Search

Purpose: To assess the efficacy and toxicity of relatively low-dose docetaxel (60 mg/m2) for previously treated advanced non-small-cell lung cancer (NSCLC). Patients and methods: Patients with advanced (clinical stage IIIA–IV) NSCLC who had previously undergone at least one series of chemotherapy were enrolled. Previous paclitaxel use was allowed, but docetaxel was not. Docetaxel was administered at an initial dose of 60 mg/m2 intravenously on day 1 over 90 min every 3 weeks. Results: From June 1997 to November 1999, 22 patients were entered into this study. The total number of cycles delivered to 22 patients was 53, with a median per patient of 2. Four patients achieved a partial response (PR), and the overall response rate was 18.2% (95% confidence interval 5.1–40.3%). The median time to progression was 13.7 weeks. The median survival time was 7.8 months, and the 1-year survival rate was 25%. About 73% of patients experienced grade 3 or 4 neutropenia. Neutropenic fever was observed in four patients (18%). Non-hematologic toxicities were generally mild. No treatment-related deaths occurred. Conclusions: Although the validity of the results of this study is limited due to the small and monoracial study population examined, low-dose (60 mg/m2) docetaxel for previously treated advanced NSCLC appears to yield antitumor activity and survival benefit comparable to those obtained with the conventional dose (100 mg/m2).

From December 1994 to July 1997, we conducted a dose escalation study of irinotecan combined with carboplatin in 17 patients with advanced non-small-cell lung cancer (NSCLC) to determine the maximum tolerated dose and the dose-limiting toxicities. Irinotecan was administered intravenously over 90 min on days 1, 8 and 15, with carboplatin given at an area under the concentration-time curve dose of 5 mg/ml x min (calculated using Calvert's formula) on day 1. The starting dose of irinotecan was 30 mg/m2 and dose escalation was done in 10-mg/m2 increments. Treatment was repeated at 28-day intervals for at least two cycles. The dose-limiting toxicities were neutropenia and thrombocytopenia, since three out of five patients given 60 mg/m2 of irinotecan developed grade 4 neutropenia and thrombocytopenia. The overall response rate was 35.3%. The median survival time and the 1-year survival rate were 10.5 months and 35.3%, respectively. The maximum tolerated dose of irinotecan with this regimen was 60 mg/m2, while 50 mg/m2 can be recommended for future use. Further studies of this combination in advanced NSCLC are warranted.

Objective To investigate the association between the economic recession and the detection of advanced cases of pulmonary tuberculosis in Osaka city from 2007 to 2009. Design A repeated cross-sectional study. Setting Osaka city has been the highest tuberculosis burden area in Japan. After the previous global financial crisis, the unemployment rate in Osaka prefecture has deteriorated from 5.3% in 2008 to 6.6% in 2009. Participants During the study period, 3406 pulmonary tuberculosis cases were enrolled: 2530 males and 876 females; 1546 elderly cases (65 years and above) and 1860 young cases (under 65 years); 417 homeless cases and 2989 non-homeless cases. Outcome measures Patients’ information included the sex, age, registry, health insurances, places of detection, sputum smear test results, patients’ delay, doctors’ delay and the grade of chest x-ray findings. They were statistically analysed between 2007 and 2008, two years before and just before the financial crisis, and between 2008 and 2009, just before and after the financial crisis. Results The total numbers of pulmonary tuberculosis cases were 1172 in 2007, 1083 in 2008 and 1151 in 2009. In health examinations for non-homeless people, higher number of cases in 2009 were sputum smear positive, had respiratory symptoms and showed advanced disease in chest x-rays than those in 2008, with a longer patients’ delay. On the contrary, in health examination for homeless people, fewer cases of advanced pulmonary tuberculosis were found in 2009 than in 2008, with a shorter patients’ delay. In clinical examinations, there was no trend towards a difference between non-homeless and homeless people. Conclusions Although homeless people might be protected by public assistance, tuberculosis prevention and control need to be reinforced for the non-homeless population after the financial crisis.

We studied the possibility of predicting PaO 2 during exercise of a given oxygen uptake ( V ˙ o 2 ) from resting pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD). The three-minute incremental treadmill exercise was performed with serial measurements of PaO 2 via intra-arterial catheter in 46 patients (mean FEV 1 = 1.09±0.49L, mean FEV 1 /FVC = 44±15 percent). In most of the patients, the changes of PaO 2 were quite linear in relation to the oxygen uptake, so a slope (PaO 2 / V ˙ o 2 ) could be obtained from the regression equation in each patient. The mean value of the slope (SL) was –23.0±16.6 mm Hg/L V ˙ o 2 /min. Correlation between SL and all parameters of resting PFTs were computed. Because of the high correlation coefficient between SL and %D co (SL = –59.3 + 0.501· %D co , r = 0.851, p 2 at a given V ˙ o 2 using the following equation: PaO 2 predicted = PaO 2 rest + SL·( V ˙ o 2 –0.25), where SL was derived from measured %D co and resting V ˙ o 2 was assumed 0.25 L/min. There was a high correlation between the predicted PaO 2 at V ˙ o 2 of 1.0 L/min and the estimated PaO 2 obtained from individual PaO 2 regression with an r value=0.898 and SEE = ± 5.8 mm Hg. A prospective study in 12 patients with COPD was then carried out. There was a high correlation (r=0.857) between the predicted PaO 2 obtained from the present equation and the estimated PaO 2 at V ˙ o 2 = 1.0 L/min. It was concluded that PaO 2 during treadmill walking with a given oxygen uptake is predictable from a resting PaO 2 and a diffusing capacity. This predicted value may be useful in the management of patients with COPD.

• Cough productive of sputum, exertional dyspnea, and hypoxemia developed in two patients with Graves' disease after six months (patient 1) or three weeks (patient 2) of treatment with propylthiouracil, 300 mg/day. Chest roentgenograms and transbronchial lung biopsy specimens revealed diffuse interstitial pneumonitis. Lymphocyte transformation by phytohemagglutinin was highly stimulated by propylthiouracil. Symptoms and signs improved after cessation of the drug therapy and administration of prednisolone acetate. These cases represent the first report of a complication of diffuse interstitial pneumonitis induced by propylthiouracil. (Arch Intern Med1984;144:1764-1765)