Survival following resection for lung cancer as a second primary cancer

A second operation was done on 59 patients with lung cancer (7.4% of all those with lung cancer) as a second primary (double primary), during 1974-1991. There were 16 synchronous tumors (interval less than one year) and 43 metachronous tumors (interval over one year). The criteria for diagnosing lung cancer as a second primary from intrapulmonary metastases were any of the following: 1) different histologic type; 2) origin from carcinoma in situ; 3) gross appearance suggestive of primary lung cancer. The initial operation was in the stomach in 14 patients and in the lung in 10. The overall 5-year survival rate in the double primaries was 57.8%, and the prognosis was similar to those in the single primaries of the lung. Nineteen patients died from the second tumor following the second operation, compared with 5 from the initial tumor. The incidence of primary lung cancer increases, and close follow-up after resection for malignant neoplasms detects a new shadow in the chest roentgenogram. It offers a chance of early detection of primary lung cancer and subsequent resection with acceptable results.

Somatic mosaicism for a DMD gene deletion

Mosaicism is a mixed state, with two cell populations of different genetic origins caused by a cell mutation occurring after fertilization. In the present case, DNA analysis of lymphocytes led to a DMD diagnosis before death. Postmortem immunocytochemical and DNA analysis showed somatic mosaicism. At age 18 years, blood lymphocyte DNA analysis showed a DMD gene deletion, upstream from exon 7 to the 5' end containing both muscle and brain promoters. As the patient's mother and elder sister had no deletions, he was considered to have a new mutation. Immunocytochemical studies of postmortem tissues showed that dystrophin was absent from the tongue, deltoid, intercostal, psoas and rectus femoris muscles, but there was a mix of dystrophin-positive and negative fibers in the rectus abdominis, cardiac, temporalis and sternocleidomastoid muscles. All diaphragm cells were dystrophin positive. Polymerase chain reaction (PCR) amplification from all tissues except the temporalis and sternocleidomastoid muscles, diaphragm and kidney, in which no deletion was found, showed the deletion from at least exon 6 to the 5' end containing both muscle and brain promoters. In this case, a genomic deletion of the DMD gene contributed to the formation of tissues derived from both ectoderm and endoderm, and cells of mesodermal origin showed genotypic and phenotypic heterogeneity. Our results indicate a mutation of the present case may have occurred just before the period of germ layer formation.

Morphometric study of the corpus callosum in Fukuyama type congenital muscular dystrophy by magnetic resonance imaging

The corpus callosum (CC) of 24 Fukuyama type congenital muscular dystrophy (FCMD) patients were studied using midsagittal MRI and the results were compared with those of 20 age-matched controls. The measurements included the thickness of the genu, body and splenium; the length, height and five specific angles of the CC. The cephalic index was also measured on axial MRI. The correlations among CC length, CC height, the five angles and the cephalic index were evaluated. One case of FCMD was found to have CC agenesis. The thickness of the genu, body, splenium and CC length were significantly reduced in FCMD. In addition, in FCMD, the CC height was increased, angle alpha was greater, angle delta reduced and the CC configuration more rounded, showing a high arch on imaging. No significant correlations among CC length, CC height, the five specific angles and the cephalic index were found in any of the FCMD data. These observations demonstrated the fact that CC development in FCMD is uniquely abnormal, and abnormal CC configuration does not have any correlation with altered cephalic index.

Muscle CT scans in preclinical cases of Duchenne and Becker muscular dystrophy

Skeletal muscle CT scans were performed in patients with Duchenne (DMD) as well as Becker muscular dystrophy (BMD) in the preclinical or early clinical stage, at the levels of the 3rd lumbar vertebra, the mid thigh, and the maximum circumference of the calf. Only slight intramuscular low density areas and muscular atrophy were ascertained on gross visual inspection from the age of 3 years onward in DMD. However, the mean CT numbers calculated for individual muscles clearly decreased with increasing age in all muscles except anterior and posterior tibialis, which indicated them to be well preserved. Comparison of the rates of decrease in the CT numbers revealed that a rapid change in the paravertebral group commenced in the muscles on the lateral side, while among the adductors of the thigh, gracilis tended to be comparatively well preserved; this is the pattern of muscle involvement characteristic of symptomatic patients. In BMD, the atrophic change was extremely slight, and the CT numbers of the muscles were higher than the corresponding values for DMD in the same age group. CT numbers represent more objective indices for the assessment of muscular lesions as compared with gross visual inspection of skeletal muscle CT scans at the preclinical stage.

