Acute exogenous allergic alveolitis with the typical symptoms of unproductive cough, dyspnoea on exertion, fever, loss of weight, headache and limb pains was observed in a 24-year-old bank employee. Leucocytosis was accompanied by raised ESR; pronounced hypoxaemia and marked restrictive ventilatory defects were found. X-ray changes consisted of severely increased fine reticular interstitial shadowing. The differential diagnosis of allergic alveolitis was confirmed by the demonstration of precipitating antibodies in serum against Pullularia pullulans, Trichoderma viride, Cephalosporium acremonium and Aspergillus fumigatus, moulds with an ubiquitous occurrence. Typical changes of alveolitis were found histopathologically and immunohistologically in the lung tissue after a mini-thoracotomy. The source of exposition leading to the disease were pot plant earth and containers in the patient's flat. Moulds could be isolated from these substrates.

Granulocyte transfusions (n = 222) were administered to 41 patients with granulocytopenia (less than 500 X 10(6)/1) and antibiotics-resistant infections. The average granulocyte content per transfusion was 2.1 X 10(10), 212 transfusions had been obtained by filter leucapheresis. Infections improved in 25 episodes, and 18 patients survived the 30th day. There was no influence in 18 episodes and only 2 patients survived beyond the 30th day. Extent and duration of bone marrow insufficiency, and type and grade of infection, clearly influenced prognosis. Further prognostically relevant risk factors were age (greater than 60 years) and platelet deficiency (less than 20 X 10(9)/1), as well as liver and renal insufficiency. Adherence to precise guidelines may prevent pointless transfusions.

5 patients with autoimmune haemolytic anaemia (AIHA) of warm type (4 idiopathic, 1 associated with systemic lupus erythematosus and thrombocytopenia) were treated with high doses of i.v. immunoglobulin (IgG; Sandoglobulin®; 2.0 g/kg body weight). IgG therapy was ineffective in all 5 cases as indicated by a lack of clinical improvement, continuous signs of accelerated red blood cell (RBC) destruction, and an unchanged survival rate of 51Cr‐labelled autologous RBC in 4 patients studied. IgG infused at equivalent doses into 5 healthy volunteers led to an increase of IgG coating of autologous RBC (irrespective of the ABO blood groups) without concomitant changes of haemoglobin, haematocrit or reticulocytes, increase of serum IgM in 3/5, a decrease of serum C4 in 5/5, and a decrease of serum haptoglobin in 2/5 individuals. We conclude that IgG at a dose of 2.0 g/kg body weight is ineffective in AIHA. This may be caused by an increased, though clinically inapparent, interaction of IgG‐coated autologous RBC with the mononuclear phagocyte system.

Forty-six patients with non-small cell lung cancer were treated with a combination of cis-platinum, 90 mg/m2 i.v. on day 1 and VP 16-213, 100 mg/m2 i.v. on days 1, 3 and 5. The overall remission rate was 22%, with a median duration of 7 months. Squamous cell and large cell undifferentiated carcinomas responded in 27 and 22% of patients, and seven patients with adenocarcinoma did not respond to chemotherapy. Survival was 7 months for all patients, 11.5 months for responders (7-27+), 8.5 months for patients with stable disease (3-27+) and 5 months for progressive tumours (1-9). Prognosis was adversely influenced by a performance status of less than 80%, a weight loss of more than 10 kg during the last 3 months before start of treatment and a radiologically demonstrable 'major' atelectasis (collapse of at least one superior or inferior lobe of the lung). Only one out of 31 patients with one or more poor prognostic factors came into remission. In contrast, nine out of 15 patients without poor prognostic factors showed objective tumour regression (60% remission rate). Stage and age did not affect the results. Haemotologic and renal toxicity were mild, but poor subjective tolerance (nausea, vomiting, loss of appetite) was prominent.

