239

the authors postulate that the high levels of GM-CSF found in the pleural fluid of these two pattents was produced by their tumors, and producuon ofGM-CSF by their lung cancers likely caused the leukocy- tosis with eosmophilia.

Effectiveness of planar image and single photon emission tomogra-

phy of thallium-201 compared with gallium-67 in patients with

primary lung cancer

Matsuno S, Tanabe M, Kawasaki Y, Satoh K, Urrutta AE, Ohkawa M et al. Department of Radiology. Kagawa Medical School, 1750-l

Ikenobe Mike-cho. Kagawa 761.07. Eur J Nucl Med 1992:19:86-95. A comparative study of planar images and single photon emtssion

tomography (SPET) of thallium-201 chloride and gallium-67 citrate was performed in 38 patients with proven primary lung cancer IO detect the primary lung tumour and to establish the presence of metastasis in the lung hilum and mediastinum. The rindings of planar images and SPET werecompared with the pathological findings after thoracotomy. It was shown that “‘TI studies were superior to 67Ga studies for evaluation of the primary lesion and lymph node metastases.

Pulmonary adenocarcinoma with intestinal-type differentiation

Weidner N. Department of Surgical Pathology, University of Califor-

nia at San Francisco. Box 0506. San Francisco, CA 94143-0506.

Ultrastruct Pathol 1992;16:7-10. A 44.year-old woman with a long history of smoking presented with

a single lung mass detected on routine chest radiographs. There were no other known primary tumors. Light microscopy showed a mucin- producing adenocarcinoma of bronchioloalveolar type. Furthermore, nogast~ointestinalprimary hasbeendiscovered I8 montbsafterdiscov- cry of the lung tumor. Electron microscopy revealed that tumor cells had microvilli containing abundant microfilamentous, dense-core root- lets that showed long extensions into apical cytoplasm. The microvilli were capped by numerous glycocalyceal bodies. These findings are similar to the ultrastructural features previously described as being specific for gastrointestinal adenocarcinomas metastatic to lung. The current case, however, suggests that the findings of glycocalyceal bodies and microvillous dense-core rootlets are not helpful in distin- guishing between primary and metastatic lung adenocarcinomas.

Surgery A rare cause of right heart failure after pneumonectomy

Tabone X, Georges JL, Le Pailleur C, Metzger JP. Vacheron A. Ciinique Cardiologique, llopital Necker, 149 Rue de Sevres, 75015

Pans. Ann Cardiol Angeiol 1992;41:23-5. The authors report the case of a 55-year-old patlent, hospitalized for

assessment of progressive right heart failure after left pneumoncctomy due to bronchial epidermoid cancer. Right cathetertzation showed a dip-shaped right ventricular plateau and equal diastolic pressures (DOP 21 mmHg, dtastolic pressure of the right ventricle 25 mmHg, capillary pressure 25 mmHg). A chest scan ruled out the possibility of pericardial invasion. Pericardial deconication was carried out on October 3, 1989. Six months later, the clinical signs of right heart fadurc had rcgresscd. Chronic constructive pericarditis (CCP) has been reported after cardiac surgery, but no cases have been rcpwted after pulmonary surgery. In the absence of radiotherapy or metastatic invasion, this case leads to a discussion of the possibility of either pericardial trauma dunng surgery or, more probably, a fortuitous association with tubercular CCP.

Prediction of postoperative pulmonary function following thoracic

surgery for bronchial carcinoma

Cordiner A, De Carlo F, De Gennaro R, Pau F, Florc FC. Forlanini

ffospital. Via Portuense 332, I-00149 Roma. Angiology 1991;42:985- 9.

