Changes of tumor size and tumor contrast enhancement during radiotherapy for non-small-cell lung cancer may be suggestive of treatment response

We evaluated sequential dynamic contrast-enhanced CT (DCE-CT) scans to assess the possibility of early prediction of treatment responses by quantifying the tumor size reduction and the change in tumor enhancement during and after a course of radiotherapy (RT). Thirty-nine patients with non-small-cell lung cancer were treated with RT for initial treatment. DCE-CT scan was performed within one week before the beginning of treatment, after 17 or 18 fractions (34 or 36 Gy), and 1 week and 1 month after the end of RT. The correlation between the relative decrease in tumor diameter and that in the attenuation value was evaluated. Nineteen patients were evaluated in this study. The median tumor size was 39.5 mm at the start of treatment, 30.8 mm at 34-36 Gy, and 16.1 mm 1 month after the end of RT. The relative decrease in tumor diameter at 34-36 Gy well correlated with that 1 month after treatment (r = 0.85, r: Pearson's correlation coefficient, p < 0.001). Relative change in the attenuation value at the rim of the tumor at 34-36 Gy did not significantly correlate with the change in tumor diameter 1 month after the completion of RT, but in the center of the tumor, the change of the attenuation value in the delayed phase correlated with the change in tumor diameter. The decrease of tumor diameter during RT may be predictive of treatment response. The relative change of tumor enhancement in the center of the tumor in the delayed phase correlated with tumor shrinkage 1 month after the completion of RT.

P2-06-01: Genomic Instability in Breast Cancers from Atomic Bomb Survivors: An Analysis of Microarray-Comparative Genomic Hybridization with Old Archival Tissues

Background: Sixty-six years after two atomic bombs (A-bombs) explosion on Hiroshima and Nagasaki, the incidence of breast cancer in A-bomb survivors still higher than that in controlled populations. We have reported a higher incidence of HER2 and C-MYC oncogene amplification in breast cancers from A-bomb survivors, which suggested genomic instability (GIN) induced by A-bomb radiation exposure might promote breast carcinogenesis in A-bomb survivors. The purpose of this study was to clarify the effect of A-bomb radiation exposure on GIN in breast cancer using microarray-comparative genomic hybridization (aCGH).

Materials and Methods: DNA was extracted from the paraffin-embedded tissues of invasive ductal cancers from 11 survivors exposed at 1.5km from the hypocenter and 9 calendar year-matched non-exposed patients followed by aCGH analysis using a high-density oligonucleotide microarray (Agilent® SurePrint G3 8×60k microarray). The total length of chromosomal aberrant region was used as an indicator of GIN, and correlation with clinicopathological factors were statistically tested.

Results: The mean of the derivative log ratio spread (DLRSpread), which estimates the log ratio noise by calculating the spread of log ratio differences between consecutive probes along all chromosomes, was 0.60 (range, 0.30 to 1.05). The concordance of aCGH results with FISH results for HER2 gene amplification was 90%. Samples from A-bomb survivors had significantly more copy number aberrations (CNA) than samples from control patients (P= 0.040). Samples with C-MYC gene amplification determined by aCGH analysis tended to harbor more CNA (P= 0.20), and age at the time of diagnosis tended to be inversely associated with the total length of chromosomal aberrant regions (P= 0.13). The multivariate analysis with covariance revealed that the status of A-bomb exposure was the only independent factor which was significantly associated the total length of chromosomal aberrant regions (P= 0.0324).

Conclusions: This study suggested that A-bomb radiation may affect the development of chromosomal aberrant regions including oncogene amplification by inducing GIN and may be associated with a higher histological grade in breast cancer found in A-bomb survivors.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-06-01.

Significance of plasma levels of pigment epithelium-derived factor as determined by multidetector row computed tomography in patients with mild chronic kidney disease and/or coronary artery disease

Little is known about the association between plasma levels of pigment epithelium-derived factor (PEDF), coronary artery disease (CAD) and/or chronic kidney disease (CKD). This study evaluated 289 consecutive patients with chest pain or at least one coronary risk factor who underwent coronary angiography using multidetector row computed tomography (MDCT). Presence of CAD and CKD, CAD severity (i.e. number of significantly stenosed coronary vessels, described as vessel disease [VD]), coronary calcification scores, visceral fat area (VFA), subcutaneous fat area on MDCT, and metabolic biomarkers were recorded. PEDF levels correlated significantly with sex, VFA, CKD presence/hyperuricaemia and high-density lipoprotein cholesterol levels. PEDF levels were closely associated with CKD and were significantly higher in CKD patients than in non-CKD patients, regardless of the presence of CAD. CKD patients with two-VD or three-VD had higher plasma PEDF levels than non-CKD patients with two-VD or three-VD. It is concluded that PEDF may be associated with CKD regardless of the presence of CAD.

