Association between smoking status and subclinical coronary atherosclerosis in asymptomatic individuals.

Objectives: In this study, we sought to evaluate the association between smoking status and subclinical coronary atherosclerosis, as detected by coronary computed tomography angiography (CCTA), in asymptomatic individuals. Methods: We retrospectively analyzed 9,285 asymptomatic participants (mean age, 53.7±8.0 years; 6,017 [64.8%] male) with no history of coronary artery disease (CAD) who had undergone self-referred CCTA. Of these participants, 4,333 (46.7%) were considered never smokers, 2,885 (31.1%) former smokers, and 2,067 (22.3%) current smokers. We assessed the degree and characteristics of subclinical coronary atherosclerosis using CCTA, with obstructive CAD defined as a diameter stenosis of at least 50%. Results: Compared with never-smokers, former smokers exhibited no significant differences in the probabilities of obstructive CAD, any coronary plaque, calcified plaque, or mixed plaque, as determined using adjusted odds ratios (aORs; p>0.05 for all). However, the risk of non-calcified plaque was significantly higher in former smokers (aOR, 1.34; 95% confidence interval [CI], 1.00 to 1.78; p=0.048). Current smokers had significantly higher rates of obstructive CAD (aOR, 1.46; 95% CI, 1.10 to 1.96; p=0.010), any coronary plaque (aOR, 1.41; 95% CI, 1.20 to 1.65; p<0.001), calcified plaque (aOR, 1.32; 95% CI, 1.13 to 1.55; p=0.001), non-calcified plaque (aOR, 1.72; 95% CI, 1.28 to 2.32; p<0.001), and mixed plaque (aOR, 2.00; 95% CI, 1.39 to 2.86; p<0.001) compared to never smokers. Conclusion: This cross-sectional study revealed a significant association between current smoking and subclinical coronary atherosclerosis, as detected on CCTA. Additionally, former smoking demonstrated an association with non-calcified plaque, indicating elevated cardiovascular risk.

Cooking oil fume exposure and Lung-RADS distribution among school cafeteria workers of South Korea.

Background: Cooking oil fumes (COFs) from cooking with hot oil may contribute to the pathogenesis of lung cancer. Since 2021, occupational lung cancer for individual cafeteria workers has been recognized in South Korea. In this study, we aimed to identify the distribution of lung-imaging reporting and data system (Lung-RADS) among cafeteria workers and to determine factors related to Lung-RADS distribution. Methods: We included 203 female participants who underwent low-dose computed tomography (LDCT) screening at a university hospital and examined the following variables: age, smoking status, second-hand smoke, height, weight, and years of service, mask use, cooking time, heat source, and ventilation. We divided all participants into culinary and non-culinary workers. Binomial logistic regression was conducted to determine the risk factors on LDCT of Category ≥ 3, separately for the overall group and the culinary group. Results: In this study, Lung-RADS-positive occurred in 17 (8.4%) individuals, all of whom were culinary workers. Binary logistic regression analyses were performed and no variables were found to have a significant impact on Lung-RADS results. In the subgroup analysis, the Lung-RADS-positive, and -negative groups differed only in ventilation. Binary logistic regression showed that the adjusted odds ratio (aOR) of the Lung-RADS-positive group for inappropriate ventilation at the workplace was 14.89 (95% confidence interval [CI]: 3.296-67.231) compared to appropriate ventilation as the reference, and the aOR for electric appliances at home was 4.59 (95% CI: 1.061-19.890) using liquid fuel as the reference. Conclusions: The rate of Lung-RADS-positive was significantly higher among culinary workers who performed actual cooking tasks than among nonculinary workers. In addition, appropriate ventilation at the workplace made the LDCT results differ. More research is needed to identify factors that might influence LDCT findings among culinary workers, including those in other occupations.

Evaluating Biliary Malignancy with Measured and Calculated Ultra-high b-value Diffusion-weighted MR Imaging at 3T.

