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1/390. Cancer-associated retinopathy in a patient with non-small-cell lung carcinoma.

    Cancer-associated retinopathy (CAR) is a paraneoplastic syndrome most often associated with small-cell lung carcinoma (SCLC), and it has been reported in patients with other malignancies. antibodies against recoverin, a 23-kDa protein, have been found in patients with CAR suggesting an autoimmune phenomenon. Herein is the first report of a patient with non-small-cell lung cancer (NSCLC) in whom anti-recoverin antibodies were detected in the serum. Steroid therapy, chemotherapy, and radiation therapy did not help the patient's vision. Progressive loss of vision in patients with lung cancer should, potentially, be tested for CAR. ( info)

2/390. Lessons from an unusual case: malignancy associated hypercalcemia, pancreatitis and respiratory failure due to ARDS.

    A 37-year old woman, presenting with severe hypercalcaemia-associated pancreatitis with pseudocyst formation, was admitted to intensive care because she developed ARDS with respiratory failure. Skeletal metastasis from non-small cell bronchial carcinoma were subsequently diagnosed. After she developed arterial occlusion in the lower limb, supportive treatment was withdrawn. Severe pancreatitis is an exceedingly unusual presentation of non-small cell bronchial carcinoma. Concepts of diagnostic and therapeutic strategies in the context of suspected unusual pathology, and the concept of futility are briefly discussed. ( info)

3/390. Unilateral lung volume reduction in preparation for contralateral pneumonectomy.

    A case of staged trans-sternal unilateral lung volume reduction (LVR) on the right followed by contralateral pneumonectomy for a locally advanced left lung malignancy is presented. The predicted symptomatic and functional benefit offered by LVR was felt to be necessary before the removal of the left lung. The patient, a 50-year-old male, with a history of chronic air flow limitation secondary to bullous emphysema, underwent a left pneumonectomy six weeks following a right LVR procedure for poor pulmonary function secondary to generalized emphysema. On admission, forced expiratory volume in 1 s (FEV1) was 1.37 L, 47% of predicted with an FEV1/forced vital capacity of 56%. Five weeks after the unilateral LVR, the patient's FEV1 was 1.85 L, and one year postdischarge from hospital, FEV1 was 0.9 L. One year after discharge, the patient did not require oxygen support, and was active and free of malignant disease. ( info)

4/390. Lung cancer, proptosis, and decreased vision.

    A 48-year-old man presented to the emergency department with a 3-day history of decreased vision in a painful proptotic right eye. The patient was being treated with chemotherapy and radiation for non-small cell lung carcinoma. Examination showed visual acuity of hand motions, decreased motility, and an afferent pupillary defect on the right, consistent with an orbital apex syndrome. neuroimaging revealed "dirty" orbital fat and no paranasal sinus disease. Orbital biopsy initially showed only fibrosis; however, on subsequent biopsies, nonseptate hyphae later identified as mucormycosis was recovered. The patient survived with exenteration and systemic amphotericin b. ( info)

5/390. Radiotherapy for adrenal gland metastasis from lung cancer: report of three cases.

    Adrenal gland metastasis is often observed during the clinical course of patients with lung cancer. However, treatment of adrenal gland metastasis is seldom considered because of the systemic spread of the disease. Treatment with curative intent is very rare, but palliative treatment may sometimes be considered when symptoms such as flank pain are observed. Three cases of adrenal gland metastasis were reported. Two of them received surgery for lung cancer and developed a sole metastasis of the adrenal gland. Case 1 developed a sole left adrenal gland metastasis with left flank pain 14 months after surgery for large cell carcinoma of the lung. Curative radiotherapy after intra-arterial chemotherapy was given. A good response was obtained, and he has been alive for 2 years and 9 months. Case 2 developed a right adrenal gland metastasis after radiotherapy for brain metastasis, after having received right upper lobectomy because of SCLC. The increase in the size of the right adrenal gland led us to treat the lesion before symptoms developed. Radiotherapy was given on an outpatient basis. Case 3, who was previously treated with chemoradiotherapy for SCLC, developed brain, liver, and bilateral adrenal gland metastasis. Huge adrenal gland metastases displaced the pancreas and caused severe pain with the increase in serum amylase level. Concurrent radiotherapy with systemic chemotherapy was given and remarkable shrinkage of the adrenal gland metastases was obtained together with pain relief. Cases 2 and 3 died after 8 and 4 months, respectively. In some cases, radiotherapy for adrenal gland metastasis is a good palliative therapy even in the advanced stage patients. Radiotherapy can sometimes curatively treat adrenal metastasis from NSCLC, as in our Case 1, in which adrenalectomy appeared difficult at the time of recurrence. ( info)

6/390. radiation-induced bronchial stenosis: a new cause of platypnea-orthodeoxia.

