Serum alanine aminotransferase as an early marker of outcomes in patients receiving anti-PD-1 or anti-CTLA-4 antibody.

Immune-oncology (IO) drug therapy is effective against various types of cancer. Although several, potential, clinical predictive markers have been identified, none so far have proven reliable. Herein we evaluated changes in serum alanine aminotransferase (ALT), which is upregulated by the accumulation of activated CD8+T cells in the liver, as a potentially reliable predictive marker. We retrospectively analyzed 265 patients with advanced malignancies at three institutions between 2016 and 2019. The patients received IO drug therapy. We defined the ALT ratio (ALR) as the serum ALT value at baseline / the highest serum ALT during IO drug therapy, then determined whether the ALR correlated with the objective response rate or progression-free survival. The median follow-up was 3.1 months. We observed objective responses in 65 patients. The ALR ranged from 0.19 to 32.2 (median 1.5), and a significant ALR increase was observed in responders (p < 0.001). In receiver operating characteristic analysis, ALR = 1.55 had the highest sensitivity and specificity. The patients with ALR < 1.55 had a significantly poorer PFS than those with ALR ≥ 1.55. A high ALR was associated with a tumor response and good PFS in patients with advanced malignancies. The ALR based on activated cytotoxic T lymphocyte dynamics is therefore a reliable predictive marker.

[Thoracic Spinal Chordoma Need to be Differentiated from the Bacteremia-associated Paravertebral Abscess].

A 71-year-old woman presented to our hospital with fever and dyspnea. Computed tomography showed shadows of bilateral pneumonia and anterior vertebral mass. She was admitted to our hospital for respiratory failure. Despite treatment with antibiotics, she developed right thoracic empyema. A high level of inflammation and fever persisted, despite chest tube drainage and continued treatment with antibiotics. Therefore, thoracoscopic curettage was conducted. The histopathological findings of the curetted anterior vertebral body lesion revealed the diagnosis of chordoma. After confirming that all the culture results and inflammation findings had turned negative, the patient was discharged from the hospital. Thoracic vertebral chordoma is being treated at the department of orthopedics.

Multiple atypical thymic carcinoids with paraneoplastic giant cell arteritis.

Multiple thymic carcinoids are rare, and giant cell arteritis (GCA) is one of the less recognized paraneoplastic diseases. The co-occurrence of these two diseases is therefore extremely rare. We report herein a patient with multiple atypical thymic carcinoids and asymptomatic paraneoplastic GCA. All the thymic carcinoids were diagnosed histopathologically as atypical thymic carcinoids with an intrathymic metastasis. Treatment consisted of a complete tumor resection followed by observation of the GCA without any adjuvant therapy. Subsequent positron emission tomography revealed a decrease in F-fludeoxyglucose accumulation in the systemic arteries. Based on these findings, paraneoplastic GCA was diagnosed. Thymic carcinoids rarely involve intrathymic metastasis or cause neopleonastic GCA. However, when they do, a complete tumor resection is the best option for management.

Fabricated bronchial artery embolization for hemoptysis using a coil.

BACKGROUND: Bronchial artery embolization is considered a conservative form of therapy for hemoptysis. This study aimed to examine the short- and long-term effects of bronchial artery embolization, as well as the performance of the coils used in our hospital. METHODS: We reviewed the background, symptoms, findings, and prognosis of 27 cases of bronchial artery embolization for hemoptysis between April 2003 and October 2011. For embolization materials, short coils combined with a long interlocking detachable coil were mainly used from March 2008. RESULTS: Aspergillosis and chronic empyema comprised the majority of cases. In terms of short-term results, there were 25 successful cases of bronchial artery embolization and 2 unsuccessful cases. Regarding the long-term outcome of the successful cases, during an average observation period of 17 months, one patient required repeat bronchial artery embolization, and one was admitted to another hospital with recurrent hemoptysis. CONCLUSIONS: Bronchial artery embolization for hemoptysis was preformed in a safe and minimally invasive manner with positive results over both the short- and long-term, thus underscoring its utility as a form of treatment. Furthermore, by combining the use of long and short coils, we were able to reduce the number of coils necessary for the procedure, and thus reduce the time and cost involved.

