Postoperative serum carcinoembryonic antigen levels in patients with pathologic stage IA nonsmall cell lung carcinoma: subnormal levels as an indicator of favorable prognosis

BACKGROUND: Elevated serum carcinoembryonic antigen (CEA) levels are sometimes attributable to the production of CEA by malignant cells, and in turn, the antigen itself can enhance the metastatic potential of malignant cells. The authors speculated that low serum CEA levels might be indicative of relatively low levels of malignant cells and a low probability of disease recurrence. This hypothesis led them to investigate whether low CEA levels in serum represented a useful prognostic factor for patients with pathologic Stage IA nonsmall cell lung carcinoma. METHODS: Between 1993 and 2001, 724 patients underwent surgery for NSCLC at Toneyama National Hospital (Toyonaka, Japan). Of these patients, the 242 who were diagnosed with pathologic Stage IA disease were included in the current study. Smoking behavior, gender, age, tumor diameter, disease histology, and preoperative and postoperative serum CEA levels were chosen as study variables, with the cutoff level between subnormal and normal serum CEA levels set at 2.5 ng/mL and the cutoff level between normal and high serum CEA levels set at 5.0 ng/mL. Prognostic indicators were evaluated using a Cox hazard model. In addition, survival probabilities were calculated using the Kaplan-Meier method, and differences in survival were assessed by log-lank analysis. RESULTS: Subnormal postoperative serum CEA levels were found to be an independent prognostic indicator (hazard ratio, 2.3; 95% confidence interval, 1.1-4.7; P = 0.03 for comparison with patients who had normal CEA levels) on multivariate analysis. Furthermore, the 5-year survival rate was 87% for patients with subnormal postoperative CEA levels (n = 146), compared with 75% for patients with normal postoperative CEA levels (n = 80) and 53% for patients with high postoperative CEA levels (n = 16) (P < 0.0001). CONCLUSIONS: Among patients with pathologic Stage IA NSCLC, those who had an extremely favorable prognosis were distinguished by their subnormal postoperative serum CEA levels.     

Biologic effects of lead on school children of urban and suburban Tokyo

Summary There are few reports on lead exposure of children in or near large cities which compare the blood lead values of those who live towards the center of cities and those living in the suburbs. Since lead poisoning among children in the United States is a serious problem, the authors wished to study the effects of lead in the environment on the young population in and near Tokyo. The results indicated much lower blood lead levels in school children than in adults in Tokyo. There is a statistically significant difference in PbB levels between urban and suburban children although the actual difference was only 1 – 2 g/100 g. Thus children living in urban Tokyo seem to have slightly higher body burdens of lead than suburban children. This difference in lead body burden is most probably not attributable to lead in ambient air but to other factors such as food. However, the possibility of the contribution of lead in ambient air cannot be totally rejected. Further investigation is required to identify the factor or factors which are responsible for this phenomenon.     

Successful use of heparin and warfarin in the treatment of cholesterol crystal embolization

We report an 81-year-old male with cholesterol crystal embolization (CCE). He had been treated with warfarin for atrial fibrillation and an old cerebral infarction but had recurrence of cerebral infarction after warfarin was discontinued as treatment of CCE. Anticoagulation therapy by heparin in addition to warfarin was restarted, with the result that symptoms of cerebral ischemic damage did not recur and skin manifestations of CCE rapidly improved. These results suggest the possibility that heparin may be effective in the treatment of CCE, because CCE is not the result of pure embolization by cholesterol crystals but is a result of a combination with simultaneous thrombi.     

Diffuse vascular injury: convergent-type hemorrhage in the supratentorial white matter on susceptibility-weighted image in cases of severe traumatic brain damage

Introduction  

Susceptibility-weighted image (SWI) is one of the most sensitive methods for detect microbleeding and useful for evaluation of traumatic brain damage. The purpose of this study is to delineate the characteristics and importance of supratentorial deep white matter hemorrhages detected by SWI in cases of traumatic brain damage.     

