Association between different types of physical activity and occupational stress in Japanese workers: a cross-sectional study

This cross-sectional study investigated the association between different types of physical activity (PA) and occupational psychological and physical stress responses among workers in Japan. Stress responses were assessed using the Brief Job Stress Questionnaire. Work-related PA (time spent sitting, sitting bouts, standing, walking, engaging in heavy labor, and moderate-to-vigorous PA [MVPA]) and exercise-based PA (frequencies [times/wk] of flexibility and muscle-strengthening activity, and walking) were measured using a questionnaire. Multiple linear regression was performed to examine the association between each type of PA and stress responses. Participants who engaged in >108 min/d of work-related MVPA exhibited a statistically significant association with higher psychological stress responses when compared to those who engaged in 0-42 min/d of work-related MVPA. For exercise-based PA, participants who engaged in flexibility activity or walking five or more times/wk, or muscle-strengthening activity one to three times/wk, demonstrated significantly lower psychological stress responses compared to those who did not exercise. Participants who engaged in flexibility activity five or more times/wok demonstrated significantly lower physical stress responses compared to those who did not exercise. This study suggests that work-related MVPA is associated with higher psychological stress responses, while exercise-based PA is associated with lower psychological or physical stress responses.

Environmental Factors Affecting Cognitive Function Among Community-dwelling Older Adults

Background

Although neighborhood environmental factors have been found to be associated with cognitive decline, few longitudinal studies have focused on their effect among older adults living in rural areas. This longitudinal study aimed to investigate the effect of neighborhood environmental factors on cognitive decline among rural older adults.

Methods

The data of 503 older adults aged > 60 years who were living in Unnan City in Japan and had participated in two surveys conducted between 2014 and 2018 were analyzed. Cognitive function was assessed using the Cognitive Assessment for Dementia, iPad version 2. Elevation, hilliness, residential density, and proximity to a community center were measured using geographic information system. Logistic regression examined the effect of each neighborhood environmental factor (in quartiles: Q1-Q4) on cognitive decline.

Results

A total of 57 (11.3%) participants demonstrated a decrease in cognitive function at follow up. Elevation (Odds ratio (OR): 3.37, 95% Confidence Interval (CI): 1.11-10.20 for Q3 vs. Q1; OR: 5.43, 95% CI: 1.89-15.56 for Q4 vs. Q1) and hilliness (OR: 3.45, 95% CI: 1.46-8.11 for Q4 vs. Q1) were associated with a higher likelihood of cognitive decline. Residential density and distance to a community center were not associated with cognitive decline.

Conclusions

Elevated and hilly environments may increase risk of cognitive decline among rural older adults.

Key messages

Residents in mountainous regions tend to have limited accessibility to various living centers. Those who live in elevated and hilly areas within the mountainous regions may have further limited accessibility and availability of locations where they can interact with others.

Clinical characterization of node-negative non-small cell lung cancer: Results of a prospective investigation

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Background: 20 to 30% of clinical stage IA non-small cell lung cancer cases were revealed to be node-positive by pathologic examination of resected specimens. In this prospective study, the clinical features of a truly node-negative population were prospectively investigated to search for candidates of a lesser resection or of a stereotactic radiotherapy. Methods: The clinical data and radiographic features of high-resolution computed tomography (HR-CT) were registered before operation in 169 clinical stage IA lung cancer patients, who were scheduled to undergo a standard lobectomy and systemic mediastinal node dissection. The nodal metastasis was pathologically defined, while the clinical factors associated with the presence of the nodal metastasis were evaluated. Results: In 130 evaluable cases, 16 of 114 adenocarcinoma and 3 of 16 other NSCLC were node-positive. Among all parameters, positivity of the serum carcinoembryonic antigen (CEA) was the only factor significantly associated with nodal metastasis (p = 0.0074). When we focused on adenocarcinomas, the serum CEA, retraction sign and intratumoral air-space on HR-CT were suggested to be predictive factors for lymph node metastasis with hazard ratios of 12.44 (p = 0.0003), 6.53 (p = 0.0533) and 0.17 (0.0073), respectively. In combination with the radiologic features of HR-CT imaging, none of 18 CEA-negative/retraction-negative cases and 3 of 65 CEA-negative/air-space positive cases showed nodal metastasis, in which the incidence of nodal metastasis was significantly lower than the counterparts with respective p-values of 0.0015 and 0.037. The tumor size and the proportion of ground glass attenuation were not associated with the incidence of nodal metastasis. Conclusions: The serum CEA and HR-CT features thus allowed us to identify node-negative lung adenocarcinomas. In clinical stage IA adenocarcinoma cases, a standard operation should be considered when positive serum CEA and/or retraction sign on HRCT is noticed.

