Complications of postoperative intrapleural BCG in lung cancer.

Sixty-four patients received bacillus Calmette- Guérin (BCG) in different dosages intrapleurally through a chest drain following resection for lung cancer. In 27 patients this procedure was followed by fever for a few days; the fever was attributed to the BCG. Late complications attributable to the BCG included recurrent fever in 4 patients, abscesses at the site of the drain in 4, wound infections in 2, consolidations on the chest roentgenogram in 3, 1 of whom had subsequent cavitation, and hemoptysis in 2. Side-effects were not dose-dependent. No relationship was found between the preoperative tuberculin response and the frequency or severity of complications. Treatment with isoniazid and rifampin failed to induce an apparent clinical response in patients with complications. We conclude that the intrapleural administration of BCG is not a safe procedure. The side-effects may considerably impair the patient's quality of life.

Pulmonary alveolar proteinosis: a complication in patients with hematologic malignancy.

We present the case of a patient with acute myeloid leukemia and secondary Pulmonary Alveolar Proteinosis (PAP), which is an underestimated cause of a persistent pulmonary infiltrate in patients with hematologic malignancies often accompanied by neutropenia due to therapy. Diagnosis is established by performing Periodic Acid-Schiff reaction (PAS) stains and transmission electron microscopy (EM) on bronchoalveolar lavage (BAL) fluid. We wish to stress the importance of the early recognition of PAP, which is potentially reversible, and routinely performing PAS staining on BAL fluid in patients with a hematologic disease especially myeloid disorders and a persistent lung infiltrate.

Lemierre's syndrome. Sepsis complicating an anaerobic oropharyngeal infection.

Previously healthy people without interfering conditions are rarely affected by anaerobic infections. We report a young patient with extended septic emboli in the lungs, after an episode of sore throat, due to anaerobic bacteremia with Fusobacterium necrophorum. The first description of oropharyngeal infection complicated by sepsis was given by Lemierre in 1936. Knowledge of Lemierre's syndrome should lead to early recognition and prompt action against this sporadic and possible fatal illness.

[Recurrent otitis media and mastoiditis due to atypical mycobacteria]. / Recidiverende otitis media en mastoïditis door atypische mycobacteriën.

An eleven-year-old girl was operated on due to right-sided chronic otitis media with effusion. After three months, an impressive enlargement of the mucosal lining developed, for which thorough debridement of the middle ear and mastoid was performed. Histological examination revealed a granulomatous inflammation, with negative Ziehl-Neelsen staining. Standard bacteriological cultures revealed no pathogenic micro-organisms. Three weeks later the same clinical picture developed, once again followed by extensive surgical debridement. After a thorough diagnostic work-up an atypical mycobacterium was found, namely Mycobacterium abscessus--formerly named M. chelonei subspecies abscessus. Following appropriate antibiotic therapy the patient was symptom-free. Mycobacterial infections should be part of the differential diagnosis of persistent otorrhoea.

Calcified lymph node metastases in bronchioloalveolar carcinoma.

A 45-year-old man was found by cytopathologic examination of bronchial washings to have bronchioloalveolar carcinoma. A computed tomography (CT) scan of the chest showed diffuse calcifications in the consolidated left upper lobe. Similar calcifications were seen in several mediastinal lymph nodes; these were shown by biopsy to be metastases with calcified psammoma bodies. When CT demonstrates diffuse calcifications in a bronchioloalveolar carcinoma, the finding of identical calcifications in the mediastinal lymph nodes should raise a strong suspicion of metastatic involvement.

Post-operative intrapleural BCG in lung cancer: a 5-year follow-up report.

Of a total study group of 99 patients 56 received intrapleural BCG in three different dosages (5 patients 16 X 10(6), 25 patients 32 X 10(6), and 26 patients 64 X 10(6) culturable particles) following resection treatment for lung cancer. This study group was compared with an historical control population, very closely matched with regard to age, sex, stage of disease, histology and type of operation. Although the clinical condition of the patients selected for BCG treatment was above average, no survival benefit ensued from the intrapleural BCG. On the contrary, disease-free survival in BCG receivers with stage I and II squamous cell carcinoma was shortened significantly at 2 years follow-up due to the earlier appearance of local recurrences, with the same tendency still present after 5 years. This observation suggests an enhancement of tumour growth by the intrapleural BCG treatment. This alarming phenomenon could be a warning to clinicians when planning clinical immunotherapy trials to be aware of the potentially deleterious effects of such treatment.

Combined modality treatment of short duration in small cell lung cancer.

Fifty-seven patients with small cell lung cancer (SCLC) (limited disease = LD in 23, extensive disease = ED in 34) received the combination of CCNU, cyclophosphamide, vincristine and methotrexate (CCOM). A mean number of only 6 (range 1-17) courses of chemotherapy were given. All LD patients received consolidation locoregional radiation (30 Gy) after two courses of chemotherapy. A complete response (CR) was obtained in 61% of LD and 12% of ED patients, and a partial response in 22 and 35% respectively. Median survival was 54 and 34 weeks for LD and ED respectively. Five LD patients survived more than 2 yr, three of them remaining disease-free 4 yr after the cessation of treatment. A subset of 12 LD patients achieving a CR after two courses of chemotherapy was randomized to receive maintenance chemotherapy or observation only after the consolidation radiotherapy. In this small-sized randomized trial maintenance treatment showed a significant decrease of the patients' quality of survival compared to no maintenance treatment. We conclude that combined modality treatment of short duration proved effective in SCLC. Future randomized studies are necessary to show whether prolonged chemotherapy has a meaningful impact on survival, or otherwise the resulting morbidity will plead against it.

Distribution of immunoglobulin-containing cells in the bronchial mucosa of patients with chronic respiratory disease.

Bronchi biopsy specimens of 42 patients with chronic respiratory diseases were studied for immunoglobulin-containing cells, using an indirect immunoperoxidase technique. The number of immunocytes was expressed per unit tissue section surface. The cells were located directly under the epithelium. In most biopsy specimens IgA-, IgG- and IgM-containing cells were demonstrable, with IgA- and IgG-containing cells in the majority. IgE-containing cells were found only in small numbers in biopsy specimens of a few patients. The presence of IgE-containing cells was nearly always accompanied by a high amount of mast cell-bound IgE in the bronchial mucosa. No correlation could be found between the number and class of immunocytes and clinical data.

Postoperative intrapleural BCG in lung cancer: lack of efficacy and possible enhancement of tumour growth.

Fifty-six patients out of a group of 99 with lung cancer received postoperative intrapleural BCG (Pasteur strain) in three different dosages (16 X 10(6) culturable particles (cp), 32 X 10(6) cp, and 64 X 10(6) cp). When comparing the whole group of 99 patients with a historical control group of 126 patients no statistically significant differences were found in survival and disease-free interval. The two groups were well matched in respect of age, sex, histology, stage of disease, and type of operation. Patients with epidermoid carcinoma stage I receiving BCG, however, did significantly worse than those who had not received BCG in terms of disease-free interval. This unfavourable trend was caused by earlier local recurrences rather than metastases. The possible phenomenon of enhanced tumour growth noted in or patients with epidermoid carcinoma stage I might be related to the dosages used in this study, but the different BCG strain used hinders comparison with other studies. We conclude that BCG has no beneficial effect on survival or on disease-free interval; possible enhancement of tumour growth in stage I epidermoid carcinoma was found.