From 11/87 until 7/90 103 patients entered a prospective randomized trial on the treatment of malignant pleural effusions (MPE) with intrapleural mitoxantrone versus placebo (pleural tube alone with instillation of isotonic NaCl). Our data suggest no statistically significant difference between the two arms with respect to response and response duration. There is no influence on survival time. The toxicity is moderate, with only fever occurring more often in the mitoxantrone arm. We recommend performance of pleurodesis in patients with MPE first by sufficient drainage with a tube of 16-20 char. Only in instances of failure it is necessary to add sclerosing agents such as tetracycline, etc.
This study was designed to assess the effect of differential leukocyte depletion during chemotherapy by monitoring the levels of exhaled hydrogen peroxide H 2 O 2 and nitric oxide (FeNO) present.In 39 patients with lung cancer (chronic obstructive pulmonary disorder up to stage II, median forced expiratory volume in one second 78% predicted), measurements were performed before a cycle of therapy (day 1), at least once during the cycle (day 8: n534; day 15: n519), and afterwards (days 21-29).There were significant changes in the level of H 2 O 2 , FeNO and peripheral blood cell differentials over the visits. The level of H 2 O 2 was decreased only on day 15, with a median (difference between the upper and lower quartiles) fall of 31 (57)%, while FeNO was reduced only on day 8, by 22 (40)%. Neutrophil numbers were unchanged on day 8 and decreased by 59 (48)% on day 15, while monocyte numbers were decreased on day 8 by 87 (39)%. On days 21-29, values had returned to baseline.Taken together with previous findings, the parallel course of levels of exhaled hydrogen peroxide and neutrophil counts suggests that a major part of exhaled hydrogen peroxide is due to neutrophils via the conducting airways. In contrast, the production of exhaled nitric oxide seems to be primarily associated with monocytes.
To investigate the role of leukocytes and neutrophils in the peripheral blood on airway responsiveness, we studied nine patients with chronic bronchitis and histologically proved bronchial carcinoma before and after chemotherapy. The concentration of methacholine (in mg/ml) necessary to increase specific airway resistance by 100%, PC100SRaw, and the number of leukocytes and neutrophils (in cells x 10(6)/ml) were measured before, and 8 and 16 days after chemotherapy. Mean (SEM) total number of leukocytes decreased significantly (p less than 0.001) from 9.0 (0.8) to 4.4 (0.6) and 3.4 (0.4), and mean (SEM) number of neutrophils decreased significantly (p less than 0.005) from 5.1 (0.7) to 2.8 (0.5) and 1.0 (0.4), respectively. Mean (SEM) PC100SRaw was 3.3 (0.9) at baseline and 3.5 (1.2) and 3.8 (1.0) mg/ml at Days 8 and 16, respectively, without significant differences. These data suggest that a significant chemotherapy-induced leukocyte depletion in the peripheral blood does not influence airway responsiveness in patients with chronic bronchitis and bronchial carcinoma.
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