Lymph node cancer of the mediastinal or hilar region with an unknown primary site

We herein report three cases of lymph node cancer of the mediastinal or hilar region, in which the primary sites could not be determined in spite of performing various systemic examinations. Two cases revealed a large cell anaplastic carcinoma in the mediastinal lymph node, while the other demonstrated a small cell carcinoma in the hilar lymph node. However, based on radiographic and pathological examinations, the primary sites could not be found in either the head and neck, lung, or abdominal organs. All cases underwent surgical resections for lymph node cancer, while two patients also received adjuvant therapy. Two patients experienced recurrence soon after treatment. Despite the rarity of this disease, lymph node cancer must always be kept in mind when an enlargement of either the mediastinal or hilar lymph node is detected in patients with an unknown primary site, and a poor prognosis is generally expected.

[Body density assessment utilizing skinfold thickness and age in Japanese women]

A study was conducted to investigate the validity of skinfold-based prediction equations for body density (g/ml) by Nagamine and Suzuki (1964), and to formulate more convenient and more useful equations for predicting body density from skinfold and age in women. Subjects of the study were 512 healthy women aged 18-66 years in or near Nagasaki City. The dependent variable in the multiple regression equation, body density, was determined by hydrostatic weighing. Independent variables included eight skinfolds, the sum of two skinfolds (triceps, subscapular), the sum of three skinfolds (triceps, subscapular, and abdominal), age, and body surface area. Skinfolds were measured with an Eiken-model skinfold caliper. Age (mean 30.1, range 18-66 yrs.), weight (mean 52.6, range 38.0-83.3 kg), height (mean 157.0, range 142.0-172.0 cm), and body density, (mean 1.04125, range 0.98806-1.08650 g/ml) were also recorded. Percent body fat was calculated using the formula by Brozek et al. and ranged from 6.4% to 48.3%. Multiple correlation coefficients (MR) and standard error (SE) of 10 regression equations (A-J) for predicting body density in women were compared. The best-fitting and the most convenient prediction equation for body density was equation-E. The regression equation developed for predicting body density was: body density = 1.07931-0.00059 x sum of three skinfolds(mm)-0.00015 x age (MR = 0.77 and SE = 0.0089). The equation was cross-validated on a different sample of 46 women. The correlation coefficient between predicted and hydrostatically determined body density was 0.813 (p < 0.001). Equation-E (Tahara's equation) appears to be useful in body density analysis particularly when the subjects are Japanese women, aged 18-50 yrs, with percent body fat 17 to 34%.

Novel xanthones with superoxide scavenging activity from Garcinia subelliptica

Two new xanthones, garciniaxanthone D (1) containing a dihydrobenzofuran ring and 1,4,5-trihydroxyxanthone (2), have been isolated from Garcinia subelliptica as superoxide anion scavengers. Their structures have been determined mainly by spectroscopic methods and some chemical reactions.

Abnormality of cerebral gangliosides in Fukuyama type congenital muscular dystrophy

Compared with DMD cases and non-neuromuscular disease controls, FCMD cases showed a reduction of total gangliosides, and an abnormal, immature ganglioside pattern in the cerebral gray and white matter. However, GM4, which is only found in myelin and oligodendroglia, and is a unique quantitative marker of myelination, was present in a relatively high percentage in the white matter, which showed frontal lobe micropolygyria and diffuse low density on CT and MR T1-imaging.

Malignant pleurisy and intrathoracic dissemination in carcinoma of the lung: diagnostic, therapeutic and prognostic implications