Bilateral ovarian metastasis of non-small cell lung cancer with ALK rearrangement

The discovery of a distinct subtype of non-small cell lung cancer (NSCLC) positive for rearrangement of the anaplastic lymphoma kinase gene (ALK) has had a substantial impact on personalized therapy for this disease. The clinical features associated with metastasis in individuals with ALK rearrangement-positive NSCLC remain to be fully characterized, however. We now describe a case of ovarian metastasis from NSCLC with ALK rearrangement. A 39-year-old woman underwent a right middle lobectomy for acinar-type adenocarcinoma of the lung (pT2aN2M0, stage IIIA). Fluorescence in situ hybridization (FISH) analysis of the resected tumor tissue revealed the presence of an ALK rearrangement. Twenty months later, a large intrapelvic mass was detected in the patient at follow-up. She underwent both left salpingo-oophorectomy and right ovarian cystectomy. Histological examination of the ovarian tumors showed acinar adenocarcinoma, and FISH analysis revealed the presence of ALK rearrangement, confirming a diagnosis of ALK rearrangement-positive NSCLC with ovarian metastasis. Although the ovary is an uncommon site for metastasis from lung cancer, physicians should be aware of the possibility for such metastasis during follow-up for female patients with ALK rearrangement-positive NSCLC. Further investigation is warranted to clarify the incidence of ovarian metastasis in NSCLC patients with ALK rearrangement.     

Imbalances between the levels of tissue factor and tissue factor pathway inhibitor in ARDS patients

INTRODUCTION: To evaluate the pathogenetic role of tissue factor (TF), tissue factor pathway inhibitor (TFPI), and neutrophil elastase in acute respiratory distress syndrome (ARDS), as well as to test the hypothesis that TFPI levels modified by neutrophil activation are not sufficient to prevent TF-dependent intravascular coagulation, leading to sustained systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), which determine the prognosis of these patients. MATERIALS AND METHODS: The study subjects consisted of 55 patients with trauma and sepsis who were divided into three groups according to the Lung Injury Score. Ten normal healthy volunteers served as control. Plasma levels of TF, TFPI, and neutrophil elastase were measured on the day of injury or the day of diagnosis of sepsis (day 0) and days 1 through 4. The number of SIRS criteria that the patient met and the disseminated intravascular coagulation (DIC) score is determined daily. RESULTS: Patients (15) developed ARDS, 23 were at risk for but did not develop the syndrome, and 17 patients were without risk for ARDS. TF and neutrophil elastase levels in ARDS patients were persistently higher than those in other two groups and control subjects. However, the TFPI levels showed no difference among the three groups, which retained normal or slightly elevated levels compared to the control subjects. DIC scores did not improve and SIRS continued during the study period in patients with ARDS. The ARDS patients showed higher numbers of dysfunctioning organs and associated with poorer outcome than the other two groups. CONCLUSION: Systemic activation of the TF-dependent pathway not adequately balanced by TFPI is one of the aggravating factors of ARDS. High levels of neutrophil elastase released from activated neutrophils may explain the imbalance of TF and TFPI. Persistent DIC and sustained SIRS contribute to MODS, determining the prognosis of ARDS patients.     

A further study of the biological effects of lead on urban and suburban Tokyo school children

Summary There are few reports on lead exposure in children living in the center and the suburbs of large cities. As subjects of epidemiological investigations on the effects of lead exposure in ambient air, school children are very significant in that they have a relatively limited sphere of movement in their daily life. In a previous study the authors compared school children living in the center of Tokyo and those in a suburb of the city and reported that the blood lead levels (PbB) were significantly higher in children living in urban areas [12]. However, it was concluded that further investigation of factors other than ambient air was required to determine the cause of this difference. In the present study, the method used was the same as that of the previous study. However, the areas investigated in the present study were distant from those of the previous study. The results again indicated that the average PbB of school children in the city-center was approximately 2.5–4.8 mg/100 g higher than that of suburban school children, a statistically significant difference. An analysis made on the combined data from both studies according to age revealed that urban school children indicated the highest level among younger urban children, showing a gradual decrease in lead levels as age increased (from 10 to 15 years of age). Suburban children did not show this decline. As a result, it was concluded that these differences in PbB might not be attributable only to lead exposure in ambient air, but to lead exposure from sources such as street dust to which young children are more readily exposed than adults.     

Castleman’s disease arising from an intrapulmonary lymph node

A 23-year-old woman was admitted to our hospital because of an intrapulmonary mass that had been observed for 7 years. Chest computed tomography revealed a 3.5-cm well-defined mass with enhancement in the left lower lobe. During the 7 years of observation, she had been asymptomatic and the tumor size was unchanged. She underwent surgical resection for diagnosis and treatment. Histological examination revealed Castleman’s disease of the hyaline vascular type. We present this rare case of solitary Castleman’s disease arising from an intrapulmonary lymph node.