Post-operative intrapleural BCG in lung cancer.
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BCG Vaccine↗
Biomedical subjects
M R Law
Publications and source records attributed to M R Law.
Hospital-acquired infection with methicillin-resistant and methicillin-sensitive staphylococci.
In-patients at a London hospital over one year from whom the south-east England strain of 'epidemic' methicillin-resistant Staphylococcus aureus (MRSA) was isolated were compared with in-patients with strains of methicillin-sensitive Staphylococcus aureus (MSSA). MRSA were virtually entirely hospital-acquired; isolates before 10 days were uncommon and related to recent previous admission. Thereafter first isolates occurred at a fairly constant daily rate of about 1.9 per 1,000 in-patients. Acquisition of MSSA after more than 4 days in hospital occurred at a similar constant rate. Such strains were less likely to be penicillin-sensitive than strains isolated in the first 4 days after admission (11 vs. 22%) and were considered to be hospital-acquired. The single MRSA strain caused 40 infections in a year, about half of all hospital-acquired staphylococcal infections. Patients prescribed anti-staphylococcal antibiotics and patients with indwelling cannulae both had about a ninefold increased risk of acquiring MRSA. There was no reciprocal increase in MSSA infections after control measures had substantially reduced the number of MRSA infections.
Cross Infection↗
Methicillin-resistant Staphylococcus aureus: associated morbidity and effectiveness of control measures.
The strain of methicillin-resistant Staphylococcus aureus (MRSA) prevalent in south-east England produced in one acute hospital in a year 40 infections (bacteraemia, pneumonia and surgical wound, skin and urinary tract infections) with three attributable deaths. Rigorous measures succeeded in controlling the outbreak despite its extent, but our results suggest that less stringent measures could fail to control outbreaks of this scale. Several subsequent localized outbreaks within the hospital, probably caused by separate re-introductions of MRSA from other hospitals, were controlled by re-instigation of control measures on individual wards. The overall success of the intervention was shown by the decline in the incidence of MRSA infections from 27 in the 6 months beforehand to 2 in the most recent 6 months, and by the decline in the prevalence of colonization among patients 10 or more days in hospital from 52% immediately before the intervention to 3% 7 months after it. The incidence of attributable morbidity and death without control measures warrants a concerted effort to tackle the epidemic in all affected hospitals in Britain.
Cross Infection↗
Bleomycin-related lung damage: CT evidence.
Computed tomography (CT) examinations of the chest were evaluated in 100 patients treated with bleomycin. The CT findings were compared with those of conventional chest radiographs and lung-function tests. Lung damage due to bleomycin was detected in 38% of patients by CT, while damage was detected in only 15% by radiography. Changes in appearance seen on CT scans due to bleomycin damage were compared with measurements of lung volume and gas transfer per unit lung volume. There was good correlation between severity of damage shown on CT scans and changes in lung volume (P less than 0.01). Gas transfer capabilities were reduced in most patients regardless of changes observed on CT scans. Sequential CT studies showed that complete resolution of bleomycin damage may occur within 9 months in patients with minor or moderate damage. Residual abnormalities were seen in all patients with severe damage. CT can confirm lung damage in a patient with suspected toxicity but a normal chest radiograph and can define the anatomic extent of disease in a patient with an abnormal lung-function test.
Antineoplastic Combined Chemotherapy Protocols↗
Bronchoscopic implantation of radioactive gold grains into endobronchial carcinomas.
We report the results of palliative treatment of non-resectable obstructing endobronchial carcinoma by bronchoscopic implantation of radioactive gold grains in 18 patients. Dyspnoea and collapse of a lobe or a lung were successfully treated in 13 cases where tumour was locally confined to a main or lobar bronchus. The response was maintained until death in nine of these patients but obstruction recurred in four longer surviving patients with tumours of main bronchus after a mean interval of 6 months. Treatment was less successful in five patients with tumour extending onto the trachea. The low penetration of interstitial radiation offers the advantage that normal lung and other tissues are not damaged, so that the procedure can be used in patients previously submitted to external radiotherapy.
Aged↗
Immune function and survival in pleural mesothelioma.