Of T4 disease of lung cancer, malignant pleurisy and intrathoracic dissemination are the greatest factor preventing a cure, despite the best efforts of surgery and various adjuvant therapy modalities. Preoperative evaluation of this disease is of first importance using conventional radiology and computed tomography. Of the 43 patients who were intraoperatively diagnosed to be the disease, 8 (18%) appeared on the conventional radiology as small amounts of pleural effusion, and 9 (21%) with a interlobar pleural thickening. Based on CT findings, 16 (67%) had one or more of some disseminated nodules, interlobar pleural thickening and broad pleural indentation. In patients with T4 disease, the 5-year survival rate was 14% in patients with malignant pleurisy and/or intrathoracic dissemination, compared with the 18% in those with direct invasion to great vessels, with no significant difference. According to intrapleural instillation as postoperative adjuvant therapy, the 5-year survival rate was 25% in the patients given interleukin-2, compared with 38 months of survival time for patients prescribed doxorubicin and 33 months for those underwent exploratory thoracotomy. A more favorable prognosis of patients whose malignant pleurisy and/or intrathoracic dissemination are first found at thoracotomy can be expected when postoperative intrapleural instillation of interleukin-2 is prescribed following the resection of the intrathoracic tumors.

Chronic localized encephalitis (Rasmussen's syndrome) preceded by ipsilateral uveitis: a case report

Chronic localized encephalitis (Rasmussen's syndrome) developed in an 11-year-old girl 1 month after operation for residual cataract due to chronic uveitis that had appeared at age 9 years ipsilateral to the affected cerebral hemisphere. Although the pathogenesis of Rasmussen's syndrome remains unknown, our case provides additional evidence indicating that a viral ocular infection is a possible cause or part of the disorder.

Refined mapping of a gene responsible for Fukuyama-type congenital muscular dystrophy: evidence for strong linkage disequilibrium

Fukuyama-type congenital muscular dystrophy (FCMD), the second most common form of childhood muscular dystrophy in Japan, is an autosomal recessive severe muscular dystrophy associated with an anomaly of the brain. After our initial mapping of the FCMD locus to chromosome 9q31-33, we further defined the locus within a region of approximately 5 cM between loci D9S127 and CA246, by homozygosity mapping in patients born to consanguineous marriages and by recombination analyses in other families. We also found evidence for strong linkage disequilibrium between FCMD and a polymorphic microsatellite marker, mfd220, which showed no recombination and a lod score of (Z) 17.49. A "111-bp" allele for the mfd220 locus was observed in 22 (34%) of 64 FCMD chromosomes, but it was present in only 1 of 120 normal chromosomes. This allelic association with FCMD was highly significant (chi 2 = 50.7; P < .0001). Hence, we suspect that the FCMD gene could lie within a few hundred kilobases of the mfd220 locus.

Skip mediastinal lymph node metastasis in non-small cell lung cancer

We retrospectively investigated 186 non-small cell lung cancer cases with N2 disease in order to clarify the significance of skip metastasis. Of the 186 patients with N2 disease, negative N1 nodes recognized to be skip metastasis were seen in 62 patients (33%). The incidence of skip metastasis was not statistically different regarding histology, T status, or M status. The incidence of the skip metastatic site consisted of 35 cases (56%) at sites 1, 2 and 3, while 8 cases (13%) were found at sites 8 and 9. Among the patients with right lung cancer, the skip metastatic incidence for site 7 (subcarinal) was higher in patients with either middle lobe or lower lobe cancer than in those with upper lobe cancer (P < 0.05). The 5-year survival rates of all N2 patients in comparison to those with skip metastasis were 22% and 24%, respectively. When the sites of mediastinal lymph nodes were classified as superior, aortic, and inferior, the 5-year survival rates of the patients with superior skip metastasis, aortic metastasis, and inferior metastasis were 23%, 36%, and 15%, respectively. No statistical difference was observed. The 5-year survival rate of the skip N2 patients with only aortic region involvement was 50% (n = 7). However, no statistically significant difference was found between the two groups (P = 0.08). Our results thus suggested that mediastinal involvement for the aortic region alone might have a better prognosis than the others. We thus conclude that a dissection of the complete hilar and mediastinal lymph nodes should be the procedure of choice in standard operations for non-small cell lung cancer because of the high frequency of skip metastasis.

