Comparison of vincristine and vindesine in the treatment of inoperable non-small cell bronchial carcinoma.

Sixty-three patients with inoperable symptomatic non-small cell carcinoma of the bronchus were randomly allocated to receive either vincristine (1.4 mg/m2) or vindesine (3 mg/m2). These drugs were given weekly for four doses, then every 2 weeks for two further doses, and then continued monthly if there had been a response. Only five partial responses (greater than 50% reduction) were obtained with vindesine and none with vincristine. Disabling toxic effects occurred in 13 patients. This was more common with vindesine, but this group also received more prolonged therapy. Vindesine has modest activity against non-small cell carcinoma of the bronchus and may be more effective than vincristine, with similar toxicity.

Pulmonary aspergilloma: analysis of prognosis in relation to haemoptysis and survey of treatment.

From 1956 to 1980 85 patients were admitted to the Brompton Hospital, London, with pulmonary aspergilloma. The mean follow-up period was 8.7 years and 85% of patients were followed for five years or until death if this was earlier. There were 41 deaths, 27 from respiratory causes: 11 from pneumonia, six from chronic respiratory failure, seven after surgery for aspergilloma, and three from haemoptysis. Medical treatment alone was given to 36 patients, of whom three died of haemoptysis. Systemic antifungal treatment was given to 18 patients without benefit. Intracavitary antifungals were helpful in three out of 10 patients. Surgical resection was performed in 41 patients, of whom three (7%) died after operation and a further six (15%) developed major complications. Cavernostomy was performed in nine patients considered unfit for resection; four died after operation. Haemoptysis was absent or minor in 40 patients, of whom 19 were treated medically and 18 by resection, with similar five-year survival rates of 65% and 75%. Frank or major haemoptysis occurred in 45 patients, of whom 17 were treated medically and 23 by resection, with five-year survivals of 41% and 84% (p less than 0.02). The better survival of the surgical group in this retrospective survey may have been due to the selection of patients with better lung function and more localised pulmonary disease. Our observations suggest that surgical resection for aspergilloma should be restricted to patients with severe haemoptysis and adequate pulmonary function. In patients unfit for resection cavernostomy is hazardous.

Aetiology of acute diarrhoea in adults.

We have studied 73 adults with acute diarrhoea and identified a micro-organism or toxin likely to be the cause in 58%. In addition to routinely cultured bacteria, Campylobacter coli/jejuni and Clostridium difficile were important pathogens in the community. Patients who developed diarrhoea after antibiotic use had a distinctive clinical syndrome and comprised the third largest group of cases. Clinical, epidemiological, and histological features in an additional group with negative cultures and no antibiotic history suggest that an additional bacterial pathogen remains to be identified as a cause of acute diarrhoea in adults.

Acute diarrhoea: Campylobacter colitis and the role of rectal biopsy.

Campylobacter spp. were the organisms isolated most frequently from 29 consecutive patients admitted with acute diarrhoea to an infectious disease unit. Rectal biopsies taken from 21 of the patients were abnormal in all but four, and in the patients with campylobacter infection there was a characteristic proctocolitis in each case. The histopathology was similar to that described for salmonella and shigella infections but clearly different from typical ulcerative colitis and Crohn's disease. Therefore in patients with acute diarrhoea we suggest that selective culture for Campylobacter spp. should be made a routine and that rectal biopsy has an important diagnostic role, particularly in patients with negative cultures.