Induced sputum and cytological diagnosis of lung cancer

Diagnosis of lung cancer by examination of induced sputum specimens for malignant cells may be a valuable alternative to diagnosis by bronchoscopy. Patients suspected of having lung cancer were recruited and randomly distributed into two groups, one group (n = 34) having sputum induced by use of an ultrasonic nebuliser before bronchoscopy, and the other (n = 33) undergoing ordinary expectoration before bronchoscopy. 25 patients in the induced-sputum group were diagnosed as having primary lung cancer; induced sputum was positive for malignant cells in 21 of these patients (84%), whereas bronchoscopy was positive in 23 (92%) (not significantly different). In comparison, ordinary sputum was positive in 15 of 29 patients (52%) diagnosed as having primary lung cancer, whereas bronchoscopy was positive in 28 (97%) (p less than 0.001). Induction of sputum by an ultrasonic nebuliser was an effective procedure for diagnosis of primary lung cancer.

Ofloxacin in the treatment of lower respiratory tract infections: report of a prospective, comparative trial

The subjects were 241 patients with lower respiratory tract infections treated at two medical centers in Austria; 161 of the patients were evaluated clinically and, of these, 69 were evaluated bacteriologically. The patients were randomly assigned to receive ofloxacin (n = 101) or a comparison drug (doxycycline [n = 27] or amoxicillin-clavulanate [n = 33]). The mean age of patients in the ofloxacin group was 61 years; that of patients in the comparison groups was 64 years. The mean duration of treatment was nine days; most patients received the study drug intravenously for three days and then orally for four to seven days. In most patients, the doses were 200 mg of ofloxacin twice daily; 100 mg of doxycycline twice daily; or 2,200 mg of amoxicillin-clavulanate intravenously two or three times daily, followed by 625 mg orally two to four times daily. The clinical response was rated satisfactory (all pretreatment symptoms disappeared) in 28% of the ofloxacin-treated patients and in 22% of the other two groups; improved (all except one symptom improved) in 70% and 65%, respectively; and unsatisfactory in 2% and 13%, respectively. The bacteriologic response was rated satisfactory in 59% of the 39 evaluable ofloxacin-treated patients and in 50% of the 30 patients in the other two groups. Most of the unsatisfactory responses were associated with persistent strains of Streptococcus pneumoniae. Transient side effects of mild to moderate severity were noted in nine of the 101 ofloxacin-treated patients and in seven of the 60 patients in the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Differential diagnosis of necrotizing sarcoid angiitis: necrotizing sarcoid angiitis and collagen disease--a case report]

The chest x-ray showed a bilateral micronodular pattern and hilar lymph nodes. Lung function test revealed a diminished VC, TLC and a reduced compliance and CO diffusion capacity. The histological examination of the lung biopsy showed sarcoid-like necrotising granulomatous formations of the vessel walls and destruction of these. Unusual was the coincidence of a sarcoidal necrotizing angiitis and a connective tissue disease which presented as Raynaud's disease. Antinuclear antibodies and antibodies against SSA-RO and Scleroderma 70 were identified. The histological examination of the skin biopsy showed changes pertaining to scleroderma. In accordance with the definition by Laevitt (4, 5), this disease is a polyarteritis overlap syndrome.

[Wegener's granulomatosis with splenic involvement and Hashimoto's lymphomatous thyroiditis]

A case of a 37-year old female patient suffering from Wegener's granulomatosis is reported. The chest x-ray showed a tumorous consolidation of the right upper lobe and of the apical segment of the right lower lobe. The histological examination of the lung, the kidney and the spleen revealed necrotising granulomas typical of Wegener's granulomatosis. Additionally, a thyroiditis lymphomatosa Hashimoto was diagnosed. So far, coincidence of thyroiditis Hashimoto and Wegener's granulomatosis has not been reported in the literature. The involvement of the spleen was a rare manifestation of Wegener's granulomatosis.

A comparative study of ofloxacin and amoxycillin/clavulanate in hospitalized patients with lower respiratory tract infections

We conducted an open randomized trial to compare the efficacy of parenteral and oral ofloxacin with that of amoxycillin/clavulanate. A total of 121 patients was studied; 92 were clinically evaluable. Of these, 59 patients were treated with ofloxacin and 33 with the comparator drug. Patients were given the drugs intravenously for a minimum of three days followed by oral preparations for the next seven to ten days. Ofloxacin was usually administered as a 200 mg dose bd. In the ofloxacin treated group all patients showed clinical improvement. In the comparator group 94% improved clinically (either a complete or partial response), while 6% were clinical failures. Of the bacteriologically evaluable patients 19 of 20 showed a satisfactory bacteriological response in the ofloxacin treated group, while in the comparator group the bacteriological response was judged satisfactory in 14 of 17 patients. A small proportion of patients (7%) treated with ofloxacin suffered mild adverse effects (nausea, vomiting, headache, hypotension and rash). On the whole, ofloxacin was well tolerated by our patients. The two deaths that occurred were in the comparator group. We conclude that ofloxacin in both oral and parenteral forms is an effective and safe drug in the treatment of lower respiratory tract infections.

