Ectopic production of parathyroid hormone by small cell lung cancer in a patient with hypercalcemia

Single brain metastasis of non-small cell lung carcinoma. Study of survival among 54 patients Demange L, Tack L, Morel M et al. Deparmeni ofRadiamn Oncology. /n.rritul Jean-Godinor. 5110 Reim. Br J Neurosurg 1989;3:81-8. WC sludled 54 patients treated for non-small cell lung carcinoma with smglc brain metastasis presenting between 1980 and 1985. Betler survival was obtained in cases of patients presenling a fair neurological condiuon who were treated by surgery. Histological condition and date of onset of metastasis had no significant influence on survival. Combmed treamem of both primary lung tumour and brain metastasis was a favourable prognosis element, and surgical resection of both locaoons led to the best results in terms of duration and quality of survival. &topic production of parathyroid hormone by small cell lung cancer in a patient with hypercalcemia Yoshimoto K, Yamasaki R, Sakai H et al. Firs1 Depnrrmen~ oflnternal Med~cine,SchoolofMedic~ne,Universilyof~~~kushima,7‘okushimo 770 J Clin Endocrinol Memb 1989:68:976-X1. Sevcrc hypcrcalcemia (serum calcium,4.37-4.84 nmol/L) was found in a 70-yr-old man who had a small cell carcinoma of the lung with multiple melaslascs. The plasma immunoreactlve PTH concentration was markedly elevated, as measured in three different PTH assays [Ntcrmmal PTH 4,650 rig/L (normal, 230.630): midreglon PTH, 13,850 rig/L (normal, 180-560); C-terminal PTH, 9,900 rig/L (normal, < 1,300)], but al autopsy the paralhyroid glands were histologically normal. The PTH conccnuation of a liver metastasis was 503.5 rig/g wel WI (normal liver, < 4.2.5.9), and the PTH m Ihe tumor cxuact elutcd at ncarll IhcsamcposiGonassynlhctic humanPTH-(I-84)ongclfiltration chromatography. Northern blot analysis revealed PTH mRNA in the tumor as a single band of 0.9 kilobase. Thcsc results indlcatc thar the cctopic PTH producxion by the lung cancer was the cause of hypercalcemla in this patient. Concurrent anaplastic bronchial cancer in identical twin brothers Norcs JM, Dalayeun J, Chcbat J, Dicudonnc P, Nenna AD. Deparrmenr oflnlernal Medicine, University of Paris. tlopilai Raymond-Poincare. F-92380 Garches. Respiration 1989;55:56-9. After having observed homozygotic identical twm brothers who simultaneously suffered from anaplastic bronchial cancer which rapldly led to death in both cases, [he authors assessthe frequency of such cases. RCVICWof Ihe available literature failed to produce identical observations, although 4 cases of twms suffering from bronchial cancer witi diffcrmg hlstologies (3 epidcrmoidal and 1bronchiole-alveolar) wcrc noted. Statistics show that in the arca where the observed twins were living. anaplaslic cancer occurs each year m 0.39 of 53.year-old men. The casts of these twins therefore support the notlon of the role of gcncLlc factors m Ihe dctcrminatlon of bronchial cancer.

Human lungcancer- Acomparativestudyofthelevelsofcirculating immunecomplexesinpulmonaryblooddrainingthetumorareaand peripheral venous blood Bukh A, Klmose H-H, Aguado MT, Linncl L, Mollcr NPH. Institure of Medical MIcrobiology, Unwersiry ofAarhus, DK-8000 Aarhus C. Int J Cancer 1989;43:837-40. Our ohjccuvc was to investigate whether low lcvcls of circulatmg ~mmunecomplcxcs(clCs) mpcripheral venous bloodofcancerpatienti could he due to removal of clC released at Ihe tumor rite during passage lo the pcrlpheral veins. In 53 patients wnh primary lung cancer, WC thcrcfore compared the cIC levels as detected by 3 dlffcrcnt assays m pairzd &les from the pulmonary vein draining Ihe lumor area and from a penphcrdl vcm. Only 6 of Ihe 53 patients had significantly mcrcascd pulmonary vcm cIC levels compared to the corresponding pcrlphcral vcm Icvcls. Thcperlpheral vein lcvclsofthcsc 6patlcnts wcrr all l::lthm (he normal range, and in none of thcsc pancnls was lhc dlffcrcncc kwccn lhc 2 elks ofanalysls although \Igmflcanl -of \uch