No significant financial relationships to disclose.

Clinical course and management of patients undergoing open window thoracostomy for thoracic empyema

BACKGROUND

While open window thoracostomy (OWT) is a safe procedure and is indicated in patients who have thoracic empyema either with or without a bronchopleural fistula, it may prolong the hospital stay.

OBJECTIVES

We retrospectively analyzed the relationship between the etiology of thoracic empyema and the open window interval (OWI).

METHODS

Between January 1986 and May 1997, 53 patients resistant to conventional therapy underwent OWT for thoracic empyema at the Department of Surgery of the National Minami-Fukuoka Chest Hospital. The patients were classified into five groups based on the etiological findings of thoracic empyema. 44 patients also underwent closure of the window until June 1999.

RESULTS

The average OWI was 180.4 +/- 51.9 (mean +/- SE) days for postoperative empyemas in lung cancer, 128.0 +/- 32.1 days for bacterial nontuberculous empyemas, 189.6 +/- 24.1 days for fungal empyemas, 365.8 +/- 201 days for empyemas caused by atypical mycobacteria and 322.0 +/- 58.7 days for tuberculous empyemas. There was no evidence that the OWI was related to either sex, age, etiology of thoracic empyemas, performance status, the existence of bronchopleural fistulae, complications of diabetes mellitus or preoperative malnutrition status in multivariable models. 5 patients underwent a second OWT because of recurrence of empyema. Mortality rate was 7.5%.

CONCLUSIONS

There was no relationship between clinical factors including nutritional assessment and OWI. OWT generally is a safe and effective procedure for thoracic empyema resisting to conventional therapy except that it can make an extended hospital stay necessary.

Analysis of various treatments for pulmonary aspergillomas

The objective of this study was to analyze the results of various treatments for pulmonary aspergilloma and to determine the surgical indications. A total of 41 patients with pulmonary aspergilloma hospitalized at the National Minamifukuoka Chest Hospital between 1973 and 1999 were analyzed with regard to their response to treatment and long-term prognosis. Five asymptomatic patients who were untreated demonstrated no change in the clinical status of aspergilloma. Analysis of the short-term response revealed surgery to be the most effective treatment. Systemic and intracavitary injections of antifungal drugs were not definitely effective, although they had a positive effect in some patients. A survival analysis revealed that all eight patients who underwent surgery are still alive. Using the Cox proportional hazard model, it was found that the favorable prognostic factors were the absence of symptoms, the absence of a superimposed bacterial infection, and surgery. There were ten deaths: three from lung cancer and seven related to uncontrollable superimposed bacterial infections, often resulting in hemoptysis. We conclude that patients with asymptomatic pulmonary aspergillomas should be clinically observed for signs of the development of lung cancer, but do not require active treatment. On the other hand, patients who are symptomatic and have uncontrollable superimposed bacterial infection will benefit from surgery.

[A case of epithelial cancer of the alveoli which responded favorably to the additional administration of UFT for refractory cancer after administration of carboplatin and docetaxel]

Epithelial cancer of the alveoli is considered to be a pulmonary non-small cell carcinoma which responds poorly to carcinostatics. In one case of epithelial cancer of the alveoli which metastasized to both lungs and caused breathing to deteriorate rapidly, chemotherapy was applied with 500 mg of carboplatin (CBDCA) and 90 mg of docetaxel (TXT). Although the tumor was reduced initially, it was found to have been aggravated again three weeks after the start of the chemotherapy. In the second and third courses of the chemotherapy, CBDCA and TXT were administered in the same dosage as in the initial course, but with the oral administration of UFT (600 mg/day). The results were favorable, as evidenced by the absence of recurring aggravation. Currently, the patient has been followed on an outpatient basis for over six months with the administration of UFT. Good QOL is being maintained without any repeated aggravation of the tumor.

Video-assisted thoracoscopic esophagomyotomy for achalasia after pulmonary lobectomy

A 52-year-old man developed achalasia and a lung abscess due to aspiration pneumonia. We conducted a right upper lobectomy by thoracotomy for the abscess and, 2 weeks later, video-assisted thoracoscopic myotomy and fundoplication (modified Belsey Mark IV procedure) though the left thorax for achalasia. Three months after surgery, the patient was free of dysphasia and chest pain and had regained his original weight. Esophageal myotomy and fundoplication using video-assisted thoracoscopy appear to be feasible in treating achalasia involving impaired pulmonary function.

