Utility of SPM8 plus DARTEL (VSRAD) combined with magnetic resonance spectroscopy as adjunct techniques for screening and predicting dementia due to Alzheimer's disease in clinical practice.

We validated the utility of SPM8 plus DARTEL (VSRAD) combined with magnetic resonance spectroscopy (1H MRS) as an adjunct screening technique for dementia due to Alzheimer's disease (AD). We examined the posterior cingulate gyri of 228 subjects using VSRAD and 1H MRS in addition to conventional cerebrospinal fluid biomarkers at baseline. At the 3-year follow-up, the 228 subject were classified as follows: 93 healthy subjects, 42 MCI-non-converters (MCI-NC), 25 MCI-converters to AD (MCI-C), 44 AD, 8 dementia with Lewy bodies (DLB), 5 normal pressure hydrocephalus, and 11 patients with other neurological diseases. Our results demonstrated that subjects with increased medial temporal atrophy (MTA) severity on VSRAD, increased Cho/Cr, MI/Cr ratio, and decreased NAA/Cr and NAA/MI ratio on 1H MRS at baseline were at risk of dementia due to AD. Receiver operating characteristic analysis showed that severity of MTA and the NAA/MI ratio distinguished patients with AD and MCI-C from controls. Furthermore, the 118 subjects without dementia and MTA showing only a decreased NAA/MI ratio at baseline developed to MCI-C, AD, and DLB 3 years later. 1H MRS detected biochemical abnormalities preceding brain atrophy and cognitive decline. VSRAD combined with 1H MRS may be routinely applied to screen for MCI/AD and prodromal AD in clinical practice.

Increased protein-conjugated acrolein and amyloid-ß40/42 ratio in plasma of patients with mild cognitive impairment and Alzheimer's disease.

The objective of this study was to determine whether plasma levels of acrolein, a compound that causes cell damage, and amyloid-ß (Aß) are useful biochemical markers for Alzheimer's disease (AD). The study included 221 elderly subjects divided into 101 non-demented [33 healthy control and 68 non-demented subjects with white matter hyperintensity (nd-WMH)], 50 mild cognitive impairment (MCI), and 70 AD. Increases in both protein-conjugated acrolein (PC-Acro) and Aß40/42 ratio were observed in MCI and AD patients compared with values in control subjects. When the combined measurements of PC-Acro and Aß40/42 ratio were evaluated using the median value of the relative risk value for dementia, they were in the order AD (0.98) ≥ MCI (0.97) > nd-WMH (0.83) > control (0.35). The results indicate that measurements of PC-Acro and Aß40/42 ratio not only detect MCI and AD patients but also nd-WMH subjects. Furthermore, both PC-Acro and Aß40/42 ratio in plasma for 120 MCI and AD patients were significantly higher than those for 101 control and nd-WMH subjects, indicating that both values become useful biochemical markers for MCI and AD subjects.

Clear cell tumor of the lung: surgical and immunohistochemical findings.

We encountered a clear cell tumor of the lung (CCTL) that was located peripherally, adjacent to the visceral pleura. The tumor could be directly observed during surgery. We believe that this case report describing the surgical and related pathological findings is highly informative. A chest radiograph during routine examination of an asymptomatic 65-year-old woman being treated for hypertension and hyperlipidemia revealed a nodular shadow in the left lung field. Wedge resection was performed by video-assisted thoracic surgery. The in vivo color of the tumor was red, suddenly changing to white after the tumor was clamped. Pathology examination showed a uniform pattern consisting of large clear cells without cytologic atypia or increased mitotic activity. Immunohistochemistry revealed tumor cells positive for vimentin and melanocytic markers (HMB-45 and melan-A) and negative for epithelial membrane antigen and cytokeratin. With the absence of clinical findings in both kidneys, the tumor was diagnosed as a benign CCTL.

Delayed diagnosis of traumatic diaphragmatic rupture.

We report a case of late presentation of traumatic rupture of the diaphragm discovered incidentally on chest radiography (CXR) during an annual medical checkup. A 60-year-old man suffered severe blunt trauma from heavy steel frames collapsing against his back, resulting in pelvic and femoral fractures as well as pulmonary contusions. The patient recovered, but 10 months later CXR performed for lung cancer surveillance during an annual medical checkup revealed a traumatic rupture of the diaphragm. Video-assisted thoracic surgery was performed with reduction of the intestine and primary closure of the diaphragmatic defect. The patient recovered uneventfully. This report serves as a useful reminder that a medical history of severe blunt trauma should provoke a high index of suspicion for diaphragmatic rupture during annual medical surveillance.

