[Pseudochylothorax during the course of rheumatoid arthritis]. / Pseudochlonka oplucnej w przebiegu reumatoidalnego zapalenia stawów.

Psudochylothorax is uncommon among pleural fluids. It can be observed during tuberculosis or rheumatoid arthritis in majority. A case of a 62 years old man with chronic pleural fluid is presented. Patient had rheumatoid arthritis diagnosed 40 years ago. For last 13 years symptomsless bilateral pleural fluid was observed. Antituberculous drugs were used without success. Plural fluid obtained after puncture had high level of cholesterol with it[symbol: see text]s crystals, without chylomikrons and triglycerides. Diagnosis of pseudochylothorax in the course of rheumatoid arthritis was established. After plural puncture fluid was removed and did not appear later. Differential diagnosis of pleural fluids is presented.

[Myocardial infarction as a cause of death in patients treated for small cell lung cancer]. / Zawal miesnia sercowego jako przyczyna zgonu chorych leczonych z powodu drobnokomórkowego raka pluca.

The aim of our study was to assess frequency of death from myocardial infarction in patients (pts) treated for small cell lung cancer (SCLC). 33 out of 845 patients treated for SCLC died from myocardial infarction. All patients were smokers. In 6 patients coexisted hypertension, in 2--diabetes and in 5--obesity. Eight patients have had cardiac disease in anamnesis. All patients were treated with one or more number of cardiotoxic drugs as DDP, VCR or VBL, E, MTX and ADR which are able to cause ischemic heart disease or myocardial infarction. Sixteen out of 33 patients have had radiotherapy of lung tumour. Death from myocardial infarction occurred from 0.5 up till 98.5 months from the beginning of start treatment. Eighteen men died from myocardial infarction in the first year of treatment. Risk of death from myocardial infarction was 15 times greater in men with SCLC than in men of the polish population at the same age and at the same time.

[The cause of infection as the main or additional cause of death in patients treated for small cell lung cancer]. / Etiologia zakazenia jako glównej lub dodatkowej przyczyny zgonu u chorych leczonych z powodu drobnokomórkowego raka pluca.

In 116 out of 845 patients treated for small cell lung cancer (SCLC) in the Institute of Tuberculosis and Chest Disease in Warsaw in the years 1980-1994 infection was the main or coexistent cause of death. In 4.1% infection was proved of bacterial origin and in further 6.5% of probable bacterial origin (in the later group cultures were negative or not done but fungal infection, pneumocystosis pneumonia and tuberculosis were excluded on autopsy). In 1.54% infection was of fungal origin, 1.2% patients died of Pneumocystis carinii pneumonia and 0.35% of tuberculosis. The majority of patients who died with and/or from infection had treatment-related leukopenia and 99 of them were treated with corticosteroids. Fungal infection, pneumocytosis and tuberculosis were found more frequently than bacterial infection in patients treated with cumulative dose of prednisone above 2000 mg. 33.62% patients had no symptoms or signs of infection. No connection was found between the absence of symptoms and treatment with steroids or the grade of leukopenia. In all cases infection was recognised very late, in 58 only at autopsy.

Autopsy findings in small cell lung cancer.

The objective of this study was to assess the pattern of autopsy findings in 174 small cell lung cancer patients treated between 1971 and 1991 at seven Polish medical centres. Eighty nine autopsied patients were previously treated with different chemotherapy regimens including 32 patients who also received chest irradiation, 74 received only supportive care and for 11 patients the data on treatment were not available. The age range at diagnosis was 28-81 years (median 57); there were 39 females (22%) and 135 males (78%). Seventy two patients had limited disease at the time of diagnosis, 86-extensive disease and in 16 the disease extent was not determined. The primary tumor and/or metastases in regional lymph nodes were present in 157 autopsies (90%). There was a significant difference in the rate of locoregional disease found at autopsy in patients given chemotherapy and in those who received only supportive care (85% and 100%, respectively; p = 0.01). Chest radiation therapy given in limited disease as an adjunct to chemotherapy did not decrease the rate of persistent locoregional disease (primary tumor in the chest was found in 92% of irradiated and in 96% of nonirradiated patients). Locoregional tumor deposit only was found in 28 (16%). Distant metastases were distributed in 143 patients (82%) and were found in 25 different locations, most frequently in liver (49%), suprarenal glands (25%), peripheral lymph nodes (21%), kidneys (18%), brain (17%) and pancreas (12%). In 3 patients no tumor foci were found. The number of organs involved varied between 0 and 10 (median 3). The number of involved organs was not dependent on the disease extent at the time of diagnosis and on the type of treatment.

