Lung carcinoma in a patient with Lucite sphere plombage thoracoplasty.

A patient with a history of pulmonary tuberculosis was treated in 1949 with Lucite sphere plombage thoracoplasty. She subsequently developed squamous cell carcinoma of the lung despite having no history of exposure to known carcinogens associated with the development of squamous cell carcinoma. The patient's lung carcinoma developed adjacent to the plombage space. Lung carcinoma has not previously been reported in association with Lucite sphere plombage.

Spectrum of clinical disease in pulmonary infection with Mycobacterium avium-intracellulare.

Cases of infection with Mycobacterium avium-intracellulare reported in Milwaukee, Wisconsin, have become more common in recent years, and their incidence--50 cases per year--is now similar to that of tuberculosis. Cases usually occur in middle-aged men with underlying lung diseases, but variations in age, sex, presentation, and severity of disease are wide. Several cases that illustrate pathogenesis and spectrum of disease, from primary, to chronic-active, to healing stages, are presented. The disease tends to run an indolent course in most cases, but extensive disease and unfavorable early course indicate poor prognosis. At a 10-year review, mortality had reached sizable numbers in this aging population with frequent serious underlying problems. Only a small number of these deaths can be attributed directly to mycobacterial disease.

"Atypical" mycobacterioses.

Infections due to atypical mycobacteria appear to be growing in importance. In part, this may be due to enhanced recognition as tuberculosis recedes and laboratory identification improves. In a larger part, however, it is due to real increase in the incidence of infections and disease and to our appreciation of a wide spectrum of manifestations of common problems as in pulmonary disease due to MAIS, as well as newer diseases in unexpected places such as infected prostheses due to M. fortuitum complex. These organisms generally conform to a role as opportunists. The average case occurs when some type of host compromise is present and the disease course is chronic and indolent. However, otherwise healthy host can be affected and severe and progressive diseases also do occur. These mycobacteria are all more resistant to antituberculosis chemotherapy than is M. tuberculosis. Effective therapy has been found for some, especially M. kansaii. For most others, more predictable, effective, and safe therapy is greatly needed.

Pulmonary mycobacterial infections due to Mycobacterium intracellulare-avium complex. Clinical features and course in 100 consecutive cases.

One hundred consecutive cases of pulmonary infection due to Mycobacterium intracellulare-avium seen during a 3 1/2-year period qualified for review on the basis of a compatible chest x-ray film, repeated isolations from cultures of sputum, and follow-up of three to eight years. Infections with M intracellulare-avium represented 27 percent of all mycobacterial infections seen during this period, including those due to M tuberculosis. The cases of disease due to M intracellulare-avium were predominantly in men with preexisting pulmonary disease, with a peak incidence in the sixth decade, but nearly one-third of the cases were in younger persons free of coexisting disease. The disease was chronic and indolent in most cases, and only a few showed a progressive course. A stable course was frequently observed despite prolonged persistently positive cultures of sputum. A favorable prognosis was most often found in those with previously treated tuberculosis. Poor prognosis was often due to a serious associated disease, such as cancer, rather than to advancing mycobacterial infection itself. Age, sex, or race was unrelated to prognosis. Conversion to negative status on culture was attained in one-half of the cases. Those with extensive radiographic involvement or cavitation were more likely to have treatment fail bacteriologically. No combination of chemotherapy appeared to be particularly effective, including the use of five or more drugs in eight cases demonstrating progressive disease. Surgery, too, was ultimately disappointing in that recurrence appeared in six of 18 carefully selected cases.

Changes in small airway function after live attenuated influenza vaccination.

Live, attenuated influenza vaccine was given by intranasal inoculation to 15 young, adult volunteers. Modest symptoms occurred within 3 days of challenge, but the agent was otherwise well tolerated. Hemagglutinin-inhibition antibodies increased in 9 of the 12 subjects whose initial volumes, but closing volume did not change. These changes in airflow reverted to previous levels after 1 week. On a second challenge 2 weeks after the first, symptoms were far less frequent, and no changes in airflow were detected. We conclude that this agent is biologically active and that the airflow changes observed may reflex involvement of small airways.