Takeshi Tsuda

Utility of creatinine/cystatin C ratio as a predictive marker for adverse effects of chemotherapy in lung cancer: A retrospective study.

Objective To determine whether the creatinine/cystatin C (Cr/CysC) ratio, which is influenced by muscle mass, can be used as a predictive marker of the adverse effects of chemotherapy. Methods This single-centre, retrospective, observational study assessed patients with lung cancer. Serum Cr and CysC levels were measured once within 1 month prior the commencement of chemotherapy. Results A total of 25 patients with lung cancer were enrolled in the study: 22 received first-line therapy; three received second-line therapy. A significant difference was noted regarding the Cr/CysC ratios between patients with nonsmall-cell lung cancer (NSCLC) and those with small-cell lung cancer (0.78 versus 0.92, respectively). A significant difference was also noted in the Cr/CysC ratios of patients with NSCLC with toxicity grades <3 and ≥3 (0.84 versus 0.70, respectively). Similar findings were observed in patients with NSCLC who received platinum-based combination therapy (toxicity gradeu2009<u20093, 0.85; toxicity grade ≥3, 0.69). Conclusion The Cr/CysC ratio could serve as a useful predictive marker for chemotherapy-related adverse effects in patients with NSCLC.

Primary pulmonary lymphoma presenting with multiple lung nodules.

A 71-year-old man taking methotrexate for rheumatoid arthritis presented with a dry cough. A chest X-ray and subsequent computed tomography (CT) of the chest revealed bilateral multiple lung nodules with mediastinal lymphadenopathy (Figure 1A). [F]Fluorodeoxyglucose–positron emission tomography with CT (F-FDG PET/CT) revealed uptake by the lesions (Figure 2). Transbronchial lung biopsy revealed diffuse large B-cell lymphoma (Figures 3A and B) positive for Epstein-Barr virus (Figure 3C). We diagnosed this case as “other iatrogenic immunodeficiency-associated lymphoproliferative disorders with histological features of diffuse large B-cell lymphoma (DLBCL),” which is most common in patients treated with methotrexate. In this case, methotrexate cessation resulted in regression of the nodules 3 months later (Figure 1B). Primary pulmonary lymphoma represents 3–4%of extranodal non-Hodgkin’s lymphoma, less than 1% of non-Hodgkin’s lymphoma, and only 0.5–1% of primary pulmonary malignancies (1). Lung involvement of primary pulmonary lymphoma is frequently bilateral, manifested as nodules or masses that may undergo cavitation (2–4). Air bronchograms, pleural effusions,

Relationship of the urine cortisol level with the performance status of patients with lung cancer: a retrospective study

PurposeCortisol plays an important role in the physical status of patients with end-stage lung cancer, but the association of urine cortisol levels with TNM stage/performance status (PS) is unclear in patients with advanced lung cancer receiving chemotherapy. The objective of this study was to examine this association.MethodsIn this single-center, retrospective, observational study, cortisol concentrations in 24-h pooled urine from 22 patients with advanced lung cancer were measured over 2xa0days. The mean concentration in each patient was compared with PS, TNM stage, and serum sodium and potassium ion levels.ResultsThe 24-h urine cortisol levels were higher in PS2 or PS3 cases compared to PS1 (pu2009<u20090.05) and increased proportionally with PS. Urine cortisol also increased in N2 or N3 cases compared to N1 (pu2009<u20090.01) and also increased in M1 cases (pu2009<u20090.05). Urine cortisol levels were negatively correlated with serum sodium (Ru2009=u2009−0.49, pu2009<u20090.05) and had a tendency for a positive correlation with serum potassium (Ru2009=u20090.40, pu2009=u20090.06).ConclusionThe 24-h urine cortisol level increased in patients with advanced lung cancer undergoing chemotherapy. Low serum levels of potassium and high levels of sodium may indicate relative adrenal insufficiency.

A phase II study of afatinib treatment for elderly patients with previously untreated advanced non-small-cell lung cancer harboring EGFR mutations

