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lin, D-10OOEerlin 39. Prax Klin Pneumol 1987;4l(Spec no):754-5. Basing on the favourable results obtained with palliative-sympto-

matic obliteration (pleurodesis) of malignant pleural effusions with tetracycline hydrochloride, we also used this therapy in 18 cases of malignant pericardial effusions - mostly caused by pleuropulmonary tumors. In 16 patients (88%) it was possible to stop the exudation within 2-l 1 days without recurrence during follow-up treatment. Since no complications worth mentioning were seen, we can consider drainage and intrapericardial instillation of tetracycline as the presently best possible method in the palliative treatment of this tumor complication.

Flare responses in small cell carcinoma of the lung. Cosolo W, Morstyn G, Arkles B, Zimet AS, Zalcberg JR. Deparfmenf ofMedical Oncology, Reparriation General Hospital, Wesr Heidelberg, Vie. 3081. Clin Nucl Med 1988;13:13-6.

Two cases of small cell carcinoma of the lung in which flare responses were demonstrated are discussed. Although the primary tumor and extraskeletal metastases responded to fist-line chemotherapy, bone scintigraphs performed 3 months after the start of treatment suggested tumor progression. Howcvcr, following repeat bone imaging and sub- sequent clinical evaluation, the interim scintigraphs appeared to repre- sent an unusual flare response, in which the activity of pre-existing hot spots increased and new lesions developed.

Scintigraphic diagnosis of rib lesions in patients with lung carci- noma. Matsumoto S. Shibuya H, Umchara I, Suzuki S. DepurfmenlofRadiol- ogy, TokyoMedicalandDental Universily. Bunkyo-ku, Tokyo 113. Clin Nucl Med 1987;12:960-2.

One hundred twenty-five patients with carcinoma of the lung re- ceived 17 1 pyrophosphate bone scans. Twenty-three ( 18%) of these 125 patients had abnormal uptake only in the ribs. Of these 23 patients, 14 (61%) were diagnosed as having a benign lesion. Five showed direct invasion from the primary carcinoma and another four were diagnosed as having mctastatic rib lesions, Benign rib lesions were also suspected in scvcral patients with multiple metastases.

Lack of clinical significance of gallium-67 uptake in non-small cell lung cancer. Buccheri G, Vola F, Ferrigno D, Curcio A, Violante B. Departmenr of Amonio Carle Ilospiuzl, 12100 Cuneo. Eur J Respir Dis 1987;71:356- 61.

To evaluate the clinical significance of tumor Ga-67 uptake, we studied 89 consecutive patients with a potentially resectable non-small cell lung cancer (NSCLC) by performing a whole body Ga-67 scan. For each scintigraphy, an overall Ga-67 accumulation index (T-N) and a volume independent index (T/Nr) were calculated. Both parameters wercrclated todiseaseextent, response to subsequenttreatmentand host survival. With the exception of the significant correlations of T-N to both stage of disease and survival - the higher the T-N, the more advanced the disease and the worse the prognosis no other relationship wasfound.Basedonthcsefindings, weconcludethat,inNSCLCatleast, gallium uptake is mainly dependent on tumor size and, therefore, of limited practical value.

Serum pseudouridine as a biochemical marker in small cell lung cancer. Tamura S, Fujioka H, Nakano T, Hada T, Higashino K. Third Deparf- menI of Internul Medicine, Hyogo College of Medicine, Hyogo 663. Cancer Res 1987;47:6138-41.

The serum lcvcl of pscudouridinc, primarily a degradation product of tRNA, was detcrmincd by high-performance liquid chromatography in

24 patients with small cell lung cancer (SCLC), 13 patients with non- SCLC with advanced stages, 15 patients with pulmonary infectious diseases, and 18 healthy controls. The mean serum pseudouridine concentration was significantly higher in the patients with SCLC I4.75 ??1.76 (SD) nmol/ml] than that in the patients with pulmonary infectious diseases (3.39 ??1.38 nmol/ml) or in healthy controls (2.21 ??0.78 nmol/ ml). The mean serum pseudouridine concentration in the patients with non-SCLC (4.07 ~0.95 nmol/ml) was significantly higher than that in healthy controls but not statistically different from that in the patients with pulmonary infectiousdiseases. Theserum pseudouridine level was elevated above the mean value plus 2 SD for the healthy subjects (3.77 nmol/ml) in 66.7% of all patients with SCLC including 3 of 8 (37.5%) with limited disease and 13 of 16 (81.3%) with extensive disease, and 53.8% oithcpaticnts with non-SCLC. Serumcarcinoembryonicantigen was elevated (>5 ng/ml) in 29.2% and serum neuron-specific enolase (>lOng/ml) in58,3%ofthecases withSCLC. In thepatients withSCLC followed up during chemotherapy, serum pseudouridinc levels changed considerably parallel with the changes in the clinical response. These findings indicate that serum pseudouridine may be a useful biochemical marker in the patients with SCLC.

