Improvement of the merthiolate-iodine-formalin (MIF) fecal technique for hookworm, Trichuris trichiura, and Ascaris lumbricoides eggs

A patient with a history of total thyroidectomy for papillary carcinoma showed a solitary hot spot in the chest on post-therapy radioiodine imaging. Subsequent evaluation demonstrated that this lesion was a primary squamous-cell lung cancer. Our case illustrates a rare but important differential diagnosis from lung metastasis of thyroid cancer in 131I scintigraphy. Alternatively, this "aberrant uptake" might be a rather common phenomenon for lung neoplasms, although the underlying mechanism is not yet known. Future experimental studies might lead to a new application of radioiodine imaging in pulmonary oncology.     

Intrapulmonary cystic lymphangioma: report of a case

We describe herein the case of a 52-year-old man found to have a solitary pulmonary lymphangioma. Computed tomography (CT) scan demonstrated a nodule with homogeneous density and a well-defined border in the lower lobe of the right lung. T2-Weighted magnetic resonance imaging (MRI) revealed a nodule with homogeneously high signal intensity. The tumor was removed by partial resection, and pathologic examination confirmed a diagnosis of primary lymphangioma of the lung.     

Imaging and lung disease: uses and interpretation

Diagnostic imaging has undergone a profound revolution since the first computed tomography (CT) unit was conceived in 1971; CT is now an integral part of daily practice in thoracic radiology, and has reached a relative technological maturity. Magnetic Resonance Imaging (MRI) has been introduced more recently. Technical difficulties still exist and are related to cardiac and respiratory motion. The storage-phosphor-based computed radiography system provides several advantages, including compensation for variations in exposure, but is still under evaluation especially in bedside radiography. Nevertheless careful plain film analysis still remains an important examination, and should be done before special procedures are taken to answer specific questions. Routine chest radiography is still the most frequent method of imaging employed today. Radiographic studies can suggest airway pathology such as atelectasis, endobronchial neoplasia or bronchiectasis, but CT provides a unique strategy for the localization and characterization of bronchial and pulmonary parenchymal disease. The most important role of CT is to determine, localize and characterize patterns within the pulmonary parenchyma, and correctly identify bronchiectasis even when bronchography is equivocal. In lung cancer, imaging has an important role in accurate staging with regard to the correct selection of patients and evaluation of prognosis. CT is one of the major tests used for staging. The staging system now adopted worldwide is based upon AJCC and ATS classification, and has two major components: anatomic extent of the disease (TNM) and cell types. The role of MRI with regard to lung cancer is not precisely determined. MRI can play a complementary role in the staging of lung cancer in cases of superior sulcus tumour; pericardial involvement, tumoral extension in subcarinal region and invasion of the superior vena cava. The radiologic detection of the solitary nodule is a difficult charge for the radiologist; CT provides the precise localization of the nodule and is reliable for analysing radiologic features such as calcification, cavitation, and spiculated borders. The problem remains of the discovery of an incidental benign pulmonary nodule in the patient with an extrathoracic malignancy, and often necessitates percutaneous biopsy under CT guidance. The evaluation of diffuse lung disease lies on pattern recognition. Chest radiography is the initial tool for diagnosis, high resolution CT (HRCT) can provide routine visualization of structures of less than 500 mu. HRCT can be useful in formulating a differential diagnosis with recognition of pattern and distribution of the disease.(ABSTRACT TRUNCATED AT 400 WORDS)     

Helicobacter pylori infection, gastritis, and the temperature of choice for hot drinks

A 44-year-old male presented with a solitary cerebellopontine angle (CPA) metastasis from lung cancer. His initial symptoms were vertigo and hearing loss beginning 5 months after the diagnosis of the primary cancer. Two months later, right facial paresis developed. His neurological deterioration was rapid. Magnetic resonance (MR) imaging with enhancement disclosed the CPA tumor. The tumor was partially removed through the retroauricular retromastoid approach. Histological examination of the specimen revealed adenocarcinoma. The characteristic rapidly progressive symptoms and MR imaging with enhancement are the most sensitive and essential examinations for this lesion.     

