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132 Lung cancer in patients under 40 years of age Ardissonc. F, Rapellino M, Oben R et al. Universirn degli Studi di Torino. Carte&a di Chirwgia Toracica, U.S.L. VIII, Ospedale Mo- linette, Torino. Minerva Med 1989;80:1301-4. We investigated a series of 30 patients younger than 40 years with histologically proven bronchogenic carcinoma. Most patients were symptomatic for a mean duration of 3 months before examination. The most common cell types were squamous carcinoma in 10 patients, oat cell carcinoma in 9 patients, and adenocarcinoma in 5 patients. The disease was categorized as Stage I in 3 patients, Stage II in 3, Stage III in 17. and Stage IV in 7. Ten patients underwent resection, whereas 3 patients were inoperable at surgery. The average length of survival for the nonoperated patients was 4.2 months (range 1 to 16 months). The mean survival for the surgically treated patients was 23.3 months (range 0 to 84 months). Extent of resection did not have any statistical significance in the survival rates which were mainly affected by staging of disease. Measurement of giutathione S-transferase pi isoenzyme in plasma, a possible marker for adenocarcinoma of the lung Howie AF, Douglas JG, Fergusson RJ, Beckett GJ. Universiry Depart- menl of Clinical Chemistry,RoyalInjirmary. Edinburgh EH3 9YW. CIin Chem 1990;36:453-6. Using a specific radioimmunoassay, we measured glutathione S- transferase (GST; EC 2.5.1.18) pi isoenzyme in the plasma of 29 patients diagnosed as having carcinoma of the bronchus. Concentrt- tions of the enzyme were significantly higher (I’ < 0.01) than those measured in a control group of 16 patients with respiratory disorders other than malignancy. Although, overall, only 19 (66%) of patients with cancer of the bronchus had increased concentrations of GST pi in plasma, eight of the nine (89%) patients diagnosed as having adenocar- cinema had above-normal concentrations of GST pi. To obviate spuri- ously high results for GST pi concentrations caused by platelet release, we assayed blood samples collected in ‘Thrombotect’ tubes, which contain inhibitors of platelet activation. Management of metastases-induced acute pancreatitis in small cell carcinoma of the lung Chowhan NM, Madajewicz S. Deparrmenr of Medicine, Division of Oncology, Slate UniversityofNew York, Health Sciences Cenrer, SIony Brook, NY 11794-8174. Cancer 1990:65:1445-8. Mefastases-induced acute pancreatitis is an uncommon condition that has a poor prognosis. Risk factors of acute pancreatitis in known cases have been studied and there is a low survival rate with more than three risk factors on presentation regardless of txatment rendered. These patients should be treated conservatively. Chemotherapy may be attempted in patients with three or fewer poor prognostic signs. Prognostic and therapeutic significance of the flow cytometric nuclear DNA content in non-small cell lung cancer Isobe H, Miyamoto H, Shimizu T et al. First Deparmznt ofMedicine, School of Medicine, Hokkaido University, Nishi 7-chome. Kita 15-jo, Kita-ku, Sapporo 060. Cancer 1990;65:1391-5. To evaluate prognostic and therapeutic significance, tumor DNA content was determined by flow cytometry in 310 paraffin-embedded tissue samples obtained surgically from 130 patients with non-small cell lung cancer. Ninety-six (76.8%) patients had DNA aneuploid patterns that were statistically higher in adenocarcinoma than in squamous cell carcinoma. A better S-year survival rate was observed in Group A (DNA diploidy, 69.6%) than in Group B (DNA aneuploidy and DNA peridiploidy, 33.2%; P < 0.001). The survival curves of the patients in Group B continued to decrease during the next 2.5 years. COX’S model analysis showed that both the pathologic stage and the DNA content were the significant prognostic factors for survival. However, the DNA content was an independent