[Imipenem/cilastatin sodium and other beta-lactams for respiratory tract infections: clinical benefit and treatment days for cure]

Therapeutic efficacy and the treatment days for cure of imipenem/cilastatin sodium (IPM/CS) in treatment of pulmonary infections were prospectively determined in comparison with those of beta-lactams other than carbapenems mainly ceftazidime (CAZ) or sulbactam/cefoperazone (SBT/CPZ). The overall response rate was 84.9% (62/73) in the IPM/CS group and 74.7% (56/75) in the beta-lactam group, the difference not being significant. In the subjects having underlying respiratory diseases, the response rate was 91.1% (41/45) and 73.9% (34/46) in the IPM/CS and beta-lactam groups, respectively. In patients with infections secondary to chronic respiratory disease, the rate was 91.2% (31/34) in the former group and 66.7% (24/36) in the latter group, respectively. The differences were significant for both stratified analyses. The treatment days for cure judged by the attending physician were 12.9 +/- 0.6 days in the IPM/CS group, and 14.5 +/- 0.7 days in the beta-lactam group. The difference was not, however, significant. In patients with mild to moderate infections, the treatment days for cure was 12.0 +/- 0.6 days (n = 64) in the IPM/CS group and 14.3 +/- 0.7 days (n = 70) in the beta-lactam group. In patients with underlying respiratory disease, the treatment days for cure were 11.8 +/- 0.7 days (n = 45) and 14.7 +/- 0.9 days (n = 46) in the IPM/CS and beta-lactam groups, respectively. In patients with infections secondary to chronic respiratory disease, the days were 11.1 +/- 0.7 days (n = 34) and 14.7 +/- 1.1 days (n = 36), respectively. Thus, IPM/CS therapy significantly reduced the number of treatment days until cure. There was, however, no significant difference between the two therapy groups in treatment of the patients with severe infections, those without underlying respiratory disease, or those with pneumonia and/or lung abscess. The treatment days for cure were also assessed by the members of review committee taking into consideration of body temperature, leukocyte count, and C-reactive protein. As the result, it was 6.9 +/- 0.5 days in the IPM/ CS and 10.3 +/- 0.7 days in the beta-lactam groups; respectively, and the difference was significant. Time (days) until cure was also compared between the two groups using survival time analysis, confirming a more rapid response in the IPM/CS group. Although IPM/CS therapy was associated with a shorter response time as assessed by both the attending physicians and the review committee, there were considerable differences between the results of these judgements. Thus, the duration of treatment with injectable antibiotics requires reevaluation in the future. No significant differences were observed between the groups with respect to parameters indicating side effects and laboratory abnormalities. There were no severe symptoms or laboratory findings, and symptoms and changes in laboratory values, if any resolved during the course of therapy or after the withdrawal of treatment. In conclusion, IPM/CS seems to be very useful as first-line therapy for respiratory tract infections and for shortening the duration of treatment.

The relationship between CYP1A1 aryl hydrocarbon hydroxylase activity and lung cancer in a Japanese population

Because aryl hydrocarbon hydroxylase (AHH) is considered to be responsible for the activation of benzo(a)pyrene and other polyaromatic hydrocarbons in cigarette smoke to carcinogens, it is important to examine CYP1A1 (AHH) activity in the determination of susceptibility to lung cancer. We investigated AHH activity in peripheral mitogen-treated lymphocytes in 108 lung cancer patients and 95 healthy control individuals. Non-induced AHH activity was detectable in all the samples. AHH inducibility (3-methylcholanthrene-induced/non-induced AHH activity) showed a very wide interindividual variation as well as non-induced AHH activity. No significant associations were found between adjusted AHH activity and histologic type of tumor among lung cancer patients. Adjusted AHH inducibility of genotype C [geometric mean and 95% confidence interval (CI); 15.56 and 11.69-20.71] in MspI polymorphism was significantly higher than those of the other two genotypes (P = 0.0001), while no significant difference was observed between genotypes A (4.76 and 3.82-5.93) and B (5.60 and 4.57-6.86). On the other hand, non-induced AHH activity of genotype Val/Val (0.121 and 0.082-0.178 pmol/min/10(6) cells) in isoleucine-valine (Ile-Val) polymorphism was significantly higher than those of genotypes Ile/Ile (0.042 and 0.034-0.052 pmol/min/10(6) cells) and Ile/Val (0.040 and 0.030-0.053 pmol/min/10(6) cells) (P < 0.0001). Even after controlling for age, cigarettes smoked per day and season of the year, high AHH inducibility (7.0 < versus 0 < < or = 3.0: OR and 95 %CI, 12.4 and 2.88-53.4) was an independent risk factor for lung cancer. The data indicate that high AHH inducibility may strongly associate with the susceptibility to lung carcinogenesis.