Clinical experience with tetracycline pleurodesis of malignant pleu- ral effusions. Sherman S, Grady KJ, Seidman JC. Pulmonary Division, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48072. South Med J 1987;80:716-9.

Because many patients with malignant pleural effusions could sur- vive for months to years beyond its onset, definitive management must be safeandeffective. Chemical pleurodesis with tetracyclinehas gained general acceptance as the therapy of choice, even though no large series confirming this viewpoint has appeared in the literature. We reviewed 108 procedures involving tube thoracostomy and tetracycline pleurode- sis, and report a succes rate of 94.4% without serious complications. Considering all patients, 49% were symptom-free at three months, and 13% wcrc alive one year later. Several potentially important changes in technique have emerged since the initial description of this procedure. With adherence to meticulous technique, tetracycline pleurodesis pro- vidcs rapid, effective, and safe palliation of malignant pleural effusions.

Gallium-67 scintigraphy and non-small-cell bronchogenic carci- noma: A quantitative in-vivo predictive assay? Lentle BC, Catz Z, Dierich HC, Scott JR, Hooper HR. Division of Nuclear Medicine, Vanvouver General Hospital, Vancouver, BC VSZ IM9. Can Med Assoc J 1987;137:815-7.

Gallium-67 scintigraphy has been of limited use in detecting lung cancers and micrometastases. To study its potential for determining the aggressiveness of a cancer, we reviewed the charts of 44 patients with non-small-cell bronchogcnic carcinoma who had not been receiving treatment when 67Ga scintigraphy was performed. The mean length of survival for the 18 patients with low or little uptake of the tracer, corrected for tumour size, was 19.7 months, and for the 26 with high uptake 9.4 months (p < 0.01). Such in-vivo predictive assays may be a rational goal for tumour scintigraphy.

Should patients with haemoptysis and a normal chest X-ray be bronchoscoped? Heaton RW. Department ofMedicine, Charing Cross Hospital. Fulham Palace Road, London W6 8RF. Postgrad Med J 1987:63:947-9.

A review of bronchoscopic records over a 5 year period identified 4 1 patients who had undergone fibreoptic bronchoscopy after presenting with haemoptysis and a normal chest X-ray. Carcinoma of the bronchus was found in 4 patients (9.7%) and the procedure yielded a diagnosis in 8 of the 20 patients in whom a specific cause of their bleeding could be

s30

identified. Thediagnostic yield is sufficiently high and the morbidity of the procedure sufficiently low to justify the investigation in patients presenting with haemoptysis and a normal chest X-ray.

Extended cervical mediastinoscopy. A single staging procedure for bronchogenic carcinoma of the left upper lobe. Ginsberg RJ, Rice TW, Goldberg M, Waters PF, Schmocker BJ. Division of Thoracic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. MSG 1X5. 1 Thorac Cardiovasc Surg 1987;94:673-8.

Despite a common misconception, bronchogenic carcinoma of the left upper lobe frequently metastasizes to lymph nodes not only in the anterior mediastinum (para-aortic and subaortic) but also in the superior mediastinum. Anterior (parastemal) mediastinotomy can be used to assess only the former compartment. This procedure alone, if not done in conjunction with standard cervical mediastinoscopy, will fail to disclose technically tmresectablc N2 or N3 disease of the left upper lobe involving the superior mediastinum. We have developed a technique to explore and sample nodes from both regions by extending a standard cervical mediastinoscopy, eliminating the need for a second incision when the anterior mediastinal compartment requires assessment. We have prospectively analyzed the first 100 procedures that we performed. Thistechniquehasbeenfound tobeaccurateandexceptionallysafewith one superficial wound infection as the only complication. We can recommend this single staging procedure forpreopcrativeassessmentof bronchogenic carcinomas of the left upper lobe.

tion, observed in 3 patients, were not fatal. It is concluded thatcarcinoids should now be considered malignancies; typical carcinoidscany a more favorable prognosis than atypical ones and can be managed by conser- vative operations without affecting the survival rate. The spreading of the tumor to lymph nodes and surrounding tissues was not associated with an increased mortality in the reported cases.

Results of resection in locally limited bronchogenic carcinoma. (Stages I and II). Schamaun M, Angermeier I. Abteilungfur Thorax- und Gefasschirur- gie, Stadfspifal Triedi, CH-8063 Zurich. Schweiz Med Wochenschr 1988;118:1406-11.