PURPOSE: Although diffusion-weighted imaging (DWI) with ultra-high b-values is reported to be advantageous in the detection of some tumors, its applicability is not yet known in biliary malignancy. Therefore, this study aimed to evaluate the impact of measured b = 1400 s/mm2 (M1400) and calculated b = 1400 s/mm2 (C1400) DWI on image quality and quality of lesion discernibility using a modern 3T MR system compared to conventional b = 800 s/mm2 DWI (M800). METHODS: We evaluated 56 patients who had pathologically proven biliary malignancy. All the patients underwent preoperative or baseline 3T MRI using DWI (b = 50, 400, 800, and 1400 s/mm2). The calculated DWI was obtained using a conventional DWI set (b = 50, 400, and 800). The tumor-to-bile contrast ratio (CR) and tumor SNR were compared between the different DWI images. Likert scores were given on a 5-point scale to assess the overall image quality, overall artifacts, ghost artifacts, misregistration artifacts, margin sharpness, and lesion discernibility. Repeated-measures analysis of variance with post hoc analyses was used for statistical evaluations. RESULTS: The CR of the tumor-to-bile was significantly higher in both M1400 and C1400 than in M800 (Pa < 0.01). SNRs were significantly higher in M800, followed by C1400 and M1400 (Pa < 0.01). Lesion discernibility was significantly improved for M1400, followed by C1400 and M800 for both readers (Pa < 0.01). CONCLUSION: Using a 3T MRI, both measured and calculated DWI with an ultra-high b-value offer superior lesion discernibility for biliary malignancy compared to the conventional DWI.

Rotation aiding technique for endobronchial ultrasound-guided transbronchial needle aspiration biopsy of intrathoracic lymph nodes: A complementary approach to the conventional jabbing method.

BACKGROUND: This study aimed to compare the lymph node core tissue lengths obtained via mediastinal or hilar lymphadenopathy using the complementary "rotation aiding" and conventional Jab technique. METHODS: We prospectively measured the lymph node core tissue length in patients who sequentially underwent the Jab and rotation aiding (RA) techniques between October 2012 and December 2014. Wilcoxon signed-rank test was used to compare the core tissue length and grade of diagnostic cells obtained by each technique. McNemar's test was used to compare the proportion of adequate cellularity (≥grade 2) between the aspiration techniques. RESULTS: The core tissue length of 61 lymph nodes from 43 patients (mean age: 63 years, range: 16-86 years) was analyzed. Pathological findings were consistent with malignant lesions in 25 (41%) patients and benign lesions in 36 (59%). The most common diagnosis in benign lymph nodes was reactive, followed by tuberculosis and sarcoidosis. We obtained longer core tissue with RA technique than with the Jab technique (83.2 ± 12.7 vs. 60.1 ± 10.1 mm; p = 0.02). There was a significant increase in cellularity grade and proportion of ≥grade 2 cells with the RA technique than with the Jab technique (2.39 ± 1.08 vs. 1.84 ± 1.14; p < 0.001, 78.7% vs. 52.5%; p = 0.002), regardless of the pathological diagnosis. CONCLUSIONS: RA technique facilitated more lymph node samples in terms of core tissue length and cellularity than the Jab technique.

Acute lung injury in a worker after inhalation of ethylene phosphorodifluoridite.

Ethylene phosphorodifluoridite (C2H4F4O2P2) (CAS No. 3965-00-2) is a colorless corrosive fuming liquid that is used as a stabilizer in the electrolyte of rechargeable batteries. There are no previous reports of toxic effects following exposure to this compound. A 28-year-old male complained of respiratory distress after accidental inhalation of ethylene phosphorodifluoridite for 30 min. The patient developed acute lung injury with noncardiogenic pulmonary edema and was treated with supportive management. The patient fully recovered and was discharged after 7 days without any significant sequelae. The patient's symptoms were attributed to non-cardiogenic pulmonary edema caused by ethylene phosphorodifluoridite exposure. The case study showed that ethylene phosphorodifluoridite should be added to the list of chemicals that can cause acute lung injury. Int J Occup Med Environ Health. 2022;35(3):361-6.

