Disorders of haemostasis and altered platelet activity have been documented in patients with malignant disease but their relation to response to treatment and prognosis are not known.Thrombin activity (fibrinopeptide A (FpA), plasmin mediated fibrinolysis (BP 1 5-42) antigen), and platelet alpha granule release (I thromboglobulin) were studied in 37 patients with small cell lung cancer to find out whether these indices show a relationship to chemoresponse. There was evidence of considerably increased thrombin activity, with a median fibrinopeptide A concentration of 13 2 (normal <4) pmol/ml, but only modestly increased fibrinolysis, with a median BPB14-42 antigen concentration of 5-6 (normal <3) pmol/ml. Thus the ratio of fibrinopeptide A to B1315-42 concentration (FpA:Bf) was raised, with a median value of 2-2 (normal < 1 33). In addition, 57% of patients had increased platelet alpha granule release, the median # thromboglobulin concentration being 50 (normal < 50) ng/ml. There was a sign'ficant association between increased thrombin generation and lack of response to chemotherapy. 7'urthermore, non-responders had higher FpA:B,B ratios. The same haemostatic markers were stu.died in nine patients who have been in complete remission for at least two years after chemotherapy for small cell lung cancer. There was a significant difference in thrombin activity and also in the ratio of thrombin activity to lysis between the pretreatment group and the group of two year survivors. Lack of response to chemotherapy appears to be related to increased thrombin activity. Such an association has not previously been reported in patients with malignant disease.

No abstract

Summary:The use of invasive investigations in immunocompromised patients with pulmonary infiltrates is controversial. We report a series of 22 pulmonary lesions occurring in 19 patients with underlying Hodgkin's (7) and non-Hodgkin's (12) lymphoma in whom invasive investigations were performed. The principle techniques used were fibreoptic bronchoscopy, bronchoalveolar lavage and transbronchial lung biopsy. A specific diagnosis was made on 12 occasions (55%). Involvement of the lung with lymphoma (6) and cytotoxic drug induced pneumonitis (4) were the commonest diagnoses, infection being found on only one occasion. In 15 of these 22 procedures (68%) the information obtained made a positive contribution to patient management.

Summary We have measured the serum concentration of the acute phase reactant, C-reactive protein (CRP), in 20 patients with histologically proven small cell lung cancer undergoing their first pulse of induction cytotoxic chemotherapy. Baseline CRP concentrations were raised in 16 of 20 patients (median baseline CRP 18.5 mg-1; normal range

In two patients who had recently undergone major abdominal operations and were later suspected of having pulmonary emboli, pulmonary angiography showed no evidence of embolism, but in both cases one of the hemidiaphragms was clearly outlined by contrast material. It is suggested that subdiaphragmatic inflammation was responsible for this unusual appearance. Case 2While being investigated for chronic relapsing pancreatitis, a 49-year-old man developed acute abdominal pain associated with a considerably raised serum amylase concentration (3100 U/l). The pain settled on conservative treatment, but in view of the long history of severe symptoms he underwent an operation involving splenectomy, partial pancreatectomy, and a pancreaticojejunostomy. There were no postoperative complications until the seventh day. Then after removal of a drainage tube from the left subphrenic region he became distressed by left hypochondrial pain and breathlessness. Examination showed considerable tenderness around the draining site and reduced breath sounds at the left base. A chest radiograph 24 hours later showed elevation of the left hemidiaphragm with a small effusion. A pulmonary angiogram showed no evidence of embolism, but there were abnormalities at the left base (fig 2). The pain gradually settled with analgesics, and the patient made a good recovery. DiscussionThese patients showed a remarkably similar pulmonary angiographic appearance, the striking feature being the delineation of the diaphragm with an arc of contrast material during the arterial phase. This was unlikely to have been caused by extravasation, since serial films did not show the 241 on 29 April 2019 by guest. Protected by copyright.