Of 238 patients operated upon for bronchogenic carcinoma between 1977and 1985thetumorwaslocallylimitedin 108,ofwhom,according to the new international staging system, 66 patients were in stage I (T1NO+T2NO)and42instageII(T1NI+T2N1).89weremaleand19 (18%) female. The mean age was 61.6 years in stage I and 63 years in stage II patients. 26 patients (24%) were aged over 70. All patients underwent potentially curative excision of the tumor. This was accom- plished by partial lung resection in 97 patients, of whom 84 underwent lobectomy with 2 postoperative deaths (2.4%). Operative mortality amounted to 5.5% in the whole group (6/108), with 3% (2/66) in stage I and 9.5% (4/42) in stage II patients. The absolute survival rate at 5 years was 50% for all 108patients,59% for the66patients instage Iand39% for the 42 patients in stage II. It was 70% for 15 patients with bronchioloalveolar carcinoma, 54% for 20 patients with adenomatous cancerand49% for56patients with squamouscarcinoma. Atpresent ofthe108patientsares~illalive(57.4%),i.e.45outof66ins~~eI(68%) and 17 out of 42 in stage II (40.5%). This retrospective study therefore confirms former reports that long term results are encouraging in the locally limited stages of pulmonary cancer. In addition, operative mortalitv is low because almost all these tumors can be removed bv partial I&g resection. In stage I lobectomy is the method of choice. _

Carcinoma of the lung with mediastinal lymph node metastasis-An indication for surgery? Merkle NM, Bulzebruck H, Probst G, Vogt-Moykopf 1. Thoraxklinik LVA Baden, Heidelberg-Rohrbach, D-6900 Heidelberg. Prax Klin Pneumol 1988;42( Soec Iss 1):360-2.

Hemolytic uremicsyndrome in a patientwith smallcell lung cancer. Avvento L, Gordon S, Silberberg JM, Zarrabi MH, Zucker S. Division ofHemafology, Health Sciences Center, State University ofNew York, Stony Brook, NY. Am J Hematol 1988;27:221-3.

Hemolytic uremic syndrome is a rare entity in patients with carci- noma and presents with a triad of renal insufficiency, microangiopathic hemolytic anemia, and thrombocytopenia. We report this syndrome for the first time in a patient with small cell lung carcinoma. Spontaneous platelet aggregation of washed normal platelets wasdemonstrated using patient plasma. Circulating immune complex levels were not elevated. The entity completely resolved after treatment with plasma, vincristine, aspirin, and dipyridamole.

Surgery

Bronchopulmooary carcinoids: Report of nine surgically treated cases. Frigo F, Montresor E. Abrescia F et al. Islituto di Clinica Chirurgica, Universita di Verona, 37100 Verona. Ital J Surg Sci 1988;18:267-73.

Nine cases of bronchial carcinoids treated by surgery are reported. Six of them were females and three males. Their ages ranged from 37 to 68 years (median 52.8 years). Lobectomy was carried out in four instances (bilobectomy in one) and pneumonectom y in three. Based on preopera- tive histology two conservative operations were performed: one patient underwent segmental resection of the right upper lobe for a peripheral carcinoid and the other sleeve resection of the bronchus. The operations were complicated only in one case in which a broncho-pleural fistula appeared postoperatively and was successfully treated by thoracoplasty. There was no postoperative death. The only patient with an atypical carcinoid died one year after pncumonectomy. The other eight patients, with typical carcinoids are alive and without recurrent disease at 6 months to 8 years from surgery. Lymph node and parenchymal infiltra-

Favourable long-term results following the surgical treatment of cancer of the lung metastasizing to the mediastinum, require a new orientation of the surgical indication in advanced bronchial carcinomas. On the basis of our own case material, an attempt was made to establish what survival times can be achieved after resection of bronchial carcinomas with mediastinal lymph node metastases, and what factors affect the prognosis. The data of 280 resected patients with histopathol- ogically confirmed lymph node involvement in the resected specimen, were analysed retrospectively, the survival probabilities computed in accordance with the method of Kaplan and Meier, and prognosis- relevant criteria determined with the aid of the log-rank test. The overall survival probability was 36% after one year, 16% after three years, and 11% after five years. The procedure of lobectomy revealed a more favourable prognosis than did pneumonectomy. Extension of the inter- vention was associated with a poorer prognosis, which is to be consid- ered to bc an expression of tumour spread. The influence of post- operative adjuvant therapeutic procedures such as radiotherapy and chemotherapy was statistically demonstrable in the first two post- operative years, but was without any influence on the long-term prognosis. In our opinion, the survival rates observed in our own case material after the resection of N2 tumours justifies establishing an indication for surgery in selected cases (general functional operability, absence of clinical N2 stage).