Arthur A. Serpick

Effect of large intermittent intravenous doses of cyclophosphamide in lymphoma

Nineteen patients with generalized lymphoma were treated with large intermittent intravenous doses of cyclophosphamide. Five patients experienced a complete response, and 2 had a partial response. The median duration of complete response was 22 months. Toxicity was not intolerable. Published results of response rates in lymphoma to various chemotherapeutic agents are summarized. Factors which contribute to survival in patients with lymphoma are discussed. It is suggested that further evaluation of large intermittent doses of cyclophosphamide be made in view of the favorable results.

Antipyretic effect of indomethacin in patients with malignancy

The antipyretic effect of indomethacin in 30 febrile patients with malignancy was evaluated. Effective antipyresis was observed in 20 of the 30 patients. Responses were usually prompt and complete and side effects were reported infrequently. Defervescence was obtained much more frequently in those patients whose fever seemed related primarily to the neoplastic process rather than to a complicating infection. In eight patients indomethacin effected a defervescence after another antipyretic had failed to do so. The authors conclude that indomethacin should be considered as an alternate antipyretic in patients with malignancy complicated by fever.

Pulmonary embolus in acute myelocytic leukemia

Seven incidences of clinically significant pulmonary embolus in severely granulocytopenic and thrombocytopenic patients with acute myelocytic leukemia are reported. Each patient had received multiple platelet concentrate transfusions but showed no rise in post‐transfusion platelet count. The possible roles of granulocytopenia and ineffective platelet transfusion in facilitating pulmonary embolus are discussed. It is concluded that severe thrombocytopenia offers no protection against pulmonary embolus.

A reversible concentrating defect in predominantly unilateral renal Hodgkin's disease

Abstract The function of each kidney was assessed separately in a patient with predominantly unilateral renal involvement by Hodgkins disease. Initially, the greatly enlarged diseased kidney exhibited diminished concentrating ability, and its glomerular filtration rate was only 6 per cent of the contralateral value. After a three month course of cytotoxic chemotherapy, utilizing a combination of four drugs, the size of the affected kidney decreased substantially. Although the glomerular filtration rates on both sides remained unchanged, concentrating ability improved markedly on the diseased side. In addition, the relative rates of uric acid and potassium excretion normalized, as compared to the contralateral kidney. These data imply that the renal concentrating mechanism in disease may be affected by intrarenal parameters extrinsic to the remaining functioning nephrons, possibly by such potentially reversible factors as cellular infiltrate, edema and elevated renal interstitial pressure.

Effects of phenylalanine and related compounds on serum alkaline phosphatase assay

Abstract Human sera were assayed for alkaline phosphatase with and without the addition of l - or d -phenylalanine, p-chlorophenylalanine, chloramphenicol, or l - phenylalanine mustard using a phenolphthalein monophosphate substrate. Significant inhibition of phosphatase activity was observed at all concentrations of l - and d -phenylalanine. Enzyme activity was not decreased by l -phenylalanine, p-chlorophenylalanine, or chloramphenicol at therapeutic concentrations, but was decreased at higher concentrations (0.01 M) of p-chlorophenylalanine. Levo stereoisomerism and p-chloro substitution on the benzene ring of phenylalanine were associated with increased inhibition of phosphatase. Serum alkaline phosphatase from patients with liver disease (heat-stable enzyme and clinical parameters) and enzyme from patients with skeletal disease (heat- labile enzyme) were inactivated to similar degrees by the compounds tested. The degree of inactivation was greater than expected if only the intestinal isoenzyme were inhibited. Phenylketonuric patients may show artifactually low alkaline phosphatase activity if measured by this method.