Severe erosive lesions in the digestive tract of patients with Henoch-Schönlein Purpura (HSP) and its impact on prognosis - presentation of two cases and statistical review of adult-onset Japanese HSP

INTRODUCTION

Although many pediatric patients with Henoch-Schönlein Purpura (HSP) recover spontaneously, disease activity in adult patients often cannot be controlled by treatment.

PURPOSE

To assess the specific signs not formerly considered to be those of uncontrollable adult HSP patients.

PATIENTS AND METHODS

Clinical records of 2 adult patients who died during HSP were reviewed and previous reports on HSP were consulted.

RESULTS

Both patients had lesions in the digestive tract diagnosed as hemorrhagic erosion in the small intestine and colon. They were elderly and showed renal dysfunction. They died from severe infection after potent immunosuppressive treatment. A univariate analysis showed that age of over 60 years, severe renal symptoms (nephrotic syndrome and/or end-stage renal failure), Birmingham Vasculitis Activity Score (BVAS) of more than 18 points, massive immunosuppression and melena had significantly higher prevalence among patients who died. Multivariate statistical analysis with theoretical quantification analysis II revealed that age of over 60 and severe renal symptoms (nephrotic syndrome and/or end-stage renal failure) contributed to poor prognosis. The presence of melena did not contribute to poor prognosis despite results of the univariate analysis and our clinical impressions.

DISCUSSION

In multivariate statistical analysis, melena was selected as a sign of severe erosive lesions in the digestive tract because some of the patients were not examined by fiberscopy. Melena is caused by various lesions in the digestive tract and each of them has different effects on prognosis.

CONCLUSION

Elderly HSP patients with severe renal impairment should be carefully treated. Examination of the digestive tract by fiberscopy is recommended when melena is observed in these patients.

Interferon-α increases monocyte migration via platelet-monocyte interaction in murine intestinal microvessels

The aim of this study was to investigate the effect of interferon (IFN)-α on recruitment of platelets and monocytes within the murine small intestinal venular endothelium. Monocytes were isolated from bone marrow of C57B6 mice. Platelets were collected from murine blood. Rolling and adhesion to submucosal microvessels in the small intestine were examined under an intravital fluorescence microscope after injection of fluorescein-labelled monocytes or platelets. In some mice, IFN-α (5×10(5) U/kg) was administered intraperitoneally. After treatment with an antibody against P-selectin, changes in monocyte and platelet migration were also investigated. Changes in monocyte migration under the condition of thrombocytopenia were also investigated. Platelets and monocytes interacted with murine intestinal microvessels, although only few platelets and monocytes showed migration behaviour. Intraperitoneal injection of IFN-α enhanced the migration of both platelets and monocytes in the intestinal microvessels. Pretreatment with anti-P-selectin attenuated the increase in migration of platelets and monocytes induced by administration of IFN-α. Thrombocytopenia decreased the rolling ratio of monocytes, suggesting that the effect of IFN-α on migration was P-selectin-dependent, derived from both the endothelium of microvessels and platelets. The results of this study suggest that IFN-α acts as a potent proinflammatory agent via its stimulatory effect on the endothelium-platelet-monocyte interaction in intestinal microvessels by a P-selectin-dependent mechanism.

[Clinical analysis of eight patients with pulmonary toxocariasis]

We encountered 8 adult cases of pulmonary toxocariasis. Five were asymptomatic, 1 had transient chest pain, 1 suffered from arthralgia and migrating skin pain, and 1 had chest discomfort due to pneumothorax. Infection was associated with the consumption of raw liver with paratenic hosts in 5 patients. The cause was suspected to be contact with infected young dogs in 1 case and was undetermined in 2 cases. All 8 cases showed some abnormalities in their laboratory examination results including eosinophilia (>500/microl) and elevated IgE (>100 IU), and all had positive results in serological examinations for the larval excretory-secretory product of Toxocara canis. In 7 patients, excluding the patient with pneumothorax, chest computed tomography demonstrated multiple small pulmonary lesions, most of which were either nodules with halos, or ground-glass opacities. One patient recovered without medication, while the other 7 were treated with albendazole (ABZ) with good responses. Although the optimal duration of ABZ therapy has not been established, 4 weeks or longer seemed necessary to obtain a complete cure in pulmonary toxocariasis.

