During the past 9 years and 2 months we have encountered 33 cases with cerebellar infarction. These patients were classified into 3 types according to their clinical course. Type 1 (18 cases); The course was benign, and symptoms and signs improved without surgical treatment. Type 2 (11 cases); The course was progressive with deterioration of consciousness between 24-72 hours after the onset. Type 3 (4 cases); The course was rapid resulting in lapse into coma within a few hours. Also, its prognosis was fatal due to coexisting brain-stem infarction regardless of any treatment. Surgical intervention was required for Type 2 in which the lesion included the region of the vermis or occupied more than one-third of the cerebellar hemisphere, and had subsequently compressed the brain-stem and caused obstructive hydrocephalus. In 9 cases out of Type 2, ventricular drainage alone was performed and prompt improvement of consciousness level was detected except in one case. We consider that ventricular drainage is not so invasive a method, and it is beneficial. However, in 2 cases of Type 1 and 4 cases of Type 2, hemorrhagic infarction occurred. Thus, one should be aware of the possibility of hemorrhagic infarction, even though it may be asymptomatic infarction. If prompt improvement of consciousness is not detected after ventricular drainage, suboccipital craniectomy should be recommended.
Serial measurements of serum CEA levels were analyzed in 226 patients with inoperable lung cancer (115 small cell carcinomas, 64 adenocarcinomas, 37 squamous cell carcinomas and 10 large cell carcinomas) during chemotherapy. Of all patients, 29.1% had pretreatment CEA levels greater than or equal to 5 ng/ml. In all of the patients with complete response, and 15 (68.2%) of 22 patients with partial response whose pretreatment CEA levels were 5 ng/ml or higher, CEA levels fell to below 5 ng/ml. All of 17 patients who showed a decrease greater than 50% in serum CEA levels during chemotherapy showed a shrinkage of more than 50% in the tumor burden. Serial serum CEA level measurements were useful as an indicator of response to chemotherapy in advanced lung cancer. Serial serum NSE levels were measured in 36 patients with small cell lung cancer. Pretreatment NSE levels were elevated to more than 10 ng/ml in 83.1% of all patients. A transient rise in serum NSE levels occurred in 22 out of 33 patients measured on the third day during initial chemotherapy. Serum NSE levels greater than or equal to 10 ng/ml declined to within the normal range in all patients responding to the chemotherapy. The survival in patients whose NSE levels (greater than or equal to 10 ng/ml) fell to within the normal range for more than four weeks was longer than that in other patients. Serial measurements of serum NSE levels were thus useful for monitoring the response to chemotherapy in cases of small cell lung cancer.
The authors report on their experience with 14 cases of cerebellar arteriovenous malformation (AVM), with emphasis on their clinical symptoms and treatment problems. The incidence of cerebellar AVM was 7.5% in all cases of intracranial AVM. Twelve of them presented with hemorrhages, one with a headache and one with a focal neurological deficit related to the "steal" phenomenon. Three out of 4 poor risk patients with intracerebellar hematoma recovered well after their operations. Thus, we can say that surgical treatment should be performed even if the patient's state seems hopeless. The nidus was located at the vermis in 7, at the cerebellar hemisphere in 5, and at the tonsil in 2 cases. The surgical approach to the superior surface of cerebellum or the tonsil near the brainstem became a problem. In our series, all surgically treated cases were approached through the suboccipital route with the patient in the prone position and the surgical results were favorable. On the other hand, one case which underwent conservative treatment died due to rebleeding. Thus, as the follow-up mortality with conservative treatment is higher and the results of surgery are better, surgical treatment should be attempted. Preoperative MR imaging is one of the useful methods used to determine whether an excision is possible without significant deficit, especially in cases in which the AVM is located near the brain stem. In our series, two patients had concomitant aneurysms related to feeding arteries. Another interesting case of a neonate who had a small tonsillar AVM is reported.
