Objectives-To examine the relation between rheumatoid arthritis (RA)
Primary intrathoracic liposarcoma is uncommon. Razzak et al in 1971' indicated that 44 cases had been recorded, of which 43 originated in the mediastinum and one in the pulmonary hilum. Sawamura et al in 19822 reported seven cases of primary pulmonary liposarcoma. We report a further case, which displays features suggesting that it was of pleural rather than mediastinal or pulmonary origin. Case reportA 61 year old man with a 30 year history of asthma and a two year history of ischaemic heart disease was admitted for investigation of a left sided pleural effusion. He gave a four week history of increasing dyspnoea on exertion associated with pain in the left side of the chest. He had never smoked and denied haemoptysis. On examination he had a cushingoid appearance as a result of long term steroid treatment for his asthma and had signs of a left pleural effusion. The haemoglobin concentration was 12.1 g/dl, the total white cell count 10.0 x 109/l, and erythrocyte sedimentation rate 120 mm in one hour. The plasma urea and electrolyte concentrations and results of liver function tests were normal. Examination of the sputum for tubercle bacilli, neoplastic cells, and asbestos bodies was negative. The chest radiograph showed evidence of cardiomegaly with a large left pleural effusion. A chest radiograph taken two months earlier had shown blunting of the left costophrenic angle. After admission pleural aspiration produced 500 ml of heavily blood stained fluid. An intercostal tube was inserted and thick jelly like material was obtained, which eventually blocked the tube. Two days after admision the patient developed intractable left ventricular failure and died.Postmortem examination showed a recent myocardial infarct and thromboembolism in right and left pulmonary arteries. The greater part of the left lung was encased in soft mucinous tumour, which covered the pleural surface in a sheet varying from a few millimetres to 4.5 cm in thickness. The tumour was adherent to the visceral pleura and extended along the interlobar fissure and medial surface of the lung to affect part of the pericardium. It did not form a macroscopically evident mediastinal mass and it compressed the lung but did not invade the lung parenchyma. There were light friable adhesions to the parietal pleura but no evidence of tumour of the chest wall. Dissection of retroperitoneum and abdominal and pelvic viscera showed
Summary A whole population survey was performed in Addu Atoll, southern Maldives to establish the prevalence of bronchial asthma. Assessments of atopic eczema, allergic rhinitis, conjunctivitis and intestinal infestation were made, and serum specific IgE titres to a number of allergens were measured. Asthma is a common condition in the southern Maldives, and there is no evidence that the IgE produced by intestinal helminths prevents the condition.
One hundred sixty-three patients with small cell lung cancer were treated with six courses, at 3-week intervals, of ifosfamide (5 g/m2) with mesna and etoposide. Thoracic radiotherapy was delivered to the limited stage (LS) patients. The complete response rate (CR, determined clinically and radiologically) was 76% for the 78 LS patients with a further 14% partial response (PR). The majority of the CRs were confirmed on a follow-up bronchoscopy. The CR rate was 27% for extensive stage (ES) patients with another 38% undergoing a partial response. The median survival for LS patients was 11 months, (16 months for CR confirmed by rebronchoscopy) and 8 months for ES patients. The 2-year actuarial survival for LS patients is 27%, follow-up ranges from 12 months to 30 months with a median of 22 months. Toxicity was not severe for the patient population, of whom only 20% had a good performance status before chemotherapy. Parental antibiotics were required on 4% of all 844 chemotherapy courses and 12% of courses were delayed due to side effects. The majority of responses occurred within the first two courses of chemotherapy and there was a corresponding improvement in the patients' symptoms and performance status. The regimen produced rapid tumor response with corresponding improvement in symptoms without marked toxicity and allowed further treatment development.
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