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ROYAL SOCIETY OF MEDICINE
930 RESULTS OF IN-VITRO TESTS
* In a synthetic medium containing albumin 0.25%. t Moist weight, Myco. tuberculosis. strain H3Tnv.
IV in the in-vitro tests, and its relative independence of inoculum size, also suggest a similarity in action to the thiosemicarbazones rather than to p-aminosalicylic acid. On the other hand, the tolerance of the mice in the above-described experiment to large doses of the compound indicates that its toxicity is lower than that of the thiosemicarbazones. More detailed pharmacological and chemotherapeutic studies of compound IV are now in progress. It is of interest that since the chemical part of this work was completed, two papers 45 have appeared dealing with the preparation of p-thiocarbamido derivatives of salicylic acid (cf. series I above) ; the authors of these papers agree with our conclusion that this series shows no enhancement of antituberculous activity as compared with p-aminosalicylic acid. C. R. HARINGTON Sc.D.
Camb., F.R.S. P. D’ARCY HART
M.D. Camb., F.R.C.P National Institute for Medical
Research, Mill Hill. London, N.W.7
R. J. W. REES
M.B., B.Sc. Lond.
Medical Societies ROYAL SOCIETY OF MEDICINE Unusual Manifestations of Bronchial Carcinoma THE section of medicine of the society met on April 28, under the chairmanship of Sir ALUN ROWLANDS, president of the section, to discuss Unusual Manifestations of Bronchial Carcinoma. Dr. PHILIP ELLMAN reviewed the common manifestations of bronchial carcinoma, a disease that caused more More deaths in 1951 than respiratory tuberculosis.
being discovered by means of miniature fluorography in the silent stage when the chances of successful surgical treatment were greatest. He described 6 examples of joint manifestations, in some of which the joint changes preceded the symptoms directly due to the lung lesion. The patients had polyarthritis of rheumatoid type or pulmonary osteoarthropathy with gross clubbing of the fingers and toes and enlargement of the nose. The most striking and important feature cases were now
the very rapid reversal of the condition after pulmonarv resection, dramatic improvement sometimes being noticed within a few hours of operation. The conjunction of bronchial carcinoma and pulmonary tuberculosis was not very rare now that carcinoma had become so common and the prevalence of tuberculosis in middleaged men had risen. Certain pneumoconioses, especially asbestosis, were sometimes associated with carcinoma and it was possible that there was a causal relationship. He described a patient with generalised ’’ honeycomb lungs ’’ and bronchial carcinoma ; it was suggested that the was
4. Aumuller. W., Horner, L., Kimmig, J., Meyer-Rohn, J. Chem. Ber. 1952, 85, 760. 5. Tietze, E., Petersen, S., Domagk, G. Ibid, 1953, 86, 312.
inhalation of chrome dust might have both conditions. Dr. Ellman referred to carcinoma of the lung presenting as a general medical disorder-e.g., "pyrexia of unknown origin," influenza, cardiac conditions, Addison’s disease, abdominal conditions, and low back pain. llr. T. HOLMES SELLORS said that it was impossible to estimate what proportion of patients had operable tumours when diagnosed : it was probably of the order of 15%. Although routine radiography did bring to light some truly symptomless cases, this was less common than many believed : patients hid their swmptoma and preferred to visit a mass miniature radiography unit rather than admit their ailments to their doctors. Of 200 consecutive cases at Harefield Hospital, 67%presented with respiratory symptoms, 11% with general swmptonm, and the remainder -with symptoms directing attention to other systems. General constitutional symptoms might be one of predominate and the clinical picture "pyrexia of unknown origin " or unexplained loss of weight. The first symptoms and signs might be due To metastases in the cervical nodes, skin, adrenals, liver. or bone, and a particularly misleading svii-iptoni wa.. persistent back pain. On occasion this had been wrongly diagnosed and treated by manipulation. A very difficult manifestation