138 Abstracts/Lung Cancer 10 (1993) 123-150

single centre have been analysed. Full protocol doses were employed throughout with no dose reduction at&r episodes of severe or life- threatening sepsis (SLTS). 50 (13 96) patients experienced 66 episodes of SLTS associated with 1978 cycles of chemotherapy (3.2% cycles affected). 20(5.2%)ptientsdiedduetosepsis(SD)ofwbomonly4had experienced SLTS with P previous cycle of treatment. The others died as a result of their first septic episode. A model comprising four variables, age (U 50 or > 50 years). Kamofsky performance stahw (KP 31 50 or > 50). treatment (two- or threedrug regimen) aad previous sepsis(SLTSornoSLTSwithpreviouscycles)wrsfoundtosPtisfactorily describe the incidence of SLTS and SD in the study population and once validatedinanotherpatieotgrwpsthismodel shouldallowideotiticatiation of high-risk individuals before treatment starts. If so, we propose that high-risk patients (age > 50 years, KP ?4 50, treatment witb three-drug regimen) receive 50% of protocol doses in the first cycle of treatment with escalation to 75 % and eventually 100 96 doses in subsequent cycles if sepsis does not supervene. Those. with one or two risk factors present t-a P relatively low risk of SLTS or SD and we consider that fidldose chemotherapy should be wed throughout in these individuals.

Paraneoplnstic limbic encephelopethy es a nonmetestatic complication of small cell llng - Amir J, Galbraitb RC. Littk Rock Diagnostic Clinic, loo01 Lik Dr. Little Rock, AR 72205. South Med I 1992;85: 1013-4.

A 52-year-old man who presented symptoms compatiblewith paraneoplastic limbic enwopathy (PLE) was found to have small cell lung cancer. Antineoplastic therapy resulted in complete remission. Because the neuropsychiattic symptoms are potentially reversible. it is

so-that treatmerIt-Carl be instituted. - .

How much brushing is enough for the dingno& of lon# tomom? Popp W, Me&Is M, S&e&r B, Rawcber H, Ritscbka L, Zwick H. Pttlmmmy~nt. KHdm stadt wkd.aim. wolkersbergentmuse 1. A-1130 Iricnna. Cancer 1992;70:2278-80.

Ltac&gnwnd. Brcmcboscnpic investigations of lung tumors require high diagnostic accuracy. Sometimes the combiition of brush biopsy with cytologic and histologic examination of fonxps~btained biopsy specimens hils to diagnose tumors. Techniques with a minimum-risk and low cost tiea reputed several tims could incrrnse the efficiency of tumor diaeoosis and heln to avoid rebnmchosco~v. Mu/w&

in 270 patients with pulmonary neoplrsiss using P flexible fiberoptic bmncho- mdded bv mdioemchic video fluomscotw. The results of

Singly, of tbe &&mats showed &l&want tindings. With repated brushing, the sensitivity of the diagnostic accuracy increpsedto89.6%.Inthepsriphsryofthsbronchialme,these~sitivity of brush biopsy was slightly lower in bmncboscopically invisible tumors. In 222 of 242 (91.7%) patients with pnsitive results of brush biopsy, there was agreement in the tinal typing of tumor morphology. Conclwion. For routine bmnchoswpy, repeated brush biopsy should be done to obtain the highest diagnostic yield.

DisgooskPndpFqFosticfsetorsiom~tplevsl~thelians: A retmspective analysis of sixty five patients Tammilehto L, Maasilta P, Kostianen S, Appelqvist P, Holsti LR, Mattson K. Department of Pdmonwy Medicine, Hekinki University Central Hospital, Haartmaninkatu 4. SFa2W Hekinki. Respiration 1992;59:129-35.

?hisre+wtisananalysisofthemedical recordsof patients registered betwea 1960 and 1980 at Helsinki University Central Hospital as having malignant pleural memtheiioma. 65 of 83 patimrr

dyspnea, cough, chest pain, fatigue aad weight loss. The median survival fromdiagnosisws 12months, and fromtheonset ofsymptoms 18 months. Clinical stage and performance stptus were significant prognostic factors. Hematogenous metastases were present at autopsy in most cases. Disease and performance stahrs therefore need to be well established and documented in clinical trials involving mesothelioma.

