Controlling malignant pericardial effusion by intrapericardial carboplatin administration in patients with primary non-small-cell lung cancer.

Malignant pericarditis, when associated with massive pericardial effusion, presents a critical condition in lung cancer patients. Because this condition often arises in terminally ill patients, intensive therapy such as multi-drug combination chemotherapy is rarely appropriate. This study evaluated the clinical relevance of intrapericardial administration of carboplatin for controlling malignant pericardial effusions associated with non-small-cell lung carcinoma (NSCLC). The method used for 10 eligible patients consisted of draining the pericardial effusion and infusing 300 mg/body of carboplatin in 50 ml of saline through an in-place catheter into the pericardial space and clamping the catheter for 40 min. Nine of the 10 patients showed satisfactory results, and 8 experienced complete regression of the effusion. No major or minor adverse effects were observed. Pharmacokinetics analysis revealed that the concentration of free platinum in the pericardial fluid was very high while that of total platinum in the circulating plasma was very low, assuring the usefulness of the intrapericardial instillation of carboplatin in terminally ill patients for controlling malignant pericardial effusion when the systemic delivery of cytotoxic agents is inappropriate.

[Acute pulmonary thromboembolism treated with E6010].

A 22-year-old man was admitted to our hospital because of sudden dyspnea and dizziness. Hypoxemia was found. Lung perfusion scintigraphy and pulmonary angiography showed massive pulmonary thromboembolism. The patient received E6010, a derivative of tissue plasminogen activator by intravenous injection for about 2 minutes. One hour after this treatment, pulmonary angiography showed lysis of the ciot, the pulmonary arterial pressure had decreased, and the cardiac index and PaO2 had increased. Despite anticoagulant therapy, pulmonary embolism recurred so we implanted a Greenfield filter in the inferior vena cava. This was the first case of pulmonary thromboembolism in which E6010 had a beneficial effect. We were also able to document hemodynamic and radiologic changes after intravenous infusion of this drug. Recurrent pulmonary embolism is an indication for filter placement, and this patient will need a long period of follow-up.

[Bronchopneumonia caused by Neisseria meningitidis--probable transmission by a family member who had been in Hong Kong].

A 22-year-old man came to our hospital complaining of bloody sputum. No abnormalities were seen on a chest X-ray film, but computed tomography of the chest showed infiltrates in the middle and lower lung fields. Neisseria meningitidis was isolated from cultured samples of naso pharyngeal secretions, from sputum, and from a sample obtained during bronchoscopy; bacterial bronchopneumonia was diagnosed. Family members were studied for meningococcal infection, and the bacterium was cultured from a nasopharyngeal smear from the patient's mother. The mother was asymptomatic. Both bacteria belonged to Group B serum group and their drug sensitivities were equal. The patient's family had been in Hong Kong, where this bacterium is endemic, for two years. They then returned to Japan and started to live together with the patient nine months before the onset of symptoms. The mother may have become infected in Hong Kong and may have passed the bacterium to her son after her return. Oral ampicillin was effective in both mother and son. Investigation of the patient's family was necessary to establish the probable route of infection and to decide on the treatment.

[Bilateral meningococcal pneumonia in a young Japanese woman].

A 22-year-old woman was admitted to the hospital with complaints of fever, loss of appetite, coughing, sputum production, and right-sided chest pain. The chest X-ray film and computed tomogram showed infiltrates in both lower lung fields. Meningococcal pneumonia was diagnosed when a sputum culture was found to be positive for Neisseria meningitidis. Infection with this organism is uncommon in Japan. The patient had never gone abroad, and the route of infection was unknown. N. meningitidis is a rare cause of respiratory infections. When this organism does cause respiratory disease, it is usually acute bronchitis rather than meningococcal pneumonia. The patient in this case was not immunodeficient. She was also not deficient in a terminal lytic component sequence (deficiency in that sequence promotes meningococcal infection). The patient was emaciated and malnourished, which was thought to have made her more susceptible to infection. Orally administered DU-6859a, one of a new generation of quinolones, was very effective and had no side effects.

[A case of chronic necrotizing pulmonary aspergillosis in which intravenous infusion of amphotericin B was effective].

A 49-year-old man with a history of left upper lung lobectomy for pulmonary asperigilloma developed a productive cough in the middle of April 1992, and his chest X-ray film showed infiltration of the left S6. Treatment with several different antibiotics was tried, but the shadow expanded and developed a cavity over the following 8 months. A clinical diagnosis of chronic necrotizing pulmonary aspergillosis was made, based on repeated detection of Aspergillus fumigatus in the patient's sputum and in specimens obtained by fiberoptic branchoscopy and percuraneous needle biopsy. Prior lobectomy and a marked idiopathic decrease in ventilation and perfusion in the affected lung are risk factors for this disease. Slow intravenous infusion of amphotericin B eradicated the fungus without any side effects. Measurement of drug concentrations during treatment revealed that the concentration in the sputum was far higher than that in the serum, and was also far higher than the minimum inhibitory concentration for the fungus.

