Myocardial metastasis from primary lung cancer: myocardial infarction-like ECG changes and pathologic findings

Myocardial metastasis from neoplastic disease is often clinically unapparent, and very difficult to diagnose. Of 151 consecutive autopsies of lung cancer patients, cardiac metastases were found in 67 patients (44.4%). Myocardial metastasis was found in only 8 patients (11.9%). ECG of patients with myocardial metastasis revealed ST-T wave changes and various types of arrhythmia. ST-T wave changes were observed in 4 with myocardial metastasis, and in 6 without myocardial metastasis (pericardial metastasis alone). ST-T wave changes is not a specific finding of myocardial metastasis. Two very rare cases with myocardial metastasis showing progressive ST segment elevation with a QS pattern are presented. The appearance of ST segment elevation with a QS pattern in clinically stable lung cancer patients without cardiac symptoms suggestive of myocardial injury indicates the possibility of myocardial metastasis. Myocardial metastasis is often elusive, thus careful observation of ECG changes is of primary importance for the antemortem diagnosis.

[A case of facioscapulohumeral muscular dystrophy complicated with complete A-V block]

Myocardial involvement and serious electrocardiographic abnormalities are rare in patients with facioscapulohumeral (FSH) muscular dystrophy. We reported a case of FSH muscular dystrophy complicated with complete A-V block. The case was that of a 48 year-old male with the complaints of exertional dyspnea. His chest X-ray showed cardiomegaly, and the electrocardiogram recorded on admission showed complete A-V block. On the His bundle electrogram, complete A-H block and prolongation of H-V intervals were noted. Therefore, a permanent pacemaker was implanted, and he has been doing well for over 10 years after implantation. Although it is well known that serious electrocardiographic abnormalities are not infrequently associated with Duchenne's progressive muscular dystrophy (DMD), there are few reports about pacing therapy for patients with muscular dystrophy. Because the daily activity of patients with rapidly progressive type of muscular dystrophy such as DMD is at a very low level, they do not require pacing therapy. Whereas in patients with the FSH type of muscular dystrophy, which is a slowly progressive type, their daily activity is maintained at a high level. Therefore, pacing therapy should be recommended if the FSH type of muscular dystrophy is accompanied with serious bradyarrhythmias.

Nucleolar organizer regions in precancerous and cancerous lesions of the bronchus

Using a silver staining technique, nucleolar organizer region-associated proteins (Ag-NOR) were studied in paraffin sections of five specimens of normal bronchial epithelium, eight of atypical squamous metaplasia, five of carcinoma in situ, and seven of microinvasive squamous cell carcinoma. The mean number of Ag-NOR in the nucleus were normal epithelium 1.2 +/- 0.1 (mean +/- SD), atypical squamous metaplasia (borderline lesion) 2.2 +/- 0.5, carcinoma in situ 3.8 +/- 0.6, and microinvasive squamous cell carcinoma 4.8 +/- 1.1. There was a highly significant difference between the Ag-NOR numbers in the atypical squamous metaplasia and those in the carcinoma in situ (P less than 0.01). The Ag-NOR staining is a useful technique for the differential diagnosis of difficult borderline lesions in the bronchial epithelium.

Small-cell-type poorly differentiated squamous cell carcinoma of the lung. Cytologic, immunohistochemical and nuclear DNA content analysis

The relationship between the nuclear DNA content, the immunohistochemical findings, the clinical characteristics (tumor volume doubling time and survival) and the cytomorphologic features of small cell poorly differentiated squamous cell carcinoma of the lung was studied in ten cases. There were no significant correlations between the immunohistochemical stainings for neuron-specific enolase and keratin and the clinical characteristics in these cases. The DNA histogram patterns were classified as type I or type II, depending on the degree of dispersion of values. There was no relationship between the immunohistochemical findings and the DNA histogram patterns. Only the DNA histogram patterns were related to some of the clinical characteristics: patients with type II histograms had significantly shorter tumor volume doubling times than did patients with type I histograms. Such information may aid in distinguishing the small cell type of poorly differentiated squamous carcinoma from classic small cell carcinoma of the lung, with which it may be confused.

