Pulmonary Hamartoma Syndrome

Table 1-Auociated DiBeaaes in 32 Patients with Pulmonary HamartomaCardiovascular diseases Hypertension Coronary disease Iliofemoral stenosis Venous insufficiency in the lower extremities Heart conduction defects Aortic and mitral stenosis and insufficiency Abdominal aortic aneurysm Gastrointestinal diseases Appendicitis Hiatal hernia Peptic ulcer Cholelithiasis Gastritis Esophageal diverticula Hernias Inguinal Umbilical Skeletal diseases Arthrosis Scoliosis Sudeeks disease of the ankle Herniated disk Genitourinary diseases Nephrolithiasis Renal cyst Acute glomerulonephritis Prostatic hypertrophy Testicular atrophy Neurologic diseases Chronic subdural hematoma Metabolic diseases Hyperlipidemia Diabetes mellitus Benign tumors Prostatic adenoma Adrenocortical hyperplasia Lipoma Ovarian cyst Cystic breast Serous tumor of the ear Malignant tumors Lung cancer Dermatologic cancer Laryngeal cancer

ated with a larger series of pulmonary hamartomas would be required in order to confirm the hypothesis developed by Gabrail and Zara.

v

M. Vallena, M.D., L. Hemdndez-Blasco, M.D., M. lzquierdo-Iutron; M.D.,

6 5 1 1 1 1 1 3 3 2 1 1 1

1 1 3 1 1 1 2

1 1 1 1

3 4

3 1 1 1 1 1 2 2 1

F. Gonzalez-Garrido, M.D., and

J

Echaoe-Sustaeta, M. D.,

Pneumology Seroice,

Hospital 12 de Octubre,

Madrid, Spain

REFERENCES 1 Gabrail NY, Zara BY. Pulmonary hamartoma syndrome. Chest

1990;97:962-65

2 Van der Bosch JMM, Wagenaar SS, Corrin B, Elbers JRJ,

Knaepen PJK, Westermann CJJ. Mesenchymoma of the lung (so called hamartoma): a review of 154 parenchymal and endobronchial cases. Thorax 1987; 42:790-93

1b the Editor:

All retrospective studies and observations have to be subjected to scrutiny. Scientific accuracy is always questioned in such studies. This is true both in positive studies, like our report describing pulmonary hamartoma syndrome, as well as the negative studies, such as the kind of report presented by Villena et ala Pulmonary hamartomas are very rare, and most series involve small numbers of patients seen over a period of several years or decades. Obviously the quality of data preservation, collection, and review will have a dramatic impact on the results of the study. Hence, it is not surprising that some series will fail to show the dramatic associations that we observed in our series. In fact, we have completed study of a second series of pulmonary hamartomas from a different institution, and it is to be submitted for publication. We were surprised again to observe most of the congenital anomalies and benign tumors reported in our 6rst series in addition to some new anomalies. We hope that other institutions will review their cases so that the identity of this syndrome can be clarified more accurately.

Nashat 1: Gabrail, M.D., and Barbara 1: Zara, M.D.,

nmken Mercy Medical Center, Canton, Ohio

Role of Clprofloxacln in Fatal seizures

*Valuesare numbers of patients with a given disease. Some patients had more than one other disease in addition to pulmonary hamartoma.

1b the Editor:

matic in 17 of the cases, since it was diagnosed while other diseases were being investigated; that fact would surely affect the incidence of concomitant pathologic conditions in this population. Similarly, 16 of the 24 patients (67 percent) studied by Gabrail and Zara were over 55 years of age, an age group in which the aforementioned pathologic conditions are frequently identified by means of physical examination or anamnesis. The increased incidence of associated malignant pulmonary tumors, as noted earlier," was con6rmed in our report by two concurrent cases. However, it may well be that the actual incidence of pulmonary hamartoma is greater than we realized, being underdiagnosed due to the few symptoms and being detected only when specific diagnostic procedures are conducted (chest roentgenography and fiberoptic bronchoscopy) or when tumor spread is being examined. Therefore, a review of the pathologic conditions associ-

Elevation of serum theophylline levels by concomitant administration of cipro8oxacin and theophylline has been well described. Less well known is the ability of ciprofloxeein to cause seizures. I would like to report a case of a fatal episode of status epilepticus associated with concomitant administration of these drugs, despite a normal serum theophylline level. A 60-year-old man with severe COPD and a history of active cavitary Mycobacterium avium-intraceUulare (MAl) infection experienced a grand mal seizure while receiving eiprofloxaein and theophylline for treatment of a community-acquired pneumonia. He had no history of prior seizure disorder, and the serum theophylline level measured at the time of the seizure was 18 J.Lglml. Electroencephalographic findings were normal, and phenytoin sodium (Dilantin; Parke-Davis, Morris Plains, NJ) therapy was discontinued four weeks after the seizure. It was assumed that CHEST I 101 I 3 I MARCH, 1992

883