[A case of congenital absence of the right pulmonary artery].

A 14-year-old girl was admitted to ur hospital with pneumonia of the left lung, and some residual abnormalities were noted on chest X-ray film after recovering, which showed a small right hemithorax, displacement of the heart and mediastinal structures toward the right, and a small right hilum. There was no radioisotope accumulation in the right lung on pulmonary perfusion scintigraphy, and pulmonary angiography showed proximal interruption of the right pulmonary artery. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the absence of the right main pulmonary artery and enabled congenital absence to be distinguished from acquired obstruction of the artery. The peripheral pulmonary arteries in the affected lung were identified on CT, and radioisotope angiography showed a blood supply to it from the systemic circulation. However, aortography and bronchial arteriography failed to show an aberrant systemic pulmonary artery. 133Xenon ventilation-perfusion scintigraphy showed that the ventilation of the affected lung was about 50% of that of the left lung, but there appeared to be no gas exchange by the affected lung. Her prognosis was expected to be good, because she had neither cardiovascular abnormalities nor had developed pulmonary hypertension.

[The defensive role of human pulmonary alveolar macrophages and polymorphonuclear leukocytes against a strongly or weakly virulent strains of Cryptococcus neoformans].

The phagocytic and killing activities of human pulmonary alveolar macrophages (PAM) and polymorphonuclear leukocytes (PMN), and superoxide (O2-) production in phagocytizing PAM and PMN were studied by using a strongly and weakly virulent strains of Cryptococcus neoformans (C. neoformans) in mice. The strongly virulent strain was encapsulated with a thick capsule while the other had a thin one. The phagocytic and killing activities of PAM and PMN against the strongly virulent strain were lower than against the weakly virulent one. There was no significant difference between PAM and PMN in terms of phagocytic or killing activities and O2- production. It seems likely that O2- plays no defensive role in the intracellular killing of C. neoformans by PAM and PMN because no correlation was found between the killing activity and O2- production. These results indicate that human PAM and PMN play an effective role in host defense against the weakly virulent strain of C. neoformans encapsulated with a thin capsule but are not effective against the strongly virulent strain encapsulated with a thick capsule.

[Clinical evaluation of ciprofloxacin in pulmonary infections in the patients with chronic respiratory diseases].

The clinical efficacy of ciprofloxacin (CPFX) was investigated in pulmonary infections in patients with chronic respiratory diseases. Out of 58 cases collected, 54 were evaluable for utility of CPFX including 20 with pneumonia, 34 with chronic bronchial infection. CPFX was given orally at 200 mg 3 times per day. In 20 cases of pneumonia, the mean age was 62.0 years underlying diseases were chronic bronchitis 9, bronchiectasis 6, inactive pulmonary tuberculosis 4, and diffuse panbronchiolitis 1. The efficacy rate of CPFX in this group was 90.0%. In 34 cases of chronic bronchial infection, the mean age was 59.8 years, underlying diseases included bronchiectasis 10, chronic bronchitis 8, inactive pulmonary tuberculosis 7, diffuse panbronchiolitis 5, and pulmonary emphysema 4. The efficacy rate of CPFX in this group was 70.6%. The overall efficacy rate in the entire cases was 77.8%, and we consider CPFX to be effective in the treatment of patients with chronic respiratory diseases.

[The treatment of pulmonary aspergilloma with itraconazole].

We evaluated the efficacy of Itraconazole (ITZ), a newly developed triazole antifungal agent, in 5 cases of pulmonary aspergilloma. A daily dose of 100-200 mg of ITZ was given orally for 5 to 20 months. In one patient, administration of ITZ was discontinued because of mild and transient hepatic injury. On computerized tomography and conventional roentgenogram of the chest, improvement was clearly observed in 2 of the remaining 4 cases. Symptomatic improvement, mainly disappearance of airway bleeding, was seen in 2 cases. Thus the overall improvement rate was 50% (two out of 4). No adverse response other than the hepatic injury mentioned above occurred. In one patient, who had two fungus balls previously, one of the fungus balls disappeared completely and the other decreased significantly in size during the course of treatment. In this case, the daily dose of ITZ was larger (200 mg once a day) and the plasma concentration of ITZ was extremely higher (2068 ng/ml) than in other cases (137-330 ng/ml). We conclude that ITZ is an efficacious drug in the treatment of pulmonary aspergilloma, and that this drug may be even more efficacious if we keep higher plasma concentration of ITZ.

[A case of Kartagener's syndrome with bilateral superior vena cava and absent inferior vena cava].