PURPOSE We conducted a phase I trial of irinotecan (CPT-11), a topoisomerase I inhibitor, combined with etoposide, a topoisomerase II inhibitor, and recombinant human granulocyte colony-stimulating factor (rhG-CSF) support because of the overlapping neutrophil toxicity of both drugs. The aim was to determine the maximum-tolerated dose of CPT-11 combined with a fixed dose of etoposide in patients with advanced lung cancer, as well as the dose-limiting toxicities of this combination. PATIENTS AND METHODS Twenty-five patients with stage III or IV lung cancer, 15 (60%) with prior chemotherapy, were treated at 4-week intervals using CPT-11 (90-minute intravenous infusion on days 1, 8, and 15) plus etoposide (80 mg/m2 intravenously on days 1 to 3). In addition, rhG-CSF (2 micrograms/kg/d) was given from day 4 to day 21, except on the days of CPT-11 administration. The starting dose of CPT-11 was 60 mg/m2, and it was escalated in 10-mg/m2 increments until the maximum-tolerated dose was reached. RESULTS The maximum-tolerated dose of CPT-11 was 90 mg/m2, since two of the three patients developed grade 3 to 4 leukopenia or grade 3 to 4 diarrhea during the first cycle of treatment at this dose level. Diarrhea and leukopenia were the dose-limiting toxicities, while thrombocytopenia was only a moderate problem. Elimination of CPT-11 was biphasic, with a mean +/- SD beta half-life of 18.17 +/- 9.09 hours. The mean terminal half-life of 7-ethyl-10-hydroxycamptothecin (SN-38; the major metabolite of CPT-11) was 43.40 +/- 37.84 hours. There was one complete response (5%) and eight partial responses (38%) among 21 assessable patients, for an overall response rate of 43%. The response rates for small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) were 58% (seven of 12 patients) and 22% (two of nine patients), respectively. CONCLUSION The combination of CPT-11 and etoposide with rhG-CSF support seems to be active against lung cancer, especially SCLC, with acceptable toxicity. The recommended dose for phase II studies in previously untreated patients is 80 mg/m2 of CPT-11 (days 1, 8, and 15) and 80 mg/m2 of etoposide (days 1 to 3) plus 2 micrograms/kg of rhG-CSF (days 4 to 21, except when CPT-11 is given). In addition, 70 mg/m2 of CPT-11 appears to be the appropriate dose for previously treated patients receiving this regimen.
With the development of extracorporeal shock wave lithotripsy treatment, the duration of hospitalization for stone patients fortunately has become shorter. However, a detailed analysis of lithogenesis is not possible during such patients' short hospital stays. We prepared a standard diet to be eaten at home for investigation of lithogenesis at the out-patient clinic. This diet was nutritionally well-balanced and contained the following: energy: 2000 Kcal, total protein: 70-75g, animal protein: 30-35g, carbohydrate: 510g, fat and oil: 50-60g, calcium: 600-630mg and magnesium: 320mg. The urine of 24 male patients with stones on a free diet and the same patients after 3 days on the standard diet was analyzed for urea-nitrogen, uric acid, sodium, calcium, phosphorus, magnesium, citric acid and oxalic acid. The results were compared with those in 17 healthy male subjects who were eating the standard diet (controls).It was found that 66% of hypercalciuria (>=300mg/day) on a free diet became normocalciuria on the standard diet. The hypercalciuria was therefore thought to be of dietary origin. Moreover, urinary excretion of urea nitrogen, uric acid, sodium and phosphorus by patients remarkably decreased after 3 days on the standard diet, which was not different from that of controls.These results suggest that the standard diet at home is useful in the screening of hypercalciuria and also quite adequate for patients with stones.
7638 Background: There are a large number of global clinical trials ongoing for patients with non-small cell lung cancer (NSCLC). Ethnic difference in toxicity has not been fully studied. Methods: We performed a systematic search of PubMed for phase II (PII) and phase III (PIII) trials of NSCLC from January 2000 to December 2009 to examine ethnic difference in hematological toxicity due to cytotoxic chemotherapy. Ethnicity was classified into Asian and non-Asian (mostly Caucasian). We chose the treatment regimens that were commonly used globally including carboplatin (CBDCA) plus paclitaxel (PTX), cisplatin (CDDP) plus gemcitabine (GEM), and CDDP plus vinorelbine (VNR) for NSCLC. Because ethnicity origins were not fully reported in the entire trials, we applied sensitivity analysis by changing the percentage of Asian patients from 5 to 15% in the trials reported from the United States and Europe. In these analysis, the percentage of toxicity in the Asian patients was settled as the mildest toxicity in the trials collected. Results: We identified 12 PII and 38 P III trials (11,271 patients), and the 14 trials had reported ethnicity origins. Grade 3-4 toxicities were more frequently observed in the Asian studies. Based on sensitivity analysis, odds ratio for the risk of grade 3 or greater toxicities (neutropenia and anemia) was higher in Asian. Although there was no significant association between median survival time (MST) and degree of neutropenia, MST was better in the Asian study (12.2 month vs. 9.6 months, p=0.012). Conclusions: Severe hematological toxicity was frequently observed in Asian patients compared with non-Asian (mostly Caucasian) in treatment of chemotherapy for NSCLC. Neutropenia Anemia Thrombocytopenia CBDCA + PTX,* odds ratio** 70.9% vs. 33.7%(p < 0.0001), 2.1-3.2 10.8% vs. 7.4%(p < 0.0001),1.2-1.4 8.8% vs. 6.5%(p = 0.11),1.1-1.2 CDDP + GEM,* odds ratio** 53.9% vs. 25.3%(p < 0.0001),1.1-1.7 24.7% vs. 9.2%(p < 0.0001),1.6-2.1 28.0% vs. 16.0%(p < 0.001),0.8-1.2 CDDP + VNR,* odds ratio** 77.2% vs. 36.7%(p = 0.02),1.9-3.0 23.9% vs. 10.0%(p < 0.0001),2.0-2.4 1.9% vs. 4.5%(p = 0.20),0.3-0.4 * Asian trials vs. non-Asian trials. ** Asian against non-Asian in sensitivity analysis. No significant financial relationships to disclose.