Treatment of severe myoclonic epilepsy in infants with bromide and its borderline variant

We studied the efficacy of bromides (BR) as add-on therapy in 11 patients with severe myoclonic epilepsy in infants (SME) and in another 11 with the borderline variant of SME (BVSME). Study subjects were aged 8.5-183 months (mean 64.4 months). Longest duration of BR treatment was 37 months (range 4-37 months; mean 19.7 months). Eight of 22 (36%) of patients with generalized tonic-clonic seizures (GTCS) had an excellent effect (> 75% reduction in total seizure frequency or duration) and 9 (41%) had a moderate effect (50-75% reduction) 3 months after introduction of BR. Twelve months after initiation of BR. 5 of the patients with significant improvement were no longer responsive; ultimately, therefore, 6 had an excellent effect and 2 had a moderate effect. Of those with partial seizures (n = 5) and myoclonic/absence seizures (n = 5), only 1 patient in each group showed a moderate effect at the 12-month time-point. Dosages and serum concentrations of BR ranged from 30 to 100 mg/kg (mean 58 mg/kg) and from 64 to 159 mg/dl (mean 101 mg/dl), respectively. Of the 12 patients experiencing side effects, including drowsiness, appetite loss, and skin rash, 1 required a reduction in BR dosage because of an extensive acneiform rash on the face. The results show that BR treatment holds promise for patients with SME and BVSME and should therefore be investigated further.

New chlorine-containing prenylated C6-C3 compounds increasing choline acetyltransferase (ChAT) activity in culture of postnatal rat septal neurons from Illicium tashiroi

The structures of two new chlorine-containing C6-C3 compounds isolated from the woods of Illicium tashiroi have been established as 2(R)-12-chloro-2,3-dihydroillicinone E (1) and 12-chloroillicinone E (2) by X-ray crystallographic analysis and spectroscopic data, respectively. Compound 1 has been found to significantly increase ChAT activity in culture of P10 rat septal neurons.

Total synthesis of ardisiaquinone A, a potent 5-lipoxygenase inhibitor, isolated from Ardisia sieboldii, and degree of 5-lipoxygenase inhibitory activity of its derivatives

Ardisiaquinone A (1), isolated as a potent 5-lipoxygenase inhibitor from the woods of Ardisia sieboldii, has been synthesized efficiently via a cross-coupling reaction between the yne 5 and the iodide 6 derived from the common intermediate 4. Inhibitory activity for 1 and its derivatives is also reported.

[Sex differences in interrelationships between percent body fat (%fat) and waist-to-hip ratio (WHR) in healthy male and female adults]

The purpose of the present study was to investigate sexual differences in relationships among percent body fat (%Fat), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), abdominal circumference to stature ratio (ASR), body mass index (BMI) and skinfold thicknesses in healthy male and female adults. Subjects were 64 males and 65 females, aged 22-60. Body density was measured by under water weighing and by skinfold anthropometry. Mean %Fat was 15.6% in males and 23.9% in females. Mean WHR was 0.83 in males and 0.72 in females. The correlation between %Fat and WHR was not significant in females (r = -0.104) but was significant in males (r = 0.631, p < 0.001). Highly significant correlations were obtained among %Fat, WSR, ASR, BMI, and sum of eight skinfolds in both sexes.

DNA polymerase alpha as an independent prognostic parameter in non-small cell lung cancer--an immunohistochemical study

We examined 70 fresh frozen sections of primary non-small cell lung cancer using a monoclonal antibody for DNA polymerase alpha (POL alpha). The tumors were divided into two groups; those with more than 5% of POL alpha positive cells were designated as POL alpha (+), while those with less than 5% were POL alpha (-). POL alpha (+) tumors were obtained in 33 (47%) cases. The incidence of POL alpha (+) in male patients was statistically higher than in females (P < 0.01). The incidence also correlated with the T(tumor) status; T1 < T2, T1 < T4, with a significance (P < 0.05). Based on data on 70 patients, the 5-year survival rates of POL alpha (+) and POL alpha (-) were 36% and 63%, respectively (p < 0.05). In 48 patients with adenocarcinoma, the 5-year survival rates of POL alpha (+) and POL alpha (-) were 25% and 60%, respectively (P < 0.05). In addition, in 26 patients with a tumor size of less than 3 cm, the 5-year survival rates of POL alpha (+) and POL alpha (-) were 13% and 74%, respectively (P < 0.01). To compare the prognostic significance of the variables, a multivariate analysis was used to show significance for survival in POL alpha (p < 0.05). Our data show that in non-small cell lung cancer, POL alpha expression is associated with the extent of malignancy and survival. Therefore, POL alpha is considered to be a useful prognostic parameter.