A 39-year-old man with a history of repeated attacks of acute bronchitis and pneumonia since childhood was admitted complaining of cough, sputum, and a high fever. A diagnosis of Kartagener's syndrome was made because of the presence of mirror-image dextrocardia with complete situs inversus, bronchiectasis in right B6 and B10, and chronic sinusitis. Examination of the ciliary ultrastructure of the bronchial epithelium showed defective inner dynein arms and impaired nasal clearance was suggested by the saccharin particle method. Contrast venography of great veins revealed a McCotter type II bilateral superior vena cava and an absent inferior vena cava with (hemi-) azygos continuation. A search to find a similar case in the literature failed. Abnormal ciliary movement from the embryonic period was implicated as a causative factor in Kartagener's triad and the morphological abnormalities of the great veins.

[Evaluation of FCR (Fuji Computed Radiography) images applied to standard radiography for the diagnosis of chest diseases].

FCR (Fuji Computed Radiography) was added to plain chest radiography in order to evaluate its image characteristics and to determine the best image characteristics and to determine the best image processing program by comparing the visibility of shadows on conventional X-rays and on six FCR hard copy images processed by six mutually different image processing program. FCR showed excellent ability to visualize abnormal lung shadows as well as normal chest structures when processed by a moderate spatial frequency enhancement (spatial frequency 0.11 cycle/mm, level of enhancement). FCR also proved superior to the conventional film-screen system in the visualization of hilar and mediastinal structure as well as lung shadows. The effects of the image processing program on the visibility of shadow, granular and linear shadows were clearly demonstrated when a more intense spatial frequency enhancement (spatial frequency 0.18 cycle/mm, level of enhancement) was performed. The same results were obtained in terms of reticular and linear shadows and calcified lesions. On the contrary, low density shadows with poorly defined margins the lung field and infiltrates from mycoplasma pneumonia were well depicted by a program with a slightly steeper gradation (gamma; 1.0) and minimal frequency enhancement. Accordingly, FCR was found to be useful for the screening of abnormal chest X-ray shadows whereas it was also likely to demonstrate the best image when processed by the most appropriate image processing programs, depending on the characteristics of the shadows.

[Clinical studies of norfloxacin on respiratory tract infections in aged people].

Norfloxacin (NFLX), an oral antibacterial agent of new quinolone derivative, was administered at daily doses of 300-600 mg t.i.d. to 20 aged patients with respiratory tract infections. The results obtained are summarized as follows. 1. Clinical efficacies were moderate in 6 patients with upper respiratory tract infections, and moderate in 11 patients and fair in 3 patients with lower respiratory tract infections. In the 20 patients, overall clinical efficacies were moderate in 17 patients, hence the efficacy rate was 85%. 2. Bacteriologically, causative organisms were detected in 10 of the 14 cases with lower respiratory tract infections. In these cases, bacteriological responses were "eradicated" in 9 cases, "decreased" in 1 case and "unknown" in 1 case, the rate of eradication was 90%. 3. No adverse reactions or abnormal laboratory test values were observed.

Studies on defense mechanisms against Candida albicans infection in congenitally athymic nude (nu/nu) mice.

The defense mechanisms against Candida albicans infection were studied by using a mouse thigh lesion model in congenitally athymic nude (nu/nu) mice and their normal littermates (nu/+). Nu/nu mice were more resistant to C. albicans infection than nu/+ mice judging from the course of the thigh lesion, the results of CFUs (colony-forming units) of C. albicans in the lesion, and histopathological observations. Histopathological and serological studies revealed that granulocytic cellular infiltration was predominant, and there were few indications of development of cell-mediated immunity to protect Candida infection in Candida-infected nu/nu and nu/+ mice. These results confirmed that lower susceptibility of nu/nu mice to C. albicans infection as compared to nu/+ mice was due to accelerated non-specific defense mechanisms in nu/nu mice, and that cell-mediated or humoral immunity played a minor role in the defense against Candida infection in this experimental model. Furthermore, treatment with high titer of rabbit anti-C. albicans serum was effective to control the number of Candida cells in thigh lesions of BALB/c mice. Above experimental results seem to clearly indicate the great variability of defense manifestation according to the experimental model exployed.

Saframycin S, a new saframycin group antibiotic.

Saframycin S, structurally the decyano-saframycin A and biosynthetically the precursor of saframycin A, is a new antibiotic and is assumed to be the active principle for the formation of the antibiotic-DNA complex to manifest its activity. In the present study on the biological activity of saframycin S, the antibiotic showed a marked activity against Ehrlich ascites tumor with the doses of 0.5 to 0.75 mg/kg/day for 10 days, and the rate of 40-day survivors was 80 to 90%. However, this antibiotic was less effective against P388 leukemia than saframycin A at the doses tested. Saframycin S also showed the highest antimicrobial activity, in particular against gram-positive bacteria, among the saframycin group antibiotics identified to date. the LD50 of saframycin S was 3.2 mg/kg (i.p.) for ddY mice. The biological activity and toxicity of saframycin S in relation to its structure were described.