Pulmonary disease caused by Mycobacterium avium presenting as a solitary cavity with a thickened wall]

A 46-year-old man was admitted for evaluation of a solitary pulmonary cavity in the apey of the left lung. Because two transbronchial biopsies followed by brushing and washing and sputum cytology did not yield any diagnostic findings, the patient was treated with INH, RFP and SM under a tentative diagnosis of pulmonary tuberculosis. The shadow decreased over two months with combination therapy, but increased again after the dose of SM was decreased. We performed a left upper lobectomy to diagnose either multi-drug-resistant pulmonary tuberculosis or lung cancer. Pathological examination of the resected lung revealed epitheloid cell granulomas with areas of caseous necrosis. Smooth chromophoric colonies were isolated on an Ogawa egg medium, and were identified as M. avium by PCR and DDH. A diagnosis of pulmonary M. avium was made. A chest X-ray film taken two years later was normal. Pulmonary M. avium disease developed in this patient, who had no predisposing lung pathologies.     

Pulmonary neoplasm with solitary cerebral metastasis. Results of combined excision

Twenty-two patients underwent excision of a primary pulmonary neoplasm and solitary cerebral metastasis. Six patients had metastatic tumor removed on two occasions and there was one operative death in 28 craniotomies. Seven of 22 patients (32 per cent) survived one year following craniotomy and were free of significant symptoms for one year. Survival for at least 9 months and freedom from significant symptoms was achieved in a total of 12 patients (55 per cent). Relief of severe neurologic symptoms for a minimum of 3 months was achieved in 17 patients (77 per cent). The over-all one-year survival rate was 45 per cent and the average survival period is 14 months with 3 patients still living. The following factors had a favorable bearing on the outcome: Stage 1 lung cancer at pulmonary resection, whole-brain radiation therapy, and a longer interval between pulmonary resection and cerebral metastasis. The experience encourages us to pursue an aggressive surgical approach to pulmonary neoplasm and solitary cerebral metastasis.     

The utility of a somatostatin-type receptor binding peptide radiopharmaceutical (P829) in the evaluation of solitary pulmonary nodules

OBJECTIVE: Many neoplasms including small cell cancers more densely express somatostatin-type receptors or more avidly bind somatostatin than granulomatous and other nonmalignant processes. While non-small cell neoplasms of the lung have not yet been shown to demonstrate this receptor expression, previous studies have documented non-small cell lung cancer detection with somatostatin analog scintigraphy. This phenomenon can be conceivably exploited utilizing technetium Tc-99m P829 (P829), a unique low molecular weight somatostatin-type receptor binding polypeptide radiopharmaceutical. The objective of this study was to determine the ability of P829 scintigraphy to noninvasively differentiate malignant and nonmalignant solitary pulmonary nodules (SPNs). METHODS: The radiopharmaceutical technetium 99mTc-P829 was utilized for scintigraphy including single photon emission computed tomography. Thirty individuals with indeterminate SPNs of > or = 1 cm and significant risk factors for primary lung cancer were identified and underwent P829 scintigraphy. Tissue diagnosis was then established by transthoracic needle biopsy specimens. RESULTS: Fourteen subjects demonstrated abnormal P829 scans in the region of the radiographic abnormality. Twelve of this group had biopsy specimens revealing neoplasia. Two subjects with necrotizing granuloma on biopsy specimen had abnormal P829 scans in the region of the nodule. Sixteen subjects had no abnormal P829 tracer uptake in the region of the nodule. Fourteen subjects had benign diagnoses on biopsy specimens. One member of this group with a non-diagnostic biopsy specimen refused thoracotomy and remains radiographically stable at 24 months of follow-up. One subject with a squamous cell carcinoma demonstrated no P829 activity in the region of the nodule. The specificity of P829 scintigraphy based on transthoracic needle biopsy specimen was 88%. The sensitivity was 93%. P829 scintigraphy correctly identified or excluded malignancy in 27 of 30 subjects. CONCLUSIONS: P829 scintigraphy reliably identified or excluded malignancy in radiographically indeterminate solitary pulmonary nodules. The sensitivity and specificity compared favorably with the reported results of F-18 fluorodeoxyglucose positron emission tomographic imaging.     