Bronchogenic carcinoma following pulmonary aspergilloma

We have observed two cases of bronchogenic carcinoma following pulmonary aspergilloma among 25 cases of pulmonary aspergilloma. Patients with a pulmonary aspergilloma may be susceptible to bronchogenic carcinoma.

[Clinical efficacy of imipenem/cilastatin sodium for respiratory infections in patients with lung cancer]

Imipenem/cilastatin sodium (IPM/CS) was administered to 102 patients with respiratory tract infections and lung cancer. Patients with other serious diseases were excluded and a total of 73 patients were enrolled. They were divided into 12 patients who underwent surgery (operated group) and 61 who did not (non-operated group); the latter group included 28 patients treated with anticancer agents or radiation therapy (treated group) and 33 untreated patients (untreated group). IPM/CS was effective in 75% of the patients, both with and without surgery. The drug was effective in 81% of the treated group, although many of the patients had Stage III or more advanced cancer, as well as bronchial occlusion. IPM/CS was also effective in 69% of the untreated group, although many of the patients have serious infections and a PS (Performance Status) of 3 or greater. Thus, IPM/CS treatment achieved good results. Bacteriological studies showed that 3 out of 4 strains in the operated group and 16 out of 18 in the non-operated group were eliminated. Safety was evaluated in all patients. Two patients (2%) experienced side effects and two others (2%) showed abnormal clinical findings, but the symptoms were mild and resolved after discontinuation or completion of therapy. In conclusion, IPM/CS was very effective for treating respiratory infections in patients with lung cancer.

Synchronous growth of triple lung cancer

The case of a 75-year-old man with three synchronous carcinomas of the lung (large cell carcinoma, adenocarcinoma, and small cell carcinoma) is reported. This is the eighth well-documented case report in the literature; however, our case is the first to be reported with the newly described histological combination.

[Bronchopleural fistula following the use of automatic stapling devices for lung cancer]

We compared automatic stapling with hand suturing in the rate of bronchopleural fistula. Twenty two hundred forty one patients of 25 hospitals, who were performed lobectomy or pneumonectomy for lung cancer from the year of 1990 to 1992, were investigated about the occurrence of bronchopleural fistula. The rate of bronchopleural fistula following lobectomy were 0.9% (11/1,227 cases) in automatic stapling, and 1.1% (8/753 cases) in hand suturing; there was no difference. However, there was a higher rate of the fistula with the use of automatic stapling devices in pneumonectomy. The rate was 11.2% (11/98 cases) in automatic stapling, and 1.2% (2/166 cases) in hand suturing. Automatic stapling may lead to bronchopleural fistula in pneumonectomy. Moreover, addition of hand suturing to automatic stapling was thought to prevent the fistula.

Japanese doctors' preferred treatment choices for their hypothetical non-small cell lung cancer: how they would wish to be treated. National Chest Hospital Study Group for Lung Cancer

We conducted a trial to clarify what Japanese clinical doctors think about the present status of therapy for non-small cell lung cancer, as well as to clarify which problems are still unresolved. One-hundred five Japanese doctors who treat lung cancer patients were asked how they would choose to be treated, if they suffered from non-small cell lung cancer. Six scenarios were presented and the doctors had to choose one treatment method for each of the six scenarios. Adjuvant chemotherapy or radiotherapy after complete resection, increase with progression of the pathological stage. Ninety-three per cent of Japanese doctors wanted surgery, even if mediastinal lymph node metastases were present. In the scenario of only one distant metastasis to the brain, 44% of doctors wanted surgery while 39% wanted chemotherapy and/or radiotherapy. In the scenario of multiple bone metastases, 33% wanted chemotherapy, 77% did not. It was concluded therefore that Japanese doctors choose surgery as the number one treatment modality when all lesions are considered resectable.

Juxta-anastomotic aneurysm in the residual infrarenal abdominal aorta

A 72-year-old man, who had undergone an emergency operation with a tube graft for a ruptured abdominal aortic aneurysm 9 years previously presented with a recurrent true abdominal aortic aneurysm near the proximal anastomotic site. True aneurysmal formation in the juxta-anastomotic aorta proximal to the prosthetic graft as seen in this case is very rare. Since recurrent aortic aneurysms impose significant problems of diagnosis and management, procedures to prevent the recurrence of aneurysms are important in the initial operation.

Giant extrathoracic hematoma after thoracoplasty--a case report

A rare case of an extrathoracic giant hematoma developing after a thoracoplasty in a 67 year old man is presented herein. The patient underwent a right thoracoplasty without removal of plombage and a left thoracoplasty with removal of plombage for tuberculosis of the bilateral upper lobes 27 and 24 years prior to presentation, respectively. He presented to us in May, 1987, with a subscapular tumor which had been growing over the last 5 years. A giant tumor, measuring 23 x 17 x 12 cm and weighing 2585 g was successfully removed and the patient has since been well without any evidence of recurrence.

