tional parameters measured before treatment

and the changes during treatment. Patients

who suffered a loss of body weight could

therefore not be singled out before the

treatment.

Reduced Erythropoietin Levels as a Cause of

Anaemia in Patients with Lung Cancer.

Cox, R., Musial, T., Gyde, O.H.B. The

Department of Haematology, East Birmingham

Hospital, Birmingham B9 5ST, U.K. Eur. J.

Cancer Clin. Oncol. 22: 511-514, 1986.

Measurement of erythropoietin (Ep)

levels in patients with the anaemia of

chronic disorders due to malignant disease

have given variable results. This variation

may be due to the wide range of malignancies

studied and the assay method (whole animal)

used. In this study Ep levels were measured,

using the foetal mouse liver assay, in 39

patients with lung cancer and 19 controls.

Twelve patients had reduced haemoglobin

levels (Hb less than 11.5 g/dl for males and

ii g/dl for females) and the features of the

anaemia of chronic disorders. Their mean Ep

level was 0.21 iu/ml. This was significantly

lower than for the normal controls, whose

mean value was 0.31 iu/ml (P < 0.02). This

data supports the concept that lack of an

appropriate Ep response to anaemia is one

factor in the genesis of anaemia in malig-

nancy.

Atypical Carcinoid of the Lung: Radiographic

Features.

Choplin, R.H., Kawamoto, E.H., Dyer, R.B. et

al. Department of Radiology, Wake Forest

University Medical Center, Winston-Salem, NC

27103, U.S.A. Am. J. Roentegenol. 146: 665-

668, 1986.

Atypical carcinoid of the lung is a

neuroendocrine neoplasm with cellular and

clinical features intermediate between those

of typical carcinoid and small cell undif-

ferentiated carcinoma of the lung. These

neoplasms exhibit a wide range of histologic

appearance and are misdiagnosed in up to 50%

of cases. The clinical records and

radiographs of 32 patients with this diag-

nosis from the University of Virginia Medi-

cal Center and Wake Forest University Medi-

cal Center were reviewed. Sixteen of these

cases had been misdiagnosed pathologically.

While the most frequent radiographic finding

was a round or ovoid lobulated peripheral

mass, other appearances included thin-walled

cavities, poorly defined nonsegmental in-

45

filtrates, and mediastinal masses. Fifty

percent of the patients in this study have

died from their tumor, with a mean survival

of 15.5 months. This contrasts with both

typical carcinoid and small cell undifferen-

tiated carcinoma, in which patients develop

fatal metastatic disease in 5% and nearly

100%, respectively. Proper categorization of

typical carcinoid, atypical carcinoid, and

small cell undifferentiated carcinoma is

necessary to determine appropriate therapy,

prognosis, and reporting of end results.

Bronchial Carcinoma Presenting with Non-

Metastatic Bilateral Papillitis.

Bennet, W.M. Medical Unit, Crosshouse Hospi-

tal, Kilmarnock KA20BE, U.K. Br. J. Dis.

Chest 80: 189-190, 1986.

Bronchial carcinoma is associated with

a variety of non-metastatic neurological ef-

fects (Posner 1982). I report on a patient

in whom bilateral papillitis was the

presenting feature of squamous carcinoma of

lung. Investigations revealed no evidence of

cerebral secondary tumour and resolution of

the papillitis followed dexamethasone

therapy and resection of the carcinoma.

6. SURGERY

Small Cell Carcinoma of the Lung - to

Operate or Not? Surgical Experience and

Results.

Maassen, W., Greschuchna, D. Department of

Thoracic Surgery, Ruhrland Clinic, D-4300

Essen 16, Germany. Thorac. Cardiovasc. Surg.

34: 71-76, 1986.

From 1962 to 1979, out of 549 patients

with small cell bronchial carcinoma (= 15%

of all bronchial carcinomas) treated in our

clinic, 109 (20%) underwent thoracotomy and

94 (17%) resection. The recurrence free 3-

year survival rate for resected patients was

22%, and after 5 years 14 of the 94 (15%)

were still alive, using absolute numbers in-

cluding postoperative deaths. From 1962 to

1975 only patients in stage T1 NO M0 or T2

NO MO survived, with one survivor in stage

T1 N2 M0. In the period from 1976 to 1979

patients with tumors in more advanced stages

were resected: now those with T1 N1M0, T1

N2 MO and predominantly with T2 N1 M0 sur-

vived, which can be attributed to the effect

of more intensive chemotherapy. Sixty-eight

percent of the operations were

pneumonectomies; the exploratory thoracotomy

rate was 14%. Surgical therapy was seen as