Successful excision of an isolated mediastinal cystic lymphangioma with bilateral thoracoscopic surgery.

Lymphangioma is a well-known benign tumor and its cystic abnormalities of the lymph vessels are predominantly congenital. Cystic lymphangioma usually occurs in the neck, axillary region, and rarely in the mediastinum, which frequently occurs in children and young adults. A 20-year-old woman had symptoms of palpitation, cough, and dyspnea during the recent 1 month. Both chest comuted tomography and magnetic resonance imaging of the chest revealed a well-defined, 13 × 10-cm cystic lesion in the anterior mediastinum. The patient underwent bilateral video-assisted thoracoscopic excision of the cyst and lymphangioma was confirmed based on histopathologic examination. Here, we report a rare case of isolated mediastinal cystic lymphangioma that was successfully excised using a minimally invasive technique.

[A cluster of paragonimiasis westermani infections in Thai immigrants].

We report a cluster of infections in four female Thai immigrants aged between 35 and 49 years who developed paragonimiasis westermani within 16 months of ingesting freshwater crabs purchased from a market in Japan. Their symptoms included cough, bloody sputum, chest pain, and dyspnea. Radiographic and CT findings comprised pleural effusion, pneumothorax, air-space consolidation, and nodular opacities. Paragonimus eggs were identified in the feces of one patient, and in the pleural effusion and the bronchoalveolar lavage fluid (BALF) of another. All diagnoses of paragonimiasis westermani were established by enzyme-linked immunosorbent assay (ELISA) of their serum. Paragonimiasis is a re-emerging disease in Japan. Moreover, since the number of immigrant patients is increasing, it is necessary to pay attention to infectious diseases resulting from their eating habits as well as imported diseases.

Long-term clinical outcome after extended thymectomy combined postoperative high-dose steroid therapy for juvenile myasthenia gravis.

Myasthenia gravis (MG) is considered to be an autoimmune disorder of neuromuscular transmission and is rare in childhood. We report 3 juvenile MG (JMG) cases of extended thymectomy (ETMX) combined postoperative high-dose steroid therapy. All patients developed MG symptoms under the age of 14 years and were given cholinergic drugs and had generalized MG: the Myasthenia Gravis Foundation of America classification II was present in 1 case and classification III was in 2. All patients were taking pyridostigmine before surgery; none was treated with prednisone preoperatively. All patients performed the ETMX combined postoperative high-dose steroid therapy. Muscle weakness of extremities and bulbar symptoms improved in all patients, but not all exhibited an unstable phase in their clinical course as a result of combined therapy. There was no postoperative morbidity or mortality. All patients had follicular lymphoid hyperplasia without thymoma. Follow-up for more than 5 years has shown one to be in complete remission and the others to have improved symptoms. Although our results are inconclusive because we used only a few JMG patients, the ETMX combined postoperative high-dose steroid therapy appeared to provide a better chance of remission or control of symptoms.

Traction versus supine side-bending radiographs in determining flexibility: what factors influence these techniques?

