Five-year survivors with resected pN2 nonsmall cell lung carcinoma

BACKGROUND

Some patients with resected pN2 lung carcinoma were long term survivors. To determine appropriate therapeutic modalities for the selected patients, the clinicopathologic characteristics of these patients were examined using the actual number of survivors rather than the cumulative survival rate because the cumulative survival rate occasionally is confounded due to patients with short follow-up periods.

METHODS

Between 1981-1990, 178 patients with pN2 nonsmall cell lung carcinoma underwent complete resection with systemic lymph node dissection. The ratios of 5-year survivors to all patients in groups with several clinicopathologic factors were compared.

RESULTS

Gender, the side that was operated on, location of the tumor, histologic type, or surgical procedure were not related to the ratio of 5-year survivors. However, T classification, skip metastasis, and the number of levels involved were associated with the ratio significantly. The authors also found that the location of the involved lymph node(s) affected the ratio.

CONCLUSIONS

Even in the presence of pN2 disease, lung carcinoma patients with T1 tumors, skip metastasis, or single level mediastinal lymph node involvement, especially Level 4, Level 5, or Level 6 lymph nodes, had a relatively favorable prognosis and may be candidates for primary resection.

Sequential loss of heterozygosity in the progression of squamous cell carcinoma of the lung

Radiographically occult bronchogenic squamous cell carcinomas are early lung cancers that localize mainly in the bronchial wall, and are thought to be a good model for investigating genetic alterations through lung cancer progression. In order to elucidate sequential genetic changes in lung cancers, we analysed the incidence of allelic losses on chromosome regions 2q33, 3p21, 5q21, 7q31, 9p21 and 17p13 for 40 cases of radiographically occult bronchogenic squamous-cell carcinomas and 40 cases of advanced lung cancers microdissected. In this study we used eight microsatellite dinucleotide polymorphic markers. Frequent loss of heterozygosity (LOH) was observed on 3p21 (53%), 5q21 (44%) and 17p13 (61%) in roentgenographically occult bronchogenic squamous cell carcinomas. 2q, 7q and 9p were lost less frequently in both roentgenographically occult bronchogenic squamous cell carcinomas and advanced lung cancers. These results suggest that several tumour-suppressor genes are associated with lung cancer progression and that genetic changes on 3p21, 5q21 and 17p13 are early events.

Pelvic extension of retroperitoneal fluid: analysis in vivo

OBJECTIVE

The purposes of this study were to describe the pathway of fluid flow from the retroperitoneal space into the pelvic extraperitoneal space on CT in vivo, to clarify the relation between its occurrence and the site or amount of retroperitoneal fluid, and to delineate the anatomic relation between the retroperitoneal spaces and the pelvic extraperitoneal space.

MATERIALS AND METHODS

We reviewed the CT scans of 37 patients with retroperitoneal fluid collections. Patients who had undergone pelvic laparotomy and patients who had either fascial thickening alone or fluid within muscle (such as the psoas muscle or iliac muscle) alone were excluded.

RESULTS

Fluid extension into the pelvic extraperitoneal space was seen in six patients (16%). Extension by the infrarenal extraperitoneal space was seen in all six of these patients, but extension by properitoneal fat was seen in only one of the six patients. In patients with large amounts of fluid in the infrarenal extraperitoneal space, we frequently saw extension into the pelvic extraperitoneal space. Extension of pancreatic fluid into the infrarenal extraperitoneal space occurred in only 15% of the 37 patients. However, it occurred in both patients with ruptured abdominal aortic aneurysms. Three pathways from the infrarenal extraperitoneal space into the pelvic extraperitoneal space were seen: extension dorsally medial to the iliac vessels (n = 6), extension dorsally lateral to the iliac vessels (n = 1), and extension medially into the prevesical space (n = 2). Coexistence of two of these three pathways was seen in three patients.

CONCLUSION

In vivo, extension of retroperitoneal fluid into the pelvic extraperitoneal space is not rare and occurs more often by the infrarenal extraperitoneal space than by properitoneal fat. Extension of retroperitoneal fluid to the infrarenal extraperitoneal space can be attributed less frequently to sources distant to the pelvic cavity such as pancreatic fluid. Such extension often derives from sources that can produce large amounts of retroperitoneal fluid such as ruptured abdominal aortic aneurysms. Of the three pathways from the infrarenal extraperitoneal space to the pelvic extraperitoneal space, dorsal extension medial to the iliac vessels is the most common, and multiple pathways often coexist.

