Small cell lung cancer (SCLC) disseminates early and has poor prognosis. However, SCLC is highly chemosensitive, thus chemotherapy has been established as the primary mode of treatment. Seventeen patients (15 males and 2 females) with median age of 60 years (range 49 to 74 years) were treated with combination cyclophosphamide 750 mg/m2, adriamycin 40 mg/m2, vincristine 1.4 mg/m2 on day 1 and etoposide (VP 16) 75 mg/m2 on days 1 to 3 (CAVE). This combination was given in 6 courses at 3 weekly intervals. The response to the chemotherapy and the quality of life of patients was assessed at the third cycle and after the completion of therapy (sixth cycle). The overall response rate was 76.4%; 52.9% achieved complete response and 23.5% had partial response. The survival rate at 6 months was 70.8% and 4 patients (23.5%) were still alive after 1 year of chemotherapy. The median survival after therapy was 36 weeks. There was a 30% overall improvement in the Karnofsky performance score at the completion of chemotherapy. This study illustrated that the CAVE regimen is effective and beneficial in the majority of our patients with small cell lung cancer.
The use of pressurised metered dose inhalers was assessed among 93 asthmatic patients attending the respiratory out patient clinic between January to October 1989. They were regular users of the inhalers prior to the assessment. 62.4% of the patients were found to use the inhalers incorrectly. Forty three percent made more than one error. The commonest error observed was the failure to actuate and inhale the aerosol together in 41.9%. There was no difference in the occurrence of incorrect performance between different sexes, age groups, duration of inhaler used and previous supervision or no supervision by the doctors.
Study site: Respiratory clinic, Hospital Kuala Lumpur (UKM), Malaysia
Four cases of acute viral myocarditis were diagnosed within three weeks. The clinical features, electrocardiography, cardiac enzymes and other laboratory investigations are described.
Lignocaine spray for anaesthetising the nasal mucosa for fibreoptic bronchoscopy often causes discomfort to the patient. We compared two techniques of applying nasal topical anaesthesia using either lignocaine spray (group A: 25 patients) or gel (group B: 30 patients) to assess patients' tolerance to the procedure. Both groups received 100 mg of lignocaine in the nostril, 40-50 mg to oropharynx, 120 mg to vocal cords and 40-100 mg to trachea and bronchi. Throat anaesthesia was the most common unpleasant part experienced by both groups of patients (34.5%), followed by examination of bronchi (30.6%) and nasal anaesthesia (21.8%). Significantly more patients in group A experienced discomfort or pain during nasal anaesthesia as compared to group B (p < 0.001). Patients' tolerance to the bronchoscopy was similar in both groups and the examination was performed satisfactorily in all patients. Thus, lignocaine gel is a simple technique, effective and less irritating as compared to lignocaine spray for topical nasal anaesthesia.
Three cases of diffuse panbronchiolitis (DPB) occurring in two Malaysian Chinese patients and one Malay patient are reported. They had similar clinical, radiological and physiological features which are characteristic of DPB. The diagnosis in one of the cases was confirmed histologically by transbronchial lung biopsy. These could be the first three cases identified in Malaysia.