Outcome of patients with lung cancer detected incidentally

Lung cancers in the early stages are sometimes detected incidentally. The aim of this study is to evaluate the outcome of patients with lung cancer detected incidentally and to compare to those in whom the malignancy was detected by symptoms. Untreated patients with lung cancer, who were admitted to our division over a 28-year period up to 2003, were analyzed with reference to their reasons for detection of the cancer. During the period, 1168 patients were diagnosed, and 173 (14.8%) of them were detected incidentally. As lung cancers detected incidentally were more often at operable stage (stage IA-IIIA) (p=0.0001), surgical treatment was chosen more frequently in the incidentally diagnosed group (p=0.0001). The outcome with lung cancer patients detected incidentally was more favorable than that of the patients detected by the symptoms (multivariate analysis, p=0.0001). The incidental detection of lung cancer contributes to improvement of the outcome. This study demonstrated a careful review of chest radiography obtained at routine or preoperative examination is important especially for the high-risk patients such as elderly and those with smoking history.     

PIVKA-II-producing advanced gastric cancer

We describe the case of a 68-year-old man with primary advanced adenocarcinoma of the stomach, who displayed extremely high plasma levels of protein induced by vitamin K antagonist (PIVKA)-II (15600mAU/ml) and normal levels of alphafetoprotein (AFP) (4ng/ml). Ultrasonography and dynamic computed tomography ruled out hepatocellular carcinoma (HCC) or liver metastasis. After preoperative chemotherapy, pancreatico-spleno total gastrectomy with D2 lymphadenectomy was performed. Postoperatively, plasma levels of PIVKA-II returned to within the normal range (29mAU/ml). Microscopic examination revealed stomach adenocarcinoma showing various histological types, such as moderately to poorly differentiated mucinous adenocarcinoma, but hepatoid differentiation of gastric adenocarcinoma was not detected. Localization of PIVKA-II and AFP within tumor cells was demonstrated by immunohistochemical staining using monoclonal antibodies. These results indicate that tumor cells from gastric cancer may produce PIVKA-II. Some cases of PIVKA-II- and AFP-producing advanced gastric cancer with liver metastasis have been reported, but this is the first report of gastric cancer without liver metastasis producing PIVKA-II alone.     

Congenital Long QT Syndrome and 2:1 Atrioventricular Block with a Mutation of the SCN5A Gene

Infants with congenital long QT syndrome (LQTS) and 2:1 atrioventricular block (AVB) have been recognized as a clinical subset of children with LQTS. However, the genotype of this disorder is not well-known. We report an infant with LQTS and 2:1 AVB with a mutation of the SCN5A gene (LQT3). In some patients with LQTS and 2:1 AVB, the disorder may be due to mutation of the SCN5A gene (LQT3).     

Milk sphingomyelin accelerates enzymatic and morphological maturation of the intestine in artificially reared rats

OBJECTIVES: Sphingomyelin (SPM) is the dominant phospholipid, comprising 38% of total human milk phospholipids. Although little is known about the nutritional importance of SPM during the neonatal period, SPM may affect the growth and development of tissues in the newborn infant through mechanisms regulating cell proliferation and differentiation. We evaluated the effect of sphingomyelin (SPM) in artificially reared rats as a suitable model of gut maturation in the suckling infant. METHODS: Seven-day-old Sprague-Dawley rat pups were cannulated intragastrically and reared artificially on milk containing 0.5% SPM or 0.5% phosphatidylcholine (PC) for 1 week. RESULTS: Intestinal lactase activity in the SPM group was significantly lower than that in the control or PC group. Upon histologic examination, intestinal villi were found to be occupied with vacuolated cells in the control and the PC group, whereas the vacuolated cells were restricted to the tip of villi in the SPM group. The Auerbach nerve plexus area of the ileum in the SPM group was significantly greater, possibly due to accelerated development, than that in the control group or PC group. CONCLUSIONS: The present results suggest that SPM, the dominant phospholipid in milk, plays an important role in neonatal gut maturation during the suckling period.     

