Paraneoplastic syndromes associated with lung cancer

Paraneoplastic syndromes are signs or symptoms that occur as a result of organ or tissue damage at locations remote from the site of the primary tumor or metastases. Paraneoplastic syndromes associated with lung cancer can impair various organ functions and include neurologic, endocrine, dermatologic, rheumatologic, hematologic, and ophthalmological syndromes, as well as glomerulopathy and coagulopathy (Trousseau’s syndrome). The histological type of lung cancer is generally dependent on the associated syndrome, the two most common of which are humoral hypercalcemia of malignancy in squamous cell carcinoma and the syndrome of inappropriate antidiuretic hormone secretion in small cell lung cancer. The symptoms often precede the diagnosis of the associated lung cancer, especially when the symptoms are neurologic or dermatologic. The proposed mechanisms of paraneoplastic processes include the aberrant release of humoral mediators, such as hormones and hormone-like peptides, cytokines, and antibodies. Treating the underlying cancer is generally the most effective therapy for paraneoplastic syndromes, and treatment soon after symptom onset appears to offer the best potential for symptom improvement. In this article, we review the diagnosis, potential mechanisms, and treatments of a wide variety of paraneoplastic syndromes associated with lung cancer.

The FOXL2 mutation (c.402C>G) in adult-type ovarian granulosa cell tumors of three Japanese patients: clinical report and review of the literature

Adult-type granulosa cell tumor (AGCT) is a rare class of malignant ovarian tumor with unique features, characterized by slow growth, late recurrence, relatively good prognosis and unified cause in almost all patients. The forkhead box L2 (FOXL2) gene encodes an essential transcription factor in the ovary. FOXL2 is important in female sex determination, follicle recruitment, and granulosa cell development. About 70-97% of AGCTs were reported to carry a somatic mutation c.402C>G (C134W) in the FOXL2 gene. However, it is unknown whether AGCTs of Japanese patients harbor the FOXL2 c.402C>G mutation. Here, we report a mutational analysis of the FOXL2 gene in four Japanese patients with AGCTs, and we review the literature to determine the precise incidence of FOXL2 mutations in AGCTs. All four patients were analyzed by immunohistochemistry for FOXL2. Genomic DNA was extracted from paraffin-embedded tissues, and was analyzed to detect the c.402C>G mutation in FOXL2 by direct sequencing. All tumors were stained with FOXL2. Three of the four tumors harbor the c.402C>G mutation. Based on the literature review, FOXL2 immunostaining is a highly specific marker for sex cord-stromal tumors (SCSTs), but it is not specific for AGCTs, one subtype of SCSTs. We identified 340 patients with the FOXL2 mutation (c.402C>G) and determined that the incidence of the mutation is 91.9% in AGCT patients. Therefore, this FOXL2 mutation is specific to AGCTs in the ovary and is useful for diagnosis of this disease.

Suppressive Effect of a Hot Water Extract of Adzuki Beans (Vigna angularis) on Hyperglycemia after Sucrose Loading in Mice and Diabetic Rats

A hot water extract obtained by boiling adzuki beans (Vigna angularis) to produce bean paste for Japanese cake showed inhibitory activity against alpha-glucosidase, alpha-amylase, maltase, sucrase, and isomaltase after HP-20 column chromatography. The IC(50) values for each hydrolylase were 0.78 mg/ml (alpha-amylase), 2.45 mg/ml (maltase), 5.37 mg/ml (sucrase), and 1.75 mg/ml (isomaltase). The active fraction showed potential hypoglycemic activity in both normal mice and streptozotocin (STZ)-induced diabetic rats after an oral administration of sucrose, but did not show any effect on the blood glucose concentration after glucose administration, suggesting that the active fraction suppressed the postprandial blood glucose level by inhibiting alpha-glucosidase and alpha-amylase, irrespective of the endogenous blood insulin level.