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Adult↗
Malignant mesothelioma of the pleura: a study of 52 treated and 64 untreated patients.
We have carried out sequential prospective studies of treatment with surgery alone, chemotherapy, and radiotherapy in malignant mesothelioma of the pleura. The survival of treated patients was contrasted with that of 64 contemporary untreated patients whose clinical condition at presentation was comparable with that of the treated patients. Non-radical surgery alone (28 patients) was of palliative benefit, particularly for the control of recurrent pleural effusions, and may have prolonged survival in one patient with localised malignant mesothelioma. Chemotherapy with doxorubicin, vincristine, and cyclophosphamide (12 patients, with preceding surgery in eight) was without objective benefit. Megavoltage radiotherapy by an off axis beam rotational technique (12 patients, with preceding surgery in eight) abolished pain and dyspnoea and may have prolonged survival in one patient and terminated recurrent pleural effusions in three, but it was of no value in the other patients. There was no significant difference in survival between treatment groups or between treated and untreated patients, and no difference when mesotheliomas of epithelial, sarcomatous, and mixed cell types were examined separately. Treatment of this disease appeared to fail because of the unresponsiveness of the tumour to existing forms of treatment and the advanced stage of the disease at clinical presentation.
Adult↗
Malignant mesothelioma of the pleura: clinical aspects and symptomatic treatment.
A series of 140 patients with malignant pleural mesothelioma is reported. Clinical presentation was delayed in cases without a large effusion, but there was extensive tumour at presentation, shown by thoracoscopy, thoracotomy or computed tomography, in all patients investigated. Thoracoscopy was a useful diagnostic alternative to thoracotomy. With progression of disease, mesothelial extension was more important than distant metastases, which were usually too small and sparse to produce symptoms. Skin deposits of tumour in sites of previous invasive procedures did not cause pain or other clinical problems, and we consider that diagnostic and therapeutic procedures should not be withheld to avoid them. In the management of recurrent pleural effusions, intrapleural bleomycin, preceded by aspiration and followed by suction, was a useful alternative to surgery. Pneumothorax, spontaneous or iatrogenic, required decortication. Adequate pain relief was difficult; radiotherapy and nerve blocking procedures were not effective and opiates were often necessary.
Adult↗
Cefaclor and amoxycillin in the treatment of infective exacerbations of chronic bronchitis.
The clinical effectiveness of cefaclor 500 mg three times daily in the treatment of acute infective exacerbations of chronic bronchitis has been investigated by a double-blind comparison with amoxycillin in the same dose in 30 in-patients and 50 out-patients. The two antibiotics were equally effective, in terms of resolution of presenting symptoms, sputum conversion and fall in 24 h sputum weight. Side effects were infrequent. Serum and sputum concentrations of antibiotics and 24 h urinary recovery were measured in 27 patients. Concentration of both cefaclor and amoxycillin was found to be significantly lower in mucoid sputum than in purulent sputum, in contrast to earlier reports in the case of amoxycillin. No clinical advantage was apparent for patients achieving higher sputum concentration of either antibiotic.
Aged↗
Evidence for longer survival of patients with pleural mesothelioma without asbestos exposure.
In a group of 23 patients with histologically confirmed malignant mesothelioma of the pleura who could not recall exposure to asbestos dust, survival was significantly longer than in a group of 83 patients with known exposure. Asbestos bodies were found by a quantitative method significantly less frequently in the unexposed than in the exposed group. The longer survival of patients without known exposure could not be correlated with any significant difference in the histological cell types of the tumours from those of exposed patients. In the 83 patients with known exposure survival did not relate to duration of exposure. Consequently, although the tumours of patients unable to recall exposure may be caused by unrecognised environmental contamination with asbestos dust, the longer survival of these patients would suggest a different aetiology.
Adult↗
Computed tomography in the assessment of malignant mesothelioma of the pleura.
