Utility of serum cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA) as tumour markers for non-small cell lung cancer.

Serum cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA) levels were determined with an enzyme immunoassay in 51 patients with non-small cell lung cancer (NSCLC), 26 patients with benign lung diseases and 26 normal individuals in order to evaluate their clinical utility in the diagnosis of NSCLC. Patients with NSCLC demonstrated higher serum CYFRA 21-1 and CEA levels than both patients with benign lung diseases and normal group. We used the cut off value which was derived from the 95th percentile value of CYFRA 21-1 and CEA levels in the group of patients with benign lung diseases; CYFRA 21-1 at 3.13 ng/ml and CEA at 7.7 ng/ml. The sensitivity and diagnostic accuracy of CYFRA 21-1 and CEA for the group of NSCLC patients were 66.7 per cent, 76.6 per cent and 35.3 per cent, 55.8 per cent, respectively. When combining CYFRA 21-1 with CEA, the sensitivity and diagnostic accuracy were 68.6 per cent and 66 per cent. These results suggest that CYFRA 21-1 and CEA are useful serum markers for the diagnosis of NSCLC; especially subtype squamous cell and adenocarcinoma, respectively. The usefulness is not enhanced by combining the assay of CYFRA 21-1 and CEA.

Survival analysis of Thai patients with non-small-cell lung cancer undergoing surgical resection.

This study examined the survival duration among patients with non-small-cell lung cancer (NSCLC) undergoing surgical resection from January 1988 to December 1992 at the Central Chest Hospital, Thailand. Patients were followed-up until death or survival as of September 1997. Survival durations for different stages were analysed by Kaplan-Meier analysis and log rank test. A total of 127 patients with histologically proved NSCLC underwent 79 lobectomies, 9 bilobectomies, 39 pneumonectomies during 1988-1992. The mean age was 60 years (SD 10.4). There were 103 males and 24 females. Percentage of histologic types were: 59 per cent adenoCA, 35 per cent squamous cell CA, and 6 per cent large cellCA. Survival analysis was feasible in 88 patients, 38 alive and 50 deaths. 1-yr, 2-yr, and 5-yr survival were as following: 85 per cent, 78 per cent, and 60 per cent in stage 1 (n = 47); 70 per cent, 50 per cent, and 30 per cent in stage 2 (n = 12); and 54 per cent, 23 per cent, and 15 per cent in stage 3a (n = 29) [log rank 19.06, df 2, p = 0.0001]. Based on the present study, the survival outcome in patients with lung cancer beyond stage 1 is uniformly poor. Measures should be made to diagnose early stage disease and expedite surgery in order that a better survival outcome can be achieved.

Pulmonary actinomycosis: a study of 16 cases from Central Chest Hospital.

Actinomycosis is a relatively rare infection. This is a report of 16 patients with pulmonary actinomycosis diagnosed from 1990 to 1997 at the Central Chest Hospital, Thailand. Twelve patients were male and 4 were female, with a mean age of 59 years and a mean duration of symptoms of 9 months. Common symptoms were cough and hemoptysis. Mass-like shadowing was the most common radiographic finding (37%). The diagnosis, based on findings of typical sulfur granules, was reached by bronchoscopy (10 cases), surgery (5 cases) and fine needle aspiration (1 case). Endobronchial mass with luminal occlusion was the most frequent bronchoscopic finding (56%). Coexistent bronchial carcinoma was present in one specimen. Penicillin was given in 10 patients, 2 of whom (20%) were cured, 5 (50%) are currently on treatment and have achieved clinical response, whereas, the other 2 patients (20%) did not respond. Surgical resection was performed in 8 patients, all of whom recovered. An awareness of the full spectrum of actinomycosis manifestations will expedite diagnosis and optimize treatment.

Survival in patients with advanced non-small-cell lung cancer receiving supportive care.