What kind of hilar lung cancer can be a candidate for segmentectomy with curative intent?: Retrospective clinicopathological study of completely resected roentgenographically occult bronchogenic squamous cell carcinoma

Although a randomized control trial demonstrated that limited surgery for small peripheral lung cancers was not as curative as lobectomy, there have been no reports concerning segmentectomy for small hilar lung cancers. In this study, we analyzed the clinicopathological features of roentgenographically occult bronchogenic squamous cell carcinomas in order to select candidates for limited resection with curative intent. From April 1982 through June 1995, 105 roentgenographically occult bronchogenic squamous cell carcinomas whose proximal edge of the lesion was more peripheral than the orifice of the segmental bronchus were completely resected. The bronchoscopic findings of the lesions were classified into three categories: remarkable, minute and hidden. Moreover, in terms of the range of endoscopic visibility, the lesions were classified into two categories: lesions within the range of endoscopic visibility and those beyond it. If lymph nodes show no signs of metastasis, roentgenographically occult bronchogenic squamous cell carcinoma is regarded as localized carcinoma and can be a candidate for segmentectomy with curative intent. In cases with minute or hidden bronchoscopic findings or of lesions within the range of endoscopic visibility, metastatic lymph nodes were never observed. Accordingly, roentgenographically occult bronchogenic squamous cell carcinomas with minute or hidden bronchoscopic findings or those within the range of endoscopic visibility can be candidates for curative segmentectomy.

[Flow cytometric analysis of the effects of 50 Hz magnetic fields on mouse spermatogenesis]

The cellular effects of an extremely-low-frequency (ELF) magnetic field on mouse spermatogenesis were assessed by DNA flow cytometry and serum testosterone. Seven week old male ICR mice were exposed to a 50 Hz magnetic field the strength of which was 1.0 m Tesla. Seven mice per treatment group were exposed for 13, 26, 39 or 52 days. For each experimental point, an equal number of mice per sham-treated group were used as a control and were exposed only to the background field below 1 mu Tesla in the same room as the treatment group. In the control mice, the testis cellular DNA content distribution by flow cytometory was characterized by four quantifiable populations; round spermatids (1C), spermatogonia and other diploid cells (2C), spermatogonial cells synthesizing DNA (S-phase) and primary spermatocytes (4C). In animals exposed for 26 days the number of cells in the 4C and the 4C:2C ratio was significantly lower, and the 1C:4C ratio (meiotic transformation) was significantly higher than the corresponding control groups. In animals exposed for 52 days the cell population in 1C and the 1C:2C ratio (total germ-cell transformation) was significantly higher, and the cell population in 2C was significantly lower than the corresponding control groups. The concentration of serum testosterone in animals exposed for 13 days was significantly higher than in the corresponding control group. These changes suggest that long-term exposure to an ELF magnetic field had a possible effect on the proliferation and differentiation of spermatogonia.

Appendiceal abscess mimicking infected urachal cyst in a child with intestinal malrotation

An appendiceal abscess with intestinal malrotation can occur anywhere in the abdomen, not only in the right lower quadrant. We report a case presenting a midline mass of the lower abdomen whose computed tomography (CT) and ultrasonography (US) findings mimicked a urachal abscess. A retrospective review of CT findings led to the correct diagnosis by showing malposition of the ascending colon.

Safety and kinetic properties of a humanized antibody to human interleukin-6 receptor in healthy non-human primates