prognostic factor in squamous cell carci- noma, but not in adenocarcinoma. These results indicate that DNA content analysis is useful for the evaluation of clinical behavior and prognosis, and that the clinical value of the DNA content must be differentiated between squamous cell carcinoma and adenocarcinoma. Pulmonary tumor associated with diffuse bilateral lung uptake of bone imaging agent Antar MA, Mack JM, Spencer RP, Crotty JM. Depawnexl ofNuclear Medicine, Veterans Administration Medical Center, Newingron, CT 06011. CIin NucI Med 1990;15:46-7. Radiogallium accumulated in a large cell carcinoma of the left lung. A bone scan in the patient showed bilateral intense uptake of Tc-99m MDP in the lung fields, as well as in the tibias, by an undefined mechanism. Rib lesions on bone scan aher thoracotomy De Geeter F. Deparlmenr ofNuclear Medicine, Academisch Ziekenhuis VUB, Laarbeeklaan 101, B-1090 Brussels. Clin NucI Med 1990; 15:40. Hot spots on tbe ribs were observed on the bone scan of a patient who underwent thoracotomy for metastatic pulmonary disease 12 days earlier. Although retraction during surgical interventionhas been mentioned as an uncommon cause ofincreased accumtdation of bone tracers, to the authors’ knowledge this is the first case in which this phenomenon is documented. A history ofrecent thoracic surgery as we11 as tbe location of the hot spots at the operative site and close to each other may serve as clues to this interpretation. Awareness of this cause of hot spots may avoid other unnecessary diagnostic procedures. Increased protein turnover despite normal energy metabolism and responses to feeding in patients wilh lung cancer Melville S, McNarlan MA, Calder AG, Garlick PJ. Roweu Research Institute, Aberdeen ABZ 9SB. Cancer Res 1990;50:1125-31. We have examined the responses of energy and protein metabolism to nutrient intake in nine patients with lung carcinoma, of whom none were cachexic and only one had distant metastases, compared with nine control patients for elective aneurism surgery, who were comparable in termsofage,bodymassindex,andsmokinghabits. Whole-body protein turnover and leucine oxidation was assessed by primed continuous infusion of L-[“C]leucine. Indirect calorimetry was used to determine energy expenditure and rates of carbohydrate and fat utilization. Lean body mass (LBM) was estimated from dilution of deuterium oxide. Measurements were made over an 8-hr period, including 4 h postab- sorptive followed by 4 h of feeding, during which small hourly meals were consumed. In the post-absorptive state, the rate of incorporation of leucine into protein was higher in the cancer group (mean f SD, cancer versuscontrol: 102f21 versus86~8pmoI/kgLBM/h,P~O.O5),aswas the release of leucine by protein degradation (126 f 19 versus 110 f 10 pmolikg LBMih, P < O.Ol), but there was no difference in rates of leucine oxidation (27 zt 6 versus 27 * 5 pmol/kg LBM/b) or Ieucine balance (-25 f 7 versus -24 i 4 pmol/kg LBM/h). There were no differences between the cancer and control groups with respect to either resting energy expenditure (37.3 f 3.5 versus 35.2f 3.8 kcalLBM/day) or the postabsorptive pattern of nutrient utilization (61 f 13% fat, 26 * 10% carbohydrate, and 13 f 2% protein versus 65 f 7%. 21 f 7%. and 14 + 2%, respectively). Daring feeding, leucine oxidation rose relative to the postabsorptive state, incorporation into protein remained the same, and release by protein degradation fell. Incorporation (106 f 20 versus 89 f 7 pmol/kg LBMib, P < 0.05) and release (59 f 12 versus 42 * 14 pmoI/lcg LBM/h, P < 0.01) remained higher in the cancer group than in controls, but leucine oxidation (43 f 15 versus 43 f 12 pmolkg LBM/h) and leucine balance (+48 f 10 versus +47 * 12 pmol/kg LBM/ h) were the same. Energy expenditure during feeding increased to 43.8 * 5.1 versus 43.2 i 4.2 kcal/kg LBIvUday, derived from 32 f 1I fat, 52