[Comparison of conventional chest radiography and computed tomography for evaluation of the degree of regression in neoplasms of patients treated for small cell lung cancer]. / Porównanie konwencjonalnego badania radiologicznego klatki piersiowej i tomografii komputerowej w ocenie stopnia regresji zmian nowotworowych u chorych leczonych z powodu drobnokomórkowego raka pluca.

The aim of the study was to assess how objective is the estimation of the chest lesions regression on RT picture and how extent chest CT can increase the precision of this assessment. The material consisted of 66 SCLC pts observed in the Institute of Tuberculosis and Lung Diseases in Warsaw between 1987 and 1994 in whom RT and CT were performed to estimate the degree of response to treatment. Chest RT were estimated by 4 specialists independently. In 28 cases (42%) opinion concerning the degree of tumor regression was the same. In 23 cases (35%) the opinions were discordant and in 15 cases (13%) (mainly after chest irradiation) all examiners agreed that degree of response is impossible to precise (it ranged between PR and CR). In the second part of this study the degree of cancer regression was assessed in the same patients by 2 specialists independently estimated CT pictures. Opinions were different only in 4 cases. The comparison between these two methods was done. CI examination allowed exact estimation of response degree in 20 out of 24 pts (83%) in whom this assessment was impossible using chest radiography. In 9 cases (21%) the assessment of chest CT changed the previous estimation made using chest radiography (in 5 cases from CR to PR and in 4 cases from PR to CR). In conclusion-estimation of tumor regression using chest RT is very subjective method and many errors are possible. Chest CT estimation is a much better method for estimation of tumor response especially in irradiated patients.

[Indications for prophylactic cranial irradiation in patients with small cell lung cancer]. / Wskazania do profilaktycznego napromieniania mózgu u chorych na drobnokomórkowego raka pluca.

Brain metastases are one of the important causes of failure in the treatment of SCLC patients. Intracranial metastases are reported in 10% of the newly diagnosed SCLC pts. Further 20% brain metastases develop during therapy. Autopsy studies showed that 40%-60% of pts had evidence of intracranial spread at the time of death. The frequency of brain metastases increases with the duration of survival, reaching a probability of 80% after 2 years of observation. The high risk of brain metastases which developed in spite of chemotherapy was the reason of introducing PCI to the treatment. PCI reduces the risk of brain metastases to less than 10%, but unfortunately, does not prolong median survival. Probably this is due to the fact, that in the majority of cases the brain is one of many sites of metastases at the time of progression. In addition, in some pts brain metastases developed in spite of PCI and/or brain toxicity may develop after this treatment. Thus, up till now the role of PCI in the treatment of SCLC pts remains controversial. The indication for this treatment could improve if we have more exact information which pts have the greatest probability do develop metastases restricted to the brain only. This question was the main aim of our study.

[Incidence of beta HCG elevation in serum of patients with small cell lung neoplasms and their prognosis]. / Czestosc wystepowania podwyzszonych stezen beta gonadotropiny kosmówkowej w surowicy chorych na drobnokomórkowego raka pluca i ich znaczenie rokownicze.

