[Case of small cell carcinoma of the lung complicated with paraneoplastic cerebellar degeneration (PCD)].
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Biomedical subjects
Publications and source records attributed to T Kamimori.
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Patients with small-cell lung cancer who survive more than 2 years have a significantly increased risk (relative risk of 3.6) of developing a second primary tumour. The cessation of cigarette smoking after successful therapy is associated with a significantly decreased risk of a second primary tumour.
We have evaluated the feasibility, toxicity, and tumour response of concurrent whole-brain radiotherapy (WBRT) and chemotherapy with cisplatin, vindesine and mitomycin in the treatment of 33 patients with brain metastasis from non-small-cell lung cancer (NSCLC). The imaging response demonstrated that 25 patients (75.8%) responded to brain lesions, including five complete responders, and the response rate to primary lesion was 18%. The treatment improved at least one grade of performance status in 30% and of neurological functions in 55% of the patients. The major toxicity was leucopenia (> or = grade 3, 84.4%). Median survival was 9.7 months and the 1-year survival rate was 40%. Concurrent WBRT and chemotherapy can be safely administered to patients with brain metastasis from NSCLC, with a remarkable response rate, improvement of neurological functions and encouraging survival duration.
We studied 90 patients with small-cell lung cancer in whom levels of Pro-GRP were abnormally high before therapy. Changes in the serum Pro-GRP level have been said to correlate strongly with therapeutic responses in patients with small-cell lung cancer. We found that changes in the serum Pro-GRP level (half-life > or = 30 vs < 30 days) were a significant prognostic factor. Multivariate analysis showed that in these patients the Pro-GRP level after therapy, Performance Status, and age were independent prognostic factors.
Thrombomodulin (TM) is a membrane protein present in the vascular endothelium. It has also been found in human plasma, within which, however, its pathological functions have not been clearly described. In this study, the plasma TM concentrations in 19 asthmatic patients were determined by sandwich enzyme immunoassay using two monoclonal antibodies for human TM. The concentration of plasma TM in exercise-induced asthma (EIA)-positive asthmatic patients was significantly increased by exercise challenge. In addition, for these patients a positive correlation was found between the severity of EIA and the degree of change in plasma TM induced by exercise challenge. These findings suggest that the increase in influx of TM into the plasma in EIA-positive asthmatics may be due to generalized pulmonary endothelial damage following exercise challenge.
A 20-year-old female was brought to our emergency unit with generalized erythema and discomfort induced by running after having eaten wheat bread. The laboratory examinations, including eosinophils, total IgE, RAST score to wheat, heat challenge test and methacholine inhalation test were within normal limits. No anaphylactoid responses occurred after provocation tests of wheat bread intake or exercise alone. However, on provocation exercise test after eating pancakes, she developed hypotension, generalized itching and urticaria associated with an elevation of plasma histamine levels. These findings suggested wheat-dependent exercise-induced anaphylaxis. This was completely prevented by daily administration of terfenadine 120 mg p.o. without side effects such as fatigue or drowsiness.
Polymerase chain reaction (PCR) for the rapid detection of Mycobacterium tuberculosis was used to test 30 clinical specimens (transbronchial biopsy specimens) from patients in whom tuberculosis was suspected on chest X-ray. In these patients, 15 cases were histologically diagnosed as tuberculosis. Among them, M. tuberculosis was detected in 8 specimens by PCR. Of 8 PCR positive specimens, 7 were also positive by smear and culture; the other was negative by smear and positive by culture. On the other hand, 15 cases were therapeutically diagnosed as the tuberculosis and these specimens showed negative results in neither PCR nor microbiological tests. We conclude that the PCR method is useful for rapid and direct detection of M. tuberculosis in transbronchial biopsy specimens.
On first admission on June 5, 1989, pulmonary adenocarcinoma of left S3b in a 62-year-old male had already metastasized to the brain and the clinical stage was T2N2M1. Radiation therapy for the metastatic brain lesion was very successful but chemotherapy for the primary lesion was not effective. He was discharged on August 24, 1989. He was readmitted to our hospital on Jan. 5, 1990 because of severe abdominal pain. His chest roentgenogram showed free air under the diaphragm. An emergency laparotomy was performed, because perforation of gastrointestinal tract was suspected. At operation, two localized tumors were found, one located in the jejunum approximately 20 cm distal to the ligament of Treitz, accompanied by perforation and another approximately 20 cm distal to the above lesion in the mesentery. The resected specimen of the perforated lesion demonstrated a deep and large ulcer, compared to the tumor size, similar to a submucosal tumor, accompanied by bridging folds. The pathologic interpretation was adenocarcinoma of the lung metastatic to the jejunum and mesentery. Primary lung cancer metastasizes to a wide variety of organs, but metastasis to the small intestine is uncommon, even on postmortem examination. Furthermore, it is rare that the metastatic lesion causes abdominal symptom leading to laparotomy.