The Günther temporary inferior vena cava filter for short-term protection against pulmonary embolism.

PURPOSE: To evaluate clinically the Günther temporary inferior vena cava (IVC) filter. METHODS: Eleven IVC filters were placed in 10 patients. Indications for filter placement were surgical pulmonary embolectomy in seven patients, pulmonary embolism in two patients, and free-floating iliofemoral thrombus in one patient. Eight filters were inserted from the right femoral approach, three filters from the left. Follow-up was by plain abdominal radiographs, cavography, and duplex ultrasound (US). Eight patients received systemic heparinization. Follow-up, during 4-60 months after filter removal was by clinical assessment, and imaging of the lungs was performed when pulmonary embolism (PE) was suspected. Patients received anticoagulation therapy for at least 6 months. RESULTS: Ten filters were removed without complications 7-14 days (mean 10 days) after placement. One restless patient pulled the filter back into the common femoral vein, and a permanent filter was placed. In two patients a permanent filter was placed prior to removal. One patient developed sepsis, and one an infection at the insertion site. Clinically no recurrent PE developed with the filter in place or during removal. One patient had recurrent PE 7 months after filter removal. CONCLUSION: The Günther temporary IVC filter can be safely placed for short-term protection against PE. The use of this filter is not appropriate in agitated or immunocompromised patients.

[Minocycline as a cause of acute eosinophilic pneumonia]. / Minocycline als oorzaak van acute eosinofiele pneumonie.

A rare side effect of minocycline is acute eosinophilic pneumonia. In the literature only ten cases have been reported. We report two cases of minocycline which induced (eosinophilic) alveolitis. A high fever, dry cough, dyspnoea and fatigue are the main features of the clinical picture. Peripheral blood eosinophilia and elevated total IgE content were seen in one patient. Bronchoalveolar lavage in this patient revealed eosinophilia. Transbronchial lung biopsies showed infiltration with eosinophilic granulocytes in both patients. Airway macrophages contained brown-black pigment granules. In the acute stage an important decrease in diffusion capacity was observed. The pulmonary and systemic symptoms promptly cleared up after discontinuation of minocycline. Provocation with minocycline was positive, because both patients noticed the same symptoms within one day.

Increased morbidity and mortality in patients with diabetes mellitus after kidney transplantation as compared with non-diabetic patients.

The results of renal transplantation in patients with juvenile-onset diabetes mellitus were compared to those of a well-matched control group of non-diabetic patients. All transplantations were performed between 1977 and 1988. In the diabetic group hypertension (72 versus 41%), coronary artery disease (17 versus 0%), and peripheral vascular disease (19 versus 0%) had been significantly more frequent pretransplantation. Fewer diabetic patients had previously been treated with dialysis therapy (69 versus 97%). Graft function measured by creatinine clearance after 1 year follow-up, and incidence of proteinuria were not significantly different. The overall graft survival was significantly worse in the diabetic group compared to the control group: 42 versus 69% after 60 months and 21 versus 62% after 90 months. This was caused by a significantly worse patient survival in the diabetic group after 105 months: 28 versus 78% in the control group. The graft survival following exclusion of the patients who died with a functioning graft did not differ significantly between the groups after 60 and 90 months: 62 and 31% in the diabetic group and 69 and 62% in the control group. The existence of any vascular disease before transplantation, especially pre-existing peripheral vascular disease, had a significant effect on mortality in diabetic patients (P = 0.0003). After transplantation, diabetic patients had significantly more cerebrovascular accidents (23 versus 3%), peripheral vascular disease (31 versus 3%), and number of infections (1.9 versus 1.2). Retransplantation was carried out in each group to the same extent, with the same success rate.

Dyspnoea after pneumonectomy.

We report the case of a 61 yr old male, who developed a severe right-to-left shunt through a patent foramen ovale, in the absence of elevated right-sided heart pressures, two months after a left-sided pneumonectomy. This is considered to be a rare complication after pneumonectomy. However, taking into account the approximately 20% incidence of patent foramen ovale in the general population, we suggest that right-to-left shunting through an unsuspected foramen ovale or atrial septum defect should always be considered as a possible cause of otherwise unexplained hypoxaemia.

Low-grade lymphoma of immature T-cell phenotype in a case of lymphocytic interstitial pneumonia and Sjögren's syndrome.

A 19-year-old male patient presented with lymphocytic interstitial pneumonia and Sjögren's syndrome, confirmed by histopathology. He was treated with prednisone; 4 months later, cyclophosphamide was added. A lymph node taken at presentation revealed no histological signs of malignancy. Lymph nodes obtained 1 and 2 years later exhibited an effaced structure and a diffuse infiltration of small-sized lymphocytic cells compatible with a low-grade non-Hodgkin's lymphoma. The immunological phenotype of the lymphoma resembled that of immature T-cells present in the normal thymus cortex--positivity for CD1, CD2, CD4, CD7, CD38 and terminal deoxynucleotidyl transferase; faint positivity for CD5 and in the second specimen for CD3; negativity for CD6 and MHC class 1 antigen. The occurrence of such a peculiar lymphoma in Sjögren's syndrome has not been reported thus far. Small numbers of putative malignant cells were found on immunohistochemistry in a lymph node and a lung biopsy obtained at presentation. This is suggestive of one underlying pathogenetic event in the development of lymphocytic interstitial pneumonia, Sjögren's syndrome and non-Hodgkin's lymphoma.

Adjuvant therapy with levamisole in resectable lung cancer.

In view of the discouraging results that have been obtained so far with the use of cytotoxic chemotherapy as an adjunct to surgery, a double-blind placebo-controlled evaluation of the adjuvant use of levamisole was conducted in 211 resectable lung cancer patients, following these patients for 2 years after their operation. Levamisole (or the placebo) was given for 3 days every 2 weeks and the dose level ranged 1.1--3.8 mg/kg per day (a fixed dose of 3 x 50 mg was given to all patients). It appeared that recurrences and carcinomatous deaths had occurred significantly less often in patients who had received a high dose (i.e., 2.1--3,8 mg/kg: patients weighing 70 kg or less) but not in the patients who received a lower dose. Patients who had more advanced cancers at the time of surgery seemed to have profited more from the treatment, but the results did not seem to depend upon the histologic type of the tumor or on the immune status of the patients as estimated from the skin test reactivity at the start. There was also suggestive evidence that levamisole may be more effective in preventing hematogenous dissemination than in inhibiting recurrences in the lung or the mediastinal tissues. Levamisole, if dosed adequately, appears to be a very suitable adjuvant treatment in resectable lung cancer patients as judged from its efficacy and its lack of troublesome side-effects.