The clinical significance of soluble E-cadherin in nonsmall cell lung cancer

AIM

Aberrant expression of the epithelial transmembrane adhesion molecule E-cadherin (E-cad) has been associated with many human malignancies. In the present study the clinical significance of serum levels of soluble E-cadherin (sE-cad) in newly diagnosed patients with non small cell lung cancer (NSCLC) was investigated.

MATERIAL AND METHODS

An enzyme linked immunospecific assay (ELISA) to determine the circulating levels of sE-cad in 20 newly diagnosed patients with NSCLC as well as in 29 healthy volunteers (control group) was used.

RESULTS

NSCLC patients exerted increased circulating levels of sE-cad compared with individuals of the control group (p < 0.001). An association was also detected between serum sE-cad levels and the development of distant metastases. On the contrary, no statistically significant correlation could be established with histological type, gender and smoking habits. Patients with increased sE-cad levels at diagnosis had worser outcome, although multivariate analysis failed to demonstrate that sE-cad levels represent an independent prognostic factor of survival.

CONCLUSION

Our data suggest that E-cad plays a role in the pathogenesis of NSCLC. sE-cad levels may be further studied as a potential prognostic biomarker.

Integrin receptors in primary lung cancer

In the present review recent data regarding the role of integrins--an important category of adhesion molecules mediating interactions among cells and components of the extracellular matrix--in lung cancer development is discussed. Investigations have shown that down-regulation of alpha3 integrin subunit may contribute to enhanced tumorigenicity of c-myc-overexpressing small cell lung carcinoma, while the loss of an integrin expression is correlated with recurrence in node-negative lung carcinoma. Increased expression of alpha1beta1 and alpha2beta1 integrins have been shown to be positively correlated with increased metastatic ability in squamous cell carcinoma. alpha3beta1 integrin is a most critical integrin for pulmonary development and epithelium integrity and its reduced expression in small cell lung cancer is probably related to the increased aggressiveness of this type. Pulmonary cancer cells generally express fewer integrin receptors than the normal epithelium. Additionally, since the ability of malignant cells to interact with extracellular matrix components is thought to be important, integrin dependent migration of lung cancer cells is a crucial process.

Direct endobronchial metastasis is a rare metastatic pattern in breast cancer

Breast cancer is the most common cancer in women. Lungs represent a common site of metastases in breast cancer cases. Lung parenchyma, pleura, lymphatics, regional lymph nodes as well as trachea with bronchi are sites of metastatic involvement of the lungs in patients suffering from breast cancer. Endobronchial metastasis, especially of the direct type, is a very rare metastatic pattern in this type of cancer. We describe a case of endobronchial metastasis in a 59 years old Caucasian woman who had had a radical mastectomy 2 years before her present admission because of breast cancer. She was admitted to Joannina University hospital complaining of non-productive cough. Chest X-rays showed atelectasis of the right upper pulmonary lobe. Flexible fiberoptic bronchoscopy findings, cytologic examination of the bronchial excretions as well as the histological examination of the excised during bronchoscopy tumour specimen, strongly suggested a breast adenocarcinoma. Hereby, review data from the literature is given in brief.

Bronchoalveolar lavage alterations during prolonged ventilation of patients without acute lung injury

Mechanical ventilation deteriorates previously injured lung, but little is known about its effect on healthy human lung. This work was designed to assess the effect of prolonged mechanical ventilation on bronchoalveolar lavage (BAL) fluid composition of patients without acute lung injury. Twenty-two ventilated patients (tidal volume 8-10 mL x kg(-1), positive end-expiratory pressure 3-5 cmH2O) without lung injury, who did not develop any complication from the respiratory system during the 2-week study period, were studied. They were subjected to three consecutive BALs, the first during 36 h from intubation, the second at the end of the first week of mechanical ventilation and the third at the end of the second week of mechanical ventilation. Total BAL protein increased during mechanical ventilation (148 +/- 62, 381 +/- 288, 353 +/- 215 microg x mL(-1) BAL for the first, second and third BAL, respectively). In contrast, BAL phospholipids decreased (2.7 +/- 1.1, 1.4 +/- 0.6, 1.2 +/- 0.7 microg x mL(-1) BAL, respectively). Large surfactant aggregates were reduced and inflammatory markers, such as platelet activating factor (PAF), PAF-acetylhydrolase and neutrophils, significantly increased after 1 week, but partially remitted after 2 weeks of mechanical ventilation. In summary, this study demonstrates that prolonged mechanical ventilation even of patients without acute lung injury is associated with the presence of inflammatory markers and surfactant alterations.