Rapid enlargement of a mediastinal mass: thymoma hemorrhage into a thymic cyst.

A 52-year-old man was admitted to Matsudo City Hospital because of an anterior mediastinal mass. One month prior, when he suddenly suffered chest pain, computed tomography (CT) showed a 4 x 3 cm mass in the chest. On admission, the symptom disappeared. However, chest CT revealed rapid enlargement of the mass to 10 x 6 cm. Based on the CT findings, we suspected a tumor. Therefore, we performed a thymothymectomy. The mass, measuring 12 x 8 x 6 cm, contained a solid tumor and a fluid-filled cyst. Pathology showed a thymoma and a multilocular thymic cyst. We speculated that hemorrhage from the thymoma spread into the multilocular thymic cyst and enlarged the mass.

Rapid regression of stage IVb invasive thymoma under palliative corticosteroid administration.

A 53-year-old woman was referred to Matsudo City Hospital for palliative care of stage IVb invasive thymoma with multiple pulmonary metastases and dissemination. Moderate doses of corticosteroid were administered for palliative effects during the preterminal stage of the disease for 2 years. The thymoma progressed slowly but continuously. At age 55, she was admitted to our hospital for a whole-body eruption and high body temperature. We could not identify the pathogen or allergen. Based on the results of a skin biopsy, with the exception of corticosteroid we stopped administering all suspicious medications, including folk medicines. After 1 month of antipyretic therapy, whole-body eruption disappeared and we encountered rapid regression of the thymoma. Unfortunately she died of interstitial pneumonitis only 2 months after the regression.

Successful thoracoscopic treatment of severe bilateral empyema in an infant.

We report a case of rapid progression of bilateral pyothorax exacerbated by viral influenza in an infant. The patient, an 11-month-old girl, was diagnosed with viral influenza, and oseltamivir phosphate was administered. However, after only 4 days the influenza was followed by rapid progression of methicillin-susceptible Staphylococcus aureus (MSSA) pneumonia and pyothorax, resulting in disseminated intravascular coagulation. Because thoracentesis and antibiotics could not control the pyothorax, a serious condition, we performed bilateral video-assisted thoracoscopic decortication on the eighth hospital day. She recovered with excellent lung expansion and was discharged on the 37th hospital day.

Large mediastinal cyst of an ectopic thyroid with small nodules diagnosed as papillary carcinoma.

A 49-year-old man was admitted to hospital for investigation of a mediastinal shadow seen on a chest radiograph. Chest completed tomography revealed a mediastinal mass of 65 x 55mm. At surgery, the mass was found to be contained within the upper mediastinum and adherent to the vertebrae, esophagus, trachea, and superior vena cava. We therefore selected sequential approaches using a lateral incision for the thoracotomy and a modified transmanubrial approach. The lateral incision enabled detachment of the adhesion between the mass and the posterior to median mediastinum, and the modified transmanubrial approach was useful for separating the mass from the upper to anterior mediastinum. The mass had no connection to the cervical thyroid gland. Histological examination revealed a large mediastinal cyst of an ectopic thyroid with small nodules diagnosed as papillary carcinoma. There was no recurrence 14 months after surgery.

[An autopsy case of pseudomesotheliomatous adenocarcinoma of the lung complicated with brain stem infarction due to nonbacterial thrombotic endocarditis].

A 53-year-old man was admitted to our hospital for back, left shoulder and upper limb pain. Chest radiography and CT on admission revealed right pleural effusion and a focal plate-like thickening of the major fissure. Pleural effusion cytology revealed adenocarcinoma, which was diagnosed as non-small-cell lung cancer with bone metastasis. The patient suffered from DIC, melena and multiple cerebral infarctions during chemotherapy and died on the eighth day of the second course of chemotherapy. Autopsy revealed a pseudomesotheliomatous adenocarcinoma covering the pleura of the right middle lobe, systemic thromboembolism and vegetations on the aortic valves due to nonbacterial endocarditis. Pseudomesotheliomatous adenocarcinoma of the lung, a rare form of lung cancer, complicated with DIC and nonbacterial endocarditis, is reported.

Positive reactions for both Cyfra21-1 and CA125 indicate worst prognosis in non-small cell lung cancer.