Measurement of glutathione S-transferase pi isoenzyme in plasma, a possible marker for adenocarcinoma of the lung

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Page 1: Measurement of glutathione S-transferase pi isoenzyme in plasma, a possible marker for adenocarcinoma of the lung

132

Lung cancer in patients under 40 years of age Ardissonc. F, Rapellino M, Oben R et al. Universirn degli Studi di Torino. Carte&a di Chirwgia Toracica, U.S.L. VIII, Ospedale Mo- linette, Torino. Minerva Med 1989;80:1301-4.

We investigated a series of 30 patients younger than 40 years with histologically proven bronchogenic carcinoma. Most patients were symptomatic for a mean duration of 3 months before examination. The most common cell types were squamous carcinoma in 10 patients, oat cell carcinoma in 9 patients, and adenocarcinoma in 5 patients. The disease was categorized as Stage I in 3 patients, Stage II in 3, Stage III in 17. and Stage IV in 7. Ten patients underwent resection, whereas 3 patients were inoperable at surgery. The average length of survival for the nonoperated patients was 4.2 months (range 1 to 16 months). The mean survival for the surgically treated patients was 23.3 months (range 0 to 84 months). Extent of resection did not have any statistical significance in the survival rates which were mainly affected by staging of disease.

Measurement of giutathione S-transferase pi isoenzyme in plasma, a possible marker for adenocarcinoma of the lung Howie AF, Douglas JG, Fergusson RJ, Beckett GJ. Universiry Depart- menl of Clinical Chemistry,RoyalInjirmary. Edinburgh EH3 9YW. CIin Chem 1990;36:453-6.

Using a specific radioimmunoassay, we measured glutathione S- transferase (GST; EC 2.5.1.18) pi isoenzyme in the plasma of 29 patients diagnosed as having carcinoma of the bronchus. Concentrt- tions of the enzyme were significantly higher (I’ < 0.01) than those measured in a control group of 16 patients with respiratory disorders other than malignancy. Although, overall, only 19 (66%) of patients with cancer of the bronchus had increased concentrations of GST pi in plasma, eight of the nine (89%) patients diagnosed as having adenocar- cinema had above-normal concentrations of GST pi. To obviate spuri- ously high results for GST pi concentrations caused by platelet release, we assayed blood samples collected in ‘Thrombotect’ tubes, which contain inhibitors of platelet activation.

Management of metastases-induced acute pancreatitis in small cell carcinoma of the lung Chowhan NM, Madajewicz S. Deparrmenr of Medicine, Division of Oncology, Slate UniversityofNew York, Health Sciences Cenrer, SIony Brook, NY 11794-8174. Cancer 1990:65:1445-8.

Mefastases-induced acute pancreatitis is an uncommon condition that has a poor prognosis. Risk factors of acute pancreatitis in known cases have been studied and there is a low survival rate with more than three risk factors on presentation regardless of txatment rendered. These patients should be treated conservatively. Chemotherapy may be attempted in patients with three or fewer poor prognostic signs.

Prognostic and therapeutic significance of the flow cytometric nuclear DNA content in non-small cell lung cancer Isobe H, Miyamoto H, Shimizu T et al. First Deparmznt ofMedicine, School of Medicine, Hokkaido University, Nishi 7-chome. Kita 15-jo, Kita-ku, Sapporo 060. Cancer 1990;65:1391-5.

To evaluate prognostic and therapeutic significance, tumor DNA content was determined by flow cytometry in 310 paraffin-embedded tissue samples obtained surgically from 130 patients with non-small cell lung cancer. Ninety-six (76.8%) patients had DNA aneuploid patterns that were statistically higher in adenocarcinoma than in squamous cell carcinoma. A better S-year survival rate was observed in Group A (DNA diploidy, 69.6%) than in Group B (DNA aneuploidy and DNA peridiploidy, 33.2%; P < 0.001). The survival curves of the patients in Group B continued to decrease during the next 2.5 years. COX’S model analysis showed that both the pathologic stage and the DNA content were the significant prognostic factors for survival. However, the DNA content was an independent prognostic factor in squamous cell carci-

noma, but not in adenocarcinoma. These results indicate that DNA content analysis is useful for the evaluation of clinical behavior and prognosis, and that the clinical value of the DNA content must be differentiated between squamous cell carcinoma and adenocarcinoma.

