Contrary to prior reports, RT-PCR may detect non-tissue-specific constitutive low-level (illegitimate) expression of CK-19 mRNA in peripheral-blood mononuclear (PBMN) cells in a significant number of healthy controls. This finding may not only hamper the use of this assay system in lung cancer patients, but also questions its proposed applicability in patients with other epithelial tumors such as breast and prostate cancer.

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A 10 yr old male with hypoxaemia, progressive infiltration on the chest radiograph and biopsy-proven desquamative interstitial pneumonia was treated with daily oral prednisolone for 6 months.Intravenous methylprednisolone pulses were concomitantly administered in doses averaging 10 mg . kg body weight -1 on three consecutive days every 4±6 weeks. After 6 months improvement could be noted and oral steroids were stopped, while pulse therapy continued. Three months later, when seven pulses had been administered, a relapse occurred and the clinical status deteriorated.Instead of reinstating daily systemic steroids, the dose of methylprednisolone pulses was increased to 20 mg . kg body weight -1 i.v. given on three consecutive days and repeat pulses every 4 weeks. This was followed by continuous improvement. After 24 months corticosteroid pulses were terminated. Normal lung function, serum lactate dehydrogenase, blood gases upon exertion and regular development was achieved. During the course of treatment, the child has grown 10 cm.It is concluded that the effect of corticosteroid pulse therapy on interstitial lung disease in childhood is dose-dependent and that the dose can be adjusted to the effect observed. Eur Respir J 1999; 14: 1429±1432. Desquamative interstitial pneumonia (DIP) is a rare disease in childhood, with distinct features that make it distinguishable from other diffuse parenchymal lung disorders [1±10]. The origin is unknown. Although no standard treatment has been developed, daily oral corticosteroids, chloroquine and high dose intravenous corticosteroid pulses have been employed successfully. The authors report for the first time on a child where augmentation of the dose of corticosteroid pulse therapy led to a complete clinical remission and had a long-lasting effect that is sustained 2 yrs after cessation of therapy. Case historyThe child was born in 1983 with a gestational age of 30 weeks (weight 1,180 g, length 37.5 cm). Soon after birth retrolental fibroplasia was diagnosed with marked reduction of vision (right eye no vision, left eye 10%). Apart from febrile seizures and a ventricular septal defect (VSD) with spontaneous closure no further abnormalities were reported until 1993, when he was presented to a hospital elsewhere because of reduced exercise tolerance. Clinically there were rales on the left lower lung with deep inspiration.Radiologically, an alveolar infiltration in the right cardio-diaphragmatic angle and streaky infiltrates in both upper, lower and middle lung fields were described and interpreted as bilateral bronchopneumonia. A bronchoscopic examination yielded Escherichia coli and Streptococcus pneumoniae in the bronchial secretions. A perfusion scan demonstrated a combined perfusion and ventilation defect on the medial parts of the lungs. The boy was treated with erythromycin, did not improve adequately and was released from the hospital with an inhalation therapy with mucolytics and intermittent oxygen. Five months later he was readmitted with progression of radio...