Vor 10 Jahren entwickelten wir einen Test, um die Sequestrationskapazität der Milz für wärmealterierte Erythrozyten (w. a. E.) zu prüfen [4]. Radioaktiv markierte Erythrozyten (5 ml), die 20 min bei 49,5° C inkubiert werden, transformieren sich zu Sphärozyten; intravenös appliziert werden sie mit einer Halbwertzeit von 6–10 min durch die Milz zu 60–75% aus dem Blut extrahiert. Normalerweise können im Maschenwerk der roten Pulpa 60–100 ml w.a. E. sequestriert werden, das entspricht ca. einem Drittel des Milzvolumens. Bei größeren Belastuggsvolumina erfolgt die Clearance der w.a. E. aus dem Blut stark verzögert, ähnlich wie bei splenektomierten Patienten. Die Sequestrationsrate sinkt auf Null. Somit ist eine funktionelle Asplenie eingetreten, wobei sich nach ca. 1 Woche die Funktionsparameter wieder normalisieren. Bei einem Hyperspleniesyndrom dagegen ist die Milz in der Lage, über 100 ml w.a. E. mit gleichbleibender kurzer Halbwertzeit aus dem Blut zu sequestrieren. Diese „Kapazitätsprüfung der Milz“ führen wir regelmäßig im Rahmen der Differentialdiagnose eines Hyperspleniesyndroms durch [5]. Bei Patienten, bei denen es im Laufe der Untersuchung zu einer funktionellen Asplenie kam, konnten wir in den darauffolgenden Tagen häufig einen kurzfristigen Thrombozytenanstieg im peripheren Blut beobachten.

Three patients with autoimmune haemolytic anaemia of warm type were treated with high doses of intravenous immunoglobulin (Sandoglobulin®). The therapy was ineffective in all three cases. The possible reasons for this therapeutic failure are discussed.

The case of a 55 year-old patient with ovarian carcinoma (stage IIb) is described in whom an ITP-like syndrome developed in coincidence with a high-dose cyclophosphamide therapy successfully treated by high-dose intravenous gamma glubulin.

Forty-six patients with non-small cell lung cancer were treated with a combination of cis-platinum 90 mg/m2 i.v., day 1 and VP 16-213 100 mg/m2 i.v. on days 1, 3 and 5. The overall remission rate was 22% (10 out of 46 patients) with a median remission duration of 7 months. Squamous cell and large cell undifferentiated carcinomas responded to the chemotherapy with a remission rate of 27% (7 out of 26 patients) and 22% (3 out of 13 patients). Seven patients with adeno-carcinoma did not respond to chemotherapy. The overall survival was 7 months (1-27+). The survival time for patients entering remission was 11.5 months (7-27+), for those with stable disease 8.5 months (3-27+), and for patients with progressive disease 5 months (1-9). Performance status of less than 80%, a weight loss of more than 10.0 kg in the last three months before starting treatment and a "major" atelectasis (collapse of at least one superior or inferior lobe) adversely influenced prognosis. Only 1 out of 31 patients with one or more poor prognostic factors came into remission. In contrast, 9 out of 15 patients (60%) without poor prognostic factors had a remission. Stage, limited versus extensive disease, and age did not affect the results. Hematologic and renal toxicity of the combination were mild, but poor subjective tolerance (nausea, vomiting, loss of appetite) was prominent.

Die Kombination von VP 16–213, 100 mg/m2 Tag 1, 3 und 5 und Cis-Platin 90 mg/m2 Tag 1 wurde bei 46 Patienten zur Behandlung inoperabler nichtkleinzelliger Bronchialkarzinome eingesetzt. Die Remissionsrate betrug 22% (1 komplette und 9 partielle Remissionen). Plattenepithelkarzinome (7 von 26 Patienten, 27%) und großzellige undifferenzierte Karzinome (3 von 13 Patienten, 23%) sprachen auf die Therapie an; dagegen wurde bei 7 Patienten mit Adenokarzinom keine Remission induziert. Die mediane Remissionsdauer betrug 7 Monate (4–27+). Die medianen Überlebenszeiten waren für Patienten mit Remission 11,5, für Patienten mit unveränderten Tumorparametern 8,5 und für Patienten mit progredientem Tumor 5 Monate. Als prognostisch ungünstig erwiesen sich ein Karnofsky-Index unter 80 %, ein Gewichtsverlust von mehr als 10,0 kg in den letzten 3 Monaten vor Therapiebeginn und das Vorliegen einer Atelektase eines Lungenober- oder Lungenunterlappens. Von 31 Patienten mit einem oder mehr prognostisch ungünstigen Faktoren sprach nur einer auf die Therapie an. Dagegen wurden 9 Remissionen bei den 15 Patienten ohne ungünstige prognostische Faktoren induziert (Remissionsrate 60%). Tumorausdehnung und Alter hatten keinen Einfluß auf die Remissionsrate. Bei relativ geringer objektiver Toxizität waren die therapieinduzierten subjektiven Beschwerden erheblich. Es bestand ein deutliches Mißverhältnis zwischen dem Therapieergebnis und der subjektiven Toxizität.