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Patients with tracheal or major airway obstruction due to inoperable carcinomas are at a high risk of developing respiratory failure or post-obstructive pneumonia, or both. This often leads to death in days or weeks. In such cases there is usually an urgent need to restore the airway. This report details the short-term results and techniques used for the treatment of airway obstruction by direct intratumoural injection of several anti-cancer drugs. A total of 93 patients with nearly complete extrinsic obstruction of at least one major airway were treated by injection of anti-cancer drugs directly into the endobronchial tumours or infiltrated bronchial mucosa through a flexible fiber-optic bronchoscope. At every session of treatment 1-3 ml each of 50 mg/ml 5-fluorouracil, 1 mg/ ml mitomycin, 5 mg/ml methotrexate, 10 mg/ml bleomycin and 2 mg/ml mitoxantrone were injected separately at different sites without pre-mixing. Local intratumoural chemotherapy relieved the obstruction in 81 of the 93 patients. Endoscopically visible tumours were reduced in size, and infiltrative changes were also improved. Obstruction was not relieved in 12 patients. The therapy was well tolerated and had no systemic side-effects, and no serious complications. Intratumoural chemotherapy can be considered a new life-saving palliative method in patients with life-threatening airway obstruction.

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T lymphocyte subsets in a positive Kveim reaction and sarcoid tissue lesions as well as peripheral blood from 16 patients with sarcoidosis were evaluated with monoclonal antibodies. The data demonstrate a redistribution of T cells from the blood to the specifically involved tissues with granulomas, i.e., sarcoid tissue lesions and positive Kveim reaction. These cells express CD2+, CD4+ phenotype as demonstrated by high CD4/CD8 ratios at the sites of positive Kveim reaction and sarcoid tissue lesions with respect to blood.

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The incidence of the location within the bronchi related to the cell types was investigated with the flexible fiberoptic bronchoscope in 355 cases of lung carcinoma. In 5 patients carcinoma was situated only in the trachea. In the other 350 cases the cell types other than adenocarcinoma were found to show different locations following their cell type. Epidermoid carcinoma was found more frequently in the two upper lobes (p less than 0.001), while small cell carcinomas showed predilection for the main bronchus on the right side, and the upper lobe in the left (p less than 0.001). No difference could be found between the upper, lower lobes and main bronchi for adenocarcinoma. It was also observed that large cell carcinomas were situated more often in the right upper lobe. The most important finding in this investigation was that, apart from adenocarcinoma, the other types were located mainly in the upper lobes, and much less frequently in the lower lobes. The predilection of localization of epidermoid and small cell carcinomas in the upper lobes suggests a possible relationship to tobacco smoke inhalation as these regions have been shown to be more affected by the smoke.

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The data on the epidemiologic situation of sarcoidosis from 24 countries of Europe have been reviewed. The new facts seem to demonstrate that the differences between the frequency of this disease in the north and south are not real. The actual situation is dependent on the general knowledge of this disease and on the extent and intensity of the active detection of its asymptomatic stage. A new prospective cooperative study of the yearly incidence of all forms of sarcoidosis in the total population of at least some European countries would be desirable.

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IgG, IgA, and IgM immunoglobulins and alpha-1-antitrypsin globulin in sera from 30 patients with lepromatous leprosy were determined and compared with 30 age- and sex-matched healthy controls. Mean levels of IgG, IgM, IgA, and alpha-1-antitrypsin were significantly elevated in the sera of lepromatous leprosy patients in comparison with levels found in normal subjects. Statistical analysis of the relationships between levels of alpha-1-antitrypsin and immunoglobulins in the sera of lepromatous leprosy patients and controls revealed no correlation. It is therefore concluded that factors responsible for concentrations of immunoglobulins and alpha-1-antitrypsin are independent of each other in patients with lepromatous leprosy.

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