Decreased cerebrospinal fluid hypocretin-1 levels near the onset of narcolepsy in 2 prepubertal children

We present 2 cases of narcolepsy with prepubertal onset. Although excessive daytime sleepiness and cataplexy had appeared early in both patients, the presence of sleep-onset rapid eye movement periods was detected several months after the onset of hypersomnia. The levels of hypocretin in the cerebrospinal fluid were reduced when measured 3 weeks (Patient 1) and 2 months (Patient 2) after the appearance of hypersomnia, before the presence of sleep-onset rapid eye movement periods was confirmed. Because the symptoms of narcolepsy in children are often obscure and easily mistaken as other diseases, and the electrophysiologic studies may not be specific in the early stage, the definite diagnosis tends to be delayed. Measurement of hypocretin-1 levels in the cerebrospinal fluid is useful for the early diagnosis of narcolepsy with prepubertal onset.     

Usefulness and prognostic value of transvaginal hydrolaparoscopy in infertile women

OBJECTIVE: To evaluate the usefulness and prognostic value of transvaginal hydrolaparoscopy (THL) in infertile women. DESIGN: Retrospective study. SETTING: Jichi Medical School Hospital, Tochigi, Japan. PATIENT(S): Thirty-six patients who were followed up for 6 months or longer after THL was performed. INTERVENTION(S): Transvaginal hydrolaparoscopy findings in comparison with hysterosalpingography (HSG).MAIN OUTCOME MEASURES: Transvaginal hydrolaparoscopy findings, HSG findings, treatment strategy, and prognosis. RESULT(S): Twenty of 36 patients (55.5%) became pregnant, including 7 by coitus, 7 by artificial insemination with the husband's semen, and 6 by assisted reproductive technology (ART). In 11 of these pregnant patients, information obtained during THL differed from findings on HSG. CONCLUSION(S): Transvaginal hydrolaparoscopy is useful in selecting a future treatment strategy.     

Levels of lipoprotein(a) in normal and compromised pregnancy

OBJECTIVE: To study maternal lipoprotein(a) levels in normal pregnancy and in pregnancy with evidence of vascular disease in the maternal uteroplacental circulation defined by Doppler ultrasound study. SAMPLES: Maternal venous blood was collected from 75 normal pregnant women and 68 pregnant women with evidence of potential uteroplacental vascular disease identified by Doppler ultrasound study. METHODS: Plasma lipoprotein(a) levels in maternal blood were measured using an enzyme-liked immunosorbent assay method. MAIN OUTCOME MEASURES: Plasma lipoprotein(a) levels and pregnancy outcome were examined. RESULTS: None of the normal group had lipoprotein(a) levels greater than 30 mg/dl, a cutoff level which has been associated with increased risk of atherosclerosis. 28 of the 68 women with uteroplacental insufficiency had lipoprotein(a) levels greater than this cutoff level. In this group there was a statistically significant higher prevalence of preeclampsia in comparison with women with a normal lipoprotein(a) level (p < 0.001). The lipoprotein(a) level was significantly higher in severe (n = 13, median 60.5 mg/dl, P < 0.001] than in mild preeclampsia (n = 5, median 34 mg/dl). Those with high levels (> 30 mg/dl) exhibited significantly more adverse indices of fetal outcome. CONCLUSION: This study has demonstrated that high levels of lipoprotein(a) interfere with uteroplacental circulation and play a role in the pathophysiology of preeclampsia. Lipoprotein(a) concentrations are associated with the severity of the disease. We suggest that high levels of lipoprotein(a) might affect the placenta and fetus.     

Dysgerminoma with a slightly elevated alpha-fetoprotein level diagnosed as a mixed germ cell tumor after recurrence

A pure dysgerminoma shows a normal serum alpha-fetoprotein level, and mixed germ cell tumors containing endodermal sinus tumor elements have elevated serum alpha-fetoprotein levels, ranging from >100 to far higher than 1,000 ng/ml. A 40-year-old woman was diagnosed as having a stage Ia pure dysgerminoma with a slight alpha-fetoprotein elevation (11 ng/ml), after a staging laparotomy, because we could not find any yolk sac element in the original tumor. After 44 months, she had a pelvic recurrent tumor with a significant elevation of the serum alpha-fetoprotein concentration (1,520 ng/ml); histological examination of a needle biopsy specimen revealed a typical yolk sac tumor. Eventually, her initial tumor was diagnosed as a mixed germ cell tumor. The patient was successfully treated with seven courses of chemotherapy and has been disease free for 22 months. It is necessary to be aware of the possibility of a mixed germ cell tumor containing a yolk sac element, even when the alpha-fetoprotein level is only slightly elevated.