Masanori Koizumi

Epidermal Growth Factor Receptor Mutations: Effect on Volume Doubling Time of Non–Small-Cell Lung Cancer Patients

Background: The purpose of this study was to retrospectively compare the volume doubling time (VDT) on serial computed tomography (CT) of non–small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation with that of NSCLC without the mutation. Methods: One hundred and two pathologically proven NSCLCs, including 69 patients with lung adenocarcinoma, were reviewed with helical CT. Each tumor underwent at least two CT scans. The VDT was calculated using a modified Schwartz formula. EGFR mutations at exons 18–21 were determined by common fragment analysis and Cycleave method. Result: The median VDT of all the patients was 188 days. EGFR mutations were noted in 35 of the 102 patients. The VDT in the 35 patients with EGFR mutations (median 676 days) was longer than that in the 67 patients without EGFR mutations (median 139 days) (p <0.001). By histology subtype, the VDT of adenocarcinoma (305 days) was longer than that of squamous cell carcinoma (81 days) and other types (90 days; p <0.001). Conclusion: In NSCLC patients, positive EGFR mutation status may be associated with longer VDT, which seemed to have a slowly progressive and less-aggressive character. More accurate evaluation of VDT may be helpful for understanding the natural history of EGFR mutation–positive NSCLC and treatment with EGFR tyrosine kinase inhibitors.

Bronchial Artery Aneurysm Treated with Video-assisted Thoracoscopic Surgery

Bronchial artery aneurysms (BAA) are a rarely noted. Asymptomatic cases of BAA are very rare. Most patients are correctly diagnosed only after BAA ruptures. The conventional treatment includes aneurysm resection through thoracotomy or transcatheter arterial embolization. In the present report, we describe a case of an asymptomatic BAA treated using video-assisted thoracoscopic surgery and careful evaluation of the vessels by three-dimensional computed tomography.

A case of intestinal obstruction caused by prominent kyphosis resulting in compression of the intestine by the costal arch.

An 85-year-old woman with no history of abdominal surgery complained of abdominal pain and vomiting and was referred to us with a diagnosis of intestinal obstruction a few days later. Upon admission to our facility, she presented with marked abdominal swelling and prominent kyphosis. Because of the kyphosis, most of the dilated bowel was compressing her thoracic cavity. No obvious strangulation or free air was observed via abdominal computed tomography imaging. We attempted decompression using a nasogastric tube, but the symptoms persisted. Surgery was performed 2 days after admission. The origin of the obstruction was a compression of the ileocecal region by the costal arch. The bowel was discolored, and thus surgically excised. There were no major postsurgical complications other than a mild wound infection. Until now, there have been no reports of advanced kyphosis inducing ileus, but there are concerns of an increase in similar cases as society continues to age.

A GROWING MASS ON THE SHOULDER

A 50-year-old man was transported to the Emergency Department by ambulance due to a growing mass on his left shoulder. One hour before admission, he had fallen down and bruised his left shoulder slightly. On admission, his Glasgow Coma Scale score was 15 (E4V5M6) and his vital signs included a blood pressure of 130/104 mm Hg and heart rate of 97 beats/min. Physical examination revealed systemic neurofibromas and cafe au lait macules that were distinctive of neurofibromatosis type 1, and the mass of the subcutaneous hematoma on the shoulder.

THE BLOOD LEVEL OF ENDOTOXIN AFTER LIVER TRANSPLANTATION IN THE PIG

ブタ肝移植において移植後のエンドトキシン (Et) の変動について検討した. 3時間 (n=5) および12時間保存 (n=2) の移植モデルで全例において血中Etが検出され, 移植後24時間の間に8～380pg/mlのピ-ク値を示し以後漸減した. このEtは従来の合成基質法では陽性に検出されたがβ-glucan感受性因子を選択的に除去したエンドトキシン特異テストでは全く検出されなかった, また移植前後での血液培養は全例が陰性であった. この現象はヒトの肝不全時にみられる, 矢島らのいうところのnon-septic endotoxemiaと同一のものであると考えられた. 移植肝の状態が悪く, 数時間で死亡した例では血中Etが低値を示す傾向が認められ, この意味で生着予後の1つの指標となりうると考えられたが, この現象は従来のspill-over学説では説明困難であった.