A monoclonal antibody, hPM-1, was constructed by grafting the complementarity determining regions to human interleukin-6 (IL-6) receptor, raised in mouse, onto a human antibody backbone (humanized antibody). It is expected to be useful as a therapeutic agent for IL-6-related diseases such as multiple myeloma. To investigate the toxicological and kinetic properties of hPM-1 preliminarily, normal cynomolgus monkeys, which showed cross-reactivity with hPM-1, were intravenously administered with hPM-1 at doses of 0 (vehicle), 4 or 40 mg/kg once a week for 13 weeks. Upon toxicological examination, there were no changes in clinical signs, food consumption, body weights, urinalyses, body temperatures, electrocardiograms, hematological and biochemical parameters including blood platelet counts, serum levels of immunoglobulin G and C-reactive protein, and pathological findings. In a kinetic study, serum concentrations of hPM-1 showed a linearity between doses of 4 and 40 mg/kg. The serum concentrations, even at a dose of 4 mg/kg, were maintained at a high enough level to inhibit the IL-6 functions throughout the period of the study. Concentrations of hPM-1 in bone marrow were almost equal to those in serum. The antibodies against hPM-1 were detected only in one of four monkeys receiving hPM-1. This study suggests that blockage of the IL-6 receptor by hPM-1 does not induce any influence on a healthy living body, and hPM-1 is not toxic under the conditions of this investigation.

[A child of malignant lymphoma diagnosed by transbronchial aspiration cytology under general anesthesia with a laryngeal mask]

A 8-year-old male with Wiskott-Aldrich syndrome was admitted to our hospital because of left hilar swelling on a chest roentgeonogram. Bronchofiberscopy and transbronchial aspiration cytology (TBAC) was performed under general anesthesia with a laryngeal mask. The specimen obtained by TBAC was immediately stained and diagnosed as malignant lymphoma. One month later, thoracotomy was performed in order to get more detail diagnosis, which is necessary to determine the regimen of chemotherapy, and the nodal specimen were diagnosed as Hodgkin's disease. The ABVD therapy was performed which induced the complete remission. The laryngeal mask is a useful device for bronchofiberscopy in children.

Adenoid cystic carcinoma of the external auditory canal: correlation between histological features and MRI appearances

A rare case of adenoid cystic carcinoma of the external auditory canal with magnetic resonance imaging appearances is reported. Both T1 weighted and T2 weighted MR images showed the tumour as a hypointense mass, although there was marked contrast enhancement. Microscopic examination of the resected tumour showed a preponderance of solid tumour cell nests. According to previous reports, these pathological and radiological findings indicate a poor prognosis.

[The significance of surgical treatment for T4 lung cancer]

A total of 114 pT4 patients underwent pulmonary resection from January 1980 to December 1993 at our hospital. The overall five-year survival rate of the 114 cases was 17%. There was no significance between the five-year survival rate of squamous cell carcinoma and that of adenocarcinoma. Five-year survival rates of 17 patients with N0 disease, 29 patients with N1 disease, 51 patients with N2 disease, 1 patients with N3 disease, and 16 patients with NX disease were 40%, 21%, 21%, 0%, and 0%, respectively. Five-year survival rate of 89 cases with single factor of T4 was 24% and that of 25 cases with more than one factor was 4% (0.05 < P < 0.1). In the patients with only single factor of T4, five-year survival rates of 6 patients with left atrium invasion, 13 patients with major vessel invasion, 9 patients with trachea/carina invasion, and 18 patients with vertebral body, were 50%, 38%, 22%, and 0%, respectively. Furthermore, in 38 pT4 patients with involvement only to single adjacent structure, five-year survival rates were 47% in curative operation (n = 17) and 10% in non-curative operation (n = 21) (P < 0.05). We conclude that surgical treatment for T4 lung cancer should be performed to patients with single structure invasion which is expected to have a curative operation. N0 disease is more favorable than N1 or N2 disease.

Changes in the amounts of neurotransmitters released from the striatum and spontaneous motor activity in rats exposed to high doses of toluene

We studied the neurotoxicological effects of high-dose toluene exposure by measuring neurotransmitter release from the striatum and spontaneous motor activity in freemoving Tokai High Avoider (THA) male rats. The rats were exposed to 1,000, 2,000, and 4,000ppm toluene for 4 hours. During the 4-hour exposure period and each one hour pre- and post-exposure periods, acetylcholine (ACh), 3, 4-dihydroxyphenylacetic acid (DOPAC), homovanilic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) in the microdialysate from kthe striatum of each rat were measured continuously using microdialysis. Simultaneously, spontaneous motor activity of each rat was monitored using an Aimex device. The amounts of neurotransmitters released and spontaneous motor activity showed similar changes for every concentration of toluene exposure during those periods. Although minimal changes in neurotransmitters and motor activity were observed in the 1,000 ppm group, increases in neurotransmitter release and motor activity were observed in the 2,000 ppm group during the entire exposure period and also in the 4,000 ppm group during the early period of exposure. On the other hand, decreases in neurotransmitter release and motor activity were observed in the 4,000 ppm group during the late period of exposure. These findings indicate that the striatum influences motor activity via changes in the amounts of neurotransmitters released during the period of high-dose toluene exposure.