At present surgery is accepted as the most effective mode of therapy for carcinoma of the lung. Because the lack of respiratory reserve is the major determinant of postoperative function, it is useful to identify the patlent, who is at significant risk. Eighteen patients with lung cancer (mean age = 56 f 6.5 years) were studied preoperattvely (preop) and postoperattve (postop) (three to four months after lung resectton) by sptrometry, measurement of arterial blood gases, and quanutalive lung scanning (pp”Tc). A predicted postoperative value of some variables was calculated by the formula: postop value = preop value x % function of regions of lung not resected. The correlation coefficient bctwecn the predicted (pred) and postoperatively observed (observ) values VC = vital capacity, FEV, = forced expiratory volume in 1 second) IS: VC pred/VC observ r = 0.83 p < 0.001 FEV, pred/FEV, observ r = 0.82 p -z O.oOl. The authors’ results agree with earlier reports and show that the method used can accurately predict the postoperatwe respiratory func- tion in pauents uqdergoing lung resection (pneumonectomy or lo&- tomy). A predicted FEV, of 0.8 L dots not permit a surgtcal program, because, below this level, carbon dtoxldc retention becomes more frequent and exercise intolerance 1s increasingly severe (poor quality of life). The method proposed to predict the postoperawe respiratory function LS stmple and routinely useful. The authors choose a pcrfusmn instead of ventilation scan, because the former provides similar prc- dictcd postoperative data, and can be done routmcly.

Chemotherapy Phase II study of weekly S-fluorouracil, cisplatin and vinblastine in

advanced non-small cell lung cancer

O’Dwyer PJ, Langer CJ, Walclak J, Levy MH, Padawc-Shaller K. Hudes G.R et al. Department of Medrcal Oncology. Fox Chase Cancer

Center, 7701 Burholme Ave., Philadelphia, PA 191 I I. Eur J Cancer 1991;27:1589-93.

The scheduling of chemotherapeutic agents may be tmportant in optimising their antrtumour actions. This has been explored m non- Hodgkin lymphoma, osteogenic sarcoma and bladder cancer wth Improved results using mtcnsive, weekly dosing schcmas. WC began a phase II study of cisplatin, 5-lluorouracil and vmblastinc m non-small cell lung cancer (NSCLC) on a weekly schedule. 38 patlents wtth advanced or mctastatic NSCLC were entered; 32 arc evaluable for response. I1 patients were treated with 5.fluorouracil I .5 g/m2 and vinblastine 4 mg/mz by 24-h continuous infusion, and cisplatin 30 mg/ m2 over 30 min, 6-8 h after the start of the mfus~on. Because of prohIbitwe myelotoxicity, the next 27 patients rcccwcd S-fluorouracll I.2 g/m2 and vinblastine 3 mg/m2. None had had prtor chemotherapy whale 6 had had previous radiation therapy. Myelosupprcwon was the predominant toxic effect. Other stde-effects included ncuropathy, dear- rhoca, mucositis, nausea and vomiting. 32 patients arc cvaluablc for response: tbcre have been 14 parual rcmtssions (44%). Rcsponsea have occurred chiefly in lung and lymph nodes. The median surwval on tbls study is 7 months, and responders did not hvc longer than non- responders. While this reglmcn is well tolerated by the maJortity of palients and has a response rate comparable to other actwc rcgtmena idenuficd in single Institution studies, surwval does not appear to be enhanced. WC conclude that the schedule mampulatlon descrrbed hcrc does not enhance the therapeutic index of these drugs m NSCLC.

A phase II trial of carboplatin in untreated patients with extensive

stage small cell lung cancer

Pallarcs C, Izquierdo MA, Paredes A, Sagarra AF, De Andres I_, Lopez JJL. Medical Oncology Unrt, Department of Oncology, fIaTpita de la

Santa Creu i Sant Pau, Avda Sant Antoni Ma Claret, 167 08025-B-

arcelona. Cancer 1991;68:40-3. Twenty-five untreated patients with extensive stage small cell lung

cancer (ESSCLC) were treated with carboplatin (CBDCA) (500 me/m’) given as a 24. hour infusion every 21 days. Thirteen patlents responded for an overall response rate of 52% (95% confidence hmlts, 32% to