[Comparison of an oxygen-conserving module "Oxytron" and the reservoir cannula "Oxymizer Pendant" with continuous oxygen administration via nasal prong in hypoxemic patients]

High costs involved in administering continuous long-term oxygen therapy to patients with chronic lung diseases and limited portability of oxygen sources stimulated research into and development of oxygen conserving devices. Oxytron (Weinmann, Hamburg) is a new electronic demand oxygen delivery system which limits oxygen flow to the early phase of inspiration. The reservoir cannula Oxymizer Pendant (Chad-Therapeutics Inc.) is a nasal prong system incorporating a pendant reservoir which stores oxygen during expiration and delivers it as a bolus at the onset of inspiration. Ten patients with significant hypoxaemia at rest received oxygen delivered at various breath interval settings with the Oxytron method and at flow rates of 2, 3 and 41/min with the reservoir cannula Oxymizer Pendant and with continuous flow. The results indicate that significantly less oxygen was required to provide equivalent oxygen saturation with Oxytron as compared with steady flow delivery: an oxygen flow reduction of greater than 75% was achieved at all Oxytron settings tested. With the reservoir cannula oxygen saving was most evident at low oxygen flows: 29.3, 19.4 and 4.7% less oxygen was required than with continuous flow at 2, 3 and 41/min. Individual patient acceptance of various drug delivery systems and response to therapy should be considered when prescribing home oxygen therapy. The use of oxygen saving techniques could result in a substantial cost saving and greater mobility may help to improve compliance in patients requiring continuous oxygen therapy.

Serum neuron-specific enolase is a useful tumor marker for small cell lung cancer

Small cell lung cancer (SCLC) may be potentially curable. A correct diagnosis of cancer cell type is important and serum markers are of great value. Although several markers have been suggested, they have been of limited value because of insufficient specificity. To assess the value of serum neuron-specific enolase (S-NSE) as a possible marker of SCLC, the serum levels of 81 patients with SCLC (59 patients with extensive disease and 22 patients with limited disease) were compared with the serum levels of patients with non-small cell lung cancer (N-SCLC) and 93 patients with nonmalignant lung diseases. The S-NSE level also was measured in 104 patients with extensive disease of various other malignancies, including 71 solid tumors and 33 malignant hematologic disorders. From 105 healthy control subjects, the upper limit of the normal range (x + 2 standard deviations [SD]) was determined as 12.3 ng/ml. The S-NSE level was elevated in 78% of patients with SCLC, including 11 of 22 (50%) with limited disease and 52 of 59 (88%) with extensive disease. In contrast, the S-NSE level was raised only in 18% of patients with advanced N-SCLC (nine of 50) and 6% of patients with nonmalignant lung diseases (six of 93). Twelve patients (17%) with other solid malignant tumors and two patients (6%) with malignant hematologic disorders had raised S-NSE levels. Serial N-NSE levels were obtained in 13 patients with SCLC. S-NSE levels fell in all patients responding to chemotherapy and increased again with progression of disease. Our results indicate that S-NSE seems to be specific for SCLC (85%), whereas sensitivity seems to be dependent on the stage of disease. Further, S-NSE may be a useful marker for monitoring treatment and predicting relapse in patients with SCLC.

[Effectiveness and tolerance of disodium cromoglycate capsules in pellet form]

The efficacy of, and tolerance to lactose-free sodium cromoglycate capsules was investigated in a multicentre trial. Data of 154 patients with asthma treated at 41 centres were evaluated over an observation period of 5 weeks. During treatment there was a significant reduction in the required dosage of concomitant medication, a marked improvement with regard to the severity of symptoms and a significant increase in peak flow rates. Assessment of treatment was "good" or "very good" in 86% of patients. Mild side effects such as cough or throat irritation were seen in only 2.6% of patients.

[Prevalence of malignancy in preoperatively undetermined solid round lesions]

We report on 20 patients submitted to surgery, with an average age of 53.9 years (+/- 8.8), in whom solitary pulmonary nodules were not amenable to preoperative diagnosis on the basis of biopsy material. It was shown that 35 per cent of the unclear solitary lesions were malignant. Provided that the medical risks of surgery can be justified, surgical clarification via a thoracotomy in patients in this age group is indicated.