a magnitude ihai the pulmonary vcm cIC lcvcl appeared higher than the normal range,i.c.,‘pos~t~vc’forclC.Pos~t~vcclClcvclswereonl~ found m 1I %of lung cancer patlents (rrrespect~vc of the siuz01 mca\uremeni). Thus,our present data, togcthcr with our prevmus findmgs indicatmg no sigmficant diffcrcnce between perlphcral venous blood clC levels in cancerpaticnlsand normal controls, contradict the theory oftumorcells expressing new antigens rcsultmg in the formatIon of zumor-associaicd CICS.

Surgery Technique of bronchial closure after pneumectom) Sarsam MAI,Moursah H,Divisionof(‘urdio~o.,~ polar Turqary, M yrhenshow Ilocpiral, Manchesw J Thorac Cxdmvasc Surg 1989;98:220-3. Three hundred Ihlrly-two palicnts had a pncumonatomy at Wythcn\hawc Hosplml. hlanchcskr. England. bcrwccn 197-1 and 1984. In all patlcnts, the bronchus was closed with apostcrlor flap from the pliable mcmbranouc bronchus, Ica\mg no \lump. and v.101 lhc suture lmc proximal to tic carma. In a mean follow-up of 5.4 m~~nths. nom of [hc paknts had bronchoplcural fistula, and 10 patients had cmpyema in Ihe pncumoncctomy space (3%). A fistulacouldnot bc found In anycjfthcsc patients. The suture malcrial used m clo\mp the hronchu\ m all thcsc CBSCS VSIS7-O chromic catgut, Khlch undcrllnc‘; Ihc t XI lhat bronchial hcalmg 14 no1 affected by Ihc type 01 \ulurc IXIICIIBI a\ long as no tension CYIG\ at the suture Imc. Effect of perioperative blood transfusion on outcome in pdtients with surgically resected lung cancer Moore5 DWO, Piantadosi S, McKneally MF. Dlvisiw~ of Cardiolhorat-lr Surgery. Aihanv.Medicnl Colleges. Albcmy. h;Y I :‘_?/I’? Ann !‘horac slug 1989;47:3*-51.Three hundred lhlrty paGems w,uh non-xmall LL’II lung cancer wcrc evaluated LOassess Ihe effect of pcrlopcrauvc blood transfusion on overall survival and time to rccurrcncc. One hundIn? sIxi?-nmcpancnts rccclvcd blood products during Ihc pcrmpcralivc pcrmd, and I61 rcccivcd none. The mean length of follow-up was 3.6 ‘{cars. Thcrc wcrc 90 rccurrcnccs, mcludmg second primaric\, and09 draths fn the group rccclvmg Iransl.usion; m thcgroupwithoullransl~u\ion, rccurrcntcancer dcvclopzd m 73 paucnts, and 68 died. Survival cornpxisons. adJu\Kd for s&gc and cell type usmg tic strallflcd log-ranh stal~\~c, showed significam reduclion in survival (p = 0.007) lor patlcnl\ rclclvmg Iransfuslon. Tlmc to rrcurrcncc wa\ \hortcr lor patlcms rccclvmg Lransfusion (p = 0.015). but bccamc icss \Igmflc,ml whl,n ad~u\lcd for both ~11 ~)pc and stage (p = O.ll) Rlood n;m\lusmn wlthm the pcrcopcratlvc pcrlod appears tn have an %hcr\c cflc< L cm \urvl!al and rccurrcncc m pauenls undergoing \ur,txdl r
Chemotherapy Carboplatin

in lung cancer

Carboplatm (CBDCA, JM-8) IS a xcond gcncr.ttll,n analoguc ol clsplaun. Ir has shown a high dcgrce of acn~ny when used as ;I single agent m small cell lung cancer. Carhoplatm m .ombmation with etoposldc and other agents IS acovc and ucll tolcralcd by p.mcnts. Kandomlxd ulals of carboplaun comhinatlon:3 arc nob rcqu!rcd LO dcfinc 11srole in small cell lung cancer. Carhoplann ha\ \omc ach\ny in mesothclioma but Intlc acl~vlty m non-mall ccl1 lung cancer. l‘hc role of carhoplatm as a radtakn scn\lu/cr and ;II hl;!h &IS~ wl!h hrmc marrow