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The distribution of HLA antigens was studied in 85 Greek patients with bronchogenic carcinoma. Fifty-seven specific HLA antisera were used to determine 27 HLA-A and B antigens, with the two-stage standard NIH microlymphocytotoxicity assay. The results were com- pared with those in a conuol group, consisting of 400 healthy individu- als. In the whole group of patients there was a significantly higher frequency of HLA-AW19 and HLA-A29 (p < 0.003 and p < 0.006 respectively) and a lower frequency of HLA-A2 and HLA-A3 (p < 0.014 and p < 0.006 respectively) than in the control population. In patients with squamous cell carcinoma there was a significantly higher frequency of HLA-AW 19 and lower frequency of HLA-A2 (p < 0.02 and p < 0.05 respectively). In small cell carcinoma patients there was a significantly lower frequency of HLA-A3 (p c 0.04) than among the controls. In patients with adenocarcinoma no significant change of HLA antigen frequencies was observed when compared to the controls.

Increased erytbrocyte magnesium levels iu small cell carcinoma of the lung. A relatiousbip with tumor growth? SaWri S, Nielsen I, Tassinari D, Trevisani L, Abbasciano V. II Divisione Medica, Dipartimento di Medicine Generale, Arcispedale S. Anna. Corso Giovecco 203,441OO Ferraro. Lung Cancer (The Nether- lands) 1991;7:385-7.

The requirement for magnesium (Mg) increases in rat erytbrozytes during tumor growth. Erythrocyte Mg (EMg) content was measured in 28 patients with small cell lung cancer and in 32 with epidermoid lung cancer by atomic absorption spectrophotometry, and compared with 40 healthy controls. EMg in small cell carcinoma was significantly higher than in epidermoid carcinoma (P<O.OS) and control group (P<O.OOl). NO difference was observed between controls and epidermoid carci- noma. EMg is an obligatory co-factor in ghnathione synthesis, and blood glutnthione levels increase in response to tumor growth. The higher mean rate of tumor growth in small cell carcinoma may explain the increased EMg content in comparison with epidetmoid carcinoma.

Staging: The key to rational management of lung cancer Miller J.D. Gorcnstcin L.A. Patterson GA. Division ofCardiothoracic Surgery, Wdshington University School ofMedicine, 1 Barnes Hospital Plaza, St. Louis, MO 63110. Ann Thorac Surgerg 1992:53:170-8.

Staging is me quantitative assessment of malignant disease and allows logical groupings of patients with a similar extent of disease for prognostic, therapeutic, and analytic purposes. In bronchogenic carci- noma a stage is assigned based on size, location, and the extent of invasion of the primary tumor, as well as the presence of any regional or metastatic disease. Selecting the most appropriate treatment for a patient with bronchogenic carcinoma depends on precise staging. The extent of local invasion and presence of metastatic disease will deter- mine the likelihood of complete resection and possible cure. Careful assessment of the history, blood chemistry, radiographic studies, bron- choscopy, mediastinoscopy, and exploration (thoracotomy) are all important staging tcols. Routine radionuclide scans have no useful role when there is no clinical or laboratory evidence of metastases. The T status of a tumor is best judged by bronchoscopy and at tboraCotomy. Thoracic surgeons must be familiar with the techniques available to determine T status intraoperatively and use this information when planning resection. Computed tomography of the chest has fallen short in predicting direct invasion of the media&urn and chest wall. Cervi- cal and anterior mediitinoscopy remain important tools in determining operability. Intraoperative assessment of node involvement determines the extent of resection and likelihood of cure.

PalIiatiou of left main bronchus compression due to malignant tumor by intubation via a tracheostomy tube Terada Y, Matstmobe S, Nemoto T. Tsuda T, Shimizu Y. Respiratory Center, Shiga Health Insurance Hospital, Fujimidai 16-l. Otsu 520. Chest 1991;100:1735-7.