Chemotherapy-induced noncardiogenic pulmonary edema related to gemcitabine plus docetaxel combination with granulocyte colony-stimulating factor support

Several cancer therapeutic agents have been associated with pulmonary toxicity. Herein, we describe the case of a 73-year-old woman with breast cancer metastatic to the liver, who developed noncardiogenic pulmonary edema (NPE) while on treatment with gemcitabine plus docetaxel combination with granulocyte colony-stimulating factor (G-CSF) support. Gemcitabine, a deoxycytidine analogue, is reported to produce mild self-limiting and only occasionally severe pulmonary toxicity. The microtubule stabilizer docetaxel has been associated with water retention complications. The combination of these two agents has shown promising activity in several solid tumors and is in a phase of clinical development with prophylactic G-CSF in most of the trials due to the high rate of dose-limiting neutropenia observed with this combination. In our case pulmonary toxicity resolved rapidly following the administration of corticosteroids. A possible deleterious synergy of the compounds involved in this case is discussed and the medical literature on NPE related to cancer therapy is shortly reviewed. We conclude that NPE should always be considered in patients with respiratory function deterioration while on therapy with the gemcitabine-docetaxel combination and G-CSF. Corticosteroids can provide maximum benefit if started early upon diagnosis coupled with withdrawal of the causative drugs.

Formoterol and beclomethasone versus higher dose beclomethasone as maintenance therapy in adult asthma

A total of 132 adult asthmatics who were symptomatic on 500 microg x day(-1) inhaled beclomethasone dipropionate (BDP) were studied in an open-label randomized, parallel group, 12 week, clinical trial. The addition of 12 microg formoterol fumarate solution aerosol (pressurized metered dose inhaler) b.i.d. to BDP at a dose of 500 microg x day(-1) was compared with a higher dose of 1,000 microg x day(-1) BDP. Mean morning premedication peak expiratory flow rate (PEF) during the final week of treatment (primary end-point) increased in both groups compared to baseline. The estimated treatment difference of 20.4 L x min(-1) (95% confidence interval 3.2-37.6) after 12 weeks of treatment was statistically significant (p<0.05) in favour of the formoterol/BDP group. The overall mean morning premedication PEF for the entire treatment period was higher in the formotero/BDP group (p=0.002). The overall number of puffs of rescue medication and asthma symptom scores were less in the formotero/BDP group (p<0.01). Safety and tolerability evaluations were satisfactory in both groups. In conclusion, the results suggest that the addition of formoterol fumarate to the existing dose of an inhaled corticosteroid should be considered as an alternative to increasing the dose of inhaled corticosteroid in the inadequately controlled asthmatic.

Severe muscle weakness due to hypokalemia as a manifestation of small-cell carcinoma

We describe the case of a 56-year-old man with severe muscle weakness due to heavy hypokalemia (serum potassium 1.44 mmol/l) associated with inappropriate kaliuria and alkalemia. Subsequent investigation revealed the presence of ectopic ACTH hypersecretion due to a small-cell lung carcinoma. A significant clinical/laboratory improvement was achieved following chemotherapy-induced regression of the primary tumor. The profound hypokalemia was probably the result of cortisol hypersecretion, which in concert with the ACTH-induced decreased 11beta-hydroxysteroid dehydrogenase activity can exhibit an increased mineralocorticoid activity. In addition, other ACTH-dependent mineralocorticoids may play a contributory role in the development of severe hypokalemia.

Antituberculosis therapy in the treatment of peripheral uveitis

Tuberculous uveitis usually appears as chronic anterior uveitis or disseminated choroiditis. From 1982 to 1989, we conducted a retrospective study of 23 patients with presumed tuberculous uveitis. All patients had a positive tuberculin purified protein derivative skin test. The diagnosis was based on history, positive skin test, and physical examination. We excluded other conditions that could induce uveitis, based on the absence of signs, symptoms, or laboratory results suggesting any other diagnosis. Tuberculous uveitis was also considered in the differential diagnosis when progressive ocular inflammation was resistant to corticosteroid therapy. The patients received the following treatment: (1) isoniazid (300mg/day) and rifampin (600mg/day) for nine to 12 months, (2) ethambutol (1200mg/day) in some cases for two to three months, and (3) corticosteroids orally where indicated. In cases with anterior uveitis, we added local instillation of mydriatics and corticosteroids. There was no regression, nor were there any side effects of antituberculosis therapy in all 23 patients. We noted clinical improvement in 78% of cases. Five patients had other conditions (cataract or retinal detachment) that worsened their vision.

Outbreak of haemorrhagic fever with renal syndrome in Greece

An outbreak of eight cases of haemorrhagic fever with renal syndrome in North-West Greece is presented. The major clinical manifestation was fever and all patients subsequently developed decreased renal function and proteinuria. The disease was diagnosed by rising antibody titers to the Hantaan virus.

Immunologic abnormalities in idiopathic Raynaud's phenomenon

Sera from 14 patients with idiopathic Raynaud's phenomenon were studied for immunoglobulin levels, autoantibodies and circulating immune complexes. In addition, the levels of immune complexes were studied in 17 sera from patients with secondary Raynaud's phenomenon. It was found that more than one half of the patients with idiopathic Raynaud's phenomenon have serologic markers of auto-immune disease. The incidence of circulating immune complexes was higher in patients with secondary (52%) compared to patients with idiopathic Raynaud's phenomenon (10%). The serologic abnormalities in idiopathic Raynaud's phenomenon patients did not correlate with asymptomatic pulmonary involvement.