UNLABELLED: We examined four tumour markers [carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), cancer antigen 125 (CA125) and cytokeratin 19 fragment (Cyfra21-1)] in 584 non-small cell lung cancer (NSCLC) patients. RESULTS: After confirmation of a significant correlation between their serum levels and clinical stages, multivariate analysis showed that Cyfra21-1 and CA125 pointed to a negative prognosis; the respective hazard ratios were 2.585 (p = 0.0008) and 2.139 (p = 0.0020) in 121 inoperable adenocarcinoma patients and 2.329 (p = 0.0004) and 1.61 (p = 0.00370) in 205 inoperable NSCLC patients. Also, patients giving positive reactions for both Cyfra21-1 and CA125 had the worst prognoses, with hazard ratios of 6.546 (p < 0.0001) in inoperable adenocarcinoma patients and 4.275 (p < 0.0001) in inoperable NSCLC patients. CONCLUSION: Cyfra21-1 or CA125 tend to imply a negative prognosis. Cyfra21-1 and CA125 together imply the worst prognosis.

A prospective study of indications for mediastinoscopy in lung cancer with CT findings, tumor size, and tumor markers.

BACKGROUND: Biopsies by mediastinoscopy remain the most reliable preoperative staging method for N2 lung cancer. Because it is neither practical nor economical to recommend mediastinoscopy for all candidates for surgery, we developed indicational criteria for video-assisted mediastinoscopy (VAM) and carried out a prospective study to validate its usefulness. METHODS: Patients with resectable primary lung cancer were chosen for VAM when at least one of three clinical indicators was present: (1) computed tomographic evidence of mediastinal adenopathy, (2) elevated levels of serologic tumor markers, and (3) diameters of primary cancers (> 2 to 3 cm). Patients without positive nodes (group 2) underwent thoracotomy, and patients with positive nodes (group 3) received induction therapy. When none of these criteria were met (group 1), thoracotomy with R2b lymph node dissection was performed without VAM. RESULTS: One hundred twenty-one men and 82 women (total, 203) were eligible for the study. The mean age of the patients was 64.4 years (range, 39 to 75 years) with primary lung cancer. The patients were comprised of 135 adenocarcinomas, 46 squamous cell cancers, and 22 other carcinomas. There were 78 patients in group 1, 87 in group 2, and 38 in group 3. The stages of group 2 patients were more advanced (chi2 = 63.2668; p < 0.001) than those of group 1. As the incidence of positive indicators for VAM increased, the ratios of N2 patients increased from 2.5% (all negative) to 90.4% (triple positive: p < 0.001). The correlation of our criteria with the pathology findings revealed a diagnostic sensitivity of 95.8% and a negative predictive value of 97.4%. Using three indicators for N2 prediction, we selected 96% (46 of 48) pN2, N3 patients and avoided 37% (76 of 203) unnecessary VAMs. CONCLUSIONS: We established and validated currently useful criteria for VAMs in the management of primary lung cancer.

The significance of tumour markers as an indication for mediastinoscopy in non-small cell lung cancer.

OBJECTIVE: The purpose of this study was to verify the significance of tumour markers as indicators for mediastinoscopy in non-small cell lung cancer. METHODOLOGY: In the past 4 years, 205 patients with non-small cell lung carcinoma (NSCLC) underwent surgical resection at Chiba Cancer Center, Chiba, Japan. The correlation between the serum levels of eight tumour markers (CEA, AFP, CA19-9, SCC, NSE, CA125, CYFRA, ProGRP) and the presence of N2 disease was analysed. Univariate and multivariate analyses were performed to determine the relationship between both marker levels and clinical findings and N2 disease. RESULTS: In multivariate analysis, positive CEA was significantly associated with the diagnosis of N2 disease. We also demonstrated that when CA125, CYFRA and ProGRP were positive, they were individually significantly associated with N2 disease. However, CEA was superior to the other markers and equivalent to a combination of various tumour markers. CONCLUSION: It was concluded that evaluation of CEA in addition to CT is of use in the diagnosis of N2 disease in NSCLC patients and should be used as an indication for mediastinoscopy.

Effect of peripheral blood lymphocyte subsets and prognosis in autologous LAK cell treatment of advanced lung adenocarcinoma / 中国癌症杂志

Purpose:To study effect of peripheral blood lymphocyte subsets in autologous LAK cell treatment of advanced lung adenocarcinoma and to discuss the prognosis.Methods:21 surgically resected cases, were confirmed as primary lung adenocarcinoma stage Ⅲ or Ⅳ. The patients had received the treatment of IL 2 and two kinds of autologous LAK cells, every 2～3 months, for two years. The results of the three groups death in 2 years and survival over 2 years were analysed statistically as a whole.Results:In total,CD4 + decreased, t =2.817, P