Biomedical subjects
Publications and source records attributed to R K Knight.
Eosinophilic granuloma of bone may involve the lung in about 20% of cases (Lewis 1964); and may present in the lung without other organ involvement. Haemoptysis occurs in about 10% of cases for unknown reasons. I document here a case with typical presentation and course, but which was complicated by haemoptysis of increasing severity leading to death. The cause of haemoptysis was diagnosed at fibreoptic bronchoscopy.
We report the results of the first 300 fibreoptic bronchoscopies carried out at the Brompton Hospital. Positive cell typing was possible in only 36% of the visible carcinomas in the first 150 patients, but in 74% of the second 150. The reasons for this difference are discussed. We suggest that fibreoptic bronchoscopy be carried out in district referral hospitals where sufficient experience can be gained to produce good results. Our results suggest that the trap specimen should be examined routinely for acid-fast bacilli, for malignant cells only if biopsy is negative and not at all for other bacteria. With experience good results can be obtained by physicians and the expertise gained is invaluable in the investigation and treatment of a wide range of patients, many of whom do not need surgical treatment.
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Sixty-nine patients with advanced breast cancer treated with cytotoxic chemotherapy were randomized to receive concomitantly either norethisterone acetate (progestogen group) or a placebo (placebo group). Objective responses were seen in 53% of patients in the progestogen group and 61% of patients in the placebo group. The median duration of response was the same for both groups (38 weeks). Three out of ten patients in the placebo group, who received subsequently the progestogen on relapse, had a further objective regression. The overall survival in the two groups was similar, although in a sub-group of patients who had operable tumors, but a subsequent short disease-free interval, survival was significantly better in the placebo group. There was less myelosuppression in the progestogen group, who were able to receive higher doses of cytotoxic drugs. Less nausea and vomiting occurred in the progestogen group, but subjective side effects were similar. It is concluded that there is no advantage therapeutically in combining cytotoxic chemotherapy and progestogen therapy and, in some patients, better results are obtained using the two treatments sequentially.
Fifty-five patients were investigated using transbronchial lung biopsy through the flexible fibreoptic bronchoscope under fluoroscopic guidance, 51 by the transnasal route under local anaesthesia, two via an endotracheal tube whilst undergoing assisted ventilation and two by the same route under general anaesthesia. Multiple specimens of lung tissue subjects with diffuse pulmonary disease and in 16 of 32 (50%) with localized lesions, giving a positive yield of 64% of all cases. The only complication was an haemoptysis of 50 ml in one patient. Our results suggest that transbronchial lung biopsy is a relatively safe procedure which gives results comparable with other lung biopsy techniques.
Forty-five patients have been treated surgically for obstructive azoospermia. Fifteen underwent reversal of vasectomy and 40% of the wives became pregnant. Thirty had epididymovasostomy, and in only 2 (6.5%) did the sperm count become normal, although a few poorly motile sperms appeared in the ejaculate in a further 4 patients. Congenital abnormalities of the vasa in 7 cases and post-inflammatory blocks in 4 cases were examples of obstructive azoospermia due to well defined causes. However, in half of the patients (15 cases) the cause was obscure although it was associated with sinusitis, bronchitis or bronchiectasis (Young's syndrome). The results of pulmonary function tests in 30 cases, and electron microscopic studies of cilia from epididymes (10 cases) and bronchial mucosa (2 cases) indicated that the basic abnormality might be malfunction of the microtubules which appeared to be ultrastructurally normal in most cases. One case appeared to be associated with dietary deficiency, and correction of diet coincided with a successful result of surgery.
Fibreoptic bronchoscopy is a simple, useful examination suitable for the investigation of outpatients without general anaesthesia. It considerably extends the range of vision and diagnostic ability that is achieved with a rigid bronchoscope. Further, it lends itself to the diagnosis and management of many medical lung diseases in addition to carcinoma. The applications of fibreoptic bronchoscopy will be discussed in more detail in Part II.
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Ninety-nine patients with advanced breast cancer were randomized to receive either cyclophosphamide continuously or a combination of cyclophosphamide, methotrexate, 5-fluorouracil and vinblastine given intermittently. The number and duration of objective responses were greater in patients receiving the combination but the differences between the two treatments did not achieve formal significance. The combination was logistically easier to manage and produced less toxicity.
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