Influence of surgical resection before and after chemotherapy on survival in small cell lung cancer

We attempted to define the role of surgery in the treatment of small cell lung cancer (SCLC). Of 81 patients with clinically localized SCLC, 36 underwent surgical resection: 19 underwent initial resection with postoperative chemotherapy, while the remaining 17 were treated initially with chemotherapy, then resection. The remaining 45 patients were treated with a combination of chemotherapy and radiotherapy. The 5-year survival for the 36 surgical patients was 38%; median survival time (MST) was 33 months. Nineteen patients treated with postoperative chemotherapy showed a 42% 5-year survival, while 17 patients treated with preoperative chemotherapy showed a 33% 5-year survival. This difference was not significant. However, stage III survival tended to be better in patients with preoperative chemotherapy (MST, 29 months) than in those who had had postoperative chemotherapy only (MST, 17 months). Although survival of the 45 nonsurgical patients was poor, stage I and II patients, or those with complete remission showed a 25% 5-year survival with an MST of 33 months, and a 21% 5-year survival with an MST of 25 months, respectively. We thus concluded that initial resection combined with postoperative chemotherapy is beneficial for patients with stage I, and probably stage II disease. For resectable stage III, particularly in patients with N2 disease, adjuvant resection after chemotherapy may be a favorable choice in the management of SCLC. For advanced stage III, complete remission by chemotherapy should be attempted in combination with radiotherapy.

Postoperative adjuvant chemotherapy in non-small cell lung cancer: prognostic value of DNA ploidy and post-recurrent survival

Eighty-six patients with non-small cell lung cancer who underwent curative operations were postoperatively randomized to control and adjuvant chemotherapy groups. In the adjuvant chemotherapy group, patients received cisplatin-based combination chemotherapy 3 or 4 weeks after operation and the average cycle of chemotherapy was 2.3 (from 1 to 6 cycles). In this trial, no evidence of improved survival or delayed recurrence was seen in the treated patients. In multivariate analysis of prognostic variables, the most important factor was the pathological stage of the disease and, second, DNA ploidy of the primary tumor. Although histology (squamous vs. non-squamous cell carcinoma) had a trend to influence the survival, it was not a significant factor. A total of 33 patients had recurrences: 17 and 16 patients were in control and adjuvant chemotherapy groups, respectively. Postrecurrent survival in the adjuvant chemotherapy group was significantly shorter than that in the control group, as determined by the generalized Wilcoxon and log rank tests. Median survival time after recurrence in the control and adjuvant therapy groups was 18.5 and 7.5 months, respectively. These results suggest that DNA ploidy of primary tumors should be considered as a prognostic factor in future trials of adjuvant therapy. Furthermore, analysis of postrecurrent survival in the adjuvant chemotherapy trial, as well as that of overall and disease-free survivals should be done.

[Epidural anesthesia with buprenorphine for chest surgery and its prophylactic effects of postoperative pulmonary complications]

To clarify the prophylactic effect of epidural anesthesia with buprenorphine on postoperative pulmonary complications, the incidence of pulmonary complications after chest surgery was evaluated in 2 groups: the group that underwent epidural anesthesia, namely the test group, and the control group. Pulmonary complications were classified as follows: mild complications, sustained wheezing and/or small atelectasis-like shadows seen on chest x-rays. These improved by conventional methods except for bronchial toilet. Moderate complications included pneumonia and/or respiratory failure and/or atelectasis which needed bronchial toilet. There were 56 cases (58%) with no pulmonary complications in the control group and 89 cases (77%) in the test group. The number of patients with pulmonary complications were 40 (42%) in the control group and 27 (23%) in the test group, respectively (p less than 0.01). Those with mild or moderate complications were 25 (26%), 15 (16%) in the control group and 21 (18%), 6 (5%) in the test group, respectively. There was significant difference between no complication group and moderate complication group (p less than 0.01). These results show that epidural anesthesia is useful in preventing pulmonary complications after chest surgery.