Computed tomography (CT) and plain radiography have been performed on 32 patients with malignant mesothelioma of the pleura, in order to assess the extent of disease and suitability for radical treatment. A comparison of the assessments by the two techniques is reported, with confirmation from either thoracotomy or post-mortem findings available in 16 cases. CT was found to be more sensitive than plain radiology in the detection of pleural effusions, although routine lateral decubitus radiographs has not been performed. The two techniques were equally effective in detecting involvement by tumour of the lateral chest wall, mediastinum and lung, with no false positive assessments by either technique, and few false negative assessments. Disease was shown to be extensive and gross at presentation in mesothelioma, so that the greater sensitivity of CT was of no advantage. Diaphragmatic involvement by tumour was accurately assessed by plain radiology but there were frequent false negative assessments by CT, possibly due to difficulty of interpretation of the curved diaphragm on the cross-sectional CT image. In this study CT offered little advantage over conventional radiology.
Adult↗
Malignant mesothelioma of the pleura: relation between histological type and clinical behaviour.
The differing clinical behaviour of malignant mesothelioma of different cell types was studied in 115 cases of pleural mesothelioma, classified histologically into epithelial (60), sarcomatous (25), and mixed (30). Epithelial mesotheliomas were associated with clinical features characteristic of carcinomas rather than sarcomas, including spread of tumour by direct extension, large pleural effusions, contralateral pleural effusions, ascites, metastases in regional lymph nodes, and occasional response to radiotherapy. Sarcomatous mesotheliomas were associated with clinical features more characteristic of sarcomas, with more frequent distant metastases, little or no effusion, and shorter survival. Mixed tumours had features of both, large pleural effusions occurring as frequently as with epithelial tumours, but survival being almost as poor as in sarcomatous cases. Despite these differences there is evidence from published reports that epithelial, sarcomatous, and mixed mesotheliomas have a common origin from mesothelial cells or their precursor cells.
Humans↗
Implications of histologically reported residual tumour on the bronchial margin after resection for bronchial carcinoma.
A group of 64 cases with histologically reported residual tumour on the bronchial margin after resection for bronchial carcinoma has been examined. Carcinoma in situ of the bronchial mucosa was described in nine cases, invasive carcinoma of the bronchial mucosa in 29, peribronchial malignancy in 18, and lymphatic permeation in eight. Survival with peribronchial malignancy and lymphatic permeation was poor. Nevertheless, the finding of earlier workers that residual mucosal tumour at the margin of the resected bronchus may not adversely affect survival has been confirmed. The reason for the prolonged survival of some patients despite reported tumours of the bronchial stump mucosa may be that such reports are sometimes artefactual, and two possible mechanisms for this are discussed.
Carcinoma in Situ↗
Value of radiotherapy for tumour on the bronchial stump after resection for bronchial carcinoma.
Two groups have been selected from 1000 patients who had lobectomy or pneumonectomy for bronchial carcinoma. The first group was of 26 patients with tumour affecting the mucosa of the resected bronchial margin reported histologically at the time of surgery. Twelve of these were given postoperative radiotherapy but with no apparent benefit, either in the incidence of recurrence of tumour at the bronchial stump or in five-year survival. The second group was of 17 patients who developed recurrence of tumour at the bronchial stump, bronchoscopically confirmed, some time after surgery. In six of these cases the recurrence was detected while it was confined to the bronchial stump region, and these patients were then given radiotherapy. Five of the six survived five years after radiotherapy, with complete eradication of the tumour recurrence confirmed by repeat bronchoscopy. In 11 cases the tumour recurrence was not detected until it had become more extensive. Radiotherapy may also have prolonged survival in some of these patients, although none survived five years.
Carcinoma, Bronchogenic↗
Complications of intrapleural BCG in the treatment of operable non-small-cell bronchial carcinoma.
Seventy-eight patients entered a randomized study of postoperative intrapleural BCG in the treatment of bronchial carcinoma. 39 patients received BCG (Tice strain), of whom 17 took isoniazid, and there were 39 controls. There was a high rate of complications related to the use of intrapleural BCG, in both isoniazid and non-isoniazid treated groups. Postoperative infections occurred in eight BCG treated patients and one control; seven BCG treated patients but only one control developed prolonged postoperative chest pain. Empyema developed six months postoperatively in three of the BCG treated group. Furthermore BCG conferred no survival advantage at one year. We considered the complications to be of sufficient severity and incidence to discontinue the study.
Adult↗