[Treatment of acute exacerbations of chronic bronchitis. Multicenter, randomized comparative study of cefuroxime axetil versus ofloxacin]. / Behandlung akuter Exazerbationen chronischer Bronchitiden. Multizentrische, randomisierte Vergleichsprüfung von Cefuroxim-Axetil versus Ofloxacin.

128 Patients (45 female, 83 male) with acute exacerbations of chronic bronchitis were treated with either cefuroxime axetil 2 x 500 mg/d (n = 65) or ofloxacin 2 x 200 mg/d for 7-8 days in a randomized controlled multicenter trial. From the respective groups, the results of 61 and 59 patients could be evaluated. Positive sputum tests were available in 85 cases (56 monoinfections, 29 mixed infections) prior to treatment. According to final clinical assessment, cure was achieved with cefuroxime axetil in 75%, but only in 50% with ofloxacin. The clinical efficacy of cefuroxime axetil was judged by the physicians to be more reliable than ofloxacin. The difference is statistically significant (p less than 0.05). Therapy with ofloxacin had to be terminated in 2 cases due to side effects. Altogether 4 adverse events were documented with ofloxacin. Compared with ofloxacin, cefuroxime axetil showed better efficacy and low risk of side effects.

[Malignant pleural mesothelioma. Value of 67Ga scintigraphy compared to computerized tomography]. / Malignes Pleuramesotheliom. Wertigkeit der 67Ga-Szintigraphie im Vergleich zur Computertomographie.

In 34 patients with suspected malignant pleural mesothelioma the results of computed tomography are compared with the findings of 67Ga-scintigraphy. The differential diagnosis of 14 pleural mesotheliomas, 7 pleural carcinoses, 10 inflammatory and 3 other pleural diseases is performed more accurately by CT than by scintigraphy. 67Ga uptake depends on the thickness of inflammatory as well as malignant lesions. Thus, numerous pleural processes that can be localised by CT escape scintigraphic detection. CT is indicated if there is clinical and radiological suspicion of pleural mesothelioma; in that case, there is hardly any indication for 67Ga scintigraphy.

Experience with ifosfamide combinations (etoposide or DDP) in non-small cell lung cancer.

In all, 171 patients with histologically verified non-small cell lung carcinoma were treated with ifosfamide 2.0 g/m2 on days 1-5 in combination with (91 patients) etoposide 120 mg/m2 on day 1. Therapeutic regimens were repeated after 4 weeks. Supportive treatment with mesna (20% of the ifosfamide doses at 0, 4, and 8 h) was performed. Cisplatin treatment was supported by mannitol-induced diuretic hydration. The overall response rate of ifosfamide/etoposide was calculated to be 27%, with 1 complete and 24 partial remissions. The median survival time for all patients was 8.5 months, for responders 14 months (P less than 0.05), for patients with no change 9.5 months, and for patients with tumor progression 4 months. With ifosfamide/cisplatin, there were 4 complete and 21 partial remissions (response rate 35%). The median survival time for all patients was 8.3 months, for responders 11.5 months, and for patients with tumor progression 4 months. Age, sex, and histological tumor type had no significant effect on survival. Patients with better performance stage and limited disease lived significantly longer. The main side-effects of the cisplatin combination were vomiting, bone marrow depression, and neuropathy. The etoposide combination was tolerated better. Urotoxicity was not significant, as a consequence of treatment with mesna. The results show that the combination ifosfamide/etoposide or ifosfamide/cisplatin are effective in the treatment of non-small cell lung cancer, being comparable to other combinations of etoposide/cisplatin and vindesine/cisplatin. Because of the better tolerability, the combination ifosfamide/etoposide is superior to cisplatin combinations.

Respiratory distress as primary symptom of relapse in a patient with non-Hodgkin lymphoma.