Membranous glomerulonephritis associated with Mycobacterium shimoidei pulmonary infection

Patient: Male, 83

Final Diagnosis: Membranous glomerulonephritis

Symptoms: Producting cough

Medication: —

Clinical Procedure: —

Specialty: Nephrology

Primate model research for endometriosis

Endometriosis is defined as the existence of endometrial tissue outside the uterine cavity, and it includes a chronic, inflammatory reaction associated with female infertility and pelvic pain. Endometriosis occurs in 7 to 10% of women. Although it has been studied for more than 50 years, the pathogenesis and development of endometriosis are still poorly understood. There is no curative therapy for endometriosis, which often recurs after surgical or medical treatment. There is a consensus that the adverse current of menstrual blood plays a crucial role in the development of endometriosis. This places a major limitation on research using rodent models of endometriosis, although these are still widely employed, because rodents do not menstruate and endometriosis does not occur spontaneously in these animals. In fact, menstruation and spontaneous endometriosis only occur in women and some non-human primates, making models that employ non-human primates the best animal models for research into the pathogenesis, pathophysiology, spontaneous onset, and treatment of endometriosis. This review assesses the effectiveness and potential of the non-human primate models of endometriosis. It also describes the current findings and theories on the pathogenesis of endometriosis that have been obtained by research using non-human primates.

Prenatal diagnosis of sirenomelia in the late second trimester with three-dimensional helical computed tomography

Sirenomelia is a rare congenital syndrome that is characterized by the anomalous development of the caudal region of the body. The anomalies include bilateral renal agenesis or dysgenesis and the absence of the sacrum and other vertebral defects. Sirenomelia is also known as "mermaid syndrome," because of the one lower extremity. It is usually associated with severe oligohydramnios, and its prognosis is very poor due to pulmonary hypoplasia that is caused by severe oligohydramnios. The patient referred to our hospital at the gestational age of 27 weeks with fetal growth restriction and oligohydramnios. The estimated fetal body weight was 970 g (-4.9 S.D.). We could identify only one-side extremities, and could not identify kidneys by ultrasound examination. Because a single lower extremity and severe oligohydramnios are characteristics of the sirenomelia, we suspected sirenomelia. However, it could not be confirmed by ultrasound examination because of oligohydramnios. Therefore, we performed three-dimensional helical computed tomography (3D-CT), which is more accurate than ultrasound examinations for prenatal diagnosis of skeletal abnormalities. 3D-CT revealed an only one lower extremity. At 36 weeks and 5 days of gestation, the woman went into spontaneous labor and delivered an infant weighing 870 g. The infant has a single upper extremity and a single lower extremity. We provided supportive care for the neonate, who however died 1 hour 36 minutes after birth from severe respiratory distress. In summary, we report the correct diagnosis of sirenomelia with 3D-CT in the late second trimester.

Long-term cumulative pregnancy rate in women with unexplained infertility after laparoscopic surgery followed by in vitro fertilization or in vitro fertilization alone

AIMS

Laparoscopy has been performed in women with unexplained infertility, but the recent trend is to commence in vitro fertilization (IVF) without prior laparoscopy. The aim of this study was to determine whether or not laparoscopic surgery is necessary for these patients.

MATERIAL & METHODS

With a diagnosis of unexplained infertility, 51 women underwent laparoscopic surgery followed by IVF (laparoscopy group) and 41 women underwent IVF without prior laparoscopy (IVF group). We reviewed these two groups retrospectively and evaluated the cumulative pregnancy rate.

RESULTS

In the laparoscopy group, 16 of the 51 women became pregnant spontaneously soon after surgery. Twenty-three patients became pregnant with IVF. In the IVF group, 32 patients became pregnant with IVF. Two of the 41 women became pregnant spontaneously while waiting to commence IVF.

CONCLUSION

Laparoscopy should be offered as an option for younger patients who desire spontaneous pregnancy because there was no significant difference of the cumulative pregnancy rate between the groups.

The Joint Interface of RT Components for Mobile Robots: The Activity Report Inform the Mobile Robot Working Group of the NEDO Intelligent RT Software Project

RT-middleware enables an interface between RT components by means of interface description language IDL, but it does not prescribe any specific format. If a unique representation format is used, it leads to a reduction in the reusability of a Robotic Technology Component (RTC). A working group of three research bodies engaged in the research and development of mobile robots was organized in the NEDO Intelligent RT Software Project, and this working group is involved in activities aimed at the jointing of RTCs for mobile robots. This paper describes specific this working group’s attempts enhance the sustainability and reusability of common RT components for mobile robots by achieving the jointing of RTCs for mobile robots.