[Effect of stress ulcer prevention on the incidence of ventilation pneumonia at a pulmologic intensive care unit]

In a retrospective analysis, the influence of stress ulcer prophylaxis on the incidence of ventilation pneumonia (VP) was investigated. In VP, we were able to isolate enterobacteria from the tracheal aspirate or bronchial secretion significantly (p = 0.015) more frequently than in the case of environmentally acquired and nosocomial pneumonia which were treated in the intensive care unit but did not comply with the criteria for VP. The detection of intestinal bacteria in the respiratory tract in VP patients supports the hypothesis that the "gastro-pulmonary" colonisation pathway represents a decisive factor in the development of VP. Patients undergoing long-term ventilation who had received ranitidine for prophylaxis of stress ulcer, developed VP statistically significantly more frequently (p = 0.044) than did patients with sucralfat cover. The non-physiologically high acid juice pH associated with the use of H2-antagonists leads to an increase in intestinal organisms within the stomach. By ascending the upper GI tract, the bacteria finally colonise the respiratory tract. Through the application of sucralfat, whose ulcerprotective action is not achieved by the inhibition of acid in the stomach, the incidence of VP in a pulmological intensive care unit was reduced.

[The significance of nonspecific bronchial hyperreactivity]

The bronchial hyperreactivity is the cause of dyspnea in asthmatic subjects. The bronchial hyperreactivity is caused by the allergic "late-reaction". Inhalative bronchial challenge tests by metacholine prove bronchial hyperreactivity. The therapy of the bronchial hyperreactivity consists in systemic and local corticosteroids and dinatriumcromoglycate. One of these substances should be part of the basic therapy of every asthmatic patient.

[Immunocytochemical studies in the diagnosis of pulmonary histiocytosis X]

The diagnostic value of immunocytochemical tests was analysed for 19 cases of pulmonary histiocytosis X (PHX) and eight of other types of fibrosing pulmonary disease (sarcoidosis, 3; exogenous allergic alveolitis, 3; chronic pneumonia, 1; fibrosing alveolitis, 1). The cellular, proliferative-fibroblastic and fibrocystic stages in the course of pulmonary changes were differentiated. PHX cells reacted with anti-S 100 protein in all stages. In three cases for which unfixed tissue was available, all PHX cells reacted with antibody Leu-6, and 35% of these cells also reacted with the proliferation marker Ki-67. The few S-100 positive cells from the eight controls were limited to peribronchial tissue. Thus the antibodies Leu-6 and S-100 are useful aids in the diagnosis of PHX.

Clinical experience with 1000 patients treated with cefetamet pivoxil

Clinical studies have been carried out world-wide on cefetamet pivoxil, a new orally active cephalosporin. This paper reports on the first 1000 patients treated with the antibiotic; another 505 patients received standard antibiotics, mainly cefadroxil and cefaclor, for comparison. The results show that single doses of 1500 and 1200 mg cefetamet pivoxil were fully effective in gonorrhoea. Comparative trials in uncomplicated urinary tract infection indicate a significant superiority of a single dose of 2 g cefetamet pivoxil (n = 158; 90.0% cure) versus 2 g cefadrox (n = 162; 77.0% cure). In complicated urinary tract infections, a comparable outcome was achieved with a single daily dose of 2 g cefetamet pivoxil for 10 days (n = 99; 90% cure) and 1 g cefadroxil twice daily for 10 days (n = 98; 76.5% cure). The clinical response rate in acute exacerbation of chronic bronchitis was 89.4% in the group receiving cefetamet pivoxil (136 patients) and 83% in the cefaclor-treated group (n = 122). Treatment with 1000 or 2000 mg cefetamet pivoxil achieved a (bacteriological) success rate of 96% compared to 95% with cefaclor in acute ear, nose and throat-infections (n = 91). Overall, based on 894 isolated pathogens prior to therapy, the bacteriological response rate was 90% and it would appear that in vivo the spectrum of this cephalosporin covers a wide range of Gram-negative and Gram-positive pathogens, including urinary pathogens, but excluding Enterococci and Pseudomonas. Cefetamet pivoxil proved to be well tolerated. Mild to moderate adverse events were reported in 7.1% of patients but only 2 of the 1000 patients treated with cefetamet pivoxil were withdrawn because of diarrhoea, which subsided rapidly. There were no clinically relevant deviations in laboratory parameters.