A report on a 74-year old woman with high-grade malignant non-Hodgkin lymphoma in clinical remission, who suddenly developed episodes of severe dyspnea and wheezing. Clinical and roentgenographic investigations including tomography of the trachea failed to demonstrate any lesion. Fiberoptic bronchoscopy revealed and endotracheal, polyp-like lymphoma 3 cm above the carina, which was immediately operated. Other sites of relapse (submandibular lymph-nodes) were found 2 weeks after the operation. Second-line chemotherapy (IMVP 16) was able to induce a second remission.

[Chemotherapy of advanced non-small cell bronchogenic carcinoma with cisplatin and vindesine]. / Chemotherapie des fortgeschrittenen nicht-kleinzelligen Bronchialkarzinoms mit Cisplatin und Vindesin.

29 patients with advanced non-small cell lung cancer were treated with cisplatin and vindesine according to the protocol of Gralla et al. 1 complete and 7 partial remissions were achieved. Because of the short observation time we cannot say anything about duration of remission and survival time of the patients. Toxicity observed during 67 cycles was severe. Because of side effects treatment had to be stopped in 10 patients. According to remission rates this protocol is comparable to other cisplatin combinations.

[Chemotherapy of the non-small cell carcinoma of the lung with ifosfamide and cisplatin]. / Chemotherapie des nicht-kleinzelligen Karzinoms der Lungen mit Ifosfamid und Cisplatin.

80 patients with inoperable non-small cell bronchial carcinoma were treated, at an interval of 4 weeks between them, with ifosfamide (2 g/m2 on days 1-5) and cisplatin (75 mg/m2, day 1). All diagnoses had been confirmed histologically. The course of 72 patients (36 with squamous carcinoma, 25 with adenocarcinoma, two with alveolar-cell carcinoma and nine with large-cell carcinoma) could be evaluated. There were four complete and 21 partial remissions (response rate 35%). In a further 14 patients temporary arrest of tumor growth was registered. Median survival time of all patients was 8.3 months, for those with complete and partial remission 11.5 months. Patients in whom the tumor progressed lived on average 3.9 months. Age and general state of the patients, as well as histological tumor type, had no influence on the results of treatment. Patients in stage IV lived, at seven months, significantly less long than those with only loco-regional spread (11 months). Main side-effects were vomiting, bone-marrow depression and neuropathy. Urotoxicity was not significant, as a result of treatment with mesna. Remission rate and survival time of these patients corresponded with the results obtained with other cisplatin combinations.

[Diagnostic thoracotomy--a contribution to its value, indications and results]. / Die diagnostische Thoracotomie--ein Beitrag zur Aussagekraft, Indikation und Durchführung.

Open lung biopsy by a limited thoracotomy has an important place in the diagnosis of localized or diffuse pulmonary disease. Its application provides adequate pulmonary or mediastinal tissue biopsy, and permits a reliable histologic evaluation. The postoperative risks are small if certain pre-requisites are observed. We recommend atraumatic removing of the tissue, excluding the middle lobe and lingula. To prevent complications careful suturing of the biopsy site with absorbable suture material seems essential.

[Resistance testing and chemotherapy results of bronchial tumours (author's transl)]. / Resistenztestung und Chemotherapieergebnis bei Bronchialtumoren.

In a pilot study of 40 patients with inoperable bronchiogenic carcinomas the results of clinical therapy were compared with those of in vitro tests by measuring the effects of cytostatic agents on the incorporation of precursors into DNA and RNA in tumour cells incubated in vitro for short periods. Tumour cells that showed little inhibition by the cytostatic agents in vitro (less than 30% inhibition at a concentration of 10(-2) mg/ml adriamycin) came from patients who responded poorly to cytostatic therapy. On the other hand, tumour cells that were strongly inhibited in vitro (greater than 30% inhibition) came from tumours which proved to be sensitive to the chemotherapy given to the patient. A strong correlation existed between the inhibition of uridine incorporation by the tumour cells in vitro by adriamycin and the responses of the tumour to clinical therapy even when combination-therapy was given without adriamycin. There was also a significant correlation between the inhibiting effect of adriamycin in vitro and the survival time of the tumour patients.