Comparison of Long Term Follow-up Chest CT Imaging in Adult and Pediatric Patients with Humidifier Disinfectant-related Lung Injury.

BACKGROUND: To compare the chest computed tomography (CT) images of children and adults in families with clusters of humidifier disinfectant-related lung injury (HDLI) after cessation of exposure to humidifier disinfectant (HD). METHODS: We reviewed medical records of 19 families with 43 patients (21 adults, 22 children) among families, which had at least one adult and one child with HDLI. Each family was exposed to the same HD exposure environment. RESULTS: In adults, centrilobular nodules were predominant (95.2%) in chronic HDLI findings after cessation of exposure to HD, however, in children, normal pattern was most prevalent on chest CT (45.5%), followed by centrilobular nodule (36.4%), bizarre lung cysts (36.4%), and reticulation (13.6%). CONCLUSION: Unlike the known chronic HDLI finding of adults, centrilobular nodules were only present in 36.4% of children. The frequency of bizarre lung cysts were significantly greater in children than that in adults after cessation of similar exposure to HD. Thus, bizarre lung cysts may be useful as another novel finding of chronic HDLI in children who have no history of pulmonary infection or other perinatal disorder such as hyaline membrane disease or other interstitial lung disease.

Diagnosing peripheral lung lesions using endobronchial ultrasonography with guide sheath: A prospective registry study to assess the effect of virtual bronchoscopic navigation using a computed tomography workstation.

Bronchoscopy has a lower diagnostic yield for peripheral lung lesions (PLL). Endobronchial ultrasound guide sheath transbronchial lung biopsy (EBUS GS TBLB) has been used to overcome such limitation. Recent studies revealed that combined methods (e.g., EBUS GS TBLB plus electromagnetic navigation [EMN] or virtual bronchoscopic navigation [VBN]) further improve the diagnostic yield. However, those systems are associated with a high cost burden. Accordingly, we attempted to use VBN by computed tomography (CT) workstation (Aquarius iNtuition, TeraRecon) not dedicated only for VBN as an adjunctive tool for EBUS GS TBLB. We performed a prospective registry study to investigate whether VBN by CT workstation could improve the diagnostic yield of PLL.Between February 2017 and February 2018, 128 patients with PLL were divided into 2 groups (VBN and non-VBN [NVBN]). In NVBN group (n = 64), EBUS GS TBLB was performed using a hand-drawn bronchial map based on CT images. VBN group (n = 64) underwent EBUS GS TBLB using VBN images.VBN using CT workstation did not improve the diagnostic yield of EBUS GS TBLB for PLL (VBN vs NVBN, 72% vs 80%, P = .284). VBN slightly reduced procedure time (minute [mean ±â€ŠSD], 25.31 ±â€Š10.33 vs 25.81 ±â€Š9.22), navigation time (time to find the lesion) (9.10 ±â€Š7.88 vs 9.50 ±â€Š7.14), and fluoroscopy time (2.23 ±â€Š2.39 vs 2.86 ±â€Š4.61), while these differences were not statistically significant.The diagnostic yield of EBUS GS TBLB was not improved with VBN (compared with using a hand-drawn bronchial map). Although VBN slightly shortened the procedure-related times, which were not significantly different.

Use of preoperative mammography, ultrasonography, and MRI to predict nipple areolar complex involvement in breast cancer.

OBJECTIVE: To identify the predictive factors of cancer invading into the nipple. METHODS: Patients with breast cancer undergoing mastectomy between May 2009 and March 2019 were reviewed retrospectively. Of these, those with breast cancer within 2 cm of the nipple areolar complex on ultrasonography were included in this study. Clinicopathological data of the primary tumor and imaging findings from mammography, ultrasonography, and MRI were compared between cases with and without nipple involvement by cancer. RESULTS: In total, 156 of the 821 patients identified were included in the analysis. Of them, 29 had nipple involvement by cancer. Univariate analysis revealed that the following imaging results were significantly associated with nipple involvement: perineural invasion, lymphovascular invasion, lymph node metastasis; relation type between the tumor and the nipple on ultrasonography; periareolar skin thickening on mammography; and short tumor-nipple distance, continuous enhancement between the nipple and tumor, skin enhancement, and nipple enhancement on MRI. However, on multivariate logistic regression analysis, only invasion type of tumor on ultrasonography and nipple enhancement and short tumor-nipple distance on MRI were significantly correlated with nipple involvement by cancer. CONCLUSION: Imaging findings on preoperative mammography, ultrasonography and MRI are effective predictors for nipple involvement by cancer. ADVANCES IN KNOWLEDGE: Preoperative mammography, ultrasonography, and MRI help predict nipple involvement by breast cancer.