Pulmonary tumor associated with diffuse bilateral lung uptake of bone imaging agent Antar MA, Mack JM, Spencer RP, Crotty JM. Depawnexl ofNuclear Medicine, Veterans Administration Medical Center, Newingron, CT 06011. CIin NucI Med 1990;15:46-7.

Radiogallium accumulated in a large cell carcinoma of the left lung. A bone scan in the patient showed bilateral intense uptake of Tc-99m MDP in the lung fields, as well as in the tibias, by an undefined mechanism.

Rib lesions on bone scan aher thoracotomy De Geeter F. Deparlmenr ofNuclear Medicine, Academisch Ziekenhuis VUB, Laarbeeklaan 101, B-1090 Brussels. Clin NucI Med 1990; 15:40.

Hot spots on tbe ribs were observed on the bone scan of a patient who underwent thoracotomy for metastatic pulmonary disease 12 days earlier. Although retraction during surgical intervention has been mentioned as an uncommon cause ofincreased accumtdation of bone tracers, to the authors’ knowledge this is the first case in which this phenomenon is documented. A history ofrecent thoracic surgery as we11 as tbe location of the hot spots at the operative site and close to each other may serve as clues to this interpretation. Awareness of this cause of hot spots may avoid other unnecessary diagnostic procedures.

Increased protein turnover despite normal energy metabolism and responses to feeding in patients wilh lung cancer Melville S, McNarlan MA, Calder AG, Garlick PJ. Roweu Research Institute, Aberdeen ABZ 9SB. Cancer Res 1990;50:1125-31.

We have examined the responses of energy and protein metabolism to nutrient intake in nine patients with lung carcinoma, of whom none were cachexic and only one had distant metastases, compared with nine control patients for elective aneurism surgery, who were comparable in termsofage,bodymassindex,andsmokinghabits. Whole-body protein turnover and leucine oxidation was assessed by primed continuous infusion of L-[“C]leucine. Indirect calorimetry was used to determine energy expenditure and rates of carbohydrate and fat utilization. Lean body mass (LBM) was estimated from dilution of deuterium oxide. Measurements were made over an 8-hr period, including 4 h postab- sorptive followed by 4 h of feeding, during which small hourly meals were consumed. In the post-absorptive state, the rate of incorporation of leucine into protein was higher in the cancer group (mean f SD, cancer versuscontrol: 102f21 versus86~8pmoI/kgLBM/h,P~O.O5),aswas the release of leucine by protein degradation (126 f 19 versus 110 f 10 pmolikg LBMih, P < O.Ol), but there was no difference in rates of leucine oxidation (27 zt 6 versus 27 * 5 pmol/kg LBM/b) or Ieucine balance (-25 f 7 versus -24 i 4 pmol/kg LBM/h). There were no differences between the cancer and control groups with respect to either resting energy expenditure (37.3 f 3.5 versus 35.2f 3.8 kcalLBM/day) or the postabsorptive pattern of nutrient utilization (61 f 13% fat, 26 * 10% carbohydrate, and 13 f 2% protein versus 65 f 7%. 21 f 7%. and 14 + 2%, respectively). Daring feeding, leucine oxidation rose relative to the postabsorptive state, incorporation into protein remained the same, and release by protein degradation fell. Incorporation (106 f 20 versus 89 f 7 pmol/kg LBMib, P < 0.05) and release (59 f 12 versus 42 * 14 pmoI/lcg LBM/h, P < 0.01) remained higher in the cancer group than in controls, but leucine oxidation (43 f 15 versus 43 f 12 pmolkg LBM/h) and leucine balance (+48 f 10 versus +47 * 12 pmol/kg LBM/ h) were the same. Energy expenditure during feeding increased to 43.8 * 5.1 versus 43.2 i 4.2 kcal/kg LBIvUday, derived from 32 f 1 I fat, 52