AIMS: To fully describe the survival duration among Thai patients with advanced non-small-cell lung cancer (NSCLC) receiving supportive care. SETTING: A 500-bed referral cardiothoracic centre. METHODS: Follow-up study in patients with advanced NSCLC, diagnosed from January to December 1996, who, for a variety of reasons, did not receive chemotherapy or radiation therapy. All patients were followed-up until death or defaulted. Kaplan-Meier survival analysis and log rank test were employed. RESULTS: A total of 130 patients with histologically proven NSCLC receiving supportive care were followed. 98 patients were males and 32 were females. The mean age was 61 years (SD 13.5). 82 patients were in stage 3B and 48 patients in stage 4. In stage 3B, the median survival was 13 weeks (range: 1-94, 75th centile = 7, 25th centile = 18 weeks). For stage 4, the median survival was 8 weeks (range: 0.5-31, 75th centile = 4, 25th centile = 10 weeks). For pooled data of stage 3B and 4, median survival was 11 weeks (range: 0.5-94, 75th centile = 6, 25th centile = 16 weeks). CONCLUSIONS: Survival among patients with advanced non-small-cell lung cancer is uniformly short. Considering this poor prognosis, implementation of resources and strategies to diagnose an early stage of lung cancer should be one of the highest priorities in the national health plans.

Hughes-Stovin syndrome: a case report and review of the literature.

A young man presented with prolonged pyrexia, recurrent optic neuritis, thrombophlebitis and bilateral pulmonary artery aneurysms with thrombus formation. The life-threatening hemoptysis necessitated mechanical ventilatory support and emergency left lower lobectomy. Systemic corticosteroids conferred clinical improvement and reduction of the remaining right pulmonary artery aneurysm. The patient eventually succumbed to sudden massive hemoptysis. This report underscores the unpredictable nature of this syndrome and emphasises the need for aggressive surgical intervention of pulmonary artery aneurysms in Hughes-Stovin syndrome.

Histologic types, staging, resectability, and smoking among Thai patients with lung cancer.

AIM: To examine the prevalence of cigarette smoking, histological types, staging at presentation and resectability among Thai patients with lung cancer. SETTING: A 500-bed referral cardiothoracic centre. METHOD: Prospective study with pre-defined outcome data, from January to December 1996. RESULTS: A total of 349 patients were histologically proved to have lung cancer. The mean age was 60 years (SD 12.5). There were 264 males and 85 females. 269 patients (77%) were smokers. Percentage of histopathologic types were 39 per cent adenocarcinoma, 30 per cent squamous cell carcinoma, 20 per cent undifferentiated cell carcinoma, and 11 per cent small cell carcinoma. The association with smoking is stronger in squamous cell carcinoma and small cell carcinoma and weaker in adenocarcinoma. Most patients (82%) were in advanced stages, stage 3B and 4.18 per cent of the patients were in stages eligible for surgery, i.e. stage 1, 2 and 3A. However, only 9.7 per cent of the patients were operable and 9.1 per cent were resectable. CONCLUSIONS: On reaching the diagnosis, most patients with lung cancer were in advanced stages of the disease, rendering a low resectability. The results emphasise the need for early diagnostic intervention in patients presenting with lung mass. Furthermore, preventive measures including a campaign against cigarette smoking, research into other possible aetiological factors should be more encouraged.

Etiology and clinical implications of eosinophilic pleural effusions.

This prospective study examined the etiology of eosinophilic pleural effusions investigated at a Thai thoracic center from January 1996 to February 1998. Among the 405 eligible pleural effusions, 31 were eosinophilic (EoPF) and 374 were noneosinophilic (NEoPF). Malignant effusions were established in 159 of the 405 patients, yielding a prevalence of 0.39. Malignant effusions were responsible in 24 of the 31 EoPF (77.4%), and 135 of the 374 NEoPF (36%)(p = 0.01). Bayesian analysis showed the post-test probability of malignancy in eosinophilic pleural effusions among our patient population to be 0.76. Tuberculous pleuritis was the etiology in 155 patients with NEoPF (41.4%) but in none of the patients with EoPF (p <0.001). There was no significant difference between EoPF and NEoPF in miscellaneous causes including paragonimiasis, amebiasis, lupus pleuritis, chylothorax, and yellow nail syndrome. It is concluded that eosinophilic pleural effusions are at least as likely to be malignant as noneosinophilic effusions. The finding of eosinophilic pleural effusions should not be regarded as suggestive of benign conditions.

