[Recommendations on the diagnosis of bronchial carcinoma. German Pneumology Society].
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Biomedical subjects
Publications and source records attributed to W Matthiessen.
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The pathogenetic role of Mycobacterium tuberculosis (M. tuberculosis) in tuberculosis is well defined, whereas its role in sarcoidosis is controversial. In sarcoidosis, activation of T-helper cells is observed, which is comparable to tuberculosis. The aim of this study was first to investigate whether M. tuberculosis DNA could be retrospectively detected in samples of patients with clinically verified sarcoidosis by polymerase chain reaction (PCR) and second, to analyze the relationship between M. tuberculosis DNA positive samples and T-cell response in sarcoidosis patients. Formalin fixed paraffin-embedded lung tissues or cell sediments of bronchoalveolar lavage, respectively, from 65 patients with sarcoidosis and lung tissues from 40 tuberculosis patients were investigated by means of different PCR assays in comparison to control samples. The primers used were derived from insertion sequence IS 986/6110 specific for the M. tuberculosis complex (123 bp PCR) and from the gene encoding the 38 kDa protein antigen b (419 bp PCR). The 123 bp assay yielded a specificity of 97% and a sensitivity of 95%. In contrast, the 419 bp PCR method showed a lower sensitivity of only 8% likely because of possible DNA degradation during fixation and embedding procedures of the tissue and the fact that this PCR uses a single copy element as target. We amplified the M. tuberculosis complex specific 123 bp fragment in 64% of samples from sarcoidosis patients. The specificity of PCR products in these cases was confirmed by DNA sequencing. Interestingly in the M. tuberculosis positive sarcoidoses, we found increased serum levels of soluble interleukin-2 receptor in correlation to the sarcoidosis stages (p < 0.05). In conclusion, the determination of M. tuberculosis by PCR alone does not permit a differentiation between sarcoidosis and tuberculosis. However these results support the contention that M. tuberculosis may play a pathogenetic role at least in the part of sarcoidosis patients with elevated interleukin-2 receptor values.
BACKGROUND: The CHART-bronchus trial sponsored by the Medical Research Council showed an improvement in survival of 10% compared to conventional fractionation to 60 Gy when patients with inoperable non-small-cell lung cancer (NSCLC) were treated with CHART to 54 Gy. At present it is not known whether this survival advantage holds when the dose of conventional treatment is increased and whether CHART can be replaced by the more practicable CHARTWEEL (CHART-weekend less). PROTOCOL OF THE TRIAL: A randomized multicenter trial of definite radiotherapy in locally advanced inoperable NSCLC was designed (ARO 97-1, Arbeitsgemeinschaft Radioonkologie der Deutschen Krebsgesellschaft). Conventional fractionation to 66 Gy (5 weekly fractions of 2 Gy) is compared with CHARTWEEL to 60 Gy (15 weekly fractions of 1.5 Gy, Monday to Friday, interval between fractions > or = 6 hours, overall treatment time 2.5 weeks). The main endpoint of the trial is overall survival. It was calculated that an entry of 665 patients is needed to detect an improvement in 2-year survival of 10%, the actual time is estimated to be 5 years or less. The trial was activated on 1.9.1997.
The chest radiograph of a 35-year-old man with fatigue, exertional dyspnoea and haemoptyses revealed a cavity in the left upper lobe and a shrunken left lung with radiolucency greater than that on the right. Acid-fast rods in sputum were identified as Mycobacterium kansasii on culture. Scintigraphy showed a 9% residual perfusion on the left and abnormal ventilation, compatible with Swyer-James syndrome. This had favoured the development of a mycobacterial infection. There was also a decrease in ciliary function (rate of 4-7 Hz, normal: 10-11). Treatment, begun when tuberculosis had been suspected, was after sensitivity tests changed to a combination of rifampicin (600 mg), ethambutol (1600 mg) and protionamide (500 mg) daily. There was marked regression of the findings within 4 weeks, but treatment was prematurely stopped after 11 months. Two years later there was a recurrence which again responded well to the same drug regimen with additional sulphamethoxazole (1600 mg/d).