Influence of chemotherapeutic agents on superoxide anion production by human polymorphonuclear leukocytes

The effects of 11 chemotherapeutic agents on superoxide anion (O2-) production were examined in human polymorphonuclear leukocytes (PMNL). All drugs, except predonine, were found to suppress O2- production in PMNL. Adriamycin (doxorubicin), mitomycin C, vindesine, cisplatin, etoposide, nimustine, and pepleomycin suppressed O2- production at relatively low drug concentrations, whereas methotrexate, 5-fluorouracil and vincristine suppressed O2- production at high drug concentrations. Time-dependent suppression of O2- production was evaluated in four drugs, namely Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), cisplatin, vindesine, and methotrexate. Only Adriamycin showed suppressive effect on PMNL-derived O2- production in a time-dependent manner. Production of O2- by PMNL is a fundamental element for its bactericidal activity. The authors' results showed suppression of O2- production in PMNL in the presence of chemotherapeutic agents. This indicates a relationship between chemotherapy drugs and susceptibility to infection. The influence of chemotherapeutic agents on O2- production by PMNL should thus be taken into consideration when assessing defense mechanisms and susceptibility to infection of patients treated with these drugs.

Long-term survival after brain metastases from tracheal carcinoma

A case of prolonged survival after radiotherapy for primary tracheal squamous cell carcinoma and the subsequent brain metastases is reported. The patient is alive and well without any sign of relapse, approximately six years after the onset of brain metastases from tracheal carcinoma. Radiotherapy proved useful in the treatment of both the primary tracheal carcinoma and the brain metastases.

[Evaluation of prognostic factors in early lung cancer]

We evaluated the prognostic factors in 52 cases of resected early lung cancer: hilar early lung cancers 9 cases and peripheral early lung cancers 43 cases. All hilar lesions were squamous cell carcinoma, and peripheral lesions were adenocarcinoma (31 cases), squamous cell carcinoma (10 cases), large cell carcinoma (2 cases) and carcinoid (1 case). No relapse was found in hilar lesions, but 7 relapses and 5 deaths were found in peripheral lesions. Prognostic factors were examined in these cases. Location of lung cancer (hilar or peripheral) was found to be important in early lung cancer. In addition, age was a significant prognostic factor in peripheral early lung cancer with multivariate analysis. No other significant factor was found in our cases. Twelve out of 52 cases with lung cancer had other malignancies after or before operation. These were cancers of second primary lung, colo-rectal, uterus, stomach, breast, thyroid, liver and malignant melanoma. Therefore, we have to carefully observe other parts even after resection of early lung cancer.

Brain metastases in patients with limited small cell lung cancer achieving complete remission. Correlation with TNM staging

We reviewed the brain metastases, after treatment, of 45 patients with limited small cell lung cancer who achieved complete remission by radiochemotherapy or curative operation. No patient received prophylactic cranial irradiation. The incidence of subsequent brain metastases was classified according to pretreatment staging as follows: two of 13 (15 percent) patients in stage I; two of ten (20 percent) in stage II; nine of 17 (53 percent) in stage IIIa; and four of five (80 percent) in stage IIIb. The brain metastases occurred from seven to 29 months after the start of treatment, and the median time of the occurrence was 13 months. Of 17 patients who developed brain metastases and who subsequently received cranial irradiation, there were two in whom relapse had occurred at no other site except the brain and who survived 26 and 79 months after the relapse, respectively. These data indicate that not all patients with limited SCLC achieving CR due to treatment necessarily benefit from PCI.

Multimodality therapy for small cell carcinoma of the lung--the role of surgical treatment

Reviewing the outcome of 70 cases of clinically localized small cell lung cancer (SCLC) treated with combined modality treatment, we attempted to define the role of resection in this disease. The survival rate for all cases was 37 per cent at 2 years and 23 per cent at 3 years with a median survival time (MST) of 14 months. For 25 resected cases the overall 5-year survival rate was 37 per cent with an MST of 26 months. According to clinical staging, 5-year survival was 64 per cent for stage I and 20 per cent for stage II. However, none of the stage III cases achieved long-term survival, of over 3 years. In 45 non-resected cases, the overall response rate was 84 per cent with a 44 per cent complete response. The overall survival rate was 27 per cent at 2 years and 14 per cent at 3 years with an MST of 11 months. The 20 cases who achieved complete response had an MST of 26 months with 51 per cent alive at 2 years and 19 per cent at 5 years. Thus, we consider that lung resection is definitely indicated in cases with stage I and probably stage II SCLC. For stage III, however, particularly in cases with N2 disease, resection seems to offer no special benefit in favor of survival compared to combination chemotherapy and radiotherapy.

Preoperative examination to detect distant metastasis is not advocated for asymptomatic patients with stages 1 and 2 non-small cell lung cancer. Preoperative examination for lung cancer

The purpose of the present study was to determine whether all patients with non-small cell lung cancer, clinically defined as stage 1 or 2, should have examinations to determine the presence of distant metastatic (M1) disease. The survival rates of patients who underwent the examinations and those who did not were compared. In all groups, the examinations had in no way positively affected survival. The 33 patients in whom distant recurrence had occurred within 12 months of curative operation, were then evaluated to establish the relationship between the recurrent site and the preoperative examination: negative scans on the examination failed to predict the low incidence of early distant recurrence. Those data suggest that the routine use of radionuclide or CT scans is of no benefit to asymptomatic patients with local, early disease.