Effects of ethyl alcohol administration to THA rat dams during their gestation period on learning behavior and on levels of monoamines and metabolites in the brain of pups after birth

Children born from chronic alcoholic mothers have shown behavioral teratogenic effects more frequently than morphological malformations. To investigate the possible mechanisms and evaluate maternal alcohol dosage levels to induce behavioral dysfunctions, we gave pregnant Tokai High Avoider (THA) rats 0, 5, 10, and 20% ethanol (EtOH) as drinking water during the gestation period. We evaluated the brain function of pups born of alcohol-administered dams. Sidman avoidance behavior test and the levels of monoamines (nor-adrenalin, dopamine, and serotonin) and metabolites (3, 4-dihydroxyphenyl acetic acid, homovanillic acid, and 5-hydroxyindole acetic acid) in whole brain were examined for neurobehavioral and neurochemical effects. EtOH-exposed THA offsprings showed high pre- and postnatal mortality, growth deficits, and brain weight reductions. Compared with the results of the same conditioning experiment using Wistar rats, the THA rat may have higher susceptibility to the effects of in utero EtOH exposure than Wistar rats. EtOH-exposed THA pups exhibited deficits in avoidance operant learning that were not shown in Wistar rats. We also observed the increased levels of all monoamines that were assumed to be related with the deficit of learning, the decreased levels of 3, 4-dihydroxyphenyl acetic acid and homovanillic acid, and the unchanged levels of 5-hydroxyindole acetic acid in pups from dams administered 10 and 20% EtOH. However, contrary alteration of monoamines and their metabolites were shown in pups from 5% EtOH-administered dams.

Percutaneous retrieval of intracardiopulmonary artery metallic needle (Kirschner's wire): a case report

We report a case of successful percutaneous retrieval of a broken Kirschner's wire that had entered the venous system and the right atrium and later migrated to the left pulmonary artery. The management of a long, rigid, nail-like foreign body within the heart and/or the pulmonary artery is discussed.

Usefulness of ultrasonography in operation for pulmonary arteriovenous fistula

A 54-year-old woman presented with nonhereditary, bilateral pulmonary arteriovenous fistulas. One of them was small (10 x 10 mm) and embedded in the parenchyma; it was neither visible nor palpable from the pleural surface. We therefore used intraoperative ultrasonography and succeeded in detecting and enucleating the small fistula with minimal resection of the normal lung tissue.

[Assessment of a new TNM classification produced by UICC for resected lung cancer with intrapulmonary satellite tumor(s)]

We examined the efficacy of a new classification produced by International Union Against Cancer (UICC) in 1993 for 61 patients who underwent resection of lung cancer with intrapulmonary satellite tumor(s) during 1952 to June 1991. Survival rate after resection was calculated according to the new classification. Survival rate of patients with stage I lung cancer was 67% at four years after surgery, that with stage IIIA was 33% and stage IIIB 5% at five years after surgery. There was a significant difference between the survival of stage IIIA and stage IIIB. Five year survival of patients with N0 or N1 lung cancer was 62%, which was significantly better than four year survival (3%) with N2, N3, or NX lung cancer. Five year survival for patients with squamous cell carcinoma was 61%, which was significantly better than that (9%) with adenocarcinoma. The new TNM classification produced by UICC is acceptable in investigating lung cancer with ipsilateral satellite tumor(s). It is necessary to investigate lung cancer with contralateral satellite tumor(s). Prognosis of patients with N0 or N1 lung cancer, especially squamous cell carcinoma, even if with intrapulmonary satellite tumor(s), was relatively good after resection. Such lung cancers may be synchronous multiple lung cancers from a therapeutic point of view.