Pulmonary drug-metabolizing enzyme in alveolar macrophages in relation to cigarette smoking

We measured the aryl hydrocarbon hydroxylase (AHH) activity in alveolar macrophages (AMs) and the AHH inducibility in peripheral blood lymphocytes (PBLs) of 56 subjects with and without lung cancer. There were no differences in the AHH inducibility in PBLs whether or not the host had lung cancer, regardless of a smoking history. The AHH activity in AMs in the current smoker group was significantly higher than in the non-smoker group. The AHH activity in AMs in the lung cancer group was higher than that in the non-lung cancer group, and the central-type group was significantly higher than the peripheral-type group. These results suggest that the AHH activity in AMs is associated with the development of lung cancer and a history of cigarette smoking.

[A case of pulmonary sarcoidosis with calcification in the lung]

A 35 year-old male farmer presented with complaints of productive cough and sputum. The chest X-ray films showed reticulonodular shadows bilaterally in the upper and middle lung fields, segmental infiltration in the right lung, and no BHL. Tuberculin reaction was negative. Serum angiotensin converting enzyme level was 26.5 IU/ml. Precipitating antibodies for Thermophilic actinomycetes and M.f. were negative. BAL showed moderate lymphocytosis (24.3%), and CD 4/8 was 1.67. A biopsy specimen of right scalene lymph node showed epithelioid cell granulomas and TBLB epithelioid cell granulomas and spot-like calcification. Pulmonary sarcoidosis with calcification in the lung is very rare.

[Studies of isolated organisms from otorhinolaryngological infections and their susceptibilities to macrolide antibiotics]

To study current situation of pathogenic bacteria and their drug resistance to macrolide antibiotics in the otorhinolaryngological infections, 609 strains diagnosed as pathogen derived from 463 patients were collected from cohospitals or institutions during the period of 1980-1983. The results obtained were as follows: Gram-positive cocci (GPC) was dominant (410 strains) and major species were S. aureus (135 strains), S. pneumoniae (81 strains), S. epidermidis (68 strains) and S. pyogenes (65 strains). In Gram-negative bacteria giving 147 strains and 43 strains, of anaerobes prevailing species were H. influenzae, P. aeruginosa and Peptostreptococcus spp. Representative species in the diseases were S. aureus (26.6%), S. epidermidis (24.5%), and P. aeruginosa (12.8%) in acute otitis media, S. aureus (34.4%), S. epidermidis (17.7%) and P. aeruginosa (14.6%) in acute exacerbation of chronic otitis media, S. epidermidis (17.0%), S. aureus (16.1%) and H. influenzae (13.4%) in acute paranasal sinusitis, S. pyogenes (29.1%), S. pneumoniae (19.6%) and S. aureus (15.1%) in acute tonsillitis. Although most of isolates were susceptible to macrolides, 62 resistant strains to macrolides were found in 501 strains and the resistant rates were 26.7% in S. aureus, 23.1% in S. epidermidis and 6.5% in S. pyogenes. The resistant pattern was somewhat different against each macrolides, resistant strains giving over 100 micrograms/ml in MIC were 55/62 in erythromycin, 35/62 in josamycin and midecamycin and 7/62 in TMS-19-Q, a new macrolide.

A necropsy case of interstitial nephritis probably related to cefazolin and methenamine

It is the purpose of this paper to alert the medical community on the potential nephrotoxicity of certain agents among certain patients, especially with some types of renal insufficiency. A young man, who was suffering from apparent renal disturbance, died of massive, post-operative bleeding accompanied by uremia. The uremia occurred within a very rapid clinical course and was related apparently to treatment with methenamine, a ruinary disinfectant, and cefazolin, a cephalosporin derivative. The patient was proved to have a fatal, servere interstitial nephritis based on gross and histological findings of the necropsied kidney, i.e., intense cell infiltration mainly in the interstitum of the cortex, absence of glomerular involvement, and marked softening and enlargement. The present case may suggest how to treat patients suffering from untoward renal ailments with various antibiotics.