MR images of mycobacterial infection

With the progress of imaging technologies such as CT and MR imaging, we can obtain various informations from CT and MR images. Especially, thin-section high resolution CT (HRCT) provides very useful information for the diagnosis of mycobacterial infection and other diseases of pulmonary parenchyma. Advantages of MR images over HRCT are higher tissue contrast and multidirection capability. The T2-weighted images and Gd-DTPA enhanced T1-weighted images accurately reflect pathologic structure of the lesion. Therefore, MR images can add many useful findings to CT on the selected cases which are differentiation of tubercloma from lung cancer, chronic empyema from mesothelioma, aspergiloma from lung cancer and lymphadenopathy from lymph node metastasis. We describe the usefulness of MR images for diagnosing mycobacterial infection and its differentiation from other pulmonary diseases.     

Diagnosis of lung cancer using functional image of 201Tl SPECT with parameter of 201Tl retention--evaluation of its applicability to post irradiated lung cancer

Thallium-201 (201Tl) SPECT is a useful method for detecting lung cancer. Moreover, the 201Tl Retention Index (R.I.) reported by Tonami et al is now available for differentiating pulmonary lung cancer from benign lesions. The diagnosis of recurrent tumors is, however, difficult to establish as they are often shaded by radiation pneumonitis or fibrosis. Therefore, we employed functional images (F.I.) obtained using as parameter a modified version of the R.I. First we indicated the statistical value of untreated solitary lung tumor as follows: sensitivity 84.6%, specificity 80.0%, and accuracy 83.3%. In our assessment, the lesions with tumor size over 2.0 cm and R.I. by Tonami et al over 12.7 were detected as positive images. Secondly in assessment of 22 cases (23 lesions) of post irradiated lung cancer, the results obtained were: sensitivity 80.0%, specificity 92.3%, and accuracy 87.0%. 201Tl SPECT functional images seem to be useful for the diagnosis of recurrent lung cancer by shaded radiation pneumonitis and fibrosis.     

Dirofilaria, visceral larva migrans, and tropical pulmonary eosinophilia

Helminthic infections are prevalent worldwide. The intestinal ascarid, Toxocara, the animal filarial parasite, Dirofilaria, and the human filarial parasite, Wuchereria or Brugia, produce an array of pulmonary disease in humans. Infections are common in temperate, tropical, and subtropical regions of the world. Pulmonary dirofilariasis is essentially an asymptomatic disease. Most cases are diagnosed accidentally after thoracotomy for a solitary pulmonary nodule presumed to be lung cancer. Clinical manifestations of toxocariasis or visceral larva migrans (VLM) are the result of allergic and inflammatory responses of the host, and manifest with airway reactivity, acute pneumonia, and persistent eosinophilia. VLM is a self-limited disease and specific treatment is rarely necessary. In acute cases, a short course of steroids reduces morbidity and mortality but preventive measures are more important in curbing toxocara infection. Tropical pulmonary eosinophilia (TPE) is the result of immunologic hyperresponsiveness to the human filarial antigen and eosinophils play a crucial role in its pathogenesis. Airway hyperreactivity, extreme eosinophilia, and pulmonary physiologic impairment are the characteristic features. Treatment of TPE with diethylcarbamazine results in dramatic amelioration of symptoms. However, low grade inflammation persists in a significant number of patients and can lead to chronic interstitial lung disease. Mass treatment of patients in certain endemic areas has been effective in eliminating TPE.     

Pulmonary delivery of nanoparticles of insoluble, iodinated CT X-ray contrast agents to lung draining lymph nodes in dogs

Lung cancer continues to be a leading cause of death around the world. Staging of this disease is critically dependent upon the involvement or noninvolvement of the lymph nodes which drain the region of lung containing the lesion/tumor. Palpation, unenhanced CT, and lymph node excision (i.e., mediastinectomy) are currently used to ascertain the status of these regional draining lymph nodes. The work reported herein details the first efforts toward the pulmonary instillation of iodinated nanoparticles for contrast-enhanced CT of lung draining lymph nodes. The data reflect the impact of dose, time post instillation, and formulation (surfactant) upon the observed CT enhancement of the tracheobronchial lymph nodes of beagle dogs. In addition, initial safety is discussed with both macroscopic and microscopic observations. The results indicate that pulmonary instillation of small volumes of iodinated nanoparticles could be successfully used to aid staging of lung cancer by CT imaging.     