Prediction of Residual Malignancy After Excisional Biopsy for Breast Cancer With Suspicious Microcalcifications: Comparison of Mammography and Magnetic Resonance Imaging.

BACKGROUND: Whether surgery should be performed after excisional biopsy based on mammography or magnetic resonance imaging (MRI) findings has not been evaluated for breast cancer with suspicious microcalcifications on mammography. This study investigated the ability of mammography and MRI to predict residual malignancy after excisional biopsy for suspicious microcalcifications and whether background parenchymal enhancement (BPE) influences the diagnostic performance of MRI. PATIENTS AND METHODS: Fifty-one patients with breast cancer who underwent excisional biopsy for suspicious microcalcifications between January 2009 and February 2019 were enrolled in this single-center retrospective study. Two expert readers independently evaluated the ability of mammography and MRI to predict residual malignancy at the surgical site. The diagnostic value of mammography and MRI was evaluated using histopathology as the standard. RESULTS: Thirty-two patients had residual malignancy. The average overall sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve for residual malignancy were 78.1%, 42.1%, 69.4%, 42.1%, 62.7%, and 0.601 for mammography and 81.2%, 57.8%, 76.4%, 57.8%, 73.5%, and 0.696 for MRI; the respective values for residual malignancy were 88.8%, 57.1%, 72.7%, 57.4%, 76.5%, and 0.73 in the low BPE group and 71.4%, 60%, 83.3%, 57.4%, 65.7%, and 0.657 in the high BPE group. CONCLUSIONS: MRI is more accurate than mammography for prediction of residual malignancy after excisional biopsy for breast cancer with suspicious microcalcifications. However, the BPE of MRI influences diagnostic performance, so careful assessment is needed in patients with moderate or marked BPE.

Angioleiomyoma of the Extremities: Findings on Ultrasonography and Magnetic Resonance Imaging.

OBJECTIVES: The purpose of this study was to describe the features of angioleiomyomas of the extremities on ultrasonography (US) and magnetic resonance imaging (MRI). METHODS: We retrospectively reviewed the US and MRI findings of 29 pathologically confirmed cases of angioleiomyomas of the extremities in 29 patients. Twenty patients underwent only US; 7 patients underwent only MRI; and 2 patients underwent US and MRI. Clinical data and histopathologic specimens were reviewed. RESULTS: There were 19 women and 10 men. The mean patient age was 48.9 years (range, 23-80 years). On US, angioleiomyomas were located primarily in the subcutaneous fat layer (n = 20 [91%]), were oval (n = 17 [77%]), had well-circumscribed margins (n = 22 [100%]), had hypoechoic protrusions on one or both ends (n = 9 [41%]), had a homogeneous echo texture (n = 17 [ 77%]), had posterior acoustic enhancement (n = 20 [91%]), and had color Doppler flow (n = 20 [91%]). On MRI, the masses showed heterogeneous enhancement (n = 7 [88%]) and enhancing structures on one or both ends (n = 4 [50%]) on contrast-enhanced T1-weighted images. CONCLUSIONS: Angioleiomyoma of the extremities is usually a well-circumscribed oval mass with a homogeneous echo texture and occasionally hypoechoic protrusions on US and shows heterogeneous enhancement with occasionally enhancing structures on one or both ends of the mass on MRI. Therefore, it should be included in the differential diagnosis of a soft tissue mass that has protruding structures from one or both ends.

Mediastinal Bronchogenic Cysts: Demonstration of Fluid-Fluid Level in Bronchoscopic US Imaging.

