Diagnosis of fungemia in bone marrow transplantation patients by examination of peripheral blood smears.

Two patients who received BMT for treatment of severe aplastic and AML-M2, developed fungemia during leukopenia. The organisms responsible for the infections were Candida parapsilosis and Rhodotorula glutinis, respectively. Early diagnosis of fungemia in these two patients was made by visualization of fungal blastospores in peripheral blood (PB) smears. These two cases illustrate that cytologic examination of PB smears is a useful method for early detection of fungus infection in BMT patients with leukopenia and unexplained fever in spite of appropriate antibiotic treatment.

Combination chemoimmunotherapy with interferon-alpha and cisplatin in patients with advanced non-small cell lung cancer.

BACKGROUND: Non-small cell lung cancer (NSCLC) has a relatively low response rate to systemic chemotherapy. Recently, several investigations have shown that interferon may augment the cytotoxic effect of chemotherapeutic agents and may improve the result of chemotherapy in treating cancers. METHODS: An open-label noncomparative phase II study investigated the efficacy and safety of combined chemoimmunotherapy for NSCLC using IFN-alpha, given by intramuscular injection with 9 million units thrice a week for a maximum of 26 weeks, and cisplatin by intravenous infusion, 100 mg/m2, every 4 weeks for a maximum of 6 cycles. Ten patients, with histology-confirmed NSCLC at stage IV of their diseases were enrolled. They included 5 men and 5 women, with an average age of 53.7 year. Five of them had adenocarcinoma; the other five had squamous cell carcinoma. RESULTS: Five patients, including two patients with squamous cell carcinoma and three with adenocarcinoma, obtained a partial response (response rate 50%). The time needed to achieve a sustained response ranged from 5 to 13 weeks with a median of 8 weeks. The response duration ranged from 14 to 37 weeks with a median of 20 weeks. The overall survival time for the ten patients ranged from 2 to 20 months with a median of 8 months. All 10 patients needed dose modifications of IFN-alpha and/or cisplatin because of myelosuppression and/or impaired renal function. Other frequently encountered side effects included gastrointestinal disturbances and a flu-like syndrome, but these were well tolerated. CONCLUSIONS: These preliminary results indicate that chemoimmunotherapy with IFN-alpha and cisplatin can be an effective alternative therapy for patients with advanced NSCLC, but there are significant side effects.

Examination of pericardial effusions by cytology and immunocytochemistry.

BACKGROUND: Cytologic examination of pericardial effusions (PE) has been uncommonly reported in the literature. Fewer reports have studied the role of immunocytochemistry in diagnosis of PE. We described our experience, according to cytologic examination and immunocyto-chemical staining of PE. METHODS: Over a four-year period, 50 PE specimens from 36 patients were examined cytologically by Wright-Giemsa stain and/or Papanicolaou stain, at Tri-Service General Hospital. Immunocytochemical stainings were further performed to ensure the cell nature. RESULTS: Eighteen of these patients had benign etiologies; the others suffered from malignant diseases. Sixteen cases, including eight benign and eight malignant, received pericardial biopsy for comparison. Commonly encountered cells in PE with any kind of etiology included neutrophils, lymphocytes macrophages and mesothelial cells. Cancer cells were additionally seen in malignant PE, but not in all cases with cancers. Furthermore, reactive mesothelial cells and macrophages were sometimes not easily distinguished from cancer cells, and reactive lymphocytes frequently mimicked hematopoietic malignancies. Further, the nature of small round tumor cells can hardly be ensured by morphologic examination only. Immunocytochemical studies were successfully used to solve these dilemmas in some suspicious cases. CONCLUSIONS: This study showed that cytology together with clinical information and immunocytochemistry can achieve excellent sensitivity and specificity in identification of malignant PE. The use of immunocytochemistry can even ensure the nature of certain cancers such as small cell carcinoma and B cell lymphoma.