Triple synchronous primary lung carcinomas treated with simultaneous resection

The fifth case of surgical treatment for three primary bronchogenic lung cancers is presented. This is the second successful surgical case in which this occurred bilaterally and the first case in which simultaneous resection via median sternotomy for three separate primary bronchogenic carcinomas was performed. We strongly advocate this approach when feasible.     

Cardiopulmonary bypass in anesthetic management of resection. Its use for severe tracheal stenosis.

On initial evaluation, two patients were found to be in severe respiratory distress from tracheal obstruction. One patient had late obstruction after a crushing injury to the chest, whereas the other had subtotal tracheal obstruction from a carcinoid adenoma. In each case, the state of the patient seemed to preclude safe anesthetic induction with an endotracheal tube as the sole means of oxygenating the patient. Partial cardiopulmonary bypass provided an adjunct to ensure adequate oxygenation for tracheal resection. Consideration for the use of this technique is recommended in similar circumstances.     

Phase I study of a novel taxane BMS-188797 in adult patients with solid malignancies.

PURPOSE: Preclinical studies show that BMS-188797 has a broad spectrum of antitumor activity in in vitro cytotoxicity assays and tumor xenograft models. We did a phase I trial designed to determine the maximum tolerated dose and the pharmacokinetics of BMS-188797 when administered i.v.Materials and Methods: BMS-188797 was administered i.v. over 60 minutes once every 21 days to 51 patients. The initial dose cohort of 3.75 mg/m(2) was set at approximately one third the lethal dose in dogs. Doses were subsequently escalated in cohorts according to a modified Fibonacci design.RESULTS: Fifty-one patients received a total of 160 cycles of therapy. The dose-limiting toxicity of febrile neutropenia occurred in two patients at the 200 mg/m(2) cohort. Moderate to severe sensory neuropathy occurred in 12 patients (24%). Four radiographic partial responses based on the Response Evaluation Criteria in Solid Tumors occurred: two in subjects with breast cancer, one in a subject with non-small cell lung cancer, and one in a subject with renal cell carcinoma. The duration of the partial responses observed were 24.1 months (renal cell carcinoma), 5.7 and 4.3 months (breast cancer), and 4.5 months (non-small cell lung cancer). Pharmacokinetics appear linear at doses through 110 mg/m(2) but not at higher doses.CONCLUSION: The dose-limiting toxicity in this single-agent study of BMS-188797 was febrile neutropenia. The recommended phase II dose of BMS-188797 as a single agent is 175 mg/m(2) i.v. for 1 hour administered every 3 weeks.     

Viral immune complexes in systemic lupus erythematosus: C-type viral complex deposition in skin.

Punch biopsies were examined by indirect immunofluorescence for immune complex deposits containing C-type viral antigen. Antisera specific for immunoglobulins and HEL-12 virus mediated fluorescence at the dermal-epidermal junction and in vessel walls of 16 of 16 biopsies involved skin from patients with systemic lupus erythematosus (SLE). Preimmune sera did not mediate fluorescence and gradient purified HEL-12 virus, simian sarcoma virus and baboon endogenous virus but not Rous sarcoma virus blocked the reaction of anti-HEL-12 virus serum with SLE tissue. Ten biopsies from uninvolved skin of the patients with SLE did not react with the antiviral serum, nor did tissue from 9 patients with discoid lupus erythematosus, psoriasis, bullous pemphigoid or normal skin. These data support the hypothesis that C-type viral immune complexes participate in the pathogenesis of SLE.