Pleural and pericardial mesothelioma in a general teaching hospital during the last fourteen years
Chen, Y.M.; Perng, R.P.; Huang, M.H.
Zhonghua Yi Xue Za Zhi 54(2): 100-104
1994
ISSN/ISBN: 0578-1337 PMID: 7954041 Document Number: 436389
The efficacy and acceptability of the angiotensin-converting enzyme (ACE) inhibitor perindopril were compared with those of an established treatment for hypertension in Canada, slow release diltiazem. Hypertensive patients aged 18 to 64 years presenting a mean sitting diastolic blood pressure (DBP) between 95 and 110 mmHg inclusive were randomized if they were without any concurrent serious renal, hepatic, cardiac or psychiatric illnesses. A total of 49 of 83 patients qualified for randomization after four weeks on placebo; 23 were assigned to the perindopril treatment group and 26 to the diltiazem treatment group. Starting doses (4 mg od in the perindopril group and 120 mg [60 mg bid] in the diltiazem group) were increased to a maximum of 8 mg od in the perindopril group and to 360 mg (180 mg bid) in the diltiazem group if DBP remained above 90 mmHg. Hydrochlorothiazide was added at week 8 if goal blood pressure was not achieved with the maximum dose. Both groups were comparable at randomization; baseline systolic blood pressure (SBP)/DBP were 153/100 mmHg and 150/99 mmHg in the perindopril and diltiazem groups, respectively. A significant decrease in SBP/DBP was observed from the second week of treatment: -10/-8 mmHg in the perindopril group and -8/-8 mmHg in the diltiazem group. This fall in blood pressure was maintained throughout the duration of the trial: -13/-9 and -13/-11 mmHg for the perindopril and diltiazem groups, respectively, at week 12, at which time monotherapy was taken by over 80% of patients and compliance was consistently over 90%. Mesothelioma is not common in Taiwan; its clinical manifestations and biological behavior in the Chinese patients have thus rarely been discussed. The chart records of mesothelioma patients collected from 1979 to 1992 in Veterans General Hospital-Taipei were retrospectively reviewed. Sixteen thoracic mesotheliomas were diagnosed in 15 patients, including 5 benign fibrous mesotheliomas, 1 malignant pericardial mesothelioma and 10 malignant pleural mesotheliomas. One patient suffered from benign fibrous mesothelioma initially, and the disease transformed into malignant mesothelioma 5 years later. Symptoms of benign fibrous mesothelioma were nonspecific and all 5 cases occurred in lower pleural cavities. One case presented with repeated hypoglycemic coma and the initial diagnosis was hepatoma. History of asbestos exposure probably occurred in 3 of 10 malignant pleural mesotheliomas. The median survival of malignant pleural mesothelioma after onset of symptoms was 14 months. Survival seemed better in epithelial type and those who received surgical treatment of malignant mesothelioma. The symptoms of mesothelioma were nonspecific. Benign fibrous mesothelioma should be considered in patients with palpable liver and hypoglycemic symptoms. Malignant transformation can occur in benign fibrous mesothelioma. Survival of malignant mesothelioma seems better in epithelial type and in those who received surgical treatment.