Intubation of me left main bronchus via a tracheostomy tube was performed in a patient with local recurrence of lung cancer associated

with invasion and obstruction of the left main bronchus after right sleeve pneumonectomy. The result was satisfactory not only for pre- venting asphyxia, but also for maintaining the patency of the airway after extubation of the endotracheal tube.

Repeat mediitinoscopy iu the assessment of uew and recurrent lung neoplasm Meersschaut D, Vermassen F, De IaRiviere AB, Knaepen PJ. Van Den Bosch JM, Vanderschueren R. St. Anronins Hospital, t’ostbtu 2500, 3430 EM Nieuwegein. Ann Thorac Surg 1992;53: 120-2.

From 1976 to 1990, 140 patients (mean age, 66 years; 91% male) underwent repeat mediastinoscopy as a routine staging procedure. The mean intervalbetweenfustandsecondmediastinoscopy was56months. Owing to adhesions, 26 repeat mediastinoscopies (18%) were consid- ered incomplete. There was no mortality, and 10 complications did not require interventional therapy. The results were positive in 2Opatients thus avoiding an unnecessary thoracotomy. In 7 patients with negative findings, positive lymph nodes were found at thoracotomy or by tmnscarinal puncture biopsy. The sensitivity of repeatmediastinoscopy in this series is 74% and the accuracy 94%. We consider repeat mediastinoscopy a safe and reliable preoperative staging procedure in new or recurrent lung cancer.

intrapleural therapy for malignant pleural effusions: A random- ized comparison of bleomycin and tetracycline Ruckdeschel JC, Moores D, Lee JY, Einhom LH, Mandelbaum I, Koeller J et al. Albany Medical College, Albany, NY. Chest 199l;loO: 1528 35.

Between December 1985 and August 1988, there were 115 patients at 13 centers who were entered on a randomized comparison of tetracycline and bleomycin for treatment of malignant pleural effu- sions. Fifteen patients were not treated, primarily due to rapid pmgres- sion of systemic cancer. Fifteen patients entered on a high-dose regimen of bleomycin (120 units) were excluded from this analysis (following early closure of that arm), leaving 85 patients randomized to low-dose bleomycin (60 units; 44 patients) or tetracycline (1 g; 41 patients). Patients were required to have a cytologically positive pleural effusion, good performance status (0, 1, or 2). lung reexpansion following tube tboracostomy with drainage rates of 100 ml/24 or less, no prior intra- pleural therapy, no prior systemic bleomycin therapy, no chest irradia- tion, and no recent (four weeks) change in systemic therapy. A total of 11 patients (five with bleomycin and six with tetracycline) were not evaluable due to technical problems with tube drainage (one), loss to follow-up (two), sudden death due to pulmonary embolus (one), and rapid progression of systemic disease (seven). There were no clinically significant differences in demographic factors, primary site, perform- ance status, or presence of metastases other than pleural effusion. Overall survival did not differ between the two groups. Median time to recurrence or progression of the effusion was 32 days for tetracycbne- treated patients and at least 46 days for bleomycin-treated patients (p = 0.037). Therecurrencerate within 30 days of instillation was 36percent (10/28) with bleomycin and 67 percent (18/27) with tetracycline @ = 0.023) (not all patients were restudied in the first 30 days). By 90 days the corresponding recurrence rates were 30 percent (1 l/37) for blwmy- tin and 53 percent (19/36) for tetracycline (p = 0.047). Toxicity was similar between groups.

Establishment of tumor cell lines as an independent prognostic factor for survival time in patients with small-cell lung cancer Masuda N, Fukuoka M, Matsui K, Kusunoki Y. Kudoh S, Negom S et al. Department of Internal Medicine, Osaka Prefectural Habikino Hospital, 3-7- 1 Habikino. Habikino Osaka 583. J Natl Cancer Inst 1991;83:1743-8.

We studied tumor samples from 39 patients, who entered our study from January 1989 to May 1990, to assess whether the ability to establish a continually growing tumor cell line from fresh tumor specimens can be associated with decreased survival times in patients