Long-term survival after bilateral adrenalectomy for metastatic lung cancer: a case report

Selected patients with solitary metastases from non-small cell lung cancer can benefit from an aggressive treatment approach that includes resection of the metastases. This approach has been used for solitary adrenal metastases, but successful long-term treatment of bilateral adrenal metastases has not been previously reported. This is the report of a patient with bilateral adrenal metastases from lung cancer who is disease-free 9 years after bilateral adrenalectomy and chemotherapy. From this evidence, one may hypothesize that adrenal metastases are occasionally lymphatic in origin and that metastases with this route of spread are more amenable to aggressive curative treatment than adrenal metastases of hematogenous origin.     

Likelihood of malignancy in a solitary pulmonary nodule: comparison of Bayesian analysis and results of FDG-PET scan

OBJECTIVE: To compare the probability of cancer in a solitary pulmonary nodule using standard criteria with Bayesian analysis and result of 2-[F-18] fluoro-2-deoxy-D-glucose-positron emission tomographic (FDG-PET) scan. SETTING: A university hospital and a teaching Veteran Affairs Medical Center. METHODS: Retrospective analysis of 52 patients who had undergone both CT scan of the chest and a FDG-PET scan for evaluation of a solitary pulmonary nodule. FDG-PET scan was classified as abnormal or normal. Utilizing Bayesian analysis, the probability of cancer using "standard criteria" available in the literature, based on patient's age, history of previous malignancy, smoking history, size and edge of nodule, and presence or absence of calcification were calculated and compared to the probability of cancer based on an abnormal or normal FDG-PET scan. Histologic study of the nodules was the gold standard. RESULTS: The likelihood ratios for malignancy in a solitary pulmonary nodule with an abnormal FDG-PET scan was 7.11 (95% confidence interval [CI], 6.36 to 7.96), suggesting a high probability for malignancy, and 0.06 (95% CI, 0.05 to 0.07) when the PET scan was normal, suggesting a high probability for benign nodule. FDG-PET scan as a single test alone was more accurate than the standard criteria and standard criteria plus PET scan in correctly classifying nodules as malignant or benign. CONCLUSION: FDG-PET scan as a single test was a better predictor of malignancy in solitary pulmonary nodules than the standard criteria using Bayesian analysis. FDG-PET scan can be a useful adjunct test in the evaluation of solitary pulmonary nodules.     

The approach to the patient with single and multiple liver metastases, pulmonary metastases, and intra-abdominal metastases from colorectal carcinoma

Recurrent colorectal carcinoma constitutes a major health care problem, with 90,000 patients diagnosed annually with metastatic disease. Recent advances have offered treatment to selected patients with liver, lung, and intra-abdominal metastases. Resection of liver secondary tumors improves 5-year survival from 0% to approximately 30% and offers the only possibility for cure. As experience mounts, hepatic surgery can be performed with quite acceptable morbidity and mortality. Adjuvant therapies are being developed that may improve results with surgery alone. Cryoablation is a new technique that appears to effectively eradicate liver tumors, but its role remains to be defined. In patients with unresectable disease, the benefit of hepatic artery infusion of chemotherapy is unproven. Resection of pulmonary metastases significantly improves survival in patients with solitary nodules. Consistent data regarding the benefit of pulmonary metastatectomy in patients with multiple nodules are not available. Combined cytoreductive surgery and intraperitoneal hyperthermic chemotherapy is being investigated as a treatment for peritoneal carcinomatosis from colorectal cancer. Although selected patients may benefit, this combined treatment modality appears to be less effective in patients with colorectal cancer than with other types of cancer.     

Primary and secondary pulmonary tumors associated with head and neck carcinoma

The authors analyze personal and literature results in surgery of primary and secondary lung cancer associated with head and neck malignancies. Eighteen patients with primary lung cancer associated with head and neck cancer were compared with six patients affected by pulmonary metastases from head and neck cancer. In the first group the 3-year postoperative survival rate was 60.5%, in the second group 33%. Differential diagnosis between primary and metastatic lung tumours may be easy when multiple pulmonary nodes are present. When only one pulmonary node is present, diagnosis is more difficult. Thoracotomy is necessary to perform the correct diagnosis and the best postoperative medical treatment.     

