[Chemotherapy versus chemoradiotherapy in patients with limited small cell lung carcinoma]. / Chemioterapia versus naprzemienna chemio-radioterapia u chorych z ograniczona postacia drobnokomórkowego raka pluca.

62 patients with a limited small cell lung cancer were randomly qualified into two groups. 32 patients of the first group were treated only with the chemotherapy regimen, consisted of three drugs (Carboplatine, Etoposide and Vincristine administered in 6 courses, on regular, 3-weeks basis). The second group of 30 patients had been treated with the identical chemotherapy schedule, but alternatively combined with a primary site irradiation in a total dose of 40Gy, applied in parts after the chemotherapy courses 2, 3, and 4. The significantly higher proportion of a complete remission results was observed in the alternate-treatment group: 14/30 (46.7%), compared with the chemotherapy-only group: 10/32 (31%). Alternate chemoradiotherapy resulted both in the increased median remission duration time, and the increased median survival time. Only in the alternate chemotherapy group, in 14/30 patients (46.7%) the pneumotoxicity symptoms appeared, whilst no differences in other organ-specific treatment-induced toxic effects were noted.

[Disturbances of polymorphonuclear neutrophil leukocyte chemiluminescence in patients with chronic or recurrent respiratory tract infections]. / Zaburzenia chemiluminescencji granulocytów obojetnochlonnych u chorych na przewlekle lub nawracajace zakazenia ukladu oddechowego.

The disturbances of polymorphonuclear neutrophil leucocytes (PMNLs) may be considered as a one of the causes of chronic or recurrent respiratory tract infections (RTI). The study carried out on patients with chronic or recurrent RTI was aimed at attempting to assess the dependence of clinical manifestations of RTI on nonspecific PMNLs dependent cellular response status. We used the chemiluminescence (CL) assay to study the ability of PMNLs to generate free oxygen forms during phagocytosis process. CL response of PMNLs to chemotactic peptide FMLP in 48 chronic and/or recurrent RTI patients and in 50 healthy blood donors of similar age (control group) was evaluated. RTI do not seem to be dependent on decreased PMNLs count (mild neutropenia was found in 35% of patients), but they may result from impaired function of PMNLs. All the values of CL response in RTI patients were lower than the lowest value observed in control group and ranged from 2.9 to 27.6 x 10(3) cpm/10(3) PMNLs. The lowest of PMNLs CL test value were found in patients with infections of pulmonary tissue (recurrent pneumoniae). The patients with infections of higher parts of respiratory tract (nasal cavity, sinuses, pharynx, trachea and bronchi) did not present such levels of PMNLs function impairment.

[Diffuse alveolar hemorrhage in Wegener's granulomatosis]. / Rozlane krwawienia pecherzykowe w przebiegu ziarniniakowatosci Wegenera.

Two cases of Wegeners Granulomatosis were presented. In the both cases diffuse alveolar hemorrhage was found.

[Are lung choriocarcinoma and giant cell carcinoma producing chorionic gonadotropins just variants of the same neoplasm?]. / Czy kosmówczak pluca i olbrzymiokomórkowy rak pluca produkujacy gonadotropine kosmówkowa to tylko odmiany tego samego nowotworu?

An article presents two cases of choriocarcinoma lung metastases. One case revealed the primary mediastinal choriocarcinoma and the second one had unknown primary localisation of the tumor, which could be suggestive of a spontaneously regressed primary gonadal choriocarcinoma. Authors discuss the clinico-pathological aspects of extragonadal choriocarcinomas, theories of their histogenesis and the morphological similarities to anaplastic giant cell lung carcinoma.

[Disseminated lung tuberculosis in a patient with undiagnosed chronic hip joint tuberculosis]. / Gruzlica rozsiana pluc u chorego na nie rozpoznana przez wiele lat gruzlice kretarza wiekszego kosci udowej.

A case of a 69-year male patient is reported. His history is an illustration of difficulties in the diagnosis of hip joint tbc. Patient suffered from severe pain in the right hip and thigh while walking for 25 years. Despite abnormal bone structure confirmed by several X-rays, no other examinations were ever performed to establish possible diagnosis. The patient was told to have "an inflammation" or "degeneration" of the bone. Anti-inflammatory and analgesic agents were given him to enable walking for years. Untreated tuberculosis resulted in the complete destruction of the proximal end of thigh bone and unilateral hip joint. Etiology was confirmed when the patient developed disseminated lung tuberculosis. Antitubercular drugs proved effective and brought about fast improvement of patient's health. On completion of chemotherapy, surgical treatment of the affected bones was performed.

[The role of pleural needle biopsy and determination of Carcinoembryonic antigen in pleural fluid for diagnosing the etiology of pleural effusion]. / Znaczenie iglowej biopsji oplucnej oraz oznaczania stezenia antygenu karcinoembrionalnego w plynie oplucnowym dla rozpoznawania etiologii wysieku w jamie oplucnej.

Results of histopathological and bacteriological examinations of specimens taken in 213 patients with pleurisy by Abrams' needle biopsy of parietal pleura were presented. Malignant cells were found in histological survey of excisions from pleura in 48/128 patients with final diagnosis of cancer (37.5%). The same examination accompanied by bacteriological survey led to establish proper diagnosis in 41/60 patients with pulmonary tuberculosis (68.3%). In 31 patients with cancer pleural fluid was searched for concentration of the carcinoembryonic antigen (CEA). In this group, in 7/19 patients with negative histological results of pleural biopsy CEA concentrations were markedly increased. This finding strongly supported further searching for malignancy in those cases. Finally, the diagnosis was established due to the pleural needle biopsy in 89/213 patients (41.8%).