Phorbol myristate acetate modulates calcium ion-dependent superoxide anion generation induced by a monoclonal antibody raised against polymorphonuclear leukocytes

We used a monoclonal antibody, YI 51, raised against human polymorphonuclear leukocytes (PMN) to induce superoxide anion (O2-) generation in cells. Although YI 51 alone played only a small part in inducing O2- generation in PMN, the amount of O2- generation induced in 5 X 10(5) PMN was 3.7 to 5.5 nmol/min when F(ab')2 fragments of rabbit anti-mouse immunoglobulin antibody were added as a cross-linking agent. This O2- -inducing activity was high compared with that of wheat germ agglutinin (WGA), insoluble immunoglobulin G immune complexes (IC), or phorbol myristate acetate (PMA). The binding of YI 51 and soluble immunoglobulin G IC to PMN was not reciprocally inhibitory, indicating that YI 51 does not interfere with ligand binding to the Fc receptor-binding site. In the absence of calcium ion (Ca2+), O2- generation induced by YI 51 decreased to 10 to 20% of that in the presence of Ca2+. In contrast, O2- generation in response to WGA, IC, or PMA under Ca2+-free conditions was not affected. When PMN were pretreated with low concentrations of PMA (10(-10) to 10(-9) M), the amount of O2- generation by the cells in response to YI 51 in Ca2+-free buffer was enhanced in a concentration-dependent manner. It also equaled the O2- generated by the cells in buffer containing Ca2+. In cells pretreated with PMA, the amount of O2- induced by WGA was enhanced two- to threefold over that in untreated cells. In contrast, there was no augmentation over untreated cells with stimulation by IC. These results suggest that YI 51, IC, and WGA induce O2- generation in human PMN in different manners.

Influence of chemotherapy on superoxide anion-generating activity of polymorphonuclear leukocytes in patients with lung cancer

The superoxide anion (O2-) generating activity of polymorphonuclear leukocytes (PMN) in peripheral venous blood obtained from 15 patients with lung cancer was measured weekly after drug treatment. The amount of O2- generated by the cells before chemotherapy was 5.74 +/- 0.42 nmol/minute/10(6) cells (mean +/- SE). The value decreased gradually and reached a nadir of 1.98 +/- 0.24 at 2 weeks after chemotherapy, at which time PMN count also reached a nadir of 1359 +/- 251/microliters (mean +/- SE). The decreased O2- generating activity of the PMN recovered gradually thereafter and reached the level seen before the chemotherapy at 4 weeks. Expression of Fc receptors on the plasma membrane in PMN was measured after chemotherapy by the binding of iodine 125 (125I)-immune complexes to the cells. Almost 40% decrease of the binding was observed in the cells obtained at 2 weeks after chemotherapy, compared with that in the cells before chemotherapy. These results indicate that PMN present in peripheral blood at 2 weeks after chemotherapy are not fully matured, in terms of O2- generating activity and the expression of Fc receptors.

The role of surgical resection in the management of small cell carcinoma of the lung

To assess the role of surgical resection in the management of small cell carcinoma of the lung, experience with 118 patients who were treated between 1973 and 1985 was reviewed. Twenty-five patients underwent surgical resection followed by combination chemotherapy in all except one. The remaining 93 patients were treated by combined chemotherapy and radiation therapy. The 5-year survival rate for patients with stage I disease undergoing surgical resection was 50.8%. For all 25 patients operated on, the 5-year survival rate was 30.7%. In the patients not operated on, only those with complete response had long-term survival, for whom the 5-year survival rate was 11.9%. We consider that surgical resection is definitely indicated in patients with stage I disease. If the response to initial chemotherapy is very good, patients with stage II or T3N0M0 disease also probably should receive resection. Patients with N2 disease are not candidates for resection, unless distant metastases are controlled completely by intensive chemotherapy.

