Colchicine, cyclophosphamide and prednisone in the treatment of mild-moderate idiopathic pulmonary fibrosis: comparison of three currently available therapeutic regimens.

STUDY OBJECTIVES: In this study we evaluated the role of three currently available therapeutic regimens in the treatment of early stages of idiopathic pulmonary fibrosis (IPF). PATIENTS: The study population consisted of 57 consecutive suspected individuals with IPF. Patients with interstitial pneumonias other than IPF and subjects with advanced disease or contraindication to therapy were excluded. We evaluated 30 subjects with mild-moderate IPF, homogeneous baseline characteristics and prognostic parameters that were assigned to 3 treatment regimens: group 1 (n = 11): prednisone 1 mg/kg/ day; group 2 (n = 9): prednisone 0.5 mg/kg/day plus cyclophosphamide 100 mg/day; group 3 (n = 10): prednisone 0.5 mg/kg/day plus colchicine 1 mg/day. We analysed response to therapy by analysis of a clinical-radiographic-physiologic (CRP) score before treatment and at 6 months intervals for 18 months. Side effects and three years survival rate were also investigated. RESULTS: Although our study was performed in a subset of patients with early disease's stages, these data showed that none of the regimens was able to interfere with IPF's course. However treatment with colchicine plus prednisone resulted in fewer side effects and re-evaluation parameters showed a significant decrease of dyspnoea (p < 0.01). No significant differences were observed in survival rate among the three groups. CONCLUSIONS: None of the regimens analyzed was effective even in the treatment of the early stages of IPF. The association colchicine/corticosteroids could be considered a safe and not expensive regimen that may be used in the treatment of IPF, especially in patients who have experienced adverse effects from immunosuppressive agents, while waiting for newer therapeutic strategies.

Strongyloides stercoralis hyperinfection in a case of idiopathic pulmonary fibrosis.

The Strongyloides stercoralis infection is a prominent cause of death in many areas of the world. A 64-year-old man with pulmonary fibrosis was admitted to the hospital because of progressive shortness of breath and increasing cough. The patient had been previously admitted for his illness and had a remarkable immunosuppression due to the use of steroids (CD4+ lymphocytes = 200 x 10(6)/l). Repeated sputum and stool studies were diagnostic for strongyloidiasis. The patient died suddenly from severe cardiorespiratory failure while he was under mebendazole treatment (100 mg b.i.d.). Strongyloidiasis occurs mostly in immunocompromised hosts, as in patients with chronic pulmonary diseases on long-term treatment with corticosteroids, oncology patients under treatment and patients with AIDS.

Solitary plasmacytoma of the chest wall. A case report.

Solitary plasmacytic lymphomas are rarely described in the lung. Generally, localized neoplasms develop into mediastinal or pulmonary lymphnodes and are hard to differentiate from other lung neoplasms. An involvement of the chest wall in multiple myeloma is not rare, and is generally associated with other skeletal localizations. A secreting solitary plasmacytoma of the ribs is rather uncommon: a personal review of the literature has showed, in the last ten years, only two cases of these tumors, secreting IgG lambda light chains. In this study we report a case of solitary plasmacytoma of the chest wall, associated with an IgG kappa monoclonal gammapathy.

Combined treatment in advanced stages (IIIb-IV) of non-small cell lung cancer.

Chemotherapy regimens based on platinum represent the reference standards in Non-Small Cell Lung Cancer (NSCLC) and when it is associated with radiotherapy and/or surgery (combined treatment) it improves survival of patients. Aim of this study was to estimate the efficacy of chemotherapy, based on high-dose epirubicin plus cisplatin, associated with surgery and/or radiotherapy. Twenty-four inoperable NSCLC patients (15 pts in stage IIIb and 9 in stage IV) were treated with epirubicin (120 mg/m2) plus cisplatin (60 mg/m2), every three weeks for at least 3 cycles up to a maximum of 6. A total of 109 treatment cycles (epirubicin plus cisplatin) were administered and two of 24 patients achieved full response (CR), 9 showed partial response (PR), for an overall response rate of 45.8%, 8 patients (33.4%) achieved stable disease (SD) and 5 (20.8%) progressive disease (PD). Leukopenia aroses in 81.9% of the cycles, anaemia in 36.6% and thrombocytopenia in 14%. After chemotherapy, nausea/vomiting was present in 33.3% of patients, while in a small number of cases there were also mucositis, diarrhea, fever, phlebitis, transaminase increase and electrocardiographic anomalies. Upon entry, at the end of therapy patients underwent restaging (CT, bronchoscopy, bone scintiscan) to evaluate the possibility of surgical resection; 15 out of 24 patients completed treatment with radiotherapy (40-60 Gy) and then were re-evaluated for surgery. Five patients underwent complete surgical resection of the neoplasia (4 after chemotherapy and one after radiotherapy). After 1 year survival was 66.6% for all patients. Combined treatment in advanced NSCLC showed a good response and survival after 1 year.

Severe subglottid stenosis, well-tolerated for many years.

A 45 year old man was admitted to our hospital due to dyspnoea. At the age of 1 yr, he had undergone orotracheal intubation for croup diphtheria resulting in dysphonia. He was in good health up to the age of 39 yrs when exertional dyspnoea arose. He had had irregular therapy by aerosol without improvement. At admittance, the flow-volume curve indicated an impairment at high flows (peak expiratory flow (PEF) and maximum expiratory flow at 75% (MEF75%)). Fibreoptic bronchoscopy revealed a thin and smooth diaphragm, with a small (7-8 mm) central orifice in the subglottid area. CO2 laser therapy improved symptoms by increasing the cross-sectional area of the diaphragm orifice.

[Mycobacterium tuberculosis. From the gene to the diagnosis]. / Il microbatterio della tubercolosi. Dal gene alla diagnosi.

Pulmonary tuberculosis still in on the list of the world major health problems. Tuberculosis has not been eradicated yet, from developing countries. Furthermore, its incidence is increasing in the industrialized world, due to the human immunodeficiency virus (HIV) epidemic. In this regard, atypical clinical presentation of tuberculosis in individuals who have a deficient immune system, such as those at risk of tuberculosis because of HIV infection, makes the diagnostic process more difficult. Tuberculosis cases are often diagnosed later in HIV individuals compared to non-HIV individuals. The ensuing greater risk of contagion thus requires rapid and sensitive diagnostic protocols. In this context, several biotechnological tools have been developed that can be applied to the diagnosis of tuberculosis. M. tuberculosis genes have been cloned, monoclonal antibodies against pure proteins have been produced, thus enabling researchers to generate molecular and biochemical probes. As a consequence, DNA hybridization and DNA amplification techniques have been applied to the detection of mycobacteria, and ELISA kits of high sensitivity are been already made available. In regard to the latter, it is likely that monospecific and highly sensitive immunoassays will be developed that are directed against "active disease" immunodominant antigens. It may thus be expected that future new technologies will supplement the traditional tools for the diagnosis of tuberculosis and rapid diagnosis protocols will be available to chest clinicians in a foreseeable future.