OBJECTIVEnThe efficacy and safety of afatinib in elderly patients with EGFR-mutated non-small-cell lung cancer (NSCLC) have not been evaluated. This study aimed to assess the efficacy and safety of afatinib in elderly chemotherapy-naive patients with NSCLC harboring sensitive EGFR mutations.nnnMATERIALS AND METHODSnWe prospectively assessed the clinical effects of afatinib as a first-line treatment for elderly (age ≥70 years) NSCLC patients with EGFR mutations (exon 19 deletion or exon 21 L858R mutation). All patients were initially administered afatinib (30u2009mg/day).nnnRESULTSnBetween May 2014 and August 2017, 40 patients (13 men, 27 women) with adenocarcinoma were included in our analysis. The median age was 77 years (range, 70-85 years). The dose was reduced in 19 patients. The objective overall response and disease control rates were 72.5% and 100%, respectively, and the median progression-free survival and overall survival were 12.9 months and not reached, respectively. Common adverse events (AEs) included diarrhea, rash/acne, and anemia. Major grade 3 or higher toxicities included diarrhea (12.5%), mucositis (7.5%), and pneumonitis (7.5%). Afatinib treatment was discontinued in 8 patients owing to AEs of elevated amylase (nu2009=u20091), liver dysfunction (nu2009=u20091), rash/acne (nu2009=u20091), nail change (nu2009=u20091), anorexia (nu2009=u20092), pneumonitis (nu2009=u20092), and diarrhea (nu2009=u20092). Two patients died due to treatment-related pneumonitis.nnnCONCLUSIONSnThis is the first study that verified the efficacy and feasibility of first-line chemotherapy with afatinib at 30u2009mg/day in elderly patients with advanced NSCLC harboring sensitive EGFR mutations. First-line afatinib of 30u2009mg/day could be a treatment option in this patient population.

Multimodal imaging findings in an adult case of Swyer‐James‐MacLeod syndrome

Swyer‐James‐MacLeod syndrome (SJMS) is an uncommon obliterative lung disease that is radiologically characterized by hyperlucency of a part of or the entire lung. A 33‐year‐old man presented to our hospital for chest tightness. A chest X‐ray revealed unilateral hyperlucency of left lower lung, and contrast‐enhanced computed tomography (CT) of the chest disclosed a hyperlucent left lung without vascularity. Three‐dimensional CT reconstruction and ventilation–perfusion scan findings were concordant with SJMS. We herein report a case of SJMS in a patient who showed the characteristic multimodal imaging findings.

Bronchial biopsy and reactivity in patients with chest tightness relieved with bronchodilator

ABSTRACT Objective: It has been hypothesized that some patients with chest tightness of unknown origin can be successfully treated with a bronchodilator and that they should be diagnosed with chest pain variant asthma. We conducted a prospective study to characterize newly diagnosed patients with chest tightness relieved with bronchodilator use and without characteristic bronchial asthma attacks. Methods: Eleven patients were registered following recurrent positive responses of chest tightness to inhalation of a ß2-agonist. These patients underwent assessments of airway responsiveness to methacholine, bronchial biopsy and bronchial lavage under fiber-optic bronchoscopy before receiving treatment. Results: For the patients with chest tightness relieved with bronchodilator use, the bronchial biopsy specimens exhibited significant increases in lymphocyte and macrophage infiltration (p < 0.05) and no significant increase in eosinophils (p = 0.2918) compared with the control subjects. The bronchial responsiveness to methacholine was increased in two of the patients with chest tightness, and it was not increased in seven; in addition, increased percentages of eosinophils were detected in bronchial lavage fluid (5% or more) from two patients, but no increase was detected in eight patients. Conclusions: We suspect that the chest tightness was induced by airway constriction in these patients, but further study is necessary to validate this hypothesis. We propose that the chest tightness relieved with bronchodilator use was attributed to airway constriction resulting from inflammation with lymphocytes and macrophages and/or that the chest tightness was directly attributed to airway inflammation. This clinical trial is registered at www.umin.ac.jp (UMIN13994 and UMIN 16741).

Pulmonary reversed halo sign as a presenting manifestation of rheumatoid arthritis.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 22 juillet 2014

Diagnostic challenges of tuberculous lymphadenitis using polymerase chain reaction analysis: a case study.

This report presents a case of tuberculous lymphadenitis that was difficult to diagnose using polymerase chain reaction analysis. An 80-year-old Japanese female was hospitalized due to swollen cervical lymph nodes. Her lymph node tests revealed paradoxical polymerase chain reaction results. Polymerase chain reaction analysis of two biopsy tissues using the Cobas TaqMan revealed a positive result for Mycobacterium avium and a negative result for Mycobacterium tuberculosis. However, polymerase chain reaction analysis of a cultured colony of acid-fast bacteria from biopsy tissue using the Cobas TaqMan and an alternative polymerase chain reaction analysis of biopsy tissue yielded discordant results. The patient was diagnosed as having tuberculous lymphadenitis. She was treated with antitubercular drugs and subsequently had a reduction in cervical lymph node swelling. Polymerase chain reaction analysis is not 100% accurate; hence, its use as a diagnostic tool for mycobacterial infection requires increased attention.