[Combination chemotherapy and radiation therapy for small cell carcinoma of the lung]

From January, 1982 to March, 1983, patients with small cell carcinoma of the lung were treated at Kyushu Cancer Center. Eleven patients received combination chemotherapy-radiotherapy and one patient chemotherapy alone. The chemotherapy regimen consisted of cyclophosphamide, adriamycin and vincristine which was repeated every 4 weeks for as long as possible. Radiotherapy was administered to the primary lesion and mediastinum following 2 cycles of induction chemotherapy. The overall response rate after receiving 2 cycles of chemotherapy was 75% with 4 complete (33%) and 5 partial responses (42%). After radiotherapy, response increased to 100% with 8 complete (73%) and 3 partial responses (27%). Complete response occurred in 6 of the 7 patients with limited disease and 2 of the 5 patients with extensive disease. Overall survival rate was 73% at 1 year, 36% at 2 years and 12% at 3 years with a median survival time of 21 months. Survival was better in patients with limited disease than in those with extensive disease (median survival time, 21.5 months vs. 14 months). In the 3-Year follow-up period, all patients had recurrences consisting of 4 distant, 2 local and 5 both. Myelosuppression was mild to moderate and there were no deaths related to the side effects of treatment.

Mechanisms involved in acute lung edema induced in dogs by oleic acid

We investigated mechanisms related to the development of acute lung edema, as induced by oleic acid in adult mongrel dogs. The intravenous injection of oleic acid (0.04 ml/kg) was considered to induce a permeability edema, as an enhancement of transvascular protein clearance was observed after the injection. The effects of oleic acid injection on systemic blood pressure (SBP), pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO) and airway pressure (AWP) were measured. A significant decrease in CO and increase in AWP were evident after the injection, but there were no changes in SBP, PAP and PAWP. Treatment of the animals with prostaglandin I2 (PGI2) did not alter the induction of edema by oleic acid. However, the decrease in CO and increase in AWP were normalized by treatment with PGI2. Blood platelet count was not affected by oleic acid given in a dose of 0.04 ml/kg. To determine the direct effect of oleic acid on the vascular endothelium, the agent was injected through a catheter placed in the pulmonary artery. Electron microscopic examination revealed severe vacuolation on the endothelium of the pulmonary artery after only 1 min of exposure to oleic acid. Increased permeation of Evans blue into the subendothelial tissue was also observed with oleic acid treatment, compared with findings in the controls. These results indicate that the lung edema induced by oleic acid is due to an increased protein clearance, probably through a direct toxic effect on the vascular endothelium rather than an indirect toxic effect of chemical mediators released from the aggregated platelets.

[Clinical significance of CEA levels in lung cancer]

Serum concentrations of CEA, Ferritin, beta 2-MG, TPA and IAP were measured in patients with lung cancer. Significant difference of positive rate between lung cancer and benign chest disease was observed only in CEA and TPA. CEA elevations occurred most frequently with stage IV and histologically with adenocarcinoma. Positive CEA levels (greater than or equal to 5 ng/ml) of pleural effusion were observed in 75% of all patients with lung cancer and increased to 94% in patients with positive cytology of effusion. There was not significant difference of bronchial washings CEA levels between lung cancer and benign chest disease. Furthermore, serial measurement of postoperative CEA levels had considerable value in monitoring the course of disease following resection.

Antitumor activity of macrophages in lung cancer patients with special reference to location of macrophages

Antitumor activity of macrophages from the peripheral blood, pleural cavity, and alveoli of 35 patients with primary lung cancer was examined. Cytostatic activities of peripheral blood monocytes and alveolar macrophages from either tumor-bearing or non-tumor-bearing segments declined in association with metastasis to regional lymph nodes, an increase in tumor size, and the development of pleural invasion. However, no such correlation could be observed between the cytostatic activity of pleural cavity macrophages and the degree of pleural invasion. The cytostatic activity of pleural cavity macrophages was found to be suppressed when the pleural invasion extended beyond the visceral pleura to the neighboring lobe or chest wall. On the other hand, the cytostatic activity of pleural cavity macrophages was markedly augmented when pleural invasion was limited to within the visceral pleura, although it was low in patients with no visceral pleural invasion. These results suggest that the pleural cavity is isolated from sites of systemic immunological response and that systemic immunological response does not strongly affect pleural cavity macrophages.

Effect of free fatty acid on pulmonary transvascular fluid and protein exchange

We demonstrated the effect of infusion of oleic acid, a common free fatty acid, on pulmonary vascular permeability in anesthetized dogs prepared with a lung lymph fistula. Infusion of oleic acid caused significant increases in lung lymph flow with no change in L/P protein ratio, resulting in significant increases in transvascular protein clearance. Pulmonary arterial and pulmonary arterial wedge pressures increased significantly from baseline but their elevation was slight. Cardiac output decreased significantly after oleic acid infusion. In contrast to the effects of oleic acid, left arterial hypertension caused increases in lung lymph flow that were associated with decreases in the L/P protein ratio. Lung water content was increased after oleic acid infusion, despite little effect on pulmonary vascular pressures. These findings indicate that oleic acid produced endothelial lung injury and increased pulmonary vascular permeability.