Monocytechemilmoin in patient9 with small cell lung cancer Hosker HSR, Ccrris PA. Chest Clinic. Hull Roy01 Infinnor, Alaby Road, Hull HVI. Lung Cancer (Tlw Netherkuuls) 1992;8: 193-202

A lucigettin-eahanced cbemiluminescence (CL) assay was wed to as- stimulated blood monocyte hmction in 25 patients with small cell lung cancer (SCLC) at diagnosis and 20 control subjects. Monccyte function was mmsured 6weeksIaterinl9oftbe25patieas with SCLC, immediately prior to the third pulse of cytotoxic chemotherapy. In addition, nine other patients with SCLC were studied in remission and 10 were shulied at relapse. CL responses in the SCLC group at diagnosis were similar to the control group. However, the 7 lwtieotswithexteasive$PgeSCU:hsdsignificantlydeprsssedmmocyte CL rwponsa compared to 18 patients with limited disease. Monocyte function at diagnosis showed P positive con&tion with subsequent response to chemotbempy and survival time. There were no differences inCLresponsebeforeslldduriogtrePt~twithcytoticcbemothempy. Patients in remissiott had lower CL values co@ to pre-treatment r and responses rose again in patients developing disease

Transient unileteral revaxe rmtilation/perfwion mismatch in P patient with lml# - Wataoabe N, Hinmo T, lnoue T, Matsumoto M, Griucbi N, Tateao M et al. Department of Nuckar Medicine, Gunma lJniwrdty Hospital, Maebmhi, Gmma 371. Clio Noel Med 1992;17:705-8.

The authors report a transient, unil&ral reverse veatilationl

perfusion (V/P) mismatch in a patient with squamous cell lung cancer. The tight lung wea well perlbsed but not ventilated (uniIateral reverse VIP mismatch). However, lung imaging performed 3 days later demonstratedtbePbsenceofbothperfusion~dventilntioa(V/PmPtch). Reverse V/P mismatch may be a tmnsieat process.

Surgery

Onehlllldredfonsefutise~Pentsundergoi~B~sssistedthoraric OpcnItiOns Lewis RJ. Cawavale RJ, Sisler GE, Mackenzie JW. IS5 Livingston Avenue, NewBrunswick. WaB901. AmThomc Surg 1992;54:421-6.

Video-assisted tbomcic surgery is P oew modality that allows visualization of and mxess to the intmtbomcic organs without making a thomcotomy incision. Gne hundred consecutive patients udenvmt 113 thoracic procedures using this technique. Eight wedge resections forme&xstaticle&ns,6pericprdialwindows, Ibmo&ogmiccystectomy, 4explorntionsoftheDottopulmoll~rywindow. I dexxwtication, Splawal sclemses, 8 bullous. ablations, 25 lung biopsies, I9 wedge resections for carcinoma, 9 explorations of the thorax, 3 lobectomies, 1 esophageal cystectomy, I4 wedge rtssctions for benign lesions, 4 plauectmnies, 1 excision of a neurogenic tumor, 3 mediitiwl explorations, and 1 imsgeduil1~dissstionwmperformsd.Thsrcw~nomortality.T~ patients had complications from which they recovered completely. Patients undergoing video-assisted thomic operations seem to have

reducedpostoperptive~,shorterhospitpliuti~,~quicLcrrecovery times. Currently. this new mxlality nppeam to have beneficial value for patieatq however, only timther expwimce will d&ermine its true

merits.

ofthisanalysis. Theremaining I8 (22%)patieats wereexcludedbecaux malignant mesotheliomn was only confirmed cytologically, or because the primary tllmor wan not P meaotbelioma. The ratio of mea to women was 2 : 1.30 of 65 (46 %) patients were not,+xvtt or not likely to have beea exposed to llsbestos. The main symptoms at presentation were

Survival aftex nse&ion of stage II non-small cell lung cancer MartiniN,BurtME.BainsMS,McCormackPM,RuschVW.Ginsberg RJ. 1275 York Awnuc, New York, NY 10021. Ann Tbomc Surg 1992:54:460-6.