Normal serum beta-galactosidase in juvenile GM1 gangliosidosis

GM1 gangliosidosis is a genetic disease with lysosomal beta-galactosidase deficiency caused by mutations of the gene coding for this enzyme. However, apparently normal enzyme activity was found in plasma or serum from juvenile GM1 gangliosidosis patients homozygous for a mutation, R201C (201Arg-->Cys), after clotting for 30 min. This extracellular fluid finding is unusual in patients with primary and genetic deficiency of beta-galactosidase. The serum enzyme activity became relatively low only after 3 1/2-hour clotting because its increase in normal controls was not observed in these patients. beta-Galactosidase assay is not always reliable, particularly with serum or plasma as an enzyme source, for the diagnosis of hereditary beta-galactosidase deficiency, unless it is conducted under well-controlled conditions.

Prognostic influence of the co-expression of epidermal growth factor receptor and c-erbB-2 protein in human lung adenocarcinoma

The epidermal growth factor receptor (EGFR) is structurally similar to the c-erbB-2 oncogene protein. One hundred and nineteen specimens of primary human lung adenocarcinoma were investigated immunohistochemically for the expression of EGFR and the c-erbB-2 protein. Positive staining for EGFR was evident in 55 (46%), and c-erbB-2 protein in 33 (28%) cases. Of the 119 cases, the number staining positively for both the EGFR and c-erbB-2 protein totalled 16 (13%). The incidence of both the expression of EGFR and the c-erbB-2 protein was greater in patients with metastasis1 (M1) than in those with M0 (P < 0.01). The 5-year survival rates of patients with EGFR positivity and those with EGFR negativity were 51% and 42% respectively, however, the results did not show statistical significance. On the other hand, the 5-year survival rates of patients with c-erbB-2 positivity and c-erbB-2 negativity were 30% and 52%, respectively, with statistical significance (P < 0.05). Of the cases with EGFR positivity the 5-year survival rates of patients with c-erbB-2 positivity (n = 16) and negativity (n = 39) were 33% and 59%, respectively, with statistical significance (P < 0.05). In contrast, for the EGFR negative cases, the 5-year survival rates of patients who were positive (n = 17) and negative (n = 47) for c-erbB-2 expression were 27% and 46%, respectively, which were not significantly different. Our data thus suggested that erbB oncogenes may play an important role in both the development of cancer and the prognosis of adenocarcinoma of the lung.

Clinical variability of congenital myopathy with type 1 fiber atrophy: a long-term observation of three cases

The variable clinical courses of three cases of congenital fiber type disproportion (CFTD) over a period of 10 years are presented. All showed improvement in early childhood, but subsequently, varying degrees of deterioration were noted: specifically, marked deterioration in case 2 and decreased muscle strength in case 3. Maximal motor function levels were attained differently among the cases. Histological findings included type 1 fiber hypotrophy and increased internal nuclei in common in all cases. Fine structural changes, such as patchy areas of myofibrillar degeneration, were noted in cases 1 and 2 (second biopsy), and cytoplasmic bodies were seen in case 2 (second biopsy). Myotubes were noted in case 3. The degree of cyto-architectural changes did not correlate with clinical severity. The heterogeneity of CFTD is also discussed.

Video-polygraphic analysis of myoclonic seizures in juvenile myoclonic epilepsy

We studied myoclonic seizures (MS) in 5 patients with juvenile myoclonic epilepsy (JME) using video polygraphic recordings to investigate the clinical characteristics of MS in this epileptic syndrome. The total number of MS analyzed was 302 (range 27-125, mean 60) seizures per patient. MS occurred either singly or repetitively (37 vs. 63%) and corresponded to generalized bilaterally synchronous single or multispike-and-wave complexes at 3-5 Hz. Video analysis of the myoclonic jerks demonstrated that either distal or proximal muscle involvement predominated. In the former, there was mild bilateral flexion and some external rotation of the forearms. In the latter, flexion of both arms at the elbow, flexion and abduction of the thighs, and extension of the back was observed. Asymmetry of MS was noted in 4 of 5 patients. Facial involvement of MS occurred infrequently in 2 patients. When the patients kept both arms outstretched, the arms dropped or there was sudden interruption of ongoing electromyographic (EMG) potentials immediately after myoclonic jerks (postmyoclonic inhibition) in all patients. One should inquire about these clinical characteristics of MS in JME when taking a thorough history in patients with primary generalized tonic-clonic seizures (GTC).