The "reversed halo" sign in pneumonococcal pneumonia: a review with a case report.

The "reversed halo" sign (RHS) is a distinct radiological sign representing a focal rounded area of ground-glass opacity surrounded by a more or less complete ring of consolidation. Initially, it was reported in two cases of cryptogenic organizing pneumonia and was considered to be relatively specific of the disease. Since then, it has been reported in a wide variety of clinical entities, thus reducing its specificity. We describe the reversed halo sign in a case of pneumonococcal pneumonia. To the best of our knowledge, this is the first report in English literature. The presence of the "reversed halo" sign during the resolution phase of pneumonococcal pneumonia has serious implications. First, it further reduces its specificity. Second, it opens new areas of research regarding its significance in cases of cryptogenic organizing pneumonia.

Liposomal cisplatin combined with paclitaxel versus cisplatin and paclitaxel in non-small-cell lung cancer: a randomized phase III multicenter trial.

BACKGROUND: Liposomal cisplatin is a new formulation developed to reduce the systemic toxicity of cisplatin while simultaneously improving the targeting of the drug to the primary tumor and to metastases by increasing circulation time in the body fluids and tissues. The primary objectives were to determine nephrotoxicity, gastrointestinal side-effects, peripheral neuropathy and hematological toxicity and secondary objectives were to determine the response rate, time to tumor progression (TTP) and survival. PATIENTS AND METHODS: Two hundred and thirty-six chemotherapy-naive patients with inoperable non-small-cell lung cancer were randomly allocated to receive either 200 mg/m² of liposomal cisplatin and 135 mg/m² paclitaxel (arm A) or 75 mg/m² cisplatin and 135 mg/m² paclitaxel (arm B), once every 2 weeks on an outpatient basis. Two hundred and twenty-nine patients were assessable for toxicity, response rate and survival. Nine treatment cycles were planned. RESULTS: Arm A patients showed statistically significant lower nephrotoxicity, grade 3 and 4 leucopenia, grade 2 and 3 neuropathy, nausea, vomiting and fatigue. There was no significant difference in median and overall survival and TTP between the two arms; median survival was 9 and 10 months in arms A and B, respectively, and TTP was 6.5 and 6 months in arms A and B, respectively. CONCLUSIONS: Liposomal cisplatin in combination with paclitaxel has been shown to be much less toxic than the original cisplatin combined with paclitaxel. Nephrotoxicity in particular was negligible after liposomal cisplatin administration. TTP and survival were similar in both treatment arms.

A 77 year old male with peripheral eosinophilia, pulmonary infiltrates and a small pleural effusion.

The presence of peripheral eosinophilia with lung infiltrates poses a diagnostic challenge for the clinician. The differential diagnosis includes a wide spectrum of diseases. In some of them (for example vasculitis, lymphoma) eosinophilic pneumonia represents just another "symptom" and not the final diagnosis. A thorough diagnostic procedure is required to examine all related clinical entities in order to establish a firm diagnosis. In particular, Idiopathic Chronic Eosinophilic Pneumonia (ICEP) is a rare disorder. In the majority of cases, it is characterized by peripheral eosinophilia, lung infiltrates, bronchoalveolar lavage eosinophilia (above 25%), exclusion of other possible causes and last but not least an impressive improvement under steroid therapy. Relapses are common but they do not seem to be related with ICEP associated mortality.

The differential effect of pentoxifylline on cytokine production by alveolar macrophages and its clinical implications.

The aim of this study was to investigate the effects of pentoxifylline (PTX) on the production of TNF-alpha, IL-1 beta, IL-6 and GM-CSF by lipopolysaccharide (LPS)-stimulated alveolar macrophages (AM). AM and peripheral blood monocytes (PBM) from 10 patients were cultured for 24 h in the presence of LPS (10 micrograms ml-1) and PTX at concentrations of 2.0 mM, 1.0 mM, 0.5 mM, 0.1 mM and 0.01 mM. TNF-alpha and GM-CSF were measured from the culture supernatants of both the AM and PBM from all 10 patients and IL-1 beta and IL-6 from the culture supernatants of the AM from five patients. The TNF-alpha production by AM was significantly suppressed in the presence of PTX at concentrations of 2.0 and 1.0 mM, while production of IL-1 beta, IL-6 and GM-CSF remained unaffected. In PBM cultures, PTX significantly suppressed the production of TNF-alpha and GM-CSF, at all tested concentrations. The present study provides evidence that PTX selectively suppresses the production of TNF-alpha by LPS-stimulated AM and may have a role in the treatment of lung diseases where TNF-alpha is involved. The mode of administration of PTX should take into account the suppressive effect of this drug on GM-CSF production by PBM.