We report the findings for 2 patients with a fluid-fluid level seen on endobronchial ultrasound (EBUS) images of bronchogenic cysts. The EBUS images demonstrated a well-circumscribed cyst with a fluid-fluid level showing an anechoic upper part and a relatively hyperechoic lower part. A fluid-fluid level on EBUS imaging of a bronchogenic cyst, which can help confirm the cystic nature of the lesion, has not been previously reported. EBUS-based confirmation of these cysts using fluid-fluid levels may help avoid unnecessary aspiration of the lesions.

CT Differentiation of Female Peritoneal Tuberculosis and Peritoneal Carcinomatosis From Normal-Sized Ovarian Cancer.

OBJECTIVE: The purpose of this study was to analyze the computed tomography (CT) features of female peritoneal tuberculosis and peritoneal carcinomatosis from normal-sized ovarian cancer for their differentiation. MATERIALS AND METHODS: We analyzed the CT features of 18 female peritoneal tuberculosis and 17 peritoneal carcinomatosis with proven normal-sized ovarian carcinomas. Omental change, mesenteric change, parietal peritoneal thickening, lymph node enlargement, ascites, ovarian CT attenuation, and ovarian capsular change were analyzed. RESULTS: Heterogeneous parenchymal hyperattenuation and capsular change of the ovary were more frequently seen in cases of peritoneal carcinomatosis than in cases of female peritoneal tuberculosis (P = 0.002, P < 0.001, respectively). There were no statistically significant differences in the other CT features. CONCLUSIONS: The differentiation of female peritoneal tuberculosis and peritoneal carcinomatosis with normal-sized ovarian cancer by CT may be a diagnostic challenge. Ovarian hyperattenuation and any prominent ovarian capsular change may facilitate the differentiation between these groups.

Foregut duplication cyst: a novel computed tomography finding mimicking a small bowel hernia: A case report.

RATIONALE: A foregut duplication cyst (FDC) is an uncommon congenital disease. This report presents a case of mediastinal foregut duplication cyst that mimicked a diaphragmatic small bowel hernia. PATIENT CONCERN: A 27-month-old girl was first referred for a mediastinal lesion found incidentally on a chest radiograph. At that time, our impression was cystic lung lesion such as congenital pulmonary airway malformation or pulmonary sequestration. At the age 6 years, she presented with recurrent vomiting. The physical examination and laboratory studies were within normal limits. DIAGNOSES: Chest CT revealed a thin- and smooth-walled cystic mass containing an air-fluid level in the left paravertebral space. It had several inner circular folds and characteristic double-layer enhancement and inner circular fold. Our radiological impression was a type I congenital cystic adenomatoid malformation. INTERVENTIONS: The patients undergone video-assisted thoracoscopic surgery for excision. The operative finding was the cystic mass with smooth bowel-like outer surface and located between the aorta and heart. The cyst was excised and confirmed to be a foregut duplication cyst pathologically. OUTCOMES: The patient was doing well with no postoperative complications during follow-up. Recurrent vomiting was improved. This is the first case report describing foregut duplication cyst mimicking a small bowel hernia. LESSONS: Foregut duplication cysts are rare congenital anomalies of primitive foregut origin. They can occur at any level of the alimentary track and comprise approximately 10% of all mediastinal tumors. Its characteristic double-layered histopathological nature, an FDC can show a double-layered enhancement pattern, which is typical in the alimentary tract.

Radiation Dose Reduction in Paranasal Sinus CT: With Feasibility of Iterative Reconstruction Technique.