Neoadjuvant intraarterial chemotherapy for stage IIB-IIIB cervical cancer in Japanese women

Chemoradiotherapy is currently the main treatment for locally advanced cervical cancer, but neoadjuvant intraarterial chemotherapy (IA-NAC) has been reported to achieve favorable results. This study investigated the efficacy of several different IA-NAC regimens. The subjects were 55 patients with stage IIB-IIIB cervical cancer who received IA-NAC between January 1991 and April 2006. IA-NAC was administered for a total of 1-3 courses at 3-week intervals, with three different regimens being employed in chronological order. The response rate achieved with IA-NAC was 90.2% for squamous cell carcinoma, 60% for adenosquamous carcinoma and 42.9% for adenocarcinoma. Surgery was performed after IA-NAC in 36 patients, and radiotherapy alone was performed in 19 patients. The 5-year survival rate was 72.9% for patients with squamous cell carcinoma and 50% for those with adenocarcinoma or adenosquamous carcinoma. PAMF therapy (cisplatin, epirubicin, mitomycin-C and 5-fluorouracil) achieved a response rate of ≥90% for squamous cell carcinoma, as did CDDP + THP therapy (cisplatin plus pirarubicin), while PACF therapy (cisplatin, epirubicin, cyclophosphamide and 5-flurouracil) achieved a better response rate for adenosquamous carcinoma and adenocarcinoma. Grade 3 or 4 hematological toxicity was significantly more common with PAMF therapy. In conclusion, IA-NAC improved the survival of patients with squamous cell carcinoma. CDDP + THP therapy achieved a high response rate with little hematologic toxicity. PACF therapy achieved a significantly higher response rate in patients with adenosquamous carcinoma or adenocarcinoma. Therefore, IA-NAC may be a therapeutic option for locally advanced cervical cancer, particularly using the above-mentioned regimens.

Integration of Manipulation, Locomotion, and Communication Intelligent RT Software Components for Mobile Manipulator System Using Scenario Tools in OpenRT Platform

The OpenRT Platform, an integrated development environment for component-based robot system development, is being constructed in order to enhance intelligent robot research and development efficiency. In this paper, a mobile manipulator system that can bring human indicated objects like a service dog is developed based on the OpenRT Platform. The system works with several components providing manipulation, locomotion, and communication functions developed as examples modularizing intelligent robotic functions. These components are integrated using scenario tools in the OpenRT Platform for achieving target tasks.

Concomitant treatment of severe uterine adenomyosis in a premenopausal woman with an aromatase inhibitor and a gonadotropin-releasing hormone agonist

OBJECTIVE

To assess the effect of aromatase inhibitors with GnRH agonist for a severe symptomatic adenomyosis that is refractory to GnRH agonist and danazol with GnRH agonist.

DESIGN

Case report.

SETTING

Clinical practice in university hospital.

PATIENT(S)

A 34-year-old woman with a complaint of severe dysmenorrheal, symptomatic anemia, and a desire to retain fertility.

INTERVENTION(S)

Aromatase inhibitor anastrozole given orally (1.0 mg or 2.0 mg daily) for 16 weeks and GnRH agonist given monthly (injected SC, 1.8 mg) for 4 months.

MAIN OUTCOME MEASURE(S)

Measurements of uterine volume and levels of serum E(2), estrone, A, dehydroepiandrosterone sulfate, LH, FSH, and CA125.

RESULT(S)

Uterine volume was reduced. The reduction rate of uterine volume estimated by magnetic resonance imaging and ultrasonography was 60% after 8 weeks of treatment.

CONCLUSION(S)

Aromatase inhibitor with GnRH agonist therapy was useful for the management of a severely adenomyotic woman whose desire was for conservative treatment.

Odd variation of 75 g oral glucose tolerance test results in a Japanese patient with polycystic ovary syndrome: a case report

We report a young woman of normal body weight who was diagnosed with polycystic ovary syndrome (PCOS) and had an odd variation of 75 g oral glucose tolerance test (OGTT). This woman underwent the 75 g OGTT to evaluate the association between PCOS and insulin secretion capacity. Although the blood sugar levels were within normal range before the OGTT load test, we noted an odd variation of insulin response in which a condition of hyperinsulinemia after the load test was followed suddenly by hypoglycemia. Hyperandrogenism in the PCOS patient and insulin resistance indicated by 75 g OGTT suggest that insulin may influence the ovary and that there could be an association between this disease and insulin resistance. The insulinogenic index in this case showed higher than normal values, demonstrating that there was a positive correlation between hyperinsulinemia and insulin resistance. This patient experienced ovulation followed by pregnancy after treatment with an herbal medicine called Shakuyaku-Kanzo-To. We believed that identifying the subset of PCOS woman who is insulin resistant may be useful, as this resistance could be import in terms of follow-up and future exploration.