[Analysis of prognostic factors for long term survival in patients with small cell lung cancer]. / Analiza czynników rokowniczych warunkujacych dlugotrwale przezycia chorych na drobnokomórkowego raka pluca.

Prognostic factors for long term survival were analyzed in a group of 719 patients with small cell lung carcinoma treated within 4 consecutive prospective multicenter trials between 1981 and 1990. 74 patients (10.3%) survived more than 2 years; 30 of them (4.2%) with no evidence of disease. The most significant determinator of prolonged survival was extent of disease: 13.9% (59/424) of patients with limited disease vs. 5.1% (15/295) with extensive disease survived more than 2 years (p < 0.001). Of 138 female patients 24 (17.4%) were long term survivors, compared to 8.6% (50/581) of males (p < 0.01). Initial good performance status and no weight loss were also found to be correlated with long term survival. Of the group of 2-year survivors 51 patients subsequently died (median survival duration 31 months), 10 are alive with cancer or are lost to follow up and 13 are in complete remission with median follow up of 64 months. 20 patients (3.8%) survived more than 5 years. This study confirms the possibility of cure in SCLC, especially in patients with favorable prognostic factors.

[Usefulness of examining levels of carcinoembryonic antigen in pleural fluid for establishing the cause of pleural effusion]. / Przydatnosc badania stezenia antygenu rakowoplodowego w plynie z jamy oplucnej dla ustalenia przyczyny wysieku.

The levels of CEA in pleural effusion fluid and serum were determined in 132 patients with pleural effusions. Malignancy was the cause of pleurisy in 92 patients, in the remaining 40 patients the cause of pleurisy were non-malignant disorders. CEA levels exceeding 15 ng/ml were found in 42/92 patients with malignancy (45.7%) and in 2 patients with non-malignant disorders (5.0%). The serum CEA levels exceeded the value of 15 ng/ml in 23/92 patients with malignancy (25.0%) and in 1 patient of the remaining group (2.5%).

The prognostic significance of bone marrow metastases in small cell lung cancer patients.

One-hundred forty-six SCLC patients were classified as localised (56) or extensive (90) using chest X-ray, bronchoscopy, brain CT, bone scintigraphy, ultrasonography of the abdomen and bilateral bone marrow trephine biopsy. Bone marrow metastases were found in 28 cases. Patients with bone marrow metastases had significantly shorter time to progression (median 20 weeks) and significantly shorter survival time (median 31 weeks) than other patients with extensive disease (medians 30 and 46 weeks). Patients with bone marrow involvement had significantly more often metastases in three or more organs than others with extensive disease. The negative prognostic significance of bone marrow involvement was however independent of the negative prognostic significance of the number of organs with metastases.

[Value of bone marrow trephine biopsy in evaluating the extent of small cell lung cancer]. / Wartosc trepanobiopsji szpiku w ocenie rozleglosci drobnokomórkowego raka pluca.

Bone marrow metastases using Jamshidi needle were found before treatment in 28 of 146 small cell lung cancer patients (19.2%). Bone marrow was a sole site of distant metastases in 3.4% of all cases and in 8.2% of those with no metastases in other organs. Patients with bone marrow involvement had more often metastases in 3 or more organs and had significantly more often liver metastases as well. Bone marrow infiltration was more often observed in patients with poor performance status and with disseminated disease, but was also found in 4 of 47 patients with good performance status and without metastases in other organs. Bone marrow trephine biopsy should be included in staging procedure in small cell lung cancer patients with good performance status, without metastases in other organs and with abnormalities in peripheral blood picture.

[Frequency of bone marrow involvement in patients with small cell lung carcinoma before treatment based on selected laboratory parameters]. / Czestosc wykrywania przerzutów do szpiku u chorych na drobnokomórkowego raka pluca przed leczeniem w zaleznosci od wyników wybranych badan laboratoryjnych.

Bone marrow bilateral biopsy was done in 106 small cell lung cancer patients before treatment. Full blood count, serum alkaline phosphatase activity, serum albumin concentration and serum Na+ concentration were compared according to presence or absence of bone marrow metastases. Decreased red cell count and elevated alkaline phosphatase activity were found significantly more often in the group of patients with bone marrow involvement. Thrombocytopenia and "blast" smear occurred only in patients with bone marrow metastases. Although bone marrow was found more often in association with low albumin level, this was not significant. It was impossible to anticipate the presence of bone marrow metastases on the base of total blood count, examination increased serum alkaline phosphatase activity or decreased serum Na+ or albumin levels. However in the presence of thrombocytopenia and "blastic" smear bone marrow metastases are very probable.

[Value of transthoracic needle biopsy of the pleura in the diagnosis of diseases of the respiratory tract]. / Znaczenie transtorakalnej iglowej biopsji oplucnej w rozpoznawaniu chorób ukladu oddechowego.

Pleural biopsy with Abram's needle was made in 160 consecutive patients with undiagnosed pleural effusions. The sampled fluid and pleural bioptates were examined histologically, cytologically and bacteriologically. In 40 cases malignant changes were found, out of 87 with confirmed malignancy. Neoplastic cells were found in 26 patients, ovreall the diagnosis was made in 65% of lung cancer cases. Out of 41 cases of tuberculosis, pleural biopsy provided this diagnosis in 24 patients (59%). Bacteriological examination and pathological of the biopsy specimen allowed to increase the diagnostic field to 63%. Pleural biopsy did not yield any diagnosis in 9 cases of circulatory insufficiency, nor in ten patients with the following diagnoses -- pleuropneumonia, reumathoid arthritis, pulmonary thromboembolism and thoracic trauma. In 13 cases the diagnosis was not made. The diagnostic yield of pleural biopsy was similar to that reported by others. It is most valuable in cases suspected of malignancy and tuberculosis.