Gemcitabine has substantial activity and acceptable toxicity in heavily pre-treated patients with advanced lymphoma. Further study is warranted.

Oral doses of F-AMP can achieve an AUC(0-24h) of 2F-ara-A similar to intravenous administration, with dose-independent bioavailability. The tablet will greatly enhance the use of F-AMP in a palliative setting.

Summary. Seventeen patients (aged 50-85 years) with relapsed or refractory non-Hodgkin's lymphoma (NHL, 10 patients) or chronic lymphocytic leukaemia (CLL, seven patients) were treated with a combination of fludarabine 25 mg/m 2 /d and cyclophosphamide 250 mg/m 2

Seventeen patients with previously treated Hodgkin's disease or non-Hodgkin's lymphoma (NHL) were treated with single-agent vinorelbine (Navelbine Pierre-Fabre Medicament) in an open study to assess the activity of this new-generation vinca alkaloid. Responses were obtained in four out of eight patients with Hodgkin's disease and four out of nine patients with NHL, including four patients who had been previously treated with high-dose therapies. Toxicity was very mild. The study demonstrates worthwhile activity and justifies the inclusion of vinorelbine in combination therapies for lymphoma.

Summary:We report a 38-year-old man who presented in 1998 with advanced multiple myeloma and newly diagnosed diabetes mellitus (DM). Subsequent BMT has been successful after conditioning with melphalan and total body irradiation, but significant ischaemic retinopathy has developed. Chemotherapeutic agents, total body irradiation, and DM are likely to have been co-factors in precipitating the rapid onset of retinopathy. Routine ophthalmic surveillance is recommended for all patients after BMT, particularly for those with additional risk factors for the development of retinopathy such as DM. Bone Marrow Transplantation (2000) 26, 695-696. Keywords: bone marrow transplantation; total body irradiation; diabetes mellitus; cotton wool spot; radiation retinopathy Case reportA 38-year-old man presented in June 1998 with advanced multiple myeloma (stage 3b) complicated by hypercalcemia and renal impairment. Initial treatment with infusional vincristine, adriamycin and dexamethasone (VAD) proved ineffective, but he achieved a partial response with intermediate dose melphalan (80 mg/m 2 i.v.).Type 2 diabetes was also diagnosed at the time of presentation, with a random blood sugar level of 29 mmol/l in the absence of ketonuria. Retinopathy was looked for and excluded at this time. Insulin was given, and he has since been maintained on twice daily insulin injections with good control of blood sugar levels.In July of 1998 he developed a left sixth nerve palsy, with MRI evidence of a large sphenoid sinus plasmacytoma obliterating the pituitary fossa. Clinical hypopituitarism was present and he received 10 Gy of radiotherapy to the pituitary fossa as a matter of urgency.

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The sensitivity and specificity of electrocardiographic (ECG) interpretation by a simple algorithm was compared with a computer read ECG machine. Clinical data and ECG findings on 264 consecutive patients admitted to a coronary care unit with suspected acute myocardial infarction were prospectively entered into an algorithm with 13 end-points. These end-points were compared with the interpretations of a computer read ECG machine (Marquette MAC PC). 86 patients (32.5%) had confirmed acute infarction. 85% of those with infarction had some form of ST elevation on their initial ECG. Patients with ST elevation presented earlier (4.9 +/- 4.9 versus 8.0 +/- 9.7 hours after symptom onset, p < 0.001), and were older (66.5 +/- 11.0 versus 62.0 +/- 12.5 years, p < 0.01) than those without infarction. According to the algorithm 94.2% of patients with infarction had some form of ECG abnormality, compared with 55.6% of those without infarction (p < 0.001). The area under the receiver operating characteristic (ROC) curve of the algorithm was 92.3% of the area of the graph. This was more (p < 0.01) than the area under the ROC curve of the interpretations of the computer read ECG machine (83.9%). Marked ST elevation with reciprocal changes was the most specific indicators of infarction (Likelihood ratio 51.7). The algorithm, therefore, was comparatively sensitive and specific in the early diagnosis of acute infarction.