Cervical cancer metastasis to the scalp: case report and literature review

BACKGROUND

Distant metastasis in carcinoma of the uterine cervix is a rare manifestation, with scalp metastasis being an exceptional event.

CASE

We describe a 48-year-old woman with Stage IIb, squamous cell carcinoma of the cervix who was initially treated with radical hysterectomy and lymphadenectomy followed by concurrent chemoradiotherapy. The patient presented eight months later with swelling over the top of the scalp. The scalp was involved in the disease as the sole anatomic site of distant metastasis.

CONCLUSION

A search of the literature revealed only seven cases of such distant metastatic involvement of the scalp from cervical cancer. More frequent reports and better understanding on these rare events may give new insight to clear strategies to prevent scalp metastases.

[Constrictive pericarditis after minimally invasive coronary artery bypass grafting: report of a case]

Constrictive pericarditis (CP) after off-pump coronary bypass surgery, especially after minimally invasive direct coronary artery bypass (MIDCAB), had rarely been reported. We presened a surgically treated case of CP after MIDCAB via left anterior small thoracotomy. A 57-year-old man underwent MIDCAB with placement of an internal mammary artery to the left anterior descending coronary artery uneventfully. Four years after the operation, he began to experience exertional dyspnea. Computed tomography of the chest showed pericardial thickening. Cardiac catheterization revealed elevation and equalization of the pressures in the 4 chambers, as well as low cardiac output. Pericardiectomy using cardiopulmonary bypass through a median sternotomy was performed successfully without injury to the bypass graft. Postoperative hemodynamic measurements were improved. The patient has resumed normal activity and remained free from heart failure for over 5 years.

Omega-3 polyunsaturated fatty acids ameliorate the severity of ileitis in the senescence accelerated mice (SAM)P1/Yit mice model

Clinical studies using omega-3 polyunsaturated fatty acids (omega3-PUFA) to Crohn's disease (CD) are conflicting. Beneficial effects of dietary omega3-PUFA intake in various experimental inflammatory bowel disease (IBD) models have been reported. However, animal models of large intestinal inflammation have been used in all previous studies, and the effect of omega3 fat in an animal model of small intestinal inflammation has not been reported. We hypothesized that the effects of omega3 fat are different between large and small intestine. The aim of this study was to determine whether the direct effect of omega3 fat is beneficial for small intestinal inflammation. Senescence accelerated mice (SAM)P1/Yit mice showed remarkable inflammation of the terminal ileum spontaneously. The numbers of F4/80-positive monocyte-macrophage cells as well as beta7-integrin-positive lymphocytes in the intestinal mucosa were increased significantly compared with those in the control mice (AKR-J mice). The area of mucosal addressin cell adhesion molecule-1 (MAdCAM-1)-positive vessels was also increased. The degree of expression levels of monocyte chemoattractant protein-1 (MCP-1), interleukin (IL)-6 and interferon (IFN)-gamma mRNA were increased significantly compared with those in the control mice. The feeding of two different kinds of omega3 fat (fish-oil-rich and perilla-oil-rich diets) for 16 weeks to SAMP1/Yit mice ameliorated inflammation of the terminal ileum significantly. In both the omega3-fat-rich diet groups, enhanced infiltration of F4/80-positive monocytes/macrophages in intestinal mucosa of SAMP1/Yit mice cells and the increased levels of MCP-1, IL-6 and IFN-gamma mRNA expression were ameliorated significantly compared with those in the control diet group. The results suggest that omega3 fat is beneficial for small intestinal inflammation by inhibition of monocyte recruitment to inflamed intestinal mucosa.

Survey on pamphlet use explaining breast cancer operations in Japan

BACKGROUND

The burden on hospitals to provide information has been increasing. This study examined the demands of surgeons and patients using a pamphlet explaining breast cancer operation procedures.

METHODS

A questionnaire with an eight-page pamphlet was sent to 367 hospitals with surgery departments in Aichi and Gifu prefectures in Japan. The same pamphlet and a self-administered anonymous questionnaire were also sent to 173 members of a breast cancer patient association, who had undergone breast cancer operations and lived in the same prefectures.

