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BACKGROUND/AIM: Serum tumor markers such as carcinoembryonic antigen and cytokeratin subunit 19 fragment are generally monitored in non-small cell lung cancer (NSCLC) patients in the clinical practice. However, their clinical relevance in stage III NSCLC treated with concurrent chemoradiotherapy (CCRT) remains unclear. Herein, we examined the clinical relevance of tumor markers in those patients. PATIENTS AND METHODS: We retrospectively reviewed 62 consecutive patients with stage III NSCLC who received CCRT. We examined the associations of tumor marker levels with their prognosis. RESULTS: There was no correlation between pretreatment tumor marker levels and prognosis. Normal tumor marker levels post-CCRT were significantly associated with favorable progression-free survival (54.8 versus 14.5 months, p=0.02) and overall survival (71.7 versus 40.4 months, p=0.06) compared with high tumor marker levels post-CCRT. CONCLUSION: We revealed that normal tumor markers levels post-CCRT in stage III NSCLC might be a useful surrogate marker for curing those patients.

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OBJECTIVE: The modified Medical Research Council (mMRC) scale is recommended for conducting assessments of dyspnea and disability and functions as an indicator of exacerbation. The aim of this study was to investigate whether the mMRC scale can be used to predict hospitalization and exacerbation in Japanese patients with chronic obstructive pulmonary disease (COPD). METHODS: In a previous 52-week prospective study, 123 patients with COPD were classified into five groups (grades 0 to 4) according to the mMRC scale and four groups (stages I to IV) according to the spirometric Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The frequency and period until the first event of hospitalization and exacerbation were compared among the groups. RESULTS: The population of patients who experienced hospitalization and exacerbation during the 52-week study period, with an mMRC scale grade of 4, 3, 2, 1 and 0 was 50.0 and 100, 55.6 and 88.9, 21.1 and 73.7, 2.6 and 48.7, and 4.0 and 22.0%, respectively. A multivariate analysis adjusted for the GOLD stage and age showed that the patients with an mMRC scale grade of ≥3 had higher frequencies of hospitalization and exacerbation than those with lower grades. Meanwhile, the patients with an mMRC scale grade of ≥2 showed a significantly earlier time until the first exacerbation, but not hospitalization, in comparison with those with grade 0. CONCLUSION: The present results indicate that, among Japanese patients with COPD, those with an mMRC scale grade of ≥3 have a significantly poorer prognosis and that the mMRC scale can be used to predict hospitalization and exacerbation.

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Patients with asthma are often complicated by allergic rhinitis, and the intimate pathophysiological association between allergic rhinitis and asthma often imposes a significant morbidity on affected individuals. The present study was conducted to assess the clinical efficacies of leukotriene receptor antagonists (LTRAs) and anti-histamines on asthma as an add-on therapy in patients with asthma complicated by allergic rhinitis. Consecutive patients with asthma were recruited to fill in systematic self-administered questionnaires concerning symptoms and conditions related to asthma and allergic rhinitis. The questionnaire was conducted twice, one month apart, and the attending physicians gave detailed information on disease control and medications on both occasions. In the study 3,140 patients with asthma participated, and 634 had concomitant allergic rhinitis (mean age: 53.1, 389 female). The second survey disclosed that treatment with LTRAs or anti-histamines had been added in 26 patients and 19 patients, respectively, without any changes in other medications. There were no significant differences in age, gender, severity of disease, or baseline treatments. The initial survey indicated that the patients who were treated with LTRAs had significantly more severe asthma-related symptoms (i.e. wheeze, cough and sleep disturbance) and experienced greater dissatisfaction with the treatment than did those who were treated with anti-histamines. The second survey disclosed significant reductions in sneezing (p=0.03), rhinorrhea (p=0.01), dyspnea (p=0.046), sleep disturbance (p=0.02), over-all asthma symptoms (p=0.013), and an improvement in satisfaction with treatment (p=0.019) in patients to whom LTRAs were added-on, whereas the patients receiving anti-histamines reported no significant changes in these symptoms. These results suggest that LTRAs are more effective than anti-histamines as an add-on therapy in symptomatic patients with asthma complicated by allergic rhinitis.

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INTRODUCTION: A necrotic lung ball is a rare radiological feature that is sometimes seen in cases of pulmonary aspergillosis. This paper reports a rare occurrence of a necrotic lung ball in a young male caused by Candida and Streptococcus pneumoniae. CASE REPORT: A 28-year-old male with pulmonary candidiasis was found to have a lung ball on computed tomography (CT) of the chest. The patient was treated with ß-lactams and itraconazole and then fluconazole, which improved his condition (as found on a following chest CT scan) and serum ß-D-glucan level. The necrotic lung ball was suspected to have been caused by coinfection with Candida and S. pneumoniae. CONCLUSION: A necrotic lung ball can result from infection by Candida and/or S. pneumoniae, indicating that physicians should be aware that patients may still have a fungal infection of the lungs that could result in a lung ball, even when they do not have either Aspergillus antibodies or antigens.

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Mycoplasma pneumoniae infection is known to produce infiltrative and/or nodular opacities that are often localized. A patient presented to us with diffuse centrilobular, peribronchovascular, and perilobular opacities after documented Mycoplasma pneumoniae infection. A surgical biopsy proved the lung disease to be organizing pneumonia, which dramatically resolved in response to treatment with corticosteroid. This case represents an unusual radiological manifestation associated with M. pneumoniae infection, thereby stressing the importance of this disease in the differential diagnosis for patients with diffuse opacities of the lungs.

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A 61-year-old otherwise healthy woman presented with gradually worsening exertional dyspnea. Routine examinations revealed bilateral pleural effusion with no other notable cardiopulmonary diseases. Systemic examinations showed ascites and a pelvic tumor, which turned out to be right ovarian endometrioid adenocarcinoma. Surgical removal and chemotherapy against the ovarian cancer resulted in disappearance of the ascites and pleural effusion, establishing a diagnosis of pseudo-Meigs'syndrome. It is common for reported cases of pseudo-Meigs' syndrome to initially present with dyspnea, therefore it is important to consider this disorder when attempting a differential diagnosis in female patients presenting with dyspnea without other noticeable conditions.

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