    Platypnea-orthodeoxia is encountered in a variety of cardiac, pulmonary, and hepatic disorders. We report its occurrence in a 59-year-old man who had had combined external-beam and high dose-rate iridium brachytherapy for a stage I non-small-cell carcinoma of the right upper lobe 2 years earlier. The post-radiation course was complicated by a severe radiation bronchitis; the onset of platypnea-orthodeoxia signalled the development of severe bronchial stenosis that was transiently relieved, initially by dilatation, and later by stent placement, though the patient ultimately died of a pulmonary hemorrhage. The dosage of brachytherapy given, the combined external-beam therapy, and the long survival after completion of radiation therapy were likely factors in the development of bronchial stenosis. We discuss the tomographic and bronchoscopic features of radiation-induced bronchial stenosis. ( info)

7/390. Paraneoplastic cicatricial pemphigoid.

    We report a 39-year-old woman with antiepiligrin cicatricial pemphigoid (CP) in association with non-small cell carcinoma of the lung. At presentation, mucosal lesions showed minimal response to combined systemic immunosuppressive agents. Following the diagnosis of non-small cell lung carcinoma and subsequent treatment with gemcitabine (a second-line chemotherapeutic agent), a significant reduction in both tumour mass and mucosal blistering was observed. Metastatic disease was subsequently associated with recurrent oral erosions. We believe this patient represents the first reported case of paraneoplastic CP. ( info)

8/390. Percutaneous brachytherapy for small-sized non-small cell lung cancer.

    A patient with a small-sized pulmonary adenocarcinoma was successfully treated by percutaneous high dose rate interstitial brachytherapy alone. The patient, who had an adenocarcinoma with 12-mm diameter in the lingular lobe of left lung, was judged to be inoperable because of poor pulmonary function due to emphysema and extensive pleural adhesion. The tumor was punctured with a 21-gauge fine applicator needle followed by the introduction of an iridium 192 (192Ir) radioactive source through the applicator needle using a remote afterloader. The tumor was irradiated for 225.1 s in one fraction. The tumor was in the inside of the iso-dose line of 40 Gy. The delivered doses calculated at nine reference points, which were 12.5 mm distant from the center of the tumor, distributed between 19.225 and 32.169 Gy, with a mean of 24.8 Gy. No apparent side effect including pneumothorax and hemoptysis was observed. The tumor shrank and showed no increment of the size for about 2 years. ( info)

9/390. The management of non-small-cell lung cancer: a case history.

    Accurate assessment and treatment of the patient with lung cancer requires a team approach involving respiratory physicians, cardiothoracic surgeons, oncologists and the palliative care team. Adequate staging and assessment of prognostic factors are essential before deciding what treatment is appropriate for an individual patient. Surgery is the mainstay of treatment for early disease. patients with medically inoperable stage 1 (T1, T2, N0) tumours should be considered for radical radiotherapy; additional chemotherapy in early stage disease may offer an additional survival advantage, but its overall role can only be assessed by further clinical trials. In more locally advanced tumours radical radiotherapy has never been formally tested. It is however, often used in patients where the tumour can be encompassed safely within a radiation field. This will depend on total dose and fractionation schedule as well as the volume of tissue irradiated. Neo-adjuvant chemotherapy prolongs survival in these patients. As only a few patients are cured, symptom control and quality of life are usually the most important goals of management and can be achieved by a variety of interventions. It is disappointing that in such a common disease less than 5% of patients are entered into clinical trials. Without such evidence the therapeutic outcomes in NSCLC cannot be improved. ( info)

10/390. Multimodality treatment of malignant superior vena caval syndrome.

    Malignant superior vena caval (SVC) syndrome due to non-small cell lung cancer is invariably fatal, with most therapy directed toward palliating the manifestations of the disease. A cure, by means of any modality, is unusual. We report a patient with SVC syndrome secondary to documented ipsilateral peritracheal nodal involvement (stage IIIB disease) who underwent neoadjuvant chemoradiotherapy and resection. At surgery, his superior vena cava was not involved and his tumor had been downstaged to stage I (T1 nanoseconds). He remains alive and free of disease 60 months after surgery. Neoadjuvant chemoradiotherapy may be used to downstage malignant SVC syndrome to resectable lesions in good functional candidates. ( info)
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