Pregnancy complicated with Buerger's disease

Buerger's disease is an inflammatory occlusive vascular disorder involving small- and medium-sized arteries in the distal extremities and is usually complicated with thrombophlebitis. Since Buerger's disease develops most frequently in men who smoke, pregnancy complicated with this disease is extremely rare. Only three pregnancies have been reported previously. All cases indicate that Buerger's disease worsens during pregnancy. However, anti-coagulant therapy appeared to be effective in this case. Accordingly, careful observation is mandatory in pregnancies complicated with Buerger's disease.

Effectiveness of antiadhesion barriers in preventing adhesion after myomectomy in patients with uterine leiomyoma

BACKGROUND

Myomectomy often causes adhesion formation and decreases subsequent fertility. The purpose of the present study was to evaluate the effectiveness of several antiadhesion barrier materials in preventing adhesion after myomectomy.

METHODS

We prospectively classified 63 women undergoing myomectomy alone into four groups according to the type of antiadhesion material used: Hyaluronic acid-carboxymethylcellulose film (Seprafilm) (n = 21, Group 1), Dextran 40 (10% Dextran 40 Low Injection) (n = 17, Group 2), factor 13 with fibrinogen (Beriplast) (n = 12, Group 3) and control (n = 13, Group 4). We performed early second-look laparoscopy after the seventh post-operative day in all patients and examined adhesion formation in the abdominal cavity. The incidence of adnexal adhesions was evaluated according to the American Fertility Association (AFS) adhesion score.

RESULTS

The incidence of uterine adhesion was 14.3% in Group 1, 70.6% in Group 2, 75.0% in Group 3 and 76.9% in Group 4. Adhesion formation in Group 1 was significantly less than that in Group 2 (p = 0.0004), Group 3 (p = 0.0005) and Group 4 (p = 0.0003). The incidence of peritoneal adhesion was 14.3% in Group 1, 29.4% in Group 2, 41.6% in Group 3 and 69.2% in Group 4. Adhesion formation in Group 1 was significantly less than that in Group 4 (p = 0.001). AFS scores in Groups 1-4 were 0.38+/-1.02, 4.58 +/- 7.02, 0.83 +/- 1.99 and 8.53 +/- 8.79 (mean +/- S.D.), respectively. Group 1 had the lowest AFS score and the difference between Group 1 and Group 4 was significant (p < 0.0001). The AFS score in Group 3 was also significantly less than that of Group 4 (p = 0.0009).

CONCLUSION

Seprafilm was highly effective and was superior to the other antiadhesion materials tested in preventing uterine adhesions after myomectomy.

Successful intrauterine treatment with radiofrequency ablation in a case of acardiac twin pregnancy complicated with a hydropic pump twin

Twin reversed arterial perfusion sequence is a serious complication of monochorionic twin pregnancy, as the pump twin that perfuses blood to the acardiac twin may experience heart failure and fetal hydrops resulting in a poor perinatal outcome. A woman with an acardiac twin pregnancy complicated by a hydropic pump twin underwent intrauterine treatment with radiofrequency ablation (RFA) at 27 weeks of gestation. Obliteration of blood flow to the acardiac twin from the pump twin was successful. Fetal hydrops resolved by the time of delivery at 32 weeks of gestation, in spite of transient deterioration, and a good postnatal outcome was achieved for the pump twin. We found that RFA was an effective intrauterine treatment for acardiac twin pregnancy and suggest that it could be introduced in cases complicated by a hydropic pump twin.

Position and Pose Estimation of Camera-Head with Foveated Wide Angle Lens

A method is proposed to correct the initial position and pose estimates of a camera-head by aligning a 3D model of its surrounding environment with an observed 2D image that is captured by a foveated wideangle lens in the camera. Because of the wide field of view of the lens, the algorithm can converge even when the initial error is large, and the precision of the result is high since the resolution of the fovea of the lens is high.