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Fibrocystic changes in the upper lung lobes are a rare visceral manifestation of ankylosing spondylitis. The impaired bronchopulmonary clearance in bronchial, pulmonary or pleural cavities predisposes to secondary microbial colonisation. Two cases are reported--one patient proved to have non-tuberculous mycobacterial disease caused by M. kansasii, the other developed an aspergilloma.
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Fifty-three patients with inoperable non-small cell bronchial carcinoma were treated at four-weekly intervals with two cytostatic drugs, doxorubicin (50 mg/m2 on day 1) and ifosfamide (2000 mg/m2 on days 1-3). To avoid urotoxicity of ifosfamide, mesna, a uroprotective drug, was additionally given intravenously at a dose of three times 400 mg/m2 on days 1-3. All diagnoses had been histologically and/or cytologically confirmed. Adenocarcinoma was present in 22, large-cell undifferentiated carcinoma in 18, and squamous-cell carcinoma in 13. Distant metastases were present in 46, seven had a regionally localized tumour growth. There were one complete and 20 partial remissions (response rate 40%). Among a further 19 patients temporary growth arrest was registered. The remissions occurred in seven with adenocarcinoma, nine with large-cell carcinoma and five with squamous-cell carcinoma. Median remission was 8.3 months, mean survival time 10.5 months. Patients without response survived a mean of 5.5 months, patients with tumour progression for 1.3 months (Kaplan-Meier method). Most prominent among side-effects were cardiotoxicity and infection during the leukopenic phase. Urotoxicity was minor, due to treatment with mesna. The results suggest that doxorubicin and ifosfamide in combination can be considered an effective means, with acceptable toxicity, of treating advanced non-small cell bronchial carcinoma.
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5 patients with inoperable bronchogenic carcinomas on a weekly therapy with a low dose of bleomycin (BL) plus irradiation with high-energy electrons, were analysed cytogenetically by cultivating peripheral lymphocytes taken immediately before the BL treatments and some hours before the irradiations. For the induction of dicentric chromosomes, linear dose-effect relationships were found: 3 of the patients responded with similar dose-effect relationships. The other 2 were different: they were not comparable with those 3 or with each other. These results were unexpected because all 5 patients received similar types of treatment.
Ethambutol is said to be capable of elevating serum urate concentration. This statement was reconsidered in three investigations using strictly supervised administration of ethambutol in a single daily dose of 25 mg. per kg. of body weight: (1) In short term administration 10 healthy subjects received ethambutol for eight days. (2) In a pilot study 13 patients suffering from pulmonary tuberculosis were treated with a triple combination including thambutol for six months. (3) In a controlled trial 23 patients were randomly allocated to one of the following regiments: In the first group patients received ethambutol plus isoniazid plus rifampicin for six months. In the second group patients received streptomycin plus isoniazid plus PAS for three months and thereafter streptomycin plus isoniazid plus ethambutol for another three months. Serum urate concentrations and clearances of uric acid and of creatinine were determined periodically in all subjects. A slight increase in serum urate concentration occurring in long term therapy showed no relation to ethambutol administration, but was obviously dependant on parameters related to the course of the disease in form of increase in body weight and physical activity, or related to the well known syntropy of chronic alcoholism and tuberculosis.
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The records of 100 patients with morphologically proven breast cancer metastatic to the chest retrospectively were analysed. The following manifestations were found by evaluating roentgenographs of the chest and available results of endoscopy and biopsy which were carried out in most of the cases: solid pulmonary coin lesion, multiple pulmonary coin lesions, lymphangiosis carcinomatosa, bronchostenosis caused by cancer, mediastinal lymph node metastases. Since life expectancy in approximatively 70 per cent can be increased by chemotherapy the authors put emphasis on the importance of early diagnosis of metastatic breast cancer disseminated to the chest.
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