HCG-like immunoreactivity has been found in many nontrophoblastic tumors, but the biological behaviour of HCG--producing cells has not been clarified yet. The aim of the study was to estimate the frequency of serum bHCG (sbHCG) elevation in SCLC patients and to assess its possible prognostic role in this type of tumor. 156 SCLC patients entered the study: 93 men, 63 women, median age 58 years. SbHCG activity was measured with immunoenzymassay (Abbott EIA bHCG 15-15) before treatment. ScHCG elevation (5 mIU/ml) was found in 21 of 156 patients (14%). Response to treatment after chemotherapy (CR + PR) was obtained in only 48% of those patients in whom elevated sbHCG was found, in comparison to 73% of response rate observed in the remaining patients. Only 5% of patients with elevated sbHCG survived 2 years, in comparison to 21% of 2-years survivors in the remaining patients. Thus sbHCG elevation in SCLC seems to be a marker of more resistant tumors and of poor prognosis.

Risk of late recurrence and/or second lung cancer after treatment of patients with small cell lung cancer (SCLC).

The aim of this study was to illustrate some difficulties in distinguishing late recurrence of small cell lung cancer (SCLC), from second primary lung cancer. Three-hundred fourteen SCLC patients were observed at the Institute of Tuberculosis and Chest Diseases in Warsaw, during the period 1976-1985. All patients were treated with chemotherapy and 125 were also treated with radiotherapy on the tumour and mediastinum. Nineteen patients (6%) survived 3 years. This group consisted of eight females (9%) and 11 males (5%). In all of them a complete remission was obtained. In six patients from this group no progression of lung cancer was observed. Four of them are still living, 7.9-16.2 years after the start of treatment. Two patients died of heart infarct. In the remaining 13 patients, progression of SCLC or development of new cancer was noted in the course of observation. In seven of them, histological proof of the character of progression was obtained. In four cases non-small cell lung cancer (NSCLC) was diagnosed after 3-11 years of observation. In one of them SCLC metastases in the liver were unexpectedly found in the autopsy, although adenocarcinoma in the lung diagnosed during bronchoscopy was also confirmed in the autopsy. In three cases SCLC was diagnosed. In one case, 2.7 years from the beginning of treatment, only SCLC metastases were found during laparoscopy. SCLC was found in two other cases after a 7-year cancer-free period. In one of those patients, a new lesion was found in the other lung while the second patient developed a new lesion exactly in the place of the former cancer. In six other patients no histological proof of the character of progression was obtained. Two of the six are still living, 8.2 and 15.1 years later. In the first of these two, a new lesion developed very early in the course of treatment in the same place as the primary tumour and it was regarded as the progression of SCLC. In the second patient, who probably had NSCLC the lesion developed in the contralateral lung after 12.5 years of remission and disappeared after radiotherapy. Four patients died of cancer after 3.2-6.4 years of observation. The cumulative risk of a second primary lung cancer after a 3-year survival period oscillated in our SCLC patients between 4% and 6% for every patient/year of observation. It was concluded that prognosis in SCLC patients is still doubtful, nevertheless, some patients made a complete recovery.

[Role of radiotherapy on tumor and mediastinum as a combined treatment with chemotherapy in patients with limited small cell lung carcinoma]. / Rola radioterapii na guz pierwotny i sródpiersie jako leczenia skojarzonego z chemioterapia u chorych na ograniczona postac drobnokomórkowego raka pluca.

A group of 154 limited small cell lung cancer patients was studied. 107 of them were treated with chemo- radiotherapy on tumor and mediastinum, 47 patients were treated with chemotherapy only. A significantly higher rate of complete remission and duration of the remission, longer survival time and lower rate of local relapses were found in the group treated with chemo- radiotherapy.

[Evaluation of the second line of treatment of patients with small cell carcinoma of the lung]. / Ocena skutecznosci drugiego rzutu leczenia chorych na drobnokomórkowego raka pluca.

Efficacy of second line therapy which included vepesid and adriamycin or vepesid, adriamycin and cis-platin, in small cell lung cancer was studied. Objective remission was seen in 35% of the once more treated patients. Analysis of survival time showed significant prolongation of it in cases treated once more in comparison with a group of patients with progression of the neoplastic process during primary therapy or patients not treated due to relapses of the process. The observed difference was bigger in patients that reacted with a remission to the second line therapy.