Changes in monocyte phagocyting activity after multi-agent chemotherapy in non-small cell lung cancer.

Changes in monocyte functions have been described in several human malignancies. The monocyte/macrophage system is known to play a crucial role in the rejection of tumor cells and phagocytosis represents an important defense mechanism used by these cells. This paper reports the adherence power and phagocyting ability (latex beads) of circulating monocytes in 20 patients with unresectable non-small cell lung cancer (NSCLC), stage IIIB or stage IV, before and after multiagent chemotherapy (carboplatin + etoposide + ifosfamide or cisplatinum + etoposide). We demonstrated that both monocyte adherence and phagocytosis were not affected in lung cancer patients before chemotherapy in comparison with healthy controls. After chemotherapy, a statistically significant decrease in monocyte count on day 4 (p < 0.05) and in their phagocyting ability on day 4 and 15 (p < 0.001 and p < 0.05 respectively) was showed. In addition, a statistically reduced monocyte adherence was found on day 4 (p < 0.05). The described impairment was prolonged but reversible. These changes in monocyte functions after chemotherapy could be due to a direct effect of the chemotherapy on these cells or to functionally immature cells circulating after myelodepression. The in vitro assessment of monocyte functions may be useful to better clarify mechanisms by which anti-neoplastic agents may act on immune functions and prevent adverse side effects.

Airway stenosis after tracheo-bronchial tuberculosis.

Primary endobronchial localization of tuberculosis without change on chest X-ray is a rare clinical entity, and bronchoscopic examination is most appropriate to reveal such an occurrence. A 38-year-old man and a 52-year-old woman underwent fibre-optic bronchoscopy many months after the onset of cough with poor sputum and dyspnoea on exercise, chest X-ray being normal. In both cases, a widespread granulomatous involvement of the tracheo-bronchial tree was found and cultures of bronchial wash grew Mycobacterium tuberculosis. Patients recovered after 6 months of combined anti-tuberculous and steroid therapy; the granulomatous lesions disappeared but stenoses were found in the trachea and/or main bronchi. In one case, CO2 laser therapy was performed with no improvement.

Dumbbell stone of prostatic fossa after prostatectomy. A combined ESWL and suprapubic percutaneous treatment.

We report our experience with a combined treatment of extracorporeal shock wave lithotripsy and percutaneous suprapubic lithotripsy for a dumbbell-shaped stone of prostatic fossa associated with multiple bladder calculi, in the same operative session. Because of the successful result, we believe the association of the two treatments for this complex calculus to be an easy, effective and minimally invasive method. ESWL should be considered for the primary management of these rare calculi, suprapubic percutaneous endoscopy can be helpful in rapid and complete removal of fragments.

Tracheobronchial involvement in 84 cases of pulmonary tuberculosis.

In suspected pulmonary tuberculosis (TB), tracheobronchial examination is required for patients with clinical and radiographic features consistent with tuberculosis disease but with negative sputum for Mycobacterium tuberculosis. We report the endoscopic findings of 84 patients who underwent fibreoptic bronchoscopy in recent years, and whose cultures of biological specimens grew M tuberculosis. Cough (86%) and fever (69%) were the most common symptoms, followed by sputum (67%), dyspnoea (30%) and haemoptysis (27%). Chest radiographic abnormalities were mostly localized (60%) with prevalence in the upper lobes; in two cases chest radiography was normal. Sixty two patients (74%) showed endoscopic abnormalities: 1) mucosal inflammation; 2) submucosal granulomas and polyps; and 3) stenoses. They were localized in 58% of patients and diffuse in 42%. Five patients were checked several times during the year following the diagnosis because of a high degree of tracheobronchial involvement. Only one subject recovered, whilst in the other four stenotic sequelae were found. Fibreoptic bronchoscopy confirmed its usefulness in the diagnosis of tuberculosis and in monitoring the course and the outcome of the bronchial tuberculosis involvement.

DNA flow cytometric studies of 66 human lung tumors analyzed before treatment. Prognostic implications.

To investigate the prognostic implications of DNA flow cytometry in human lung tumors, we analyzed specimens from patients with neoplastic and non-neoplastic lung disease. Most non-neoplastic and normal (taken at the resection border) lung samples yielded a single cell population with diploid DNA content (only two normal lung specimens from two cancer patients had aneuploid DNA content). At least one aneuploid cell subpopulation was seen in 91 percent of NSCLC and 50 percent on SCLC. To show intratumor heterogeneity, multiple-site sampling was done whenever possible in both primary tumor and metastatic sites, revealing a high incidence of multiclonality (50 percent). Although diploid tumors were rare, they associated with a higher survival rate than aneuploid monoclonal and multiclonal tumors with hypoploid and/or hypertetraploid clones, which had the lowest survival. Cellular DNA content analysis in patients with lung tumors may be useful in prognostic evaluation.

[Netilmicin in single daily doses for the bacterial bronchopulmonary complications in patients with advanced bronchogenic carcinoma]. / La netilmicina in monodose giornaliera nelle complicanze batteriche broncopolmonari in pazienti con carcinoma broncogeno avanzato.

In 40 patients with bacterial bronchopulmonary complications during polychemotherapy for advanced bronchogenic carcinoma, once-daily netilmicin (4.5 mg/kg every 24 h) brought about complete resolution of the infective process in 90% of the cases and eradication of the responsible pathogen in 82%. This result must be considered good in view of the patients' precarious condition due to their advanced neoplastic disease.