Exertional myalgia syndrome associated with diminished serum ammonia elevation in ischemic exercise testing.

A 36-year-old man with chronic severe exertional myalgias had a normal serum lactate elevation and diminished serum ammonia elevation on an ischemic forearm exercise test (IFET). The IFET is commonly performed in the evaluation of patients with complaints of exertional myalgias, cramps, and rhabdomyolysis. The finding of a normal serum lactate elevation and a diminished serum ammonia elevation after ischemic exercise is usually considered indicative of myoadenylate deaminase deficiency. However, myoadenylate deaminase activity was normal in this man's muscle biopsy specimen. This case suggests that a diminished serum ammonia elevation in the IFET is not always indicative of myoadenylate deaminase deficiency, a disorder of ammonia production. A diminished serum ammonia elevation in the IFET could also reflect an impairment of net ammonia efflux from muscle into blood.

Clinical nuclear magnetic resonance imaging of the body.

NMR promises great advances in diagnosis and has delivered so much already that it is expected that in the future it will replace many applications of the currently used imaging modalities. Although x-ray computed tomography is continuing to advance in speed of scanning and resolving power, NMR will most likely soon eliminate its use in many studies of the central nervous system and also in many other areas of the body. The promise of combining topical spectroscopy with imaging is also exciting and should provide further information about metabolic processes of various organs. Progress in NMR is so rapid and the future is so bright that one of the great problems will be to develop a new breed of radiologists who are versatile in biochemistry, mathematics, and computers, as well as competent in morphologic anatomy and pathologic physiology. As time goes on, advances in NMR will be achieved only by teams of clinical and basic scientists encompassing multiple disciplines.

Effects of resination on actions of anorexigenic agents.

The salt and resinated forms of three anorexigenic agents, d-amphetamine, d,1-amphetamine, and phentermine were examined in rats using two test systems. Appetite depression was determined using a deprivation-induced food consumption test and central stimulatory activity was measured by a two-lever continuous avoidance responding task. Dose-response and time-response studies indicated that the resinated forms of all three compounds had a delayed onset of action as anorexigenic agents and a reduced degree of central stimulatory activity as compared to the salt forms.

Disseminated aspergillosis, Cushing's syndrome, and oat cell carcinoma of the lung.

Disseminated aspergillosis is a known complication of neoplastic disease; however, it is usually associated with neoplasms of the hematopoietic or lymphoreticular systems or with immunosuppressed states. We describe the previously unreported association of disseminated aspergillosis and Cushing's syndrome secondary to a corticotropin-secreting oat cell carcinoma of the lung, and we review the current literature on disseminated aspergillosis complicating neoplastic disease.