Do patients with nonmetastatic non-small cell lung cancer demonstrate altered resting energy expenditure?

BACKGROUND: The cancer cachexia syndrome occurs in patients with non-small cell lung cancer (NSCLC) and includes elevated resting energy expenditure (REE). This increase in REE leads to weight loss, which in turn confers a poor prognosis. This study was undertaken to determine whether the cancer cachexia syndrome occurs in patients with nonmetastatic NSCLC. METHODS: In this case-control study, 18 patients with nonmetastatic NSCLC (stages IA to IIIB) were matched to healthy controls on age (+/- 5 years), gender, and body mass index (+/- 3 kg/m2). Only 4 cancer patients had experienced > 5% weight loss. Cancer patients and controls were compared on the basis of: (1) unadjusted REE, as measured by indirect calorimetry; (2) REE adjusted for lean body mass, as measured by dual x-ray absorptiometry; (3) REE adjusted for body cell mass, as measured by potassium-40 measurement; and (4) REE adjusted for total body water, as measured by tritiated water dilution. RESULTS: We observed no significant difference in unadjusted REE or in REE adjusted for total body water. However, with separate adjustments for lean body mass and body cell mass, cancer patients manifested an increase in REE: mean difference +/- standard error of the mean: 140+/-35 kcal/day (p = 0.001) and 173+/-65 kcal/day (p = 0.032), respectively. Further adjustment for weight loss yielded similarly significant results. CONCLUSIONS: These results suggest that the cancer cachexia syndrome occurs in patients with nonmetastatic NSCLC and raise the question of whether clinical trials that target cancer cachexia should be initiated before weight loss.

The prognostic effect of increased resting energy expenditure prior to treatment for lung cancer.

OBJECTIVE: Increased resting energy expenditure (REE) is thought to confer a poor prognosis in patients with non-small cell lung cancer (NSCLC). However, no study has validated this hypothesis to date. This study's objective was to examine the prognostic significance of REE in NSCLC. METHODS: Seventeen patients with NSCLC (stages IA-IIIB) underwent measurement of REE with indirect calorimetry before the initiation of cancer treatment. Similar measurements were performed in 17 control subjects, each of whom was matched to a cancer patient by age ( +/-5 years), sex and body mass index ( +/-3 kg/m2). Patients were classified as hypermetabolic or hypometabolic based on a direct comparison of measured REE between cancer patients and their matched controls. After cancer treatment, these 17 patients were followed for evidence of metastatic disease for up to 32 months. RESULTS: Six patients developed metastatic disease. The eight hypometabolic cancer patients had a significantly shorter mean disease-free survival compared to the nine hypermetabolic cancer patients: 19 months (95% confidence interval (CI) 12, 26) versus 29 months (95% CI 24, 34), respectively (P < 0.05 by log-rank test). In contrast, Cox regression showed no relationship between disease-free survival and differences in REE between cancer patients and their matched controls (P = 0.20). CONCLUSIONS: These results suggest that hypermetabolism may predict a longer disease-free survival in NSCLC patients. This finding differs from the prevailing hypothesis that hypometabolic patients with NSCLC survive longer, and deserves further investigation.

Transvenous and subcutaneous implantable cardioverter defibrillators: radiographic assessment.

PURPOSE: To assess chest radiograph configurations in 102 patients following total or partial transvenous and subcutaneous insertion of a non-thoracotomy lead implantable cardioverter defibrillator (NTL-ICD) device. MATERIALS AND METHODS: The four overlapping system types reviewed were the Endotak (49 patients), PCD (32 patients), Res-Q (10 patients), and hybrid combinations of NTL-ICD and surgically inserted pericardial and epicardial automatic implantable cardioverter defibrillator (AICD) devices (15 patients). RESULTS: Abnormalities were detected on radiographs both at the time of implantation and at early follow-up. NTL-ICD electrodes partially replaced or augmented AICD systems in 11 patients (10.7%) because of sensing lead or defibrillation failure or infection. Defibrillation failure necessitated augmentation of NTL-ICD systems with AICD pericardial patches in four patients (3.9%). Catheter displacement, lead fracture, or pneumothorax was detected in eight patients (7.8%). CONCLUSION: Complex radiographic appearances may be seen and important abnormalities may be detected after insertion of these devices.

Cranial computed tomography in the assessment of neurological complications in critically ill patients with systemic lupus erythematosus.

The cranial computed tomography findings in 22 critically ill patients with systemic lupus erythematosus in the intensive care unit were reviewed to document the spectrum of pathology encountered and to assess the contribution of cranial computed tomography to the diagnosis and management of such patients, many of whom had severe multisystem disease. Thirty-one scans were performed in 22 patients, all of which were abnormal. Premature cerebral atrophy was identified in fifteen patients (68%), cerebral infarction in five (23%), intracranial haemorrhage and cerebral oedema in four each (18%), and hydrocephalus in three (14%). Six patients had multiple pathologies. The cranial computed tomography findings confirmed the clinical diagnosis in 13 of 22 cases (59%) and altered it in nine (41%). The contribution to diagnosis and management justifies transportation and computed tomography scanning. The contribution to patient outcome, however, is uncertain as mortality was 91%.

The use of computed tomography in the management of facial trauma by British oral and maxillofacial surgeons.

A survey of 184 British oral and maxillofacial surgeons on their use of computed tomography (CT) in the management of craniofacial trauma showed that the majority of the 116 surgeons who replied used this form of imaging for frontal, nasoethmoidal, and orbital fractures. Only 6% of respondents reported no advantage in CT imaging over plain radiography. The access to CT scanners and the value of the reports in the management of patients was rated as satisfactory by 75% of respondents, and a similar percentage reported that CT service was becoming increasingly available to their units.