[Comparison of the effectiveness of ceftazidime and cefazolin/tobramycin in patients with inflammatory diseases of the lower respiratory tract]

We compared the efficacy of ceftazidime and cefazolin in combination with tobramycin in the treatment of lower respiratory tract infections. Bacterial pathogens were isolated from sputum or bronchial secretions from 92 patients. The clinical results were identical in both groups: All patients showed an improvement of the clinical symptoms or were cured. 88% of the patients in the ceftazidime-group and 76% of the patients in the cefazolin/tobramycin-group showed an eradication of the pathogens without superinfection. This difference was not statistically significant (p = 0.095). Monotherapy with ceftazidime was clinically and bacteriologically as effective as a combination therapy with cefazolin and tobramycin.

[Correlation of clinical, roentgenologic and functional findings with cell distribution in bronchoalveolar lavage]

Bronchoalveolar lavage cytology in patients with sarcoidosis revealed a high relative lymphocyte count (28.4 +/- 22.4%), a manifestation of lymphocytic alveolitis. The extent of this alveolitis does not correspond with the clinical findings (symptomatic and asymptomatic patients), nor the chest radiological findings (with or without pulmonary involvement), nor the pulmonary function tests (normal or reduced vital capacity, FEV1 and compliance). A very high relative number of lymphocytes can be found in symptomatic patients with extrapulmonary manifestation of the disease. Clinical, radiological and functional findings in sarcoidosis do not reflect the extent of the lymphocytic alveolitis. Hence, distribution analysis of the cells obtained on bronchoalveolar lavage supplements the usual diagnostic investigations in patients with sarcoidosis.

[Idiopathic fibrosing alveolitis: correlation of the clinical, roentgenologic, hematologic, serologic and functional findings with cell distribution in bronchoalveolar lavage]

Bronchoalveolar lavage (BAL) in patients with diffuse idiopathic interstitial fibrosis showed a high increase in the relative number of neutrophils and a moderate increase in the relative number of lymphocytes. The relative number of neutrophils and lymphocytes found on BAL did not correlate with duration of the disease, nor with the normal to pathological auscultatory findings, nor the chest X-ray appearance of reticulonodular densities with or without alveolar filling, nor with the haematological and serological findings (moderate to high erythrocyte sedimentation rate (ESR), normal to pathological alpha 1, alpha 2 and beta globulin and LDH), nor with the moderate to high reduction in vital capacity and pulmonary compliance. Examination of the BAL cellular distribution is a useful supplement to the determination of conventional parameters in the diagnosis of diffuse idiopathic interstitial fibrosis.

[Pulmonary histiocytosis X]

Four patients, aged between 17 and 56 years, were found to have pulmonary histiocytosis X. Radiologically they had reticulo-nodular increases in density and cystic changes in the lungs, especially in the upper fields. Pneumothorax and bone lesions were common. Despite the employment of transbronchial lung biopsies, open lung biopsy was almost always necessary to confirm the diagnosis. Broncho-alveolar lavage in one patient revealed 28% lymphocytes: T-suppressor cells predominated over T-helper cells (49% and 45%, respectively). Cell distribution returned to normal after steroid treatment.

[Tinidazole in the therapy of anaerobic pulmonary infections]

The purpose of the study in 10 patients with anaerobic lung infections was to demonstrate the efficacy of therapy with Tinidazole. In 9 patients, the clinical evaluation as well as X-ray and bacteriological evidence showed positive results of therapy, while in one patient a mixed anaerobic infection with Streptococcus an., Bacteroides frag., and Clostridium sp. was still present after the end of therapy. Side effects were not observed with Tinidazole therapy.

A comparative study of the efficacy of ceftazidime versus cefazolin and tobramycin in patients with acute exacerbations of chronic bronchitis

Fifty-nine adult patients have entered this study. The initial pathogens were eradicated from the infection sites and all except two of the patients who were assessed clinically in the ceftazidime group and 4 cases in the comparative group were cured or improved. No adverse reactions were connected to ceftazidime or to tobramycin and cefazolin.

[Therapy of chronic fibrosing alveolitis (author's transl)]

The treatment with steroids, spironolactone, immunosuppressive drugs and D-Penicillamin is studied in 25 patients suffering from fibrosing alveolitis. A clinical improvement and an improvement of vital-capacity and total-capacity is seen, but no change in atrerial blood gas tensions.

[Diagnosis of retroperitoneal and intrathoracic Schwannomas (author's transl)]

Retroperitoneal and intrathoracic Schwannomas are difficult to diagnose in the preoperative stage. The following methods of examination may be used: 1. X-ray examinations to exclude diseases of the internal organs and to establish displacements.--2. Computertomography to determine localisation and size of the tumour.--3. Immediate section for microscopic examination under surgery to determine the dignity of the tumour and needlebiopsy with histological and cytological examination to obtain an exact diagnosis.