STUDY DESIGN: Prospective clinical, radiologic study of adolescent idiopathic scoliosis (AIS). OBJECTIVE: We evaluated a Cobb angle in standing position, patient age, the level of the apex, and the number of involved vertebrae in patients with AIS to determine whether the corrective ability of traction or side-bending radiographs was superior. SUMMARY OF BACKGROUND DATA: Side-bending and traction radiographs are used to evaluate curve flexibility during corrective surgery for AIS despite notable differences in the flexibilities of identical curves. Thus, interpretation for the differences among these techniques should be investigated. METHODS: A total of 229 consecutive patients with AIS who were surgically treated were evaluated. Standing, supine side-bending, and traction radiographs were obtained before surgery. Curves were divided into main thoracic (MT) or thoracolumbar/lumbar (TL/L) curves, and proximal thoracic (PT) curves. We evaluated the Cobb angle in standing position, the level of the apex, the number of involved vertebrae, kyphosis angle of main thoracic curve, and patient age in patients with AIS to determine whether the corrective ability of traction or side-bending radiographs was superior. RESULTS: A total of 219 curves were observed in MT lesions. The traction flexibility rate (FR) was higher than the side-bending FR at angle of > or = 60 degrees (P = 0.02), in patients younger than 15 years (P = 0.02), in curves whose apex was located at T4-T8/T9 (P = 0.01), in curves whose involved vertebrae were 6 or 7 (P = 0.02), and at kyphosis angle between 10 degrees and 39 degrees (P = 0.02). In 96 TL/L curves, side-bending FR was higher at angle of < 60 degrees (P < 0.01). In 163 PT curves, traction FR was higher at angles of > or = 40 degrees (P = 0.02). CONCLUSION: In addition to a Cobb angle, patient age, the level of the apex, and the number of involved vertebrae also influence the conditions under which the corrective ability of traction radiographs is superior to that of side-bending radiographs.

[A case of lung cancer showing a bronchial cast shadow caused by impaction of the squamous cell carcinoma itself].

A 69-year-old man presented with bloody sputum. Chest X-ray showed a trabecular shadow in the right upper lung field. Chest CT showed a bronchial cast shadow in the right B3a, extending along the bronchial bifurcations to the periphery. Impaction of the bronchus was suspected. Sputum cytology was class IIIb. Though bronchoscopic examination did not reveal a tumor or obstruction at the orifice of the right B3a, squamous cell carcinoma was diagnosed by biopsy. Right upper lobectomy was performed. Pathologically, the tumor was diagnosed as moderately differentiated squamous cell carcinoma, measuring 25 x 20 x 10mm in size. The tumor showed intrabronchial branching growth into the peripheral site of the right B3a and neither mucoid nor inflammatory granulation tissue was present. Impaction of the bronchus was made up by the squamous cell carcinoma itself. Lung cancer originating in subsegmental or sub-subsegmental bronchi, showed bronchial cast appearance due to intrabronchial growth is very rare.

[A case of desmoid tumor involving the posterior mediastinum].

A 36-year-old woman visited our department because of back pain. Chest CT showed the 35 x 20 mm mass to be located in the left posterior mediastinum. Neurogenic tumor or pulmonary sequestration was suspected. We followed the tumor for 2 years, chest CT revealed an increase in size. En bloc resection of the tumor was performed. The tumor originated in the posterior mediastinum, protruded into the thoracic cavity and adhered to the left lower lobe and invaded the diaphragm, measuring 65 x 50 x 25 mm in size. This tumor was diagnosed pathologically as desmoid tumor which showed proliferation of spindle shape cells with collagen fibers, but with no cytologic atypia or mitotic figures were present. The tumor was alpha smooth muscle actin-positive, vimentin-positive, CD34-negative. Desmoid tumor of the posterior mediastinum is very rare. Desmoid tumors grow infiltratively and the recurrence rate after operation is high. Therefore, long-term follow up will be necessary in this case, although the patient has been well for 10 months.

Surgically treated dumbbell schwannoma arising in the brachial plexus with intrathoracic extension.

We report excision of a brachial plexus dumbbell tumor in the superior mediastinum in single-stage surgery via an anterior approach. A 40-year-old man found in the chest radiography to have a 3.5 cm mass in the right superior mediastinum was confirmed by chest computed tomography and cervical and chest magnetic resonance imaging to have a mass in the C-7 vertebral body and pedicle. The lesion was found to be a dumbbell schwannoma extending through the vertebral foramen. We attempted to resect the tumor via an anterior approach without changing the position. The methods appears to be safe and enabled us to avoid injuring adjacent nerves and vessels.