[Severe lactic acidosis due to metformin therapy in a patient with contra-indications for metformin]. / Ernstige lactaatacidose bij metforminegebruik bij een patiënt met contra-indicaties voor metformine.

A 52-year-old woman with a medical history of diabetes mellitus type 2, chronic alcoholism and liver function disorders was hospitalized because of complaints of haematemesis, abdominal complaints and dyspnoea. This was due to a severe lactic acidosis caused by acute alcohol intoxication and the use of metformin. With bicarbonate infusion and haemofiltration, the lactic acidosis disappeared, but she developed a distributive shock with multiple organ failure and died 23 days after admission. Lactic acidosis is a rare but serious adverse effect of metformin. Almost all patients described had contraindications to the drug, like renal failure, liver disease, alcohol abuse, and intercurrent conditions causing hypoxia or ischaemia. It is important to be aware of the circumstances in which metformin should not be prescribed.

A phase II study of paclitaxel in heavily pretreated patients with small-cell lung cancer.

The purpose of the study was to delineate the efficacy and toxicity of paclitaxel (Taxol, Bristol Myers Squibb) in the treatment of drug resistant small-cell lung cancer (SCLC). Patients with SCLC relapsing within 3 months of cytotoxic therapy received paclitaxel 175 mg m(-2) intravenously over 3 h every 3 weeks. The dose of paclitaxel was adjusted to the toxicity encountered in the previous cycle. Of 24 patients entered into the study, 24 and 21 were assessable for response and toxicity respectively. There were two early deaths and two toxic deaths. No complete and seven partial responses (29%) (95%CI 12-51%) were observed and five patients had disease stabilization. The median survival (n = 21) was 100 days. Life-threatening toxicity occurred in four patients; in others (non)-haematological toxicity was manageable. Paclitaxel is active in drug-resistant SCLC. Further investigation in combination with other active agents in this poor prognosis group is appropriate.

Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs.

A double blind study was carried out in 51 patients suffering from lumbar root compression syndrome of 12 days to 36 weeks duration. All patients had signs, symptoms and radiological abnormalities related to a herniated lumbar disc. Each patient received an extradural injection of either 2 ml (80 mg) methyl prednisolone or 2 ml normal saline solution. Neurological examination and interview of the patients with the aid of a questionnaire before and after extradural injection failed to demonstrate any statistically significant difference in outcome between the two groups. At follow-up 14 +/- 6 months after extradural injection 58.3 per cent of the patients in the control group and 51.9 per cent of the patients in the treatment group had undergone surgical treatment with laminectomy. Our results indicate that a single extradural injection of methyl prednisolone (80 mg) is no more effective than a placebo injection in relieving chronic symptoms due to myelographically demonstrable lumbar disc herniation.