Pharmacokinetics of tacrolimus (FK506) in primary orthotopic heart transplant patients

STUDY OBJECTIVES: Local recurrence is high when sublobar resection is chosen as primary management of stage I non-small cell lung carcinoma. Postoperative external-beam radiotherapy may reduce this local recurrence problem. A technique of intraoperative brachyradiotherapy following thoracoscopic wedge resection is described as an alternative to adjuvant external-beam radiotherapy for high-risk patients who are not candidates for pulmonary lobectomy. PATIENTS: Fourteen patients with significant impairment in cardiopulmonary function having small peripheral solitary pulmonary nodules underwent video-assisted thoracoscopic (VATS) wedge resection and were found to have non-small cell cancer. Surgical margins were pathologically clear and mediastinal nodes were benign-stage I (T1NO). INTERVENTIONS: A custom polyglyconate mesh (Vicryl) containing 125I seeds was applied to pulmonary resection margins following wedge resection of peripheral lung cancers. A total dose of 100 to 120 Gy at 1 cm was applied to the target area. RESULTS: All patients had histologically clear surgical margins. Postoperative dosimetry confirmed adequate resection margin coverage. There was neither operative mortality nor morbidity related to the VATS wedge resection or the brachytherapy implants. Implants did not migrate, and there were no cases of significant radiation pneumonitis or local recurrence at mean follow-up of 7 months (range, 2 to 12 months). CONCLUSIONS: Intraoperative brachytherapy appears to be a safe and efficient alternative to external-beam radiation therapy when adjuvant radiotherapy is considered following therapeutic wedge resection of stage I (T1NO) lung cancers. The impact on local recurrence, disease-free interval, and survival will require additional follow-up.     

Surgical results of T3 lung cancer with combined resection

Forty six patients with T3 lung cancer underwent pulmonary resection in our institutes. The actual survival rate of lung cancer patients with invasion in pericardium at five years is significantly higher than that in parietal pleura and chest wall (63.5% vs 13.2%, 11.1%). The survival rate of patients with large cell lung cancer is significantly lower than that with squamous cell lung cancer and small cell lung cancer (0.0% vs 39.9%, 16.7%). It is suggested that T3 large cell lung cancer patients might be contraindication of pulmonary resection. The five-year survival rate of patients with n0, n1, n2 disease are 35.5%, 66.7%, 6.7% respectively. There are significant differences in survival rate between patients with n0 + n1 and n2 disease.     

Managing solitary pulmonary nodules

A solitary pulmonary nodule (SPN) on a chest radiograph represents a major diagnostic dilemma. The goals of management are to resect malignant tumors without delay and to avoid unnecessary thoracotomy if the nodule is benign. But because of the difficulty distinguishing benign from malignant nodules, even with advances in imaging techniques, these goals cannot be met in all cases.     

Alpha and omega: studying resuscitation at the beginning and end stages of life

BACKGROUND: To clarify whether or not multiple pulmonary metastases from colorectal cancer are contraindicated for a surgical resection, we retrospectively evaluated the influence of the number of pulmonary metastases on both the postthoracotomy survival and the pattern of the first failure. METHODS: From 1981 to 1993, 36 patients underwent a complete resection for pulmonary metastases from colorectal cancer. RESULTS: Of the various factors investigated including gender, primary site, disease-free interval, tumor size, the number of metastases, type of resection, and the history of hepatic metastases, only the number of pulmonary metastases was found to be significantly related to postthoracotomy survival. The rate of disease-free survival at 5 years was 62% for solitary metastasis (n = 17), 35% for two metastases (n = 8), and 0% for four or more metastases (n = 11). The pattern of failure also differed according to the number of pulmonary metastases. In particular, the incidence of local recurrence at the primary site increased with the number of pulmonary metastases (ie, 1 of 17 patients with a solitary metastasis, 3 of 8 with two metastases, and 6 of 11 with four or more metastases). CONCLUSIONS: These results suggest that multiple metastases might indicate the presence of local recurrence at the primary site; therefore, in cases of multiple pulmonary metastases, the primary site should be thoroughly explored.     

Halothane acts on many potassium channels, including a minimal potassium channel

Three patients who had genitourinary cancer combined with lung cancer are reported. One patient had pulmonary adenocarcinoma and bladder transitional cell carcinoma, one had small cell lung cancer and squamous cell carcinoma of the penis, and one had large cell lung carcinoma and prostatic adenocarcinoma. In Japan, where society is aging rapidly, cases of multiple primary cancer with lung and genitourinary cancers are expected to increase considerably in the future.