Video thoracoscopic lung biopsy in diffuse interstitial lung diseases.

The present study examined the use of video thoracoscopic lung biopsy (VTLB) in diffuse interstitial lung disease, in comparison with open lung biopsy (OLB). Twenty and fifteen patients underwent VTLB and OLB, respectively, from 1987 to 1997 at the Central Chest Hospital, Thailand. Data in mean (SD). The mean age was 39 years in both groups. VTLB yielded equivalent size of lung tissues, 4.7 (2.32) cm3, and was as diagnostically useful as OLB. Estimated blood loss, 60 (37) mls, and length of pleural drainage, 2.8 (0.5) days, were comparable in either technique. As OLB had been in practice for decades, it took shorter operative time, 64 (11) mins, than VTLB, 105 (30) mins, (p = 0.005). Both VTLB and OLB approaches were safe and not associated with major postoperative complications.

Clinical efficacy of itraconazole with initial flucytosine in AIDS-related cryptococcal meningitis: a preliminary study.

This open, prospective study systematically examined the clinical efficacy of itraconazole and initial flucytosine in AIDS-associated cryptococcal meningitis. Clinical as well as mycological responses were evaluated in 10 patients. Satisfactory outcome was achieved in 8 patients (cure in 4 and improvement in 4). In all, 5 patients died, three as a result of cryptococcal meningitis. The remaining 5 patients have been followed for 5-12 months. The treatment proved to be well-tolerated and safe.

Salmonella lung abscess and bacteraemia in an AIDS patient.

This report describes a 28-year-old, HIV-infected man presenting with subacute onset of pyrexia, cough, dyspnoea and pleuritic pain. Chest radiograph showed bilateral multiple cavitary lesions. The diagnosis of salmonellosis was secured by isolation of salmonella typhimurium in blood, as well as in sputum. Therapy with sequential ceftriaxone/ciprofloxacin led to satisfactory improvement symptomatically and radiologically. The present report serves to heighten the awareness of AIDS-associated salmonella bacteremia and lung abscesses.

Psittacosis pneumonia: a case report and review of the literature.

A case of acute, severe pneumonia with respiratory insufficiency due to Chlamydia psittaci is described. Rapid improvement with tetracycline therapy in all symptoms and arterial blood gases is demonstrated. The diagnosis of psittacosis was secured by both cultivation and serological verification. A comprehensive review of the literature is appended. The present report attests to the need for inclusion of C. psittaci as a possible aetiologic agent causing fulminating community-acquired pneumonia.

Clinical aspects and treatment outcome in HIV-associated pulmonary tuberculosis: an experience from a Thai referral centre.

This case-control study examined the impact of HIV infection on clinical presentation, response to treatment, and outcome of pulmonary tuberculosis. Symptoms, radiographic pattern, sputum direct smear, drug susceptibility, treatment outcome and adverse reactions of 88 HIV-infected patients with newly-diagnosed, culture-proved, untreated pulmonary tuberculosis were compared with those of age and gender-matched HIV-seronegative patients. No differences in the frequency of pyrexia, dyspnoea, cough or haemoptysis were evident. Cavitary lesions and upper zone infiltrates were observed significantly less often in the HIV-infected group (p = 0.02 and 0.01, respectively). Direct smear positivity was comparable in the 2 groups. The resistance rates to antituberculous drugs were not different except for Streptomycin which was higher among the HIV-infected patients (p = 0.01). Cutaneous hypersensitivity reactions and drug-induced hepatitis occurred more often in the HIV-seropositive group, albeit not reaching statistical significance. Default was much higher in the HIV-infected patients (33%); however, the culture conversion rate was satisfactory among those completed treatment. Twelve HIV-infected patients died during the course of treatment, four of whom as a result of tuberculosis. Based on these observations, physicians should maintain a high index of suspicion for tuberculosis among HIV-seropositive patients for short-course chemotherapy to be promptly instituted.