Treatment of ulcerative endobronchial tuberculosis and bronchial stenosis with aerosolized streptomycin and steroids.

OBJECTIVES: Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree. It has been reported that aerosolized therapy with streptomycin and steroids is useful for EBTB; however, the effectiveness of this therapy for bronchial stenosis has yet to be clarified. This study was undertaken to determine the effectiveness of aerosol therapy in the treatment of bronchial stenosis due to EBTB. DESIGN: An observational, historical, controlled comparative study. Retrospective analysis of 27 patients treated with conventional therapy, and prospective analysis of 30 patients treated with aerosol therapy. METHOD AND PATIENTS: Flexible bronchoscopy was performed at least twice in 57 patients with ulcerative EBTB, in whom the degree of bronchial stenosis between the first and last bronchoscopic examinations was estimated. Bronchial stenosis was graded as minimal, mild, moderate, severe or obstructive, and the follow-up of bronchial stenosis assessed as aggravation, no change or improvement. RESULTS: Conventional therapies led to aggravation in 13 patients, no change in 13 patients, and improvement in one patient. Aerosol therapy led to no change in 27 patients, and improvement in three patients. No patients developed aggravation. The differences between the therapeutic groups were significant. CONCLUSION: Aerosol therapy helps to prevent progressively severe bronchial stenosis due to EBTB.

[Clinical features and outcome of pneumonia in patients with lung cancer].

We reviewed our experience with pneumonia in patients with lung cancer over a 14-year period at Kurume University Hospital. We examined the clinical features and significance of pathogenic microbes isolated from sputum in patients with lung cancer complicated by pneumonia. Many investigators have noted that patients with squamous cell lung cancer tend to contract pneumonia more readily than patients with cancers of other histopathological types. Our review, however, disclosed no significant differences among histopathological types. Bacteriological examinations of sputum revealed the frequent involvement of Staphylococcus aureus, Enterococcus faecalis, and various gram-negative organisms (e.g., Pseudomonas, Acinetobacter, Enterobacter, and Klebsiella species) that are known to be causative agents of hospital-acquired infection. Beta-lactam and CLDM were less effective. Carbapenem used alone as the second regimen of treatment for lung cancer patients with pneumonia was found to be as effective as combination therapy with beta-lactam and aminoglycoside. However, more detailed investigations (e.g., randomized prospective studies) will be needed to identify suitable antibiotics against pneumonia in patients with lung cancer. We concluded that it will be necessary to evaluate the clinical features and outcome of pneumonia in lung cancer patients in order to provide more effective treatment.

Diagnostic features and therapeutic outcome of erosive and ulcerous endobronchial tuberculosis.

SETTING AND OBJECTIVE: Erosive and ulcerous endobronchial tuberculosis (EBTB) is distinct from pulmonary tuberculosis in some aspects. We evaluated the clinical features of 56 patients (26 males and 30 females) with EBTB to characterize the clinical features of the disease. RESULTS: The chief complaint in 70% of patients was intractable cough, particularly in those with tracheal tuberculosis. The predominant radiological features were patchy bi-apical infiltrates of variable intensity without cavitation; for six patients, however, plain radiographs revealed no abnormalities. The ulcerous lesions could be classified into three stages: active, healing and scarring. Furthermore, we divided scarring stage into two subtypes, polypoid and non-polypoid. Most of the patients were treated with isoniazid, rifampin, and streptomycin (SM) or ethambutol. Approximately one-third of the patients, not randomly selected, were treated with aerosolized SM and corticosteroids in addition to conventional oral therapy. CONCLUSION: EBTB involves typical clinical and radiographic features. In this uncontrolled series, it was our impression that the period of time to healing of ulcerous lesions seemed to be shorter in those treated with aerosol therapy including streptomycin and corticosteroids.

Changes in phenytoin concentrations in blood and cerebrospinal fluid caused by direct hemoperfusion in a patient intoxicated with phenytoin.

We performed direct hemoperfusion (DHP) 5 times on a patient with consciousness disorder and phenytoin intoxication. We then measured the phenytoin concentrations in her cerebrospinal fluid (CSF) and blood at various times. After the first DHP session, consciousness began to improve, and it normalized after the fourth DHP session when the blood concentration of phenytoin had decreased from 54.0 microg/ml to 16.5 microg/ml. The average plasma phenytoin elimination rate of DHP was 18.0% over 120-180 min. The concentration of phenytoin in the CSF decreased as that in the blood was lowered by DHP. The average reduction rate of phenytoin in the CSF after a DHP session was 23.7%, which was similar to the rate of elimination from the blood. The CSF/blood phenytoin ratio was 0.17, and no marked changes were detected before or after a DHP session.

Production of granulocyte colony-stimulating factor by malignant mesothelioma.

We present the case of a male patient, aged 45 yrs, with malignant mesothelioma producing granulocyte colony-stimulating factor (G-CSF). The diagnosis was established by histopathological examination of the autopsied pleural tissues. Production of G-CSF was confirmed by immunoperoxidase staining, using a specific monoclonal antibody against recombinant G-CSF (rhG-CSF).

[Self-expandable metallic stent therapy for inferior vena cava obstruction secondary to malignancy: clinical observations].

To evaluate the self-expandable metallic stent therapy for inferior vena caval obstruction (IVCO) secondary to malignant liver tumors, changes in caval pressure, the symptoms and hemobiochemical values were observed. Among 16 IVCO cases with higher caval pressure than 20 cmH2O at the peripheral caval lumen to the stenosis, nine cases consisting of five extracaval compression cases and four intravenous tumor thrombi cases subjected the stent therapy. Other three subjected radiotherapy and the other four cases inactive supportive care. Immediately after the Z-stent implantation, the averaged caval pressure distal to the stenosis decreased from 27.7 +/- 3.5 cmH2O to 14.7 +/- 2.6 cmH2O. One case developed 8 cmH2O increase of right atrial pressure but no lung edema. The urine excretion volume increased after stent. The decrease in caval pressure correlated with the urine volume of the day after the stenting (gamma = 0.83), symptomatic improvements of leg edema (gamma = 0.68), ascites (gamma v 0.51) and scrotal edema (gamma = 0.70). Five cases showed gradual increase in platelet number. All elevated LDH and elevated fibrinogen value decreased. These changes would suggest physiologic benefits of the IVC stent therapy. Compression cases showed better improvements and courses than the thrombi cases. Two thrombi cases endured severe conditions suspected of triggered by the procedure. Conclusively, the stent therapy to the IVC obstruction was thought to effect hemodynamically and hematobiochemically.