Sequelae in long-term survivors of small cell lung cancer.

PURPOSE: Central nervous system (CNS) effects of chemotherapy and prophylactic cranial irradiation (PCI) are studied in long-term small cell lung cancer (SCLC) survivors. The exact significance and pathogenesis of the neurotoxicity is still unknown, as studies on this subject lack sufficient patient numbers and are performed in an extremely varied manner. METHODS AND MATERIALS: Fifty-nine survivors (> 2 years from diagnosis) were examined neurologically and neuropsychologically, and underwent a cranial computer tomography (CT) scan or magnetic resonance (MR). Eight patients were excluded from further analysis for various reasons (not SCLC-related CNS disease, n = 6; no chemotherapy nor PCI treatment, n = 2). The remaining 51 patients were divided into three groups; group 1 = chemotherapy alone (n = 21), group 2 = sequential PCI (n = 19), and group 3 = concurrent or sandwiched PCI (n = 11). Groups were neuropsychologically compared in matched controls. RESULTS: Performance status did not differ significantly between various treatment groups; all patients remained ambulatory and capable of self-care. Mental impairment (n = 20), motor abnormalities (n = 9), and visual complaints (n = 1), were found in five patients in group 1 (24%), eight patients in group 2 (42%), and eight patients in group 3 (73%). Analysis of brain atrophy revealed no significant results; however, white matter abnormalities were found more frequently in group 3. Neuropsychologically no significant group differences existed, although interference sensitivity and difficulties with divided attention tended to occur more frequently in patients treated with PCI. Mean neuropsychometric results of treatment groups were significantly worse than those of matched controls. CONCLUSIONS: Although more intensively treated patients showed more neurologic impairment and patients in group 3 had more white matter abnormalities, there was no statistic evidence for additional neurotoxicity of PCI. Marked neuropsychometric differences between patients and matched controls may indicate that cognitive impairment is partly disease related, probably due to emotional distress and deteriorated physical condition.

A preliminary study of externally and self-ordered task performance in schizophrenia.

Frontal lobe dysfunctions are assumed to be involved in the cognitive problems of schizophrenia. The inability to plan or organize behavior, however, may be the result of an inability to process information (i.e., attention disorder) as well as of an incapacity of information processing (i.e., overstimulation). Wiegersma et al. (1990) described impaired performance in frontal lobe patients on self-ordered tasks (Randomization Span and Sequential Pointing span) but intact performance on externally ordered tasks (Digit Span and Missing Item scan). These four tasks were used in the present study in which ten schizophrenic patients and ten matched controls participated. The schizophrenic patients exhibited significant impairments in the self-ordered as well as in the externally ordered tasks. It was concluded that the impairment of schizophrenic patients may be caused by overstimulation rather than by attention disorders.

Effects of adaptation and cross-adaptation to common ions on sourness intensity.

The effects of self and cross-adaptation of acetic acid and HCl solutions on the perception of sourness, were investigated using a filter paper method. In contrast to acetic acid and to pH-buffered acetic acid solutions, self-adaptation could not be obtained with HCl. In fact the sourness of the HCl test-stimulus after adaptation to HCl was increased compared to the sourness obtained with the unadapted tongue. Such a sourness potentiation was also observed with acetic acid and buffered acetic acid solutions after adaptation to distilled water. The results suggest that the reception process eliciting the sour taste of H+ ions and of undissociated acids are different and probably independent.