in the nervous system was vague personality changes due to metastases in ’the frontal lobe. He had seen intussuseeption due to secondaries in the small intestine that were only discovered after operation. The diagnosis of unresolved pneumonia could be the cait,,e of unnecessary delay, and the term should be abolished. Mr. Holmes Sellors emphasised the need to investigate fully all cases of repeated bloodstaining of the sputum. Pleural involvement by the tumour might lead to referred pain in the abdomen. Mediastinal involvement might cause loss of voice, dysphagia, or obstruction of the superior vena cava. The deep chest pain that was so common a complaint might also arise from invasion of mediastinal structures. Among the cardiac manifestations were heart-block, pericarditis, and auricular fibrillation. Dr. R. A. HENSON discussed the neurological manifestations of bronchial carcinoma and described 15 cases seen at the London Hospital. In none of them was there evidence of metastases in the nervous system. Subacute cerebellar degeneration, sensory polyneuritis had already been described, and he gave 8 examples of motor neuropathy, a condition not previously recorded in this disease. In 7 the nervous symptomspreceded those directly due to the carcinoma, and in I they began nine months after an apparently successful pneumonectomy. All these patients had an atrophic paresis, limited at first to the limb girdles. In some there was also bulbar palsy, ptosis, diplopia, and depression or absence of the tendon reflexes. Only 1 had any sensory loss, although 6 had paræsthesiæ and pain. -.ometime-very severe. 4 had extensor plantar responses and 1 had cerebellar signs. In 1 there were no abnormal signs in the nervous system, the condition appearing as a pure myopathy. Some degree of myopathy may have been present in all the cases. In 1 there was a remission after pneumonectomy, and another patient improved after neostigmine had been given because of all erroneou diagnosis of myasthenia gravis ; but 2 others had similar remissions they received no treatment at all. 1 had a remission after multiple-vitamin therapy, hut it was unlikely that the treatment was responsible. TJJt’ cause of the lesions in the nervous system was unknown. It had been suggested that they were due to metabolic disorders or to a virus infection. In 2 of Dr. Henson’s cases, the post-mortem changes in the spinal cord Were apparently inflammatory. It was probable that the cancer and the were linked by a common cause, rather than that one was directly caused by the other.
prolonged produced
might
neuropathy—and
although
neuropathy
* In a synthetic medium containing albumin 0.25%. t Moist weight, Myco. tuberculosis. strain H3Tnv.
IV in the in-vitro tests, and its relative independence of inoculum size, also suggest a similarity in action to the thiosemicarbazones rather than to p-aminosalicylic acid. On the other hand, the tolerance of the mice in the above-described experiment to large doses of the compound indicates that its toxicity is lower than that of the thiosemicarbazones. More detailed pharmacological and chemotherapeutic studies of compound IV are now in progress. It is of interest that since the chemical part of this work was completed, two papers 45 have appeared dealing with the preparation of p-thiocarbamido derivatives of salicylic acid (cf. series I above) ; the authors of these papers agree with our conclusion that this series shows no enhancement of antituberculous activity as compared with p-aminosalicylic acid. C. R. HARINGTON Sc.D.
Camb., F.R.S. P. D’ARCY HART
M.D. Camb., F.R.C.P National Institute for Medical
Research, Mill Hill. London, N.W.7
R. J. W. REES
M.B., B.Sc. Lond.
Medical Societies ROYAL SOCIETY OF MEDICINE Unusual Manifestations of Bronchial Carcinoma THE section of medicine of the society met on April 28, under the chairmanship of Sir ALUN ROWLANDS, president of the section, to discuss Unusual Manifestations of Bronchial Carcinoma. Dr. PHILIP ELLMAN reviewed the common manifestations of bronchial carcinoma, a disease that caused more More deaths in 1951 than respiratory tuberculosis.
