Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial

Forceps, brushes or needles are currently the standard tools used during flexible bronchoscopy when diagnosing endobronchial malignancies. The new biopsy technique of cryobiopsy appears to provide better diagnostic samples. The aim of this study was to evaluate cryobiopsy over conventional endobronchial sampling. A total of 600 patients in eight centres with suspected endobronchial tumours were included in a prospective, randomised, single-blinded multicentre study. Patients were randomised to either sampling using forceps or the cryoprobe. After obtaining biopsy samples, a blinded histological evaluation was performed. According to the definitive clinical diagnosis, the diagnostic yield for malignancy was evaluated by a Chi-squared test. A total of 593 patients were randomised, of whom 563 had a final diagnosis of cancer. 281 patients were randomised to receive endobronchial biopsies using forceps and 282 had biopsies performed using a flexible cryoprobe. A definitive diagnosis was achieved in 85.1% of patients randomised to conventional forceps biopsy and 95.0% of patients who underwent cryobiopsy (p<0.001). Importantly, there was no difference in the incidence of significant bleeding. Endobronchial cryobiopsy is a safe technique with superior diagnostic yield in comparison with conventional forceps biopsy.

Mitomycin C and Vinorelbine for second-line chemotherapy in NSCLC--a phase II trial

Single-agent therapy with Docetaxel or Pemetrexed is the current therapy of choice for second-line treatment in advanced non-small-cell lung cancer (NSCLC). The role of older agents was underattended over the last years. This study presents the combination of Mitomycin C and Vinorelbine in pretreated patients. Forty-two patients (stage IIIB and IV, pretreated with platinum-based chemotherapy) received 8 mg m⁻² Mitomycin C on day 1 and 25 mg m⁻² Vinorelbine on days 1 and 8 of a 28-day cycle. End points were objective tumour response, survival, and toxicity. Additionally, quality of life (QoL) was assessed. Five patients (11.9 %) achieved partial responses and 13 patients (31.9%) stable disease. Progression-free survival was 16 weeks. The median overall survival was 8.5 month. Eleven patients (26.2 %) suffered from grade 3 or 4 neutropenia and four patients (9.52%) from grade 3 or 4 anaemia. Evaluation of QoL showed that some items ameliorated during therapy. The therapeutic concept including Mitomycin C and Vinorelbine offers an efficacious and well-tolerated regimen, with relatively low toxicity. Objective response and survival data correlate with other second-line studies using different medication. As costs of Mitomycin C and Vinorelbine are lower compared with current drugs of choice, this regimen is likely to be cost-saving.

Störung der Monozytenfunktion bei Diabetes mellitus Typ 1 und 2

Monozyten sind an der Hämostase, der Wundheilung und der Arteriogenese, d. h. der Bildung von Kollateralarterien, beteiligt. Diabetes mellitus ist mit einer Reihe zellulärer und molekularer Defekte vergesellschaftet. Jüngst veröffentlichte Daten zeigen, dass der Diabetes mellitus mit einer Störung der durch Wachstumsfaktor VEGF-A induzierbaren Monozytenmigration vergesellschaftet ist. Allerdings ist die Migrationsfähigkeit der Monozyten nicht generell aufgehoben, denn andere chemotaktische Stimuli wie das Tripeptid fMLP sind in der Lage, die Migration von Monozyten, die von Diabetikern isoliert wurden, zu stimulieren. Als molekulare Basis der Monozytendysfunktion bei Diabetikern wurde ein Signaltransduktionsdefekt postuliert, denn die VEGF-Rezeptor Kinase Flt-1 ist in diesen Monozyten intakt. Die Charakterisierung der Monozytendysfunktion erscheint für das Verständnis der Diabetes-mellitusassoziierten Krankheitsprozesse wichtig.