OBJECTIVES: To (1) compare the radiation dose of low-dose computed tomography (CT) to that of standard-dose CT, (2) determine the minimum optimal radiation dose for use in patients who need endoscopic sinus surgery, and (3) assess the reliability of iterative model reconstruction. STUDY DESIGN: Prospective single-institution study. SETTING: Tertiary care center. SUBJECTS AND METHODS: We recruited 48 adults with medically refractory sinusitis. Each patient underwent 4 scans with different CT parameters: 120 kV and 100 mAs (standard dose), 100 kV and 40 mAs (low dose), 100 kV and 20 mAs (very low dose), and 100 kV and 10 mAs (ultra-low dose). All CT scans were reconstructed via filtered back-projection, and ultra-low dose scans were additionally reconstructed through iterative model reconstruction. Radiation dose, image quality, and diagnostic performance were compared among the scans. RESULTS: Radiation doses decreased to 6% (ultra-low dose), 12% (very low dose), and 22% (low dose) of the standard-dose CT. The image quality of low-dose CT was similar to that of standard-dose CT. Ultra-low-dose CT with iterative model reconstruction was inferior to standard-dose CT for identifying anatomic structures, except for the optic nerve. All CT scans had 100% agreement for diagnosing rhinosinusitis. CONCLUSIONS: With low-dose CT, the radiation dose can be decreased to 22% of that of standard-dose CT without affecting the image quality. Low-dose CT can be considered the minimum optimal radiation for patients who need surgery. Iterative model reconstruction is not useful for assessing the anatomic details of the paranasal sinus on CT.

Periosteal chondroma with spinal cord compression in the thoracic spinal canal: a case report.

Periosteal chondroma is a very unusual cartilaginous neoplasm of the spinal canal. We herein report a case of periosteal chondroma in a 41-year-old male who presented with gait disturbance and paresthesia of both lower extremities. Magnetic resonance (MR) images showed an extradural mass which caused compression of the spinal cord at the T5/6 level. The mass showed iso-signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and nodular and peripheral rim enhancement on post-contrast T1-weighted images. Computed tomography (CT) images showed a mass with punctate calcifications and extension into the left T5/6 neural foramen. MR and CT images showed extrinsic cortical bone erosion of the posterior inferior body of T5 and superior pedicle of T6, bone remodeling with overhanging margins, and sclerosis adjacent to the tumor. The patient underwent a complete excision of the mass by left T5/6 hemi-laminectomy and exhibited complete resolution of his symptoms. Histopathologic examination revealed periosteal chondroma. Tumor recurrence was not recorded during the 18-month follow-up period.

A Case Report: Cavitary Infarction Caused by Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Pancreatic Intraductal Papillary Mucinous Neoplasm.

Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.

Non-infected and Infected Bronchogenic Cyst: The Correlation of Image Findings with Cyst Content.

We hereby report a case on bronchogenic cyst which is initially non-infected, then becomes infected after bronchoscopic ultrasound (US)-guided transesophageal fine-needle aspiration (FNA). The non-infected bronchogenic cyst appears to be filled with relatively echogenic materials on US, and the aspirate is a whitish jelly-like fluid. Upon contrast-enhanced MRI of the infected bronchogenic cyst, a T1-weighted image shows low signal intensity and a T2-weighted image shows high signal intensity, with no enhancements of the cyst contents, but enhancements of the thickened cystic wall. The patient then undergo video-assisted thoracic surgery 14 days after the FNA. The cystic mass is known to be completely removed, and the aspirate is yellowish and purulent. To understand the image findings that pertain to the gross appearance of the cyst contents will help to diagnose bronchogenic cysts in the future.

Ultrasonographic analysis of subcutaneous angiolipoma.

OBJECTIVE: To describe and analyze the ultrasonographic appearance of subcutaneous angiolipoma in pathology-proven cases. MATERIALS AND METHODS: We retrospectively searched the January 2004 to May 2011 surgical pathology database for cases of pathology-proven angiolipoma. The ultrasonographic findings were analyzed for angiolipoma size, shape, margin, echo texture, echogenicity, acoustic enhancement, calcifications, and color Doppler flow. RESULTS: Of 31 angiolipomas, 19 lesions occurred in an upper extremity, one in a lower extremity, nine in the chest and abdominal wall, and two in the back. The mean tumor size was 17.7 mm. Twenty-five cases (80%) appeared as oval mass and all tumors had well-defined margins. All cases showed hyperechoic; 14 (45%), homogeneous; 17 (55%), heterogeneous. Seven cases (23%) showed blood flow in the mass. Acoustic enhancement and calcification was not shown in any cases. A correct preoperative diagnosis was made in three cases (10%) by ultrasonography. CONCLUSIONS: Most subcutaneous angiolipomas are oval-shaped, have well-defined margins, and hyperechoic appearance on ultrasonography. Although color Doppler flow of subcutaneous angiolipoma is not seen in many cases, it may helpful in differentiating angiolipoma from ordinary subcutaneous lipoma.