being discovered by means of miniature fluorography in the silent stage when the chances of successful surgical treatment were greatest. He described 6 examples of joint manifestations, in some of which the joint changes preceded the symptoms directly due to the lung lesion. The patients had polyarthritis of rheumatoid type or pulmonary osteoarthropathy with gross clubbing of the fingers and toes and enlargement of the nose. The most striking and important feature cases were now
the very rapid reversal of the condition after pulmonarv resection, dramatic improvement sometimes being noticed within a few hours of operation. The conjunction of bronchial carcinoma and pulmonary tuberculosis was not very rare now that carcinoma had become so common and the prevalence of tuberculosis in middleaged men had risen. Certain pneumoconioses, especially asbestosis, were sometimes associated with carcinoma and it was possible that there was a causal relationship. He described a patient with generalised ’’ honeycomb lungs ’’ and bronchial carcinoma ; it was suggested that the was
4. Aumuller. W., Horner, L., Kimmig, J., Meyer-Rohn, J. Chem. Ber. 1952, 85, 760. 5. Tietze, E., Petersen, S., Domagk, G. Ibid, 1953, 86, 312.
inhalation of chrome dust might have both conditions. Dr. Ellman referred to carcinoma of the lung presenting as a general medical disorder-e.g., "pyrexia of unknown origin," influenza, cardiac conditions, Addison’s disease, abdominal conditions, and low back pain. llr. T. HOLMES SELLORS said that it was impossible to estimate what proportion of patients had operable tumours when diagnosed : it was probably of the order of 15%. Although routine radiography did bring to light some truly symptomless cases, this was less common than many believed : patients hid their swmptoma and preferred to visit a mass miniature radiography unit rather than admit their ailments to their doctors. Of 200 consecutive cases at Harefield Hospital, 67%presented with respiratory symptoms, 11% with general swmptonm, and the remainder -with symptoms directing attention to other systems. General constitutional symptoms might be one of predominate and the clinical picture "pyrexia of unknown origin " or unexplained loss of weight. The first symptoms and signs might be due To metastases in the cervical nodes, skin, adrenals, liver. or bone, and a particularly misleading svii-iptoni wa.. persistent back pain. On occasion this had been wrongly diagnosed and treated by manipulation. A very difficult manifestation in the nervous system was vague personality changes due to metastases in ’the frontal lobe. He had seen intussuseeption due to secondaries in the small intestine that were only discovered after operation. The diagnosis of unresolved pneumonia could be the cait,,e of unnecessary delay, and the term should be abolished. Mr. Holmes Sellors emphasised the need to investigate fully all cases of repeated bloodstaining of the sputum. Pleural involvement by the tumour might lead to referred pain in the abdomen. Mediastinal involvement might cause loss of voice, dysphagia, or obstruction of the superior vena cava. The deep chest pain that was so common a complaint might also arise from invasion of mediastinal structures. Among the cardiac manifestations were heart-block, pericarditis, and auricular fibrillation. Dr. R. A. HENSON discussed the neurological manifestations of bronchial carcinoma and described 15 cases seen at the London Hospital. In none of them was there evidence of metastases in the nervous system. Subacute cerebellar degeneration, sensory polyneuritis had already been described, and he gave 8 examples of motor neuropathy, a condition not previously recorded in this disease. In 7 the nervous symptomspreceded those directly due to the carcinoma, and in I they began nine months after an apparently successful pneumonectomy. All these patients had an atrophic paresis, limited at first to the limb girdles. In some there was also bulbar palsy, ptosis, diplopia, and depression or absence of the tendon reflexes. Only 1 had any sensory loss, although 6 had paræsthesiæ and pain. -.ometime-very severe. 4 had extensor plantar responses and 1 had cerebellar signs. In 1 there were no abnormal signs in the nervous system, the condition appearing as a pure myopathy. Some degree of myopathy may have been present in all the cases. In 1 there was a remission after pneumonectomy, and another patient improved after neostigmine had been given because of all erroneou diagnosis of myasthenia gravis ; but 2 others had similar remissions they received no treatment at all. 1 had a remission after multiple-vitamin therapy, hut it was unlikely that the treatment was responsible. TJJt’ cause of the lesions in the nervous system was unknown. It had been suggested that they were due to metabolic disorders or to a virus infection. In 2 of Dr. Henson’s cases, the post-mortem changes in the spinal cord Were apparently inflammatory. It was probable that the cancer and the were linked by a common cause, rather than that one was directly caused by the other.
prolonged produced
might
neuropathy—and
although
neuropathy