patients, survival was substantially longer than for patients whose condition was classified as Rai Stage IV. Tha importance of identify&r the subgoup of patients with chronic lymphocytic leukemia with reversible thromb~~o~ia is emphasized.
Continued on page A66
Various renal complications occur during the course of neoplastic disease. The therapeutic and prognostic implications differ according to the reversibility of both the underlying malignancy and the superimposed complications in the kidney. Since the mechanisms of renal failure vary signifi~tly in patients with different types of malignancy, it is essential to avoid Qeneralizations about etiologic factors or likely outcomes of the disease processes. The pathophysiologic abnormalities shouki be determined in each patient, and the reversibility of both the neoplastic and renal problems assessed before therapeutic decisions are made. This often requires a team effort by the internist, oncologist, nephrologist, urologist and, more importantly, the patient.
Fer MF, f&Kinney TD, Richardson RL, Hande KR, Oldham RK, Greco FA: Cancer and the kidney: renal complications of neoplasia. Am J Mad 1981; 71: 704-718.
Electrolyte abnormalities
Neoplasms
The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achiive bactericidal levels in purulent cembrospinal fluid. Because optimaf antibiotic therapy of meningftii occur when tha cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered. The newer cephalosporins or cephalosporin-type antibiotics (cefotaxima, moxala&m), by virtue of their marked activity against gmm+egative bacilli and their ability to achiive signifi~t CSF levels, merit serious cons~atfon as therapy for punitive baciltary meningitis. Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a gowing number of cases. In the goup presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures.
C~ai~ns Gram-negative aerobic bacilli
rneni~i~~
We measured three systemic markers of skeletal muscle oxygen availability-exercise VO,, mixed venous lactate concentration and oxygen debt-durfng submaximal exercise in 15 patients with heart failure both before and after hydralazine (nine patients) or isosorbide dinitrate (eight patients) administration. Hydralazine increased the cardiac output during exercise from 4.9 f 1.2 liter/min to 6.5 f 1.8 liter/min (p
Meningitis
Gram-~atfve
Landesman SH, Corrado ML, Shah PM, Armengaud M, Sarza M, Cherubin GE: Past and current roles for ~e~losp~in antibiotics in treat~nt of meningitis. Emphasis on use in gram-negative bacillary meningitis. Am J Med 1981; 71: 693-703.
Exercise
Wilson JR: Circ~atory improvement after hydralazine or isosorbide &nitrate administration in patients with heart failure. Effect on metabolic responses to submaximal exercise. Am J Med 1981; 71: 627-633.
Nitrates
Heart failure