[Two cases of clear cell tumor of the lung]

We report two cases of benign clear cell tumor of the lung, which were found as well-circumscribed lesions on chest X-ray films without any symptoms, and removed surgically. Light microscopy showed proliferation of clear cells filled with glycogen in both cases. Immunohistochemical examination performed in a case suggested that the tumor cells might be associated to a derivation from neural and/or smooth muscle cells, because of positive staining for NSE and SMA. In another case, the tumor formed a necrotic cavity, which could be detected by the preoperative MRI examination. This report might introduce a note of caution for the pathologic and radiographic diversity of this disease.

[Standardization of use of 4-F size catheter for selective transcatheter angiography and intervention of abdomen]

To evaluate the safety and efficacy of a new 4 French (F) catheter/sheath system with large lumina for selective abdominal arteriography and intervention, the usefulness of the 4F sheath (4F group, 88 patients) was compared with that of a 5.5F sheath and a 7F sheath (5.5F group, 7F group, 156 patients). The compression time of the arterial puncture site and the ambulation time in the 4F group were significantly shorter than those in the 5.5F and 7F groups. The hemorrhagic complication rate in the 4F group (15%) was less than those in the 5.5F group (23%) and 7F group (27%). The severity of hemorrhagic complications in the 4F group (hematoma 2.3%, woozing 14%, and rhexis 0%) was significantly less than in the 5F group (3%, 21%, 0%) and 7F group (11%, 19%, 2.4%). The controlability of the 4F catheter as compared with a 5F catheter was estimated in 35 patients by questionnaire. The torque transmissibility and the endurability of the kink of the 4F catheter were poor in comparison with the 5F catheter. However, with respect to the ability to follow over a guidewire, the 4F catheter showed great advantage over the 5F catheter. It is concluded that the 4F catheter/sheath system is feasible for general use in selective abdominal arteriography and interventions.

A case of cerebral air embolism predominant in the left cerebral hemisphere following subclavian catheterization

We report a case of cerebral air embolism caused by right subclavian vein catheterization. A large amount of air was seen only over the left cerebral hemisphere on computed tomographic (CT) scans. Although neurological deficit was observed bilaterally at the onset, the degree of ischemic brain damage was far greater in the left cerebral hemisphere than in the right. This unusual left-sided predominancy of cerebral air embolism was presumably due to the tortuosity of the ascending aorta.

[Results of surgical treatment of intrathoracic recurrence after complete resection of non-small cell lung cancer: clinical significance of subsequent lesion in lung parenchyma]

Results of surgical treatment for 33 intrathoracic recurrence after complete resection of non-small cell lung cancer were analyzed. Prognosis of the second surgical treatment were favorable in patients with subsequent cancer with in situ component and solitary lesion in lung parenchyma. Retrospective study of 53 patients who recurred and were thoroughly followed up their clinical course until lung cancer death revealed that the solitary one tends to be confined to the intrathoracic location, and the multiple one did not confined to the intrathoracic location but also extended to the extrathoracic distant metastasis or to the supraclavicular lymph nodes.

Multiple intrahepatic aneurysms following transcatheter arterial embolization. Work in progress

PURPOSE

To discuss the mechanism of multiple intrahepatic aneurysm formation after transcatheter arterial embolization (TAE) performed in five patients with hepatocellular carcinoma.

MATERIALS AND METHODS

TAE was performed with gelatin sponge particles and iodized oil as embolic materials. Mitomycin C was also used in four cases.

RESULTS

Three to 14 aneurysms 1-6 mm in diameter were found in third-to sixth-order branches of the hepatic arteries at repeat angiography performed 25-45 days after TAE. Follow-up angiograms in three cases revealed that most aneurysms were no longer apparent except in one patient in whom two aneurysms remained and were larger than before. In none of the five cases were any signs of aneurysm rupture noted.

CONCLUSION

Radiologists should be aware of this complication of TAE. It is speculated that the main cause of aneurysm formation in these patients was the embolic agents used.

Persistent common bile duct hematoma caused by a small cancer: case report

We report a case in which an intrabiliary duct hematoma secondary to a coexisting smaller choledochal cancer was observed for more than a month. Initial noncontrast enhanced X-ray computed tomography (CT) showed the hematoma as a high-attenuation mass, leading to the preoperative diagnosis of choledochal stone or calcified tumor.