RESULTS

Responses to the questionnaire from 196 hospitals (53%) and 122 patients (71%) were analyzed. Breast cancer operations were conducted at 8 departments of 5 university hospitals, 37 governmental hospitals, 25 non-profit hospitals, and 66 private hospitals, a total of 1 36 hospitals. Among them, 34 hospitals participated in clinical trials. Fourteen hospitals had already used pamphlets as a tool for the explanation of breast cancer operation procedures. Hospitals having experienced special discussion with patients regarding the operation procedure were few, and only two hospitals reported claims or lawsuits concerning the operation procedure. About 60% of the hospitals wished to use the pamphlet, while 86% of the patients answered that it would have been useful if handed out before the operation. These patients stated that hospitals should provide this kind of pamphlet to breast cancer patients before operations.

CONCLUSIONS

It was clearly demonstrated that the great majority of hospitals in Japan lacked the basic tools for information provision on breast cancer operation procedures, while patients want enough information for self-determination.

[A case of diverticular form type of congenital choledochal dilatation with anomalous arrangement of pancreaticobiliary duct]

We report a case of diverticular form type of congenital choledochal dilatation with anomalous arrangement of pancreaticobiliary duct and bile duct stone. The patient was a 63-year-old woman with the chief complaint of epigastralgia. Abdominal CT showed low density area suggesting cystic lesion at the region of pancreatic head. MRCP and ERCP revealed dilatation of the common bile duct in the multiple diverticular form with anomalous arrangement of pancreaticobiliary duct. A 2.0cm sized stone was also recognized in the dilated common bile duct. The patient underwent resection of gall bladder and dilated common bile duct, followed by hepatico-jejunostomy. Histological findings did not revealed malignant changes in the mucosa of both gall bladder and dilated common bile duct.

Relationship between baseline cerebral blood flow and vascular responses to changes in PaCO2 measured by positron emission tomography in humans: implication of inter-individual variations of cerebral vascular tone

AIM

Inter-individual variations in normal human cerebral blood flow (CBF) at rest condition have been reported. Inter-individual variation of cerebral vascular tone is considered to contribute to this, and several determinants of cerebral vascular tone have been proposed. In the present study, the relationship between CBF and cerebral vascular tone to inter-individual variation at rest condition was investigated using positron emission tomography (PET).

METHODS

CBF was measured using PET with H(2) (15)O in each of 20 healthy subjects (20-28 years) under three conditions: at rest (baseline), during hypercapnia and during hypocapnia. The vascular response to change in P(a)CO(2) was calculated as the percentage changes in CBF per absolute change in P(a)CO(2) in response to hypercapnia and hypocapnia.

RESULTS

A significant negative correlation between baseline CBF and the vascular response to hypocapnia was observed in the thalamus, temporal cortex, parietal cortex, occipital cortex and cerebral cortex (P < 0.05). A trend towards negative correlation between baseline CBF and the vascular response to hypocapnia was observed in the cerebellum and putamen (P < 0.1). A significant negative correlation between baseline CBF and the vascular response to hypercapnia was observed in the occipital cortex (P < 0.05). No significant correlation was observed between baseline CBF and haemoglobin concentration, and P(a)CO(2).

CONCLUSION

These findings support the assumption that cerebral vascular tone might incline towards vasoconstriction and vasodilatation when baseline CBF is low and high between individuals respectively. Although several determinants of cerebral vascular tone have been proposed, the mechanism of such inter-individual differences in cerebral vascular tone is unknown.

Primary phacoemulsification and aspiration combined with 25-gauge single-port vitrectomy for management of acute angle closure

PURPOSE

To describe a technique using phacoemulsification and aspiration (PEA) combined with 25-gauge single-port vitrectomy as a primary treatment for acute angle closure (AAC).

METHODS

Seventeen consecutive cases of AAC were treated with 1) transconjunctival limited single-port vitrectomy with a 25-gauge vitrector and 2) transcorneal PEA and cortex removal followed by implantation of foldable intraocular lenses (IOL).

RESULTS

Intraocular pressure (IOP) control was achieved in all 17 eyes examined. Mean preoperative IOP was 51.8+/-13.1 mmHg, and mean IOP on postoperative day 1 was 18.3+/-8.5 mmHg. Additional anti-glaucoma surgery was necessary in one eye. IOL could not be implanted because of zonular dialysis in one eye. Postoperative complications were seen in three cases (one retinal hemorrhage and two papilledema).

CONCLUSIONS

The PEA procedure is efficient as a primary treatment of AAC. Single-port vitrectomy with a 25-gauge vitrector facilitated PEA and IOL implantation.