Pulmonary alveolar microlithiasis with an unusual radiological pattern

We present a case of pulmonary alveolar microlithiasis with an unusual radiological pattern in an an otherwise asymptomatic young woman. It was characterized by a reticulonodular pattern predominantly in the lower lung fields with Kerley B lines. The diagnosis was made by transbronchial lung biopsy. We found an otherwise asymptomatic brother with the same radiological pattern.

Tobramycin nephrotoxicity. A prospective clinical study

The nephrotoxicity of tobramycin given at a dose of 4·5 mg/kg/day for a period of 12 days to a group of 90 patients with a mean age of 62·9 years was studied. Toxicity was determined on the basis of 3 main criteria (oliguria <400 ml/24 hr, serum creatinine 0·4 mg increase over a minimum basal level of 1·2 mg/100 ml, BUN 5 mg increase over a minimum of 25 mg/100 ml); and 3 minor criteria (proteinuria, microhaematuria and cylindruria). These parameters were determined before treatment at 7, 10, 14, 17, 21, and 30 days afterwards. The age and coexistence of factors such as hypertension, diabetes, anaemia, cardiac insufficiency, shock and dehydration were considered. Nephrotoxicity level ranges from 3·3 to 38·8% depending on the criterion used, and is related to hypertension (P<0·001), age (P<0·005) and association with ampicillin (P<0·005). Nephrotoxicity was reversible spontaneously in 96·7% of the cases and no differences have been observed between patients with moderate renal insufficiency and those with normal renal function on the initiation of treatment.

[Hepatic involvement in boutonneuse fever (author's transl)]

Boutonneuse fever is a rickettsioses which is endemic in the Mediterranean countries. Since 1972 we have had the chance to study eight observations os this disease (6 in the last year) and our attention has been drawn by the constant hepatic involvement. This was biological in all cases and histopathologic in the five patients submitted to a liver biopsy. Functional liver tests showed an elevation of SGOT and SGPT in six patients, as well as of the alkaline phosphatase and/or gamma-GT in five. No signs of hepatocellular insufficiency were detected and posterior controls demonstrated a complete normalization of the analytical parameters. As regards the histopathologic findings the most important was the fibrous enlargement of the porta spaces with slight infiltration by round cells, hyperplasia of the Kupffer's cells, and accumulations of histiocytes and lymphocytes. In no patient did we observed epithelioid granulomas. The authors conclude that the hepatic involvement in boutonneuse fever is benign but very constant, which means that it ought to be known about and that it has no defined histopathologic patterns.

VP 16-213 (VP 16) and cyclophosphamide in the treatment of primitive lung cancer in phase M 1

Sixty patients suffering from primitive lung cancer in Phase M 1 were included in two successive chemotherapy Protocols, 30 patients to a group. The first of these (an attempt at cellular synchronization by combining VCR-Cyclophosphamide-Prednisone) is used as a historical group as compared to the second. In the second protocol the combination of VP 16.213 (100 mg/m2, po, day X 5 days) and cyclophosphamide (100 mg/m2, ev, day X 5 days) was attempted. The positive results obtained (more than 60% of the responses were above 50%) together with low toxicity was not accompanied by improvement of survival with respect to that observed in international medical literature. On the other hand, the number of cases studied--30 patients--was too low to permit a better evaluation of our results. Despite this fact, it seems appropriate to continue clinical investigation of the VP 16.213-Cyclophosphamide combination in lung cancer.