Advanced age is not correlated with either short-term or long-term postoperative results in lung cancer patients in good clinical condition

OBJECTIVES: Several investigators have reported that operative mortality in the elderly is acceptable. However, their patients are potentially biased with regard to some factors such as performance status (PS) and comorbidity. In this study, we discuss surgical indications for the elderly and effects on perioperative mortality and prognosis. STUDY DESIGN: A retrospective study was carried out by reviewing the records of 1,114 patients who were referred for treatment of non-small cell lung cancer between January 1993 and December 2002. The patients were classified into younger (< or = 75 years of age) and elderly (> or = 76 years of age) groups. The histologic subtype, TNM stage, Eastern Cooperative Oncology Group PS, and treatment were reviewed for members of each group, and the proportion of patients who underwent surgery was compared between the two groups. The surgical procedures, perioperative mortality, and prognosis of the two groups were also compared. RESULTS: There was a significant difference in the histologic distribution with no difference in TNM staging between the two groups. Regarding treatment, 51.0% of those in the younger group and 36.1% of those in the elderly group underwent surgery. The proportion of elderly patients who underwent surgery was significantly lower than that of the younger patients, mainly due to worse PS and comorbidity in the elderly patients. The perioperative mortality rates for the younger and elderly groups were 0.9% and 4.1%, respectively, with no significant difference, and the overall survival was similar between the two groups. CONCLUSIONS: When compared to younger patients, fewer elderly patients underwent surgery because of worse PS and comorbidity. However, in elderly patients with good PS and no comorbidity, the rate of perioperative mortality and the prognosis were similar to those in the younger patients. Therefore, advanced age only is not a negative factor for surgery in elderly patients.     

Hemangioendothelioma of the brain presenting with intracerebral hemorrhage: a case report]

Hemangioendothelioma (HE) is an uncommon vascular tumor that is intermediate in histological appearance between a hemangioma and an angiosarcoma. Presently, it is regarded as endothelial tumors of low-grade or intermediate malignancy. It has been reported in the liver, lung, heart, mediastinum, lymph nodes, extremity, and bone. The occurrence in the brain is extremely rare; only 16 cases have so far been reported. We report a 51-year-old woman who presented with transient visual disturbance and weakness of the left upper limb on April 12th 2003. Computed tomography (CT) revealed a high density mass in the right parietal lobe. In magnetic resonance imaging (MRI), the lesion is hyperintense on TIWI, isointense on T2WI, and no enhancement with gadopentetate dimegliumine. Intratumoral hemorrhage was indicated and preoperative diagnosis was cavernous angioma. The tumor was excised completely on April 28th 2003. Pathologically, the tumor cells resembled endothelial cells, positive immunoreactivity for Factor VIII, and grew in small nests or cords. Postoperative MRI showed complete removal of the tumor. There has been no recurrence for 8 months after the surgery, but we have to follow MRI up for a long time. We discussed intracerebral HE clinically and neuroradiologically.     

Immunohistochemical Investigations on Cerebellar Purkinje Cells of Menkes' Kinky Hair Disease: Disappearance of Inositol 1, 4, 5-Triphosphate Receptor Protein,and Expression of Phosphorylated Neurofilament Proteins, αB-Crystallin and Stress-response Proteins

Immunohistochemical investigations were carried out on cerebellar Purkinje cells in patients with Menkes' kinky hair disease (MD) and normal control subjects (ages: 1–65 years). Six antibodies were used. They were specific to inositol 1,4,5-triphosphate receptor protein regarded as P₄₀₀ (P₄₀₀/IP₃R), phosphorylated neurofilament proteins (pNFP), αB-crystallin, stress-response protein (srp) 72, srp 27 and ubiquitin, respectively. In normal brains, all Purkinje cell bodies, axons, and dendrites including the spiny branchlets of dendrites were positive for anti-P₄₀₀/IP₃R antibody. In comparison, not every Purkinje cells in MD cases had P₄₀₀/IP₃R immunoreactivity. And some of the cells were more intensely stained than others. The immunoreaction products of P₄₀₀/IP₃R were frequently detected in cell bodies and proximal portions of the dendrites, but not in the peripheral dendrites including spiny branchlets. Most of the Purkinje cell bodies in MD reacted with anti-pNFP antibody, while only a small fraction of the cells was positive with anti-αB-crystallin and srp 72 and srp 27. Ubiquitin immunoreactivity was not detected. In contrast, Purkinje cell bodies from normal subjects were not recognized by antibody to pNFP, αB-crystallin, srp 72 and srp 27. Our results indicate that MD is associated with the loss of inositol 1,4,5-triphosphate receptor in Purkinje cells, and an aberrant phosphorylation of neurofilament proteins or aberrant distribution of normal phosphorylated neurofilament proteins. These impairments may lead to the expression of stress response proteins or αB-crystallin in some cells.     

A young adult case of spontaneous basilar artery dissection]

We reported a case of basilar artery dissection in a 20-year-old man suffering sudden onset of consciousness disturbance. Brain CT revealed a cerebral infarction of the whole territories of vertebro-basilar artery and his 3DCT showed the occlusion at the base of basilar artery. Autopsy revealed that the subintimal dissection was found at the base of basilar artery and the dissection was spreaded to the distal of bilateral posterior cerebral arteries. The characteristics of his vertebro-basilar artery were small in diameter, thin media and thickened intima. According to these findings, we supposed this rare case of basilar dissection occurred all at once based on a functional abnormality in his small vertebro-basilar arterial wall.     

A case of brain-biopsy proven progressive multifocal leukoencephalopathy: Pathological findings and analysis of JC virus regulatory region

A 57-year-old woman with chronic myelogenous leukemia developed neurological abnormalities. Brain biopsy revealed enlarged and basophilic nuclear cells with bizarre astrocytes on the background of demyelination, which are the characteristic histological findings of progressive multifocal leukoencephalopathy (PML). Immuno-histochemical analysis confirmed JC virus infection. Analysis of the viral regulatory regions demonstrated two different clones. DNA sequences of both clones showed a constant rearrangement of duplication and deletion, which was characteristic of the PML type of JC virus.     

6‐Formylpterin protects retinal neurons from transient ischemia–reperfusion injury in rats: A morphological and immunohistochemical study

Neuroprotective effects of 6‐formylpterin (6FP) on transient retinal ischemia–reperfusion injury were evaluated in rats by means of counting the number of retinal ganglion cells, measuring the thicknesses of the inner plexiform and inner nuclear layers, and by immunohistochemical detection of apoptotic cells in the retina. Sixty‐one Sprague–Dawley rats (12 weeks, male, 295–330 g) were subjected to transient retinal ischemia–reperfusion by elevated intra‐ocular pressure (80 mmHg for 60 min). Intraperitoneal injection of 6FP (3.8 mg/kg) was performed before or after ischemia. The retina was histologically better preserved in rats with 6FP treatment than without 6FP treatment. 6FP showed more strong neuroprotective effects when it was administered before ischemia. The number of single‐stranded DNA‐positive cells in the retina also decreased remarkably in rats with 6FP treatment, especially when administered before ischemia. These results suggest that 6FP protects retinal neurons from transient ischemia–reperfusion injury, at least in part by inhibiting apoptotic cell death.