Prospective phase II trial of a combination of gemcitabine and UFT as first-line treatment in elderly patients with advanced non-small cell lung cancer.

BACKGROUND: The standard regimen in elderly patients with non-small-cell lung cancer (NSCLC) is still uncertain. Gemcitabine is one of the most widely used drugs for the treatment of NSCLC, and several phase II trials specifically designed for elderly patients with advanced NSCLC have confirmed the role of gemcitabine in this setting. In addition, oral uracil-tegafur (UFT) was associated with a survival advantage in the adjuvant setting. Therefore, we performed a phase II study using the combination of gemcitabine and UFT as first-line therapy in elderly patients with advanced NSCLC. METHODS: Chemotherapy-naïve, elderly (≥ 70 years) patients who had histologically or cytologically confirmed with stage IIIB or IV NSCLC with a performance status of 1-2 were enrolled. Patients received gemcitabine (1250 mg/m(2) on days 1 and 8, respectively) and UFT (400mg/day on days 1-14) every 3 weeks for up to four cycles. Patients who had not progressed after four cycles continued UFT monotherapy until progression. Primary endpoint was overall response rate and secondary endpoints were overall survival, time to progression and safety profiles. RESULTS: Between March 2008 and November 2010, 48 patients were enrolled. The median age was 74.5 years (range: 70-84 years), and there were 29 males. The performance status was 1 in 41 and 2 in 7 patients. Thirty-one (64.6%) patients were stage IV and seventeen (35.4%) patients were stage IIIB. Thirty patients (62.5%) completed four cycles of chemotherapy. Response was evaluated in 44 patients. Partial response was achieved in twelve (25.0%) patients and stable disease in 23 (47.9%) patients. Disease control rate was 72.9%. The median survival time was 6.1 months (95% confidence interval [CI]; 5.1-7.0 months), the 1-year survival rate was 29.1% and the median time to progression was 4.6 months (95% CI; 3.7-5.5 months). Toxicities were mild and mostly hematological adverse events. Grade 3/4 neutropenia occurred in 8.3% of patients and one patients experienced febrile neutropenia. Grade 3/4 anemia and thrombocytopenia occurred in 2.1% and 2.1% of patients, respectively. Non-hematological toxicities were tolerable. CONCLUSIONS: The combination of gemcitabine and UFT was effective in disease control and well tolerated first-line regimen in elderly patients with advanced NSCLC.

Direct lipiodol injection used for a radio-opaque lung marker: stability and histopathologic effects.

The objective of this study was to evaluate the effects on the histopathologic findings of directly injected lipiodol into lung and to identify the existence of remaining lipiodol in the lung according to the follow-up time. Forty rats were randomly assigned to 1 of 4 groups: group I (n = 10) served as the control group and received 0.2 mL of normal saline; groups II (n = 10), III (n = 10), and IV (n = 10) served as experimental groups and received 0.1-0.2 mL of lipiodol under fluoroscopy. At 3 hours (groups I and II), 24 hours (group III), and 1 week (group IV) after injection, the radiographic presence of lipiodol and histopathologic findings of each group were evaluated. Minimal acute lung injuries developed and the radio-opaque lipiodol nodule remained in group II. In group III, acute lung injuries were the most serious. However, acute injuries disappeared and foamy macrophages accumulated within the alveolar space in group IV. In this group, remaining lipiodol was also identified on radiograph. Directly injected lipiodol caused acute lung injury, which disappeared at 1 week along with the resolving process. On radiographs, directly injected lipiodol remained after 1 week. Lipiodol could be used as a safe and stable biomaterial for marking pulmonary nodules.